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Blackwell Publishing LtdOxford, UKNUPNursing Philosophy1466-7681Blackwell Publishing Ltd 2006

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Book review

Book review

Book review

Book review

Ageing, Spirituality and Well-being

By A. Jewell (ed.). Jessica Kingsley, London, 2003, 17.95
($29.95) (paperback), 224 pages. ISBN 1-84310-167-X.

This publication brings together plenary addresses
and other papers originally presented at the Second
International Conference on Ageing, Spirituality and
Well-Being (2002, Durham University). The contribu-
tions are compassionate, warm, and humane; and
although the subject matter is somewhat romanti-
cized, successful editing ensures that the book is
cleanly presented and easy to read. This is not an
academic tome (though several contributors are
respected scholars). However, it is often insightful,
frequently surprising and can, without hesitation, be
recommended as an introductory text to undergrad-
uate nurses who wish to pursue those themes so ably
captured by the title.
That said, like other conference publications, the
resulting concoction is something of a mixed bag.
Research reports, conceptual critiques, discursive
homilies, and transcendental excursions, such as that
by King (Chapter 9) on the Dance of Life, sit side
by side and heterogeneity is both a blessing and a
curse.
Differences in style and form between contri-
butors can be jarring and clear discrepancies in
terminological usage are apparent between chapters
e.g. meaning as individual construction vs. discov-
ered or revealed meaning. More positively, the
range of perspectives and approaches that are pre-
sented provide an Aristotelian vantage from which
the reader can make connections across chapters
that may not have been apparent to the contribut-
ing authors. Here, I briey comment on one such
cross-chapter theme, namely, the concept of bene-
cial or positive spiritual suffering and the difculty
of presenting this type of subject to sceptical health-
care professionals.
So many contributors discuss or refer to spiritual
suffering (overtly or by implication) that the book
might have been subtitled:

Spiritual suffering and per-
sonal growth at the end of life

. The concept is por-
trayed as both the prelude to and antithesis of
spiritual well-being. However, the majority of those
who cover the topic tend to view suffering as a nec-
essary precursor to spiritual well-being or integra-
tion (generally undened) rather than something
that can or should simply be avoided.
For example, Hudson (Chapter 6) sees suffering as
a prelude to spiritual integration and growth. She
claims that suffering may have an enriching, inher-
ently transcendent value (p. 95) and this enriching
potential is viewed as part of what it means to be
human. Similarly, Missinne (Chapter 8) argues that
suffering is often inevitable and potentially benecial,
a vital part of personal development. Indeed, in a
chapter on The Search for Meaning of Life in Older
Age, Missinne suggests that suffering provides

priv-
ileged

access to lifes meaning. We are told that, out
of sacrices came the most beautiful people, not out
of happiness (p. 118) and that the Meaning of life
is . . . closely related to the meaning of suffering (p.
122).
Commenting on the effect that suffering has upon
observers, Coleman (Chapter 7) notes that The dia-
lectic inherent in all lifes stages requires people to
feel . . . tension [suffering] in order to develop. . . .
But tension and struggle are not what we normally
expect of older people, who we hope often for our
own piece of mind to have already overcome lifes
trials (p. 107). The need felt by observers to maintain
composure or control is also acknowledged by
Mowat (Chapter 3) who, after suggesting that Suc-
cessful ageing . . . could well be painful (p. 50), illus-
Book review

69

2007 The author. Journal compilation 2007 Blackwell Publishing Ltd

Nursing Philosophy

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8

, pp. 6870

trates the potentially disempowering role that
observers (healthcare workers) can play vis--vis suf-
ferers when she points out that the current under-
standing of successful ageing is dangerously close to
being ageing that doesnt become a nuisance to oth-
ers (p. 55).
Yet, Mowat also implicitly suggests that there is
something morally good about ageing

per se

(she
romanticizes the concept) and hints (as do many con-
tributors) that

successful

spiritual journeys follow an
ideal plan i.e. they do or should move purposively
towards interior integration and coherence (p. 50).
Other contributors, for example MacKinlay (Chapter
5), link this pilgrimage in spiritual status to the
accomplishment of spiritual tasks in the last career
of the dying (p. 80). Completing these tasks is indeed
a normative expectation for the aged or those
approaching death albeit that the specic mechanics
of task performance remain unclear.
There is, of course, nothing new in viewing suffer-
ing as a potentially benecial experience. Western
Christianity traditionally valued certain forms of suf-
fering as a route to Christ and many 19th and 20th
century European existential and phenomenological
thinkers explored dolorist themes. Further, the con-
cept possesses an intuitive appeal for many people
who have experienced personal trauma or witnessed
the trauma of loved ones.
And yet! The idea of redemptive, penitential or
positive suffering is troublesome and disturbing. It is
unlikely that the concept gures prominently in nurs-
ing curricula and, without considerable further devel-
opment, it is difcult to see how the idea can usefully
inform clinical practice. None of the contributors to
this book adequately engages with the problematic
issues generated. We are not told for example how
the transition from suffering to integration is to be
recognized or promoted. And, if spiritual suffering is
a prerequisite for spiritual development (and if such
development is important), then logic dictates that
carers should on occasion initiate or sustain it?
The implications of non-benecial (non-
developmental) suffering for those who witness or
experience it are also under-explored. It is not clear
whether personal responsibility attaches to those who
fail to make the transition to integration i.e. might
failure to achieve integration be an appropriate
response to lives led in a disreputable or reprehensi-
ble manner? Indeed, is there a relation between
moral status and the degree of experienced and/or
desirable suffering? Contributors to this book who
suggest that spiritual suffering has a potentially ben-
ecial role would presumably want to answer no to
all of these questions. Yet, we may reasonably ask for
their rationales.
It is also difcult to understand what contributors
actually mean or imply when they ascribe a transcen-
dentally directive aspect to spiritual journeys. Spiritu-
alitys inevitable association with teleological and
supernatural purpose(s) is a problem to those who
identify themselves with naturalist (monist) perspec-
tives as well as those who simply baulk at unsubstan-
tiated and imperialist claims that we all have a
spiritual dimension. The difculty of introducing tran-
scendental or supernatural factors into secular and
rationalist healthcare discourse impacts upon the
credibility of spirituality in general and not only on
ideas concerned with spiritual suffering. It is an issue
that the writers of texts such as this need to engage
with.
Perhaps the greatest problem faced by writers on
spirituality and health (for elderly or other client
groups) is that practitioners are exalted to justify
practice with reference to some form of evidence base
(often empirical research evidence) in regard to all
aspects or domains of care. And writers who wish to
engage with anything other than a committed core of
spiritually aware readers must, therefore, present
their ideas in a manner that connects with an audi-
ence who are encouraged to think sceptically and
critically and who want the evidence.
Many nurses assert that patients have a spiritual
dimension (variously dened) and claim this as a
legitimate and necessary focus for attention. Yet, as
McGrath (2002, p. 189) notes Marginalised as soft
talk suitable only for anecdotal rumination, spiritu-
ality has until recently been something of a scholarly
no-go area. This is now changing. Recent publications
of merit include Archer

et al

.s (2004) challenge to the
logic of academias default secularism, Sandmans
(2005) critical review of values around the concept
of good death, and Stanworths (2004) narrative
70

Book review

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Nursing Philosophy

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, pp. 6870

research on the spiritual needs of dying people. Fur-
ther, Cobbs (2001) provocative attack upon the abil-
ity of health professionals (i.e. nurses) to deliver
effective spiritual care is receiving considerable atten-
tion. These titles are important. They engage with
their subject matter analytically and they are the
benchmark against which works such as Jewells will
be judged.
However, contributors to

Ageing, Spirituality and
Well-being

rarely attack their subject with scholarly
gusto. There is a sense in which the authors are speak-
ing to the converted and signicant questions go
unasked. For example, the possibility that conict can
exist between spiritual values or belief systems is (bar
oblique comments in Chapter 13) unexamined and
the danger that spiritual/religious concepts can legit-
imate the disempowerment of gay and/or feminist
groups is ignored. Conceptual imprecision also
abounds. We are told for example (p. 120) that psy-
chologically, A positive sense of meaning in life is
associated with . . . membership of groups. Yet, pre-
sumably for the purpose of health or spiritual pro-
motion this means

nice

groups and not the local
branch of the British National Party?
It is, of course, unfair to criticize a book for failing
to do what it does not set out to do and, as stated, this
is not an academic tome. The unabashed decentness
of this publication will appeal to a substantial audi-
ence and, in fairness, the book compensates through
readability and accessibility for occasional lapses in
scholarly vim. Yet, in terms of the quality of its scru-
tiny,

Ageing, Spirituality and Well-being

represents
the poor relation to those texts described above. This
book will not convince sceptical healthcare workers
that they should take spiritual issues seriously.
Rather, it is a work that can be appreciated by those
committed to expanding the role and place of spiri-
tual care in health care.
Martin Lipscomb

University of the West of England

References

Archer M.S., Collier A. & Porpora D.V. (eds) (2004)

Tran-
scendence: Critical Realism and God.

Critical Realism:
Interventions Series. Routledge, London.
Cobb M. (2001)

The Dying Soul: Spiritual Care at the End
of Life

. Facing Death Series. Open University Press,
Berkshire.
McGrath P. (2002) New horizons in spirituality research. In:

Spirituality and Palliative Care

(ed. B. Rumbold), pp. 178
194. Oxford University Press, Oxford.
Sandman L. (2005)

A Good Death: On the Value of Death
and Dying

. Facing Death Series. Open University Press,
Berkshire.
Stanworth R. (2004)

Recognizing Spiritual Needs in People
Who Are Dying

. Oxford University Press, Oxford.