Gaby Jacobs, member of the research network Critical Ethics of Care, presents a summary of her inaugural lecture Meaning in Spiritual Care (2020) in the following article.
Meaning in life is of great interest in Western society. Influenced by Huber’s concept of positive health (2014), also healthcare professions show an increasing attention for this aspect of humanity and wellbeing. Traditionally, meaning has been the domain of spiritual care and was then connected to philosophy of life and the moral dimension of existence. Spiritual care can be defined as professional guidance, assistance and advice on giving and experiencing meaning and philosophy of life. This guidance can take various forms: individual conversations, group meetings, training work, commemorations, celebrations, reflection moments, presentation work, rituals, moral deliberation, and advising organizations and policy on issues of humanization, meaning and philosophy. In this contribution I will address the question of how the ‘care for meaning’ by the spiritual counselor differs from that of other professionals. For me, the distinguishing feature is ‘existential meaning’ as a contextual concept.
Meaning: from individualistic to contextual concept
I interpret meaning from a philosophical perspective, defining existential meaning as the ‘process in which a person relates to the world’ (Smit, 2015). This apparently simple description hides a lot. It concerns both the movement inwards towards the deeper aspirations and ultimate values, also referred to as the soul or the heart. At the same time it encompasses the outward movement of making contact with the world and taking care of this world, following Joan Tronto’s (1993) views on care. The definition shows that existential meaning refers to being a person in context; it is not a mere inner or psychological process.
Existential meaning and spirituality are often linked and are then connected in different ways. For me, spirituality focuses on the need for and experience of transcendence; it is part of meaning as the process of relating to the world. In line with Christina Puchalski’s definition (Puchalski, Vitillo, Hull & Reller, 2014), spirituality is about the experience of connection with the moment, with the self, with others, with nature or environment, with the meaningful or ultimate good. Like the philosopher Marc van den Bossche (2017), I do not look for spirituality in something higher, a vertical transcendence, but in the embodied interaction with the world as a horizontal transcendence characterized by the physically felt experience that we are in the other and part of the world around us. This view of spirituality thus puts embodiment at the heart of existential meaning.
Questions regarding the meaning of life often arise from existential experiences. These are experiences that break through the everyday way of being and acting. These can be positive experiences with, for example, art, music or friendship that contribute to self-development or ‘human flourishing’ (Alma, 2018, p. 151) or peak experiences that result in wonder and ultimate happiness (Maslow, 1970). However, the focus of spiritual care is on existential experiences that evoke a deep sense of alienation or displacement, a lack of meaning, i.e. experiences that make it difficult to be in the world. Within this category of existential experiences I distinguish four types, which naturally occur in all kinds of mixed forms.
Contrast experiences occur at times when the vulnerability of existence is experienced. It concerns the major life events that happen to us and over which we have little or no control (Alma, 2018; Anbeek & De Jong, 2013). Examples include illness, the death of a loved one, a natural disaster like the Corona outbreak, or divorce. These experiences are deeply imbued with the vulnerability of being human and the fragility of meaning.
I refer to the second category of experiences as the profound experience of uncertainty that life entails. Sociologist Anthony Giddens (1991) uses the term ‘fateful moments’ to point out that situations arise in a human life in which this uncertainty comes to consciousness. It is often experienced at the crossroads in human life, such as leaving home, starting a new relationship or getting a child. Uncertainty is a common phenomenon in Western society, because the increasing prosperity and the idea of self-development have not only increased the number of options, but also the urge to make use of them and preferably as much as possible. The increased possibilities, however, are accompanied by uncertainty, also referred to as the dilemma of modernity.
Social border situations
The third category of existential experiences is of a different nature than the previous two, because it is motivated by social circumstances that have a dehumanizing effect. Brazilian critical educator Paulo Freire (1972) argues that people exist in a dialectical relationship between freedom and borders. Border situations are situations that are characterized by objectification: the non-recognition or incomplete recognition of their humanity. These are situations in which freedom is at stake. The theme of objectification is also strongly present in this time and place. Consider, for example, the exclusion of groups of migrants or refugees from society or the bureaucratic treatment of patients within the health care system.
Finally, there are also morally charged situations that lead to tensions (moral distress) or even ‘injuries’ (moral injury) and that require ethical reflection. Moral distress and moral injury are experienced by professionals in contemporary healthcare, in education, in uniformed professions such as the armed forces and the police; and also with volunteers. These are negative experiences of stress in situations in which one cannot act according to personal and professional values and always concerns a tension between the person and context (Rushton, Caldwell & Kurtz, 2016). It often occurs in a context where political or administrative decisions are made that put “good work” at stake.
The contribution of spiritual care to meaning
In existential meaning, the relationship to the world is central. That relationship is an embodied experience, as I indicated earlier, and is expressed in images and stories. I distinguish three – connected – ways in which spiritual care contributes to meaning in life.
First, the relationship between the spiritual caregiver and the client is an embodied experience of being known and recognized to the client. The relationship is ‘meaning-ful’ as such, because people feel known, connected, cared for and safe. The experience of connection and recognition are important existential needs (Derkx, 2011; Benjamin, 2018). Relational feminist psychology (Baker Miller & Stiver, 2015; Jordan, Walker & Hartling, 2004) is an important source of inspiration in figuring out the value of the relationship for spiritual care. According to these therapists, authentic connections with others are growth-promoting and mutually empowering. Participants in such a relationship feel they matter; feel more connected; are better able to act in the relationship (and in relational connections beyond the caregiver-client relationship), which is also referred to as relational agency; and there is an increased experience of zest for life (Jordan, Walker & Hartling, 2004; p. 56).
Secondly, the dialogue between the client and the spiritual counselor provides a setting to ‘come to terms’ with life, i.e. to define and redefine the relationship to the world. Here, meaning of life is an outcome of the relationship. This is based on the view that humans are narrative creatures; we use stories and images to express experiences, make connections, give meaning and position ourselves in the world (McAdams, 1993; Bruner, 2004). Spiritual care largely involves working with stories: clients talk about their lives, their identities, their relationships and their losses. Spiritual caregivers listen, ask questions and tell stories, with the help of (literary or other) texts, poetry, art, experiences from their own life and rituals. It is a dialogical process of generating meanings and images that supports the client in relating to the world (Shotter, 2008).
Finally, spiritual care also plays an important role in creating space for meaning, for values and the dialogue about them, within organizations, communities and society at large. A growing area in this regard concerns ethics support by spiritual counselors. This can take various forms, such as moral deliberation with caregivers, reflection meetings in the armed forces or participation in multidisciplinary consultations to support shared decision-making. Spiritual caregivers are also increasingly active as change agents within the organization or neighborhood, trying to establish connections between sections and groups to promote reflection on difficult issues. This includes the promotion of organizational learning in which the ‘small stories’ of professionals and clients can have a place and can be investigated in relation to the ‘dominant stories’ of the organization and policy (Abma, 2003; Ruijters, 2018).
I have argued that spiritual care contributes to processes of giving meaning in various ways and that relationship, dialogue and connection are core concepts in this. I would therefore dare to say that spiritual care is a radically relational practice and that it shows a different way of being in the world and being in organizations. However, I must add the comment that it concerns a complex practice. The tendency to leave the relationship is always present as the fundamental relational paradox: ‘The path of connection is filled with disconnections, the vulnerability of seeking reconnection, and the tension around needing to move away, possibly to hide in protective inauthenticity.’ (Baker Miller & Stiver, 2015, p. 6) The task of research for further development of the profession of spiritual care is to gain more insight into what is going on in those relationships, in all their complexity, tensions and conflicts, and where and how this contributes to existential meaning for the people involved.
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