A Spirited Misunderstanding

January 9, 2009

Whenever I hear the word “spiritual,” I reach for my revolver.

Well, not really.

But I’ve learned the hard way that when I hear “spiritual” it’s good practice to reach for the question “What precisely do you mean by that?”

Here’s a fresh example of the mischief that word can make, one that might have unfortunate implications for nonreligious hospital patients.

I occasionally participate in interfaith events in the Buffalo area, representing the secular humanist viewpoint as I share the stage or rostrum with (honest!) a priest, a minister, a rabbi, and an imam. A few days ago, the interfaith group presented a continuing education seminar for nurse managers, sharing information about the medical and pastoral-care preferences of patients from varying religious perspectives. I gave a presentation on attitudes toward healthcare among the nonreligious. I described unbelievers as a diverse group, ranging from the merely unchurched and the “spiritual but not religious” to folks who are resolutely both non-religious and non-spiritual. (Full disclosure: I stand firmly in that latter camp.)

During the question period, one of my co-presenters, a hospital chaplain, shared a story about a strict atheist patient who refused pastoral visits of any sort. One of the attendees, a senior nurse manager, then asked a question about patients who were non-spiritual. More attendees weighed in, sparking a conversation about patients real or hypothetical who refuse any spiritual interaction, just want to be left alone, and demand not to be touched in any way. At first I thought they were talking about patients who ordered chaplains out of their rooms and ordered the chaplains not to touch them. Eventually it clicked: these seasoned nurse managers were talking about patients whom the nurses believed they must not touch, or comfort, or support in any human way – out of respect for the worldviews of patients who disdain ordinary human contact because they’re not spiritual.

Say what?

Allow me to unpack the nested ironies here. First, nurses generally take justifiable pride in offering patients the warmth, support, and human comfort that physicians are, at least by stereotype, too cold, haughty, and scientific to provide. Quite a few nurses view their work as a profoundly spiritual calling, and several at this seminar said so in no uncertain terms. Taking my own advice, I asked, “What precisely do you mean by ‘spiritual’ in this context?” The nurse managers told me they considered having a quiet conversation with a patient, holding a patient’s hand, evaluating a patient or family member’s emotional state, even giving a comforting alcohol rub, as providing spiritual care. “But couldn’t we more accurately characterize that as emotional care?” I asked. “Holding the hand, the alcohol rub, don’t those bridge the emotional and the somatic?” No, came the reply: anything pertaining to the non-technological side of nursing, anything having to do with warmth and support and comfort, even favoring a patient with caring language, was in their usage inherently spiritual. “It’s very important to express my spirituality in every aspect of my nursing practice,” one participant said, and it was the human side of nursing that she meant.

Now the next irony. Today’s healthcare professionals are trained to be deeply respectful of diverse religious and lifestance perspectives. Most take great care to avoid violating these preferences, so long as they have enough accurate information about the patient’s particular tradition to do so.

Finally, the ultimate irony: since for them spirituality encompasses the entire “human” side of their practice, when these nurses learn that a patient is not spiritual they seem to assume they’re dealing with some hyper-rational “emotional basket case” who spurns anything having to do with affective resonance or human warmth … and likes it that way.

As someone who is proudly non-spiritual, I was taken aback. Let me take my own advice and ask myself precisely what I mean by “spiritual.” I understand “spiritual” in what I think is that word’s more ordinary sense: “having to do with spirits.” I don’t believe in ghosts or angels or souls, or more generally in immaterial substances or causes. I’m a philosophical naturalist, a small- m materialist if you will; I think “spiritual” refers to a class of entities that are wholly imaginary. An enthusiasm for sunsets, the ecstasy of music, the consoling warmth of holding a sick person’s hand: they’re all beautiful aspects of life, but on my view they’re not spiritual: they have nothing to do with the immaterial.

It’s just my personal suspicion, but I bet most thorough-going naturalists who identify themselves as non-religious and non-spiritual understand “spiritual” more as I do, not the way it was meant by many of the nurses at that seminar. Of course, when those naturalists are in the hospital and too sick to speak for themselves, it’s the nurses and their view of what “non-spiritual” means that will rule.

With the gift of hindsight, I see the question I wish I’d asked at the seminar. When those nurses spoke about non-spiritual patients from whom they withheld human contact out of respect for what they honestly believed to be the patients’ convictions, was that a hypothetical discussion? Or are there really humanist and atheist patients who’ve suffered alone in hospital beds, denied anything beyond efficient mechanical nursing by caregivers who genuinely think their patient is some sort of shriveled grinch who prefers things that way?

Next time I take part in one of these seminars, I’ll make sure to raise the question whether this sort of attitude toward non-spiritual people actually guides the care patients receive. Who knows, I may have discovered a brand-new form of wholly inadvertent discrimination against the nonreligious … rooted in our old friend, the endlessly pliable meaning of the word “spiritual.”