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Spiritus, Fundamentum, Credere. Spirituality and Philosophy of Spiritus in Hospitals and Dementia Health Care Centers

Sébastien Falardeau

Sébastien Falardeau

L’auteur est intervenant en soins spirituels au CSSS de Rouyn-Noranda, Vice-Président et chercheur au CÉINR.





“What is spirituality?” It is a complex question. One thing we can say is that spirituality is present in the life of human beings: “The wind blows where it wills” (Jn 3: 8). Spirituality is rooted in today’s world. Indeed, spirituality is not limited to academics and practitioners in the field of spiritual care. We find the theme of spirituality in many preferred books written for small children: for example, think of Dora the Explorer, Merry Christmas (2012). They are various shows in which young children listen to religiously or, should I rather say, spiritually, such as The Simpsons: “The Father, the Son, and the Holy Guest Star” (06/15/2005); “Homer the Heretic” (10/08/1992); “Missionary Impossible” (2/20/2000) “Simpsons Roasting on an Open Fire” (12/17/1989), not forgetting Homer’s Spirit Guide, the Space Coyote alias Wolfy. Achille Talon and Spirou, exceptional comics, also evoke spirituality. Worth mentioning are also popular magazines such as Spirituality & Health; Soul & Spirit; Body, Soul & Spirit; Spiritual Wisdom. The cartoonist Loren Fishman and his drawing on spirituality Ifin 439 “Make me one with everything” depicts a Buddhist who request the hot dog seller to give him a hot dog with all the ingredients available. Another design 115027 (8-23) of Rina Piccolo “Credit Rating Bureau. For an additional fifteen dollars you can have your karma checked as well” evokes the economical aspect of spirituality as does the Canadian court: Spirit Drinks Trade Act, S.C. 2005, c.39. Spirituality today also inspires musicians like reggeaman Mike Love and the death metal group Death and their album “Spiritual Healing”. Radio, magazines, comic books, novels, TV shows, economics, politics and law: spirituality is at the rendez-vous in your life.

Why so many evocations of spirituality in this scientific era, an era centered on empiricism? “Notre époque est celle du rejet ou de l’oubli de l’a priori” note Jean Grondin. What characterizes our time can be a “cécité métaphysique qui nous empêche d’intuitionner quelque a priori que ce soit”. As in Kant’s century, one could argue that today we also discredit (or, at best, show an indifference towards) metaphysics (Kant, AK, IV, 8; XI A). Have we really lost “the sense of a priori”? Should we restore metaphysics at all costs in spiritual care?

Reminiscent to Kant’s reflection in his own time, our goal is to share some thoughts on the meaning of “spirituality” in today’s spiritual care. Throughout the course of this article, we will show that the importance of the breath has not been lost and that our century remains basically philosophical with regard to three key concepts: spiritus, fundamentum and the credere.

Some time ago, we did write and lecture on the topic of listening, based on metaphysics of credere and philosophical a prioris, laying the foundations of listening in a metaphysical perspective. The present article will focus on the listening of spiritus, a new concept that emerges from our experience in clinical spiritual care. How can we integrate listening to spiritus in clinical spiritual care? We believe that from listening to spiritus, we can open new horizons in the field of listening in spiritual care, which will have an impact in other areas of listening.

Our thesis does not deal with the philosophical debate between metaphysics and physics or the debate between spirituality and neurosciences. Indeed, the originality of our posture is to present an inclusive rather than an exclusive thesis: we do not oppose metaphysics to physics, or spirituality to neurosciences, for example. The novelty of the notion of listening to credere is significant, but it may sometimes fall into a dualistic logic (credere or truth) or, at the opposite, take for itself all the meaning of the life into credere. The assumption that we put forward, the listening to spiritus, helps weave together both physical and metaphysical aspects: the listening to spiritus belongs to the dimension of the unseizable (insaisissable).

We shall start with an overview of the definitions in contemporary spirituality before proposing a return to the etymology of the term spiritus which will form the basis for listening to spiritus in health care centers; and this notion will be grafted to the fundamentum and the credere in the field of listening in spiritual care.




1.1. Philosophy of Spiritus


1.1.1. Definition of Spiritualities

Today, as well as in the 20th century, there has been effervescence (and flaws) in the scientific literature on secular (or lay) spirituality, particularly in hospitals and health care centers. Indeed, a simple quick look on studies in spirituality is sufficient to note that specialists such as Sandra M. Estanek, W. McSherry & K. Cash, Michael B. King & Harold G. Koenig, view spirituality as an independent field of religion. Spirituality would be, then, a new emerging discipline, a secular spirituality that is no longer under the tutelage of theology and religion, as underlined by Philip Sheldrake. In this regard, Jinpa remarks that contemporary definitions of spirituality are strictly secular, thus opening the way to the advent of spiritual anthropology in the medical field in hospitals and health care centers, for example. We will present here some definitions of spirituality that seems to be the most representative of this era:

  1. “Spirituality is the personal quest for understanding answers to ultimate questions about life, about meaning and about relationship to the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of community”.

  2. “Everyone embodies a spirituality, even if it be a nihilistic or materialistic spirituality…Spirituality refers to a person’s ultimate values and commitments, regardless of their content”.

  3. “(…) the experience of conscious involvement in the project of life integration through self-transcendence toward the ultimate value one perceives”.

That said, despite the secularization of the notion of spirituality and the strictly rational turn made by anthropology and the medical sciences in the realm of spirituality, the fact remains that, even among specialists, major problems arise concerning the definitions of spirituality. In this regard, as argued by Van Ness, contemporary notions of spirituality are applicable to both the secular and the religious sphere. Indeed, Kourie rightly observes that spirituality is a concept that applies to and is used in many professions: “The present era is witnessing an ever- increasing interest in the phenomenon of spirituality, not only among religious persons, but from all quarters of society. In fact, the term ‘spirituality’ has become something of a ‘buzz’ word, used, inter alia, by medical doctors, psychologists, psychiatrists, political scientists, business women and men, ecologists, sociologists, human rights activists, anthropologists, literature scholars, artists, as well as theologians”.

At first glance, the availability of a universal concept of spirituality, a tailored concept ready-to-wear, does not seem to be a problem. But a closer look at it led Sandra M. Estanek to bring two interesting arguments: first, in agreement with Philip Sheldrake, she emphasizes the fact that there is no consensus on the definition of spirituality; in addition, there are several definitions of spirituality which appear too vague, even if we can draw some similarities between them.

In fact, W. McSherry, K. Cash, Michael B. King and Harold G. Koenig observe that too many definitions of spirituality may cause a loss of its significance when devoid of any reference to specific traditions or a to the specificity of some professions: “(…) when almost any experience can be called spiritual any attempt at definition risks becoming for all practical purposes useless (…) this can also mean that if spirituality is everything then it is also nothing”. In sum, according to Kourie:

The persistent interest in the phenomenon of spirituality is all the more remarkable given the fact that there is no clear, unequivocal definition of the concept that is acceptable to all interested in the field. In fact, in many circles there is widespread confusion regarding the very meaning of spirituality, and its use has become “fluid”. In certain quarters, spirituality denotes escapism, inactivity, and irrelevance while in other quarters it refers to full human maturation. It is an umbrella term which covers a myriad of activities ranging from the deeply creative to the distinctively bizarre. Its popular usage covers all sorts of beliefs and values, and its usage is often imprecise. The amorphous nature of the term thus contributes to the fact that it is resistant to a concise definition. It has been described as an “applause-word”.


1.1.2. Problematic Definitions of Spirituality in Health Care Center


We would like to make a few remarks about contemporary spirituality in Quebec hospitals and health care centers. Recently, steered by the Health Ministry, there has been a transition from the traditional confessional approach to a non- denominational approach for the delivery of spiritual care in hospitals and health care centers. The result of this noble “revolution”: spiritual care is no more relies on Christian theological concepts. However, spiritual care that relies only on the anthropological and the secular definitions of contemporary spirituality, without theological references, faces crucial problems: not only does it loose its specificity and its theological roots, but its role in hospitals and health care centers becomes so vague that it seems to be the apanage of almost all professions. Indeed, health professionals of various fields work with essentially the same indefinite, all- inclusive definitions of spirituality. They also employ, not always soundly, the concepts of spirituality used to define the particular meaning of life, daily life, identity, transcendence, values  and beliefs; all concepts that were before the specific field of philosophers and theologians. Although contemporary definitions of spirituality do have the merit of providing a “middle field”, appealing for different specialists in hospitals and health care centers, the fact remains that their blurred edges bring more confusion than clarity. In this regard, we note that doctors, nurses, social workers, psychologists, as well as “spiritual stake-holders”, do rely on the same vague definitions. How, then, can we characterize the concepts of values, meaning of life, beliefs, among others?

It is not uncommon to hear spiritual care professionals define their role as “psychologists”, while social workers argue that they do the same type of work. This tendency to sanitize and uproot the concept of spirituality from its two basic traditions, philosophy and theology, in order to obtain a neutral, objective concept suitable for all situations is counterproductive. Although a strictly anthropological position is a relevant field to deepen, it should be supported by a philosophical concept, the transcendental dialectic, as we shall see. It is by rediscovering the philosophical and theological definition of spirituality that spiritual care will be able to fulfill its very specific role in hospitals and health care centers.

It is true that many scholars have made a radical distinction between spirituality and theology. That said, there are erudite studies that question this radical separation between spirituality and theology: for example, the works of Jean- Claude Breton, C. Kourie, and K. Waaijman. These well-documented studies (although not refering to the Greek philosophical heritage of pneuma) explicitly show that spirituality is closely linked to Christianity, is rooted in the Bible with St. Paul, and extends into the patristic current. Despite an effort to reinstate the concept of spirituality within biblical theology, the fact remains that these researches emphasize the primacy of spiritual anthropology; at any time, it has priority over theology and religion.


1.1.3.Towards a Return to the Etymology of Spiritus in Hospitals and Health Care Centers


Unlike Quebec spiritual care professionals who built their practice in hospital and health care centers on the basis of contemporary definitions of spirituality, we propose a revolution in spiritual care by putting forward a definition of spirituality grounded on philosophy and theology. The major change involves a return to the etymology of pneuma, ruach and spiritus. This means for us to draw in philosophical sources.

We will see that the concepts of pneuma, ruach and spiritus are not secondary concepts: on the contrary, they are at the center and at the source of the philosophical and the theological arsenal. It is imperative to study the etymology of pneuma, ruach and spiritus in order to define as much as possible our clinical hypothesis and avoid unfortunate interpretations and misinterpretations that could obscure rather than clarify the definition of the spiritus.

Our primary goal is not to make a detailed historical exegesis of the philosophical notions of pneuma (as presented by Presocratics, Plato, Aristotle, Plotinus, Porphyry, Stoics and others) nor of the biblical definitions of ruah/pneuma or the theology of spiritus as found in the works of the Fathers of the Church. A detailed analysis of these notions can be found in the scholarly work of G. Verbreke and the excellent study of Richard Bodéüs, the works of Jean-Claude Breton, Odette Mainville and André Myre (which yield an exceptional panorama of biblical citations) and the semantic maps of breath by Alexandre François.

The etymology of pneuma (πνεύμα), whether philosophical or theological, refers exactly to the same thing: the breath. The biblical etymology of ruach in the Old Testament in Hebrew also relates to the breath, literally: breathing, wind, concept closely related to Nephesh, שֶׁפ נֶּ ַ which is quite often translated as: being alive, the principle which makes the living body, soul and flesh, ie the whole person. It is the Hebrew word ruach of the Old Testament, translated as the Greek word pneuma found in the New Testament, which yields the notion of breath. In the Latin Christian tradition, the equivalent word for pneuma and ruach, is the term spiritus. The legacy of spiritus according to Richard Bodéüs is twofold: the pneuma of the Greek philosophers and the pneuma of the evangelists. The words spiritus, spiritulis and spiritualis are formed from the Latin root “spir” which means “breath” or “breathing”. To this root, one can add the suffix – tus to form names such as spiritus, meaning “the breath”. One can also add the suffix -alis (suffix used to form adjectives in English -al composed of, for example, spiritual), to form spiritualis, meaning relating to the breath or the mind; and finally, there is also the suffix -itas as in spiritualitas, defined as the life of the mind or soul.

The study by Richard Bodéüs is essential for understanding the concept of pneuma among Greek philosophers and among evangelists. It is true, he notes, that philosophers, biblical scholars and theologians oppose the immaterial to the material, the intangible to the tangible or, if one prefers, the intangible to biology or the unmeasurable to what can be measured empirically. Although the patristic writers and modern philosophers have developed an immaterial or metaphysical conceptions of breath in order to get the breath oppose matter, this is a late semantic evolution:

Il en est résulté des conséquences pour les questions à débattre, si l’on ose dire, en aval et en amont. En aval, depuis les Temps Modernes et jusqu’à nos jours, les questions philosophiques ont engagé l’esprit dans un dilemme où il s’oppose non seulement au saisissable, mais à la matière : “Au regard de tous les phénomènes matériels, l’esprit c’est l’autre. Autre que tout ce qui peut être mesuré, observé, compté, vérifié”. Dès lors, tout se passe comme si la matière pouvait être réduite à l’épaisseur du saisissable, et comme si l’immatériel devait échapper à l’intelligible. Ce genre de conviction consacre, maintenant encore, le divorce malheureux entre une science “dure”, conspuée pour ses certitudes massives, et une pensée “légère”, non scientifique, décriée pour son inintelligibilité éthérée.

In this regard, it is worth emphasizing those philosophers (Plato and Aristotle, among others) and biblical authors who do not refer to a concept of opposition when they discuss the notion of breath. It is an exegetical mistake to oppose the breath to matter by allocating an immaterial or a material component to breath. The distinction of epistemology, ontology, philosophy, theology and physics as separate fields is a construct of the human mind based on the concept of duality/opposition: metaphysics and physics, being and non-being, intangible and tangible, etc.

What is important to understand in our argument is that, even within the being, there is a certain duality/opposition inherent to its ontological structure; the breath refers strictly to the elusive aspects of the being, both material and immaterial: “the part of the being escaped”. In other words, the breath does not belong to a logic of either metaphysics or physics, material or immaterial, because it is in the realm of the unseizable (“l’insaisissable”, “what cannot be grasped”). Like the ancient philosophers (Plato, Aristotle), the biblical authors use the notion of ruach and pneuma to talk about the elusive subtlety of the immateriality, underlining also, at the same time, the elusive subtlety of matter.

In this sense, the essential aspect of the breath is that it cannot be reduced to one of two dualities or oppositions. The essence of the breath encompasses both dualities and cannot be grasped in either one or in between. Indeed, the breath highlights both the part of immateriality and of materiality that escapes human beings at both the epistemological and the moral levels, as underlined by Richard Bodéüs. The pleading for the concept of breath does not revolve around the debate between the intangible and the tangible, but on the aspects of the unseizable, bearing that way some analogy with the debate over divinity:

Non seulement le souffle divin n’a pas de forme (permanente ou consistante) qui se laisserait appréhender ou connaître, mais cela même qui le rend perpétuellement insaisissable (dans son perpétuel changement) est commandé par sa propre volonté : lui seul a les secrets de son être. On voit ici à quel point, en conférant à Dieu la nature de l’esprit, le philosophe grec (Posidonios) répond à une question étrangère à celle de savoir s’il est corporel ou non, et dans quel sens assez précis va la question à laquelle il s’efforce de répondre en affirmant que Dieu est d’une subtilité insaisissable : il s’agit de savoir s’il est de nature telle que nous puissions le concevoir et percer son secret, la réponse suggérée étant négative.

The situation is essentially the same in the biblical texts dealing with the notion of breath. When discussing the nature of God, John the Evangelist does not speak about the materiality or the immateriality of God, but rather on its unseizable aspect (Jn 3:8). The episode of the disciples of Emmaus (Luke 24:13-37) is another excellent example of the unseizable aspects of the breath: Jesus appears as a physical entity, so corporal, but remains at the same time intangible. In this setting, the breath emphasizes the elusiveness of the body of Jesus and the intangibility of the bodily resurrection of Christ.

In summary, the concern of philosophers, theologians and biblical scholars treating of the breath, the spiritus, is not really to settle the debate over its materiality or its immateriality, but rather to emphasize the fact that these entities are unseizable to human’s mind.


1.1.4. Opening perspectives in clinical spiritual care


In contemporary hospitals and health care centers, spiritual care places itself, albeit unconsciously, in an ambiguous and rather vague posture. Indeed, following the scientific discoveries in psychology, in social work, and in medicine, the mainstream in spiritual care in Quebec is to create tools or clinical instruments to achieve a “spiritual diagnosis”. The goal is to find ways to measure spiritual symptoms. This is quite different from our proposal which is to listen to the spiritus. Our position does not settle for one side or the other of the transcendental dialectic. In this sense, as we shall see, listening to the spiritus is listening to the elusive part that we can not control or can not calculate in the spiritual experience of patients and residents with or without dementia. “Listening in spiritual care” is structured around the spiritus. Indeed, the empirical neurological hypothesis of dementia, for example, remains a mystery even now, since the cause is not yet fully known, as pointed out by many scientific studies.


2. Philosophy of Fundamentum


In our path to lay a psychic foundation for spiritual care, we will look at the philosophical notion of a priori. We will see later how the notion of spiritus is linked to the a priori and a posteriori in spiritual care. It may seem odd to return to the primary interest of philosophy: the a priori. Philosophy focuses on the root cause (or root causes), the principles, the a priori, on what precedes the experience, the contingency, the mutability, the ephemeral, as noted by Jean Grondin in a master study:

Depuis Parménide et Platon, la réflexion qu’on appelle philosophie a toujours aspiré à une connaissance a priori, c’est-à-dire un savoir qui ne dépende pas de l’expérience et qui soit, par conséquent, nécessaire et universel. De Parménide à Wolff, le domaine de l’a priori est celui des vérités immuables et éternelles que peut atteindre le vous, la raison, l’organe divin en nous.

In this definition of philosophy, we can see that the a priori is present and is independent from the experience, a strictly pure knowledge a priori, as amply discussed by Kant. The area of interest and the specificity of philosophy is the field of anteriority, of metaphysics, of ontology as well as the field of phenomenology. The scholar Jean Grondin goes on to note that the a priori would be the domain of the foundation of everything else:

Tout dictionnaire de la philosophie signalera qu’a priori vient du grec πρότερον, ce qui est ‘antérieur’ ou ‘premier’, par suite ce qui est ‘fondamental’. Le πρότερον est un concept de relation, plus exactement un comparatif (que marque – τερον en grec) : il désigne un rapport de plus grande antériorité en regard de ce qui est postérieur, ϋστερον, c’est-à-dire a posteriori. Philosophiquement, le πρότερον, le ‘plus antérieur’, c’est le rapport du πρώτον, du principe, à ce qu’il fonde, à ce qui en dérive.

Now, rightly, Jean Grondin points out that it would be surprising that a theory, no matter which one, can be built without a philosophical a priori :

Quelle que soit la forme qu’elle (la philosophie) emprunte, la recherche a priori détermine en son essence l’interrogation philosophique. Il ne sera à coup sûr jamais possible, ni même souhaitable, de trouver une caractérisation du travail philosophique qui satisfasse tous les philosophes et toutes les tendances. Mais si un consensus très général peut être établi, il gravitera sans doute autour de l’idée de la philosophie comprise comme réflexion fondamentale. Pour la pensée classique, cette conception désignait automatiquement l’objet de la recherche philosophique : la philosophie doit porter sur les fondements (du réel, de la connaissance, de l’agir, etc.), les principes, les causes premières, en un mot l’a priori, ce qui est premier, antérieur et fondateur de tout le reste. Pour nous, cette idée de la philosophie caractérise peut-être moins l’objet que l’élan ou l’accomplissement, existentiellement enraciné, de l’activité philosophante : la philosophie se comprend aujourd’hui comme la discipline sur des questions fondamentales ou réflexion sur les problèmes fondamentaux (le langage, la vérité, la praxis, l’epistèmè qui nous détermine, etc.). L’approche et le thème de la réflexion varient selon les écoles, mais chaque philosophie élève la prétention d’être une méditation fondamentale. La réflexion sur le langage, l’être social ou la volonté de puissance, par exemple, devient philosophique dès l’instant où elle s’impose comme incontournable. L’interrogation sur l’être social peut paisiblement relever de la sociologie comme celle sur le langage de la linguistique si ces dimensions ne sont envisagées que comme des aspects de la réalité qui cohabitent avec d’autres, sans se déclarer plus fondamentales. Mais dès que le sociologue entreprend de démontrer que l’homme n’est dans son essence (a priori) rien d’autre qu’un rouage de sa classe sociale ou de la lutte des classes et que cette détermination sociale fonde tout le reste (l’idéologie, l’agir, la connaissance, la religion), il s’aventure sur le terrain de la réflexion philosophique, d’une théorie a priori.

In this regard, nursing and social services venture out, blindly, on the ground of philosophy, in strictly developing a priori theories. For example, according to Dezerotes, some major studies in social work define spirituality in terms of strength of relationship and unity between the subject and its social environment, this unification allowing the restoration of the social health of the person. Canda and Furman define, in turn, spirituality in social services as a healthy spirituality as opposed to a negative spirituality with false beliefs. St-Amand is also trying to establish a social theory on the laws governing the social world, values and the Other.

In turn, nursing, according to the scholarly research of Taylor, argues that spirituality is an essential and basic need of human nature, fulfilling at least three basic needs: needs related to the self and other needs linked to transcendence. There is nothing new in such a priori theories of social sciences and nursing. In fact, both enroll in the current empiricism or idealism. Idealism, as underlined by Kant, presupposes the existence of an a priori concept, whereas empiricism, founded by Francis Bacon and his successors, Thomas Hobbes, John Locke and David Hume, considers that the foundation and the first principle of knowledge reside in the sensory experience, thus in the matter.


2.1. The Transcendental Dialectic


However, the question of the a priori can not be separated from the problematic of transcendental dialectic. In the Critique of Pure Reason, the aim of Kant was to question harshly the function, the constitution and the internal limits of pure reason in the field of the a priori in metaphysics, psychology, cosmology as well as ethics. Briefly, Kant argues in metaphysics that the principle inherent in pure reason, which is to seek the unconditioned from the conditioned, leads to an infinite regression, precluding the possibility of ever reaching a final conclusion. In addition, going back from the effect to the cause results in an infinite movement since it is impossible to reach and prove a first principle. In this sense, the syllogism is then the key to the logical and rigorous support of both aspects of the thesis and the antithesis. Thus, even though the syllogism remains the basis for reasoning, the first principles themselves cannot be proved. This phenomenon has been clearly identified by Kant who calls it “transcendental dialectic” or questions that can be argued endlessly.

Consequently, with regard to speculative and theoretical psychology, pure reason is also in an uneasy position, one of “transcendental illusion”, in Kantian terminology. Far from being a scientific evidence of the nature of the soul and the transcendental ideas, psychology is rather the result of human subjectivity   39. This is a major consideration, from which it can be assumed that, at the level of rational psychology, a demonstration of the “thinking soul” or of the “I” is impossible since the subject cannot get rid of his subjectivity in order to achieve pure objectivity. According to Kant, then, pure reason is forever sentenced to believe in the a priori or the constitutive principles of the soul, with no possibility to overcome the necessity of the belief. Why? Unable to grasp a canonical proof of the a priori by pure introspection (a non-sensible intuition), pure reason is challenged by paradoxes (antinomies) and is forced, by the very nature of its subjective position in the psyche, in a relation to believe. In this regard, we should recall that the objective of Kant is not limited to the plain elaboration of  a “transcendental grammar that contains the foundation of human language” nor to the introduction of the “the only text of rational psychology”. Kant also uses psychology to show that the belief is right at the heart of the psyche of the transcendental subject and metaphysical questions are inherent to the pure reason. According to Kant, the psychic structure is built upon the logic of an a priori error inherent to and constitutive of the reason; and psychic structure inevitably leads to a dialectical illusion, falsely claiming the knowledge of objects outside the scope of the experience.

This affirmation is important because it helps to understand why, in the first preface of Critique of Pure Reason, Kant cautions readers about metaphysics being in “anarchy”. And, with regard to first principles, this statement does not only apply to metaphysics but also to psychology which, unable to provide a proof by concept or by syllogism, is as much in anarchy as is metaphysics (i.e. without principles) due the fact that it focuses on, and cannot solve, problems and paradoxes (aporias) beyond the scope of empirical experience and subjectivity. In fact, the Kantian revolution is a radical demarcation from the Cartesian postulate of Cogito ergo sum as well as the res cogitans and from Locke’s “self of consciousness” (a direct access to oneself). The hypothesis that we can access our own thoughts is no more tenable after Kant refutation of the paralogisms of rational psychology.

In contemporary hospitals and health care centers, spiritual care and neurology (and psychiatry) have the same metaphysical and empirical debate. Currently, spiritual care bends on the side of metaphysics while neurology and psychiatry promote an empirical thesis of neurological and psychiatric diseases. Psychologists and social workers also discuss the dimension of spirituality from an empirical point of view, trying to use some scientific tools and measurable parameters to assess “spiritual diseases” and the delivery of spiritual care in hospitals and health care centers. However, it is important to emphasize that transcendental dialectic teaches us that, whatever the position taken, one is forced to start his demonstration from an a priori which cannot be proved. For example, at the beginning of the 21st century, it could be equally appropriate to support a strictly scientific (neurological) theory of dementia as well as, conversely, a metaphysical thesis of dementia, considering the actual impossibility to prove the first principles.

That said, in spiritual care, the transcendental dialectic posture can not decide between idealism versus empiricism: listening to spiritus is certainly linked in a transcendental dialectic, but at no time listening to spiritus is directed toward either a priori or a osteriori. Instead, listening moves towards the fundamentum, to the unseizable, to the first foundation (first principle), but without taking a position for, or against, metaphysics or physics, for or against a metaphysical or an anthropological definition of spiritual care. The transcendental dialectic approach to spiritual care has the merit of dual stand allowing for a sound intervention based on both the anthropological and metaphysical aspects of spirituality. Whatever the position, be it empirical or transcendental, adopted by the neurologists, psychiatrists, the social workers, the nurses or the spiritual care professionals, it will be impossible to ignore transcendental dialectic, which is an inherent part of the psychic dimension of the transcendental subject.


3. Philosophy of Credere


This operation of the mind, which forms the belief of any matter of fact, seems hitherto to have been one of the greatest mysteries of philosophy; though no one has so much as suspected that there was any difficulty in the case; and that even when I think I understand the subject perfectly, I am at a loss for terms to express my meaning.

We now reach the third concept, credere, which we want to include in our approach to clinical spiritual care. In transcendental dialectic, credere is closely linked to the spiritus. In fact, credere is inherent to the structure of the subject of spiritus. Credere, as an act of trust, directly involves the “talking”. According to Algirdas Julien Greimas :

Le latin “credere” couvrait en même temps les champs de signification, aujourd’hui séparés, de croyance et de confiance ; la confiance entre les hommes, établie et maintenue, fondait la confiance dans leur dire sur les choses et, finalement, dans les choses elles-mêmes.

We see clearly in the definition of Greimas, that credere (believe) covers both the field of belief and the field of trust. In this regard, one of the errors of modernity is to associate too quickly believe, belief and faith with the religious field. It is true that believing, defined as an “acte de confiance (en un dieu) impliquant restitution sous forme de faveur divine accordée au fidèle” has a religious connotation. However believing is also given an analogous definition in the economic domain: “confier une chose avec certitude de la récupérer”. So, there is a credit in the act of exchange, for a return.

There is not an absolute correspondence between theories and objects. When the first principles cannot be proved, a relationship of trust, or believe, between theories and objects must intervene. But we often forget that this philosophical quest for principles arises from hypotheses whose etymology is very significant because it involves a lack, a deficiency, an opinion, an assertion. The building of knowledge blossoms on the mere existence of a lack. However, the building of knowledge would be impossible without the intervention of credere in the first principles. The philosophical quest is done from various approaches: the unconscious, the consciousness, the reason, and the soul for example. In this article, we base our quest for truth, the origins, the beginnings, among others, on the central concept of credere. From the point of view of the subject of credere, this certainly has to do with the truth, but in the sense of “holding-for-true” (Fürwahrhalten).

The assertion that credere is experienced from, and within, the psyche implies that we have to rely trustfully upon language even though networks of significant dynamic differentials interact and contribute to structure our soul without our knowledge. Thus, the introduction of a new variable in our psyche and our network of signifiers is sufficient to bring about a change in our relation to credere and to induce changes modifying the interrelations and interactions of the structuring elements of the psyche and the signifiers. Indeed, it is the credere which allows for the movement, not only of variables, but also of the structures, either by introducing new elements or by modifying the signifier structure. Experiencing the believe starts from the articulation of signifiers. The listening to credere is a movement of the human being who, by her words, constructs himself as a speaking and a desiring subject. In fact, credere can propel us in another scene and another dimension of love.

Nonetheless, believe provides opportunities for knowledge by uncovering new paths to knowledge. Our knowledge, which hopefully points to the truth, is based on believe. There is no prior knowledge about and science regarding pre archetypes. In clinical spiritual care, when patients talk about their experience of credere, they do not express certainty, but a sense of lack, doubt, and uncertainty. In other words, the immediacy of credere is not given in direct relation to the object. How then can we listen to a patient by taking into account his relation to credere without reducing his belief to a scientifically analyzable object? In this sense, in the clinical field, listening to the credere takes into account the relation of a person to credere without reducing the credere neither to the sole subjective dimension nor to the simple empirical analysis of an object.

Unlike in spiritual care, other professionals in health care centers address credere on the side of the imaginary, the conscious self, although credere belongs to the field of the spiritus. For example, in a classic case, when a person from a sect is hospitalized, the primary objective of other professionals is to bring the patient to reality. The goal is to have the patient get rid of his beliefs, his imaginary world, and find the truth, the reality as seen by “normal” people. On the other hand, spiritual care does not lie on the imaginary side, but on the symbolic side of the act of the subject. For other health professionals, these beliefs are a cognitive distortion, something that opposes reality, an intellectual aberration that should be corrected. Spiritual care does not put the emphasis on reality, since it is not the content of the beliefs that seems fundamental, but the relation to credere that puts the subject in a movement.

If we stay in the sphere of the mere beliefs, we risk harming the patient by wanting to change his belief in order to reach our truth. Listening to credere, the act of believing of the subject, allows us to stand on the slope of credere of the spiritus and share the moment when the transcendental subject is concerned with identity, with something that transcends the symbols of his beliefs. Spiritual care is not a therapeutical relationship: such an approach implies that the person is sick and needs treatment (helping relationship and helping alliance): spiritual care is rather the art of listening to the subject, to the credere itself, in order to intervene in spiritual crisis.


Conclusion


Throughout this article, we did try to identify the essence and the uniqueness of spiritual care starting from three major concepts: spiritus, fundamentum and credere. Based on the concept of spiritus, we fundamentally challenge the definitions of contemporary spirituality. Our objective is to go back to the etymology of spiritus in order to make a turn from the current dilute definitions previously proposed and provide an original approach which, we think, is crucial for the future of clinical spiritual care research. The major contribution of our thesis is that listening to the spiritus in spiritual care, which differs from listening to the credere, can not be described in terms of opposition. We want to emphazise that the notion of spiritus is a hyphen notion of metaphysics and physics. Listening to the spiritus does not belong to the dichotomy of immateriality and materiality, of belief and truth, but to the realm of the unseizable.

Although other health care professions such as psychology, sociology, psychiatry, for example, may claim that they tackle objectively the phenomenon (“what can be grasped” empirically), they nonetheless have to refer (consciously or not), as do philosophers and theologians, to a first principle, to a fundamentum which cannot be proved but from which they have to start in order to elaborate their thesis. In so doing, they have to rely on credere, they have to believe that the first principles are true.


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ISSN: 2291-8116

Numéro d'organisme de charité : 132473364 RR0001

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