doi:10.1558/hscc.v2i1.99

Accounting for the Unaccountable:

Making Sense of Extra-Ordinary Experiences in Hospitals

Chris Swift1

Head of Chaplaincy Services, Leeds Teaching Hospitals NHS Trust

[email protected]

Stephen Sayers2

Social Psychologist, York

[email protected]

Abstract: Chaplains are familiar with patient narratives which recount “extra-ordinary” experiences. These may include a vision or awareness of a deceased person. It may take other forms of description which do not fit into day-to-day discourse. There is also a significant multi-faith and multi-cultural diversity to the nature and expression of such events. This paper outlines a narrative structure which could be used authentically by health care staff to enable and value the patient’s experience of extra-ordinary episodes. This is seen as a significant way to support a patient’s dignity and enable them to integrate experiences in an effective way.

Introduction

Chaplains know from experience that their presence can give rise to quizzical or semi-humorous comments from NHS colleagues. In one Trust the apparently random number assigned for a chaplaincy budget code included the figure 666. This caused occasional rye comments and e-mails from personnel in finance. Such minor observations suggest that chaplains are identified with a world of significance and associations largely silent in the practices of other health care staff. It may also mean that chaplains are uniquely available to expressions of the supernatural or, as we shall call them in this paper, extra-ordinary experiences. What follows considers how experiences of the extra-ordinary are handled within health care, and whether there are ways health care providers and patients might respond constructively to what otherwise appears to be irrational.

Patients and relatives have reported moral dilemmas that arise when reporting to health care professionals that they have had extra-ordinary experiences (Chapple 2011; Curtis 2012). Chaplains are familiar with such experiences but no systematic research has been undertaken to gauge the nature and frequency of what is being shared. It is already known that some conditions are associated with heightened spiritual experiences, with much of the literature focussing on near death and mental health. There is, for example, a recognition that spiritual experiences are a characteristic of temporal lobe epilepsy. It has been noted that this is problematic for nursing staff and a multi-disciplinary approach is recommended:

Instead of merely attributing an episode to culture, a nurse hearing of a patient having a profound aura experience should consult hospital chaplaincy, whose pastoral support does not impose doctrine but illuminates personal meanings in coping with illness (McCrae & Elliott 2013: 350).

While this recognition of the chaplain’s expertise in this area is helpful, very often nurses will be the first to hear about the patient’s experience. Often there is no satisfactory way of responding to their concerns and attendant anxiety, especially when the people involved have no particular religious commitment or who are indeed, non-religious. This paper sets out to explore tentative ways in which special mediating narratives might be developed that would enable patients and health care professionals of all faiths and none to reflect upon their extra-ordinary experiences in order to make sense of them.

Case Study of a Hospital Chaplain’s Account of a Patient’s Extra-ordinary Experience

The patient, Emma, calls across to me when I have finished seeing another patient in the same bay. ‘Have you got a minute? I… I just wanted to speak with someone’. I indicate whether I should get a chair, Emma nods and I sit near her. Emma appears to be having difficulty expressing herself, as though there is some inner conflict about what she has to say. ‘It’s about my father’, she begins, ‘he died a few years ago. Last night he was standing there, at the end of my bed’.

In the following conversation Emma talks about her potentially life-threatening condition and recounts the difficult relationship she had with her father. All this tumbles out as we talk, and for Emma the reality of her visitation is confirmed because it was contrary to what she imagined. When I asked Emma how she felt seeing her father she spoke about its peacefulness. ‘It was my father – but not like I remember him: it was peaceful’.

When it is time for me to go Emma puts her hand on my arm. ‘Thank you for listening to me. I daren’t share it with them (indicating the nursing station) because they’d think I was mad’. I part with a sense of having made a connection and spoken about something profound, personal and healing.

Reflection

Chaplains will probably be unsurprised by this encounter. There is something about this kind of experience which resonates with the identity and role of the chaplain. Chaplains are identified with liminal experiences, from birth to death, as well as representing a link to pre-Modern forms of knowledge and practice. Emma’s request to speak with the chaplain is opportunistic. It is a reminder of the significance of the chaplain’s presence on wards. Not every patient in need of spiritual and pastoral support will feel able to route a request to see a chaplain via the nursing staff. Equally, the hesitation apparent at the start of the visit may represent an inner conflict for Emma about whether her experience should be shared at all. The presence of the chaplain appears to give permission for this and it may be that Emma has observed the chaplain’s visit to the other patient in the bay and decided to risk this conversation.

The encounter is not a near death experience. Emma’s condition is potentially life-threatening but, like so many admissions to hospital, issues of her own mortality are present. Hospitals are also places we associate with visits to the dying. The chaplain didn’t ask Emma where her father died but it may well have been within the same facility. The main role of the chaplain in this encounter appears to be one of careful listening, which enables Emma to tell her story and find some affirmation by being heard. An experience which may have been dismissed by other staff is attended to as carefully as any other pastoral encounter by the chaplain. The possibility of being heard in this way appears to give Emma the courage to articulate her experience. The altered nature of her encounter with her father (the same but different) appears to bring peace to Emma as she continues to live with different memories from her past.

The case study does not provide any evidence as to whether the chaplain offered prayer or subsequent contact. It feels as though this was a particular encounter that enabled Emma to express a need she was feeling intensely. The peace of the extra-ordinary meeting with her father appears to be mirrored – possibly completed – by the opportunity to tell someone what had happened. The fact that this was the chaplain, identified with both this world and the next, may have been significant in enabling the experience to be shared and affirmed.

While the particular characteristics of the chaplain may be significant in facilitating such a discussion, chaplains cannot always be present everywhere. This paper therefore goes on to consider how other staff might be assisted in responding constructively to patients who find the courage to share their extra-ordinary experiences.

Discussion

The phenomenon of “deathbed visions” has been recorded since the earliest of times and in many cultures. Edmund Gurney, Frederic Myers and Frank Podmore first provided a systematic account of it in their book Phantasms of the Living in1886. This was followed by William Barrett’s Deathbed Visions in 1926 and Karlis Osis and Erlendur Haraldsson’s comprehensive studies in 1961 and in the sixties in the United States and in the seventies in India. Since then other studies have appeared including those of Gillian Bennett (1999), Peter and Elizabeth Fenwick (2013) and Elizabeth Notworthy-Keane (2009) have explored the area and in the Fenwick’s’ case, have made some useful suggestions about how an understanding of deathbed visions might inform patient care. But none of these contributions have addressed comprehensively the problem of how end of life parapsychological experiences should be discussed by health care workers in order to overcome any attendant cognitive dissonance and allay confusion and anxiety in their patients.

By the very nature of their circumstances, patients and health care professionals can sometimes experience heightened states of emotion. These states can be unusually intense and prolonged. When they occur, the people involved might have to contend with fundamentally extra-ordinary incidents that are difficult to explain. George Tyrrell (1953) introduced the term “crisis apparitions” to allude to a similar phenomenon in his seminal work Apparitions. Melvyn Willin (2011) has given an impressive survey of extra-ordinary near death experiences of hearing music by the dying and those who witness the death. Others see colours, clouds, mist, lights and heat hazes or experience a “gentle breeze” (Fenwick & Fenwick 2013).

Some people are equipped to cope with extra-ordinary incidents by virtue of their life experience, or religious or political faith, or for a variety of other reasons. Others are not. Consequently, it is likely that some people will develop degrees of cognitive dissonance, confusion and anxiety as a result of what they have experienced. This state of affairs is not conducive to health and recovery or to marshalling resilience in circumstances where death and bereavement are involved.

Hospital chaplains and others have developed a wealth of experience in addressing the concerns of patients’ and health care professionals who are already spiritually engaged with the world (Swift 2014). But for those people who are not, or whose spiritual engagement is of an order that does not permit of it, a problem arises. How can cognitive dissonance, confusion and anxiety be allayed when there is no mediating narrative with which to address the extra-ordinary experience that gave rise to it in the first place? This problem is highlighted in the fact that people have reported to chaplains, and researchers, that they are reticent to share their experiences with clinical staff. At present there is no informed way of dealing with it. Usually, such matters are dealt with spontaneously, patchily and without psychologically informed direction.

We would like to redress this situation. Our task is difficult and there is no obvious point of departure. We do recognize, however, that there is widespread agreement amongst social scientists of varying hues that there is a powerful link between language and cognition. Theorists argue about the direction of causation, or even if causation is a convenient concept at all in a matter that might involve some sort of psychological elective affinity between language and cognition. But since the advent of the “Sapir-Whorf hypothesis” on the linguistic relativity of thought developed in 1940, and published by Benjamin Lee Whorf in 1956, there has been a measure of agreement that, in some indeterminate way, language tends to structure experience and that a manipulation of language can lead to changes in the definition of experience. This possibility points the way to our entry into the field of investigation.

Alasdair MacIntyre affords us a beginning when he suggests (our italics) that:

The explanation of rational belief terminates with an account of the appropriate intellectual norms and procedures; the explanation of irrational belief must be in terms of causal generalizations which connect antecedent conditions specified in terms of social structures or psychological states – or both – with the genesis of beliefs (MacIntyre 1971: 247).

We will regard this strategy as indicative. The aim of our research is to create a narrative that will allow people who have experienced extra-ordinary events to make sense of what they have experienced. It must be a narrative that will apply to everybody: it must enable those who are confused or those who think of themselves as rational, or religious, or not religious (indeed irreligious) to define, and by so doing, to make legitimate, what they have experienced. The narrative must then allow people to reflect upon their experiences so that these might be defined as meaningful events in the person’s life-world. In this sense, the narrative must have conversionary characteristics: it must enable the assimilation of the “wholly other”, or at least the idea of it, into the experience of everyday life.

It is suggested that the narrative be informed by the following indicative qualities:

Universal

The language must be intelligible and acceptable to patients, families and professional practitioners from culturally diverse backgrounds.

Parsimonious

The language should be simple as possible. It must be immediately comprehensible.

Impartial

The narrative must be theologically neutral and yet it must carry the possibility of being theologically referable. It must be easily translatable into familiar theological terms for those who have a theology. Therefore it must be secular without being fully secularized.

Plausible

The narrative must have the direct potential to resonate with the subject’s own experiences. It must be perceived as being genuinely revelatory.

Systematic

The narrative must be sufficiently differentiated that it can be used to refer satisfactorily to a range of extra-ordinary experiences.

Significant

The narrative must provide a sense of insight through the creation of meaning. It must lend itself to ownership of the understanding it enables, so that it must permit of a particular kind of experience and one in which the patient or health care professional can rationalize their perception of events.

Integrative

The narrative must enable the subject to reflect upon and assimilate the extra-ordinary event(s) they have experienced. It is precisely through the process of cognitive assimilation that cognitive dissonance, and any attendant confusion and anxiety are dissipated and the patient or health care professional is restored to a stable state of mind.

These qualities are indicative and not exclusive. They provide for modification in the light of experience. They are intended to lend themselves to revision and amendment as progress is achieved.

The Language of the Proposed Narrative

When the narrative is being produced, it is essential that thought be given to the denotations of the words employed. It is widely recognized that the denotations of words can be problematic amongst culturally diverse groups (Mweri 2010). For example, if we refer to the Chaplain’s account offered above (that of the commonly occurring experience of patients or health care professionals feeling “a presence” in the room and who then find that they have been deeply disturbed by the experience) then those who seek to apply a healing narrative would have to be cognizant of unhelpful denotations. It might be fairly obvious to avoid the denotative appellation: “altered state of consciousness” when referring to mood of the person, since this might not be recognised or understood. But other terms might have a similarly unhelpful effect. For example, the term “mental” has a widespread pejorative denotation amongst laypeople who often use that term as a descriptor for a state of mental illness.

But other, apparently more accessible words might lead to connotational difficulties. Indeed, it is arguable that the greatest misunderstandings occur with respect to linguistic connotations, because these evoke predominantly intrinsic rather than predominantly extrinsic meanings. For example, the term “subjective” might be used instead of “altered state of consciousness”. The denotation of the word might be understood, but it could be perceived as a pejorative to a doctor who has been trained to think in terms of an objective imperative, or as patronizing by a patient who feels that the term “subjective” implies bias, or fickleness or some other unintended unfavourable association. In the same way, if the term “psychological” were used, it might be recognised, understood and seen as acceptable by a doctor, but as recognized, understood and seen as unacceptable by a patient, who may associate that term with mental disorder.

However, if the seven indicative qualities are employed and thought is given to avoiding pejorative denotative and connotative aspects of language we might proceed. Let us imagine that when talking to a person who has experienced a presence in the room the following sentence is used to assist the person to restructure their experience of the event:

You may have experienced an extraordinary reaction to an extraordinary event.

Notwithstanding the abstract nature of the terms employed in the sentence, their direct simplicity and lack of any obvious denotative and connotative pejoratives suggest that it will be acceptable to those receiving it. The sentence will provide a starting point for further considerations by framing the event and providing the means to make sense of it. In addition the same sentence might help a person, who is spiritually engaged with the world as well as one who is not. The result might be acceptable to both people and it might enable them to see that their experiences were recognized and understood by other people. They might make sense of their experiences in the following way:

Spiritually engaged person	Spiritually non-engaged person
The experience is explicable	The experience is explicable
What happened was “natural”*	What happened was natural
I now know it was an extra-ordinary event	I now know it was an extra-ordinary reaction
Acceptance	Acceptance

*The term “natural” is presented in inverted commas because to those people who are spiritually engaged with the world, the supernatural is an accepted part of their natural world-view.

So far this paper has framed its proposals largely in terms of the potential benefits to patients and health care professionals that the development of a mediating narrative might provide. There is, however, ample prima facie evidence that health care professionals might benefit particularly from its application. For example, the entire training of medical staff is typically underwritten by a sound commitment to scientific rationality. So that repeated experiences of extraordinary experiences in the work setting might confuse, undermine confidence and through the ensuing dissonance which often follows, lead medical staff to the misplaced conclusion that these experiences are somehow stress related and are therefore pathological in nature. Equally, the naturalistic content of clinical training may incline practitioners to ignore or sideline the patient’s experience. An application of a mediating narrative in such circumstances might go some way towards dispelling dissonance and its attendant consequences.

Concluding Remarks

This paper is not intended to be comprehensive in any way whatsoever. Rather it is tentative and it is offered as a path-finding exercise. The ideas outlined are intended to mark a site of investigation and to open lines of inquiry that might lead to some practicable ways of addressing the problem as it has been presented. It is our contention, based on the above, that extra-ordinary experiences are substantially under-reported. There may be many factors leading to that under-reporting, which in turn may indicate that patients like Emma are often left to cope with significant experiences on their own. Struggling with such events in isolation is unlikely to aid recovery or coping, although the impact on wellbeing can only be hypothesised at this stage.

If chaplains and other researchers wish to contact us regarding their experience of this phenomenon please do so via the e-mail addresses provided. We shall be equally interested to know of instances where a professional narrative has failed to provide cognitive support to a person seeking to integrate such an experience into their world view.

References

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Bennett, G. (1999) Alas, Poor Ghost! Logan, UT: Utah University Press.

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