Embodied Soul. The Focus For Nursing praxis

·期刊原文

Embodied Soul. The Focus For Nursing praxis

Picard C

J Holist Nurs

Vol.15 No. 1 Mar.1997 Pp.41-53

Copyright by J Holist Nurs

EMBODIED SOUL

The Focus for Nursing Praxis

This article explores the nature of embodied soul as a phenomenon of
concern to nursing. Examples of the body/soul debate from early Greek
philosophers to the present day are examined. Early writings on the subject
echo in medieval writings and in present-day knowledge of neuroscience and
physics, as well as in the writings of Merleau-Ponty. The author proposes
that nursing embrace the concept as it relates to Berry's patterns of
differentiation, subjectivity, and communion in the universe. These
patterns exist from the cellular to the cosmic level. It is through the
embodied soul that one engages in this process. The works of selected nurse
theorists are examined as they relate to the topic. Both the subject of the
client and of the nurse as embodied souls are addressed.

Behold, the body includes and is the meaning, the main concern,
and includes and is the soul;
Whoever you are, how superb and divine is your body
or any part of it! (Whitman, 1992, p. 17)

The phenomenon of the soul and its relationship to the body has been
written about by philosophers, theologians, mystics, and scientists over
the past 4 millennia. Nurses have also explored this phenomenon (Lane,
1987; Nagai-Jacobson & Burkhardt, 1989; Newman, 1994; Nightingale,
1860/1969; Parse, 1981; Picard, in press; Roach, 1992a; Rogers, 1970;
Vaillot, 1970; Watson, 1985). The debate on this relationship continues to
this day.

HISTORICAL ELEMENTS OF EMBODIED SOUL

Embodied Soul/No Soul: Old Testament and Buddhist Traditions

In pre-Hellenic times, beliefs in both Western and Eastern religious and
philosophical traditions described embodied soul as the nature of person.
The Hebrew word nepes means soul and also the human person as he or she
begins to live (Tresmontant, 1960). Soul as consciousness is another
element of nepes. According to Tresmontant, the Hebrews understood that
"soul is the man. Indeed, we should not say man has a soul but that he is a
soul; nor consequently that he has a body, but that he is a body" (p. 94).
This sense of integrality of person as embodied soul and form of
consciousness is also found in Buddhism, although some writings on the
subject might disagree. Buddha's gospel includes a dialogue regarding the
nature of soul (Buddha, trans. 1915). When asked about the immortal nature
of the soul, Buddha denied it. But in a reading of the passage, the idea of
soul as embodied consciousness, unique to each person, can be understood.
Buddha did not believe in the soul as a separate entity but stated that "he
who understands by (the word) soul mind, and says that mind exists, teaches
the truth which leads to clearness and enlightenment" (Buddha, 1915, p.
151). This aspect of mind enabled the Buddha to appreciate the sense of
communion with the world and the absurdity of thinking of each sell or
soul, as distinct and unengaged with the universe. For Buddha, the notion
of immortal soul as a unique expression of a person's self was inaccurate.
Buddha himself can be interpreted as embodied soul as, in deep meditation,
he became aware of the flux of all things in the world, including persons.
Buddha was able to have a direct experience of this flow between self and
world through a heightened awareness of the subtle vibrations both within
and around his body (Spretnack, 1991).

Greek Philosophers: Heraclitus, Plato, Aristotle

Heraclitus (trans. 1979), a pre-Socratic philosopher, described soul in
terms of flow in the universe. Embodied soul as person exists in sameness
despite constant shifts in the stability of the world. Heraclitus believed
that the soul has the possibilities of expansion: "To the soul belongs a
report that increases itself" (trans. 1979, p. 75). The soulfulness of a
person is expansive and always flowing. Depth as a quality of both embodied
and world soul was also expressed by Heraclitus. He believed one could
never find the limits of soul "no matter how hard one tries, so deep is its
report" (trans. 1979, p. 45).

This concept of flow is also found in the writings of Plato, who described
the changing nature of both body and soul (Plato, trans. 1927/1974). Plato
believed in an immortal soul, separate from the body, that is self-moving.
Soul is the moving principle of the body. It is a formless intangible
essence, known only to mind. He also believed in a world soul, or the soul
in its totality, which is the mover of inanimate things (Plato, trans.
1927/1974). He associates virtues of beauty; wisdom, and goodness with the
divine soul, which struggles with the mortal aspects in his image of the
horses and charioteer. His idea of the soul beholding absolute truth,
beauty, and love is the guiding principle behind immortality for perfect
souls and the need for reincarnation of those less perfect.

Aristotle described soul as the "essential whatness," or ousia, of a thing,
the definitive meaning, and its essential character. The body is the
material condition, but its activities are soulful (Aristotle, trans.
1960). Soul is unique to body and the formative, particular force in
defining that being. Aristotle argued that the body is ensouled as a
particular organic totality and disagreed with Plato that a soul could
transmigrate to another body. For Aristotle, body/soul was a special
relationship of two interagents.

With the Platonic and Aristotelian traditions in Greek thought, it is
understandable that in Greek translations of the Hebrew Bible, nepes (soul)
was translated into two different terms, pneuma and psyche. According to
Hillman (1975), the Greek spirit, or pneuma, is a masculine aspect
associated with light, speed, lifting, or soaring. Soul, or psyche, is a
feminine principle more closely linked to earth and the body; with
characteristics of depth and darkness. The Hebrew belief in embodied soul
continues to be a part of the New Testament but primarily in the gospels
(Hillman, 1975). In the Christian tradition, by the 8th century; embodied
soul as an integral aspect of person is eliminated and spirit, or pneuma,
is identified in its place (Bilaniuk, 1967). Although soul becomes part of
the church's teachings again, its meaning is changed. The philosophical
concept of body and soul as connected but separate is established.

Medieval Mystics

In the Middle Ages, the Christian church was the predominant spiritual
belief system of European people. The concept of body and soul as joined
but separate was a strongly held belief. However, a movement within the
church emerged that began with Hildegard of Bingen and continued with the
Rhineland mystics, such as Meister Eckhardt (Fox, 1988). These religious
leaders believed in the capacity of persons to have a direct experience of
the Divine and embraced a belief in embodied soul that celebrated
embodiment as a cause of joy and revelation in the mysteries of creation.
Hildegard of Bingen wrote on the subject of viriditas, or greening power
(Fox, 1985). Viriditas is the capacity of the Divine to nourish one's soul.
Hildegard drew her spiritual imagery from the body and the surrounding
world to express this concept. For Hildegard, "the soul is the freshness of
the flesh, for the body grows and thrives through it just as the earth
becomes fruitful with moisture" (see Fox, 1985, p. 32). This integrality of
embodied soul is also found in the writings of Meister Eckhart, who stated,
"You should consider how it is that/the body is more in the soul/than the
soul is in the body" (cited in Fox, 1983, p. 105).

Descartes's Legacy: Soul as Disembodied

Whether Descartes meant for his philosophy to support the dualistic
framework that was to rule science for 200 years is debatable (Spicker,
1970). In the meditations of Descartes, body and soul are perceived as
separate and distinct substances. The body is mortal, divisible, and
mechanical; and the soul is immortal and indivisible and contains the
intellect. Body and soul are mutually exclusive in their properties
(Descartes, 1641/1993). Descartes believed that thought made us distinctly
human and was the essence of our being. There is no wisdom of the body in
his philosophy. Descartes believed the body acted on the soul and that the
soul had influence on the body, but his imagery of the body as machine, and
its extension to nature as soulless and in need of control, became a
metaphor that influenced the consciousness of science and technology until
the middle of this century. Science could investigate the body and focus on
technology, but the soul became the domain of the church.

EVERYTHING OLD IS NEW AGAIN: TWENTIETH CENTURY'S THOUGHT ON EMBODIED SOUL

Science, Once Blind, Can See: Physics, Cell Biology, and Neuroscience

Scientific theories in the 20th century reflect what was known by Buddha,
Heraclitus, and other ancients. In physics, the principles of unity,
complexity, and subjectivity as explored by Einstein and others result in
an understanding that matter and energy are different manifestations of the
same thing (Capra, 1983). The observer in the world has an effect on the
observed, playing a role in a unified order that has many possibilities of
expression. For example, the decision to measure light as a particle or a
wave has an effect on its expression in reality. More recently, Bohm's
concept of "implicate" order, or an underlying pattern of the universe and
our observations of explicit order as visible or measurable manifestations
of that order, echo older wisdom traditions (Bohm, 1980).

Another old and new way to approach the nature of the universe is the idea
of consciousness. Consciousness exists at the subatomic level in the sense
of interrelationship of particles and at higher levels expressed by
persons. Body wisdom, or the wisdom of cells responding to nutrients, or
organ systems responding to a threat, or a person's ability to solve
problems and to create are all manifestations of consciousness. DiMasio
(1994), a neurologist, studied emotion and reason, describing the richness
of the interrelationship of aspects of mind and body as they are expressed
in the person. DiMasio believes that embodiment is an essential way of
knowing person: "It is just that soul and spirit, with all their dignity
and human scale, are now complex and unique states of the organism" (1994,
p. 244). If person is a consciousness, embodied soul is a clear term to
describe lived experience as embodied soul. The concept of expanding
universe and expanding consciousness can be perceived as two expressions of
the capacity of an ensouled world.

Merleau-Ponty's philosophy emphasizes the embodiment of subject in the
world. The idea of unity of conscious life rests on body as unity
(Merleau-Ponty, 1962). Persons cannot be other than engaged in this world
and are part of consciousness. Merleau-Ponty described person as
body/subject, with self not separate from body. For him, human beings are
embodied selves living through the world. Merleau-Ponty speaks of soul
essential to embodied experience: "The significance of a thing inhabits
that thing as the soul inhabits the body; it is not behind appearances"
(Merleau-Ponty; 1962, p. 319). Embodiment refers to meanings, expectations,
styles, and habits expressed and experienced by the body/self. Rawlinson
(1982) described the body as a system of possibility rather than a simple
physical entity. Body/subject is lived through in movements, desires,
attentions, and gestures.

Hillman (1975), a psychologist, believes much of our 20th century distress
comes from a lack of attention to soul and its relation to embodied
experience. He conceives of soul as perspective instead of substance and
believes metaphor, images, and contemplation are what nourish soulfulness.

Harre (1991) discusses embodiment as an aspect of personhood. Using the
example of preparation for surgery as a ritual of separation of personhood
from body, Harre argues that body and person might be engaged separately.
For the physician, the above scenario may be true; however, for the nurse,
the person is embodied soul, whether conscious or not.

In the early 1960s, as part of the societal turmoil, a challenge was made
to established religions in terms of the importance of spiritual beliefs,
including soul. An erosion of faith in religious and political structures,
challenges to established values and mores related to sexuality and the
role of women, the death of national leaders, war, and environmental
problems all contributed to this crisis. What emerged at the end of that
decade was a renewal in hope for soul expressed in the ecology movement,
embracing the needs of the planet and person's role in relationship to it.
As persons looked to relationships to search for embodied soul, they also
began to explore older wisdom traditions of Eastern and Native American
spirituality. Feminists began to reclaim the power of being in relationship
as a value to be explored not only in the private spheres of life but in
science and public policy areas as well (Keller, 1983). Feminists also
reclaimed the body as a source of knowing, beginning the self-help
movement. Fox (1988) and Berry (1988), two theologians, wrote on the wonder
and joyful creativity of a spirituality which honors the soul of the
individual and of the cosmos. Berry integrated knowledge from science and
older wisdom traditions and identified three guiding principles of the
earth: differentiation, subjectivity, and communion. These concepts were
included in writings in nursing, with differentiation reflected in the
uniqueness of each patient, subjectivity in the lived experience of the
individual, and communion in the need for relationship and connection
(Benner & Wrubel, 1989; Gadow, 1990; Kesselring, 1990; Lane, 1987; Lindsey,
1995; Moch, 1990; Nagai-Jacobson, 1989; Newman, 1994; Picard, in press;
Roach, 1992a; Rogers, 1970; Watson, 1985). Berry credited the scientific
community with giving mankind an appreciation of the universe. Although
science could continually add to the knowledge of how the universe works,
its purpose remained ineffable.

Embodied soul is the human form of possibility in all unique expressions.
The experience of being in the world is by its nature subjective, and the
principle of soulfulness is what connects us to all aspects of our
planetary life. Meeting the world as a besouled and engaging person
provides one with a deeply connected sense of communion.

Nursing's Emergence as Being and Engaging With Embodied Soul

Watson (1985) referred to soul as the geist, the spirit and an essential
core aspect of person. She acknowledged the quality of mystery in her
discussion of soul and reflected on a sense of higher consciousness and
transcendence of the body/self as immortal. Watson presented soul as the
first in her basic beliefs about human life and identified a disturbance in
inner soul as a cause of illness. In Watson's theory, nurses care for
persons in the integrality of their three spheres of being as
body/mind/soul (Watson, 1985).

Newman (1994) describes consciousness as the essence of all matter. This
conceptualization of consciousness includes consciousness as existing from
the basic molecular to the cognitive and nonlocal forms of consciousness.
One example of this consciousness is that of the immune system.
Consciousness here is not only a state of being but a potential as well.
Newman's theory that consciousness is reflected in movement is parallel to
Plato's self-moving principle of the soul. She believes that care of the
soul, attending to embodied consciousness, is the moral imperative of
nursing (Newman, 1994). Newman's challenge to nursing to embrace a
collaborative model of caring speaks to Berry's principles: the need for
unconditional love as manifested in sensitivity to self (subjectivity),
attention to others (communion), and creativity (differentiation).

Roach (1992b) believes nursing must be anchored by metaphysics and
discusses unity as a metaphysical concept for nursing. "In our diverse
reflections, there is a thread of unity in the awareness of the mysterious,
the sacred, the specialness or uniqueness of the human being" (Roach,
1992b, p. 40). Roach conceives of nursing as person in relation, which she
also identifies as human community. Roach goes further by identifying the
caring artistic paradigm as the root metaphor for nursing and the need to
reclaim a sense of awe before the mystery of creation (Roach, 1995). She
conceives of embodied soul as a unity, whereby the person is "the meeting
point of fusion into one nature of the visible world of the today and the
invisible world of the spiritual soul" (Roach, 1992a, p. 22).

Current Nursing Research on Embodiment

Gadow (1980) described the change in the relationship of self to body
during illness and aging. In this process, the sense of integrality of
body/self as a unity is disrupted. There is potential in this crisis to
move from an experience of body as object, not self, to one of
body/subject, a fuller and richer experience of self as embodied person.
This change in consciousness of body/self relationship is the opportunity
of illness.

Benner and Wrubel (1989) examine embodiment in their study of stress and
coping, citing the importance of this integrated way of understanding
person. Their exploration of embodied intelligence has importance both for
nurses and for their patients in designing strategies for care. For
example, nurses can design interventions that support recovering bodily
capacities once known but lost through injury or illness.

Doolittle (1994), in a study of 13 stroke survivors, examined the
experience of recovery, with particular attention paid to the importance of
embodied experience. Doolittle described the importance of the ability of
the survivors to engage in social activities and routines that required
bodily engagement. The capacity to perform these activities was more
important to subjects than an overall improvement in functional status.

In a study examining the meaning of comfort to 36 patients with serious
illness, surgery, or trauma, Morse, Bottorff, and Hutchinson (1995) found
that one of the most distressing aspects of the illness experience related
to change in their embodied experience. The subjects in this study
described their feelings in terms of suffering, pain, and loss of trust or
control over their bodies. Comfort, according to the authors, is more
notable by its absence in the embodied experiences of discomfort (Morse et
al., 1995). These researchers defined comfort as a state of integration and
health of body, and believe the examination of ways of restoring this
integration is a main goal of nursing. In a study of living with breast
cancer, Moch (1990) identified lack of control over one's body while in
treatment for breast cancer and the uncertainty over the possibility of
recurrence as sources of distress for subjects. A theme that emerged from
the research was of new perspectives on life as a result of the illness
experience, including a heightened sense of connectedness to others and
time spent in self-reflection and self-care. Again, Berry's (1988)
principles are present in these findings of nurse researchers. om surgery;
described respondents' healing as a process of active participation,
achievement of balance, and evolution beyond their presurgical state of
being. Each aspect of the process involved a heightened body experience
whereby subjects moved from feeling out of control and disconnected in
mind/body to an reintegration at a higher level (Criddle, 1992). Healing
from chronic illness has similar dimensions. As reported by Lindsey (1995)
in a study of patients' experiences healing from chronic illness and
disability, subjects described moving through a process of expanding
consciousness and integration of self into wholeness of mind/body/spirit.
Subjects reported that the healing modalities most helpful were those that
worked on the body or those that focused on mind, emotions, and spirit.
Although the study was limited in its generalizability due to the small
number of subjects, the participants called for health care providers to
attend to wholeness of experience. Further research on the role nurses can
play in this process is also needed. Price (1993) examined the phenomenon
of body listening, based on lived body experience of illness, and defined
the body paradigm, an explanatory model of subjects' definitions of
themselves as embodied persons. The paradigm includes awareness of energy
level, circadian rhythms, past and present physical health and illness
experiences, and in-the-moment conscious awareness.

Kesselring (1990) described the embodied experiences of 18 women undergoing
chemotherapy for breast cancer The experience of embodiment described by
the subjects had three dimensions: body as shaper of the self and one's
world, body as an identity encountering medical interventions, and body as
a conceptual entity (Kesselring, 1990). Knowledge about the body on the
conceptual level was not adequate to help these women to cope with their
treatments and illness. The altered reality of being unable to perform
basic, ordinary taken-for-granted activities and functions as embodied self
created the most suffering and feelings of vulnerability in the subjects.
The author recommended the inclusion of embodied soul in nursing's
conceptual models (Kesselring, 1990).

As the above research indicates, there is a need for nurses to acknowledge
the person as embodied soul, as one whose experiences are more than a sum
of biopsychosocial dimensions and who has embodied wisdom and knowledge
from his or her unique experience of being in the world. Kesselring's
(1990) subjects never once mentioned body image, a construct that has
received considerable attention in nursing. They did, however, spend a
great deal of time describing the embodied experience of living through
chemotherapy just as Doolittle's (1994) subjects described living through
recovery from stroke.

THE FUTURE OF NURSING KNOWLEDGE AND EMBODIED SOUL

What are the implications of such a concept taking hold in the center of
the debate for the future of nursing? The concept of embodied soul implies
a sense of reverence in the culture that the concept of consciousness does
not. Soul is rooted in a deep spiritual tradition crossing millennia and
cultures. Moore (1992) reflects that there is no understanding of the soul
but a need for its contemplation and nurturance. In this postmodern age,
there is a need for reclaiming a sense of wonder about the nature of the
world. Often, it is the artist who can best express such an idea.

Embodied soul is the mystery, an expression of the capacity for growth and
expansion, with the need for nurturance. Nurses need to appreciate this
mystery as well as conduct research into what will help those who need our
care. As Gadow (1990) states, the concern for embodiment is critical in our
care delivery systems. Without honoring the soulful experience of
patienthood, the person is left in a disengaged, vulnerable, potentially
suffering place. Cassell (1992) concurs that suffering involves a lack of
meaning and a disconnectedness. The hazards are great in our health care
system for dishonoring embodied soul. The value placed on efficiency and
technological solutions to health problems is reflected in the amount of
time given to care for patients. Units of care are factored on activities
to be performed and not the need for interaction with person.

As a way to honor embodied soul, nurses can begin to reflect on symptoms
and illness as body parables (Spretnack, 1991), expressing dimensions of
embodied epistemology that value the subjectivity of both the nurse and
patient. Nurses can experience themselves as embodied souls engaged in
mutual creative processes with those cared for and appreciate the need to
honor and care for self as well as other. Nursing practice and research can
be approached as a form of extrovert meditation (Fox, 1979). Extrovert
meditation is a "centering by way of creating" (Fox, 1979, p. 132). The
focus is the soulfulness of engagement as communion, at whatever level of
care the person needs, be it a wound-dressing change for a person in coma
or a dialogue about the loss of a child. With this orientation to practice,
education, and research, nurses can honor the reverence of each unique
human life in a new way, opening up to the creative potential inherent in
all activity. This is an essential aspect of compassion and care for
embodied souls.

To explore the concept of embodied soul with patients, areas fruitful for
research include phenomenological studies of the lived experience of
healing relationships. What makes the difference for patients? What do they
experience as healing? How can nurse researchers, leaders, and managers
incorporate supports for nurses to nourish themselves as embodied souls?
What happens if nurses incorporate time for self-reflection and self-care
as a priority? What is the embodied experience of caring for patients?

Embodied soul as a way of thinking of person holds rich promise for nursing
theory and research. By placing high value on meaning, embodiment,
subjectivity, differentiation, and communion, nurses can influence their
own experience of being in the world and that of those for whom they care.

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~~~~~~~~

By Carol Picard, M.S.C.S., R.N. Fitchburg State College

Carol Picard, M.S., C.S., R.N., is an associate professor at Fitchburg
State College in Lunenburg, Massachusetts, and a doctoral student at Boston
College School of Nursing. Two of her recent publications are "Images of
Caring in Nursing and Dance" in the Journal of Holistic Nursing and "Walk
in Beauty: Aesthetics, Caring and Spirituality" in From the Heart: The
Convergence of Caring and Spirituality. Her research interests include
caring and the arts, as well as international nursing collaboration.
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