by Kelly Kahlstrom
“To heal, a person must first be a person”
As some of you know, in my Monday through Friday 8-5 life I am a nurse case manager for one of the state Medicaid programs. I work with women who have high risk pregnancies. These risk factors can be physical, like diabetes or high blood pressure; it can be emotional like anxiety/depression or other mood disorders; or social, like being homeless. Bella* is typical of many of the women with whom I have the privilege to speak. She is a 22-year old who is 3 months pregnant with her second child. Her oldest child, Rocky, is 15 months old. Bella’s pre-pregnancy weight was 215 and she was just diagnosed with Type II Diabetes. Her mother is her primary support both emotionally and financially while she stays home to care for her son. Bella and the father of the baby are not getting along since the news of this second, unplanned pregnancy. She has a history of anxiety but has never sought treatment for this. She has had one year of college and eventually would like to go back to school but her first pregnancy interrupted her studies. Historically my conversations with her would center on her diabetes and how it affects her pregnancy. I would offer behavioral health support and most of the time the offer would be declined by saying “I can manage it on my own; I just need to stay positive”. And I would leave it at that.
Recently however there has been a push within Medicaid to “integrate” disciplines so we do a better job of addressing more domains of health, noting that physical health, emotional health, spiritual health, and social health are all interrelated. Statistically, patterns have emerged which indicate that symptoms in one domain usually cascade through the other domains in fairly predictable ways. For instance, if one has a food addiction like Belle, it can be predicted that one might also suffer from physical limitations such as obesity and diabetes. Prescription drug use from back or joint pain is likely. Often there is a history of untreated anxiety/depression or other mood disorders and maintaining close relationships with others can be difficult. As you can see, an illness in one domain affects all domains of health. Illness is a spiritual event.
Now if we visualize the domains of health on a horizontal axis, as a snapshot in time, it is also helpful to remember that health throughout a person’s lifetime lies on the vertical axis. There is good reason to believe that two-thirds of us experienced at least one traumatic event in childhood. We now know that the more trauma a child has experienced, the greater the change to the neurobiology of the brain. This affects the body’s ability to process and recover from stress, especially chronic, unpredictable, toxic stress. Chronic exposure to this type of inflammation correlates significantly with auto-immune diseases, mood disorders, as well as substance use in adulthood decades after the initial exposure. So, with Belle, like many of the women I talk to, it is best to assume a history of trauma rather than not. This information radically broadens the conversation. The starting point may indeed be in the physical domain but, as rapport is established, the conversation can move across to other domains or backward to previous experiences and how these experiences might affect present and future health. It is here that I learned she was ridiculed as a child for her weight and she witnessed her older brother die of a heroin overdose. Often interpreted in childhood as a defect in their character, these types of experiences contribute to an ongoing angst in adulthood, pushed from thought by “being positive”, belied by reaching for the 8th cookie on the plate.
Which brings me to my real area of interest…spiritual health, and alas, it is the one domain of health I cannot talk openly about at work so I’ll muse about it here instead. Spiritual health is the point of origin, in my humble opinion, of both the horizontal dimensions of health and the vertical history of “how your biography becomes your biology”.
What exactly is Spiritual Health? Spiritual health is something that we all have a sense of but it is not always easy to articulate. I am drawn to Rabbi Abraham Heschel’s quote “To heal, a person must first be a person”. Could it perhaps be said then that spiritual malaise looks like a forgetting of what it means to be human? Without a protracted discussion with the philosophers amongst us, I would argue that one aspect of personhood is the need to make sense of the experiences in our lives. As Lord Rabbi Jonathan Sacks reminds us, “religion survives because it answers three questions that every reflective person must ask. Who am I? Why am I here? How then shall I live.” When we have forgotten who we are, what we are put on earth to do, and are unable to live up to our identified values, we have experiences but often miss the meaning of these experiences in our lives. Experiences without meaning leave us feeling empty, anxious, apathetic, conflicted, hurried or harried, self-absorbed or feeling we have something to prove. These disembodied feelings can originate from events that have occurred on either axis.
So if spiritual malaise is a forgetting of who we are, either from not recognizing that each domain of health affects the others, or by not understanding how events from childhood shape our adult health, what is the prescription? How do we recover the meaning by which we are able to re-interpret our experiences? “To heal, a person must first be a person” and awaken (again) to their own identity. I offer these as possibilities but this hardly represents an exhaustive list.
- A remembrance can happen through engaging in activities of quietude such as meditation, prayer, visualization, stretching, yoga, dream work, labyrinths, and mandalas.
- A remembrance can happen through a flash of insight while engaged in the profane or mundane tasks of our lives.
- A remembrance can happen when we take our faith seriously and actively work to deepen our spiritual life.
- A remembrance can happen through the development of strong social ties to a community that makes room for questions about identity, purpose and ethics.
- A remembrance can happen through consciously seeking ways to exercise each domain of health every day, i.e., eating well, participating in the spiritual practice of your choice, reaching out to a friend, or volunteering with an organization.
- A remembrance can happen when we work with professionals like spiritual directors and counselors who help us recognize and name the patterns of our experience.
Spiritual health opens up space to fully claim our humanity in the moments when we are awake. It allows us to be more fully in relationship with God or the Divine. It allows us to feel grounded in our purpose, to live with a sense of wonder and joy, to befriend death, to be a global citizen, and to practice forgiveness, compassion, and unconditional love. Not too shabby, huh?
I would argue that Bella is not unique to the population I work with. Her story, while uniquely hers, has elements that ring true for many of us. In fact, she is our colleague, our neighbor, our fellow congregants, and committee members. Perhaps even ourselves.
To heal a person must first be a person. Blessings on your journey!
* Names have been changed.
