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The psychologic and spiritual turmoil being experienced in the world community in the days and weeks after the horrific events of September 11, 2001, lend a heightened importance to this classic article. Through Bombeck's clinical and pastoral expertise we have been given an understanding of the spiritual needs of those destabilized by adversity. Her understanding of this human affliction is grounded in theology and the behavioral sciences. The narrative of her patient Iona's deep distress vividly portrays the need for understanding that goes beyond what the behavioral sciences offer. The nature of every person's inner life is complex and mysterious. According to the author of The Cloud of Unknowing (Wolters: Great Britain; 1961:137-138), the human soul is embodied in one's memory, reason, will, imagination, and senses. It cannot be predicted how horrific events will affect individuals spiritually, whether they will experience a painful and debilitating grief but still be able to find comfort in their faith in a higher being or turn away from their long-held faith into a crushing fear of the past and the future. If their entire world has become one of turmoil and dispossession, they then may experience spiritual affliction. Simone Weil's Waiting for God (Craufurd E, trans. New York: Perennial Library; 2000:119) helps us to understand human affliction and its serious implications and underscores what Bombeck asks us to consider in her essay on spiritual disequilibrium. Weil tells us that an affliction is born of an event that has seized and uprooted a life in all its parts-social, psychologic, and physical. In our practices we are now seeing individuals of all faiths whose lives have been irrevocably altered by the assassinations that took place on September 11th, the subsequent retaliations, and the continued threats. Many face an entirely uncertain future. Realizing that many who seek our assistance may be on the edge of spiritual chaos underscores the essential need for intelligent sensitivity to help the afflicted find hope not only to survive but also to live.


Jeanine Young-Mason, EdD, RN, CS, FAAN


Persons whose most cherished beliefs are challenged in the context of traumatic life events are likely to experience severe spiritual disequilibrium. The complexity of this experience cannot be adequately conceptualized in terms of general systems theory. A formulation of this phenomenon in terms of the concept of self-organization from chaos theory can give the nurse a useful assessment of spiritual disequilibrium. The case study method describing the psychotherapeutic relationship between a CNS-the author-and a woman who experienced this phenomenon is used as an illustration. Specific guidelines are discussed for the use of chaos theory in nursing practice.