It is hard for me to imagine how one can be so privileged as to watch the wonder and mystery of birth and death and not be moved to reflect deeply on spiritual matters. I know that many of my peers have gone the way of all society and thrown out spirituality together with organised religion, which is arguably deserving of dismissal. These neo-atheists may be forgetting that organised religion consists only of "man’s" meagre interpretations. It makes as much sense to throw out science because many scientific errors have been perpetrated upon society.
Purpose, identity, direction
In the recent past I was consulted by a high level performer in a major public organisation. That performer and colleagues were in a depressed state. They had been with the organisation nearly two decades when there was a coup-style takeover. It would be easy to simplify the matter to say that they suffered a "bereavement" type loss as an explanation for their depression. Another therapist may conclude that the problem was a form of Post-Traumatic Stress Disorder in view of the patient’s recurring nightmares. Indeed, I would suggest that every brand of therapy would give its own version of the cause of this patient’s problem. I was struck in particular with the extent to which the patient emphasised the loss of their identity in spite of the fact that the patient had ample other identities as a parent, as part of an extended family and part of a community. In addition, the patient emphasised a loss of purpose, which was the reason for getting up each day. Of course, the patient did get up to seek a future but for now had no future or purpose in life.
Viktor Frankl proposed in his logotherapy that the cause of some peoples’ problems lay in their lack of purpose. He developed his ideas in his experiences in Auschwitz and explained his thoughts in his classic book Man’s Search for Meaning. I refer you to my ideas on other pages of this Web site as to what I believe to be the four "legs" of good therapy. The last of these legs is the spiritual leg. "Last" not because it is the least important; indeed, quite the reverse. I have put it there because it is the most advanced aspect of personal development, being one that the atheists would have difficulty in addressing, but I suggest that even they have a need for a personal identity, direction and purpose in life. They too will one day need to face their final journey but even as they journey each day death can be as Carlos Casteneda calls it our "ally" and source of wise counsel. Death is our greatest hidden (and for some not so hidden) fear. Peter Ustinov said he did not fear death, for in acknowledging death it gave meaning to each day that he lived. I suppose he meant that for him life becomes more full of meaning. Harold F Kushner said "vulnerability to death is one of the given conditions of life".
God and the Laws of Nature
All scientists would believe in the laws of nature, the laws of thermodynamics, the theory of relativity and so on. These laws cannot be broken; they are immutable. Those who believe in a God would believe He created all things including the Laws of Nature. True believers have to accept that God is not going to allow these laws to be applied selectively. If God is just, we all abide by the same laws of nature. For this reason we are being unfair to ask that God make an exception for us. To ask this of God is to ask Him to be unjust and to do something that He cannot do, namely break the laws of nature. Why are we disappointed and blame God when we ask something unreasonable of God, something that He cannot grant us?
Spirituality versus religion
Fortunate are those who come to me with spiritual beliefs and a sense of the hereafter - whether it is in reincarnation or in a life hereafter or a Heaven. I totally reject any idea that it is my role or right to change anyone’s spiritual beliefs. Some do come to me asking for clarifications of spiritual matters, and some maybe are even doubting their God. I do not see this as an opportunity to convert them or to find them an alternative belief system. Rather, I see it as my role to assist them to clarify their belief system, or sometimes to find a new explanation or meaning in their own belief system. Sometimes they find a new path - but it is their journey and not one I should in any way dictate.
In the same vein, I am critical of those who happen to be an atheist imposing their prejudices upon a patient when something much more humane is appropriate. Sometimes I am asked if I am Christian. In my opinion it matters not if I am Christian. If I was a Christian, I would not be a Muslim, nor a Buddhist, nor a Taoist. I wish to be able to support each and all adherents to these religions in their spiritual search or journey. I wish to serve mankind whatever man’s religion - just as I wish to serve regardless gender or race. The question I am asked is wrong. The question needs to be: "are you spiritual?" And it must be borne in mind that spirituality involves love.
When help is sought by those who are dying - sometimes with unfinished business - or by those who are bereaved sometimes prematurely, unexpectedly or violently it is not good enough to come out with scientific explanation, or atheistic rationalisations or even spiritual platitudes. It is our task, not just as therapists but as fellow human beings in the presence of great suffering, to help our kin to find meaning in their suffering. The doctor is closest to hand at these times and if they are found wanting it would be a great shame. If doctors are found wanting because of their own spiritual emptiness it would be sad. I do not want this statement to be a platitude; it genuinely would be sad if the treating doctor was spiritually empty.
Knowledge, wisdom and spirituality
One major feature of being human is the fact that we know and we know that we know. Christians would say that this is because Eve ate from the "Tree of Knowledge of Good and Evil".
What do we know?
Humans "know" that sex is "evil", whereas animals don’t know this. For animals, sex is simple. Could the animals be correct? Could we have complicated our lives in our "knowledge"? We know that we "live in the shadow of the valley of death". Some say that animals know when their death is imminent but they do not live their lives in that knowledge. There are many things we may grow to know, when and if we grow up. Some may come to know how to defer gratification; some to make moral choices; some to take responsibility and not just demand their rights; and some may come to know self-discipline.
Philosophy claimed many things into its domain when we did not know better. Science cannot claim many of these matters in its domain. It is hard to argue that these philosophical matters are not spiritual matters that indeed are bound up with the practice of medicine.
The spiritual being
M Scott Peck defined love as "the will to extend oneself". In medicine and in therapy there is constantly the call to extend oneself more than in the physical sense of working long and hard - although these too are required. I interpret Peck to mean "extend" in these more difficult areas of beliefs and attitudes. Love also involves "giving" of oneself - not just time and work and skill but of ourselves and bending our rigidities, of giving our ingenuity and wisdom to help those who are suffering to find the sense and the means to go on at the limits of scientific medical knowledge, and to meet the spiritual needs of our patient. We do not need to have a religion; we do not need to have the same religion as our patient; but we do need to have true compassion and, dare I say, "love" in the climate of this "me" society - a society where personal rights, personal satisfaction and personal goals seem to be all important. Is this a cause or a result of society’s spiritual emptiness?
I recall being "attacked" in court about the use of the word "love" in the context of doctors’ patients. I was appearing on the defence side for a Christian doctor. Obviously, the opposing barrister wanted to corner me into some discussion about sexual or romantic love and the implication for doctors’ ethical conduct. My response, couched in terms of spiritual and Christian love, put an end to that line of questioning. I have heard it said that barristers should not ask questions to which they do not know the likely answer before they ask the question. Obviously this barrister did not consider the possibility of my answer. Was this because of his unfamiliarity with the concept of spiritual love? Was this because he was, like the society in which he lives, spiritually empty?
Old Philosophies and Modern Psychotherapy
The twentieth century theologian Rheinhold Niebuhr is often credited with writing the original words that, slightly altered, are now part of the well known Serenity Prayer, being: “God, grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”
Buddha said that “suffering” is part of the human condition and that liberation from suffering is through the “path of right conduct”, being the route to happiness.
Chung says that to struggle against what is unchangeable as part of life is to compound “suffering”. “Acceptance” is not about “giving in”, but about a realisation that “this too will end”, and that a particular source of “suffering” will pass for nothing is forever.
Modern psychotherapy has spawned another form of treating psychological “pain”, being acceptance-oriented therapy, a subset of which is acceptance and commitment therapy. Modern psychology suggests that we “live in the now” and that we bow to “the power of now”. These notions, too, are rooted in Buddhist philosophy.
Chung notes the quote: “Yesterday is history; Tomorrow is a mystery; Today is the only tangible reality”. Yes, we learn from yesterday and make contingency for tomorrow, but we must live today in the reality of the moment.
These are but two (of many) borrowings from Buddhist teachings to be found in modern psychotherapy.
Poetic reflection on the human condition
The following poem by Ian Chung reflects his long and ongoing interest in the human condition.
Before twilight heralds day's end,
The Sunset lights the sky,
To brighten and colour this moment
That invites reflection,
To marvel at the Beauty,
To reflect on the day that must pass.
A time so momentary it demands that
Those who know must savour this brief time,
To know that storms of the day have passed,
To know who we are is who we are,
To know what was done is done.
Regret and guilt and anger need the elixir of acceptance and forgiveness,
That now, at Sunset, it is
the time to find tranquility,
To find peace before Twilight that must herald the days passing.