Opening Possibilities for a Meaningful Life Narrative Identity in Service of Existential Health and Spiritual Care

Between Modern Humanism and Postmodern Antihumanism

Much of contemporary philosophy is determined by an odd double heritage of both modern philosophy of the subject and postmodern decentralization of that same subject. On the one hand, Sartre's existentialist humanism appears as the culmination of a modernity ranging from Descartes’ cogito to Kant's “sapere aude” (Kant, 2016). This philosophical lineage of humanism has placed the human perspective at the center of its attention. In his famous slogan “existence precedes essence” (Sartre, 1996), the perspective of the pour-soi has become central not only for knowledge but also for its own normative project. There is no other way of being than being what one does. Sartre rejects any recourse to external forces determining who we are as a sign of bad faith, of failing to be oneself. Modern philosophy tells us who to be by not telling us in any way how or what to be: it's up to each individual to determine this for themselves through each of their actions.

On the other hand, a common theme in postmodern philosophy is that of the decentralization of the subject. Michel Foucault most poignantly summarized this at the end of his Les Mots et les choses, observing that “one can certainly wager that man would be erased, like a face drawn in sand at the edge of the sea.” (Foucault, 1998) With this diagnosis, Foucault has also been called a structuralist thinker, according to whom the subject is a variable in a larger system or structure that determines its actual form. Some will look to a linguistic structure (psychoanalysis), others to economics (neo-Marxism), others still to science and history, which is what Foucault does. In each of these cases, the subject is a mere result of those structures, a contingent form that emerges from its effects.

Sartre's modern exaltation of the pour-soi and Foucault's postmodern decentralization of the subject are in stark contrast. But they share the problematic nature of the meaning that individuals encounter in their own lives. Sartre's existentialism tells you that no one but you can decide what to do with your life. Freedom is absolute – and the responsibility that this implies is unnegotiable. Life “has” no meaning, other than what each of us makes of it. In Sartre's own example of a student who asks him for help in resolving a dilemma between caring for his mother or fighting in the war, Sartre abstains from giving any specific advice (Sartre, 1996). His point is that, in choosing to approach Sartre for counsel, that person secretly already knows the answer they will receive. With this example, Sartre expresses the absolute impossibility to delegate or consult with regards to how one should live.

Foucault's position is no less problematic. Despite some important shifts over the course of his works, his comment that the subject is “a form, not a substance” (Foucault, 2001, p. 1537) summarizes the historic contingency and substantive indeterminacy of the subject. If we follow Deleuze's classification of Foucault's work into three axes (Deleuze, 2004), in the first two instances the subject is a variable of knowledge systems (epistemes) and of power relations. The form that subject takes on, their way of being and acting, their ideals, are a result of processes of “assujettissement”. In a third instance, Foucault does turn to the role of the subject itself as an active force in its becoming a subject. But with that, the indeterminacy of the subject is only heightened: how and what the subject could be as a result of the tripartite influences of knowledge, power, and subjectivation, becomes an open question. Referring to Kant's “Was ist Aufklärung”, Foucault observes that in his view also, what we do with our lives is something to be experienced and experimented, and other than a historical genealogy, nothing can be said about present or a future way of living (Foucault, 2001, pp. 1498–1507).

The Double Heritage of Philosophy As a Way of Living

Historian and philosopher Pierre Hadot was one of the first to propose an understanding of philosophy as a form of spiritual exercise. According to him, this means that philosophy is a constant activity, intent on transforming one's own life (Hadot, 2002, pp. 289–304). In his wake, philosophy as a way of living has grown into its own field of practical philosophy over the last decades, notably drawing both on Sartre's imposition of authenticity (e.g. Dohmen, 2011), and on Foucault's techniques of subjectivation (e.g. Nehamas, 1998). With that, groundbreaking work has been done in bringing philosophy back to the question of living well, a central preoccupation in classical philosophy. In this contemporary revival, much attention has been dedicated to the difficult ontological issue of what the subject is – for instance a rational and autonomous pour soi, or a historical and contingent form, by Sartre and Foucault respectively. The issue of how that subject becomes to be what it is, has also been much debated (“existence precedes essence”, or “techniques of the self”). But both these traditions stay silent with regards to the normative question why it matters to be a self, or to the meaning of life. From a humanist point of view, only individuals themselves can give any meaning to their existence; in itself, life is meaningless. And from a posthumanist point of view, genealogic structures ascribe the meaning that subjects then encounter; there is no criterion to evaluate the meaning of life from outside its historic situatedness.

To experience meaning in life is of profound importance for human existence (Baumeister, 1991; Frankl, 2020). The question for the meaning of life arguably surpasses the scientific delimitation of much of psychology and is more properly a philosophical theme. But neither the answer that it is up to each of us individually, nor that it is dependent on pre-existing structures, seems to fully satisfy the need for meaning and the complexity of the challenges it entails.

A conception of philosophy as a way of living intermediate between humanism and posthumanism could acknowledge the importance of experiencing meaning, as well as incorporate a conception of its constitution in individual lives. To that end, we shall first present an ontological understanding of the self as neither an exclusively personal creation ex nihilo, nor a mere variable of superseding structures. The self could be shown to consist in both an ensemble of factors that we do not control, and a certain self-determinacy in making sense of life. And by turning to the quest for meaning rather than focus on the (absence of) limits to the constitution of the self, a normative content can be reinserted into the project of philosophy as a way of living that might otherwise remain absent or overlooked. By considering one's own philosophy as a way of living as not only an existential and a critical endeavor, but also as a hermeneutic activity, the self appears as a being capable of living a meaningful life. In addition to this, a practice focused on assisting individuals in the dual task of creating and encountering meaning in their lives could be formulated.

The Self: a Hermeneutic Approach

The challenge in dealing with the meaning of life, is that it is not an ontological given. Not anymore. Institutionalized religion has for a long time dedicated itself to uniting questions such as “Where do we come from? What are we? Where are we going” ² , linking together descriptive ontology with hermeneutic understanding of meaning and normative ethics. In the wake of the gradual decline of the self-evidence and omnipresence of faith in 20^th and 21^st century times, the answers to these questions have steadily found renewed topicality in philosophy. ³ To borrow from Lyotard's terms we could say that, at the same time as the “grand narratives” collapsed, the need in which those narratives somehow foresaw once again became apparent. (Lyotard, 1979) Meaning and meaningfulness are no longer inherent in the description of being.

This does not mean ontology stops being relevant. On the contrary: we can understand the human being as ontologically determined by their search for meaning. And by approaching the being of man through a hermeneutic perspective rather than an ontological one, the tension inherent in the search for meaning becomes the pivotal element, rather than any being as either substance or form. Heidegger proposed to understand hermeneutics not only as the practice of interpretation or the methodology of the sciences of the humanities (Geisteswissenschaften), but also as the effort to “work out the conditions of the possibility of every ontological investigation.” (Heidegger, 1977, p. 37) In particular, hermeneutics opens up a perspective on the human being not as a substance or a form, but as capability – the capability to encounter and ascribe meaning to their existence.

Twentieth-century French thinker Paul Ricoeur provides us with such a hermeneutic understanding of human being. In the Introduction to his key work Oneself as Another, he proposes to resist both the self-founding ontological fixation of Descartes’ Cogito and the Nietzschean dissolution of the self. (Ricœur, 2015, pp. 15–27) He then works out an ontology of the self that is neither a fixed entity, nor an indeterminate openness, but rather a combination of identity and difference of the fixed self that we are, and the constant changes that make us who we are. He refers to these two elements as idem and ipse, related in a hermeneutic relation where neither precedes on the other (Ricœur, 2015, p. 140). In order to understand what the human being is, we must refer both to things that remain the same and to things that change over time.

Examples of things that stay the same, our idem, include the nominal identification of a person, their biological provenance, their numerical unity. Idem refers to the fact that, although one may become an entirely different person over the course of a lifetime, or even in a short time after an impactful event or moment in life; that other person is still me. ⁴ Neither things that we do, nor things that are done to us, affect our identity as idem: they are things that I do, that happen to me.

But to stop at this reference to a barren substantive identity as idem would do the self short. Who we are is at the same time profoundly determined by a complex interplay of our identity as ipse. When we ask the question “who we are”, we are asking for the result of that interplay, in which Ricoeur brings together four questions: “Who is speaking? Who is acting? Who is telling his or her story? Who is the moral subject of imputation?” (Ricoeur, 1994, p. 169) With that, Ricoeur distances himself both from the ontological simplification of a single and static conception of being, and as its opposite, the dissolution of identity. Instead, identity becomes irreducibly complex and dynamic; it continues to be something that we seek to adhere to, all the while allowing for its evolution.

We’ll get to the last two of Ricoeur's questions, the narrative and the normative aspects of the self, later on. About the first two questions, “who is speaking” and “who is acting”, it's worth noticing that determination of the self is at the same time something that applies to that self, and something that exceeds it. The reply to these questions never entirely coincides with the self it attempts to identify. In the case of speech, this is clear from the very use of words: they require recourse to a language that is per definition a shared world. Even in an internal monologue, we are presuming an interlocutor to whom we are speaking. In the case of action, Ricoeur observes that “Ascription consists precisely in this reappropriation by the agent of his or her own deliberation” (Ricoeur, 1994, p. 95). To decide on something, to act, is to assume authorship. This means at the same time that we assume a relationship with our own bodily being; but also that we assume an agency in the face of the other; and possibly even that we inscribe our action in the wider horizon of those who Ricoeur calls “le tiers”, the third person or society in general. ⁵

This irreducible divergence between the reply to the fourfold question for the self and the self they seek to define should not be taken to assume that there is an underlying, “authentic” self that we could theoretically fully identify, but to which words and deeds just fall short. On the contrary, and that is the essence of a hermeneutic understanding of the self as opposed to a purely equiprimordial ontological understanding: although stating “Who is speaking? Who is acting? Who is telling his or her story? Who is the moral subject of imputation?” is always insufficient, it is also the plural foundation of the self. To ask these questions is to ask for the being of the self; to answer them is at the same time to chase after a definition of the self that cannot be complete – and in doing so provide a definition of the self. The hermeneutic ontology of the self thus presents us with an open-ended self, a self that is both a trace of action (understood as act, speech, narrative, and moral imputation) and the possibility for deviation. This is the first hermeneutic exercise.

Bringing Together Sinngebung and Weltanschauung

A second hermeneutic movement requires that we delve deeper into the source of this divergence inherent to the hermeneutic self. Trying to find out “who I am” is not only a factual question; it's a hermeneutic question. When with Gauguin we wondered “what we are”, this question was inherently accompanied by the questions “where we come from” and “where we are going”. In other words: the question who we are, is a dynamic question, one of time and direction. In this directional axis of the self, two areas or fields can be distinguished.

The first is that of the activity of the self with regards to that direction. The best way to clarify this line, is to oppose the way we give meaning with the way we encounter it. In the first sense, it's the self who ascribes meaning to their own constitution, and to the world around them, or to borrow a term from Husserl, Sinngebung (Husserl, 1991). That is to say, for life to have a meaning, is for the self to give life meaning, to make it meaningful. This is probably closest to Victor Frankl's existential interpretation of psychotherapy, where even in the face of suffering, one can find meaning by actively interpreting life as such (Frankl, 2020).

At the other end of this field, is the proposal more commonly inherited from religious adherence, where meaning is something we encounter. In this case we could rather speak of Sinnerfahrung; an experience of the world as it imposes itself on us, beyond our control. As such, an experience is something that profoundly determines us, but that we ourselves have not chosen. In this case, we find meaning because it befalls us, whether we were looking for it or not. Here we are closer to Frankl's description of love, an experience that we cannot willingly call for, but that always surprises us.

Meaning is, then, something both given and received, both active and passive, both Sinngebung and Sinnerfahrung. This is where Gadamer's description of the hermeneutic circle comes in. In Truth and Method, Gadamer proposes the hermeneutic circle as a principle of understanding of text. This movement is neither subjective nor objective, but rather “describes understanding as the interplay of the movement of tradition and the movement of the interpreter” (Gadamer, 2011, p. 293). For our purposes it can suffice to point out that the interpreter and the surrounding world both participate in the constitution of meaning. To Gadamer, the perspective of the researcher is a part of the research they carry out, and any position, including (especially) a critical position, is at once turned against and facilitated by the context from which it springs. In a similar way, meaning in our own lives is at the same time something that befalls and determines us, and that we ourselves bring to the table.

The second field inscribed in the process that links the self to meaning, concerns our bios, or the matter at hand. If the first line was about “how” we find meaning in life, this line is about “what” exactly it is that we have to find meaning in. We already saw that this bios is neither a simple ontological substance nor a baseless form, but that the self is ultimately an irreducible complexity of speech, action, narration, and moral imputation. It's at this point that narrativity comes to the fore.

In Ricoeur's oeuvre, the complexity of the bios of human existence is something of a recurring theme, taking on different forms along the way. In The Voluntary and the Involuntary, for instance, he attempts to work out how our voluntary self is always accompanied by an involuntary shadow. In understanding acts of the will as consisting of a decision, a movement, and a consent, on all three levels, our voluntary acts are always also in part involuntary. This involuntary element of our will is reflected in the form of our pre-reflexive motivations, of an ensemble of more or less submissive bodily abilities and powers, and of conditions of life we did not choose, i.e. “the absolutely involuntary with respect to decision and effort” (Ricœur, 1966, p. 8). Although his Time and Narrative delves into the role of literary and historical narratives and thus appears to keep hermeneutics locked into its strictly textual application of interpretation, in the final conclusion, Ricoeur ventures to observe that “the identity of this “who” […] itself must be a narrative identity” (Ricoeur, 2008, p. 246). The role he assigns to this narrative identity is that of balancing between what he calls at this time the discordant and the concordant. To clarify these two forces, he uses Augustine and Aristotle as references.

In his Confessions, Augustine famously described how he was torn apart by conflicting desires and intentions. Throughout much of the book, Augustine is searching for a peace of mind, but we stand by as he constantly fails, turning to sects, or losing himself in distractions and earthly delights (Augustine, 2016). About this, Ricoeur remarks that “Augustine groaned under the existential burden of discordance” (Ricoeur, 2009, p. 31). Personal drives he is unaware of, bodily passions, and the forces of life's events, all undermine Augustine's “repose of the heart”. These discordant forces are something we must all live with. Both from around us and from within ourselves, we have to deal with elements that break up our sense of self, or of the world we live in. We lose our job, the love for a spouse fades, a person dear to us passes away, we are stricken by a serious disease. The list is endless. And each time, we are challenged to somehow make sense of it all. These forces are discordant because they undo our sense of self: they are, in the literal sense, a source of distress.

Ricoeur's reading of Aristotle presents us with the tools to articulate the other end of the spectrum, that of concordance. Ricoeur suggests that “Aristotle discerns in the poetic act par excellence – the composing of the tragic poem – the triumph of concordance over discordance” (Ricoeur, 2009, p. 31). While in Augustine we witness a constant emergence of involuntary irruptions into his life, Aristotle's analysis of the verbal effort of emplotment (muthos) offers a means for a unifying concordant effort. We create intrigues to make sense of things. We do this by bringing together pluralities of facts or experiences into a single, complete, total, and properly extended whole (Ricoeur, 2009, p. 38).

Before we turn to the individual's narrative understanding of the self on the junction between Sinngebung and Sinnerfahrung and between discordance and concordance, we should acknowledge that hermeneutics is primarily the study of the interpretation of texts. This means, first, that the material we dispose of to effectuate any narrative effort, originates from the discursive realities that surround us. Gadamer's critique of the illusory autonomy of the modern self is particularly poignant. The hermeneutic circle moves between the world of the researcher, the world of the text – and the world of the author of the text, its origins. His telling example goes to show that the very ideal of autonomy and individual authenticity free from historical or cultural indebtedness, is itself indebted to a specific context in which it emerged – and to which we are in turn contributing, whether we like it or not (Gadamer, 2011, pp. 274–285). ⁶

Ricoeur in turn describes this indebtedness to tradition as “sedimentation”. In the context of narrative understanding, a sedimented tradition contains “the models that constitute in retrospect the typology of compositions which allows us to order the literary genres” (Ricoeur, 1986, p. 125). Now, this process of sedimentation is only one side of the medallion. Ricoeur continues: “the possibility of deviance is entailed in the relation between sedimentation and innovation which makes for tradition.” (Ricoeur, 1986, p. 125) Innovation refers to that particularity of one individual work, both adding to a tradition and articulating its uniqueness. When we try and make sense of our lives, we do so with the tools we have at hand; and these are, to a very large extent, provided by tradition. We understand ourselves and our world through the eyes of our peers, both concrete and abstract. But in doing so, we are always obliged (and allowed) to bring our own particularity to the table.

A Narrative Understanding of the Self

Ricoeur initially articulates his analysis of discordance and concordance in reference to the world of narratives as texts. But he closes the last volume of his Time and Narrative by extending the validity of his idea of narrative understanding beyond texts and to ourselves. In our narrative identity, the historical field of sedimentation and innovation, the temporal field of discordance and concordance, and the interpretative field of Sinngebung and Sinnerfahrung come together in the individual's efforts to make sense of their lives and the world around them. And the means in which an individual does this, is neither a humanist reduction to the accumulation of true and authentic actions, nor the antihumanist reduction to historical and contextual determination, but rather a situated creative process of “composing the intrigue”. ⁷

What then makes for a meaningful life? We already mentioned how Ricoeur makes use of the conception of emplotment put forward by Aristotle in his Poetics. The triple requirement guiding the effort of imposing concordance by wholeness, unity, and probability ⁸ subscribe to meaning understood as constituting a semantically coherent whole. That is, a meaningful life is a life that has coherence. The concordant effort of the narrative self consists in tracing back the diversity of experiences and interpretations to a narrative unity.

This concordant effort of imposing coherence is a creative process. Discordance must be included. It's typically in the face of moments that are experienced as profoundly discordant, that the narrative coherence of life can fall away: the loss of a loved one, an accident, an emigration. ⁹ Ricoeur insists on the nature of tragedy that Aristotle studies, where adversity and affliction are a necessary ingredient to drive any plot forward (Ricoeur, 2009, p. 38). In a similar fashion in our lives, we noted earlier how an element of the involuntary always accompanies us. There are things we do not control: our bodily impulses, unconscious motives and convictions, and life events themselves constantly interfere with the coherent narrative we have formulated at any given time. Rather than a challenge, then, or a difficulty to be overcome, these elements of the involuntary are the necessary transgressions of the narrative unity to keep it alive as a narrative. A meaningful life is one that manages to balance the tension between a concordance of narrative unity with life's discordant interferences. Things make sense.

But semantic unity does not cover all meanings of meaning. A second dimension is meaning as purpose. While meaning as coherence was situated at the semantic level of the referential interconnectedness of a plurality of elements into a coherent whole, in considering meaning as purpose it is the relation between the narrative self and some form of fundamental existential motive that is at stake. To what extent can we say that our understanding of our life actually constitutes who we are? What does the narrative actually refer to? This move brings us to the limits of hermeneutics itself, where a basic premise is that what cannot be understood or interpreted, cannot be experienced. This brings to the fore challenging cases, such as life experiences that defy any expression; as well as lives that are deemed unworthy of any meaning or evaluation. ¹⁰ In any case, from a hermeneutic perspective, little can be said about this field of possibilities, except that this field only takes on any existential relevance once it is encountered in a narrative understanding of self and world. Or to put it the other way around, hermeneutic understanding is what actually opens up such a field of possibilities for the self to give and find meaning, and thereby begin to incorporate existential experiences into a narrative understanding of the self.

Thirdly, meaning as purpose can also be understood in a teleological sense. It refers to the “whereto” of our actions. Who or what are we trying to become? Notwithstanding any criticism of Aristotelian teleological metaphysics that may be raised, in discussing our lives as narrative identities rather than as mere biological phenomena, there is always a teleological element present. We do what we do because it contributes to some end we have in mind, and ultimately because it contributes to who we hope to become. A meaningful life understood as a purposeful life is a life that subscribes some idea of the good life.

Meaning as purpose thus directs the narrative understanding of our lives toward a more pronouncedly ethical framework. A life that is meaningful is also a life that has some sort of significance. Ricoeur's small ethics famously relates “aiming at the ‘good life’ with and for others, in just institutions” (Ricoeur, 1994, p. 172). A significant life is a life that links our own sense of coherence and purpose with a sense of significance for others, or for the world around us.

This ethical aspect can take many forms. Another basic assumption of hermeneutics is precisely that there is no ultimate truth, no grand narrative subsuming all others (Ricoeur, 2008, p. 259). This reverberates in individual narratives. Some may find significance in a political career in which they seek to make a difference with regards to global inequality. Others in being a bus driver and ensuring their passengers are always on time. Others still find it in raising their children to be good citizens. Significance is neither entirely subjective, nor entirely objective. Again, narrative identity opens up the possibility for, and requires, creativity.

A Hermeneutic Conception of Spiritual Care

To the self, hermeneutics offers at the same time the need for modesty, and the courage for creativity. Over the course of his works, Ricoeur's anthropology moved from the articulation of a fallible man, determined not only by his deliberate volition but also by an involuntary dimension of self that we briefly mentioned earlier, toward a description of man as a capable being. We have seen how as narrative beings we are capable of “becoming who we are”, to state it in Nietzschean terms. Ricoeur is more modest than the Nietzsche he criticizes in his introduction to Oneself as another, however, by insisting on the limits of our self-creation. He states: “we learn to become the narrator of our own story without completely becoming the author of our life.” (Ricoeur, 1986, p. 131) We ourselves may be the ones who reply to the fourfold interrogation that determines who we are in “Who is speaking? Who is acting? Who is telling his or her story? Who is the moral subject of imputation?”. But we are not in control of our bios: the involuntary is a part of us. Furthermore, we constitute ourselves in dialogue with the other close to us (the “You” that authors such as Levinas and Buber speak of), as well as living in and through institutions and cultural horizons. Our freedom is not boundless.

But it's precisely those boundaries that allow for us to develop our capabilities. This requires creativity. Spiritual care from a hermeneutic point of view consists in striving to open up those possibilities of the self, to become aware of them, and to apply them in constituting a meaningful life. Ricoeur concludes his insightful text on narrative identity with the observation that “the subject is never given at the beginning” (Ricoeur, 1986, p. 132). Narrativity is a powerful tool in constituting our subjectivity and living a life that is not so much a work of art (Foucault, 2001), but rather that is meaningful. It opens up a field of possibilities for the self in and through which it can build a life that has coherence, purpose, and significance, even (or especially) in the face of adversity.

The narrative identity that is thereby assumed is at no point a fixed entity. We may not become the author of our life, but we can be its narrator. This is a fundamentally creative process, positioned on the intersection between sedimentation of historical traditions and cultural frameworks on the one hand, and personal innovation on the other. This innovation necessarily draws its inspiration from experiences of the involuntary, of discordance, and of experiences of meaning. These experiences are then accompanied by our voluntary efforts to construct a narrative and constitute a meaningful life.

Indications for Spiritual Care Practice

In closing, a few words on spiritual care practice. The contribution of philosophy to spiritual care may not always be immediately evident. As Hadot observes, over time philosophy has moved away from a spiritual exercise to an academic discipline practiced within the confines of universities and theoretical debates (Hadot, 2002, pp. 297–298). The rediscovery of philosophy as a way of living in the second half of the twentieth century has, however, opened up the possibility for a reevaluation. In this respect, philosophical hermeneutics might already be traditionally closer to the historical roots of religious chaplaincy than much of philosophy, as it originates from the study and interpretation of religious texts (Gadamer, 2011, pp. 175–184). Paul Ricoeur's key contribution to philosophical hermeneutics, is that it transposes the theoretical exercise of the interpretation of texts to human existence. Furthermore, it does so in a way that intimately link the self with the other.

From Ricoeur's hermeneutics of the narrative self, the main task that can be articulated for a spiritual care, is that of supporting the patient in (re)constituting an understanding of the self. Most existential crises that spiritual care must attend to, consist in a variety of disruptures of the aspects of the self distinguished by Ricoeur. A patient suffering from an illness, the loss of a close one, an incarceration, etc., will generally include a reduced capability to act, an incapacity to articulate or communicate their suffering, a discordance that refuses to be incorporated in the narrative of their lives, and a moral distress that could range from a sense of innocence (“why me?”) to one of culpability and moral guilt (Marin, 2013, pp. 13–34). Accordingly, spiritual care cannot consist in assisting either an active rational and free individual in choosing their mode of acting, or in a subject's submitting to the structures that determine the form of their being. Rather, a hermeneutic understanding of spiritual care could focus on supporting the other in their efforts to make sense of their lives and of what is happening to them. The focus that is proper to spiritual care consists in assisting in the process of understanding and interpretation.

At the most basic level, at which the patient is most directly engulfed in the passivity of their suffering, the inability to communicate in any articulate way and the distress of the self, spiritual care can only include a silent compassion and being present. Subsequently, however, the properly hermeneutic contribution to spiritual care calls attention to the need to make sense of a life that has gone through, and might still be going through, a suffering. At this point, the objective is to aid a patient in moving from what Ricoeur would call “fallibility” to capability. In particular, this includes the capability to reconstitute a sense of self in terms of coherence, purpose, and significance.