One
of FiOP’s aims is “to promote and deepen
understanding of the spiritual care needs of older people wherever they are
situated”
We know that many people find spiritual care difficult to define and
through a range of events and materials we have tried to de-mystify the issue
and to bring it alive for those who provide care - whether physical, emotional,
mental or spiritual
In October last year we brought together Professor Mary
Marshall,
recently retired as the Director of the Dementia Services Development Centre in
Stirling and the Rev Malcolm Goldsmith, the founder of FiOP to debate:
Is there a difference between good person-centred care and spiritual care?
The event was superbly moderated by Professor
Frank Clark,
Convenor of the Scottish Commission for the Regulation of Care and held in the Lifecare Centre in Stockbridge,
Edinburgh.
The event was very well attended with
representatives from health and social care, academics, churches and
individuals.
 |
Prof Frank Clark,
Prof Mary Marshall.
Rev. Malcolm
Goldsmith.
|
Revd Malcolm
Goldsmith.
In his introduction Malcolm Goldsmith
clearly stated that it is not person-centred care versus spiritual care but
that it is important to consider the crucial areas of overlap.
There are many definitions of spiritual and
his favourite was Mel Kimble’s (2001):
“The spiritual
dimension is the energy within that strives for meaning and purpose. It is the unifying and integrating dimension
of being that includes the experience of transcendence .. and the mystery that
is at once overwhelming and fascinating, that renders my existence significant
and meaningful in the here and now. It
is also a mystery in that it is unmeasurable, unprovable and lacks universal
definition.”
But how, Malcolm argued, do we translate
this view into everyday terms. We have
to unpack some archetypal images; the stories and myths by which we live, the
poetry which communicates beyond rationality; attitudes derived from youth
which provide continuity and for some a sense of guidance through life acquired
through a spiritual power.
He emphasised the fourteen spiritual needs of ageing
identified by Koenig in 1994 and pointed out that at least 11 of them could be
seen as identical with person-centred care and had a particular focus on the
‘need for meaning, purpose and hope’ in coming to terms with our lives.
Our spiritual needs encompass the need to
be included; to be comforted; to be occupied, as it gives us a sense of urgency
and sometimes a chance to give time and help to others. For Malcolm this included his need to be
quiet, on his own, relating to nature because to be calm he needed to hear
birdsong, feel wind and rain and smell soil and leaves. For others this might be music, art or expression
of faith.
For Tom Kitwood all these elements needed
to be fulfilled to achieve good person-centred care. It is vital that we maintain and reinforce
identify and Malcolm held the view that faith and worship meets all these needs
for some people. Again some people can
transcend poor physical care and poor health but for most of us our body, mind
and spirit are profoundly inter-related.
Malcolm gave several examples where the
spiritual insights go beyond good person centred care. One was of a well known hymn ‘O love that
will not let me go’ with the verse that says “ I trace the rainbow through the
rain and feel the promise is not vain that morn shall tearless be” which takes
up the biblical myth of the flood but which provides a powerful image to share
with someone in deep distress and opens up a whole treasury of spiritual wisdom
and experience.
He concluded by saying that he would always
want to be treated in the context of good person-centred care but that he would
not wish to be bereft of the stories and myths that had sustained and been of
fundamental importance to him.
Professor Mary
Marshall
The focus of her presentation was to talk
about people with dementia and the importance of getting care right for
them. If this happens then it is
possible to ensure that care for everyone is right.
The definitions of 'person centred care'
are those developed by Tom Kitwood who was a vicar turned psychology
lecturer. He was enraged by the type of
care given to people with dementia in the 1980's and 90's and he gave voice to
a whole set of new approaches to the understanding and care of those with
dementia.
Professor Marshall made two clear points:
1. Good person centred
care is the same as spiritual care – people use different language.
2. There are dangers
in suggesting that spiritual care is something different and special.
What Mary meant by good person-centred care
was about maintaining and enhancing personhood and quoted Tom Kitwood’s three
approaches which she believed should be taken together. The term personhood, together with its
synonyms and parallels can be found in three main types of discourse;
those of transcendence,
those of ethics and
those
of social psychology.
“The functions of
the term are different in these three contexts but there is a core of meaning
that provides a basic conceptual unity.
Discourses of
transcendence make their appeal to a very powerful sense held in almost every
cultural setting, that being-in-itself is sacred and that life is to be
revered. Theistic religions capture
something of this in their doctrines of divine creation.
In Eastern
traditions of Christianity, for example, there is the idea that each human
being is an 'icon of God'. Some forms of
Buddhism, and other non-theistic spiritual paths, believe in an essential,
inner nature, always present, always perfect and waiting to be discovered
through enlightenment.
Secular humanism
makes no metaphysical assumptions about the essence of our nature, but still
often asserts, on the basis of direct experience, that the 'ultimate is
personal'.
In the main ethical
discourses of western philosophy one primary theme has been the idea that each
person has absolute value. We have an
obligation to treat each other with deep respect and never as a means towards
some other end.” (Kitwood)
The principle of respect for persons it was
argued by Kant and those who followed in his footsteps required no theological
justification; it is the only assumption on which our life as social beings
makes sense. The parallels to this kind
of thinking is the doctrine of human rights and this has been used
theoretically in many different contexts, including that of dementia (Kings Fund 1986).
Mary’s contention was that if spirituality
is considered to be additional and essential then it would undermine the
confidence of those providing person centred care and that the potential of the
language of spirituality being considered as superior could be divisive when
the focus should be on meeting the needs of people with dementia effectively.
The speakers raised interesting and varied
issues which stimulated many questions from the floor which was pleasing as it
demonstrated that there is an active interest in the topic and much to be
explored.
We would like to receive your views on whether you
feel there is a difference between spiritual care and good person centred care
and how you enable the spiritual care need of older people to be met.
