By Susan De Longis
How can chaplains address the pain of patients who identify as “spiritual but not religious”?
Prayer and traditional methods of pastoral care are effective for those practicing religion, but we all know that the population of the “nones” is growing, and our plans of care within an interdisciplinary model must evolve with them.
A variety of alternative techniques can support patient self-awareness and expression, but along with new opportunities come new concerns. Spirituality, combined with or in place of religion, is unique to each individual. A growing trend toward selecting what suits one’s personal needs has generated a multi-billion dollar industry, with varying degrees of credibility and credentialing. Further, alternative spirituality can sometimes move into New Age or occult practices. Catholic chaplains are challenged to discern and respect this diversity in our patients, while maintaining the integrity of our own beliefs.
We must not only maintain appropriate boundaries within our scope of practice, but in compliance with the guidelines of the Church. Resources can be found on the Vatican website, “A Letter to the Bishops of the Catholic Church on Some Aspects of Christian Meditation” and the USCCB document “Guidelines for Evaluating Reiki as an Alternative Therapy”. These teachings are primarily based on a lack of scientific evidence and/or a foundation in non-Catholic religions.
However, I’ve used literature, music, and art in a variety of ways. A young man I worked with on palliative care service faced a lifetime of painful spine surgeries. After two months in a small, dark room across from the nurses’ station, and in constant pain, he withdrew into himself. At wits’ end, I suggested we move him to a newly available large and bright room in a quiet corner. He immediately responded to this healing environment, sitting up, engaged and alert. I gave him a book of beautiful nature photos, which refreshed his spirit, opening his closed system of intense suffering. I later showed him materials I had for coloring, from which he chose a complicated tropical bird. On returning, I was stunned by the brilliant colors and incredible detail of his work. With his pain now managed and his sense of self recovering, he was ready to invest in life again, and our beautiful bird soon flew out the door.
A devout woman in her mid-50s was a rare example of a hospice patient placed on home infusion for uncontrolled pain. It wasn’t working, and a deeper suffering lay hidden. She loved and missed the outdoors. Her sister played soft music with nature sounds, and I recommended turning her bed to face the large window framing her garden. Given her level of spiritual maturity, spiritual direction was most appropriate. Employing Ignatian scripture reflection, she used the gift of her imagination to enter into a passage, reaching a new comprehension of the deep sorrow in her troubled relationship with her husband. She was able to transcend her pain in every sense, in a transforming experience of forgiveness and reconciliation within herself, with God and with her husband. She let go of the inner conflict that had plagued her for decades, turning her attention toward completion of end-of-life tasks, including the composition of a loving, inspiring letter for her children. Her pain now well managed, infusion was discontinued and she calmly prepared for her journey home.
Another patient exasperated the staff at her residence. She was bitter and had constant, vague complaints of pain, which I observed usually followed episodes of anxiety. But she loved Asian art and allowed me to share a lovely book. She offered wonderful insights that helped her reconnect with herself. Her image of God was distorted by a life of conflict and an angry daughter, telling her to repent or she’d go to hell. I emphasized God’s love for her, and she delighted in this new understanding. As unconscious venting gave way to meaningful expressions of buried anger and disappointment, her bitterness dissolved and her pain was well managed. Having opened herself to God’s love, affirmed during many pastoral visits, she was reconciling her life and death within herself, with God and with three of four estranged children. She died with her family present, expressing and receiving genuine love for the first time.
Art and nature are, of course, very helpful when working with children. One young father tragically died, leaving several young children. Following an age-appropriate time of quiet sharing, each wrote a message on colorful balloons. They released them to a beautiful sky and watched, with eyes of wonder, as they soared, building a concrete image of lasting comfort and connection.
In every place I’ve worked, I’ve been fortunate to have regular time set aside with staff for spiritual care reflections. This offers experiential learning to understand, integrate and utilize the many-faceted resources and skills of the chaplain. A creative, interactive approach is personally helpful to staff and builds familiarity with the concepts and language of existential suffering, pastoral assessment and response, and the measurable outcomes that serve patients, staff, organization, and mission.
In exercising our creativity, we invoke the Holy Spirit as our constant partner. We serve as a model for others to recognize and express their own strengths and gifts in the universal language of meaning and beauty, instilled by our Creator. For some, we may be their first experience of unconditional love. Ultimately, our love is a witness to the miraculous and intimate love of God. Nourished and growing, our own daily spiritual practice increases our empathy for our patients in their struggles and joys. All that we are inspired to do in the beautiful mystery of love will draw those who are suffering closer to the true source of all peace and healing in the love of Christ.
Susan De Longis, BCC, practiced and taught in hospital, hospice and palliative care settings as a chaplain, bereavement counselor, and family systems specialist for 27 years.
