Abstract
Introduction
Transpersonal psychology has been a controversial field that found resonance in the study of Jung, Maslow, and others. 1 From time immemorial, healers such as the Native American medicine (wo)man, the aboriginal healer, the Siberian shaman, priests, rabbis, and imams have worked in transpersonal space as intercessors between the realm of God/Allah/Spirit/unseen powers and the person or community seeking healing. Transpersonal medicine is an arcane field of western medicine, resting upon the premise that there are forces beyond the self, which can be drawn upon and used to help heal ourselves and others. Transpersonal medicine as a concept emerged out of frustration with the allopathic/biomedical model of medicine and the lack of attention and respect given to the emotional and spiritual needs of patients. 2 The biomedical model views the physician as a diagnostician and technician, perceiving the patient's condition as a problem to solve or machine to be repaired. 3 The clinician listens with the ears, processes with the mind, and forms a hypothesis regarding what is happening with the patient. According to Carson, in transpersonal medicine, the clinician shifts her attention from the intellect to the heart by accessing her intuition. 3 This process does not involve words and is familiar to practitioners of meditation. When clinicians engage this inner resource in caring for patients, they are accessing a transpersonal space in which answers to challenging questions may “appear.” This process likely forms the basis of clinical intuition, which goes beyond experience and accumulated knowledge. The following article provides examples utilizing a transpersonal approach to illustrate its place in clinical practice to support patients confronting serious illness.
Transpersonal Medicine: Going Beyond Symptom Management and Curing Disease
For many patients, serious illness becomes a watershed event in their lives. 4 Some will survive, perhaps with sequelae, whereas others will die quickly or slowly with medical technology extending their lives artificially, often creating additional suffering. We have found transpersonal and integrative modalities to be beneficial in the acute care setting to relieve adverse symptoms as depicted in Figure 1, which represents self-reporting by patients and family members offered energy healing (touch) or massage. The figure reflects the fact that patients and family members obtained relief of distressing symptoms when comparing responses before and after the interventions. These approaches can facilitate the much needed humanization of institutional medicine. 5 They represent important opportunities to apply integrative modalities in both acute care, as well as in the palliative care and hospice settings, where symptom burden is a major focus and human touch becomes a primary therapeutic tool.
Effect of energy healing (touch) offered to patients
When survival is uncertain, transpersonal interventions and integrative modalities offer important opportunities to support patients. As reflected in Figure 1, patients who can respond to us value human touch through massage or energy healing. We may assume that patients who cannot respond can also derive benefit from the attention of an integrative practitioner.
LD, a young teenager was critically ill with Goodpasture syndrome. Her mother prayed and asked God why he was trying to take her child (she had experienced pregnancy losses viewed as punishment from God). The ICU offered a shamanic healer's intervention, who met with the family to determine their goals and wishes. She offered a spoken guided journey, similar to guided imagery, during the ICU period and shamanic drumming as a support to LD's spirit with the intention of providing grounding and comfort. 6,7 When LD regained consciousness, her mother reported that the drumming brought LD to a mindful state where she experienced peace and comfort. LD reported seeing butterflies, representing bravery, and a beagle named Shilo, representing a totem spirit. She received a renal transplant and is thriving. For child and parent, this experience provided lessons about life, their bond with one another, and the joy of the return of her daughter's wellbeing despite the mother's fears. Journeying and drumming served as a focal point in her care and perhaps supported her spirit in deciding whether to live or die.
This case represents an example of using integrative methods (journeying and rhythmic drumming 6,7 ) to support a person facing life-threatening illness. Conceptually, shifting from a purely biomedical support to a transpersonal focus provided comfort, insight, and sustenance to the whole patient as well as a focus for her parent's energy in seeking support and restoration of health. Such effects are also possible through contemplative prayer and other integrative modalities. Our patient's transpersonal experiences frequently reflect similar beneficial outcomes.
A fundamental task in hospice is completing one's lifework and bringing closure to unfinished business. 8 –10 Most often, life completion work is done verbally. Presumably everyone has unfinished business, so how do we help the patient with cognitive impairment or preverbal children achieve closure? Does unfinished business cease to exist when a person lacks the capacity to express and process it or does it continue to impact the human spirit when the body dies as some believe? 11
Healing the Human Spirit at End of Life
The palliative care team met Greg after his condition worsened and his doctors thought he was dying from advanced colon cancer. He looked to be in a coma on initial evaluation. He communicated with his family briefly after being placed on comfort care then became comatose again. What astounded his providers also confounded them. He was on a considerable amount of continuous intravenous morphine to control his symptoms. He was cachectic and frail, debilitated and seemingly without caloric reserve, but he continued to breathe after several days. As his physician sat with the family, he contemplated an integrative solution because the case was not progressing as he would have expected. His clinical intuition suggested to him existential pain and he told the family he needed to look outside conventional medicine for guidance. His mom said, “We will try anything.” The physician told them he had a colleague, Anna, who is an “energy healer” and they agreed to meet her.
Anna saw Greg and the family. She is perceptive and intuitive and always stays in her lane, which is deep and wide. She brought her flute and settled on a song of joy, since she was told Greg “did not want any sad songs.” Her intention was to connect Greg at a soul level with his loved ones to facilitate resolution of whatever issues may have been holding him to life.
The palliative care team often sees families distressed when their loved one dies slowly. The reasons to suggest that Anna get involved were twofold. First, through comments made by family members, there was a sense of a conflict that existed between the family and Greg, not bitterness but something unresolved or left unsaid. This is an area that western psychiatry does not directly address (i.e., soul/moral injury). Secondly, the physician suspected that Anna's presence might help Greg, not to transition faster, but to provide ease for the family to let him go.
The family knew how deeply the team cared and were grateful that the medical service was willing to connect western and traditional healing practice. Greg died on his own terms. Accepting the death of a loved one takes time and follows an individual blueprint. Anna's intervention contributed to that process by providing peace, comfort and connection for Greg and his family. The family's openness to including an integrative approach enabled a shift in their perception of Greg's unexpressed, inner needs. Afterwards, the physician speculated that Anna had created a transpersonal connection between Greg and his family, heart-to-heart, without words, which facilitated the resolution of the unspoken family conflict, allowing Greg a peaceful death.
This case illustrates a clinician's trusting in clinical intuition to inform the next steps in the care of a dying patient with the goal of facilitating life closure in a minimally interactive patient. Greg's palliative medicine physician (P.M.) commented: “Integrative medicine is the prescription for conflicts that lie inside and outside the normal psychological boundaries. Sentient beings, such as ourselves, seek such psychological resolution. My only ‘proof’ that we helped the family is their own words. They knew we cared and were willing to connect western and traditional healing practices to demonstrate this caring. Our intervention served a small portion of that process of guiding the family and patient to the end of life, providing some peace and comfort along the way.”
Conclusion
The aforementioned vignettes demonstrate far-reaching benefit for transpersonal interventions, including alleviation of existential distress as death approaches. Although clinicians must assure that patients and families give permission for the involvement of integrative healers, our patients' experiences with transpersonal medicine in palliative care have been overwhelmingly positive. These methods deserve greater inclusion and formal investigation as support modalities for our life-limited patients.
Footnotes
Authors' Contributions
The article was conceived of and developed by Dr. Steinhorn. The content was written by Drs. Steinhorn and Macmillan and Ms. Din. Case material was developed and contributed by Ms. Din and Drs. Steinhorn and Macmillan. All authors participated in editing and refining the article in its final form.
Author Disclosure Statement
The authors attest to having no conflicts of interest, financial relationships, or other bias in the creation of this study.
Funding Information
No funding was received for this article.