Care of the Soul in Medicine

A

s we move further into a new century, we can reflect on where we have come from and where we want to go. In the field of medicine, we can only stand astonished at what has been accomplished scientifically and technologically. Doctors of the past would envy what medical science has been able to achieve and is still developing. One hopes that this science will only increase in imagination and effectiveness.

But talk to almost any patient today and you hear a number of complaints that point to certain matters that have been largely overlooked. These are the human issues. Patients will tell you that their doctors don’t give them enough attention and are not warm and engaging, that hospitals are cold and impersonal places, and that doctors are not open to their concerns about nutrition, alternative therapies, and their emotional and spiritual needs. When I first published Care of the Soul I 1992, I began to receive invitations from medical schools, hospitals, and conferences to present my ideas about creating a more soulful environment in all aspects of culture. Since then I have visited many medical centers, including McGill University Medical School, Sloan-Kettering, Memorial Hermann, the University of Tennessee Medical Center, NYU Cancer Center, the Mayo Clinic and several other large and small medical groups.

Doctors, nurses, administrators, chaplains and others have told me how busy they are and how their education left no room for consideration of the human side of medical practice. Not so explicit but quite clear was an attitude among some that these “soft” matters are not as important as the hard science of medicine. My impression is that one-third to a half of the doctors are interested in what I have to say, while the rest are skeptical.

The Spirit and Soul of Medicine

There is a clear movement in many countries today toward expanding our view of medical care. Integrative medicine, alternative therapies and the spirituality of medicine are becoming common themes in hospitals and schools. I have seen firsthand how pastoral care and counseling have grown and changed in medical settings. Where once a few chaplains might have tended their own, today pastoral counselors get more professional training and make themselves available to patients without a necessary affiliation. These developments clearly come from a more general sense that spirituality is a broader and more personal matter than religious institution and set of beliefs. I have also seen how the hospice movement has affected hospitals, demonstrating the value of attention to families, counseling and spiritual sophistication.

But my work moves in a somewhat different direction. While spirituality concerns itself with meaning in life, prayer, meditation, belief and ideas about the afterlife, soul is almost identical with psyche, having to do with the deep emotions, relationships, work, home, family, memory, beauty, attachments, symbol and dream. I follow an ancient tradition, often referred to as Platonist, that considers these issues of great importance to the health and well-being of persons. In an age of “whole person” medicine, I want to speak for the deep soul. For example, while most hospitals today try to give a patient’s family consideration in such things as visiting hours and treatment discussion, they don’t go far enough, in my view, in thinking of the family as an integral part of illness and treatment. I go so far as to say that a person’s family is part of his or her identity and plays a central role in illness and healing.

I don’t have to interview patients or read research studies. I know from dealing with my own elderly mother and father how difficult it can be as a son to get information about vital matters of a person I love and who needs my help in dealing with the medical system. When my mother was in a life-and-death situation and the family was faced with extremely difficult decisions, we sought information and we told to try to find the doctor while she made her rounds at 6 a.m.

A few years ago I gave a lecture at a conference in Ireland on the problem of elderly patients who refused to leave their country homes when they needed hospitalization. We discussed the deep need of the human soul for home, an archetypal need that can be satisfied in some measure by evoking a sense of home in a hospital. Again, some hospitals are moving in that direction by installing kitchens and making patient rooms cozier. But the examples I have seen come across as half measures—sterile kitchens with no real food around and rooms with only symbolic or minor signs of a home environment.

A Healing Environment

Care of the soul is a concrete, sensuous, felt practice and not just an idea. The physical environment for healing can be of real importance in the treatment of patients. Medical centers tend to be cool places—cool in color, texture, sound, and furnishings. Everywhere I go to discuss health care, people immediately mention the bad smells in hospitals and the drab colors they see everywhere. Then we get talking about the threadbare, minimal gowns a patient has to deal with at the very outset of a hospital visit.

Professionals who are focused on the science of treatment may well overlook these issues that are important to patients. They account for anxiety and the feeling of being treated as an object on an assembly line. I heard that analogy from many patients. One doctor, who was with me as we visited an unusually imaginative and soulful hospital, commented that his hospital at home was a factory in comparison.

Thoughtful choice of colors, textures and images could not only make a medical center ore attractive, it could also contribute significantly to an atmosphere of healing. Without such an atmosphere any work done at the place has to counter the impact of the cool and sterile environment, whereas a warm, soulful context continually supports the work of healing. The symbolic aspects of the physical environment also affect treatment. As a student of religion, one of my interests is the experience of passages. I mean physical passages that affect the human imagination and feeling. Most church doors and entrances, especially those in older churches, help a person make the shift from the secular world to the spiritual realm by means of thick, ornate and often multi-level doorways. In many churches, even after you have opened a heavy, impressive door, you go through a dark antechamber or vestibule to further lead you into the atmosphere of the spirit.

A place of healing is similarly a special environment and calls for architecture that creates an effective passage from ordinary life to a focus on healing and health. The ancient Greeks used to have columns and huge statues of the god and goddess of healing and health, Asklepios and Hygieia, to impress this atmospheric change on patients. Most hospitals I visited were designed for function and not deep initiation into the mysterious dimensions of healing. In other words, they were entirely secular with little appreciation for the soul and spirit in illness and treatment.

Soulful Talk

A final consideration in this limited summary of the soulful practice of medicine is the way medical professionals communicate to patients, families and each other. It’s a topic much discussed in medical centers, and I have participated in conferences on the subject. Most approaches I have seen concentrate on techniques for delivering bad news or even scripts for talking to patients and fellow workers.

With the soul in mind, I think the Buddhist ideal is a good foundation: heal first with your presence. If you are present, if only momentarily with a patient or family, and not thinking about the many other things on your schedule, you will probably know what to say. “Mindfulness” is a key word these days. It applies to being with patients. Remember that he or she is a human being with deep and tender feelings, no matter how soft or gruff the patient may appear on the surface. In fact, a strong surface usually suggests and tender subsurface.

You don’t really need lessons on how to talk as a human being. A resident once asked me how he, not a professional counselor, could talk meaningfully to a patient. What should he say? I recommended: “How are you doing? How about that weather?” All you have to do is peek out from behind the mask of professional doctor, nurse, technician, or receptionist and be a human being for a few seconds. Any patient will tell you that the briefest genuine human exchange makes all the difference. I went to a doctor for six years, and he never once called me by my first name.

I was standing at a nurse’s station once when a call came through from a patient who wanted to talk to someone. The nurse spent ten minutes on the phone trying to find a social worker, psychiatrist, or pastoral counselor. I wondered why she didn’t go and have a word with a patient who “wanted to talk to someone.”

Care of the soul in medicine is about being a human being helping human beings in a time of need. It can be a profoundly rewarding calling if the professional doesn’t lose his or her soul in the busyness and technical thinking of the science. It can be fulfilling if the doctor or nurse connects with real people in brief but genuine encounters that contribute to the healing process.

. . .