Recognizing Spiritual Distress: What Caregivers Need to Know

by | Aug 23, 2022

A spiritual care coordinator, chaplain and bereavement specialist with Chapters Health System share ways for families and patients to address spiritual distress in a loved one.

Your body is very good at telling you when something is wrong. Pain, discomfort, hunger and thirst are just some of the signals our brain processes, telling us our physical body is experiencing stress. Did you know your spirit also sends signals when it’s stressed? Recognizing spiritual distress is important. It can manifest itself in many ways, both physical and emotional. The causes and symptoms can vary from person to person, making it difficult to recognize. A team of professionals, including bereavement specialists and chaplains with Good Shepherd Hospice and Chapters Health Hospice, explain their experiences so caregivers and families know what to look for with their loved ones

Defining Spiritual Distress

Recognizing spiritual distress isn’t always easy, but according to the Hospice and Palliative Nurses Association, spiritual distress is defined as a disruption in a person’s belief or value system.

Meet Charles Harkala, spiritual care coordinator and preceptor for Good Shepherd Hospice

Charles Harkala, spiritual care coordinator and preceptor for Good Shepherd Hospice.

“One of the founders of modern hospice, Dame Cicely Saunders, shared something I will never forget,” said Charles Harkala, spiritual care coordinator and preceptor for Good Shepherd Hospice. “We are not physical beings having a spiritual experience, but we are spiritual beings having a physical experience.”

Physical experience is life. When physical experience is challenged, our spiritual selves are also challenged. In the hospice space, a life-altering illness, death of a close loved one, and financial hardship related to care are some of the challenges pervading our public lives and strike at our spiritual core.

“People experience spiritual distress when they have a disruption in the life principle pervading their entire being,” said Suzy Soliday, licensed mental health counselor and bereavement specialist with Good Shepherd Hospice. “Those long held beliefs and non-negotiable principles are challenged, often by circumstances out of our control.”

As a result of those circumstances, a person may question the sources they once turned to for comfort, love, faith and hope.

The Signs of Spiritual Distress

“Warning signs of spiritual distress are often hidden inside of physical and emotional symptoms,” said Harkala.

The warning signs:

  • Sadness, anger, despair, anxiety
  • Questioning people and institutions, such as clergy, practitioners, helping entities.
  • Continuously questioning the meaning of their suffering.
  • Asking “Why now?” and “Why me?”
  • Expressing a feeling of emptiness, loss of direction, abandonment.

These are the signs that something is missing. Something medicine cannot cure. Recognizing the signs and reporting them to a licensed mental health counselor or spiritual care specialist is the first step.

Professional Ways to Address Spiritual Distress

There are many ways to address spiritual distress, in both hospice patients and their loved ones. At Chapters Health System, a dedicated team of professionals, including physicians, nurses, bereavement specialists, social workers, chaplains and volunteers, would be available to help find the best course of treatment. Common choices include but are not limited to:

1. Pet Therapy

A recent study from the University of Toledo shows service animals and emotional support animals can provide quantifiable mental health benefits. The study is the first of its kind with peer-reviewed, published scientific evidence.

One such animal, “Elvis” the Basset Hound, helps hospice patients and their families throughout the Florida Keys with his handler, Kerry Foote, who works as a chaplain with Chapters Health Hospice.

Meet Elvis, an emotional support dog with Chapters Health Hospice - Keys

Elvis, the emotional support dog with Chapters Health Hospice in the Florida Keys.

“Spiritually, he lifts people’s hearts,” said Foote. “I wasn’t prepared by how much bringing a dog in would make a difference. I was shocked.”

Pet therapy is available to patients and families throughout Chapters Health System’s network of community-based affiliates.

2. Bereavement Support

“A bereavement approach would be to provide encouragement and validation of feelings,” said Soliday. “The client, whether it’s a patient or their family member, would be encouraged to openly express their feelings and concerns. They would be further encouraged to explore ways to cope in their own life such as journaling or physical outlets like walking and sports.”

Many hospice care providers can assist families and caregivers with bereavement. At Chapters Health System, bereavement services are free of charge and include a range of support options for both adults and children. The options include individual and group therapy sessions, including weekend grief camps for children.

3. Spiritual Support

This level of support would include a chaplain, who works in conjunction with the rest of the hospice care team available to patients and families. A chaplain is a certified clergy member who provides spiritual care for individuals in a non-religious organization, rather than a church congregation. It’s important to remember, chaplains do not necessarily belong to any religious denomination. They do not preach sermons and do not attempt to convert patients to any religious denomination.

“I am a Christian personally, but I also have knowledge in Buddhism, Hinduism, Islam and Judaism,” said Foote. “I am also an adjunct professor at Florida Keys Community College, where I teach religious studies. I believe there are three questions in life, that all humanity tries to answer. Where do I come from? Why am I here? And where am I going? All religion deals with those three questions. I try to stick within those three questions and try to meet you where you’re at.”

The role of a chaplain is to simply provide any spiritual support a patient or family requires.

“For me, it’s essential to focus on building a relationship through active listening, dialogue and openness,” added Harkala. “You must have patience, positive attitudes and empathy. Then, when they are ready, share sources leading back to faith, hope, love, meaning and assurance.”

Advice for Family

The assistance of chaplains, bereavement specialists and emotional support animals can go a long way to helping someone with spiritual distress. But what happens when those resources are not present? How can families comfort their hospice patient when the care team is not present?

  • Provide a calm, relaxing setting
  • Treat the person with dignity and respect
  • Be present
  • Listen
  • Spend quality time and look for ways to make positive memories
  • If asked, be open to contacting a spiritual leader of their choosing.

“Acceptance, love, compassion and sharing hope in its many forms are great tools for battling and ultimately defeating spiritual distress,” said Harkala.

Chapters Health System has a variety and services and support for patients. As always, Chapters Health is committed to serving their needs as well as the needs of our families, caregivers, health providers, partners, and communities.

For more information, please call our helpful Chapters Health team at 1.866.204.8611 or Contact Us.

Austin Mudd

Austin Mudd

Austin Mudd, Media Relations Specialist at Chapters Health System, is responsible for external communications for the nonprofit organization. Email: [email protected]

About Us

Established in 1983 as a community-centered, nonprofit entity, Chapters Health has grown exponentially through its radical approach to healthcare that leverages a one-of-a-kind system to support patients, families, and caregivers across the country, while remaining grounded in the mission of taking care of patients, or taking care of those who do®.

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John J. Whyte, MD, MPH

CEO and Executive President,
American Medical Association

John Whyte, MD, MPH serves as the CEO and Executive Vice President of the American Medical Association, the nation’s largest physician organization.

Prior to the AMA, Dr. Whyte served as the Chief Medical Officer at WebMD, leading initiatives that expanded strategic partnerships, created new business opportunities, and positioned WebMD at the forefront of digital health innovation. He was a pivotal force in evolving WebMD’s digital platforms from content delivery engines to powerful tools connecting consumers directly to care, establishing critical new revenue models. He is a recognized leader in healthcare delivery and regulation and is consistently named as one of the Top 20 Health Influencers.

Before joining WebMD, Dr. Whyte served as Director of Professional Affairs and Stakeholder Engagement at the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research. There, he spearheaded groundbreaking initiatives to modernize clinical trial design, expand diversity in research, and advance the regulatory use of real-world evidence — efforts that continue to impact patient-centered drug development today.

Earlier, as Chief Medical Expert and Vice President of Health and Medical Education at Discovery Channel, Dr. Whyte launched educational programming that captured both medical and mainstream audiences, successfully aligning mission-driven health education with corporate funding strategies and building new multimedia brand identities.

At the Centers for Medicare & Medicaid Services (CMS), Dr. Whyte played a pivotal role in formalizing Medicare’s national coverage decision process, directly shaping payment policies and advancing innovative models to improve healthcare outcomes. His experience at CMS demonstrates a deep understanding of health policy, reimbursement strategies, and the critical intersection of clinical innovation and payment models.

A board-certified internist, Dr. Whyte completed his MD at Hahnemann University School of Medicine, his residency at Duke University Medical Center and earned his MPH in Health Policy and Management at Harvard University. He previously served as a health services research fellow at Stanford University. An accomplished author, Dr. Whyte has written extensively for both professional and consumer audiences, including five best-selling book

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Dr. Venki Ramakrishnan

Nobel Laureate

Venki Ramakrishnan is an American and British molecular biologist who shared the 2009 Nobel Prize in Chemistry. He currently works at the world-renowned MRC Laboratory of Molecular Biology in Cambridge, England and from 2015-2020, he served as President of the Royal Society, one of the world’s oldest scientific organizations. He is best known for his work on protein synthesis, the process by which genetic information is used by the ribosome to make the thousands of proteins that make life possible. This process is fundamental to all life and its dysfunction leads to many diseases as well as to aging. He is a member of the US National Academy of Sciences and was knighted by the British government in 2012. In 2022, he received one of Britain’s highest civilian honors, the Order of Merit, which is restricted to 24 people across all fields.

In addition to his academic work, Ramakrishnan is a science partner of the venture capital fund Ahren Innovation Capital, and on the boards of the AI-based drug development company, Isomorphic Labs, and the British Library. He recently co-founded RNAvate, an RNA therapeutics company based on stable, next-generation RNA molecules. In the public arena, he played a leadership role when he was president of the Royal Society, including dealing with the consequences of Brexit and helping convene the Society’s response to provide advice during the covid pandemic and did a significant amount of public engagement including articles in the press and appearances on national media.

Ramakrishnan is the author of two popular books: Gene Machine (2018), a very frank scientific memoir about the race for the structure of the ribosome that led to the Nobel Prize; and Why We Die: The New Science of Aging and the Quest For Immortality (2024), which looks at the biology of aging and efforts to combat it.

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Marwa El-Menshawi, MD, MPH

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Marwa El-Menshawi, MD is the Chief Operating Office for Hope PACE. She is a triple board-certified physician, specializing in Family, Geriatric and Hospice Medicine. Dr. El-Menshawi's focus is on improving the lives of those affected by advanced age and serious illness through innovation in high complexity and value-based care. She has almost 20 years of clinical, academic and healthcare leadership experience.

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Andrew Molosky

President and CEO, Chapters Health System

Andrew Molosky is the President and Chief Executive Officer of Chapters Health System, the country's defining chronic illness organization, comprised of more than 30 different companies and programs, including the nation's largest nonprofit hospice network, PACE, value-based care such as CareNu, a Medicare Advantage plan, managed services organizations, technology solutions, advanced illness offerings, and more.
Established in 1983 as a community-centered, nonprofit entity, Chapters Health has grown exponentially through Molosky's innovative approach to healthcare, becoming a national leader recognized by Great Places to Work, Fortune, USA Today, and others for being a top place to work.
As a leading voice in healthcare, Molosky is routinely engaged as a consultant, speaker, and mentor. Molosky is modeling and leading across several industries concurrently.
Molosky has more than 20 years of experience spanning an array of geographies and organizations, including publicly traded, privately held, and nonprofit. He completed his undergraduate work at the University of Toledo and his Master of Business Administration from the Ken Blanchard College of Business at Grand Canyon University, additionally holding his Fellowship from the American College of Healthcare Executives.

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