What's the difference?

[req_read]

A statement I have heard from different people at different times under different circumstances (including here on allnurses) usually goes something like this: "There is a difference between religion and spirituality."

Hospice professionals are present during some of the most vulnerable and revealing times of people's lives; i.e. while dying, so may have some special insight into that very issue... then again, maybe not. But the question begs to be asked.

If there is a difference between religion and spirituality, what is it?

[req_read]

The thought around the question is this:

EricEnfermero’s website (thank you by the way) makes the point that science is inclined to study religion while “In contrast, spirituality, and in particular, patient spirituality, has received greater attention in clinical practice.”

In other words religion, because it has doctrine and is written down, is relatively easy to study. Spirituality, on the other hand, is almost completely unique to the individual… which makes it extremely difficult to study.

Science, in that regard, is rather like the drunk who dropped a coin in the alley but looks for it under the street light… because he can see better there.

Additionally, one’s personal spirituality (pardon the redundancy) is often hidden… at least until dying process comes along, dissolves the façade and exposes it. Consequently, insight into spirituality usually falls within the purview of a select few; often, individual clinicians… the nurse who is present at 2 AM for example.

What science finds extremely difficult to study at all (and so far, has not) hospice nurses see all the time; i.e. human spirituality in the raw.

Which makes me wonder…

Would hospice nurses then not have some particular insight… some special understanding… of human spirituality? Including the difference between spirituality and religion?

And by extension, are they not aware of differences in how religion and spirituality play out in dying process?

Posts in response to this question are remarkably consistent. They are notable for their lack of dogma, indeed for a certain antipathy for dogma. The highly unique quality of spirituality is acknowledged (by experienced hospice nurses) and the conformity that is so often encouraged by religion is lamented.

All of which suggests that the supposed difficulty in making accurate observations of unique phenomena may not be so difficult after all. Experienced hospice nurses seem to draw very similar conclusions. To wit…

Dogmatic, closed-minded, know-it-all types have a harder time with their dying… whether they be of the religious or scientific variety. Dogma is dogma after all, regardless of its genus.

Dying involves moving into the unknown. To withstand the impact of the unknown one must be as open-minded as possible. Fluidity, adaptability and openness are the keys to success. Practicing and developing these attributes in life prepares one for more life.

We are inclined to think (so did I initially) that if a person is religious or smart, s/he should be better prepared. However, my experience ran contrary to that expectation. When it comes to predicting the degree of ease and grace with which a person will handle their dying, it is better to evaluate their openness than their religion or their intellect. Indeed, strict adherence to religious dogma or rigid intellectual constructs is more often a harbinger of angst than of grace.

A good example of this is a sixty-some year old patient I once had who was mentally retarded… not severely, but he was no Einstein. He was, interestingly enough, born and died in the same house, the same room and the same bed. He died very nicely. Shortly before he passed he saw things I could not, accepted them and moved on. He was open to his experience and handled it much better than most of the preachers and professors I have known.

What I am intensely curious about… and will probably never get the chance to study (at least from this side) is how hospice nurses die. Because they are the beneficiaries of extremely rare and valuable data, my theory is they should do well with their own dying. Do you suppose I will be disabused of this presumption too?

Coot

[leslie :-D]

And by extension, are they not aware of differences in how religion and spirituality play out in dying process?

Coot

hi req,

you have stated yourself:

the way people die almost always reflects the way they lived.

i've always been 'aware' of the evident contrasts between religion and spirituality.

i was well aware of them long before i became a hospice nurse.

so i think i will probably die the same way i lived-highly spiritual.

conversely, i too have had hospice pts who were extremely religious- and experienced profound anxiety and fear.

these religious pts shared their fears in being judged/punished and the what-ifs-of-life.

it's important to add that many of my pts have questioned the what-ifs; so it is definitely not exclusive to the religious.

even though this is a subject that is infinite in thought, i avoid writing long posts so, in summary:

i don't think all hospice nurses are necessarily spiritual.

in the absence of their spirituality, they may overlook the spirituality (dang, this word IS redundant!) of their dying pt, therefore, overlook some crucial work that is being done.

afterall, it's so very common for religion and spirituality to be considered synonymous.

furthermore, i applaud your courage in writing your books.

although i and many others, share your experiences, many have not.

metaphysical observations are not a norm in todays' society.

so i hesitate in elaborating on my seemingly spiritual observations in dying.

if you live spiritually, you'll die spiritually.

i don't think it's relevant if you work in hospice.

leslie

[req_read]

Hi Leslie,

Regarding “the way people die almost always reflects the way they lived.” That is true… I have said that. But there is a caveat…

A friend of mine often states, “A tiger never changes his stripes.” That is true… statistically speaking anyway. Most tigers never do change their stripes. However, they could… any old time they wanted to (we’re talking figuratively here… not actual tigers.) People can change, boom! Just like that. It’s uncommon, but it’s possible.

I have heard it said that all change is instantaneous. One might go through a lengthy process before choosing… deciding. But the decision itself is instantaneous. Which reminds me… have you seen the movie “Sixteen Blocks” yet? It’s about this very subject… and well done I thought.

By the way, I liked your first post (i've always viewed religion as something learned and spirituality as something felt.) Short, sweet and hard hitting.

Yes… not all hospice nurses see the same things, even in the same situations… especially in this age of “productivity” and bottom-line economics. It is sad. But I hope experienced nurses will still share their insights and feelings with those on their way up. Perhaps it will open some eyes. And one of these days some “old” hospice nurse will go back to school and get her PhD and write a thesis on this stuff and the next thing you know it will all be old hat.

But when it comes to getting through one’s dying process with some measure of grace… I will still put my money on a hospice nurse long before a doctor or a preacher. I’m biased… I admit it and make no apologies.

[BeExcellent]

Is it important what is spiritual and what is religious as long as we hospice nurses don't confuse our issues with theirs? I have seen many in that private moment of release from life. The mother that rocked the child on, the compadre of Pancho Villa that laid down and shut his eyes not to open them again. Being an inpt nurse allows hours and days to watch a person change. It is like watching layers of a person peel away. Haven't we all seen the busy grieving family and friends with a private, totally introverted pt laboring toward death? If the dying have time and a space of peace free from physical discomforts they focus inward, they hear and see things I do not and they often die well no matter what they may have done in life. I don't know what to call it. I don't think hospice nurses die better. That would be like saying a surgeon tolerates and heals faster from a surgery. We aren't dying hospice nurses, we are just the dying. It is all really quite beautiful.

[leslie :-D]

yes, it is really quite beautiful when the process moves w/little interference.

as an aside, i thought i'd share that when i have a pt dx'd w/terminal delerium, i often respond as if s/he were in spiritual distress.

and often, this has resolved the former dx of terminal delerium.

leslie

[BeExcellent]

How do you respond? I am not always quick to intervene with mild restless that seems to come from some mental or emotional "work". I think, too, we really do try to interpret too much. Lovely man once whispered to me, "I'm Lutheran." I thot we had had a wonderful shared moment to find out that a sitter had been strongly trying to bring this pt to be "born again."

[river1951]

I've always believed religion is created by and run by man as a recognition of the higher power and spirituality is a gift from the higher power (however you see that!) to man.

Interesting discussion:specs:

[BeExcellent]

Interesting and thoughtful. i just finished reading a group of essays on the meaning of death to the pt, the nurse, the family and loved ones. One essay focused in on the degree of control the people wish or try to exert during the dying process. Control people whether pt, nurse or loved ones all seem to have a harder time. Death, you can guide it and herd it along (symptom control) but not control it. Interestingly, I have never had a pt that I know of do something with the intent to end their lives. Life becomes precious to the most jaded of us.

[req_read]

Gee… I’ve been so busy preparing for a wilderness backpack trip I’ve missed the last several, very interesting posts.

One of the greatest difficulties (in hospice) is acknowledging human spirituality while avoiding proselytizing. For some, proselytizing is such a temptation that the founders (of hospice) separated “medicine” and “religion” in the very structure of hospice. That was smart… for the same reasons the Founding Fathers separated “church” and “state.”

But there is a rub… human beings actually are both physical and spiritual at the same time (at least while on the physical plane.) Keeping these two aspects of the human condition separate and distinct may be politically correct while not yet dying, but while dying humans are overtaken by a powerful urge to mend this split… this rent… in their thinking.

Not proselytizing is one thing, but denying that there is a dynamic interface between body & spirit is just plain incorrect.

It is possible to acknowledge the spiritual component of human beings without proselytizing; i.e. trying to push patients towards this or that religious doctrine. Indeed, it is impossible to understand dying process… to explain what happens and why… without acknowledging an interplay between spirit & body.

So the issue becomes… how does one acknowledge spirituality WITHOUT proselytizing? Upon first flush that seems very difficult… impossible you say?

Not really.

First, one must understand the difference between “religion” and “spirituality.” Some of the posts on that question have been very insightful. Leslie’s comment, “i’ve always viewed religion as something learned and spirituality as something felt…” was a slam-dunk! The statement has brevity and depth… and it takes on more meaning with time.

BeExcellent’s statement was wonderful! “If the dying have time and a space of peace free from physical discomforts they focus inward, they hear and see things I do not and they often die well no matter what they may have done in life.” This sentence has sufficient depth to merit prolonged contemplation and is likely to yield a myriad of complex & interrelated insights. Among other things, it indicates that the study of dying process actually can be outcomes-based… free of dogmatic entanglement.

By “outcomes-based” I mean… certain thinking patterns and lifestyles do yield predictable outcomes, (dying patterns) IF you look in the right places.

For example, “faith” is sometimes thought to be a predictor of a “good death,” or a “fearless death.” In the real world however, that does not always pan out. Why?

Here is another brief but profound statement. “You can control nothing… but you can create anything.”

I have been contemplating that statement for years and sometimes despair of ever getting a good hold on it, but occasionally I make a little progress.

We can control nothing… but we keep on trying! Addiction is doing the same thing over and over again… each time expecting a different result.

Control is the mother of all addiction. All addictions are merely attempts to achieve control… and ultimately, control over our emotions.

So what’s the difference between “controlling” and “creating?”

Another of BeExcellent’s statements provides a clue: “Control people whether pt, nurse or loved ones all seem to have a harder time. Death, you can guide it and herd it along (symptom control) but not control it.” This statement is outcome-based. It makes no judgment… has no hidden agenda. It is a simple observation based on experience.

For some, their “faith” is an addiction. They seek to control their destiny… and their fear. But we can control nothing. We have influence… we have input. We can “herd it along,” as BeExcellent states. Indeed, we are responsible for adding our input. But we can control nothing. This is a paradox. We are required to participate, but can not control anything. As Gandhi put it: "Whatever you do will be insignificant, but it is very important that you do it."

Control freaks… concrete thinkers… know-it-alls… do not do well with dying. And since dying teaches us how to live we may also conclude: control freaks… concrete thinkers… know-it-alls… do not do well with living either.

Religion is often used in an attempt to control or even eliminate negative or unwanted (normal & natural) emotions. A typical example would be the fellow I saw interviewed on TV during the Terri Schiavo debacle who stated, “people of faith have no fear of death.”

Obviously, the guy was not actively dying at the time. The not-yet-dying are very brave!

Spirituality requires acute sensitivity to feeling. Awareness of the non-physical aspects of who we are (since it is non-physical; i.e. non-concrete) necessitates focusing on one’s feelings… being open to emotional nuance.

Using religion to mitigate emotion and to learn more about who we are is a good thing. Using it to control or eliminate our emotions is an addiction. The same can be said about food, drugs, alcohol, work, sex, etc. Used in moderation these things are helpful… used to excess they are harmful.

Sensitivity and open-mindedness yield better results than obsessive attempts to control. I should think hospice nurses would see these outcomes in their work. If not, I guess they won’t do any better with their own dying than anyone else. But at least they’ve had the opportunity to see it first-hand… to know better.

Pardon my verbosity, but I will be in a high mountain wilderness for the next week and a half. I expect y’all will have this post neatly dissected and critiqued by the time I get back.

[river1951]

If it was that easy, we would've already finished it. Speaking of this difference how do you move a chaplain from prostyletizing to talking about the patients' beliefs? I have one who is a great friend and a lovely person, but doesn't get it. I'm clueless how to proceed.