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.”



#1 Annie (Guest) on Friday January 09, 2009 at 4:19pm

This is not a surprise, but those nurses are uninformed.  One of the problems with nursing education is that there are various educational routes to entry into professional practice.  About 2/3 of nurses enter at the two year associate degree level, and the majority do not further their education.

That they can’t and don’t distinguish between emotional support and spiritual support is wrong, but that conflation and sloppiness is the norm, in my experience as a clinical nurse, nursing faculty member in associate and baccalaureate degree programs and as a nursing administrator.  Moreover, if they are employees of a religious-affiliated institution, they may be inculcated into approaching emotional support as spiritual as part of the institutional-religious corporate ideology.

If you are so inclined, it might be worth a call to the chief nurse executive of the institution(s) to share what you have here in this disturbing post.

Overall, professional nursing is tipping precipitously toward catastrophic failure as a profession into an externally regulated technical occupation. The breadth, depth and lack of understanding of essential key concepts by experienced nurses is an example of how insufficient professional nursing education is and how poorly nursing autonomy over practice is being preserved.

#2 Ophelia Benson on Saturday January 10, 2009 at 9:20am

That’s depressing not just in light of what it means for patient care but also in light of what it means about the general view of atheists. Yeah right we’re people who don’t care about sunsets or music or touch or affection - in fact we’re not human and we’re not even mammals; we’re some kind of mutant fleshy robot.

As for me - I don’t mean anything by spiritual, because it’s not a word I use from the first person point of view, I use it only in contexts like this, as a third person thing - what do other people mean by it or understand it to mean. I don’t mean anything by it, and I understand it to mean a couple of things: one, what you said, ‘having to do with spirits’; two, what other people mean by it, which (as you say) is anything and everything. I think of the second ‘definition’ as highly elusive and even evasive; as often a way of patting oneself on the back for having various emotions and reactions and attitudes which are not particularly rare; as a way of palliating non-theism (you know, as in the common ‘I’m not religious but I am spiritual’); as a way of disavowing atheism, reason, science, etc, or at least of disavowing ‘excessive’ commitment to them. In short it often boils down to saying ‘I’m as woolly-minded as the next person, I promise.’

#3 Teamonger on Tuesday January 13, 2009 at 1:32pm

This is certainly an excellent question; one I’ve wrestled with more than once, especially in the context of a single guy dating women who are “spiritual but not religious”.  I have mostly decided that I can accept the word spiritual, but that “my definition may be different than yours”.

The dictionary definition “relating to or affecting the spirit” is fine as far as it goes, so the next quesition is, how to define “spirit”.  One of the definitions is “the immaterial intelligent or sentient part of a person”.  Leave out the word “immaterial” and I’m okay with this.  I like to think of spirit as a very remarkable function of the material, a natural attribute of the human organism, in the same way that an electron has charge.  Perhaps another word for “consciousness”.  So I like to say, the spiritual is (most probably) inextricably tied to the material.  I don’t see evidence that our spirits can survive death, except in the sense that influence is passed on to future generations.  Thus I have no problem saying “the spirit of Thomas Jefferson lives on”, etc.

That being said, I can see this usage leads to fuzziness in thinking, and that does bother me some.  But it does perhaps help me better communicate with nurses… rather important when dating them!

#4 Tom Flynn (Guest) on Wednesday January 14, 2009 at 12:16pm

I’d hate to interfere with Teamonger’s love life, but stretching the definition of “spirit” so as to eliminate “immaterial” risks stretching an already-too-pliable definition until it breaks. In popular usage, “spiritual” almost always connotes “immaterial.” Which is part of the problem: when humanists cross their fingers and redefine the word Teamonger’s way and then say they’re “spiritual too,” most listeners will interpret that as an admission that they’re not really naturalists, or never took their naturalism very seriously.

#5 Ophelia Benson on Wednesday January 14, 2009 at 12:28pm

Also, in popular usage ‘spiritual’ is almost always a hooray word, one that conveys the message that people who fail (or, worse, refuse) to be ‘spiritual’ are bad in all sorts of ways - cold, shallow, unaware, tuned out, hard, insensitive, impoverished, limited. If the word is also redefined to cover thoughts and emotions then there is even more social pressure for everyone to shrug and join the spiritual bandwagon. Well I don’t wanna!

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