The Response to Spiritual Pain

October 5, 2012I have no disclosure nor conflict of

interest

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

Introduction

• Why?

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

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

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.

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

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.

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.

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.

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.

DEFINITIONS• RELIGIONA particular system of faith and worship,

assimilated to help make sense with life here and after. It is thought of in a community sense.

DEFINITIONS• SPIRITUALITYA 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.

DEFINITIONSSPIRIT: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.”

DEFINITIONSDISEASEThe Oxford Dictionary defines disease as “an unhealthy condition caused by infection, or diet or condition of life, or inherited.

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.

Chronic Pain and Suffering

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.

AMA – 1846 – EOL CAREA 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

Preferences & Alternatives

• DEFINITIONS– 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.

Preferences & Alternatives

• DEFINITIONS– Holistic Care: Defined by

www.holistichelp.net – 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.

Victor Frankl “Man’s Search for Meaning”

“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.

GOALS OF MEDICINE

CURE

CONTROL

PALLIATIVE

VERY END OF LIFE

LIFE HAS MEANING

COMFORT

PAIN

GOALS

HOSPICE

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

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.

Spiritual Issues

Identity

Connectedness

Values

Meaning

Purpose

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

What can one hope to achieve for and with someone in spiritual pain?

Nietzsche writes “someone with a why can bear any how.”

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

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.

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.

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

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

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

Some practices that have been proven to help in the management of physical pain include:

PrayerRelaxation techniquesChantingRitual cleansingActs of atonementShamanic treatmentsAcupunctureHerbal remedies

Spiritual pain and suffering may be caused by physical pain and other symptoms

Loss of personhoodDespairFeelings of abandonment by God

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.