Lift Up Your Hearts: Humour and Despair in Later Life

SUMMARY

According to Erikson, the homework of later life is integrity versus despair. The work of integrity is difficult, especially when faced with loss and grief, with the pain, suffering and anxiety that often accompany later life. However, it is also the case that humour accompanies the ageing process, and that elderly people laugh at all things associated with ageing right through to death. This paper explores the relationship between humour and despair in the task of integrity. It does so from the work of Kierkegaard, who argued that despair is a sign that we are spiritual beings. Humour comes from our responses to despair–either as giving in too easily and not attempting integrity at all, or as a willful defiance and denial of this task. Ageing humour is used to illustrate Kierkegaard's argument. Humour is then shown to function in various ways. It raises our sights when we too easily retreat into our perishing bodies. It earths us when we attempt to get too spiritual, and it gives us a glimpse of the larger framework of God's future out of which we are invited to live, and to “lift up our hearts.”     

Beyond the Biomedical Paradigm: Generating a Spiritual Vision of Ageing

SUMMARY

The time has come to enlarge our understanding of what an ageing older person truly is. What is called for is an approach to ageing and its multiple processes that moves beyond an empirical research model, which is limited to a positivistic focus on the bio-medical and social conditions of ageing. The spiritual dimension of the individual as well as the physical and social need to be acknowledged and valued in any definition of human existence. A segmental approach to the ageing process can only result on a reductionistic, one-dimensional caricature of the older person. There is an imperative need for the inclusion of the spiritual dimension in the study of ageing and its meaning. By issuing a call for a new wholistic paradigm that moves beyond the bio-medical model, and understanding the personhood is affirmed which includes a person's capacity to find meaning in life, indeed, even in ageing, suffering and dying.     

Spiritual Care: Recognizing Spiritual Needs of Older Adults

SUMMARY

This paper explores aspects of spiritual needs and assessment, while emphasizing the importance of aged care providers being spiritually self-aware. The context of this exploration is meaning in life, spirituality and quality of life as experienced by older adults. Depression and dementia are frequently seen among older adults in residential aged care with resultant lowered quality of life. Pastoral and spiritual care may be used effectively to help alleviate depression and support older people who have dementia. However, to be able to provide appropriate spiritual care, spiritual needs should be assessed. Ways of assessing spiritual needs are suggested.     

Ageing Health Care and the Spiritual Imperative: A View from Scotland

SUMMARY

This paper, given as a keynote presentation at the third international conference on Ageing and Spirituality 2004 in Adelaide, Australia, offers a perspective on ageing that makes central and fundamental the spiritual journey. Ageing is not confined to the old. We are all ageing all the time and whilst the imperative of ego integration (Erikson, 1986, 1982) is more pressing in old age, the march of time makes no exceptions. The paper starts with a consideration of the Scottish context and the current interest in Scotland in spirituality and health. Borrowing from the human developmental ideas of Frankl, Jung, Erikson, and Klein, the paper takes the view that we are all spiritual beings, and we are all trying to be successful, integrated reconciled and mature individuals. Ageing and spirituality is relevant to every individual. Successful ageing is fundamentally concerned with the successful self. The spiritual journey is bound up with the search for meaning. Ageing is part of the task of being human and it involves decline and loss. The spiritual journey–search for meaning–is unique to each one of us. The spiritual journey is made evident in the search for the ultimate destination of giving up self, transcending self. Remembrance and routine are methods by which the ageing and the spiritual journey can be facilitated. A successful ageing, according to this perspective, is therefore one that embraces and self-consciously embarks upon a spiritual journey. To take it further–the spiritual journey is bound up with ageing–and further still–ageing is a spiritual journey (Bianchi, 1984). The primary task of ageing is spiritual development. Spiritual development is helped by an appropriate societal context in which ageing as spiritual journey can flourish. This has implications for health and social care services.     

Authentic Humor as an Expression of Spiritual Maturity

SUMMARY

Erikson's understanding of ego integrity and Fowler's depiction of conjunctive faith provide theoretical insights into the holistic nature of spiritual maturity. In order to ground the theory in the actual experience of aging persons, this paper demonstrates, how authentic humor represents an expression of spiritual maturity. Authentic humor can articulate the trust, hope and the faith of elders who maintain a sense of meaning and wholeness despite the changes, losses and suffering which often accompany the aging process. Persons who possess the resource of authentic humor experience the paradoxicalities of aging without yielding to despair.     

Spiritual Inquiry and Well-Being in Life-Limiting Illness

ABSTRACT

Introduction: End of life, as a developmental phase, is accompanied by inner resources as well as losses. Spirituality is a potential inner resource for integrating illness that often occurs during this time. Despite the increase in spirituality research, how spiritual perspectives are used in life-limiting illness remains under-investigated. Better knowledge about this process may be useful for health care providers, family caregivers and patients themselves to enhance well-being at end of life. This study describes the process of how patients and family care-givers use their spiritual resources to facilitate well-being at the end of life.

Method: A qualitative study was designed, based upon the grounded theory method, that entails theoretical sampling of concepts (not sampling of people as in quantitative designs), and the analytic technique of constant comparison of the data until conceptual categories are saturated with supporting data and a theory can be identified. The sample consisted of 12 respondents: 6 dyads of elderly patients with a life-limiting illness and family caregivers. Interviews occurred over a 2-year period.

Results: Data analysis generated a theory about a process called “transcending life-limiting illness,” which derived from two related themes: spiritual inquiry and end-of-life dimensions.

Conclusion: The results expand existing knowledge about how people, either as patients or as family caregivers of persons facing end of life, live with life-limiting illness. The process of transcending life-limiting illness goes beyond merely coping to tap resources for well-being. This resource is expressed through an ongoing dialectic process of spiritual inquiry about life and death as supported by six critical life dimensions.     

Models for Ministry: The Spiritual Needs of the Frail Elderly Living in Long-Term Care Facilities

ABSTRACT

Litte information has been available pertaining to the spirituality of the institutionalized elderly. This paper presents the self-perceived spiritual needs of the elderly living in long-term-care facilities. Additional information is presented indicating the clergy's perceptions of these needs.

Semi-structured interviews were conducted with resident council members from three nursing homes in western North Carolina. The following three domains of spirituality were covered: (1) relationship to God; (2) relationship to church; and (3) relationship to community. Semi-structured interviews were also conducted with these residents' pastors and other clergy members who minister in these three facilities. Data collected from these interviews indicates a variation between the residents' self-perceived spiritual needs and the clergy's perceptions of these needs.

Data analyses suggested a three-step process of the resident's spiritual journey in the nursing home. This process provided a model describing the spiritual journey of the nursing home resident.     

The Life of Spirit: The Self and Sanctification in Søren Kierkegaard's The Sickness unto Death

Danish theologian and philosopher Søren Kierkegaard is often overlooked as an author in the Christian spiritual tradition. This paper answers Christopher Barnett's call to investigate themes of Christian spirituality in Kierkegaard's writing. In this paper, I argue that we can construct of vision of sanctification from Kierkegaard's The Sickness unto Death. While Kierkegaard does not directly deal with themes of sanctification in The Sickness unto Death, Kierkegaard's pseudonym Anti-Climacus does demonstrate the ‘spiritless’ life of despair. The ‘spiritless’ life, as Anti-Climacus defines it, is a life that is not truly a ‘self’. Anti-Climacus systematically demonstrates four categories of despair, and all people not living in faith, whether they realise it or not, fit into one of these categories of ‘spiritless’ existence. I argue that by constructing the opposites of Kierkegaard's categories of despair I demonstrate that a ‘spirit-filled’ life exemplifies a vibrant Christian life of sanctification.     

Three Models of Clergy Systems: Analysis of Couple Processes and Spiritual Meaning

This study explores how parts of the clergy system interact in response to congregational and familial demands. Qualitative analysis of semi-structured interviews with twenty-four clergy and their spouses identified three clergy system models based on the spiritual meaning and relational dynamics between the clergy, their spouses, and the congregations: The living sacrifice model emphasizes service to the congregation at the expense of personal and familial needs; the faithful spouse and parent model focuses on family needs over the congregation and practices several disciplines to maintain such a focus; and the peacemaker model seeks as much as possible to satisfy their congregation and their family by intentionally juggling their demands. Results illustrate how relational processes and spiritual meaning contribute to how clergy systems respond to systemic demands and pressures.     

Spiritual Transformation: A Phenomenological Study Among Recovering Substance Abusers

As a complement to an earlier quantitative investigation, this qualitative study was concerned with describing the lived experience of spiritual transformation within the context of a 12-month resident substance abuse recovery program called the Lazarus Project, which is sponsored by a southern U.S. Pentecostal-based congregation. We conducted phenomenological interviews with 10 participants (eight European-Americans; two African-Americans) who had been in the program from six to nine?months and asked that they describe their most important spiritual experiences that brought about change. A hermeneutical analysis found that a pattern of five overlapping themes emerged consistently across all 10 protocols to describe the meaning of the experience of spiritual transformation for these participants. The themes were: (1) “Sick and Tired”, (2) Unmerited Love, (3) “I’m Changing,” (4) Fast/Gradual, and (5) Destiny. The themes are discussed from an existential perspective and related to the literature on spiritual transformation as well as the earlier quantitative study at the Lazarus Project.     

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians and patients religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.     

Reflections on Spiritual Maturity and Gerotranscendence: Dialogues with Two Sufis

ABSTRACT

Late life development-from the perspectives of spiritual development and gerotranscendence-has been studied using the Life History Approach followed up by thematic semi-structured interviews with Iranian Sufis residing in Sweden. On the basis of this study and proceeding from the theory of gerotranscendence, this article illustrates the distinct role of aging in the development toward wisdom and maturity when mystical ideas are already integrated into individuals' ways of thinking. This is achieved by contrasting, in terms of certain gero-transcendent dimensions, an aged Sufi's view of her/his Self and the surrounding world with that of a middle-aged Sufi.     

Spiritual Development in the Fourth Quarter of Life

SUMMARY

Spirit, the activating or essential principle influencing a person, and body interpenetrate each other but do not dominate each other in predictable ways. Normal aging is neither a failure of the human spirit nor a failure in the body's Biology. The spirit becomes more apparent as a result of spiritual development.

The fourth quarter of life covers age 75 to 100 years. Prior to age 75, the human spirit undergoes significant developmental events: a crisis of meaning which may result in conversion or more commonly stripping or shedding; transitions, including loss of clearly defined roles and loss of the sense that the individual's life makes a difference.

One motif applied by our culture to old age is the “iconic illusion”; however, it is evident that in some respects this motif has limited application to the fourth quarter of life. “Meaning making” is, in fact, enhanced in the fourth quarter of life, given reasonable levels of cognitive health. The desire and ability to make sense out of existence, to draw together an understanding of a meaningful life trajectory, is best done in the fourth quarter of life. The dominant sense of time in the fourth quarter of life particularly facilitates spiritual development.     

Widows' Spiritual Journeys: Do They Quest?

SUMMARY

Two studies examined the spiritual experiences of older women shortly after their husbands' deaths. The central question was, in the process of becoming and being a widow, do the older women begin a reflective dialogue with existential questions and initiate spiritual journeys as recent widows? One study is based on the widows within a random sample of older adults. The second study involved in-depth interviews with 15 recent widows. Both studies included Batson's measures of means, ends, and quest religious orientations. There was more evidence of an “ends” (intrinsic) orientation among the widows than “means” (extrinsic) for religious involvement; there was also no change over time in these orientations. Their quest orientation, however, became significantly less prevalent in the follow-up. It seems that women indeed quested, and by follow-up engaged their faith for religious consolation. Data from Study 2 revealed two themes: religious involvement provided a sense of continuity and direction, and through faith and prayer the women were able to (re)find meaning and purpose to life.     

‘Just Because I Can't Remember …’ Religiousness in Older People with Dementia

SUMMARY

This paper reports part of a pilot study that used spiritual reminiscence techniques to explore issues of religiosity, church attendance and meaning in life of a group of older people with dementia. The study used small groups, individual interviews and participant observation to examine the experience of dementia and the search for meaning used by people with dementia. There were 22 participants from three aged care facilities involved in the project. The majority of participants had been long-term church attendees and could describe how their religion and relationship with God had impacted on their lives. They had few fears for the future and derived considerable meaning in life from their relationships with family. Participants were able to describe early memories and also remember things happening recently in their aged care facility. This would seem to be the opposite of community expectations (and sometimes staff expectations) of older people with dementia.     

Spiritual Need One: Spiritual Development: The Aging Process: A Journey of Lifelong Spiritual Formation

SUMMARY

To grow old is but one chapter in a lifelong journey of spiritual formation. Spirituality can be defined most easily by what it is not. Aging is a process of discovery and pondering, reminiscing, and acting, integrating and meaning making, even surrendering to Life as it is, not as we will it to be. Spiritual insights are gained from James Fowler, Viktor Frankl, Thomas Merton, Paul Tournier, Adrian Van Kamm, and Rachel Remen.     

Ageing and Isolation: Is the Issue Social Isolation or Is It Lack of Meaning in Lige?

SUMMARY

Social and spiritual isolation are growing issues for an ageing society that promotes the ideals of autonomy and high levels of individuation amongst its citizens. This chapter explores the issues of social and spiritual isolation for older adults and ways of addressing these issues both now and in the future. The need for intimacy with God and with others is illustrated using material from in-depth interviews with older adults who live independently and others who are residents of aged care facilities.     

Vocational Souljourn Paradigm: A Model of Adult Development to Express Spiritual Wellness as Meaning,Being, and Doing in Work and Life

The author invites counselors to consider integrating spiritual, philosophical, and psychological ideas regarding work and life to encourage client well‐being. The Vocational Souljourn Paradigm is a model that can be used with adult clients who are exploring their work and life choices in a holistic and spiritual context. The variables meaning, being, and doing and the work paths Job, occupation, career, and vocation are defined. The model explains how dynamic interactions of meaning, being, and doing can propel an individual into a particular work/life path.     

Spiritual Wellness for Clients With HIV/AIDS: Review of Counseling Issues

The epidemic of HIV/AIDS has resulted in an increasing population of individuals in need of counseling services: persons living with AIDS, as well as family, friends, and caregivers. The relationship between HIV/AIDS clients' counseling and spiritual issues is demonstrated by a review of salient literature. Three broad themes are used: terminal illness issues such as post-death existence and existential meaning of life, religious disenfranchisement from society or families of origin, and multicultural spiritual and religious issues. Practical recommendations for counselors and research implications are included.     

The ‘Connection’ Health Care Providers Make with Dying Patients

SUMMARY

The literature confirms illness and hospitalisation can become spiritual encounters for patients and their families. Further, it has been established that both patients and their families are better equipped to deal with loss and change if they have a healthily developed spiritual sense of self. The aim of the study sought to determine the benefit or otherwise of a previous model of spiritual care. It asked ‘from the perspective of the nurse and other health care providers, what constitutes spiritual care giving?’ An ethnography was undertaken where data consisted of field notes, interviews, records, and diary entries. This paper reports on interview data, from which themes were derived. The major theme titled their space is expressed via a new model of spiritual care. It was shown that when caring for patients and their relatives, nurses and other health care professionals enter the world of the other to determine the other's needs. In so doing they typify agapé (altruistic love), where the individual cares for a complete stranger as if that stranger were family. This connection with the patient and their family is the foundation for spiritual care.