In my work as a hospice chaplain I find that I work in a world most people know little about and where most are uncomfortable. That is the world of spiritual pain.

When I broach the subject of spiritual pain I'm often asked what I mean by spiritual pain. For a long time I fell back on Supreme Court Justice Lewis Powell and his definition of pornorgraphy: "I know it when I see it." Humerous as that is, it's really inadequate and now I see it this way: Spiritual pain occurs when there is an event that violates the core values, beliefs, or needs of the person. Here are a few examples: Ann is a strong Christian and a believer that God rewards those who do the right thing and punishes sinners. Then one day she is told by her doctor that she has incurable cancer. This does not fit her belief about God and she now wonders if God exists. Or, Cathy is another person who does not necessarily believe in God but does believe that karma dictates that evil will be punished. She is then the victim of a brutal robbery and her assailant is acquitted on a technicality. While her physical wounds have healed, her spiritual wounds continue and cause her to wonder if there is any point in going on.

Not all spiritual pain is related to hospice but this appears to be a good place to start. When most people think about hospice they think about people who are dying. That's true in that a person has to have a medical diagnosis that states he has an illness that cannot be cured, and if it keeps progressing on its course he will die within 6 months (please note that patients often live longer than 6 months while on hospice: we won't kick somebody off if they're still alive after 6 months). Much of the day to day work of hospice is palliating (decreasing or eliminating) pain and when people thing about pain they think about physical pain. To be fair, that makes some sense: if you're in severe physical pain nothing else really matters. And we're good at it. When someone is admitted to hospice care and is in pain, we're able to successfully palliate it within 48 hours over 90% of the time.

The other good news about physical pain is it doesn't requre very much of the sufferer. For example if I have a headache I can take an asprin. I don't need to know how it works, the chemistry, the affect on my pain receptors, etc. I take the pill, wait 20 minutes, and the headache is gone. There are a variety of pain medications, just like there is a variety of pain, but the choice of which medication is best is made by someone else.

Spiritual pain, however, is different. There is no pill to palliate spiritual pain and the point of spiritual pain is not to get rid of it. Unfortunately we oftentimes don't know what to do with spiritual pain and we treat it in the same way we treat physical pain. When I say there is not pill for spiritual pain, that doesn't mean we don't look for one: alcohol, work, sex, etc. There is nothing wrong with these except that they don't work. Alcoholic spiritual pain, or workaholic spiritual pain, or sexaholic spirtual pain is still spiritual pain; in fact instead of eliminating the pain, these things add more pain to an already existing pain. A wise friend once told me that drinking to eliminate pain is like taking a laxative for tennis elbow: it doesn't fix the tennis elbow and creates a whole new problem.

The palliation for spiritual pain isn't elimination but integration. The painful experiences in our lives inevitably become the painful memories and we can't change that: what we can change is how we remember them. Let me use Cathy as an illustration. The experience of the robbery cannot be eliminated and neither can the memory. The initial experience of spiritual pain is exacerbated by the fact that her views of justice, karma, and safety have been violated. She can't elimate the experience nor can she ever again think of herself as someone who has never been robbed: something has been taken from her. Her immediate response to the assailant being set free is a belief that there is no such thing as justice, karma, or safety and she was a fool for ever believing there was. Left to itself that spiritual pain can continue to fester and grow and adversely impact all areas of her life.

But it doesn't have to. Cathy does not need to spend the rest of her life thinking of herself only in terms of being robbed. She doesn't have to see every encounter through the lens of the fear and helplessness she felt at that moment. This is a little cliche but she does not need to be a victim for the rest of her life: she can be a survivor. In other words she can recognize that being robbed is part of her story but it doesn't define her. At the end of the day she is still a woman, a friend, a sister, a coworker, a gardner and a scratch golfer.