Article by Roberto Massaro, priest of the Diocese of Conversano-Monopoli, teacher at the Faculty of Theology of Apulia and at several pontifical universities. Editor of Apulia Theologica and the Theologica series, and also collaborator with Credere Oggi and the Italian Bishops’ Conference’s National Office for Family Pastoral Care.
There is a precise moment, in the course of a serious illness, when the words of official medicine are no longer enough. It happens when the diagnosis has been given, treatment protocols have been started, and the hospital’s organizational machinery is running at full speed. And yet, precisely within that perfect mechanism of clinical efficiency, something begins to tremble. It is the ground beneath the patient’s feet, which can suddenly crumble in the face of immense questions: Who am I now that my body is changing? What has happened to my future? What is the meaning of all this?
For a long time, Western healthcare culture dismissed these questions as “personal matters,” almost private details to be dealt with outside the ward, or relegated them to the purely religious sphere. But human suffering is not divided into sealed compartments. When a body becomes ill, the whole person becomes ill, together with their biography. And it is here that the dimension we now call “spirituality” enters, with increasing urgency.
We are not speaking of Catholic faith or religious denominations—although for some people religion is undoubtedly an important source of support—nor of the administration of sacraments or the repetitive recitation of prayers. We are speaking of something more universal: the innate need of every human being to find meaning in experience, to feel connected to others and to the world, to preserve hope, and to have their dignity recognized, especially when personal autonomy begins to fall apart.
The Metamorphosis of Identity in Hospital Wards
If we think of long-term conditions, neurodegenerative diseases such as ALS or dementia, or brain tumours, we realize that the real challenge is not only the management of physical symptoms. The real wound is the progressive loss of parts of oneself. Those who lose the ability to move, speak, or remember go through a continuous mourning of their own identity. Roles within the family change, work disappears, and social networks are transformed.
In these situations, spiritual needs are neither fixed nor easy to identify; they change because the body itself changes. And so, the initial anger and search for a reason are replaced by a need for stability in the face of the impact of the diagnosis. Later comes the need not to feel like a burden, to leave a good memory of oneself, and to reconcile with one’s inner fractures.
Care centres cannot ignore these processes; otherwise, they end up treating the disease while abandoning the patient: a clinical and ethical paradox that narrative medicine has been trying to dismantle for years, by placing the patient’s story back at the centre of the therapeutic pathway.
The “Toolbox” of Silence and Presence
But how, in concrete terms, can space be made for spirituality in a hospital ward or hospice, where time is often dictated by hectic shifts and bureaucratic deadlines? The answer does not lie in adding yet another formal procedure or standardized questionnaire. Rather, it is rooted in a genuine “conversion” in the way healthcare professions are understood and practiced in places of care.
Spiritual care, in fact, is not—and cannot be—an exclusive competence of a specialized figure, such as a chaplain or psychologist. It is, rather, a responsibility shared by the entire care team. It passes through small gestures that redefine the clinical space. It is expressed in the ability to ask an open question and to remain present within the answer, even when that answer is a cry or a heavy silence.
Especially in the advanced stages of illness, or when speech is no longer possible—one may also think of paediatric palliative care, where the child does not yet have the linguistic tools to abstract their own pain—spirituality becomes “embodied.” It becomes the act of sitting beside the bed without the anxiety of having to do something at all costs. It becomes a gentle touch on the hand, the choice of background music, respect for a cherished object placed on the bedside table, or the creation of an environment that does not smell only of disinfectant, but of lived life. Non-verbal gestures and physical presence are, in many cases, the only remaining bridge through which connection with the other person can be maintained.
Care That Includes Those Who Remain
This approach cannot exclude family members and caregivers, who often experience a parallel spiritual suffering, made up of powerlessness and what is commonly called “anticipatory grief.” Accompanying a loved one towards the twilight of life means seeing one’s own points of reference collapse. Offering a space for listening to family members—recognizing their existential pain and not only their physical fatigue—is an integral part of the therapeutic act.
Ultimately, integrating the spiritual dimension into care settings means making an act of humility: recognizing that medicine has insurmountable limits, whereas “spiritual assistance” does not. It means accepting that, even when there is no longer room for the healing of the body, there is always immense room for protecting a person’s story, dignity, and sense of meaning. It also means transforming hospitals from places where only a battle against death is fought into spaces where the quality and meaning of life are protected until the very last moment. There are people who are incurable in terms of healing, but no people who are beyond care!
Allow me to offer an example drawn from my own spirituality. I believe that this movement of “drawing near,” in which care ceases to be a protocol and becomes a close encounter, finds a powerful echo in one of the most beautiful passages of the Gospels: Jesus’ encounter with the leper at the beginning of Mark’s Gospel (Mk 1:40–45). Jesus is approached by the poor sick man, who begs to be healed. The restrictions laid down in the Book of Leviticus (Lev 13:45–46) left no room for ambiguity: the person with leprosy had to remain “outside the camp,” cry out “Unclean! Unclean!” and avoid contact with any man or woman, otherwise he would transmit his impurity to them. He was both incurable and marginalized.
What is striking in the passage is not only the transgression of these norms—by both the leper and the Master—nor the immediate healing, which we find in other Gospel episodes as well, but rather the profound stirring of compassion that the sight of the man awakens in Jesus: “Moved with compassion, Jesus stretched out his hand, touched him and said…” (Mk 1:41). The focus is not on the miraculous gesture, but on the relationship between the two figures.
Rediscovering suffering as a call to otherness is a feature of “spiritual closeness” that the life of Christ transmits to us. If alienation from one’s own pain and from the pain of others is one of the risks experienced by human beings who do not accept their limited condition, then suffering with and identifying with those who suffer, living and practicing empathy, are characteristic traits of our personal existence, whose identity is deeply bound to relationship with the other.