THE SPIRITUAL DIMENSION OF AGEING

As a nurse and Anglican priest, the author brings both knowledge and empathy to her subject, arguing in this study that the spiritual dimension constitutes the core of caring. The original edition of 2001 has been updated with a new study of baby boomers and ageing, and it is clear that this generation has different expectations of the spiritual dimension of ageing, especially in relation to what Mary Catherine Bateson calls Adulthood II, the age of active wisdom. They expect to remain more active and productive than previous generations. However, as the title of this review suggests, ageing brings a gradual move away from activity and doing towards being, partly due to diminishing energy. However, whether this results in increased self-centredness or self-transcendence is a key spiritual issue and indeed task.

The author uses the research tool of Spiritual Health Inventories for Elderly People (SHIE), which enables her to identify six major themes in spirituality and ageing (p. 72). These are ultimate meaning in life, response to ultimate meaning, then the more specific dynamics of self-sufficiency/vulnerability, wisdom/provision to final meanings, relationship/isolation and hope/fear. Spirituality is identified with the sphere of ultimate meaning in people's lives, the meaning arising from the core of one's being. The study finds spirituality protective against various vicissitudes of ageing, and in the sample there is a definite emphasis on the category of spiritual but not religious. Spirituality is mediated in a number of different ways, including relationship, worship, prayer, nature, art and music. The author then develops the spiritual themes into tasks of ageing in response to request for ultimate meaning. This involves transcending loss/disabilities, finding intimacy with God and/or others, finding final meanings and finding hope. This may entail spiritual reminiscence and life review.

For the Christian, ultimate meaning in life is one centred in God (p. 121), and the tasks become dying to self (self-transcendence), growing into Christ or intimacy with God, growing in wisdom and final meanings, and finding hope in the future. An important part of this process is letting go or stripping away, what Christians call kenosis, or emptying. Sociological models use the language of activity theory with people losing former roles and disengagement theory involving withdrawal. Spiritually, this means an increased focus on interiority, which is a deep level means self-transcendence, defined in this book by Paul Tillich as 'the recognition that the goals of increased awareness, freedom and relatedness are only possible when the self continues in relation to the divine source or its being.' (p. 230) The author quotes Victor Frankl on the shift from provisional to final meaning in relation to death. She discusses this in a chapter devoted to wisdom: 'the spirit grows, finding meaning in being, accepting the inevitable losses of life, and letting go of things that are no longer important.' (p. 250) Psychologically, this may entail dealing with guilt and arriving at forgiveness, also struggling with hope and despair, with fears of advancing frailty and dependency.

An important strand running through the book is narrative or story, which helps us forge meaning out of our lives. Not only do we have stories, we are story, and much of our culture consists of stories, telling and listening. This helps us reflect on pattern and purpose where our story is part of our identity, 'an expression of the sum of our being.' (p. 144) In the end, she contends, story is the vehicle of meaning in life. Another key factor in meaning is relationship, and many respondents report that the relationship with their spouse gave them the greatest sense of meaning. For others of a more spiritual turn, they may seek intimacy with God. This may lead to what the author calls spiritual integrity where the individual shows through example and attitude a sense of peace with themselves and others, 'and development of wholeness of being' (p. 280) A further interesting finding is the difference in the use of humour between men and women – men use humour as a means of deflection when subjects become too personal, while women use it to enhance connection.

Erikson noted 20 years ago that we lack a culturally viable ideal of old age and a concept of the whole of life. In the light of her findings, the author suggests that we need to rethink the contribution of older adults in part-time work and new careers and tap into the wisdom present within the community. She concludes that a spiritual journey and continued spiritual development are a reality to older people as they move towards spiritual integrity as defined above. I found her model of spiritual tasks in relation to themes very helpful and constructive, and one that we can surely apply individually. Hemingway once wrote that as we grow older we do not grow wiser, we grow more so. I see this as the challenge to move from self-centredness to self-transcendence, to move beyond an individual view and adopt a more universal outlook, growing into wholeness of being. In this sense, one can also appreciate the centrality of the spiritual dimension in health care, and as such, the book can be recommended especially to healthcare professionals, but it is also accessible to general readers.