In 13 years of publishing Palliative and Supportive Care, we have tried to be true to our mission of focusing the scientific and editorial content of the journal on psychiatric, psychosocial, existential and spiritual domains of palliative, and supportive care. I believe we've been true to this mission, and somewhat successful in providing an academic publishing home for clinicians and researchers whose research and practice emphasis falls into these areas. There have been many papers published on psychiatric and psychosocial aspects of palliative and supportive care. And of course meaning and existential issues have filled the pages from time to time. We've also had prior Special Issues on Ethical issues in end of life care, Cultural issues in palliative care, and Distress screening. We will soon have special issues on Caregivers of patients with cancer, and Delirium. This first issue of Volume 13 focuses on the sometimes controversial issue of “Spirituality” in our work. We are fortunate to have an extraordinarily interesting series of original research papers, review articles, essays, poetry, and a wonderful letter to the Editor on “Spirituality” from our avid reader and contributor Professor Par Salander.

Investigators Emma Stein and colleagues ask the important question,” Do spiritual patients want spiritual interventions?” This paper highlights how intertwined the terms religious and spiritual are for cancer patients. Professor Erci describes “Meaning in life in Turkish cancer patients” and suggests that “meaning” may be an existential, spiritual, or religious concept for our patients. Professor Borasio and colleagues examine the role of Chaplains in end of life care, and once again, the lines of spirituality, existentialism, and religious are intimately intertwined. Professor Fegg and his group report on the usefulness of mindfulness practice in caregivers. mindfulness is often thought of as a “spiritual practice,” but ultimately mindfulness can be practiced like yoga, without any element of spirituality attached to it, but rather as a practice of attention control. Professor Ganzini reports on the efficacy of music vigils in end of life care, specifically with Harp music. The thought of angels and metaphysical spirits is of course evoked, but music, of many types and genres can affect the “spirit” of us humans. Of course the question is “does music affect our human spirit or merely influence the types of brain waves in our very animal” brains — though highly evolved and larger than most animal brains. Professor Vornax investigates the spiritual experiences of cancer patients, and yet again demonstrates the often intertwining of the religious, metaphysical, and the spiritual. Professor Lambie illustrates to us that the topic of spirituality is poorly understood, and in fact interpreted in many ways when it is being taught to medical schools. Most however view it as important, even if they don't all agree on what it is. Professor Robertson focuses on “time” in the experience of the terminally ill. A topic of great interest to many of us attempting to develop interventions in end of life care. The spiritual dimensions of the experience of time are quite complex and poorly understood.

Drs. Dunn and Bryson review important aspects of the role of chaplaincy and spiritual assessment in palliative and supportive care.

Our friend Per Salander, once again, challenges us to truly question what we mean by the concept of spirituality. His Letter to the Editor responding to a proposed definition of spirituality by Professor Simon Wein is a cogent deconstruction of yet another attempt at defining Spirituality.

For me, the essential question of the relevance of the term “spiritual” or “spirituality” lies in the question of the physical versus the metaphysical, and the question of whether there exists anything in between these two realms. The question is merely: “Is the experience of being a human being simply and completely a function of the activity of our organs and especially our brains?” If the answer is “yes” then we are merely machines. Turned on we exist in all aspects of our being; turned off we cease to exist. Steve Jobs, the founder of Apple Inc., was disturbed by this idea, and so he consciously and intentionally (did he actually have free will to make this choice? — if we are machines we cannot have free will — as many neuroscientists do believe) did not design on and off switches on his apple products (but rather buttons to put the device to sleep?). So if all we are as human beings are the thoughts that our brain thinks, then is there no room for a term like “spirit” or “spirituality?” Now I am not suggesting the existence of anything metaphysical. No soul that enters the body at fertilization and leaves as the physical body dies. No ghosts. Nothing unsupported by science or physics. Our human “spirit” is not, in my estimation, a metaphysical entity or the “ghost in the machine.” I see it perhaps as a “gestalt” concept. The idea that we, as whole human beings, are greater than the sum of our organ functions. That we use these organs, particularly our brains, to contemplate ourselves, to create art and beauty, to create new ideas, to create an existence that transcends the our human biological limitations. The idea that we can contemplate whether our existence is worth continuing; that we can ask the question “to be or not to be,” to actually utter the words “ I cannot stand myself” indicates that in fact the I (our “self”) has a relationship with our brain's thoughts. Of course our brain may in fact be producing “both of us”— our thoughts and our “selves” who are aware of these thoughts. So who am I talking to when I utter the words” I can't stand myself,” or “I am a failure,” or “I would give my life to save the life of my son!” Eckhart Tolle would say that this voice is the “stillness” inside us — our spirituality. I am not susceptible to vague new age terminology. I don't know if it is a stillness, or a space. I know it's not a metaphysical ghost or soul. But I experience it as something that is unique to the human experience and is at the essence of what makes us uniquely human. And the term spiritual, as opposed to religious or existential makes more sense to me. It is more poetic than “the electrical activity in your amygdala.” It is like the “big bang theory.” It is scientifically a fact, explainable by physics, but it is full of wonder and joy, and awe — it's a spiritual experience.