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  Reflections and Reactions from Readers of the Medical Humanities Report

Spirituality as Exclusion

I am trying to understand why I am hesitant about embracing spirituality in medicine. I do not see myself being very spiritual (and I admit here that I conflate being spiritual with being religious). I grew up as the only non-Catholic in my school, and being gay and remaining sane at a Catholic high school is, well, difficult. For me, spirituality still holds a lot of pain since I associate it with the Roman Catholic Church, its doctrines, and the entire system to which I didn't belong.

I'm also at the age where many of my friends are getting married, and most of these have been in religious (either Catholic or Jewish) ceremonies. I've caught myself wondering if my partner and I are missing something important by not doing something similar? There is something enticing about these expressions of spirituality: the architectural beauty of a church, the formality of the ceremony, the moral teachings of the Bible and Torah. Why wouldn't I want to take part in this?

On reflection, it's not the sense of spirituality that I am envious of, it's the sense of community. This community is also what I am drawn to in Clayton Thomason's suggestions to "Create a safe place," "Accept your naivete," and "Remain flexible" (MHR, Spring 2000). These are all phrases that have been part of my political life in developing lesbian/gay/bi/trans political issues. I want to develop a community where these ideas are at the forefront. They should be universal guidelines that need not have anything to do with spiritual matters in medicine. Yet framing these concepts under a religious heading brings back all my old worries of being the only gay kid, the only non-Catholic kid in the group. Spirituality was not used to make me feel included, but instead worked to keep me feeling isolated.

Barry DeCoster, M.A.
Department of Philosophy

Spirituality as Coercion

All this talk about spirituality in medicine is beginning to make me irritable, especially when accompanied by the usual denial of its religious intent. Oh sure, this has nothing to do with religion. Forget it. Most of the spirituality talk fosters a religious agenda, disguised though it may be. Spiritual means now, and has always meant, things religious. And in the culture we live in, the meaning of spiritual is usually Christian.

The new speak is that physicians should take care of their patients physical, emotional and spiritual needs. Ask someone who says this what is meant by the spiritual part of the mantra and see how often the response has to do with religion. If it does not, then odds are that you will be hearing some vague talk about meeting the patient's transcendental needs, although it may be phrased in a large variety of muddled jargon.

Physicians are struggling to meet patients' physical and emotional needs, which can be rather clearly defined and we are worrying about meeting their spiritual needs? Wandering into patients' spiritual lives as part of treatment is an open invitation to the subtle, and from what numerous patients tell me, not so subtle imposition of the physician's values. After years of complaints about physicians playing God, now some of them would like to play clergy. Fine, if they want to, but it should be out of their offices and away from the bedside.

I am also irked by what I perceive to be advocating a religious view of humankind that disguises itself as embracing everyone but is really a majority viewpoint. No problem here if such talk takes place in a religious institution. In the patient-care or classroom setting the usual expression of religion is an imposition. In a secular democracy, it diminishes the validity of the beliefs - or lack of beliefs - of many members of the society and does so in a way that makes people reluctant to speak out. Why? Because they are usually in the minority and do not want to court ostracism. These are some of the problems with the expression of religion (spirituality) in public places that its advocates do not seem to fathom or to which they are insensitive.

From all of the above, the reader might assume that as a physician I do not discuss religious matters with my patients and I am unconcerned about their meaningful connections to others or their beliefs. Nothing could be further from the truth. I always ask my patients who lack social supports, struggle with isolation, and have substance abuse problems, for example, if they have or have had meaningful religious ties in their lives. I encourage these people to consider renewing such ties, if it is something they are at all inclined to do. This is not being spiritual. It is applying sound principles of medical care and an understanding of human needs and the importance of social connectedness to good health. Oh yes, I also ask my patients about other things they have done that have lent meaning to their lives and encourage renewal of those things. I could not care less whether it is religion, running or singing that provides meaning and I doubt that it really makes any difference what it is, except to the patient.

Spirituality may be politically correct talk in some circles but it is time that people were more critical about what it means.

Arnold Werner, MD
Department of Psychiatry

Pain as an Enemy

In veterinary school in the early 1970's, some of our surgery professors maintained that pain is our friend when dealing with surgical patients. The reasoning was that an animal in pain would be less likely to move about after surgery, thereby sparing damage to the surgical site or to any bandage or cast material that might be applied. Use of analgesic drugs was discouraged.

In fact, veterinary technicians providing care and observation for post-surgical animal patients have the opposite experience with analgesics in animal patients. When pain-relieving agents are given, the animal rests quietly through the first night after surgery and is likely to have a good appetite the next morning. The animal denied pain relief after surgery tends to be restless throughout the night, frequently changing positions and sometimes vocalizing. This post-operative restlessness creates the potential for adverse consequences after surgery.

A physician recently commented that treatment of pain in human beings "is not always good, especially if one does not know the cause of the pain." Physicians should err on the side of the angels with regard to pain relief. Patients can accept that diagnosis may be a difficult and lengthy process, but they definitely want relief from pain and suffering in the meantime. Pain relief will not change hematological values, serum chemistry, microbiological cultures, the results of diagnostic imaging, and the myriad of diagnostic tests available. In fact, pain has serious and detrimental physiological effects on patients. Untreated pain can interfere with anesthesia, wound healing, and bodily functions such as eating, drinking, and resting.

For the patient and the physician, pain is a billboard announcing a problem, but it is always an enemy. The physician should escort that enemy out of the patient's room as soon as possible.

Sally Walshaw, M.A., V.M.D.
University Laboratory Animal Resources