Ewan Bowlby considers what spiritual care might look like in the context of contemporary secular healthcare institutions.
Delivering spiritual care used to be easy. In pre-Enlightenment Europe, spirituality was a fixed concept, inseparably linked to Christian theology. Healthcare institutions were familiar with this shared, stable spirituality and knew how to cater for it. In the famous Hospices de Beaune, founded in 1443, spirituality was integral to the care offered to the sick and dying. Staffed by a religious order, the hospice was intended to meet the medical and spiritual needs of patients. This dedication to the preservation and elevation of souls was symbolised in vibrant visual imagery by the Beaune Altarpiece. An ornate polyptych created by Rogier van der Weyden, the altarpiece consisted of a series of panels showing scenes from Christian mythology. Saint Sebastian and Saint Anthony, both associated with healing, were included in a range of images intended to reassure patients and direct their minds away from failing bodies toward higher things. Wards were intentionally placed within view of the altarpiece, so that patients could contemplate this irresistible statement of faith from the relative comfort of their bed.
In modern, secular healthcare institutions like the NHS, this approach to spiritual care is no longer viable. Scenes of Christian salvation have lost their relevance. In an increasingly diverse patient body, “spirituality” is now a complex, contested idea that means different things to different people. Before we can even begin trying to “do” spiritual care, we must work out what spirituality is within this contemporary context. Yet establishing a fixed definition of spirituality that can accommodate atheists, agnostics, a plurality of religious traditions, and all the personal spiritualities that fall between these categories, is surely impossible. Whilst it might be tempting, considering this, to abandon the enterprise of spiritual care, this is not an option. A growing body of evidence tells us that patients both want and need spiritual care. Patients still fell that spiritual issues are relevant to them, even if one person’s idea of what these issues are may differ greatly from another’s. Although attempts have been made to design ways of addressing spiritual needs and delivering spiritual care, these have been hampered by uncertainty caused by the vaguery and polyphony of spirituality today. As a result, spiritual care tends to be limited to a single question on a hospital admission form.
Important questions remain unanswered. What should spiritual care look like in the context of contemporary Western healthcare? How should spiritual care be delivered? And, can the arts continue to play a role in the provision of spiritual care?
The aim of my current research is to begin to answer these questions by showing how arts-based interventions can become the foundation of a new approach to spiritual care. Where once the intricate panels of the Beaune Altarpiece helped suffering souls to find consolation, I am investigating how modern, mass-media artforms can enrich a cancer patient’s search for meaning. These artforms can provide the language and narrative framework required for the discussion or resolution of spiritual concerns. Accessible fictional narratives found in novels, films, or television series often deal directly with the “Big Questions” cancer raises, addressing themes like mortality, hope, and despair. These cultural products also tend to engage with the diverse, democratised form of spirituality prevalent in the arts today – the collective search for meaning amidst the chaos of life, sickness, and death. What if these artforms can fulfil an analogous role to religious symbolism and mythology, providing inspiration, stories, and imagery that can be integrated into spiritual care? Of course, we have a different relationship to these artforms. They are not the vehicles of universally held, indisputable religious doctrines. Instead, they seem to have become a new site for spiritual exploration – a new way of accessing and understanding the existential tumult of illness.
When, as a young man, I was diagnosed with brain cancer, it was not my superficial, unchallenged Christian faith that first enabled me to find meaning in my situation. Instead, it was flashes of resonance in fictional narratives that provided me with a means of processing and expressing my thoughts and emotions. When I returned to research, I began to wonder if what I had learned could be productively applied in spiritual care. Could what had been, for me, a serendipitous process governed by coincidence, become the basis for targeted interventions?
Now, I am nearing the end of a PhD project in which I have designed and trialled new arts-based interventions in spiritual care, using fictional narratives to help cancer patients address key spiritual themes. Instead of trying to resolve the uncertainty surrounding the conceptual vagueness of spirituality, I have shown how fictional narratives can open up neglected areas of experience, in a manner which accommodates each patient’s unique spiritual perspective. Whether as an aid to private reflection, or in a group setting, fictional narratives can frame and illustrate relevant spiritual issues without limiting the range of possible responses. This balances the objective need for spiritual care practices against the subjective requirements of each patient.
Working in collaboration with the Maggie’s Cancer Care Trust, and Northumberland Cancer Support Group, I have gathered evidence of the capacity for accessible, mass-media artforms to draw patients into a process of spiritual exploration. Like the Beaune Altarpiece designed to elevate patients too ill to leave their beds, these accessible artforms can afford imaginative impetus to the weary and suffering today. Through identifying with, or contrasting their perspective to, fictional portrayals of the existential impact of cancer, patients can consider and convey their own response to this impact. Through my research, I have also seen how fictional narratives can introduce patients to alternative perspectives, leading them toward new sources of hope and meaning. When I present my research at the Northern Network for Medical Humanities Congress in April 2021, I hope to show how these findings can inform a generous, inclusive approach to spiritual care, suited to the rich diversity of spiritualities that the NHS must cater for.
Ewan Bowlby is a doctoral student at the Institute for Theology, Imagination and the Arts (ITIA) at the University of St Andrews, researching ways of using popular artworks (novels, films and television series) in spiritual care interventions for cancer patients. He is developing the impact of his research through collaborations with the Maggie’s Cancer Care Trust and Northumberland Cancer Support Group (NCSG).
 See, for instance, Richard Egan, Anna Graham-DeMello, Sande Ramage and Barry Keane, ‘Spiritual care: What do cancer patients and their family members want? A co-design project’, Journal for the Study of Spirituality, 8:2 (2018), 142-159; Anja Visser, Bert Garssen, and Ad Vingerhoets, ‘Spirituality and well‐being in cancer patients: a review’, Psychooncology, 19 (2009), 565-72; Alan B. Astrow, Ann Wexler, Kenneth Texeira, M. Kai He, and Daniel P. Sulmasy, ‘Is failure to meet spiritual needs associated with cancer patients’ perceptions of quality of care?’, Journal of Clinical Oncology, 25 (2007), 5753-57.
 Nessa Coyle and Betty R. Ferrell, The Nature of Suffering and the Goals of Nursing (Oxford: Oxford University Press, 2008), p. 3.
 See Rina Arya, “Spirituality and Contemporary Art”, Oxford Research Encyclopaedias: Religion (Published online 31st August 2016): https://doi.org/10.1093/acrefore/9780199340378.013.209
Kutter Callaway and Barry Taylor, The Aesthetics of Atheism: Theology and Imagination in Contemporary Culture (Minneapolis: Fortress Press, 2019); Jeremy Begbie, Redeeming Transcendence in the Arts
Bearing Witness to the Triune God (London: SCM Press, 2018).