BY: NEIL SOGGIE, DMin
Dr. Soggie teaches health psychology at Atlantic Baptist University,
Moncton, New Brunswick.
Our society has a deep and unquenchable need to reclaim the humanity of health
care and wellness. I was struck, at a recent ethics conference on health care
and pain management, by what I think of as the deep "unfixableness" of humanity.
At this conference, as at any such meeting of health care workers, "fixing,"
"healing," and "curing" were recurring themes. However, some other underlying
themes were even clearer: suffering, pain, hopelessness, frustration, and despair.
Modern medicine assumes that if pain cannot be traced to a biological etiology,
it is not genuine. But to assume that only puts us in another quandary: "What
is suffering?" Why is it that one person suffers from pain for which no physical
reason can be found, while another person, who endures incredible pain, is
not suffering? This mystery points toward a realm into which the professionals
at the conference dared not travel. For it was clear that they were all well
trained—trained, that is, not to venture into a realm beyond the bounds of their
biochemical education. It seemed an area well suited to health psychologists,
yet they dared not to venture into it.*
* Health psychology, a branch of psychology, applies psychological principles
and research to the enhancement of health and the prevention and treatment
of illness. Its concerns include social conditions (such as the availability
of health care), biological factors (such as family longevity and inherited
vulnerability to disease), and even personality traits (such as optimism).
The work of a health psychologist is similar to that of a counseling psychologist.
It was clear that although the conversation did not touch on the "spiritual,"
the spiritual was in fact the topic that begged to be discussed. It was evident
from the tone the doctors (both physicians and psychologists) used to discuss
their case studies that the deepest questions to be asked were: "How can we
learn to live with the unfixableness of life?" "How can we care for those who
are living the very depth of unfixableness?" and "How can we find joy in this
state of utter and apparent hopelessness?"
As a psychologist, I too have been forced to ask these questions. How can
I sit here and try to "do therapy" when, deep in my heart, I know that this
person will not be "cured"? A neurologist I know recently lamented that, as
she put it, "I have the most hopeless of professions because I know that my
patients will never get better and that in the end I am powerless to help them."
It is such professionals, and the medical and psychology students who long to
struggle with these issues, whom I address here.
Beyond Therapy
To put it simply, health care must be more than therapy, whether that therapy
is physical or psychological. Health care must also involve community and spirituality.
Indeed, I argue that health care truly exists only when community and spirituality
are allowed to flourish, for community and spirituality are the most fundamental
modes of humanity in dealing with brokenness, pain, suffering, and death.
Undoubtedly some will argue that, in a secular society, we must separate the
physical from the spiritual. However, as the great psychologist Carl Gustav
Jung pointed out, the deepest and most human psychological function is spirituality.*
Definitions of "spirituality" among biblical languages implied that it is something
"innate" in the physical realm. The ancients plainly believed that something
intrinsic to the natural physical world is moved, formed, and given life by
the spiritual.
* This theme, which runs throughout Jung's work, is central to his Modern
Man in Search of Soul (Harvest Books, New York City, 1955).
According to the ancients, the Platonic idea of a separation of the physical
and the spiritual—a notion shared by modern "secular" thinkers—is false. These
mysterious elements of life cannot be separated—and must not be separated, as
any patient in a hospital will tell you. A person is a person spiritually and
physically, and to treat him or her as no more than a sick or broken object
is to deny that person genuine care. Indeed, to ignore the fact that a person
is inseparably physical and spiritual is to do harm, for it denies the reality
of life.
So what should we health psychologists do when we encounter someone in a hopeless
situation? We must first recognize that we have moved beyond the proper limits
of health psychology and into the realm of spiritual care. Our goal is no longer
"therapy"; it is simple human caring in its purest, most spiritual sense, for
the person's spiritual needs. First and foremost, we must recognize that the
person is spiritual—not religious or "otherworldly" perhaps, but spiritual nonetheless.
There is, within any person, a need for community, meaning, purpose, love, understanding,
peace, and belonging. All these basic ontological needs will inevitably have
an impact on the physical, just as physical well-being (or the lack of it) will
affect these foundational spiritual needs.
Keeping this in mind, we must meet this person in the midst of his or her
life—including his or her current circumstances; life story (and its meaning
for him or her); and sense of direction and purpose, love, peace, and belonging.
We must also be aware of our own sense of direction and purpose, love,
peace, and belonging—or lack thereof. Caring for someone spiritually is a fully
human act of intimacy, demanding that there be no "healthy healer" on one hand
and no "sick patient" on the other. Instead, there are only two people, both
of whom are unfixable in this life, lost in their search, and longing to share
their story of journey in life.
An Essential Vulnerability
The defining difference between health psychology, as it is commonly understood,
and the higher calling of "psyche (or spirit) care" is the essential need for
vulnerability that the context demands. Typically, the health psychology model
dictates that a healthy therapist function with a rational detachment that provides
a psychological mirror for the sick. However, this very limited model fails
in the most difficult situations in life, and then we are called to pick up
the basic theme of spiritual care. And the basic theme is this: If genuine care
is to be provided, rational detachment must be left behind. The therapist must
not simply give without receiving, for doing so frustrates the sick person's
own deep psycho-spiritual need to give to and care for others; sharing one's
suffering with another gives it meaning. We are physical creatures, to be sure,
but it is our capacity to love others in community and to find meaning in suffering
that separates us from the rocks and stars.
It was a failure to recognize this basic principle that, at the conference
I attended, kept the medical professionals from asking the deeper questions.
To have asked such questions, we would have had to admit that human life goes
beyond the bounds of our professions—and, in the end, reveals those professions
to be utterly powerless. Human life is broken, in both the physical and spiritual
sense, and anyone who doubts either of these points should visit a hospital
nurse in the morning, a palliative care patient in the afternoon, and a chaplain
in the evening. Human life is both a gift and a burden that demands to be lived
authentically. Sooner or later, life will force a person, sometimes violently,
to recognize that fact.
To try to care for psychological needs, from the perspective of the strictly
rationally detached health psychologist, is—if one is, for example, dealing
with a terminally ill patient—inauthentic. It will utterly fail to meet the
challenge of suffering. To take the step beyond the bounds of professional rational
detachment, when one caring for the psychological needs of a person in the depths
of suffering, is the difference between living as a rock and living as an authentic
human being. At times, indeed, dropping one's detachment is the first essential
step toward treating the patient as a valued human being, a creature having
the common human experience of being unfixable. This is also essential for our
own professional self-awareness, because it forces us to realize the unfixableness
of our context, our own unloveliness, our own unworthiness. It helps
us to recognize why there is all the suffering and pain we see in life. However,
it also shows us that we are unfixable people who need other unfixable people
to love us and to be loved by us.
Undoubtedly, this process will lead to some emotional and existential pain
as we are forced to ask the question: "Is this all there is to life?" Unfortunately,
we must start with what we know before looking for what we need. So, here we
are, broken people who are guilty of continuing the "breaking" in life. We are
standing on a common plain, with common needs and desires and with a common
burden. The question is: What is the next step? What is it that we all need?
Another Realm
The next step in the process leaves all remnants of therapy behind, as we enter
the realm of the existential and the spiritual.
Much suffering is life teaching us to frame our questions in a way that helps
us recognize "who we are" and "what we need." A great deal of this pain could
be avoided if only we knew how to frame questions about our longings and were
willing to forgive those with whom we have had conflicts. For forgiveness is
an external thing that we must experience. And life always points us
to that fact—that life is experienced only in relationship and hope is found
only in forgiveness.
Therefore, we health care professionals have to recognize that at times we
must go beyond the limits of our professions, including health psychology, and
enter the very human realm of spiritual care. Indeed, this type of health care
is nothing more than living authentically, the way life forces us all to live.
It is simply trying to discern the way life has grabbed one by the head and
forced him or her to gaze in the direction of his or her true existence. For,
too often, we fight to look in another direction. It is in such moments, as
one struggles to turn one's gaze away from life, that one's neck and back begin
to feel the stress of the fight.
In community, people find out who they are; they discover the meaning of suffering,
life and of death; and, above all, that they are loved. To care for people in
the unfixableness of life is to allow them to live toward death in relationship
with their caregiver. Doing so requires us to allow them to share of themselves
and to remind them that they are loved. This is the simplest, most authentically
human act there is. Unfortunately, in an age in which professionalism and technological
change increasingly dominate health care, this simple, authentically human act
is sometimes absent.
Still, the fact remains: It is only in forming a community of love around
the person and allowing him or her to express his or her spiritual self that
both the patient and the professional find joy in the midst of the unfixable.
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.