“Medicine appealed to me because I felt it was the most real thing you could do,” she said. As a doctor, Sweet cared for people in the most difficult — or joyous — times of their lives.
However, throughout her career in medicine, Sweet said she has seen the field erode with an increasing emphasis on efficiency and profit.
Sweet has seen a shift from a more holistic medicine rooted in care to an industry treating health care as a commodity. “It’s a commodification that I think completely leaves out the essentials,” she said.
What’s critical, Sweet said, is creating space for true person-to-person connection in medicine. “The essence of what happens between doctor and patient runs very deep,” she said. “This space, to me, feels sacred.”
When medical care has been spiritual care
“Modern medicine is secular,” said Gary Ferngren, a professor emeritus of history at Oregon State University who studies the history of medicine and religion. “Since the end of the 19th century, it has developed very rapidly, cutting itself off from any religious or spiritual value.”
For much of human history, societies have used religious frameworks to understand the meaning of illness and pain, Ferngren wrote. The disease could be attributed to causes such as a magical curse or divine punishment.
But Ferngren wrote that the historic presence of religion in the infirmary also provided patients with tools to tackle issues still relevant in the 21st century. At a time when health care and religion were more closely intertwined, a patient could receive not only medicine when seeing a doctor, but also religious consolation, comfort, and meaning.
“What happens at death’s door?” said Ferngren. “For a person lying in bed wondering what kind of future there is, that’s hugely important.”
Invite spiritual care into the consultation room
Graham defined spirituality as “our innate ability to connect – to connect to others, to our environment, to transcendent mystery, and to our deepest true selves”. Like Sweet, he said modern medicine’s emphasis on efficiency leaves out this larger view of patients’ well-being and their spiritual and religious needs during illness.
Meeting those needs is known as spiritual care, which Graham said most doctors don’t have the proper training to do.
When working with medical students today, Graham shares lists of questions that could open the door to a deeper conversation with patients. “They might ask, ‘In the past, when you went through a difficult problem, where did you find the strength to get through it?’ “, said Graham.
For some patients, the answer is religion. Some patients are happy to share their own religious practices, Graham said. Or they could mention a connection to nature. Others talk about meditation or a trusted family member they turned to for advice.
Each patient brings different beliefs to the conversation. And advocates believe that all individuals – including atheists – can benefit from access to spiritual care.
Even an atheist can face ‘spiritual distress’
Spiritual distress has been shown to be particularly high in patients with severe, chronic illness, Puchalski said, and addressing it is critical in the case of palliative care.
“People who experience high spiritual distress — which is often linked to higher depression and anxiety,” she said. “People who have high spiritual well-being also tend to have better overall health.”
However, when it comes to measuring impacts, Puchalski said clinical research on spiritual care is an area that has a lot of room for growth.
“It’s a relatively new and promising area,” she said. “When it comes to considering spiritual distress as a clinical marker, we are currently involved in building this area of research.”
Is the world facing a crisis of spiritual distress?
And over the past two years, Puchalski said, the Covid-19 pandemic has sparked renewed interest in the field of spiritual care. “All of a sudden, people were dealing with really intense existential and spiritual distress,” she said, highlighting the loneliness and grief the pandemic has brought.
Millions have lost loved ones. Healthcare providers have seen patients slipping away into intensive care units at a hospital without family members present. And people all over the world wrestled with questions about death and dying.
“People have been dealing with these questions for centuries, haven’t they?” Puchalsky said. “It’s just that during the pandemic we’ve all been affected, whether we face serious illness or not.”
“Many of us have been called upon to serve others,” she said, pointing to the wave of burnout among healthcare workers around the world. “Serving people – it impacts us.”
But the effect of Covid-19 on spiritual well-being is not just about distress and languor. Ms Puchalski said she also sees room for positive change as people around the world seek solutions to the problems the pandemic has highlighted. She said she hopes it will spur growth as the world looks to the future.
“I see people searching for meaning and purpose,” Puchalski said. “And I see a kind of desire for kindness, which is a beautiful thing.”
Jen Rose Smith is a writer from Vermont. Learn more about her work at www.jenrosesmith.com.