Johanna Ryan, ND
In ancient times, care was always multidimensional because it was understood that there were different elements of a person’s well-being – body, mind and spirit. Medieval chart notes from the hospices of that era reveal notations written in the margins by the anamcara, an ancient Gaelic role, literally meaning “soul friend.” In determining “prescriptions” for the spiritual dimension of a person under a hospice’s care, the anamcara would choose from a variety of options, many of which would be classified as alternative healing modalities of our modern day. There was a genuine interest in and a respect for helping a person explore the many dimensions of personhood.
In the modern end-of-life care movement, treating the whole person by addressing spiritual-existential issues in addition to one’s physical and emotional needs is well-accepted and practiced. In fact, there is a plethora of literature not only substantiating its benefits, but also evidence-based methods for putting whole-person care into practice at the end of someone’s life. The literature and practices continue to evolve, as there is a genuine interest in easing pain and suffering that an individual may experience.
Whole-Person Care in Everyday Practice
It is perplexing, though, why whole-person care does not translate to the everyday-care that patients receive. We have all had those patients who book appointments for a particular physical ailment, only to discover that something “non-physical” is at the heart of their concern. Modern life is full of difficulties, disappointments, and losses, which can be overwhelming to even the most resilient of us.
Why does this element of care often get ignored? It is a complex issue and there are various factors influencing how medicine is practiced – the insurance industry, practitioner comfort with such topics, patient expectations, how much time is allotted for each visit, etc. There is also confusion about the definition of spirituality, which often gets confused with religiosity. To me, “spirituality is that aspect of humanity that refers to the way that individuals seek and express meaning and purpose, and experience their connectedness to the moment, to self, to others, to nature, to the significant, or sacred.”1
Opportunities As Naturopathic Physicians
As practitioners in the field of naturopathic medicine, with what frequency and consistency are we addressing spiritual-existential issues with patients? Our profession has the benefit of being guided by:
- Naturopathic principles, such as the vis medicatrix naturae, tolle causam, tolle totum2
- The Therapeutic Order2
- The determinants of health2
- Characterizing illness and healing as a process2
As we work through the process of remedying disturbance, there is the possibility to reflect on the concept of spiritual integrity2 with patients. Inquiring about how patients experience peace and joy, and exploring patients’ “core beliefs and values”1 allows us the potential for tackling disturbances standing in the way of healing. In the midst of illness, patients may experience profound existential crises as they seek to make sense of their current circumstances. Navigating the realm of spiritual integrity with patients can bring a greater sense of well-being, improve quality of life, and provide meaningful support.1
Responsibility & Benefits
Standing in this sacred space with patients is about 1 individual witnessing the experience of another – a real soul-to-soul connection. Exploring this realm with others is really about facilitating patients’ self-discovery and helping people “feel” what has been suppressed. The ease of these conversations depends on such factors as the quality of the practitioner’s presence, an ability to listen deeply, and having no preconceived agenda. Opening ourselves up like this does require self-exploration and self-reflection. The possibility exists that patient interactions can trigger uncomfortable emotional responses in the practitioner. It makes it easier to stand in these spaces with patients when we have examined similar issues in our own lives.
Technical medical expertise will always be critical to effective patient care, but the additional exploration of the spiritual aspects of our lives holds the promise for much far more complete healing.
Johanna Ryan, ND, is a naturopathic physician who trained academically and clinically at Bastyr University in the tenets of naturopathic medicine and mind-body medicine and had a private practice in Seattle, WA. Her training and experience in end-of-life care has helped to shape her approach to patient care. She holds a locum position at Stillwater Healing Arts in Lyons, CO. Current projects include designing training programs for centers providing care to seniors that help patients find meaning and purpose in the midst of illness and aging.
References
- Puchalski, CM. Ethical Concerns and Boundaries in Spirituality and Health. AMA J Ethics. 2009;11(10):804-815.
- Zeff JL, Snider P, Myers SP, DeGrandpre Z. A Hierarchy of Healing: The Therapeutic Order. A Unifying Theory of Naturopathic Medicine. In: Murray MT, Pizzorno JE, eds. The Textbook of Natural Medicine. St. Louis, MO: Churchill Livingstone; 2013.
