1. Spiritual Causes of Physical Pain Tim Harlow Caring in Devon

2. Palliative Care

Active total care of patients whose disease is not responsive to curative treatment, where the control of pain, of other symptoms and of psychological, social andspiritualproblems is paramount, and where the goal is the best quality of life for the patient and their family Back, N. Handbook Palliative Medicine: 2001, p188.

3. Doctor, why am I ill? Your heart valve leaks. Yes but why me? Wait, Ill call the vicar. Bert Keizer 1996, Dancing with Mr D 4. Total Pain

Dame Cicely Saunders

Iceberg- Tip we see is physical pain, driven by many other things underneath

5. One of those things underneath is spiritual distress 6. When a man lies dying, he does not die from illness alone- he dies from his whole life Charles Peguy (1873-1914) Basic Verities 7. Does Spiritualitymatter ?

A significantly larger number of terminally ill adults indicated a change towards increased spiritualityReed 1987

Spiritual Well Being associated with decreased desire for hastened death, decreased hopelessness, suicidal ideation, depressionMcClain 2003, Nelson 2002

8. Weathering the Storm: thedark night of the soul (St John of the Cross-1577) 9. Yes- it really matters

We do see pain which is difficult to control but which is eased significantly by addressing the spiritual

10. Spiritual?

The Quest for meaning

Deliberately wide definition- many non-Christians will use Christian context and language

Many will have a Christian Faith

Many of those who wish to help will come from a Christian background

11. Meaning?

Despair is suffering without meaning (Victor Frankl, 1975)

Suffering is pain without meaning( Nietzsche)

12. Interpretations of Spirituality

Jesus is with me.So many people are praying for me, I will join the Lord when He wills it.

It is not for us to know when it is written that someone will die, we must trust in Allah.

It is the nature of existence to suffer, the suffering will be left behind when I leave this body behind.

I am a grain of sand in the cycle of evolution.

13. Non Christians?

Many people will have an element of themselves reasonably described as Spiritual

Maybe specific faith- Christian, Muslim, Jewish, Hindu, Buddhist- may need to help them within that context

Maybe no formal faith- still have significant component of spiritual distress or insight

14. 15. Deathbed conversions?

Faith is enhanced amongst those with a strong faith

Faith did not emerge in those without a faith initially-[great challenge for those attending with a strong faith themselves].

Spirituality increases over time and is greatest at death(Thompson, 2008, Strathcarron Hospice)

16. Not just what causes pain

Pain in the context of fear and feeling out of control can be unbearable and overwhelming, whereas pain that is expected and for which there is known to be relief available, if wanted, is much more often bearable.Iona Heath 2008

17. Tahir

32year old man.Close family, exiles from homeland.Cancer affecting bones, multiple sources of pain- nerves, bones, back.Pain very difficult to control.

Often found his predicament unbearable.

Suffering, not good in itself but recognised as natural -guidance from Imam.

Times when Tahir seemed inconsolable but greatly eased by readings from the Quran

Medication vital but very far from enough.

18. Nigel

Deep Christian faith, church very important part of his life such that his pain and painkiller requirements decreased significantly when he was able to get to the cathedral once more.

19. Absolution

From many sources clergy, friends, family.

Very important need, can help the whole person, including their physical pain.Hidden experiences

Opportunistic- not see as our role?

20.