Spiritual Assessment in Three Questions

The following article was was published in PlainViews, the online journal for chaplains, on October 4, 2011. (Vol. 8 No. 17) I was happy for the publication. However, since PlainViews is a subscription journal (only limited articles are available for free), I'm aware that many may not have seen the article. Now that the next edition has been released (10/19/2011 Vol. 8 No. 18), I am now posting the article here.


A further note about PlainViews: while full access requires a subscription, many chaplains find it a worthwhile resource, and well worth the cost. You can find subscription information here. If you'd like to see the kind of articles PlainViews provides, you can find many earlier articles at the PlainViews' Legacy Archive Page. Peruse and see for yourself the quality of the material available.

Any profession must take on the task of setting standards of practice, and chaplaincy has been no exception. Especially important for chaplaincy has been the concept of spiritual assessment or diagnosis. Beginning with Paul Pruyser’s book, The Minister as Diagnostician, those of us in the field have been thinking about, and working to develop, means of assessing the spiritual condition and needs of a patient.

That’s not as simple to do as it is to say. What are the appropriate categories? What sort of language works, and how applicable is it to all patients? Especially difficult in our predominantly theistic and even Judeo-Christian culture (yeah, the institutions may be losing influence, and even coherence, but the vast majority of Americans say in surveys that they believe in God or a Higher Power) is coming up with forms that aren’t Judeo-Christian, or even theistic; because there are more folks around than we used to see for whom those categories don’t work.

I have been working for some time with my own system, and have taught it locally. I would also like to share it with and receive comments from colleagues.

I believe that those aspects of our lives that we might call “spiritual” can be discerned through three questions (with gratitude to Douglas Adams, author of The Hitchhiker’s Guide to the Galaxy series). The first:

“What do I believe about Life, the Universe, and Everything?” Is God, or is God not? Is the universe sensible and aware, or mechanical? Are events random, or somehow organized? Does the arc of the universe bend toward justice, or are we alone in the vast, soul-sucking emptiness of space?

The second question:

“Who am I, in light of what I believe about Life, the Universe, and Everything?” Am I the paragon of creation, or a worm and no man? Am I the result of a million years of random chance, or of God’s creative intervention? Am I alone or in a community? 

The third question:

“How ought I to act, based on who I am, in light of what I believe about Life, the Universe, and Everything?” Am I accountable; and if so, to whom? To God? To my fellow human beings? Only to my own conscience? Do I base my actions on principles, or on my emotions? Am I to do unto others as I would have done to me? Or, am I to do unto others before they do unto me?

As a shorthand, I think of the questions as “Reality, Identity, and Morality.” I think these questions can allow us to appreciate the spiritual circumstances of those we serve, and whether they are properly or maladapted.

Consider, for example, these questions, heard often enough by chaplains: “Why is God doing this to me? What did I do to deserve this?” The questioner believes in God, and believes that God is engaged in creation. Specifically, the questioner believes that God attends to this person, who is individually important enough to God to be under direct judgment. The questioner believes that he or she has some agency, which he or she may have misused, and so is accountable. So, just from these two questions we have some sense of the patient’s Reality, Identity, and Morality.

Alternately, consider this comment: “I’m not really religious. I just try to be a good person.” This suggests that the person believes that creation is orderly and not random, and that the person is a participant with meaningful agency. Indeed, this person believes that behaving properly is sufficient, and that there is no need to participate in a religious community to live in a meaningful way.

These are the categories that help me assess a patient’s spiritual status. With them I am able to develop a plan based on supporting the patient’s self awareness and helping the patient adapt to circumstances so as to live appropriately within the patient’s own beliefs. As the concept of adaptation and function are central to the practices of nursing and other ancillary services, it communicates will with other professions. It is simple to apply, and can be based on the patient’s own comments, without requiring interrogation. Finally, it is respectful of the diversity of our contemporary culture.