Liberating unmourned loss and unforgiven guilt/shame

Spiritual Care: The Paradoxical Dimension

by Deborah Grassman

Peace that lies beyond human understanding is derived from the spiritual dimension. This dimension creates energy — that spark of life that powers the soul. It is the dimension that gets blocked when barriers are created that interfere with soul access. Those barriers are often unmourned loss and unforgiven guilt/shame – barriers which can precipitate a Soul Injury if the person begins to feel tainted, unworthy, or in some other way separated from his/her own sense of self.

During times of trouble or sorrow, people often contemplate deeper and more serious issues of the soul; they may even encounter despair. This time of darkness can be beneficial because it cultivates humility; humility accesses the soul. In the soul’s dimension, lies pervasive peace where energy beyond the material world is generated.

A word that might capture the essence of soul energy is “vitality.” When I stop denying feelings and instead open up to them, I experience vitality; I become more alive. When I reckon with hardships rather than cope with them, I become vitally alive; my soul is engaged. My soul is important because it’s the most authentic and enduring part of me.

The National Consensus Project Guidelines for spiritual practice defines spirituality as, “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” 

Teilhard de Chardin offers yet another perspective: “We are all spiritual beings here for a human experience.” These definitions capture the nature of our soulful beingness where energy and vitality are generated.

It’s easy to confuse religion and spirituality. Sometimes I conceptualize that their relationship is like trees and forests. Religion is the trees of beliefs that we create to understand the spiritual forest of our existence. We all live our religion (the values and beliefs that underlie our actions); even atheists live out their “religion.” Beliefs, however, sometime interfere with understanding existence because “we can’t see the forest for the trees.” Many people discount the value of religion because of this distortion of perspective. Yet, forests can’t exist without trees; and the quality of the forest is dependent on each tree’s contribution. Forests and trees are not mutually exclusive; in fact, they might be mutually inclusive. I learned this from a rabbi on National Public Radio. He was on a panel of religious leaders of different faiths discussing religion and spirituality. All of them agreed that not all spirituality is religious. Almost all panelists agreed that all religions are spiritual. A rabbi disagreed. He said that any religion that teaches exclusivity is not spiritual because spirituality is based on humility not arrogance. I liked his distinction.

As death approaches, people start contemplating deeper issues. Their perspectives shift, and frequently they undertake a spiritual quest.

“Tell me how you are doing spiritually,” I’ll say to a patient.

Often the response is, “Oh, I don’t go to church.”

“Sounds like you’re not a religious person, but I’m wondering if spirituality has any meaning to you,” I’ll reply. “Do you receive strength or comfort from a source of energy or power beyond your own?”

Many will say they believe in God; others talk about nature or their family; some say spirituality has no relevance in their lives. I distinguish between religion and spirituality because I want patients to know I have no interest in trying to convert them to a religion, impose my personal beliefs, or urge them toward any specific beliefs at all. My attitude is important because many patients have had experiences where others had an agenda to change or impose religious ideas; sometimes this kind of imposition was done in a manner that did not respect the patient’s personal beliefs or his or her need to doubt and question.

I usually try to provide nonreligious spiritual care. It takes time to assess a person’s beliefs, time I don’t usually have. Also, there are many different faiths, even divisions within the same faith. It requires time to discern the particular meaning of a patient’s religion. Instead, I provide open-ended “generic” spirituality so the patient can infuse his own personal meanings. I let the patient lead and I follow. I’m secure enough in my own religion that I don’t worry about differing beliefs sabotaging my own. Neither do I think it’s my business to convince them of my beliefs. Sometimes, we explore spiritual ideas together. I proceed cautiously though, always mindful that the patient could be vulnerable to my authority as the healthcare provider. I’m also aware that I might unconsciously want him to think like me.

I’ve learned a lot by watching other people provide religious and spiritual care. Shaku, one of the nurses on our Hospice unit, is Hindu, a religion not shared by many of our patients. She has learned prayers and practices of other religions so she can respond to patients’ varying needs. It’s not unusual to hear her reciting the Lord’s Prayer or the rosary with patients. Patients frequently tell me what a comfort Shaku is to them. 

I had an encounter with a nursing assistant who reminded me of Shaku when I, myself, was a patient. I had abdominal surgery and afterwards a small artery began bleeding. I lost many pints of blood, and all my clotting factors were consumed. I not only needed several blood transfusions but a second surgery to control the bleeding. I was left weak and debilitated. I also had severe diarrhea. Too weak to quickly get to the bathroom, I was incontinent. Embarrassedly, I activated my call light. When the nursing assistant came to the room, I told her apologetically about the mess awaiting her under the sheets.

“Oh, that’s okay. That’s why I’m here,” she said cheerfully. “You don’t worry about a thing. Your job is to just let me help you.”

Long after she left, I thought about this woman who made me feel like there was nothing more she wanted than to have the opportunity to clean up my stinky mess. She gave me graciousness, and that was a gift of the spirit that remains with me to this day. "God" was never mentioned, but she helped me realize that tenderly emptying a bedpan for a patient is one of the most spiritual things I can do.

This nursing assistant’s act made me reflect on an adage that sometimes circulates in healthcare circles: “Nursing assistants aspire to be nurses; nurses aspire to be physicians; and physicians aspire to be God.” I sometimes ask myself, “To what role in a hospital does God aspire?” I wonder if the answer is that God aspires to be a patient whose suffering is redeemed through the love of a compassionate care provider like that nursing assistant who knows how to empty bedpans spiritually.