From Selfcare to Taking Care of Our Common Home: Spirituality as an Integral and Transformative Healthy Lifestyle

Abstract

One of the great threats to health in the 21st century is the relationship between health and environmental issues, as there is an inevitable relationship between the planet’s degradation and health problems. In this sense, health is also seen as a problem of public order, and more precisely of political order, to the extent that such an environmental issue implies public health as a social value that affects the spaces of political decision making; moreover, to the extent that the environmental issue also intersects with the religious issue, namely with the 2030 Agenda in the 21st century. This article intends to think about how such a confluence occurs regarding religion, public health, and the environment, considering how spiritual care provided in the healthcare domain is related to care in the common home (Cf. CITER, Project «Common home and new ways of living interculturally: Public theology and ecology of culture in pandemic times»). In particular, this article intends to analyse such issues in Brazilian and Portuguese contexts.

“Solutions will not emerge from just one way of interpreting and transforming reality” Pope Francis, Laudato si #63.

1. Introduction

This article is an outcome of the Working Group “Spirituality and Health of the Common Home”, linked to the project “Common home and new ways of living interculturally: Public theology and ecology of culture in pandemic times” developed at CITER (Research Centre for Theology and Religious Studies) of the Universidade Católica Portuguesa, in partnership with several institutions and researchers from different areas.

In this context, the theme of Spirituality and Health has been explored within the cultural context of post-secular societies and the epistemological framework of complexity. On the one hand, regarding the post-secular society considering the religious reconfiguration in Western and Eastern religiosity, this phenomenon can be characterized by a new religious dynamic together with the erosion of a hegemonic religion, the consolidation of a plural religious phenomenon, and the emergence of the category of “non-religious”, “agnostics”, and those “believers” who consider themselves “spiritual (or spiritualised)”. In addition, the emergence of new practices rooted in spiritual foundations should be considered, such mindfulness, art, creativity, and contemplative activities. There are also a growing number of believers with an inclusive and tolerant profile towards differences and minorities.

On the other hand, in the typical context of religious recompositing of post-secular societies and within the framework of certain political projects, there is still a dimension of self-referentiality in religious traditions that is often exploited as an immunising factor in response to critical debates within the public sphere. This form of self-immunising and self-referential stance within political decision-making spaces may not contribute to the construction of a common project shared by a pluralistic society; however, it can serve as an instrument for the political reinforcement of identity blocs. This perspective often avoids separating spirituality from historical and hegemonic identity projects of religious traditions, while reinforcing elements of theodicy, where all events in the human condition are expressions of divine will (Teixeira et al. 2022).

There is a phenomenon of dualization, in which traditional approaches are proven to be inadequate in their dialectical rationality (private vs. public, individual vs. social, cultural vs. universal, secularised vs. religious, and progressives vs. conservatives), which ends up feeding back into such polarisations, resulting in the ideal scenario for the political opportunism to take hold in the dynamics of identity blocs. This process of disjunction requires a definition of religion characterised by complexity, encompassing its numerous cause−effect relationships. This complexity is particularly evident in the field of research on spirituality and health, where a critical understanding of the religious phenomenon often accompanies therapeutic and liberating effects, addressing the existential dramas that challenges the belief systems, especially during profound moments in life.

This is where the cultural context of post-secular societies and the issue of complexity intersect, resulting in a way to overcome traditional thinking about religion that deactivates the dominant mechanisms of mutually self-referential bipolarisations. Recognising religious plurality and new ways of revisiting spirituality are as important as the need to reframe historical religious traditions. This last task aims at removing the dominant façade from religious traditions, resulting in peaceful coexistence within a framework of a pluralistic society with common goals.

In this sense, Pope Francis’s pontificate seems to be appropriate from the outset to navigate the intersection between the complexities of religion in post-secular societies and the search for religious, theological, and spiritual reflection in a way that “goes forth” from the constitutive self-referentiality associated with the hegemonisation of identities, towards the creation of a “reconciled diversity”. He has expressed this since his first Apostolic Exhortation Evangelii Gaudium (Pope Francis 2013, #20, 230).

Regarding the epistemological choice of this research to consider the current challenges related to spirituality, as described above, in January 2000, Stephen Hawking, in an interview about the research work of the 21st century, whether physics or biology would be dominant, replied, “I think the next century will be the century of complexity” (Chui 2000). Similarly, in his White House conference a few years ago on “Science in the Next Millennium”, when talking about the search for a “theory of everything”, also known as the “ultimate theory”. He emphasised that this was not a static scientific theory, but rather a new world opening up for research, “The ultimate theory will place no limit on the complexity of systems that we can produce and it is in this complexity that I think the most important developments of the next millennium will be”. However, he pointed out that such complexity is not far away from people’s everyday lives, including health issues, as “by far the most complex systems that we have are our own bodies” (Hawking 1998).

In addition, Edgar Morin, in the context of an extraordinary accumulation of knowledge and information, as well as the countless possibilities for exchanging experiences in a plural and global society, pointed to the task of reconnecting knowledge as the great epistemological challenge of the 21st century (Morin 2001).

In this sense, several studies in Portuguese language have already related complexity to the area of health (Cabral et al. 2020; Copelli et al. 2016; Arruda et al. 2015). In the same way, integral ecology, as a sort of natural habitat, has been developing this complex perspective as a phenomenon in which everything is interconnected, considering the common condition of everything that exists as inhabitants of a common home, as proposed by the Encyclical Letter Laudato si’ [Ls]- on care for our Common Home (Pope Francis 2015, #16; 70; 90–91; 117; 120; 137–138; 142; 240). Not only do both fields experience the same epochal challenge, but the issues of health and common home have a direct relationship between the exploitation of the planet and the impact on collective health, as pointed out in the report of 14 May 2014, “United Nations Environment Programme, Post 2015, Note #3: Human Health and the Environment”, in relation to the Sustainable Development Goal #3 “Ensure healthy lives and promoting well-being for all at all ages” in 2030 Agenda (UNEP 2021).

The United Nations Environment Program clearly states how global environmental challenges are also a significant threat to public health. About 8 million people die each year due to air pollution. Every year, 4.3 million people die prematurely from illnesses related to household air pollution, and 3.7 million deaths can be attributed to air pollution, mainly caused by transport, energy production, and industrial production; more than half of the world’s hospital beds are occupied by people suffering from water-related diseases, while 90% of diarrhoeal diseases are linked to environmental pollution and lack of access to safe drinking water and sanitation. Diarrhoea is still the cause of 4% of all global illnesses worldwide, despite being preventable and treatable, and is responsible for 760,000 deaths a year; climate change contributes to cardiovascular and respiratory diseases through concentrations of fine particulate matter and ozone in the air, with an estimated of 6300 deaths a year in the 21st century. In addition, weather-related disasters result in over 60,000 deaths per year. Developing countries suffer the most from the health effects of environmental problems, such as exposure to chemicals and waste, especially in situations of poverty; there is a direct link between ecosystem degradation and malnutrition. About 1.5 billion people directly depend on degraded farmlands, resulting in reduced food production. About 45% of all child deaths are related to malnutrition. Of the estimated 842 million undernourished people, approximately 827 million live in developing countries. Increased global warming tends to aggravate these numbers. This change will require integrated solutions (UNEP 2021, pp. 1–2).

From an epistemological point of view, one of the main tasks of interdisciplinarity and transdisciplinary is to organise unrelated phenomena in order to provide an integrated view of reality.

In this way, it is possible to understand transdisciplinarity as a translation of the complexity in order to present science as a cultural value. This clarification can be seen as an exercise in translating scientific knowledge and critical sense into common sense. As the Austrian epistemologist Fritz Wallner said, “For getting knowledge, it is needed that you integrate something into your linguistic frame, i.e., to translate it. If you are not able to translate a language of description, then you do not understand it. Thus, translation is the point of proof for understanding” (Wallner 1998, p. 365).

Wallner’s epistemology distinguishes between two types of reality. On the one hand, there is the environment or given world (Wirklichkeit), which is seen as “the world we are living with, and we are connected by life”. On the other hand, there is the reality (Realität), which “means our cognitive world being the result of a process of construction”, and in this way, scientific knowledge aims to promote the connection between human beings and the environment (biology and culture). In this distinction, the environment cannot be understood. We can only try to understand its complexity with the help of our conceptions of reality. For science to be perceived as having cultural value, it needs to be translated from scientific knowledge (the critical sense) to common sense. This translation begins through an interdisciplinary process, in which each area is supposed “to leave one’s own linguistic framework and embark on a different one”; or, in other words, “it means to take a proposition system out of its framework and take into the framework of another scientific microworld” (Wallner 1998, pp. 365–67). The transdisciplinary approach works by integrating levels of interdisciplinarity in a shared manner so as to produce an integrated view in everyday life that is consolidated through concrete practices, as is the case with health.

In Wallner’s view, four levels can be distinguished: (1) Imperialistic interdisciplinarity: one discipline is fundamental for the development of another discipline. (2) Importing interdisciplinarity: one discipline uses concepts, methods, and theories from another discipline to gain deeper knowledge in its domain, but without giving anything back to the “donor” discipline. (3) Reciprocal interdisciplinarity: two or more disciplines work together as equal partners. (4) Transdisciplinarity: involving disciplines from completely different scientific areas such as the humanities and natural sciences.

The method of transdisciplinarity develops axioms shared by the areas as a principle that serves as the basis for subsequent demonstrations. Complexity epistemology offers a vision inspired by the premise “everything is connected”, and in in health, ecology, and theology research, care is a central category that can be mobilised for a transdisciplinary endeavour, encompassing and integrating different practices with a new intelligibility that results from an integrated perspective.

2. Spiritual Care

The term “spiritual care” has been frequenting in international scientific literature for the last 30 years. For the last five years, it has been emerging in the Brazilian and Portuguese context, particularly in health sciences. The concept is often described as being difficult to define (Esperandio and Leget 2020). It is, therefore, a very recent trend in the paradigm of humanistic care and dignity-preserving care, indicating a new direction of research that address good healthcare practices.

In this sense, the development of this discussion was foreseen in the exercise of “pastoral care” and chaplaincy services. In theology, spiritual care and chaplaincy are anchored in an area of study known as “pastoral care and counselling”. However, theological studies in this area have become scarcer in recent years. Furthermore, the graduate programs that developed these themes have not been able to provide healthcare staff with the competencies in spiritual care. In addition, the concept of spiritual care, as used in healthcare, is often described from an operational perspective, and further epistemological understanding may be needed. Interestingly, when analysing the literature, some healthcare disciplines or contexts of care are more related to spiritual care, such as nursing, psychology, and palliative care.

Given the need to integrate spiritual and religious issues for humanised care, clearly defining this concept may facilitate in the training and implementation of good practices. However, this should be a task that involves different healthcare providers and patients, aimed at a clear but common understanding of the concept. This concept should also be culturally sensitive, especially in the context of the post-secular society, in which the tendency to use the expression “spirituality” instead of “religiosity” is becoming evident and normal. This shows the changes in perception and meaning regarding the way contemporary subjectivity experiences the spiritual dimension. Therefore, new demands for care in the social context, as well as new studies on the subject, are necessary (Esperandio and Caldeira 2022, pp. 100–1).

The Emergence of the Concept of Spiritual Care

Reflection on spiritual assistance activities in the context of health is not new in the field of theology. However, in general, this assistance has been understood as an activity inherent to pastoral work, regardless of religious confession, although with interesting differences. Among a large portion of the Catholic population still remains the belief that a visit from a priest to an inpatient should be related to death. Here, spiritual assistance in health is reduced to offering rites of passage, such as “giving extreme unction”. Thus, spiritual assistance in health is be reduced to the meaning of religious practices provided by pastoral care.

In 1980, in an inaugural lecture given at the Faculty of Theology of the Evangelical Lutheran Church, Professor Lothar Hoch addressed the difficulty of naming the pastoral activity known as poimenics—a word that “comes from the Greek ‘poimaino’, which describes the activity of someone who shepherds a flock” (Hoch 1980). Hoch pointed out the tendency at the time to use the term “counselling” implicitly into the concept of caring. For him, the expression “pastoral counselling” was also problematic as the word pastor carries a connotation of power over the flock and does not characterise the activity of one who dedicates himself to pastoral care activities. In addition, the idea of counselling refers to “giving advice” as a dimension of caring. The term “pastoral care” does not appear on this occasion. Lothar opened up the discussion and provided no final answer, and concluded his conference by highlighting the aspect of suffering that stems from the family, social, and political context of the individual. For him, individual crying could also be seen as the cry of an entire people. In this sense, poimenic action would be an actualization of God’s grace through actions of solidarity with those who are suffering. With the expansion of palliative care, greater attention has been given to the spiritual aspects of care, and the term “spiritual care” has become more frequently used. Still, most models that provide spiritual care have been developed by medicine and nursing, and the field of theology is beginning to realize its absence in theoretical−practical reflections and models of spiritual care. Additionally, there is a shortage of health trainers specialising in spirituality and chaplains with cultural, theoretical−technical competence for spiritual assistance services. There are even fewer hiring opportunities for chaplains to work in palliative care teams (Esperandio and Leget 2020). Given the above, it should be noted that spiritual care is not synonymous with “religious care” or “religious assistance”, although it encompasses both. Just as spirituality and religiosity are distinct but sometimes overlapping terms, the same is true for spiritual care and religious assistance. If we understand spirituality as “the immaterial human part, the power of life that develops and expresses itself throughout the existence of the human being in the world” (Esperandio 2020), it is an unending search for meaning and purpose in life and connection in situations that seem profoundly without meaning or hope, as is the case of a serious, progressive illness.

Spiritual care is thus derived from a concept of “spirituality” that has no necessary relationship with religion. Religiosity can be understood as a form of expression of spirituality linked to some instituted system of religious beliefs and practices. Spirituality already comes from spiritus—breathing; life is related to how the individual seeks and expresses meaning and purpose in life. It has to do with how the person experiences their connection with the moment, with themselves, with others, with nature, with the significant and transcendent other, or with what they consider, in some way, sacred. Spiritual care has been discussed from these basic perspectives in health sciences.

In this sense, spiritual care is broader than religious assistance and, thus, also encompasses people without any profession of faith; it is not conditioned to meet the spiritual or religious needs of someone who has the same belief as the one who assists him/her (chaplain), nor is it aimed only at people who claim to have any belief in a deity, transcendence, or superior being. Spiritual needs (for meaning, connection, and hope) as well as spiritual conflicts, are intrinsic aspects of human existence. Therefore, they can also be identified in atheist people.

Although these new trends in spiritual care emerge in the context of health, there is a polarisation between the recognition of spirituality as a dimension that impacts treatment and the unpreparedness of professionals for the adequate implementation of spiritual care. This is a barrier that needs to be overcome. Evidence of this is based on studies that show that although health professionals (especially medicine and nursing) agree that spirituality plays an important role in coping with disease situations, they feel unprepared to integrate the approach of spirituality into daily care (Esperandio 2014, pp. 805–32; Esperandio and Machado 2019, pp. 1172–87). Another barrier to be overcome is related to the construction of a new perception of the figure of the hospital chaplain, both by him/herself, as well as by the multidisciplinary team and even by the hospital institution. The most recent discussions about spiritual care in health point to the need for new skills for chaplains. These are required in order to practice spiritual care based on inter-religious and intercultural competencies, a practice that is intentionally focused on the spiritual needs (and not just the religious ones) of the sick person (and their family members), regardless of the chaplain’s faith tradition. The professionalisation of chaplaincy is required in order to equip individuals in this industry with new skills, attitudes, and knowledge so as to better understand and meet the spiritual and existential needs of the sick person. The potential of spiritual care lies in one of the barriers that need to be overcome: its interdisciplinary and transdisciplinary nature. As spirituality is an aspect of human nature, both spiritual resources and needs can emerge in the interactions with each professional within multidisciplinary teams. These expressions may vary in form and intensity, indicating the transdisciplinary expression of spiritual care. However, no single discipline can handle the challenges of holistic care, in which the spiritual dimension holds significant importance. This necessitates that the provision of spiritual care is essentially interdisciplinary (Hefti and Esperandio 2016) and requires a theoretical foundation that considers the practical implications involved.

3. Spirituality and Transformative Selfcare: An Approach since Michel Foucault

If, on the one hand, there is a progressive tendency towards dissociation of spirituality in relation to religion, especially as an attempt to dissociate from a hegemonic and controlling perspective on the lives of individuals, on the other hand, there is an inflation in the use of the expression spirituality. This phenomenon is evident through the extensive prescence of social networks across various channels dedicated to the subject. Each of these channels mobilizes millions of followers, not to mention the almost incalculable number of books (physical and digital) that promise, through spirituality, quick and easy solutions to a wide range of problems. In an ideal society that experiences a surplus of positivity and that incessantly seeks to experience pleasant and fluid feelings, it does not seem to be difficult to associate, in an almost magical way, spirituality with a kind of harmony and tranquillity, which excludes every form of conflict, mystery, insecurity, and fear.

This became more evident in the COVID-19 pandemic. Frequently, there were offers of “spiritual content” by “prophets” who promised, in an almost always palatable, universal, and non-compromising way, a recipe for consolation for coping. In many cases, they offered passive acceptance of the pandemic as a divine punishment, for example—of what seems to have been the greatest recent catastrophe in human history. At times, much of this “content” was packaged in a naïve optimism, and frequently lacked critical examination, demobilizing every form of resistance to what commonly accepted. It is not, therefore, a question of underestimating the place of spirituality as a source of meaning and as a tool for the resignification of reality; however, it should not be reduced to a formula applied according to a series of instructions and containing all the answers to individual and collective dilemmas.

The contemporary overuse of the concept of spirituality, sometimes in a secularized sense and at othertimes with new religious connotations, makes it difficult to perceive the inherent relationship between health, spirituality, and politics that classical culture usually fostered. In this context, an unexpected author in the field of religious enquiry was chosen to examine this nexus betweeen spirituaity and care, as conceptualized by the French philosopher Michel Foucault.

Foucault’s later works offer two intriguing and potent definitions of spirituality. The first of these is from the “forgotten” interview, granted by the French thinker to Le Nouvel Observateur on 3 January 1979, published 39 years later by the same French Weekly on 8 February 2018. This interview takes place within the context of the “Affaire Iran”, encompassing 13 journalistic articles commissioned by the Italian newspaper Corriere della Sera. Most of these articles were published in the same newspaper, with others also appearing in different periodicals between September 1978 and January 1979. In these works, the French thinker discussed the process of the Islamic insurrection in Iran. Walking the streets of Tehran and the holy city of Qon and interviewing “witnesses” ranging from experts to ordinary people, on his two visits to the country, from 16 to 24 September and 9 to 15 October 1978, Foucault was able to witness and collect a series of information that “marked not only the keys to understanding the avatars and paradoxes of the modernization process, but also, among other things, the meaning of the Muslim religion in its relation to the political struggle, the perplexities implied in the popular demand for an Islamic government and the agglutinating function of religious representatives, in their unique way of publicly articulating what was happening” (Foucault 2018, p. 23).

We did not intend to analyse Foucault’s public participation in the debate that developed around Islamic politics and religiosity—analyses that already figure fruitfully in the academic world—but rather to better understand the possible developments of the idea he coined as political spirituality. To the question “what is spirituality”, he replied to believe the following:

“[…] this practice by which man is displaced, transformed, upset, until the renunciation of his own individuality, of his own position as a subject. No longer to be a subject as it has been until now, a subject in relation to a political power, but a subject of a knowledge, subject of an experience, subject also of a belief. For me, this possibility of insuring oneself the position of a subject that was fixed to him by a political power, a religious power, a dogma, a belief, a habit, or a social structure, is spirituality, that is, to become another than oneself, another than oneself”

(Foucault 2018, p. 21).

Foucault emphasized that spirituality is not reducible to a religious doctrinal body, but rather concerns an attitude towards oneself, responding to an imperative of self-transformation. Religion can indeed be a vector, “a kind of welcoming structure for forms of spirituality”, but it is necessary to clearly distinguish one thing from the other in order to avoid what he considerd “a remarkable salad”, “a marmalade”, and “an impossible confusion” (Foucault 2018, p. 20).

In this sense, it is very interesting to note how Foucault found in the East, in a singular connection between spirituality and the Islamic religion, what seems to have been weakened in the West—the spark, the breath of the spirit, which escaping any idea of an awareness anchored by science or history, presents the energy necessary to build the possibility of another being, from somewhere else. Western spirituality, in turn, over the centuries, has been configured as something devoid of a signifier, which, sometimes imprisoned and docilised by a specific religion or serving as an explanation for many things, has lost its modifying and mobilising force.

It follows, then, that if spirituality is, as Foucault states, a practice through which a subject, bending external forces, transforms themself to have access to the truth, one of its particular effects in the encounter with the political dimension is to become a collective will. As a unique force of hope, of sacrifice, this will can make itself an event, insofar as it breaks with historical linearity and with the traditional understanding of revolution, almost always reducible to class interests, ideologies, and the political party. Imbricated in a specific religious conjuncture, the case of the Iranian revolution showed, for the French thinker, how spirituality was a catalyst for a people’s yearning that, in the face of a “terrifying, terrible, and terribly strong regime, since it has an army, an absolutely gigantic police” (Foucault 2018, p. 18), became a tool of resistance and of “impatience”, marking both the eloquent refusal, “from this small piece of land whose soil and subsoil are the scene of world strategies” to the archaic Western-style modernization implemented by the Shah’s regime; thus demarcating a new beginning for the tradition of the people, guided, from then on, decisively by Islam.

Even if, a short time later, the results were shown to be absolutely questionable and paradoxical, to the extent that the revolution, in its most proper characteristics, triumphed and politics could resume, Foucault had an outlook on such events that cannot be forgotten. He recognised the depletion of traditional forms of revolution and, as an alternative, envisioned insurrections. These insurrections, often reffered to as “tears of time”, are characterised by their lack of arms, absence of programs, and absence of personal or corporate interests. The form as a result of a single, rare, and intense moment where the spiritual and political intersect. These instances illustrate how a people, armed with only their bare hands and willing to sacrifice their own lives, can view spirituality as possessing novelty, defiance, and restlessness. This view not only challenges their own subjectivity, but also challenging the established powers.

It is worth considering here that the experience of the Iranian insurrection enabled Foucault to reflect on significant aspects of his analyses of the subject. The search for this “other” identity, rebelling against a previously fixed position. This directly challenges the traditional notions of the subject—sometimes as an autonomous individual, possessing an essential identity; as a thinking nucleus, from which all other concepts emanate; or as a starting point of modern knowledge, destined for revolution, freedom, or the conquest of nature. At stake, then, for him, is the critique of the main foundations of the three most important contemporary philosophical views in terms of establishing the subject as a core identity: Marxism, phenomenological consciousness, and positivist science. Thus, the French thinker showed that rhter than being a creator of knowledge or power, these elements make up the subject. They are products of processes involving objectification and subjectivation, occuring within a complex interplay of discourse and power strategies that evolve within historical and cultural contexts in an unlimited manner. As he himself recalled, “in the course of their history, men have never ceased to construct themselves, that is, to continually displace their subjectivity, to constitute themselves in an infinite and multiple series of different subjectivities, which will never end, and which never place us before something that would be man”. However, such a conclusion is only possible to the extent that it breaks with the idea of absolute domination, as predicted by classical political theory, and begins to conceive of the exercise of power as something multiple, not limited to unilateral or bilateral relations.

It is precisely within the possibility of multiple power relations that political spirituality operates for him. It does not wish to take the place of those who govern, but aims to introduce the elements of novelty into the political field: a subjectivity that forms in response to resistance to the forces that intend to condition, fix, and establish. Above all, it is an exercise that disturbs the habitual order of things and thoughts, and that causes the subject to move to always provisional ways of existing, that is, a place characterised by differences. However, this does not happen by acting on the externality of knowledge−power relations; on the contrary, it operates in the “unlent twist”, in the process of constant modification of oneself that produces singularities. These, in turn, should never be normalised; on the contrary, the exercise should be to continually redefine what is considered normal through the fluctuation of differences ineach time.

In 1982, in his course l’Hermeneutique du sujet delivered at the Collège de France, we find the second definition of spirituality given by Foucault. There is no doubt that it retains similar traces from the previous definition, but it is no longer set in the context of the Iranian events of the late seventies. He was not only a spectator to these events, but also became a witness and narrator. Immersed now in the set of studies on the notion of selfcare (epimeleia heautô), the French thinker turned to the Greco−Roman period, particularly the first two centuries of the Christian era. This allowed him to define spirituality as “the set of these pursuits, practices, and experiences, which may be purifications, ascetic exercises, renunciations, conversions of looking, modifications of existence, etcetera, which are not for knowledge but for the subject, for the subject’s very being, the price to be paid for access to the truth” (Foucault 2005, p. 15).

Through the problematisation of the subject; an ethical reading of the practices of the self; and a detailed analysis of classical authors such as Epictetus, Plutarch, Marcus Aurelius, and Musonius Rufus, in this course, Foucault opposed the knowledge of the self, which had its golden age in Antiquity, with the phrase “know thyself” (gnôthi seautón). He showed how in Western historiography, the latter became dominant over the former. At the end of the first hour of class he recapped the lesson by calling the disregarded and forgotten care of oneself “spirituality” and the prestigious knowledge of oneself “philosophy”. Above all, this concerns the privileged way in which the subject, simply through its ontological−cognoscente structure, can have access to the truth, without the need for any inner work of an ethical nature; however, spirituality calls for the transformation that is required of the subject so that he can access the truth—a kind of transfiguring “inner experience” that makes the subject both him and “other” than him. If, in the course of Western thought, care of the self was no longer able to allow knowledge of the self, at the exact moment of the birth of the two concepts, termed the “Socratic−Platonic moment” by Foucault, the care of the self would take priority over the knowledge of the self.

Spirituality is linked to selfcare, through a set of spiritual practices or exercises, which are distributed throughout life—such as writing, attention to the present time, examination of conscience, listening, meditation, reading, and dietetics—and requires an individual transformation. However, it is also a transformation in one’s approach to the world and others, and is a continual endevour of unity between thought and action. This process causes the truth to return back to the subject, who, by incorporating it, constitutes themselves as someone capable of making the correct decisions. The notion of spirituality was so fundamental in the course of 1982, that across hundreds of pages, its various meanings and applications are proliferate. These included a wide spectrum from Plato to Christianity, encompassing the Epicureans and Stoics. Salma Tannus Muchail described examples such as “Western spirituality”, “spiritual transformation of the subject”, “condition of spirituality”, “monastic spirituality”, “Christian spirituality”, “ancient spirituality”, “Stoic spirituality”, “Seneca’s spiritual exercise”, “Marcus Aurelius’ spiritual exercise”, sixteenth- and seventeenth-century spirituality’, “spiritual knowledge”, “spirituality of knowledge”, “spiritual experience of the subject” (Muchail 2017, p. 90).

By relating spirituality to a set of exercises, it is essential to connect Foucault’s thought to the studies of Pierre Hadot, to which Foucault himself admitted to being partly indebted when it came to his research on the theme of selfcare. In his work entitled Spiritual Exercises and Ancient Philosophy, Hadot both defined the notions of “exercise” and “spiritual” as applied to antiquity, and mades a point of differentiating the idea of “moral exercises” from “spiritual exercises”. For him, “exercise” was something that did not operate only at a grammatical or conceptual level, nor did it refer to a metaphysical theory. It is, rather, an activity, a practice, an ascetic work that one does on oneself. The “spiritual” comes to qualify “exercise”, preventing it from becoming a purely intellectual or even physical product, but embracing the totality of the individual. As Arnold I. Davidson recalled in the preface to Hadot’s work, “The denomination of spiritual exercises is therefore ultimately the most appropriate because it emphasises that they are exercises that compromise the totality of the spirit” and, for this very reason, “ancient philosophy is a spiritual exercise because it is a way of life, a way of life, a life choice” (Hadot 2002, p. 6). By establishing themselves as having existential value, encompassing thought, imagination, sensitivity, and will, spiritual exercises are distinguished from moral exercises, as these can only represent a code of good conduct, that is, a set of “external” rules that in no way modify the individual’s way of being and existing in the world.

Spiritual exercises are, first, an ever-awakened awareness of oneself, a constant tension of the spirit. They involve all the effort and actions of life and from which nothing should escape, not even the smallest and simplest everyday actions, such as lying down and getting up, what one eats, what one drinks, what one wears, and with whom one speaks. The first invitation is to calm the passions, then, to assess, at any moment, what is happening within, to rectify the intentions, and to accept with equanimity everything that does not depend on one’s own will. Such an awareness makes it possible to perceive that most of the projections that are made of the future do not fit with the desires that are necessary for existence at that specific moment, and that concern about past actions, such as guilt, shame, or the way others perceive an individual’s own words or actions carry a lot of irrationalities. As Hadot remembered, “Such a transformation of vision is not easy, and it is precisely here that spiritual exercises come in. Little by little, they make possible the indispensable metamorphosis of our inner self” (Hadot 1999, p. 83).

These aspects show that despite their conceptual differences, Foucault and Hadot seemed to agree with the fact that ancient spirituality, expressed through practices and exercises, is constituted by an agonistic character. To change oneself, to become someone else, transforming oneself in order to accept the truth, is a practice that is, above all, a struggle; a struggle against oneself and against one’s own passions. One of the most significant metaphors in this regard is that of the athlete. “The Stoic athlete, the athlete of ancient spirituality also has to struggle” (Foucault 2005, p. 322). Therefore, being a good athlete does not mean exercising all the movements all the time; but, on the contrary, it means to prepare, with the utmost attention (próseche), for the struggles that will have to be faced, having at hand (prócheiron) the gestures often used for this. Moreover, he must always be prepared, as he does not know what opponents he will face and when he will face them, “He has to be ready for a struggle in which his adversary is anything coming to him from the external world: the event” (Foucault 2005, p. 322). The practice of the self is configured, then, permanently as a battle; the spiritual exercise does not consist “in discovering a truth in the subject”, but in “arming the subject with a truth that he did not know and that did not dwell within him” (Foucault 2005, p. 501). In this sense, in one of his letters to Lucilius, Seneca reminds him that it is the battle that forms the good athlete!

“no prizefighter can go with high spirits into the strife if he has never been beaten black and blue; the only contestant who can confidently enter the lists is the man who has seen his own blood, who has felt his teeth rattle beneath his opponent’s fist, who has been tripped and felt the full force of his adversary’s charge, who has been downed in body but not in spirit, one who, as often as he falls, rises again with greater defiance than ever”

(Seneca 1979, pp. 72–73).

However, in no way does the ancient spirituality, as selfcare, configure itself in a practice of solitude; on the contrary, it is a set of well-designed relationships, for example, the obligation of those who are more advanced in their formation, usually with the most advanced age, to render this service to others; the exchange of correspondence between friends and relatives, sealing bonds of friendship; or even the creation of a system of reciprocal obligations. For this very reason, this subject discovered as a result of care is, above all, a citizen of the world, a member of the human community, a being of relations. Such an understanding is not detached from an ethical commitment. First, it is always an invitation to act correctly, as true subjects of their own attitudes, thoughts, and decisions. So, on the one hand, it is a practice that expands existence, for it is not about isolating oneself from the world, but instead participating fully in it. However, on the other hand, it is also a limiting attitude, as it requires from each of us a clear understanding of how, where, and in what way it is most advantageous to participate. It is a Stoic precept that we will never be perfect, but we have a duty to seek, at every moment, to get it right as much as possible, for as Epictetus tells us “… What, is it possible thenceforth to be entirely free from fault? No, that is beyond us; but this at least is possible: to strive without cease to avoid committing any fault. For we must be contented if, by never relaxing our attention, we manage to escape a small number of faults” (Epictetus 2014, vol. IV, pp. 12, 19).

When arranged side by side, the two notions of spirituality proposed by Foucault figure in the verticality of the present. They not only “break” or “escape” historical linearity by introducing subjectivities and temporalities into these new forms, but, above all, they have the potential to shatter pre-established schemes, removing the subject from their exact position where they have been placed, either through political power, religious power, or a social or scientific structure. It involves introducing novelty and reinterpreting the way other forms of life, religions, and different experiences and participations are percieved. “All the great political, social and cultural upheavals could only effectively take place in history from a movement that was a movement of spirituality” (Foucault 2018, p. 21).

To move, to transform, and to adapt are not movements imposed on the subject by their inherent condition or through a mere act of knowledge. An individual must transform themselves into the very truth they have sacrificed to attain, becoming the subject of verifiability. This transformation paves the way for the political act of self governance and governing others, sometimes even endangering one’s own life. Therefore, spirituality is becomes a commmitment, a courageous pursuit of truth that manifests as an ethical choice that implies different ways of relating to work, the body, culture, nature, the world, and, certainly, oneself. In this sense, Foucault describes spirituality as a way of rekindling hope in the West amidst the many crises and economic and humanitarian political disappointments that have persisted from the 20th century to the present day. It represents a way of thinking and behaving differently, because, as he himself states in an interview with Farès Sassine in the early summer of 1979, “(…) there can be, within our time and history, an opening, a point of light and attraction that gives access, from this world, to a better world” (Foucault 2018, p. 52).

4. From Selfcare to Care for the Common Home: Spirituality as an Integral Healthy Lifestyle

A characteristic of Foucauldian thought, and a point of convergence with Pope Francis’ proposal for analysing the present, is the need for a “polyhedron of intelligibility” (polyèdre d ’intelligibilité) in order to better grasp the events that cause disruptions in the way knowledge is conceived and establish new connections through multiple processes (Foucault 1994, p. 24; Pope Francis 2013, #236). Polyhedral analysis aims to identify the rationality regime present in a set of singular practices during the events that produce singularities.

This procedure focuses on both analysing the singularity of the hegemonic processes of conduct in the present time and on the need to conceive forms of resistance through a political spirituality network.

It is in this direction that we can identify the “acontecimentalisation”, to use Foucault’s concept, of the rise of the fields of spirituality and health as a form selfcare intersecting with the ecological agenda as a form of political spirituality. This intersection became noticeable after the engagement of religious traditions in relation to Agenda 2030. In this sense, spirituality is no longer seen as a religious aspect, but as a shared dimension involving lifestyle and ecological commitment, with repercussions that are not only personal, but also cultural, social, political, economic, and linguistic, as can be seen in the Encyclical Letter Laudato si’:

“Given the complexity of the ecological crisis and its multiple causes, we need to realize that the solutions will not emerge from just one way of interpreting and transforming reality. Respect must also be shown for the various cultural riches of different peoples, their art and poetry, their interior life and spirituality. If we are truly concerned to develop an ecology capable of remedying the damage we have done, no branch of the sciences and no form of wisdom can be left out, and that includes religion and the language particular to it”

(Pope Francis 2015, #63).

At this intersection of health and the environment, Ls, as an expression of this new moment of spirituality in the present time, can help us realise that the ecological issue requires not only an educational programme, but also “a lifestyle and a spirituality which together generate resistance to the assault of the technocratic paradigm” (Pope Francis 2015, #111), uniting spirituality as selfcare and political spirituality. For this instance, “it is the polyhedron, which reflects the convergence of all its parts, each of which preserves its distinctiveness. Pastoral and political activity alike seek to gather in this polyhedron the best of each” (Pope Francis 2013, #236).

In this way, the agenda of Ls introduces a pivotal axis of religious engagement with the 2030 Agenda. The common home is a shared concept between the UN Agenda 2030 for Sustainable Development Goals (SDGs)1 and Laudato si’ Goals (LSGs)2. Ls was published on 18 June 2015, 6 months before the 2015 Paris Conference on Climate Change (COP21) and three months before the United Nations adopted the Sustainable Development Goals (SDGs). These dates signal the pontiff’s intention to assume a public agenda for a joint collective effort and a common universal ambition. Among the various convergences between the SDGs and Ls, the main one is that the environmental crisis is simply the flip side of the social crisis (UN 2015b, #7; 36; Ls #53; 62–63; 111–114; 119; 144; 156–157). COVID-19 and the humanitarian crisis underscore the urgency of adopting a public agenda that requires a collective political and social effort to overcome the cultural contradictions of economic determinism. It calls for shared responsibility, supported by a culture of solidarity. In the words of Pope Francis, this moment reveals humanity’s thinking that it would be possible to always be healthy in a sick world (Pope Francis 2020). In times such as these, religions have great potential for empathy and social cooperation with public agendas. The «last» Habermas viewed this alternative aspect of religious traditions in post-secular societies as a possible source of wisdom, with value for fostering consensus on shared life or life in common (Habermas 2009).

In addition to Pope Francis, some other world religious leaders—The Orthodox Patriarch Bartholomew I of Constantinople, the Muslim Grand Imam Ahmed el-Tayeb, Rabbi Noam Marans, from the American Jewish Committee, The Archbishop of Canterbury Justin Welby, Primate of the Church of England, and the Ayatollah Mohaghegh Damad, among others—have committed to the 2030 Agenda, to the point of being recognised by some UN analysts as a «spiritual» sector (Albright 2015). Ls also explicitly relates human health (Ls #20–22; 183) to the “health of the environment” (Ls #193) and the challenge of overcoming a throwaway culture, which affects both. This perspective of ecological conversion implies a re-education regarding how things are perceived as all being connected.

One of the important criticisms about the Global Agendas is their portrayal, which does not show the interconnected nature of issues and hinders the consideration of coordinated actions.

For this criticism, the limits of what is called the Christmas Calendar model of the Global Agendas (Figure 1) are pointed out, namely the Millennium Development Goals (MDGs)3, the Sustainable Development Goals (SDGs), and the Laudato Si’ Goals (LSGs).

Rockström and Sukhdev suggested the Wedding Cake model (Rockström and Sukhdev 2016), in which the Sustainable Development Goals of the 2030 Agenda can be thought of in interconnected spheres (Figure 2). The SDGs are distributed in the main spheres according to their specificities, but, at the same time, they are connected with other spheres, influencing them and being influenced by them (cf. description bellow on

Table 1. Possible correlations between SGDs and LSGs.

Cultural Sphere	LSG Ecological Spirituality LSG Community Engagement and Participatory Action	SDG 17 (Partnerships for Goals)
Economic sphere	LSG: Ecological Economics	SDG 8 (Decent work and Economic Growth) SGD 9 (Industry, Innovation and Infrastructure) SDG 10 (Reduce inequalities) SDG 12 (Responsible consumption and production)
Society sphere	LSG Response to the cry of the poor LSG Adoption of simple lifestyles LSG Ecological Education	SDG 1 (No poverty) SGD 11 (Sustainable cities and communities) SDG 16 (Peace, Justice and Strong Institutions) SDG 7 (Affordable and clean energy) SDG 3 (Good health and well-being) SDG 4 (Quality Education) SDG 5 (Gender equality) SDG 2 (Zero hunger)
Biosphere	LSG Response to the cry of the Earth	SDG 15 (Life on Land) SGD 14 (Life bellow water) SDG 6 (Clean water and sanitation) SDG 13 (Climate action)

).

By sharing this model concept here, we also propose an adaptation to a model that integrates LSGs and SDGs (Figure 3). It includes adding a cultural dimension where spirituality is activated, starting from raising awareness about the agenda and extending to concrete execution across all domains. This is due to the connection between these aspects and culture, and consequently, offering a way of thinking about life.

In this way, spirituality acts directly on culture, and both act as an empathetic and questioning gaze on the pain of the planet and those who suffer most from the current situation. Such sensitivity requires the production of knowledge that contributes to the ethical discernment of actions and promotes commitment to the transformation of reality in the spheres as a whole.

This makes it possible to establish correlations between the two agendas and to create cooperative analogies between the spheres and agendas (Figure 4; Table 1).

In this perspective, the proposal of an ecological conversion is not a matter of mere ecological awareness, but a way of thinking with an awareness about the relationship between all things. A point of convergence between the relationship between religion and health and religion and the environment is the commitment of both areas to the role of spirituality as a path for resilience and regeneration by pointing to the need for a new lifestyle as a way of caring for oneself and the common home (Ls #202–203). The category of care can be revisited as the principle of spirituality, which implies forms of self-care and, at the same time, care of the common home. While spirituality is not restricted to the religious sphere, care as a search for integral, personal, social, and environmental health (Deane-Drummond [2008] 2016) can be thought of as a lifestyle, as a way of searching for existence around a core of meaning nourished by care practices. When thinking about SDGs from the perspective of complexity, that is, everything is interconnected, selfcare is present through the integrated relationship between biological spheres. The primary nexus is with the dimension existential, but it also encompasses social, political, and economic aspects. Furthermore, there is an important role for knowledge-producing institutions offering cultural literacy play a vital role in making this nexus visible.

Therefore, spirituality as a lifestyle is constituted by the belief that life is capable of meaning, and spiritual practices unfold in the form of wisdom—providing meaning to life. As Christoph Theobald commented about the founding and fundamental experiences that shape a way of living through the establishment of a belief as a way of life:

“Let it be clear: “faith” does not immediately refer to God or Christ, but, above all, to the mysterious capacity that a being has to believe in life, to rise up even in the most difficult moments with the hope that life keeps its promise. In its many forms, this act of trust, which constitutes the backbone of our existences, also produces more elementary bonds and founds our life in society”

(Theobald 2006, p. 63).

However, given the ambiguity of its usage, there is also a theological responsibility to reinterpret spiritual practices regarding the issue of health and spiritual care in the context of health, not without considering their political consequences. Indeed, the so-called Plague of Athens between 430 and 426 BC seems to have been the first phenomenon classified as an epidemic by Hippocrates of Kos. It was a public health problem categorised through a political concept and with cultural, social, political, and religious consequences, as described by the historian Thucydides (Villas Boas 2020).

Just as Foucault pointed to a lost unity between philosophy and spirituality, so too does this exist for spirituality and medical and health care practices. Hippocratic medicine emerged from the reframing of the healing practices of the Asclepiad shrines dedicated to the deities of healing, which formed a kind of religious community of medical “priests”. Hippocrates of Kos was one of its members, and perhaps the most famous. The decline of Athens was caused not only by the epidemic, but also by the Peloponnesian War, which resulted in increased hunger, poor hygiene, and the intensification of poor public health. In this context, religious practices of seclusion grew in society, with people seeking peace and salvation for their immortal souls. This resulted in the rise of Orphism, which was responsible for influencing thinkers such as Pythagoras and Empedocles, as well as the emergence of Epicureanism. On the other hand, the shrines of Asclepius achieved great importance and expanded to the extent that their religious cults included traditional healing practices that are associated with new medical practices. In this context, there is not a rejection of religion, but rather a greater discernment of discursive and social practices concerning the relationship between spirituality and health. This initial exercise of the Asclepiades, the concept of pneuma used by Hippocrates as a nexus between the vital elements, was then extended by the Stoics as the realm in which a sympathetic or cosmic connection takes place, as the basis for a Stoic salutology, a Greek spirituality that it incorporates the ideal of health (salus) in its complex formation. It is in this context that Christian soteriology incorporates Stoic salutology, conceiving salvation as an exercise of care for oneself and all creation. The attribution of soter to a deity was first given to Asclepius, and only in a second moment does the Christus medicus also come to be conceived as Iésus Christós Sotér, from the intense dialogue with Stoic idea of salus. In this sense, Ancient Christianity is the first movement responsible for the secularisation of medical knowledge insofar as it incorporates its theoretical−practical knowledge and spirituality, but not the deities to whom the cures are attributed (Villas Boas and Lamelas 2022).

Salus is a cosmopolitical category, which situates and connects the cosmos and its political organisation at the same time. In this context, the soul is seen as a sort of axis between the two, which, when dynamized by selfcare, unfolds empathetically in the necessary political transformation for the health of the whole. In the Christian reception of salus, this empathic movement gives rise to the task of discerning transformative action that contains in itself a political potential.

In this sense, the concept of care is not an isolated act and is not reduced to the mere repetition of practices, but it has an intelligence of the practice in its integral and visceral relationship with the world. Spirituality, therefore, is constituted by a set of practices arising from a change in mentality, which aims to transform the way of seeing life and the world. Spirituality, in this sense, is also a vital commitment and implies an ethical choice, and it is here that the rescue of the political dimension of spirituality, as carried out by Foucault, corroborates the integral perspective of Laudato si’, in which the “cry of the earth” is directly linked to the “cry of the poor” (Ls #49). In the last instance, in Pope Francis’ utopian project, spirituality as care of the self implies transforming everything that threatens life and, thus, has the task of transforming culture, unjust structures, education, and the economy, through concrete agendas such as the Laudato si’ movement, the Global Educational Pact, and Francis’ and Clare’s Economy, among other initiatives.

Moreover, as the term care became linked to pastoral care, especially in Latin America, this notion became intertwined with a more communal and practical perspective, due to the influence of Liberation Theology, which was notably embraced by the Base Ecclesiastical Communities (CEBs). This expansion transformed the concept from mainly pastoral or religious to a public task. Such a stance not refrained from mischaracterizing the notion of religious identity, but also conferred a holistic or integral dimension to the model of liberation. In effect, Ban Ki-moon, in The Millennium Development Goals Report 2015, noted that one of the great challenges of global agendas is not related to knowing what to do, but to the lack of political will that calls for a culture of shared responsibility in order to promote a collective, long-term effort:

“Experiences and evidence from the efforts to achieve the MDGs demonstrate that we know what to do. But further progress will require an unswerving political will, and collective, long-term effort. We need to tackle root causes and do more to integrate the economic, social and environmental dimensions of sustainable development. The emerging post-2015 development agenda, including the set of Sustainable Development Goals, strives to reflect these lessons, build on our successes and put all countries, together, firmly on track towards a more prosperous, sustainable and equitable world. Reflecting on the MDGs and looking ahead to the next fifteen years, there is no question that we can deliver on our shared responsibility to put an end to poverty, leave no one behind and create a world of dignity for all”

(UN 2015a).

5. Conclusions

Thinking about care in a polyhedral manner is a way of connecting spirituality and health as selfcare and political spirituality as care for the health of the common home. These two dimensions explore different aspects of life, but in convergent ways. In this way, a culture of care helps to establish the boundaries that could jeopardise a life. However, it does so by considering an integrated approach, adopting a polyhedral perspective in which everything is connected in a complex phenomenon—which is life.

One of the greatest threats to public health in the 21st century is clearly directly related to the health of the planet. Environmental quality directly impacts people’s quality of life. The complexity of the relationship between health and the environment demands a new awareness of how everything is connected in order for more effective coordinated actions.

In this sense, health can be a sphere of perception and awareness regarding the complex connections that involve personal health and environmental health, especially since the transdisciplinary use of the category care.

The transdisciplinary endeavour aimed to explore the conceptual semantics of each area so as to operationally translate them into practical terms that can be collectively understood, stemming from the fundamental philosophical foundation that enables their implementation in the therapeutic sphere, academic forums, and policy-making spaces. Above all, this translation exercise helps to identify the intelligibility of practices in different cultures that allow for an awareness of the transformation of culture and society, in the form of a network around an agenda that involves lifestyle (personal health) and commitment to the common home that inhabits humanity (health of the planet).

In its most practical application, where care is invoked as spirituality, it can be conceived as a way of life, especially considering care practices aimed at achieving holistic wellbeing. A healthy life is a form of preventive health, which implies consideration and awareness of the health conditions of the world in which one lives. In the same way, spirituality as care can become more intense in moments of greater fragility and even upon completion of the course of life at the moment of death. Simultaneously, it serves as a foundational element within the patient’s immediate community, be it their family and friends, or the multidisciplinary care team that is called to adopt a transdisciplinary approach to their care. It is in the function of perceiving life as a carrier of meaning that the principle of care is installed as constitutive of a community empathy around the awareness of a common dignity. This principle can be thought of in its entirety and encompass the common home in which this common dignity resides.

This is the same principle through which spiritual care can be expanded to an integral consciousness that implies thinking about the health of the whole, including health for all and especially for the most vulnerable. From an integral perspective, care can be seen as a transformative healthy lifestyle in which, from practices of attention to one’s own health, individuals can also take a critical and political stance of support and incorporation of a public agenda from a personal perspective, as is the case for the 2030 Agenda. A healthier planet offers better health conditions for humans, especially those who have fewer resources to ensure their health and that of their loved ones. A healthier population enables a better allocation of public and private resources to attend to other aspects that concern the improvement of quality of life. A full awareness of the complexity involved in the relationship between selfcare and caring for the common home allows for a more self-critical, proactive, and participatory lifestyle in the search for intercultural solutions for different people with common problems and, above all, with shared dignity who inhabit the same home.

In this exercise of rediscovering spirituality as a fundamental human dimension, it is also important to consider, especially with the emergence of post-secular societies, the task of re-signifying spirituality in their religious environments, in order to overcome a proselytising and hegemonic vision that is often incompatible with the health sciences. In this way, Laudato si is fundamental as a catalysing movement in the process of going forth from religious self-referentiality through the engagement of the great religious traditions with the 2030 Agenda. This ecological spirituality could be an opportune historical moment for reconciling public ethics in a plural and multicultural society, which could have repercussions for better integration in the dialogue between the sciences and religious phenomena, such as spirituality and health, considering integrated solutions connecting a healthy lifestyle with a sustainable lifestyle.