How can health care providers address the spiritual needs of their patients suffering from chronic illnesses facing the prospect of living the rest of their lives in pain?
There are a number of practical coping strategies used by those who deal with chronic illness and pain. These include (1) prayer, (2) use of the "Faith Factor" with the Relaxation Response, (3) humor, (4) music and bibliotherapy, (5) keeping a journal, and (6) reaching out to others. Sharing information about these coping skills is an important aspect of spiritual care.
People with chronic illness use prayer to present their needs to God, to express their thankfulness, and to confess their dependency on a God whose strength is infinite. Prayer provides tremendous comfort to someone who daily experiences the finiteness of personal strength and resources. Prayer reflects an intimate relationship with a God that is loving and accepting; it can be an expression of hope that God will be and is reliable. Prayer also provides an outlet for anger and confusion toward a God who is seen as the source of pain, suffering, and loss.
With all these benefits in mind, it is important to recognize that prayer is not always easy for someone with a chronic illness. Sometimes the illness saps energy and mental concentration to such a degree that only the briefest entreaty to God is possible. At such times the prayers of a supportive person, a prayer network, or shared prayer with the suffering individual can fill the gap between the individual and God. As healthcare providers, we cannot prescribe prayer unless we know through our spiritual history that this is something the patient values. As an educational intervention, however, we might be able to share research findings about the value of prayer without any hint of coercion or proselytizing on our part.
The "Faith Factor" with the Relaxation Response
Experiencing stress and anxiety is part of living with chronic illness. It is important that patients learn how to relax and release the stress they feel. Dr. Herbert Benson describes the effectiveness of the faith factor as an additive to one's use of the relaxation technique: "The combination of a Relaxation-Response technique with the individual's belief system is what I call the 'Faith Factor'…two powerful but familiar vehicles are combined: (1) meditation and (2) a deeply held set of philosophical or religious beliefs."1
Dr. Benson is not promoting one religious faith over another. In fact, he is not promoting religion. He contends, however, that it does matter what we believe. It is out of our conviction about the unique power of faith that we ignite quantifiable, scientifically measurable physiological changes that serve to disrupt the inner anxiety cycle. "It allows your mind to 'settle down,'" says Benson, "and move into more productive thought patterns."2 Dr. Benson provides examples of phrases from the Christian and Jewish traditions, the Hindu and Buddhist traditions, and the Muslim tradition to be used along with relaxation.
Laughter has the power to bring healing to body, mind, and spirit and to allow the suffering person to transcend—if only for a moment—the limitations imposed by pain and illness. Keeping a folder of humorous stories, jokes, and funny anecdotes is a useful strategy for patients coping with chronic illness. Asking patients about the last time they had a good belly laugh opens the door to a discussion about the therapeutic value of humor. Finding humorous Web sites might be a beneficial activity for someone who is homebound and dealing with a chronic illness. The discovered jokes, stories, and anecdotes could be shared with others as well as providing benefit to the searcher.
Music and Bibliotherapy
Music feeds the soul by providing both an emotional and a spiritual release. Music can relax and refresh the body. Some chronically ill persons, when asked how they coped with suffering, reported that they listened to music.3
A story of a nurse who provided care using her love of singing comes from Amy Pollman.
I was visiting a patient in her home for treatment of severe depression. I learned that her husband was also very ill; he was suffering from asbestosis. My patient got better and I discharged her, but my concern about her continued because I knew her husband's prognosis was very poor. After the discharge, I continued to call the patient to check on her and periodically stopped by to see her. In one of my telephone calls, I learned that the woman's husband had just died, and I offered to visit the patient's home to offer comfort. I wanted to do something to make her feel better, so I brought along a musical accompaniment tape. While I was in the home I sang a song entitled, "Friends in High Places." This was so comforting to my patient. She asked that I sing this at her husband's funeral, which I did.
Faith-Related Words and Phrases to Be Used with the Relaxation Response
For Roman Catholic and Other Christian Traditions
Variations on the Lord's Prayer: "Our Father who art in heaven," or "Hallowed be Thy Name"
Phrases from the Hail Mary: "Hail Mary, full of grace"
A phrase from Mary's Magnificat, Luke 1:46-55:"My soul magnifies the Lord"
Psalm 23:"The Lord is my shepherd"
Psalm 100:"Make a joyful noise unto the Lord"
Jesus' teachings or word: "My peace I give unto you" ( John 4:27),"Love one another" ( John 15:12), or "I am the Way, the Truth, and the Life" ( John 14:6)
Other meaningful passages from the New Testament, such as "Thy peace which passes .l.l. understanding" (Phil. 4:7), or "We have the mind of Christ" (1 Cor. 2:16)
The Hebrew word for "peace": Shalom
The Hebrew word for "one": Echod
Passages from the Old Testament, such as "You shall love your neighbor" (Lev. 19:18), or "God said, 'Let there be light'" (Gen.1:3)
Phrases that conform to King David's practice of meditating on God's promises, precepts, law, works, wonders, name, and decrees
The word for "God," Allah; "The Lord is wondrous, kind"
Adahum, "one God," the words of the first Muslim who called the faithful to prayer
For Hindus and Buddhists
The Bhagavad-Gita, the preeminent Hindu scripture, says, "Joy is inward" Mahatma Gandhi said, "Turn the spotlight inward"
Part of a favorite invocation of Hindu priests, "Thou art everywhere" and "Thou art without form"
Buddhist literature contains phrases like these: "Life is a journey" and "I surrender indifferently"
(Adapted from Herbert Benson, Beyond the Relaxation Response.)
Bibliotherapy means purposeful reading that allows people to broaden their horizons, learn from others, or experience catharsis. Reading not only provides a useful and enjoyable pastime, it provides wisdom, comfort, insight, guidance, inspiration, and patience as we hear our own experiences reflected in the writings of another.4 In addition, religious writings may support faith and courage.
As healthcare providers, we need to encourage listening to music and reading a good book. In fact, it is helpful to share with patients music or reading material that we have found particularly soothing, refreshing, stimulating, or in some way enlightening to us.
Reaching Out to Others
It is easy to fall into a trap of despair, believing that chronic illness and pain have placed a huge roadblock in the way of creativity and reaching out. It is sometimes out of this pain, however, that inspiration is born. Chronic illnesses do not end a life; they may lead to a slower pace and even demand that new priorities be established, but they do not signal the end. Many people find that reaching out to others is the best medicine. Reaching out shifts the focus away from self and personal pain to the needs of others—and it just plain feels good!
For example, a homebound elderly woman with severe arthritis sends greeting cards to other shut-ins within her church community. A wheelchair-bound woman with multiple sclerosis mans the telephones to organize the volunteer network at her church. These activities not only benefit others, but they give meaning and purpose to a life in which meaning and purpose have been brought into question because of the limitations imposed by chronic illness. As healthcare providers encounter patients who feel full of despair, believing they have no purpose, we need to provide them an alternate view of what their lives could be like. Sharing stories of people who found their talents and gifts and made a difference in the world after being diagnosed with chronic illness5 is a powerful intervention, as long as we don't make the patients feel as though they are being compared—which could further deflate their sense of self-esteem.
Contributions of People with Chronic Illness
Emily Dickinson produced beautiful poetry despite her poor health and a life of seclusion.
Henri Matisse took up painting as a distraction while convalescing from a serious illness.
Robert Louis Stevenson suffered with severe pulmonary disease from birth; he wrote Treasure Island, Dr. Jekyll and Mr. Hyde, and Kidnapped while living in the shadow of death.
Franklin Delano Roosevelt, thirty-second president of the United States, the only president elected to four terms in office, was a polio survivor.
Ann Ruth, a quadriplegic, is an artist and president of the Ann Ruth Greeting Card Company. She paints by holding the brush in her teeth.
Wendy Whiting, restricted to a wheelchair due to spastic cerebral palsy, choreographs ballets. Although she cannot perform, she has dancers who help her make her vision a reality.
(E. G. Wheeler and J. Dace-Lombard, Living Creatively with Chronic Illness)
The practice of keeping a journal can serve many purposes. Recording feelings, struggles, and prayers can release pent-up emotions, open the door to new ways of thinking, renew the spirit, and build a storehouse of memories. Journaling is a conversation with self that helps to clarify thoughts and feelings; doubt and anger may be released and faith affirmed. The Psalms, which many people find so comforting, are in reality David's journal cataloging the ups and downs of his spiritual journey.
Even the medical literature documents the benefits of journaling. The results of a randomized clinical trial of journaling, conducted in patients with asthma or rheumatoid arthritis, was published in the Journal of the American Medical Association in 1999.6 Investigators found that asthma patients in the experimental group showed significant improvements in lung function (increase of FEV1 from 63.9 percent at baseline to 76.3 percent at the four-month follow-up), whereas control group patients showed no change. Similarly, rheumatoid arthritis patients in the experimental group showed a significant reduction of 28 percent in overall disease severity at the four-month follow-up, whereas control group patients did not change. Combining all 107 patients, 47.1 percent of experimental patients had clinically relevant improvement, whereas only 24.3 percent of control patients had improvement.
A suggestion to a patient by a healthcare provider regarding the value of journaling may open up a new avenue for coping and perhaps even improvement in the disease.
- Benson, Herbert (1984), Beyond the Relaxation Response (New York: Times Books), 5-6, 106-111.
- Benson, Beyond the Relaxation Response, 104.
- Starck, R. (1983), "The Meaning of Suffering Experiences as Perceived by Hospital Clients," final report (Troy, Ala.: Troy State University School of Nursing).
- Stoll, "Spirituality in Chronic Illness," 199.
- Wheeler, E. G., and Dace-Lombard, J. (1989), Living Creatively with Chronic Illness (Ventura, Calif.: Pathfinder Publishing), 7-9.
- Smyth, J., et al. (1999), "Effects of Writing about Stressful Experiences on Symptom Reduction with Asthma or Rheumatoid Arthritis: A Randomized Trial," Journal of the American Medical Association 281(14): 1304-1309.
From Verna Benner Carson and Harold G. Koenig, Spiritual Caregiving: Healthcare as a Ministry (Philadelphia: Templeton Foundation Press, 2004), 119-24.