Enhancing Imaginaries and Care of the Soul
Daniel Sulmasy, MD, PhD, Director, Kennedy Institute of Ethics, Georgetown University; Ruth Farrell, MD, Cleveland Clinic; John Yoon, MD, University of Chicago; William Schweiker, PhD, University of Chicago; Guenter Thomas, PhD, Ruhr University Bochum (Germany); Sara Bigger, University of Chicago; and Marie Kim, University of Chicago
This seven-person panel will detail the recent work of our research laboratory on the importance of religious and social diagnostic imaginaries, what we call "counterworlds," for the sake of helping patients and medical professionals confront situations of “orientational distress.” The limits of medicine become apparent in the need of healthcare providers and patients to use counterworlds in order to orient their lives and care for their bodies and souls. After all, the soul is the vital core of life that must both integrate life and navigate complex situations.
The four presentations in this panel include the following topics. The panelists represent different disciplinary expertise and institutional settings.
1) The meaning and use of counterworlds in diagnosing and reshaping situations of orientational distress
2) Judging when life is enhanced or what is good soul care for the integrity of life
3) The healthcare provider and counterworlds: tending to body and soul
4) Results and findings of our research laboratory
Let us explain the basic ideas in this panel.
By counterworlds we mean the way people and communities use the imagination to create social visions, or imaginaries, that diagnose, reframe, and help to reorient how they live here and now. Often found in stories, myths, artistic forms as well as through concepts and even theories, counterworlds provide the means to understand and to design processes of change and transformation in favor of enhancing life. Furthermore, counterworlds are resources that enable "survival" within corrosive environments causing orientational distress. They are a basic part of soul care.
The concept of orientational distress assumes that human beings and certainly every professional must navigate life within complex social and institutional arrangements. These arrangements entail expertise, duties and obligations, personal moral and/or religious values, laws and regulations that provide orientation and guidance to people working and living within social arrangements. Orientational distress happens 1) when people lose the ability and confidence needed to navigate the complexity of their institutional context, and/or 2) when under unexpected circumstances, several, if not all, of these institutional arrangements simultaneously break down. As widely discussed, moral distress results from the inability to do what one feels to be ethically right because of institutional demands; e.g., a nurse must perform an invasive medical test though she knows it will not help the patient. Orientational distress, as we are developing the concept, deepens the analysis of moral distress by situating it within a complex account of the person, the institution, and their interactions.
The COVID-19 pandemic has exacerbated the distress and well-being of patients and medical professionals who are already experiencing hardship stemming from the contemporary challenges of modern health care systems. Ideas like burnout and moral injury have been helpfully used, yet those concepts tend to focus on the experiences of individual patients or professionals rather than on institutions (with their challenges and dynamics) and the interactions between institutions and their workers and patients.
Our research laboratory focused on the condition of healthcare providers in situations of orientational distress. This is important for the current panel because, after all, medical professionals’ well-being is the eye of the needle through which the soul care of patients is achieved.
In order to address orientational distress, we suggest a comprehensive approach with three basic elements which we call our “toolkit.” The toolkit includes descriptions of:
1) the five basic dimensions of life that must be integrated in an individual way,
2) the twelve key dynamics of life needed to understand the possibilities and challenges to a resilient and dynamic form of life, and
3) experiential counterworlds, needed to provide perspectives of criticism and reorientation.
This panel will only briefly discuss the dimensions and dynamics of life in order to focus on the social imaginaries we call counterworlds. In order to render this concrete we draw on the work and findings of the five online sessions of the 2021 research laboratory. The laboratory’s goals for participants included: 1) to understand their situation using the lens of orientational distress, 2) to develop the tools and thus the resilience to address and stave off orientational distress, and 3) to find or rediscover well-being in their professional and personal life. Further details of the laboratory’s work with healthcare providers is described in a manuscript that is currently under review for journal publication.
We anticipate interacting with audience participants to assess the helpfulness of the laboratory’s ideas for the sake of medical education amid current and ongoing experiences of orientational distress for patients and medical professionals alike. It is, we argue, a way of conceiving of soul care in a social environment too often dismissive of religion and yet encountering genuine and profound spiritual problems and experiences.
The four presentations in this panel include the following topics. The panelists represent different disciplinary expertise and institutional settings.
1) The meaning and use of counterworlds in diagnosing and reshaping situations of orientational distress
2) Judging when life is enhanced or what is good soul care for the integrity of life
3) The healthcare provider and counterworlds: tending to body and soul
4) Results and findings of our research laboratory
Let us explain the basic ideas in this panel.
By counterworlds we mean the way people and communities use the imagination to create social visions, or imaginaries, that diagnose, reframe, and help to reorient how they live here and now. Often found in stories, myths, artistic forms as well as through concepts and even theories, counterworlds provide the means to understand and to design processes of change and transformation in favor of enhancing life. Furthermore, counterworlds are resources that enable "survival" within corrosive environments causing orientational distress. They are a basic part of soul care.
The concept of orientational distress assumes that human beings and certainly every professional must navigate life within complex social and institutional arrangements. These arrangements entail expertise, duties and obligations, personal moral and/or religious values, laws and regulations that provide orientation and guidance to people working and living within social arrangements. Orientational distress happens 1) when people lose the ability and confidence needed to navigate the complexity of their institutional context, and/or 2) when under unexpected circumstances, several, if not all, of these institutional arrangements simultaneously break down. As widely discussed, moral distress results from the inability to do what one feels to be ethically right because of institutional demands; e.g., a nurse must perform an invasive medical test though she knows it will not help the patient. Orientational distress, as we are developing the concept, deepens the analysis of moral distress by situating it within a complex account of the person, the institution, and their interactions.
The COVID-19 pandemic has exacerbated the distress and well-being of patients and medical professionals who are already experiencing hardship stemming from the contemporary challenges of modern health care systems. Ideas like burnout and moral injury have been helpfully used, yet those concepts tend to focus on the experiences of individual patients or professionals rather than on institutions (with their challenges and dynamics) and the interactions between institutions and their workers and patients.
Our research laboratory focused on the condition of healthcare providers in situations of orientational distress. This is important for the current panel because, after all, medical professionals’ well-being is the eye of the needle through which the soul care of patients is achieved.
In order to address orientational distress, we suggest a comprehensive approach with three basic elements which we call our “toolkit.” The toolkit includes descriptions of:
1) the five basic dimensions of life that must be integrated in an individual way,
2) the twelve key dynamics of life needed to understand the possibilities and challenges to a resilient and dynamic form of life, and
3) experiential counterworlds, needed to provide perspectives of criticism and reorientation.
This panel will only briefly discuss the dimensions and dynamics of life in order to focus on the social imaginaries we call counterworlds. In order to render this concrete we draw on the work and findings of the five online sessions of the 2021 research laboratory. The laboratory’s goals for participants included: 1) to understand their situation using the lens of orientational distress, 2) to develop the tools and thus the resilience to address and stave off orientational distress, and 3) to find or rediscover well-being in their professional and personal life. Further details of the laboratory’s work with healthcare providers is described in a manuscript that is currently under review for journal publication.
We anticipate interacting with audience participants to assess the helpfulness of the laboratory’s ideas for the sake of medical education amid current and ongoing experiences of orientational distress for patients and medical professionals alike. It is, we argue, a way of conceiving of soul care in a social environment too often dismissive of religion and yet encountering genuine and profound spiritual problems and experiences.