Spirituality in the Biomedical World

Moving between Order and "Subversion"

Guy Jobin

• Publisher: De Gruyter
• Year: 2020
• Print ISBN: 9783110525267
• eBook ISBN: 9783110639209
• Edition: 1
• Topic: Theology & Religion
• Subtopic: Psychiatry & Mental Health

The need to take the spiritual experience during illness into account is part of a broader trend in Western societies—a fascination with the practical uses of spirituality and its contribution to individual wellbeing, whether through a religious or a humanist tradition. This understanding of spirituality differs from traditional views embedded in religious traditions. This book takes a critical point of view at the biomedical representation of the function of spirituality in care. Medicine reorders notions such as life, death, health, sickness, and spirituality. This process is called here "sapientialization", i.e. the spiritual experience is expressed and understood under the auspices of and in terms of wisdom. This view tends to identify spirituality and ethics. I propose an alternate understanding of spirituality, grounded on its subversive power. Inspired by the work of the theologian John D. Caputo, it is critical of some problems that are associated with the sapientialization of spirituality in biomedicine, such as the medicalization of spiritual experiences or the instrumentalization of spirituality. It provides an understanding of spirituality that honours both the medical interest in it and its capacity to resist to instrumentalization.

1 Introduction

Why talk about spirituality in connection with the world of healthcare? The question will seem pointless to some, and self-evident to others. First, of course, it will seem pointless to anyone inside or outside healthcare who looks at only the technical and scientific aspects. Why include spirituality, a fuzzy, hard-to-define and unquantifiable notion, as a focus of healthcare? From this point of view, spirituality has no connection with biomedical science and the care options it provides. Second, the same question will seem self-evident to anyone who considers healthcare to be a holistic action which, like illness itself, affects the whole person and not just the body. For this group, it is obvious that healthcare must take into account, and even put to use, the sick person’s spiritual experience.

Both attitudes can be experienced in the healthcare world, at least in Western countries. The degree to which one takes precedence over the other varies, from one care sector and one institution to another. However, in institutions open to the spiritual experience, spirituality is increasingly considered as something that must be taken into account by caregivers, obviously within the boundaries of their own professional discipline. And, going beyond the level of personal initiatives, the need for healthcare teams as a whole to pay attention to what patients experience at the spiritual level has been increasingly recognized in recent years.¹

The need to take the spiritual experience during illness into account is part of a broader trend in Western societies—a fascination with the practical uses of spirituality and its contribution to individual wellbeing, whether through a religious or a humanist tradition. As portrayed in the mass media and specialized literature aimed at the general public,² the contemporary interest in spirituality appears to have replaced religion as the main vector for meaning in Western societies that have “departed from religion”, to paraphrase philosopher Marcel Gauchet.³ From these clues, it is possible to deduce that the spiritual question is increasingly a component in the institutional structures and cultural representations of Western societies. I will use the term “spiritual question” in this book to refer to all aspects of the attention paid, in the healthcare world, to the spiritual experience during illness. Included as components of the “spiritual question” are: the intellectual exercise of defining spirituality and theorizing its connection with existing religious traditions; the problems caused by the drive to institutionalize consideration for the spiritual experience during a period of illness, and the attempts made by organizations to solve those problems; the development of knowledge and clinical tools to take the spiritual experience into account during a period of illness; the drafting of legislative and regulatory instruments to provide a framework for spiritual and religious support in care settings; and so on. Like social issues in the 19^th century, and sexual issues in the 20^th and 21^st centuries, the spiritual question has emerged in the wake of a social and cultural movement. Last, it is important to note that the spiritual question is not confined to the world of healthcare; it also affects the business management⁴ and education⁵ sectors.

1.1 Link to contemporary culture

The world of healthcare is closely entwined with contemporary culture, and therefore also affected by the general fascination with the spiritual question, but for its own reasons. First, the link between contemporary culture and healthcare is created by the preponderant role played by healthcare institutions in the emergence of what has been called the therapy society,⁶ or, at the very least, the culture of support, of which therapeutic support is a major component.⁷ This is the culture in which a person who feels vulnerable in his or her personal, professional or social life can rely on the expertise of an individual or institution for assistance in coping with a physical, mental or, once again, social problem. The role of the therapist is to provide support for vulnerability. This idea can be extended theoretically to suggest that in a therapy society, therapy can be seen as a “total social fact”, to borrow an expression from French sociologist Marcel Mauss,⁸ in other words as something that fundamentally structures relationships between individuals and between individuals and institutions. In a society that is seen as being aggressive towards individuals by placing too many requirements on them—to the point where A. Ehrenberg has written about the “fatigue of being oneself”⁹ and the “unease-inducing society”¹⁰— healing, or at least support along the path towards some form of healing, becomes an objective and a process of self-reappropriation.

1.2 A health-based logic

However, the idea that we live in a therapy-based culture is not the only reason for addressing the spiritual question in healthcare institutions, since the conditions in which care is provided also provide an incentive to address the issue. Without giving an exhaustive list, the conditions include those given below, which will be investigated at more length in later sections of the book. They are expressed in the form of paradoxes.

First, the very nature of healthcare institutions plays a role. Spirituality is a welcome addition to a highly technical and highly bureaucratic world that is, nevertheless, dedicated to the healing of flesh-and-bones individuals. The contrast, and even the antinomy, between caring for a suffering body, unique in every case, and the cold technical environment in which care is provided, is one of the anchor points for the spiritual question in healthcare institutions. Whatever the institution has lost in “humanity” will, according to this approach, be compensated for and even reinstated by an ongoing focus on a patient’s spiritual experience, and by the attention paid by the institution to the spiritual experience of its caregivers. After all, the spiritual dimension can be one of the many inputs in the choice of a profession and in professional identity.¹¹

Secondly, the biomedical world relies on evidence-based medicine and a scientific approach. Science, like other modern-day disciplines, has made its own contribution to the disenchantment of the world,¹² in other words the loss of credibility of religious or magical explanations of the physical and human world.¹³ On the other hand, the biomedical world has, in several care sectors and thanks to palliative care, discovered or rediscovered the holistic reality of each sick person. There is now recognition for the fact that the effects of illness have impacts on the person’s body, mind and social and family relationships.¹⁴ These dimensions of human life have become part of the focus of care; in other words, they receive professional attention from caregivers.

Third, healthcare institutions in many Western societies were originally founded by religious or philanthropic groups. In both cases, the value systems of the founding group left a mark on the institutional culture and the focus of care. At the same time, these value systems determined the nature of the medical approaches that could be practised. It is possible to state that the monotheist traditions (Judaism, Christianity, Islam) continued to support institutional caregiving in the West and in some societies, including Québec, until the mid-20^th century. In addition to this support, it is important to note that in the institutions founded by religious groups, the relevant religious rites for times of illness or imminent death were provided alongside medical care.

In the 20^th century, the situation began to change, leading to a shift in the relationship between religion and healthcare institutions. The secularization of Western culture was often reflected in organizational structures by the laicization of the governance and day-to-day operations of the institutions making up “the basic structure of society—the main political and social institutions and the way they fit together as one scheme of cooperation.”¹⁵ Healthcare institutions form part of this basic structure, even more so when the societies they serve are imbued with a therapy culture.

The two influences outlined above, one from the prevailing culture and one from the world of healthcare, combine and make it possible to include the spiritual question in the actual organization of Western healthcare institutions. The institutions pledge to include in their organizational structure a focus on the impacts of illness and medical care on the patient’s spiritual experience; a focus, of one kind or another, on the patient’s “spiritual resources” in the care plan;¹⁶ and recognition of the patient’s, and the patient’s family’s, need to experience illness in a way that goes beyond a strictly physiological or psychological approach. Quebec offers a clear example of this institutional openness, since one of the fundamental pieces of legislation that deals with the organization and delivery of care in healthcare institutions requires them to take their patients’ spiritual needs into account.¹⁷

1.3 Spirituality, public use of reason, secularization

It may appear surprising that institutions are responsible for this interest in spirituality, especially in a culture in which spiritual matters are generally seen as a strictly individual concern. In fact, sociologically speaking the difference between a religious culture and a “spiritual” culture is what Heelas and Woodhead have called the subjective turn.¹⁸ This cultural shift is, in their view, “a turn away from life lived in terms of external or ‘objective’ roles, duties and obligations, and a turn towards life lived by reference to one’s own subjective experience.”¹⁹ One’s own “self” is no longer seen as the place where an ideal life defined by tradition and imposed from the outside is updated, but rather as the very source of the ideal life. This description follows on from the sociological tradition inaugurated by Thomas Luckmann, for whom the individualization of belief was the marker for the transformation from religious life to modernity.²⁰ The fact that religion has been made invisible in the modern lifestyle coincides with its relegation to the private sphere, outside the bounds of the public sphere. The healthcare world’s interest in spirituality calls this interpretation into question, since it shows that spirituality, instead of being relegated to the private sphere, has now acquired a public dimension—and, in addition, in laicized institutions.

1.4 Place in institutions

The “arrival” of the spiritual question in the healthcare world has been welcomed by a large majority of stakeholders and observers of healthcare trends. This enthusiasm extends to the fields of both clinical care and research. As we will see in later chapters, various reasons are given for the support shown by caregivers for the inclusion of spirituality in the range of care provided. However, the main reason is clearly the fact that they perceive and interpret it as having beneficial effects for both sides of the care relationship (patient/caregiver), for the care relationship itself, and for the institution. Enthusiasm in the research field is reflected in the growing number of studies and publications that analyze and determine the conditions, mechanisms and effects of integrating spirituality into healthcare. A close reading of the biomedical literature on the spiritual question quickly reveals a major focus—to extend and integrate the inclusion of spirituality in order to improve the care provided. However, it is important to note the small number of critical studies in this research area. With few exceptions, the research that has been published is always in some way favourable to even more integration. This will be covered in more detail later. It may be that this situation is typical of an emerging field of research and reflects the fact that the institutionalization of the spiritual question is still at a crucial phase where the most effort is directed at gaining recognition for the field in an institutional sector still offering some resistance, as I mentioned above. Research therefore tends to emphasize the relevance of integrating spirituality for institutions, and also demonstrate the clinical advantages it brings.

1.5 Questions

Despite the clear strong fascination with the inclusion of spirituality in healthcare, the approach is still questioned. The questions can be sociological, anthropological, political, epistemological or theological in nature, and it is worth citing some of them here, in the same order. What does the inclusion of spirituality say about the Western relationship with religion and the question of meaning? What...

Table of contents

• Title Page
• Copyright
• Contents
• List of Tables
• 1 Introduction
• Part I. Order, or the sapientialization of the spiritual experience
• Part II. The “subversive” nature of spirituality in healthcare
• Credits
• Bibliography
• Index nominum
• Index rerum