Positive Spirituality in Health Care

Positive Spirituality in Health Care

Nine Practical Approaches to Pursuing

Wholeness for Clinicians, Patients, and

Health Care Organizations

Positive Spirituality in Health Care

Nine Practical Approaches to Pursuing

Wholeness for Clinicians, Patients, and

Health Care Organizations

Frederic C. Craigie, Jr., PhD

Maine-Dartmouth Family Medicine Residency, Dartmouth Medical School,

and Arizona Center for Integrative Medicine,

University of Arizona College of Medicine

M i l l C i t y P r e s s

M i n n e a p o l i s , M N

Copyright © 2010 by Frederic C. Craigie, Jr., PhD.

Mill City Press, Inc. 212 3rd Avenue North, Suite 290 Minneapolis, MN 55401 612.455.2294 www.millcitypublishing.com

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author.

ISBN – 978-1-936107-48-3 ISBN – 1-936107-48-1

Cover Design by Wes Moore Typeset by James Arneson

Cover art © 2008 Caren Loebel-Fried www.carenloebelfried.com

Printed in the United States of America

To Heather, Matthew, and Tom Craigie. The spirit and commitments of your lives inspire me

and make the world a better place.

Index of Strategies……………………………………………….. xi

Acknowledgments………………………………………………. xiii

Foreword………………………………………………………….. xvii

Introduction…………………………………………………………. 1

The Context

1. Perspectives on Spirituality……………………………… 17

• Defining spirituality • So what, then, is spirituality? • Dimensions of spirituality • Suffering

2. Why Spirituality Matters………………………………… 53

• Spirituality is intimately related to health, wholeness, and well-being

• Spirituality mediates choices in health behaviors • Spirituality often frames the ways that people

cope with adversity and pursue the journey toward wellness/wholeness

• Spirituality is important because people want to be known in this way by their caregivers

Contents

3. Who Provides Spiritual Care?…………………………. 85 • Patient and clinician perspectives on spiritual care • Contributions to spiritual care by providers

of health and wellness care

4. Three Arenas of Spiritual Care……………………….. 97 • The personal arena • The clinical arena • The organizational arena • Three interlocking pieces

Nine Practical Approaches to Bringing Positive Spirituality into Health

and Wellness Care

Personal: Connections with What Matters to You

5. Stay connected with your purpose………………….. 123 • Spiritual aliveness • Aliveness and purpose • Staying connected with purpose

6. The moments of your life: Cultivate qualities of character…………………………………………………..145 • Positive Psychology • Discovering qualities of character • Working with qualities of character

7. Ground yourself in healing intention and presence….. 163 • Intention and presence • Cultivating intention and presence

Clinical: Connections with What Matters to Your Patients

8. Pick one or two areas to inquire about people’s spirituality……………………………………….. 189

• Two types of spiritual inquiry • Practical clinical approaches to spiritual inquiry • When in the course of human events

9. Partner with patients in pursuing what they care about……………………………………………………. 217

• A template for collaborative spiritual care conversations • Goals: What matters to you and where do you want to go? • Approaches: How are you going to get there? • Next steps

10. Be attuned to recurring themes of transcendence and valued directions……………………………………. .263

• Transcendence and valued directions • Spiritual care toward transcendence and valued directions • Approaches to transcendence • Encouraging patients in valued directions

Organizational: Connecting with the Shared Energy of People Working Together

11. Honor organizational mission and values………… 313

• Mission and values • Developing an understanding of mission and values • Mission and values as part of organizational life • Organizational specialists

12. Cultivate community………………………………………331 • Community in health care organizations • Positive qualities of community in health care

organizations • Cultivating community

13. Exercise empowering leadership……………………… 347

• Leadership and spiritual care • Windows on health care leadership: Voices of clinicians • Qualities of spirited health care leadership • Becoming a leader

Afterword………………………………………………………… 370

Appendix I: A Dozen of Fred’s Favorite Spirituality and Health Websites………………………… 372

Appendix II: A Fiddler’s Dozen of Fred’s Favorite Books on Spirituality and Health Care………………… 376

About the Author……………………………………………… 381

Index……………………………………………………………….. 383

Index of Strategies

1: Find your personal statements 136 2: Write your own origin story 137 3: Create a statement of personal mission 141 4: Describe your own approach to present awareness 143 5: Identify your own signature strengths of character 156 6: Nurture your own character 161 7: Be well 177 8: Pursue a practice of re-focusing and renewal during the day 179 9: Create a personal affirmation 181 10: Use conversational templates for spiritual inquiry 198 11: Identify conversation-openers 206 12: Adapt spiritual inquiry to the circumstances where

you see people 214 13: Get patients talking about what they care about 237 14: Elicit patients’ wisdom and competence 250 15: Express your own wisdom in some new ways 255 16: Collaborate with patients in defining next steps 259 17: Experiment with one or two approaches to transcendence 301 18: Invite patients to define key role values 305 19: Talk about the mission 323 20: Keep talking and develop a wider view of mission

and values 327 21: Define positive qualities of workplace community 340 22: Choose some next steps in building goodness in your

workplace community, and bring a colleague into the conversation 345

23: Be guided by your own evolving definition of leadership for spiritual care 363

24: Pick one or two points of growth for yourself as a leader with soul 367

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Acknowledgments

Anyone who looks back along a journey that has been worth taking can see a remarkable collection of fellow travelers who have offered encouragement and support. This is certainly the case with me.

My closest associates in the work of spirituality and health care in the last several years have been my faculty colleagues at the Arizona Center for Integrative Medicine; Howard Silverman, MD MS, David Rychener, PhD, Victoria Maizes, MD, Tieraona Low Dog, MD, Patricia Lebensohn, MD, Moira Andre and Andrew Weil, MD. Thank you all for your friendship, for the affirmation that spirituality is really central on the path toward healing and wholeness, and for your enlightened conversation about how we invite spirit into the work that we do. I am also particularly grateful to Dr. Maizes for her kind and generous Foreword.

My ideas about spirituality and health care have been greatly en- riched over the years by the stories and dialogue from the fellows in Integrative Medicine at the Arizona Center for Integrative Medicine. Among many hundreds of such exchanges, I have included material (with generous permission) from Barbara L. Bakus, DO, Angela Lynn Barnett, MD, Katherine Bayliss, MD, Suzanne Bertollo, MD, MPH, Trevor M. Braden, MD, Christine Bugas, DO, Rosemarie Butterfield, MD, Gary Conrad, MD, Kathalina A. Corpus, MD, Deborah A. Dunn, MD, MPH, Susana Escobar, MD, Paula Renee Fayerman, MD, FCFP, Vani Gandhi, MD, Janet Lewis, MD, Jill Mallory, MD, Mark D. Moon MD, David Moss, MD, Amy Pabst, MD, Robert A. Pendergrast, Jr., MD, MPH, Mary Ellen Sabourin, MD, Christina Louise Stroup, MD, MS, and Joseph Zirneskie, MD.

Among my local colleagues and friends, I am ever grateful to three people in whom I always find wisdom and inspiration in the conversation about spirituality and health; Diane S. Campbell, MD, Elizabeth B. Hart, MD, and Richard F. Hobbs, III, MD, FAAFP, DABMA.

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My 1996 sabbatical colleagues at the Seton Cove in Austin, Texas, helped with the formation of my ideas about organizational soul and have remained dear to me over the years: Sr. Mary Rose McPhee, DC, Jan and Ed Berger, Leslie Hay, and Travis Froelich.

The leadership and staff of the community health centers in my exemplary practice research will remain anonymous because of the protocols of doing this kind of research. You are still out there, though, providing great health care to Maine people and caring about one another, and you have my sincere respect.

For miscellaneous permissions and words of feedback and support; Amy Madden, MD, Priscilla Abercrombie, RN, NP, PhD, Larry A. Willms, MD CCFP, Harold G. Koenig, MD, MHSc, Sara Roberts, PA-C, Margaret J. Wheatley, EdD, Christina Puchalski, MD, MS (and the George Washington Institute for Spirituality and Health), Everett L. Worthington, Jr., PhD, Robert D. Enright, PhD, Lynn Underwood, PhD, Gowri Anandarajah, MD, Lee G. Bolman, PhD, Kay Gornick (Prairie Home Productions), Renee Anthuis, AAFP, and Douglas Harper (the Online Etymology Dictionary).

Thanks to my community of writers for their feedback and support. Led by the irrepressible Bill O’Hanlon, MS, they also include Mary Beth Averill, LICSW, Ph.D, Sandy Beadle, Adele V. Bradley, MA, LCMHC, Niel Cameron, Hope W. Hawkins, Ryan Nagy, Lisa Robertson, and Robin Temple.

The late David B. Larson, MD was a generous collaborator on early meta-analytic research on spirituality and health, and helped to form my professional direction and passion in this area. The late Thomas Nevola, MD set in motion some conversations in Central Maine that have evolved into a vital Department of Pastoral Care at the Augusta campus of MaineGeneral Medical Center, and a 23-year annual symposium that bears his name.

The cover image, Tree of Life, was graciously provided by the artist, Caren Loebel-Fried. The bird nestled in the tree is a phoenix, the mythical firebird that symbolizes renewal in the traditions of many world cultures. Readers can see more of Caren’s stunning work at http://www.carenloebelfried.com/. Hearty thanks to the broadly-

Acknowlegments

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talented Matthew Craigie for the portrait on the back cover. Thanks also to Mark Levine and the staff at Mill City Press. A

pleasure to work with. My wife, Beth, remained patient and cheerful over the winter of

2008-2009 with her husband impersonating a piece of furniture, planted ten feet away from the pellet stove, staring at the laptop. She is also among the wisest, most spiritually grounded, and up- lifting people I have ever been blessed to know.

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Foreword

Physicians and other health care providers are invited into the most intimate moments of people’s lives. Birth, death, sexuality, and loss of bodily and mental functions are revealed in the therapeutic union created between patient and clinician. Within this context, but often missed or ignored, are spiritual questions. Buried just below the surface of most clinical encounters lie questions related to meaning, to faith, and to larger existential matters. “Why did this happen to me?” “I have been a devout Christian (Jew, Muslim, etc.); why would God give me cancer?” “My father was a good man; how could he now be stricken with Alzheimer’s, with his dignity lost and all that he valued gone?”

Doctors and nurses have often sidestepped these questions as not part of our domain as health care providers. Indeed, many of these questions are not answerable. Rainer Rilke in his timeless book Letters to a Young Poet suggests that we learn to “love the questions themselves.” While this may be good advice for the questioner, how does it relate to the health professional? By bearing witness, by acknowledging the unspoken questions, we provide an oppor- tunity to our patients for growth. Challenges of all kinds hone our development as human beings. They can serve as tests that provoke us to express our finest selves.

Parallel to our human potential for physical prowess and in- tellectual capacity, we have a wellspring of spiritual strength from which to draw. This may be of profound importance not only in times of crisis; it may be the waters that sustain us through our ordinary day to day existence as well. Whether wrestling with pain from osteoarthritis, an addiction to alcohol or drugs, a depression, or even boredom, spiritual resources can help us surface from the depths. Indeed, spiritual answers may serve as our most powerful approach to overcome life’s obstacles, offering us direction, hope, meaning, and renewal.

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Expressions of profound gratitude may also be of a spiritual nature. “I am so deeply grateful for this healthy baby” is not only a common sentiment among new parents; it is often experienced as a spiritual event. The middle-aged woman challenged by years of diabetes may feel similarly blessed to “see my daughter graduate from college.”

Health professionals can certainly refer to others with more training, expertise and even comfort. But they must recognize the subtle hints that are often the only expression of the agonizing questions being asked. Medical educators have suggested sets of questions that can be taught to students and residents so that they take a good spiritual history. While these questions serve to enhance comfort and are a good starting point, they may imply that one can either include or exclude a spiritual history the way one decides on the need for a sexual history or a mental status exam depending on the presenting problem. Like Dr. Craigie, I believe the more ap- propriate model is an embodiment model of spirituality. Framed this way, we acknowledge the presence of the spiritual domain in whatever is going on.

In this wonderfully researched and written book, Dr. Fred Craigie leads by example, weaving together compelling stories that reveal to us how spirituality impacts health. He reviews decades of research and makes a compelling case for health care providers to delve into this part of their patients’ lives. He reminds us, with vivid cases, how these conversations enrich our lives as well as those of our patients. He reminds us that our patients want us to be present, to listen generously and with compassion, and to provide realistic hope. While we may all recognize these attributes of good medicine, he points out that when these elements are present, our patients feel spiritually cared for.

Dr. Craigie then proceeds to teach us nine approaches to bringing spirituality into healthcare. He frames his approaches in three domains: personal, clinical, and organizational. The personal reveals how we can stay connected with a higher purpose, how we

Foreword

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can cultivate our own character, and ways to ground ourselves in the context of a healing intention. The clinical covers practical approaches to working with patients. This includes history taking and partnering with patients as they discover and pursue what is meaningful to them. It also includes learning to recognize and support transcendence in others. Finally, Dr. Craigie challenges us to include the organizational level by honoring mission and values, by cultivating a workplace community that attends to the spiritual domains, and by exercising empowering leadership.

I have worked with Dr. Craigie for a decade now. He has taught spirituality and medicine in the Fellowship Program at the Arizona Center for Integrative Medicine since its inception in 2000. He is beloved by the more than 500 fellows who studied with him and found his teaching of supreme value. I am confident that you will have a similar experience.

Ultimately, Dr. Craigie enriches us with his years of experience teaching spirituality to health providers. He gives us a frame to use and language we need to help us be more comfortable and focused in providing spiritual care. He reminds us of the value of simply sitting with another human being and witnessing their journey. And in the end, it is our patients who benefit by feeling seen and acknowledged for who they are and for what is important to them.

Victoria Maizes, MD Executive Director, Arizona Center for Integrative Medicine Associate Professor of Medicine, Family Medicine, and Public Health University of Arizona