Mosaics, ambiguity and quest: constructing stories of spirituality with people with expressive aphasia

Despite the current emphasis on person centred, holistic care in health, the concept of spirituality has been discussed very little in the field of speech and language therapy (SLT). The nursing spirituality literature has proliferated in the last twenty years but, by contrast, very few SLT studies exist which mention the spiritual needs of patients with communication problems and how they express them.

Individuals experiencing severe, life-changing events, such as a stroke, may need to engage with and discuss their spiritual needs, in order to make sense of what has happened to them. The aim of this study was to discover what it is like to express spiritual issues when one has an acquired communication impairment (aphasia). I also wanted to discover what it is like to be a healthcare professional working with people with communication impairment expressing their spirituality.

I used a phenomenological approach in order to interview eight people with aphasia about their spirituality. Participants with aphasia used a variety of strategies to express these ideas, which included employing non-verbal communication techniques, such as gesture, writing key words, intonation and artefacts. I also interviewed five members of the multidisciplinary stroke team (MDT) about what it is like to work holistically with people with aphasia.

Each interview resulted in a participant story. People with aphasia talked about religious themes, such as visions and prayer, but also non-religious life meaning-makers, such as gardening and art. MDT members discussed themes such as spirituality as part of their remit and giving the patient time to communicate. The stories were then explored through the interpretive lens of some concepts propounded by Merleau-Ponty (2002), namely ambiguity, lived body, language and thought, and wonder. Frank’s illness narratives (chaos, restitution and quest) were also considered in order to analyse the participants’ stroke journey in relation to expressing spirituality.

People with aphasia can and do discuss their spiritual concerns, particularly when they are entering a quest phase of their illness narrative. They employ many non-verbal mosaics in order to convey spiritual issues, and are helped by the listener employing a phenomenological attitude of openness and attentiveness. Healthcare professionals expressed their willingness to listen to their patients’ spiritual stories, in the interests of holistic practice. Being able to express spiritual needs can enhance wellbeing, help foster therapeutic rapport, and enable people to engage more fully in the rehabilitation process.