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Why do some people age gracefully, while others do not?

Why do individuals differ so greatly in their ability to roll with the punches? How is it possible for one person to be content and engaging despite significant physical challenges, while another in relatively good health is constantly grumpy and discouraged?

One reason is the way each person deals with the reality of suffering in life.

A matter of meaning

No one likes to suffer. After all, to suffer is to experience continual, undeserved pain of the body, mind, and spirit. To suffer is to feel pain that will not go away. Yet suffering, we must realize, is in the eye of the beholder. One person can be in pain without suffering, just as another can suffer without being in physical pain.

People who feel pain but do not suffer are unsurprised by pain. They recognize pain is a part of life, and a reminder they are alive.

Looking at their present situation, these individuals may not find meaning or purpose at the moment, but they expect to discover it someday. They understand they are human — vulnerable, finite, imperfect.

In contrast, people who suffer without physical pain believe they deserve a pain-free life. To their way of thinking, limitations should be managed, controlled, manipulated, and mastered. These individuals cannot easily find meaning or purpose in their present situation, because the pillars upon which they built their lives have been threatened or destroyed. They are in spiritual distress, hurting in the soul as well as the body.

Viktor Frankl, the noted Viennese psychiatrist and Holocaust survivor, coined this formula:

D=S-M, or despair (D) equals suffering (S) 'minus,' or without, meaning (M). Despair is the combination of pain with a sense of meaninglessness.

The other side of the coin is that having a sense of meaning in our lives can inure us to almost any pain. Frankl quotes Martin Heidegger, the existential philosopher, by noting that a person with a 'why' to live can deal with any 'how.'

Responses to pain

We all suffer, but to varying degrees. It's what we do with our pain that distinguishes people who age 'spiritedly' from those who do not.

Caring health and wellness professionals always consider how their patients respond to pain as individuals. Are they, as older adults, able to transcend pain and suffering to see the value and purpose in life? Do they realize they can find meaning in spite of pain, and sometimes even through that pain?

Unfortunately, health and wellness professionals sometimes cope with their patients' suffering by avoiding its complexities. That's because, in dealing with the suffering of others, professionals must often confront their own pain, vulnerability, and limitations. But professionals who have yet to come to terms with their pain may be closed or insensitive to their patients' pain and suffering.

Another way health and wellness professionals may deal with suffering is to try to fix it, as if they have the power to remedy another's suffering.

The truth is no one can fix another's pain. If Frankl is right and D does equal S-M, only the sufferer can work through his or her despair, because only he or she can judge this suffering to be meaningful, valuable, or worthy. Most sufferers do not seek 'answers.' They need companions who will listen to them and support them while they are suffering.

The gift of growth

My personal trainer once said the same words my high school track coach used to shout many years ago: "No pain, no gain." This cliché might be controversial in a senior wellness/fitness setting, but it turns out it is true in spiritual caregiving as well that growth comes whenever life is challenged.

Recommended Reading

• Albom, M. Tuesdays with Morrie. New York NY: Doubleday, 1997
• Byock, I. Dying Well: The Prospect of Growth at the End of Life. New York NY: Riverhead Books, 1997
• Eiesland, N. The Disabled God: Toward a Liberatory Theology of Disability. Nashville TN: Abingdon Press, 1994
• Frankl, V. Man's Search for Meaning. New York NY: Simon and Schuster, Inc., 1959
• Frankl, V. The Will to Meaning. New York NY: A Meridian Book, 1988
• Kurtz, E. and Ketcham, K. The Spirituality of Imperfection. New York NY: Bantam, 1992
• Lustbader, W. Counting on Kindness. New York NY: The Free Press, 1991

Labels: Feature Articles, For the Spirit, Koepke, Staff

While health care professionals are proficient in physical and even mental caregiving, few receive training or coaching in how to provide spiritual care. A holistic approach to care and interpersonal relations requires that not only the needs of body and mind are tended to, but the spiritual as well.

How does a health care professional provide spiritual care in a multi-religious or even a setting devoid of religion? The answer is to become aware of spiritual needs rather than focusing on religious requirements. What is the difference? While not everyone may practice a religion, every person has a spirit.

Four specific needs are suggested in an article titled "Spiritual Needs of Patients: Are They Recognized?" (Highfield, Carson. Cancer Nursing 6 1983: 188). These primary human needs are spiritual, but not specifically religious. While many persons fulfill these needs through religious practice, many others do not. But virtually everyone, whether practicing a religious tradition or not, has these same fundamental spiritual needs.

1. The need for meaning and purpose

Everyone needs a reason to get out of bed in the morning. Many of the best dementia care units provide "chores" that residents are responsible for (like watering the flowers or sweeping the room) as a method of lending meaning, motivation, and purpose to the day at hand. People who are aware of no purpose in their lives often become listless, depressed, angry or withdrawn. "Why can't I die? I am no good for anyone anymore!" are familiar laments by people who have lost their sense of meaning.

2. The need to give love

A person needs to give love, not just to receive it. In fact, many depressions develop not because the individual has no one to love them, but because of an inability or lack of opportunity to love others. Instead of having a focus outside of themselves, the focus of these people is directed inward – to a recent health setback, a perceived slight, or the latest ache or pain. All of us have a very real need to be concerned, connected, and involved in something beyond ourselves and our immediate interests.

3. The need to receive love

All people have a need to be loved. Many studies suggest that if infants are not cuddled they do not thrive. The same is true for people of advanced years. Sometimes love is hard for a person to receive out of fear of becoming dependent or indebted to someone else. Yet the need to be loved, and know that we are loved, remains an essential component of our well-being.

4. The need for forgiveness, creativity, and hope

Finally, there is the need for forgiveness, creativity, and hope. Every person needs to feel as though their future is open and holds possibilities. Sometimes, people need to be able to release and forgive the past in order to move on. But every individual needs to feel as though they are a player in the creation of their own future. We all need the hope that tomorrow will be livable and worth living for.

Each one of us is trying in some way to fulfill these spiritual needs through what we do, how we feel, and how we respond to life's twists and turns. If any one or more of these needs are unfulfilled, spiritual distress arises, a distress that is often beyond the purview of physicians and nurses, but makes perfect sense to the spiritual caregiver.

Within every social or caregiving encounter we have with a senior, we have a new opportunity to become aware of and attentive to their spiritual needs – looking not only at the body and mind, but also at the spirit, with an approach that respects the needs of the "whole person."

Rev. Donald Koepke is the director emeritus of the Center for Spirituality and Aging (CSA), a program of California Lutheran Homes and Community Services, headquartered in Southern California. Rev. Koepke has presented many workshops on spirituality and aging. He is also the producer of the DVD, "Caring for Elders: Body, Mind and Spirit," which presents the concepts of the author, psychiatrist and Holocaust survivor, Viktor Frankl, as applied to aging. For further study on spirituality and aging visit the CSA website at http://www.spiritualityandaging.org/.

Labels: Feature Articles, For the Spirit, Koepke, Religion, Spiritual Care