Attention: A Potential Vehicle for Spiritual Care

our interpretive efforts (11). Based in primary experience, this awareness is of the first order and has a bearing on how we live, and on what we treasure and value. More easily recognized than explained, this transcendent dimension cannot be isolated or shared in the sense of a lowest common denominator (which sometimes seems to be the quest of indices of spirituality), but by analogies of experience across cultural or religious boundaries. The spiritual may resist all attempts at enclosure or definition, making it frustratingly difficult to talk about, but this does not mean that nothing useful whatsoever may be said. The major religions all attempt to articulate man's spiritual awareness and present his most comprehensive understanding of reality. They are, however, second-order interpretations. A religion is the life complex of stories, practices, norms, or structures of a community, which find their origins in the first order: a founding revelation or an original spiritual experience. The spiritual, however, is not necessarily anchored in a religion. Indeed there is no such thing as a "specific religious language, precisely because religion is not a specifically distinct realm of meaning or culture. It is the opening out of every sector of human action and culture to the Unlimited, the Beyond, the Transcendent" (12). A useful analogy may be drawn with the ancient Roman concept of the architectonic (13), that quality which invests structures with grace and beauty. Indivisible from their proportions and composites, the architectonic is not another thing, yet neither is it no thing. Dismantling a structure to isolate its poise yields only rubble. Similarly, permeating every dimension of life, the spiritual also evades neat compartments. It is a distinctive, but not distinct aspect of reality. Resorting to another metaphor (14), for this is the most real way of discussing spiritual issues (IS), if medicine, psychology, or sociology provide certain horizons for human experience (with relevant areas of overlap, incorporation, or dispute), the spiritual is a horizon further, broader, and even more ungraspable than these or any other. In Richard II, Shakespeare writes, "The tongues of dying men enforce attention like deep harmony. " The experience of many patients, however, suggests otherwise. It is not unusual for terminally ill people to feel marginalized, even by family or longstanding friends (1). Often, they express guilt for causing sorrow and inconvenience (2). Ironically, those who love them most may bundle them into the role of heroic fighter (3), so that anxieties only surface when they are alone, usually in the small hours of the night (4). Patients who do experience the deep listening and genuine attention of another, however, seem to feel a healing or comforting, rather than a literal curing effect (5). Regarded by many palliative care workers as a way of meeting patients' and families' spiritual needs (6), this authentic presence has come to be known as "being there", as distinct from doing anything (7). This paper makes a number of related arguments. First, in the somewhat confused area of spiritual care-currently described as wide open to any interpretation (8)-this phenomenon of being there is more rigorously approached as "attention". Second, although attention does not necessarily characterize every satisfacto~y meeting of patients' spiritual need.s thr~~gh I~S . exercise, spiritual care is potentially a legitimate aspect of the professional ,Practice o~ ~ny number of disciplines" (8). Finally, the limitations of the concept are acknowledged. It does not explain exactly how spiritual needs. ~re met, nor why one patient may respond positively to an attentive presence whilst another may not. Paradoxically, this requires us to accept that spiritual care may largely be about "preparing for an experience we cannot evoke" (9).