The Dark Night of the Soul: A Sacred Anatomy of Dying

Abstract

This practical theology dissertation is grounded in palliative care practice, comprising an introduction, six articles, and implications. The main research question is: What is the spiritual experience of dying? Each article integrates the contemplative theology/spirituality of the Dark Night of the Soul with clinical palliative care questions: What is spiritual suffering? How does it differ from depression? How can it be assessed? How may it be best managed? “Nancy’s Story” researched the contemplative journey of dying using the hermeneutical phenomenological method of Max van Manen. Four themes emerged: Lamenting the Impassable Why? ; Faith, Hope and Love: Moving Toward Transcendence; Experiencing Transcendence: An Unexpected Presence; and Experiencing the Gift of Insight Given within Transcendence. A spirituality study group yielded a contemplative spirituality definition grounding translation of Dark Night theology into accessible clinical constructs for spiritual assessment; resulting in a palliative spiritual assessment model. The study engaged two formal evaluations within medical education: the experience of residents’ spiritual care education; and a focus group evaluation of palliative residents and fellows engagement with a palliative spiritual history. Article one commends the Dark Night as a single theoretical construct for suffering, identifying the signs of the Dark Night. Article two, examining differential diagnosis between the spiritual suffering of the Dark Night and depression, includes: a Dark Night Lexicon, a Clinician [Spiritual] Self-Assessment, similarities and differences between the Dark Night and primary depression, and a palliative patient narrative. Articles three, four, and five use a palliative case study to illustrate spiritual assessment. Products reflect Dark Night theology translated into clinical constructs: a language for spirituality and spiritual suffering, a palliative spiritual assessment model, and tool. Article six on managing spiritual suffering, builds upon the CanMEDS framework, contributes contemplative spiritual care competencies for the medical profession, and demonstrates their application in a case study. Spiritual suffering may be understood as the process of the Dark Night, differing from depression as a transformative form of suffering and non-pathological. This research introduced a language for spirituality at end of life, and can advance clinical practice – through tools that aid clinician’s understanding, assessment, and intervention.