Spirituality at the Sharp End. The challenging world of social work

and social care.

Margaret HollowayProfessor of Social Work

University of Hull

Core Values of Social Work

SW is concerned with that which has meaning and value for the service user

the relationship between the social worker and service user is of prime importance

SW adheres to a clear code of conduct which stems from the fact that it is essentially a moral activity

Humanistic spirituality (Holloway 2012 in Cobb, Pulchalski and Rumbold)

Spirituality is concerned with meaning and purpose, in particular, the search for meaning;

Spirituality is experienced through relationships, and those relationships may be with an external or ‘higher’ source, or they may be experienced through families, friends or communities;

Spirituality promotes certain behaviours and practices, within oneself and also towards the other person.

1. Based on ethical principles (Canda & Furman, Cheers et al, Gardner, Holloway & Moss, Consedine)

Social justice; restorative justice; valuing diversity2. Working with biography & narrative (Hodge, Holloway,

Mathews, Crisp, Gilbert)

journey; life course3. Facing the darkness and tension with positive spirituality

(Moss, Lloyd/Holloway, Gilbert, Ungar)

resilience/strengths perspective; maintaining the spirit

4. Non-western paradigm (Chan, Wong & Vinsky, Yip, Zapf, Coates, Gray)

Communitarian values; environment as sacred; rejection of ‘spiritual not religious’; privileging of connectiveness over self actualisation

Social work’s contribution to spirituality discourse

drawing on social science….. critical theory

celebrating diversity

underpinned by its commitment to personhood

working in partnership with the service user

Dementia

Abuse of vulnerable persons

Contemporary religion and belief

Current social and spiritual challenges

How do we understand and respond to the growing numbers with dementia?

Autonomy? Independence?

Linked to personhood

Capacity to be self-governing

Degrees of; not absolute concept

Problem of competence when mental deterioration

Dementia does not make less -than-

human

Personhood as moral concept

Concept of autonomy at

meeting point of ethical and social constructions of

personhood

Liminal phase before death. Oldest old do contemplate and accept inevitability of death

(Johnson and Barer, 1997). Attitudes to death/dying remarkably consistent across

ages, but older people:◦ don’t want to burden family◦ existential fear of death becomes fear of dying◦ disproportionately high rates of suicide, but not related to

terminal illness Religiosity/spirituality

◦ increase in old age? Or encounters with death?◦ cultural identity

Preparation for death◦ may not have set affairs in order whilst still able◦ unresolved relationship issues may cause agitation

The dying phase of life

Spirituality in Contemporary Funerals study Great grandchildren will not attend funeral but grandchildren will. One grandson to be released from prison to attend. Deceased was very supportive of daughters and grandchildren…Ill health last 10 years and short term memory started to go There was no collection box but those who wished could send donations in her memory to the Stroke Association or to dementia charities of their choice. (There may have been conflicts between the daughters and widower over donations – at the FD meeting the elder sister said Dad does not want donations. Could this have been something to do with not wanting to say that the deceased had dementia?)

Welcome Me as I am Churches Project (Ben Bano)‘It’s still me Lord’

What life do we celebrate?

Taking care of ‘adapted self’; maintaining familiar roles (Kitwood 1997)

Constructing ‘feasible and valid choices’ (Dunn 1999) Importance of collective self-help (Bowes and Dar

2000) Advocacy and capacity building (Postle and Beresford

2005) Tackling ageist assumptions in service provision Biographical assessment; narrative approaches

(Gearing and Coleman1996, Bornat 1999, Richards 2000)

NB Link with SW + spirituality approaches

Addressing these dilemmas

Spiritual understanding which re-frames the relationship between person with dementia and surrounding community as reciprocal gifting◦ Cherishing shared memories◦ Sharing humour◦ Valuing patience◦ Enjoying the moment◦ Self awareness and taking care of oneself◦ Enjoying family◦ Acceptance of others for who they are◦ Nurturing sense of belonging

The ‘gift’ of Alzheimer’s(Zeisal, 2009; La Tourelle, 2013)

How do we understand and respond to endemic and growing abuse of vulnerable persons?

Asylum seekers Modern slavery People trafficking Abuse in care – children and adults Domestic violence Child abuse – ‘the crushing of the spirit’

(Mathews, 2009)

Includes abuse within and by religious groups; also religious leaders turning a blind eye

What lies behind….?

COMPASSION NEEDCAREHUMANITY/

SPIRITUALITY

How do we engage with contemporary religion and belief?

Statistical evidence of sharp decline in religious observance (Crockett & Voas 2006) – except fundamentalist

Distinction between doctrinal beliefs & personal beliefs (Astley 2002)

Surprising array of fragments of religious belief in secular societies; pick ‘n mix (Heelas & Woodhead 2005; Spencer & Weldin 2012; Holloway et al 2013)

Religion remains a way of life for minority ethnic and migrant populations

BUT spirituality discourse has paid little attention to belief(s) or their content; ‘spiritual not religious’ position increasingly under attack

Patterns of contemporary belief

1. The ‘religious instinct’ is an essential element in the human make-up and will continue in some shape or form irrespective of the social and cultural context.

2. Belief in ‘God’ and an afterlife is the ultimate insurance policy against the fear and impact of death.

3. It has to do with personal meaning-making and does not require external reference points.

“Funerals are a time when people’s spirituality comes out in its diverse forms and to, to bring to mind and to bring to heart the hope of life after death is appropriate. Even, I mean I actually have a, part of my eulogy is something on the lines of I recognise the diversity of belief here, some will be strong believers, some will not be, most of you will be in between, what I want to say to you today is that whatever you believe, there is a sense in which Uncle Bob lives on. If you don’t believe, he lives on in your hearts and memories and that’s not insignificant”

Explaining apparent contradictions

ACTION 1Develop the evidence base and tackle new frontiers

URGENTLY REQUIRED!

What we know

• Religious coping• Meaning production• Hopeful reframing

Spirituality can be beneficial for

patients facing the end of their

lives

• Lack of clarity over what it is• Secular professionals lack confidence to

address spiritual need • Changing roles of chaplaincy and clergy• Resistance based on particular assumptions

about religion

Spiritual care can be difficult to

provide

What we don’t know

• Most of the research is done in the US within a much more religious context

The relationship between a more generic spirituality and human well-being.

• Evaluations of the implementation of the Liverpool Care Pathway revealed that health care professionals do not adequately address the spiritual dimension due to lack of understanding of the concept

How well professionals understand the concept of

‘spirituality.’

• Companioning and competency models are favoured by UK practitioners

What strategies and models are being used, particularly within the UK to deal with

spiritual issues.

Spiritual/philosophical frameworks employed by dying/bereaved people. Lloyd [Holloway] M. (1996)

1. Beliefs from childhood2. Beliefs/ values

developed through crisis3. Mature religious faith4. Humanistic approaches5. No frameworks

Bailey et al (2013) Black mothers bereaved through gun death.

Examining relationship between cognitive appraisal processes and resilience in traumatic loss.

Mothers’ spiritual beliefs enabled them to see the deaths served a purpose for them to fulfill a spiritual calling. The hope of fulfilling this purpose became greater than the pain of their suffering.

Importance of spirituality in facing death

ACTION 2Engage with social and public policy

Cognitive structure of compassion - 3 cognitive judgments:

1. The suffering is serious;2. The suffering is unmerited or excessive3. The victim is similar to oneself in significant

ways

Danger of parochialism- must find ways of widening sphere of concern and institutional mechanisms to ensure impact

Compassion (Marshall, 2012)

Hallmark is the spiritual liberation of the individual through changing the conditions of his or her life.

Liberation theologies

ACTION 3Embrace the model of the Wounded Healer

Origins in ancient Greek mythology and a number of writers have applied it to modern health and social care practice (Jung 1993; Nouwen 1994; Kearney 1996; Wright 2004);Wright suggests ‘woundedness’ resonates with chronic conditions of contemporary society BUT little used outside of palliative care. ‘For the patient, their wounds authenticate their narrative. For the healer, an exploration of the wounded self gives meaning to the healing process’ (Wright, 2004, p. 77). ‘Very simply, it is out of shared weakness and vulnerability that the healer reaches out to heal. The model teaches us to value rather than avoid our own pain, perhaps from a similar personal experience, as the key element which enables the healer to connect and communicate with the dying or bereaved person’ (Holloway, 2007, p. 178)

Spiritual Care – 4 concepts

Transcendence Transformation

Wholeness Hope

Means problematic situation no longer has problematic,

painful or oppressive impact

Spirituality which creates

transformational change

May mean holding all the

messy bits together

Not losing sight of the goodness of

life even when not visible

‘Light in light is invisible….but light in darkness gives great light and hope’ (Indian guru quoted in Maguire, 2001, p. 136).

‘….resurrection-faith is not to be had by passing over suffering, concrete conditions, opposition and antagonism, but only by going through all these. ..The cross is “surmountable” only in the light of the resurrection, but the resurrection can be lived only in the shadow of the cross (Kung, 1984, p. 147).

Illuminating the darkness

Stephen Cherry ‘Barefoot Prayers’

And so I pray:not for wisdom, not to see more, not to understand betternot to find life predictablenot to be the one who knows…but for the graceto see enough through my own beclouded eyes,to accept the morning mist in my mindand to walk into mystery

Mystery Hull-style

So erm, where do they actually go? Bloody hell… I don’t know… my mum’s maybe got a smoking room up there ... I don’t really know. But erm I do believe that they do come together. I believe that they do come together

And yet….