Journal of Religion and Health

, Volume 49, Issue 4, pp 581–590

My Ishvara is Dead: Spiritual Care on the Fringes


    • Chaplain, Spiritual Care ServicesKaiser Permanente
Original Paper

DOI: 10.1007/s10943-009-9285-3

Cite this article as:
George, T. J Relig Health (2010) 49: 581. doi:10.1007/s10943-009-9285-3


Human suffering speaks differently to different lived contexts. In this paper, I have taken a metaphoric representation of suffering, Ishvara, from the lived context of a Hindu immigrant woman to show that suffering is experienced and expressed within one’s lived context. Further, a dominant narrative from her world is presented to show that the same lived context can be a resource for spiritual care that could reconstruct her world that has fallen apart with a suffering experience. Having argued that suffering is experienced and expressed within one’s lived context, and that lived context could be a resource, in this paper I present that spiritual care is an intervention into the predicaments of human suffering and its mandate is to facilitate certain direction and a meaningful order through which experiences and expectations are rejoined. Finally, I observe that spiritual care is an engagement between the lived context where suffering is experienced and the spiritual experience and orientation of the caregiver.


Spiritual careLived contextImmigrantHindu womanMeaningSuffering experience

The Self that is subtler than the subtle and greater than the great

is seated in the heart of every creature

One who is free from desire sees the glory of the Self

through the tranquility of the mind and senses and becomes absolved from grief

Katha Upanishad, 1-II-20 (Panoli)


Human responses to illness experiences and the attempts to cope with those experiences are complex. They are even more complex when it comes to articulating and expressing those experiences of illness. Gall (2005) reviews some of the recent literature on illness experience, to observe that coping is a process that attempts to explain, to respond and to make meaning out of a ‘stressor’. Drawing resources from some of the mainline theoretic discourses like, psychotherapy, religion and anthropology—anthropology being a new avenue of inquiry that provides for the cultural construction of experience within the purview of spiritual care—I propose in this paper to present the experience of suffering as a meaning—making process, i.e., the creation of new meaning in the wake of the disruption of meaning and continuity caused by suffering, which Becker has analyzed (1997, 16ff). I further propose to place suffering within one’s lived context and to proceed to the narrativization of the experience of suffering and its metaphoric representation. Finally, I arrive at spiritual care as a meaning reconstruction intervention within the same lived context where the breach of meaning has been experienced. More specifically I will be taking a metaphor, one of the prime devices to represent experience (Fernandez 1974), from a spiritual care intervention that I initiated and sustained as a chaplain, with Neelam Patel, an immigrant Hindu woman from India, to represent her suffering and to present both, meaning as a product of the interpretation of experience, especially the experience of suffering, on the one hand, and spiritual care as an intervention that recovers and reshapes one’s sense of meaning in the face of the loss of meaning in the encounter of meaning—destroying events, on the other.

The case below has been drawn from a reflective journal maintained during the multiple chaplain interventions while Neelam Patel’s husband was admitted in the Intensive Care Unit (ICU). The journal recorded observations, perceptions and explored themes, encompassing a critical analysis of the chaplain’s self-awareness. The journal, which did not contain any personal identifiable data and has been shredded since, analyzed the encounter from the chaplain’s perspective primarily for the chaplain’s own critical learning. The names in the case are not real.

The Case

I met Mr. Patel within a couple of hours after he was admitted to the ICU for respiratory distress. When I met him, he was aware of what was going on, but would not talk because of the Nasogastric tube. Whatever I knew about him and his wife came from his wife, Neelam Patel.

Mr. Patel was a Hindu from the northern part of India and in his seventies. He was a frail man, with an air of calm and serenity around him, and his eyes and face did not express any intense feelings ever. He would lie on his back with his eyes closed, or staring at the ceiling. He would slowly open his eyes whenever I entered the room as if he sensed my presence. Though I did not want to make any noise, just in case he was sleeping, he would turn his head toward me and acknowledge my presence. Much of our interactions were limited to me softly talking to him and him acknowledging it either by nodding his head mildly or by slightly raising his index finger.

Mr. Patel, after retiring from the government came to the US in the nineties with his wife, to join his children, who moved to the US during the high-tech boom. Neelam Patel was a small woman in her early seventies, thin and wore a red or a pink Saree. She would have fresh bindis everyday, one on her forehead and the other above it, where her hair divided. During the initial days of admission, she would tell me how socially isolated they were in the US with a tone of nostalgia about their home town in India.

Later, as Mr. Patel’s health seemed to decline, she would sit in a chair, pulled against the window, motionless, hands on her lap and staring at her husband from a distance. Once in a while she would walk to the bed and stand next to her husband, lightly touching his hand or just stand next to the bed, gripping the bed rails. Her face often looked blank, but on closer look I could see the tense facial muscles. She would be there until late in the evening, until her son or daughter would come to take her home.

She became remorseful as Mr. Patel’s condition deteriorated. I would touch her hand and ask her how she was doing. She would always say that she was doing fine, without any expression on her face and without taking her eyes off of her husband. She knew that I perceived her distress and would gently touch my hand, as if to tell me that she was okay.

The afternoon before Mr. Patel died I sat with Mrs. Patel and asked her what it meant for her to go through what she was going through at that moment in her life’s journey. She fell silent for a while then pointed to Mr. Patel who by that time was sedated and nonresponsive and told me that, he was her “Ishvara”.

Representing Disruption

All of us expect that our lives be predictable, ordered, meaningful (Janoff-Bulman and Berg 1998, p. 36, 37) and that the world in which we live is just and coherent. The order and meaning of our world get disrupted with external encounters, the loss of a loved one for instance (Davis and Nolen-Hoeksema 2001). At the outset, experience can be seen as an encounter with an external “environment”, responses to it (Lagerspetz 2002), and an articulation or expression of the encounter. Experience refers to an active self, to a human being who not only engages in an action, but also shapes it with feelings and reflections (Turner and Bruner 1986, introduction). When experiences do not fit within the vision of normalcy and stability, of how life should be, they change our perception of order and normalcy and disrupt our sense of being in the world. An experience which is at odds with one’s expectations of being and order and that disrupts one’s sense of stability makes an individual feel different from others and renders social relationships uncomfortable and cumbersome (Becker 1997, 16). Hence, a disruptive experience alters one’s relationship with oneself as well as with the surrounding world. When death intruded into this woman’s world, creating havoc, and became her experience to live with, her sense of being in the world, her sense of stability, and her relationship with herself were disrupted.

While we live our experience we also strive to express that experience. One’s life experience demands expressions of those meanings that one makes out of the experience. According to Turner and Bruner (1986), one can only experience what is received by one’s own consciousness. In spite of cues and inferences, one can never completely comprehend another person’s experience. Hence, it is challenging for one to express one’s experience without risking the loss of its meaning. There is a tension between the perception of one’s experience, the conveyance of its meaning, and the ability of another to comprehend the meaning. This tension is very much at the heart of the search for means to express our experience and share its meanings with another. To bear the meaning of disruption and suffering is significantly challenging and often people turn to metaphors to carry the meaning, to find a vehicle that makes meaning known. “Metaphor confers the properties of one concept on another and all of our cognitive, affective and somatic ways of knowing may be brought to bear to elaborate metaphoric correspondence” (Kirmayer 1992). Hence, metaphor resides at the connection between meaning and experience and makes a relationship between meaning and experience.

Metaphors also presuppose narrative construction of human experience. Narratives validate one’s experience by laying out the events and circumstances, articulating meanings and responses, and ultimately assigning one’s place in one’s lived contexts. Narrative construction of one’s experience is integral to establishing a personal continuity of meaning between one’s past and present (McLean 2008). While describing the experience from the perspective of the present, they project us into the future and try to constitute a continuity of meaning (Good 1990, 139). Additionally, narrativisation helps one to move from the “particular to the universe, from event to meaning or from experience to language” and opens up the “possibility of self-understanding and understanding others” (Monks 2000). Hence,

Stories guide action; that people construct identities (however multiple and changing) by locating themselves or being located within a repertoire of emplotted stories; that “experience” is constituted through narratives; that people make sense of what has happened and is happening to them by attempting to assemble or some way to integrate these happenings within one or more narratives; and that people are guided to act in certain ways, and not others, on the basis of the projections, expressions, and memories derived from a multiplicity but ultimately limited repertoire of available social, public and cultural narratives (Somers and Gibson 1994, p. 38, 39).

One implication of narratively constructing one’s experience of suffering is that personal accounts of distress open up one’s own life history or ‘biographical context’ and give meaning to events that have disrupted and changed the course of one’s life (Hyden 1997).

Karma, Dharma, and a Woman’s World

Hinduism places an individual within a complex social, cultural and religious whole and explains the placement as karma, as the “link between an action and its results” (Sharma 2008). Along with that placement comes the duties and obligation attached to it—the dharma. The four basic castes of Hinduism, Brahmana, Kshatriya, Vyshya and Shudra designate an individual’s place in the society and assign certain duties, the dharma, that he needs to perform by virtue of his birth into the caste. Dharma is also a virtue that needs to be pursued in life’s journey, purusartha along with success (artha), passion (kama), and toward self-realization (moksha). Dharma while justifying the worldly social order of success and passion points toward an order beyond the social that is, to an individual’s spiritual nature, the moksha (Sharma 1999).

Both the Manusmrti, an ancient code of ethics in Hinduism and the Bhagavad Gita, endorse the validity of fulfilling one’s caste obligations or obligations attached to one’s stage in life’s journey but without attachments. Sharma (1999) further quotes from the Manusmrti that one’s dharma must be performed in a spirit of nonattachment to the results of the duties. If one were a priest he should do his dharma without any concern for the possible consequences to himself. Gupta (2006) finds this tone of the Manusmrti repeated in the Bhagavad Gita that dharma should be practiced for the sake of dharma, not withstanding its consequences. In the first chapter of the Bhagavad Gita, Krishna reminds Arjuna that it is his dharma to fight the war of Kurukshetra, without any attachment to the results of the fight, the niskamakarma (Framarin 2006).

The above discussion of karma and dharma opens up the complexity of placing it within the lived context of a Hindu woman. Conventionally, karma determines one’s current station in life within the social whole, based on merits accrued from previous births, and dharma or the “moral lifestyle” determines what is “deemed appropriate in life” (Sharma 2008). When it comes to a woman, karma may explain her place in the social system, but what about her dharma? Is there a dharma that corresponds with her social position as a woman? The dharma of a married woman is popularly perceived as the dedication and commitment to her husband with the Sita of Ramayana as the role model. Sita being an ideal wife rejected her own comfort to sustain and enforce her husband’s dharma, his karma assigned duties. The story of Sita is also a message that any sexual conduct outside the established norms is a threat to the honor of the male members of her family, and the patriarchal agenda (Arora 2006). The Sita of Ramayana is a role model to the nostalgic attempt to recreate a woman’s dharma in relation to her husband.

Like any religion, Hinduism has assigned a woman her place in the complex structure of society. The main authority on this assignment is the Manusmriti, and according to the Manusmriti, a woman should be dependent, first on her father, then her husband, and finally on her son (Buhler 1886, 195). Over the centuries, the Codes of Manu on women became inseparably intertwined with the day-to-day life in Hinduism. On that note, let me turn to a ritualistic practice in Hinduism that symbolizes the dependency, the rite of passage of marriage where the bride accepts her husband as her Ishvara, the lord of her life with whom she will be passionately attached for the rest of her life—Kanyadhan. It is an elaborate ritual marking the transfer of a virgin from her father and brother to her husband. During the wedding ceremony, assuming fire as the witness, the father, or the brother, of the bride ties the corners of the bride’s dress to the bridegroom’s and they walk around the fire, the bride trailing behind the groom seven times. Through this ritual the bride accepts the groom as the lord and master of her life and agrees to follow him while they walk the path of life, an attachment that assigns a woman her place in the world.

The dependency is further transferred to her son when a woman’s husband dies and she assumes her identity as a widow. In traditional Hinduism, the discontinuity from her attachment to her Ishvara, into widowhood re-determines a woman’s identity and respectability, not only within the family circles but also within the wider community. Traditionally, every married Hindu woman prefers to die before her husband. If the husband dies before the wife, it is an indication that the wife did not live up to be a pativrata, an ideal wife dedicated to the health, wealth and long life of her husband, and hence she is a “husband eater” (Ahmed-Ghosh 2009). The death of her husband initiates a woman into a new identity of widowhood, and in colonial and pre-colonial India widows popularly followed their deceased husbands into funeral pyres, the act of Sati. Sati comes from the Sanskrit root sat, meaning truth, reality or good. The feminine form Sati, means ‘the chaste’, substituted the original referent of god with that of the husband and the woman immolating herself at her husband’s funeral pyre is an ultimate testimony of her chastity and inseparability to her husband (Lakshmi 2003).

In traditional Hindu communities, the intensity of widowhood for a woman is determined by factors such as having a son, her youth, membership in a joined family, and her access to resources (Firth 1997, 164ff; Wadley 1995, p. 100, 218). The initiation to widowhood is marked by rituals that disrupt continuity. One of the first things discontinued is the red bindi, the second vermillion on a widow’s forehead that she has been wearing fresh everyday for the wellbeing of her husband. She is stripped of all her jewelery and allowed to wear only white clothes. The Hindi film Rudhali dramatically portrays the initiation into widowhood. When Rudhali’s husband seemed to be dying, a woman sitting next to her grabs Rudhali’s hand, crushes all her bangles, and then forcefully smears off her bindi. In some higher castes, the widows shave their heads and keep them covered. For the rest of their lives, they are not allowed to wear any colored clothes. Another film that dramatizes the “social death” (Mukherjee 2008) of widowhood is Water by Deepa Mehta. Deepa Mehta narrates the story of a widowed child in Varanasi, India during the colonial era.

Traditionally, a widow would accompany her husband into the funeral pyre. The act of sati was considered as an act of being committed and dedicated to one’s husband, a duty of a pativrata or according to Weinberger-Thomas (1999, p. 45, 46), an act of purification. Sati has been banned in India since 1829. However, Sati is still elevated in some parts of India, and there are temples built on spots where sati was committed. One of the recent publicized acts of sati was in September 4, 1987 in Rajasthan of Roop Kunwar an 18-year-old wife (Sankari and Vaid 1996, 253–255).

Ishvara is also about devotion and unconditional love and attachment. With popular Hinduism, especially in the Bhakti tradition, a devotee is passionately attached to his or her Ishvara and that attachment is expressed through devotions which is the path to self-realization (moksha). One of the prominent teachings of Visistadvaita is the attachment of soul (cit) and matter (acit) to Ishvara.

“The relationship between Ishvara and the universe of cit and acit is conceived in the same way as the body is related to the soul. The body is regarded as sarira (italics original) in the technical sense that it depends wholly and necessarily on the soul for its existence; it is controlled by the soul and it exists for the soul”

(Chari 1988, 16).

Visistadvaita emphasizes a devotional path toward self-realization and teaches the attachment of cit and acit to Ishvara, as an ‘organic’ unity between the three, based on their mutual dependency.

The story of Meera Bai, a mystical poet who lived in the 16th century is a classical example of this unity. Meera Bai was born in a royal family in the late 15th century in Rajasthan in India. While she was a child, her mother gave her an idol of Krishna, and she would spend her days playing with the idol. Her mother died when she was ten, and she grew up with her grandfather. As she grew up, she got attached to Krishna as her lover, would compose poems and dance and sing them in public. Later, she was married off to a neighboring prince. Her attachment to Krishna became an issue, and she was considered mentally sick. A few times her in-laws tried to poison her, but she escaped. By 1527 A.D. she lost her husband, her father, and her father-in-law. In a society where women depended on their male relatives for their survival, honor, and social status, the loss devastated her. She defied sati, left her place and took up wondering while singing her songs to her lover, Krishna until she died around 1546 (Nisson 2003).

In the case narrated above, Ishvara metaphorically opens up a Hindu woman’s world and places her within a complex social system, assigns her duties and virtues and justifies her experience of suffering in relation to her husband. It is about her attachment as much as disruption. The death of Ishvara expresses a disconnect between her experience of suffering, expectations of normalcy and stability, and the desires to reconstitute the world that fell apart in an encounter with death. The tension between expectation and experience demands a mediation to represent her experience, specifically the reflections and meaning associated with the act of experiencing. This tension calls for adequate expressions, hence the death of Ishvara represents the experience of suffering of disruption and an initiation into a new identity of widowhood. While accessing her world of experience, the death of Ishvara expresses the absence of stability, normalcy and a longing for continuity. It is a longing to shape and reshape her experience, its meaning and express it adequately to convey her world of disruption.

Putting One’s World Together: A Mandate for Spiritual Care

Popular stories in Hinduism portray Sita as a figure of undying love and loyalty to her husband Rama, as exemplified by her following him wherever he went and taking it upon herself as a virtue to enhance his duties, even to the extent of trying to prove her own chastity after being rescued from Ravana who abducted her. Arora (2006) presents a shift in the Sita story, a shift that can be a significant direction for spiritual care. Refusing to be subjected to Rama’s consistent trial to prove her purity and chastity, Sita realizes her true self and invokes the Earth to swallow her up. Arora (2006) further refers to women who perceived Sita as an icon of strength and independence. For instance, a woman survivor of domestic violence admires Sita for her strength “in bearing life’s difficulties head-on” and “not falling apart”. These women created their own narratives of Sita from within their lived experiences that resonated with their own experiences of disruptions in life. The women drew from dominant narrative and from their lived contexts in order to create their own narratives to reshape their experience of suffering and its meaning. The new narrative becomes theirs as it reshapes meaning and continuity. While a woman can justify suffering on her being borne in a specific context, the same context can be her resource to reshape her suffering. This insight becomes a resource for spiritual care, and with spiritual care, people make, unmake, negotiate, and remake meaning in the greatly divergent contexts of human conditions of suffering and disruption.

Suffering is context dependent and mediated by a metaphoric and conceptual grid. The experience of suffering challenges the sense of meaning the sufferer has constructed so far and places her in the forefront of uncertainty and distress. Spiritual care enters this world of suffering, into the predicament of human striving to come to terms with disruptions, and appropriates one’s experience, disowns what one needs to and opens oneself up toward a meaningful reshaping of one’s story. The intervention reconstructs meaning, gives one’s story a certain direction and a meaningful order through which experiences of disruption and expectations of normalcy are rejoined. While spiritual care attempts to articulate and integrate distress events and mediate them to rebuild the story differently, a critical question for spiritual care is what it means to suffer, a question that should transform the “experiential existence” (Kleinman 1997) of suffering.

Kleinman (1997) further observes that, in many spiritual traditions, the engagement with pain and suffering is an essential teaching, integral to human existence. In Hindu spirituality, for instance, suffering is explained in terms of the karma-dharma discourse. The karma-dharma discourse places one within a complex social, cultural and religious structure where each person has his dharma—his duties and virtues—to fulfill by being born into a caste. As far as Hinduism is concerned one’s karma explains one’s current experience of suffering and encourages one to perform one’s dharma within the position one finds oneself in life without any attachment to its results.

The critical question for spiritual care, what it means to suffer, brings the theoretic and experiential orientation of the provider into the forefront and engages him or her with the lived world in which suffering is experienced. For a professional spiritual care provider, the intervention is an engagement between one’s own experiential and spiritual orientation, and the lived context of the one experiencing suffering. For instance, within Christian spiritual tradition the Suffering Servant song, a Biblical text in Isaiah 53 brings in a transformative potential of suffering that engages the world where suffering is experienced, without elevating suffering to an essential prerequisite for transformation. The song is a paradigm that culminated in Jesus being revealed as a suffering Creator. While engaging the world of suffering of a Hindu immigrant woman, the Suffering Servant song surfaces certain theological themes that can orient a Christian care giver.

First, suffering does not necessarily imply that an act deserves punishment. The suffering servant is a paradigm for accepting suffering without having done anything to deserve it (Dohman 2003). Hence, the paradigm detaches the sense of being a victim from the act of suffering. It addresses the questions, “Why me?”, “What have I done?” or “I have always been a good person” and engages the sense of being a victim unjustly suffering with the possibility of emerging new meanings and integrating suffering as an existential experience. The paradigm shifts the focus of suffering to an experience that is not bound up with one’s past deeds, but as experiential existence.

Second, the suffering servant presents a Creator identifying with and participating in the suffering of the creation because suffering is not alien to the Creator’s nature (Dohman 2003). The imagery I have is the agony of Jesus in the garden of Gethsemane and later, on the cross. In Jesus, the sufferings of creation became integral and intimate to the Creator. Who else can understand human suffering better than the Creator who went through suffering and death? Hence, the journey of suffering and pain becomes an accompanied endeavor and not a solitary ordeal.

The accompaniment of course does not diminish the sense of loss and tragedy of death and destruction. It does, however, bring the hope of transformation, of meaning. It initiates a journey of discovering and rediscovering one’s inner self. This leads to my third and final theme, the hope of transformation. Suffering is an engagement with our deepest emotions. The engagement with the deep emotions of our being, combined with the awareness that the Creator has taken suffering into the Creator’s own self, can transform suffering into creating and re-creating the meaning of our existence. The transformation of suffering, governed by meaning, produces change from within one’s lived situation, involving new hopes and dreams. Suffering has an existential meaning that is vital to theologizing—the hope of transformation, the hope for a new creation and a journey of self-discovery. In the midst of suffering there is a self to be discovered, over again.


Spiritual care is an intervention into the world of suffering and into the predicament of human striving to come to terms with disruptions. The intervention facilitates an appropriation of one’s experience, attempts to articulate and integrate distress events while mediating them to rebuild the story differently. The process of spiritual care intervention reconstructs meaning, gives one’s story a certain direction and a meaningful order through which experiences and expectations are rejoined to make a new story. Rebuilding the story is a dialog, an engagement between the world where suffering is experienced and the spiritual experience of the care giver. In this paper, I took the metaphoric use of Ishvara to open up a Hindu widow’s world, place the death of her husband within her lived context and with the metaphor I proceeded to present that reconstructing of one’s story to a meaningful conclusion as a mandate for spiritual care. I took the story of Sita, a wife devoted to the duties and virtues of her husband and presented the shift in the narrative that was vital to reconstruct a woman’s world that has fallen apart.

The day before Mr. Patel died I told Neelam Patel the story of Sita, the faithful companion of Rama in his pursuit of dharma and her suffering and self denial. I concluded the story with the twist that at the end Sita had to pursue her own moksha, the way to her own self-realization. Neelam Patel sat silently through my story staring at the emptiness before her. At one point during my story, she gently lifted a corner of her saree and pressed it against her eyes. I sat with her for a few more minutes after the story, then I stood up, moved directly in front of her, touched her hand and said pranam, with my palms joined at my forehead, prostration to the sacred, the Suffering. By the next morning, the Patels were gone.

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