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The Response to Spiritual Pain October 5, 2012 I have no disclosure nor conflict of interest.

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Presentation on theme: "The Response to Spiritual Pain October 5, 2012 I have no disclosure nor conflict of interest."— Presentation transcript:


2 The Response to Spiritual Pain October 5, 2012 I have no disclosure nor conflict of interest

3 Pain insists on being attended to. God whispers to us in our pleasures, speaks in our conscience but shouts to us in our pain. It is His megaphone to rouse a deaf world. C. S. Lewis: The Problem of Pain

4 Introduction Why?




8 History Ancient issue concerning the problem of Pain and Suffering Pain and suffering was considered not separate issues They came to be dealt with as separate Now we see they can be related

9 History Can they be related? – Medicine is the last Scientific Discipline to let go of the demand of total Empirical Demands. – We still have the same issues and philosophical problem – Problem of perception


11 So even with better physical treatments we are still dealing with the same issues concerning the connection of pain and suffering! Then maybe it may benefit us to examine the Psychosocial-Spiritual Aspects of Pain Management.

12 Definitions - Pain Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the “funny bone". Wikipedia


14 Definitions - Pain Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.


16 Definitions - Pain Pain is the most common reason for physician consultation in the United States. It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning. Social support, hypnotic suggestion, excitement in sport or war, distraction, and appraisal can all significantly modulate pain's intensity or unpleasantness.quality of life

17 Definitions - Suffering The word suffering is sometimes used in the narrow sense of physical pain, but more often it refers to mental or emotional pain, or more often yet to pain in the broad sense, i.e. to any unpleasant feeling, emotion or sensation.physical painmental or emotional pain

18 Spiritual distress is a disturbance in a person's belief system. As an approved nursing diagnosis, Spiritual Distress is defined as "a disruption in the life principle that pervades a person's entire being and that integrates and transcends one's biological and psychological nature. nursing diagnosis




22 DEFINITIONS RELIGION A particular system of faith and worship, assimilated to help make sense with life here and after. It is thought of in a community sense.

23 DEFINITIONS SPIRITUALITY A system of belief about the way life is or should be that each of us have. Our way of viewing the world and our relationship to it that brings order into the chaos of living and helps us cope with the uncertainties and distresses of life. Science, philosophy, religion, pragmatism, and many other belief systems are adopted and utilized for this purpose.

24 DEFINITIONS SPIRIT: The word “spirit” is a translation of the Greek word pneuma, which means “wind” or “breath.” Webster defines spirit as “an animating or vital principle held to give life to physical organisms” and “the activating or essential principle influencing a person.”

25 DEFINITIONS DISEASE The Oxford Dictionary defines disease as “an unhealthy condition caused by infection, or diet or condition of life, or inherited.

26 When humans experience a disease, crisis event their ordered world and their sense of vitality is powerfully shaken if not shattered. This event leaves them “breathless” or without an animating or activating energy. It is as if the “wind” has been knocked out of them with an accompanying sense of betrayal by life. In this context of experience humans are confronted with a situation where the potentiality for both positive and negative outcomes is greatest.

27 Chronic Pain and Suffering

28 HYPOCRITES – GOALS OF MEDICINE Doing away with the suffering of the sick lessoning the violence of their diseases and refusing to treat those who are over mastered by their diseases realizing that in such cases medicine is powerless – but we should treat those who are powerless.

29 AMA – 1846 – EOL CARE A physician ought not to Abandon a patient because the Case is deemed incurable; for his attendance may continue to be highly useful to the patient, and comforting to the relatives around him, even in the last period of a fatal malady, by alleviating pain and other symptoms, and by soothing the mental anguish. First Code of Medical Ethics - AMA

30 Preferences & Alternatives DEFINITIONS through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. – Palliative Care: 2000 World Health Organization – Palliative care is a medical approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

31 Preferences & Alternatives DEFINITIONS – Holistic Care: Defined by – It’s a wellness approach that addresses the body, mind, and spirit or the physical, emotional and spiritual aspects of an individual. This is best achieved in the context of team care. Pts. Have complex needs and it takes a team of professionals and volunteers to help meet them all. The pt. may not label their problems as physical, emotional or spiritual, but is often desperately seeking simultaneous help on all these fronts.

32 Victor Frankl “Man’s Search for Meaning”


34 “By ‘spiritual’ I understand the essence of what it means to be human. Spiritual issues are issues of the soul and concern our deepest values and meaning.” Michael Kearney Someone has said that Spiritual Pain is like Supreme Court Justice Powell’s definition of pornography: “ I know it when I see it.” Spiritual pain occurs when there is an event that violates or perceives to violate the core values, beliefs, or needs of the person.


36 This holistic health approach says that health depends not only on genetics, and biochemistry but also on physical, emotional, mental, environmental, nutritional, and even spiritual factors. The Holistic Model The person does things to compensate for the environment

37 Biomedicine has been characterized by mechanistic notion that the body is as a machine composed of separate parts – and reductionism. The reduction of illness to a set of physical symptoms. Mechanism and reductionism tend to separate diagnosis and treatment from the patients subjective and social experience of disease; This distances the patient from caregiver and severs personal meaning from the process of healing.

38 Spiritual Issues  Identity  Connectedness  Values  Meaning  Purpose

39 Just as spiritual issues affect everyone so too a patient’s ‘spiritual pain’ is the concern of each member of the multidisciplinary caring team.

40 What can one hope to achieve for and with someone in spiritual pain? Nietzsche writes “someone with a why can bear any how.”

41 Perhaps then one might describe the task here as enabling that individual to recognize their unique and individual why, to recognize the meaning that ‘connects’ for them, knowing that this has the potential to transform their pain. Afterwards certain aspects of total pain may still be there or even worsen, and a majority of individuals will experience feelings of sadness and grieving. However, the pain is somehow now no longer the problem it was before. Where there was a restlessness and an agitation there is now a ‘knowing that it is OK’, a sense of being held, which is not a rationalization but has such qualities as quietness, broadness and a light solidity. Michael Kearney

42 The balm (salve) for spiritual pain is not something I have out here, like a couple of aspirins, which I can give to a patient for their pain. No, the balm for spiritual pain is to be found in the experience of the pain itself. I suggest we need to find ways to enable the individual to wait in the troubled waters of their experience, even to let go more deeply to that experience and I am not sure this possible to do this without in some way entering those waters ourselves.


44 The palliation for spiritual pain isn’t elimination but integration. The painful experiences in our lives inevitably become the painful memories and we can’t change that: what we can change is how we remember them and integrate them.

45 Physical pain itself can be exacerbated by non-physical causes such as fear, anxiety, grief, unresolved guilt, depression, and unmet spiritual needs Likewise, the inability to manage physical pain well can be due to emotional or spiritual issues Persons may refuse pain medication due to fear or because they wish to be alert to interact with loved ones or because they believe they deserve to suffer Unrelieved physical pain, among other symptoms, may itself cause emotional or spiritual suffering Finally, some emotional or spiritual suffering — especially in certain cultures — may manifest itself as physical pain or other physical maladies

46 Spiritual influences on physical pain Spiritual frameworks and religious traditions influence how persons interpret and experience physical pain How mind, body, and spirit are understood in relationship to each other and, in some cases, in relationship to a deity or deities is important to understand Usually this framework is broader to include suffering of all kinds, whether its cause is physical or due to other causes

47 Cultural interpretations of pain and suffering may conflict with goals of palliative care Sometimes, these cultural and religious interpretations of pain and suffering can conflict with the stated goal of palliative care: to relieve pain and suffering This is why a holistic, interdisciplinary assessment of pain is necessary Plans to manage pain pharmacologically often fail or patients do not comply with these plans when the larger spiritual framework is not adequately understood and integrated into the plan of care Spiritual practices may help in the management of physical pain Increasingly, medical staff recognize the palliative nature of religious and spiritual practices

48 Some practices that have been proven to help in the management of physical pain include: Prayer Relaxation techniques Chanting Ritual cleansing Acts of atonement Shamanic treatments Acupuncture Herbal remedies Spiritual pain and suffering may be caused by physical pain and other symptoms Loss of personhood Despair Feelings of abandonment by God

49 Example 1: Ann is a strong Christian and a believer that God rewards those who do the right thing and punishes sinners. Then one day she is told by here doctor that she has incurable cancer. This does not fit her belief about God and she now wonders if God exists. Example 2: Cathy is another person who does not necessarily believe in God but does believe that karma dictates that evil will be punished. She is then the victim of a brutal robbery and her assailant is acquitted on a technicality. While her physical wounds have healed, her spiritual wound continue and cause her to wonder if there is any point in going on.


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