John D Morgan. Handbook of Death and Dying. Editor: Clifton D Bryant. Volume 1. Thousand Oaks, CA: Sage Reference, 2003.
We use the term spirit in many ways, to refer to the vitality of a high school team, to the content of beverages, as well as to the position that there are conscious beings that are immaterial. In this last sense, the term fundamentally means independence from matter: either that the creature is an immaterial being or that there is something about the being that acts in an immaterial way, that is, in a way that cannot be fully explained by bodied functions. Other meanings of spirit are extensions of this idea of immateriality, which we inherited from classical thought. Because the language of Greek philosophy was a convenient tool for presenting their message, early Christians adopted the idea of an immaterial, spiritual soul, a notion not found in quite the same way either in Judaism or in non-Western philosophies. We who live in a Western culture shaped by both the language of the Greek intellectual experience and the Christian religious experience often identify the idea of spirituality with religion, but the spiritual nature of the person is broader than at least organized religion.
The literature dealing with the spiritual needs of the dying and the bereaved, or spiritual questions that persons may ask in the face of death, has grown significantly in the past 20 years. Many articles, chapters, and books deal with the spirituality of children (Coles 1990), of adolescents (Balk and Hogan 1995), of the aged (Koenig 1993), of the dying (Heyse-Moore 1996), and of the bereaved (Klass 1999). Such material has been written by nurses (O’Connor 1998), physicians (Ley 1992), and chaplains (Gilbert 2002), among others.
One might think that spirituality is a newly discovered source of special insights into the needs of the dying and bereaved, but this is not the case. The beginnings of the modern hospice movement in the United Kingdom were rooted in the Christian viewpoint of Dame Cicely Saunders, the founder of that movement. Saunders held that the spiritual needs of hospice patients, their families, and hospice staff must be not only cared for, but central to treatment (Wald 1986:26). In 1989, the International Work Group on Death, Dying, and Bereavement solidified much of the thinking up to that point with the following set of assumptions (Corless et al. 1990:34-41):
- Each person has a spiritual dimension.
- The spiritual orientation influences mental, emotional, and physical dimensions.
- Dying and grieving can be times of spiritual growth.
- Spiritual beliefs and practices are exhibited in widely different ways.
- Spiritual needs can arise at any time or place.
- A broad range of spiritual opportunities should be available for the dying and bereaved.
- Joy and humor are essential parts of human spirituality.
In this chapter, I examine an argument for the spiritual reality of human beings as well as present a formulation of the idea of spirituality that I believe to be useful to those who work with dying and grieving persons.
A Classical Definition of Spirituality
Although it is evident that human beings are composed of material bodies, the idea that they cannot be described adequately in material terms is seemingly as old as the first recognition by a primitive that humans differ from other animals. All animals know—that is, they become informed by their surroundings, and they use this information as they go about satisfying their needs. Self-consciousness, however, is different from simple knowing. Human beings know that they know. This seems to be one way in which they differ from nonhuman animals. If other animals are self-reflective, they have not developed the language they need to express their self-reflexiveness in a way humans can understand. In addition, there are different levels of knowing. Nonhuman animals are aware of the tastes, colors, smells, tactile qualities, and sounds of their immediate surrounding environments, but their lack of symbolic language as a way of communicating seems to imply also a lack of abstract thought.
Language requires not only information from things, but information about things that is sufficiently abstracted from the immediate individual things that it is possible to refer to those things using symbols. For example, the sound of the word wine and a visual sign reading WINE refer to the same thing. This ability to know abstractly seems to be a uniquely human phenomenon. Some 25 centuries ago, Plato believed that this was the fundamental characteristic of human beings (see, e.g., Plato 1937:4490). In the abstraction of the idea “wine,” the human mind is aware of the sense data received but has the ability to transcend the immediate sense data to arrive at a universal.1 Because each person is a material being who gets its existence one moment at a time, we experience material things one experience at a time. Yet in spite of the immediacy of all experience, persons can think—that is, be aware of the commonality, the common characteristics of the individual things found in experience. Thinking, awareness of the common characteristics of things, is the fundamental example of the spiritual nature of the human being.
The question “Do you like red wine?” is easily understood by both those who like the product and those who do not. It is even understandable, by analogy, to those who have never tasted wine. The question is not “Do you like the red wine that is on your tongue at this moment?” Rather, the question is “Do you like red wine?” that is, any red wine at all. When we stop to think about it, we realize that we have never tasted “any red wine at all”; we have tasted only “this individual drop of red wine on my tongue now” or some other. In spite of the fact that all of my experiences of red wine have been in particular places and at particular times, I still understand the question “Do you like (any) red wine at all?” We can explain the fact that the human mind is aware in a way that is not limited by the immediacy of surroundings only if we hold that there is some aspect of the person that dematerializes, or spiritualizes, the data of experience. The cause of this universal idea of “wine” cannot be the individual liquids outside the mind. Each of them is individual, tied to a particular space and time. But the concept “wine” is not tied to any given space or time.
Not only does the human mind know things in an abstract way—that is, a way outside the limits of individual space and time—the human mind can also know itself. The human mind is capable of answering the question “What is a human mind?” The human mind can reflect on itself. We can, for example, give a definition of the mind as “the process by which we are aware of experience in a nonspatial or nontemporal way.” Even if one were to disagree with a particular definition of thinking, the point remains that the human mind (the thinking power) is capable of defining itself, capable of thinking about what thinking is. No other material or animal capacity seems to be able to reflect back upon itself. This conceptualization beyond the limits of immediate experience is spirituality.
Free choice is also a spiritual function. By choosing, by willing, by committing oneself to a goal or a plan, one determines that something one knows abstractly, only as a future possibility, not only can exist, but can exist as a goal. The value of this goal exists only in the human will determining that it shall be. This goal is by definition something that is not yet. Deciding that one is going to make the “best apple pie ever” does not imply that the apple pie exists anywhere except in one’s thoughts. The human being can commit him- or herself to that which is not yet.
The meaning that humans find in music, art, and literature, although dependent on the physical characteristics of tones, rhythm, paint, canvas, and words, is not identifiable with these tools of expression. Art, as Maritain (1966) says, is “the expression of the inexpressible” (p. 60). It is the creation, or at least the awareness, of a value that is not found directly in the material makeup of the work of art. The arts can be used to enable people to find meaning, “to overcome fragmentation in their lives” (Bailey 1986). Culture—”the ideas by which we live” (Ortega y Gasset 1944:37)—does not exist as a group of physical facts, but as human interpretations of fact, and thus is part of our spiritual heritage.
Ethics consists in doing the right thing, whether that “right thing” is perceived of as duty, as the greater balance of good over evil, or as the Will of God. Ethics is rooted in the capacity of the individual to perceive a set of possibilities outside the immediate and to compare those possibilities with their conceptualized ego ideals. The Greek word ethos, from which the English word ethics is derived, means character. Ethics is the determination of the character or person one wishes to be. Ethics understood in this way would be impossible if we were not able to understand ourselves outside the immediacy of space and time.
The spiritual nature of the person opens the door to the possibility that each of us is a part of a larger whole. We not only find the meaning in our lives in that larger whole but have some obligation to it. This is what is usually meant by religion. In this sense, the term religion applies not only to the usual Western or Eastern religions, but also includes philosophies and other movements in which persons find meaning in their lives. Each person asks what it is that gives meaning to life, and whether whatever he or she chooses will be a defense against the bad times that come into each life, such as death and bereavement.
Toward a Practical Definition of Spirituality
I believe that the following will be helpful in the analysis of spirituality. Barely skimming the surface of the history of thought, we see many definitions of what it is to be a person. These definitions range from “spiritual substance” (Plato) to “will to power” (Nietzsche), and include such awarenesses as the person as a moral creator (Kant), the person as a problem solver (James), the person as a network of relationships (Marcel), the person as worker (Marx), the person as freedom (Sartre), the person as sexual (Freud), the person as part of the Absolute (Hinduism), the person as redeemed (Christianity), and the person as destined to do the will of God (Islam).
Each of these views is intrinsically understandable. Each can be intelligently defended. Each makes a certain kind of sense. We find ourselves agreeing with many of these positions in whole or in part. Yet the diversity of viewpoints teaches us the greatest lesson of spirituality: The person is a self-creator, a being who decides in one way or another what kind of being he or she will be. Our spirituality gives each of us the particular integration of these identifying characteristics. We thus arrive at a more formal definition of spirituality: Spirituality refers to the ability of the person to choose the relative importance of the physical, social, emotional, religious, and intellectual stimuli that influence him or her and thereby engage in a continuing process of meaning making (Morgan 2002). Spirituality is not some supernaturally oriented package of ideas; rather, it is a focus on what we can become (Hefner 1998:540).
Another way of discovering spirituality is to examine the difference between pain and suffering. According to the International Association for the Study of Pain, pain is “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (quoted in Chapman and Gavrin 1993:5). It may be acute (that is, of limited duration and with a specific meaning) or it may be chronic (that is, of unlimited duration and with no specific meaning, or with a specific meaning that is already held). It is relatively easy for individuals to tolerate the pain of sunburn, minor headaches, stubbed toes, insults, or failure to receive what they perceives to be their due. In chronic pain, physical or psychological, the pain no longer operates as a signal that something is wrong. The person who is feeling the unrelieved pain of a growing tumor already knows that something is wrong.
Suffering, however, has the connotation of “perceived threat to the integrity of the self, both physical and psychological” (Chapman and Gavrin 1993:6). That is, in suffering, one has the sense of “losing it,” of no longer being in control of one’s own life, of helplessness and hopelessness. Callahan (1993) divides suffering into two levels: At the first level, the individual deals with uncertainty, fear, and dread; at the second, he or she deals with “the meaning of suffering for the meaning of life itself” (p. 100). Suffering occurs when one has the sense that the level of pain has become intolerable, that one can no longer be the kind of person that one wants to be. Aside from very important individual differences in pain thresholds, a major factor in how much pain one can tolerate without disintegration into suffering is one’s perception of the world, the philosophy, the sense of meaning, that one holds: one’s spirituality. A Buddhist who accepts the First Noble Truth (Smith 1986:148), that life is pain, will relate to pain differently, and presumably will suffer less, than a materialist consumer who defines him- or herself only in terms of possessions. A person’s philosophy can operate as a buffer against suffering. As Callahan (1993) puts it: “We are all fated to suffer and die. We are not fated to make one interpretation only of this necessity, or one response, or to have just one possibility of shaping the contours of our suffering” (p. 136).
Because humans are meaning-seeking beings, we experience spiritual pain when we have the sense that our lives may be meaningless. No one individual can tell another where to find meaning; we can only support one another in the process of meaning creation. We offer each other social support—that is, we ask each other “How are you?” and stay around long enough to hear the answer.
The Self and the Other
In our consciousness of our spirituality, we realize that our ego boundaries become permeable (Klass 1993:52); we realize that there is more out there than the individual person. I am on this stage of life, but I am not alone. I respond to other people, with their spiritualities. I become aware of my connections to other persons, to the environment, to our God (Graydon 1996:326).
We know that we cannot survive as loners. Exclusionary self-interest is destructive. Because primates cannot survive outside the group, whatever disrupts group bonding leads to extinction (Clark 1998:656). However, each of us must still be a unique person. As Clark (1998) notes, “Societies where a meaningful social identity is denied to the autonomous individual ultimately fail” (p. 657). The ideal is to create a human society that encourages full cooperation while at the same time encouraging the fullness of individual accomplishment.
Spirituality and Religion
By religion, I mean an awareness that the individual is part of a larger whole and that the meaning that he or she has is found in a relationship to that larger whole. There are both descriptive and prescriptive aspects to this relationship. The descriptive aspect indicates how the universe exists and the relationship of the individual person to that universe. The opening lines of the Hebrew Bible (“In the beginning God created the heavens and the earth”) provide a description of how the universe exists, and the later lines that state that the human is created in the image of the Divine are a description of the place of the individual person in that universe. The prescriptive side of this is that, given the relationship we have with the Divine, we ought to conduct our lives in a manner that will enhance that relationship rather than diminish it.
This human search for meaning is found in the traditions of the five religions of the world that account for most membership: Hinduism, Buddhism, Judaism, Christianity, and Islam. Although they may differ in many details, these traditions have some elements in common. The first of these commonalities is the idea that the real is more than meets the eye (Smith 1986). Although these traditions differ in the manner in which they express this truth and the foundations on which they hold the truth, they all agree that there is more to reality than physical objects. The world that we see, touch, taste, smell, and hear is only a small part of the whole. In addition, these five religions share the belief that this whole is itself the Divine, or is causally related to the Divine. In the words of Immanuel Kant, the person “is a citizen of both worlds.” The human being is the bridge between the physical world and the world of the spirit, or the Divine world. This belief is founded on a revelation—that is, an event on the part of the Divine that allows the believer to enter into an awareness of the true nature of reality, something that might not happen otherwise. Underlying this thinking is the view that the Divine wills the happiness of all. Because the Divine wills the happiness of all, a pulling back of the curtain, a revelation, has occurred.
The Hebrew Bible tells us that Adam was made from the dust of the earth and that Eve was made from Adam’s rib. Whether or not the Divine performed surgery in the Garden of Eden is not the point of the story, however. Rather, the point is that we are related to the earth itself, and that men and women are so related that humans of the two sexes do not achieve fulfillment apart from each other. There have been hermits in history, but even their hermitage was for the sake of the rest of the human race. The various religious traditions differ in the ways that they say it, but they agree that the person needs to be lovingly related to others (Smith 1986). Blending the various themes above, we have the ideas of the church, or communion of saints—that is, a fellowship through the Divine with each other.
To summarize: There is a reality outside ourselves that reveals itself to us and is a standard for us. We each create ourselves in light of that standard, and we do it in fellowship with others. However, we all fail. The major traditions differ in their formulations but agree that we all have a need for forgiveness: peace with ourselves, our fellows, and our God (Smith 1986). This forgiveness, or peace, among ourselves, others, and the Divine is as much of freedom from suffering as we have in this present state, because in it we find a meaning that puts all the pieces together and has withstood the test of time.
All cultures have developed ceremonies and rituals that convey these realities to the living and the dying. It is helpful to remember the points that Edgar Jackson (as cited in Rando 1984:316-17) made some years ago about the value of religion to the dying:
- It helps them control their fears and anxieties by revealing not only the tragedy and sorrow of life, but also its blessings and rich experiences.
- It emphasizes those events in the history and experience of humanity that make life seem more understandable and give more people a sense of changelessness in the midst of change, of the eternal in the midst of time.
- It helps them to turn their best thoughts and feelings into constructive action.
- It inspires those of faith to act as they believe, to fulfill their aspirations in life.
- It allows them to transform the tragic events of life through the direction of its hope and the power of its love.
- It leads to deeper sensitivity of the spirit, higher aspirations of service, and a firmer conviction that the cosmic purpose is best understood as creative goodness. Therefore, although grief is painful and disappointing, it does not lead to despair.
- When it contains a belief in immortality, it relieves some of the guilt and sorrow that would be present if it were thought that at no point in time or eternity could wrongs be righted or injustices rectified.
- It highlights tradition, giving people a longer view by allowing them to tie present sufferings to time-honored sources of spiritual strength, and thus transcend current pain.
- It gives courage in the present and direction for the future.
- It moves attention away from death and tragedy, not by denying them, but by fitting them into a larger perspective.
- Through community religious rituals, it provides evidence of group strength and comfort, and recognizes the dignity of life and the validity of feelings prompted by facing death.
The Existential Quest for Meaning
When the World’s Fair was held in New York City in 1960, the Vatican gave the commissioners of the fair permission to transport Michelangelo’s Pietà to New York for exhibition. People were worried. The statue was to be moved by boat, and boats do sink—not very often, but they do. If such an accident were to happen, the Pietà would be lost. We are often quite concerned over the loss of precious things, and many things are precious precisely because they are rare. The Pietà is a wonderful creation, but it is not, by far, the most precious thing in existence. The Pietà and similar artifacts are literally set in stone; they do not have the ability to be self-creations. Persons, however, are self-creations. Each person is a once-in-a-lifetime-of-the-universe event. Although our bodies and our instincts are structured by nature, and we are influenced by parental guidance and culture, each of us decides what person we shall be. Each of us is unique.
What is it to be a person? Fundamentally, a person is a subject. The definition of subject, from logic, is “that which has powers.” The term power is not used here in any political sense, or in the sense of power over others. Rather, it is used in its root sense of “the capacity to do” (e.g., the power to see, the power to taste). The term object refers to anything that activates a person’s powers. A subject is a potential seer, but unless there is a colored object (the lining of my tie), the subject will not see. The colored object (my tie) has made the subject’s power to see specific. A subject is a potential seer of any color whatsoever, but becomes an actual seer of a specific colored object. A subject is a potential hearer of any sound, but because of the object now hears a specific sound. Objects get their meaning and value from subjects. Color would be meaningless if there were no seeing creatures in this world. Sounds and odors would have no meaning if there were no sensate creatures in the world.
Unfortunately, we often think of persons, ourselves and others, as objects. It was not too long ago that the common understanding of a woman was that she was “somebody’s daughter,” then “somebody’s husband,” then “somebody’s mother,” and then eventually “somebody’s widow.” A woman was defined in terms of other persons. She was thought of objectively—that is, as a thing that gets meaning from outside. When we think of persons primarily as their sexes, their races, their religions, their nationalities, their careers, their sexual orientations, we think of them as objects, as things that get their meaning from without. But a person is not an object. A person is a subject, that which creates meaning.
A subject is one who says, “Yes, but”: “Yes, I am a woman, but…”; “Yes, I am a tennis player, but…. ” Each of us realizes that there is more to the self that we are than a list of categories can formulate. What existentialist philosophers call the “moment of subjectivity” is the realization that no list of categories could ever possibly describe the unique person. The moment of subjectivity is the moment in which a person realizes that never before in the history of the universe did he or she exist, and never again will he or she exist. Each person is a once-in-the-life-time-of-the-universe event.
Our realization of our uniqueness has two consequences. The first is that we understand that we will never be truly known by another person. In moments of depression or sadness, we may feel sorry for ourselves, saying to ourselves, and to anyone who will listen, “Nobody really understands me.” The philosopher Jose Ortega y Gasset (1956:50) uses the term “radical solitude” to describe what it is to be a person. There is something about each of us that others just cannot grasp and something about them that we cannot grasp.
The second consequence of our realization of our uniqueness is that we realize that we have a limited amount of time to be who we can be. Each person is unique, yet destined to cease to be. Nothing makes the person more conscious of his or her uniqueness than death. No one has said this better than Ernest Becker (1973):
Yet, at the same time as Eastern sages also knew, man is a worm and food for worms. This is the paradox, he is out of nature and hopelessly in it; he is dual, up in the stars yet housed in a heart-pumping, breath-gasping body that once belonged to a fish and still carries the gill marks to prove it. His body is a material fleshly casing that is alien to him . . . the strangest and most repugnant being that it aches and bleeds and it will decay and die. Man is split in two; he has an awareness of his own splendid majesty, yet he goes back to the ground to rot and disappear forever. (P. 27)
We are unique, yet we know that we will go into the ground to rot forever. Each of us is a special selfcreation, but as far as nature is concerned, we are nothing but body (Becker 1973:31). Once we have passed our genes on to the next generation, we have done our evolutionary work. The awareness that we are nothing but bodies, and bodies die, forces us to ask the question, “What kind of God would make such fancy worm food?” (Becker 1973:26).
In the process of growing up, we discover ourselves. Our culture tells us how to define ourselves, but, being self-creating beings, we stop and ask ourselves if our culture is correct in the definition it has provided. We step aside from our culture from time to time. The human condition is that we find ourselves on the stage of life knowing we have roles to play but not knowing what those roles are, or even the plot of the story. No other animal has to live this terrible condition. Nonhuman animals have instincts by which they run their lives. For Becker (1975), “Spirituality is not a simple reflex of hunger and fear, it is an expression of the will to live, the burning desire of the creature to count, to make a difference on the planet because he has lived, has emerged on it, has worked, suffered, and died” (p. 3).
Achieving Self-Conscious Spirituality
Everyone is spiritual. However, many of us adopt “shortterm spiritualities” or meaning systems. Materialism is a meaning system. Consumerism is a meaning system. Marxism is a meaning system. Graydon (1996:328) suggests that the following questions may be useful for opening the door to self-conscious spirituality—that is, to an evaluation of the fruitfulness of one’s meaning system or spirituality:
- When you are discouraged and despondent, what keeps you going?
- Where have you found strength in the past?
- Where have you found hope in the past?
- Who have you looked up to?
- Who inspires you?
- What does death mean to you?
- What does suffering mean to you?
- What does [religious] community mean to you?
- What does healing mean to you at this point in your life?
- What is your attitude to your death?
- Can you forgive others?
- Can you forgive yourself?
- What would bring you inner peace?
- Can you find strength in yourself?
- Do you love yourself?
- Can you perceive yourself as being loved by others, by God?
- How are you relating to yourself?
- How are you relating to others?
- How are you relating to the universe?
- How are you relating to your God?
Spiritual awareness can also be opened up in ways other than through questioning. Art therapy, music therapy, bibliotherapy, guided meditation, journaling, telling our life stories, examining photographs and other memorabilia—all of these can be effective tools for opening persons to self-conscious spirituality.
The Need to Be Comfortable in Our Own Skins
We will always have fundamental insecurities in our lives. Each of us is a unique being who has to make sense out of life and do it on our own. We stand on the shoulders of giants, but we still have to do it on our own, as Abraham did. And that’s scary. Those who are uncomfortable with ambiguity, uncomfortable in their own skins, may believe that they need to be protected from others. To protect myself from your influence, I may want to kill you—if I can kill you, that proves how much power I have.
Each of us eventually realizes that everyone we love is going to die. We have a lot of choices when faced with this realization: We can pretend that it is not so, or we can take the energy the realization stimulates and perhaps try to make a better world. The great contribution made by such groups as the Compassionate Friends, Bereaved Families of Ontario, the Candlelighters, and Mothers Against Drunk Driving is that they have made meaning out of chaos. We need to try somehow to create a culture in which meaning might triumph over chaos.
Once one has faced death, nothing else matters in the same way. Death has the ability to teach us to accept reality in its fullness, to accept the limits of what it is. This is the work of death education, palliative care, bereavement service. We try to make people comfortable in their own skins.