Mitigating Existential & Spiritual Distress: Part V Human Development

 Spiritual Direction in the Journey of Illness

ERIKSON’S STAGES OF DEVELOPMENT

My personal notes and notes taken directly or paraphrased from John Shea’s Illness and the Quest for an Adult Faith ( Spiritual and Psychological Aspects of Illness. Ed Beverly Musgrave et al.) Uncovering where is the person in their development is by listening within one’s narrative for key elements and what areas of ‘virtues’ to support.

1.  TRUST VS MISTRUST

Birth to age one

Learn from your mother, outer good becomes inner good Okay to have bodily needs

Mistrust in Illness

•      Whom can I trust?

•      Can’t trust my body!

•      Initial loss of hope

•      What people are saying to me is true?

•      Can I trust God?

Support focus Trust in the Virtue of ‘hope’

1.  AUTONOMY VS SHAME AND DOUBT

Age 1-3

I am me, learning sense of control

Doubt comes when loss of control or shame - something wrong with who I am

Shame and Doubt in Illness

•      Loss of control, too exhausted to even have will power.

•      Embarrassed of being taken care of, shame in the exposure and loss of control.

Support focus Autonomy - Virtue is ‘free will’

2.  INITIATIVE VS GUILT

Ages 3-6 Preschool Sexuality develops

To make like, fantasy - develop to control both fantasy and action

Guilt in Illness

•      Who am I? comes into question

•      Loss of purpose in being alive

•      Unable to dream of a joyful end

•      Can I initiate a relationship with others, staff, God?

•      Burden on the family

Support focus initiative - Virtue a ‘sense of purpose’

3.  INDUSTRY VS INFERIORITY

Age 6 to Puberty

Time to make things, to do a job

Inferiority in Illness

•      New landscape, navigate a foreign system and language

•      How to learn to be a patient

•      Becoming their own advocate in a disease, patient centered or a person-centered system.

Support focus on Industry - Virtue is ‘competence’

4.  IDENTIFY VS IDENTITY DIFFUSION

Puberty – Adulthood

Time to be oneself, quest for identity

Identity Diffusion in Illness

•      Who am I now to myself to others? a burden? What is a sick person?

•      Loss of others - friends, uncertainly in who I will be

Focus on Identity

Virtue is ‘strength to relate to others in fidelity’

5.  INTIMACY VS ISOLATION

Fullness of Young Adulthood

Able to fuse your identity with someone else’s without fear you are going to lose something of yourself. Danger isolation ‘to be absorbed in oneself’.

Isolation in Illness

•      Becoming ill isolates the self from the self and others, moving through stages from being self-absorbed to reaching out – acceptance.

•      Who will I share this most inner recess of my life? I will locked myself .

•      Fear of being not accepted, in hating God, or feeling helpless?

•     Spiritual Director/ Caregiver helps by - Self disclosure

Focus on Intimacy - Virtue is ‘love’

6. GENERATIVITY VS. STAGNATION

Mature Adulthood

Time to take care of next generation.

Danger is stagnation

•      What can I do for others when I can’t do for myself? What can I give myself?

•      Caregiver: Reinforce their positive decisions on living purposively whatever one can do for what time is left.

Focus on Generativity (See Dignity Therapy a future blogpost Virtue is ‘Care’ log

7.  INTEGRITY VS DESPAIR

Culmination Old Age

Reconciliation or restitution, forgiveness and acceptance in choosing integrity. A time of having been, of acceptance of what was and had to be. Adjusting to the disappointments. Being happy and content.

Danger is despair, no time to start over.

Can I accept my life now as it is?

A detached concern with life itself in the face of limited time of aging or death Accepting the ongoing chronic disease or disability.

Focusing on Integrity Virtue is ‘wisdom’

Key components for a person to achieve integrity of well-being in the midst of an illness.

•  Reconciliation

•  Restitution

•  Forgiveness

•  Acceptance

The focus is not just to be on the recovery, but the renewal.

The renewal of oneself as such is a shared process. It needs to be a dialogue in which caretaker, who in listening to the narrative of the ill person, enters into a mutual relationship. Both will experience a transformation in the movements through desolation and consolation in the sharing relationship.

HELPFUL QUESTIONS

IN A CRISIS- THE QUESTION

The Question: Tell me what happened?

Relaying the story helps break through the shock, emphasizes the reality of what has happened, reduces confusion, brings some clarity, reduces the intensity of the feelings, conveys support and care.

A crisis is a turning point, demanding reflection and decision making over time

o   Are you clear about what the doctor has said ( is saying)?

o   Do you have any questions you like to ask the doctors?

DAILY VISIT QUESTIONS

o   What’s going on with you today?

o   What is your main concern now?

o   In times like these, do you find your faith makes a difference?

o   I’ve noticed that…

o   I’ve heard you say…

o   What helps you cope?

o   I’d like to come back to something you mentioned that may be important to you…

o   What weighs heaviest on you right now?

THE SPIRITUAL DIRECTION QUESTION

o   What do you feel God is asking of you right now in this situation?

PERSPECTIVE OF GOD IN FINDING MEANING IN THE SUFFERING WITHIN AN ILLNESS

Image of God needs to be renegotiated, who is God or them, how they see God being there for them in the present moment. And one needs to be willing to engage in that conversation.

Many continue to hold the image of God that one found in one’s childhood.

3John Bickel in his essay The Spiritual Pain of Illness, in finding meaning in our illness or losses, he describes three different ways one can come to find meaning to these experiences:

•      Punishment (“I deserve this”)

•      Mystery (“Why is it happening to me”)

•      Ultimate source of good (“Something good can come out of this experience”)

We will hear one or more of these ways of finding meaning expressed in the person’s narrative. Depending upon where one is developmentally in their spiritual life,God is either a super ego God who is a Supreme Being, the God of law, a God of dependency and control, versus the God of an adult faith who is a living God, is a God as Thou, it is a living God of love, and of mystery, of freedom, and of community.

Shea summarizes and restates that it is critical for a seriously ill person to be able to tell their story in order to be connected to reality in life. This is a challenge to address our image of God which we may lead us to stop believing in a super evil God, or it may leave us petitioning to God, or maybe we may begin a quest to experience the living God in relationship.

In listening to the seriously ill person, the author states that we need to be aware of what is happening developmentally to the person and that the listener honors the story by not changing it.

3 pg. 11 Partners in Healing: Bringing Compassion to People with Illness or Loss, Paulist Press 2003

Part I: Introduction & Definitions

Part II Signs & Symptoms

Part III Listening & Assessment

Part IV The Narrative

Part V Human Development

Part VI Offering Scriptures

REFLECTION QUESTIONS WILL BE ADDED HERE SHORTLY

Spiritual Direction in the Journey of Illness

*This 6-Part Series is for spiritual directors who accompany individuals facing life-altering illnesses, as well as those who serve as caregivers. It draws from presentations I have given to spiritual direction interns, nursing students, nurses, and parishioners involved in ministry to the sick and homebound. The content is shaped by my background in family practice as a chiropractic physician, my years of service as an on-call chaplain at Yale New Haven Health, and my work as a patient advocate and spiritual director accompanying individuals through illness and suffering, and years of collecting notes from various sources. I take no personal credit for the work as original.