Understand what we thirst for

Whether for water or meaning, it’s a primal force.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A child wearing a wool hat holds a glass and drink water from it.

Johnny McClung on Unsplash

Quenching thirst is a global problem. It can also be profoundly personal, impaired by illness. For nurses, it can be ethically and emotionally difficult, when treating dying patients. But is there ultimate relief?

Thirst is the subjective sensation of a desire to drink something that cannot be ignored. The world is thirsty; globally, 703 million people lack access to clean water. That’s 1 in 10 people on the planet.

Thirst is a life-saving warning system that tells your body to seek satisfaction through swallowing fluid. It works in partnership with other body processes - such as changes in blood pressure, heart rate and kidney function - to restore fluid, and salt, levels back to where they belong. Failure of any part of this beautifully balanced system leads to dehydration (or water intoxication), and perhaps to seizures, swelling of the brain, kidney failure, shock, coma and even death.

Sometimes it’s difficult to quench thirst, because of problems with supply. According to the World Health Organization, at least 1.7 billion people used a drinking water source contaminated with faeces in 2022. Sometimes in war, water is weaponised, with systematic destruction of water sources and pipes. Water laced with rat fur, arsenic and copper has meanwhile been reported in prisons across the USA.

At other times, there may be “water everywhere, but not a drop to drink” because of individual problems with swallowing. As a nurse, some of my most heartbreaking moments have been when I have been unable to fulfil a need as basic as a patient’s thirst; when even thickened fluids have led to intense coughing and distress, and a realisation that I can only moisten mouths and give so-called “taste for pleasure”: very small amounts of a favourite liquid or taste using a soft toothbrush, or a circular brush gently sweeping around the mouth and lips to release some of the liquid - even, and especially, at the end of life when the patient is unconscious.

Difficulties in drinking are common in dementia when fluid can seem foreign and swallowing a surprise to the system. It’s thought that over 50 per cent of people in care homes have an impaired ability to eat or drink safely; 30 to 60 per cent of people who have had a stroke and 50 per cent of those living with Parkinson’s may struggle to swallow.

Other conditions that may affect swallowing include multiple sclerosis, cerebral palsy, and head and neck cancers. Diabetes is characterised by a raging thirst owing to problems with insulin (diabetes mellitus) or an imbalance in antidiuretic hormone levels (diabetes insipidus). In intensive care, patients are predisposed to thirst through mechanical ventilation, receiving nothing by mouth, and as a side effect of some medications. But thirst is a “neglected area” in healthcare, writes palliative care researcher Dr Maria Friedrichsen.

“Knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient’s record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.”

Is there another thirst that is also being missed in nursing, and in life in general – a spiritual thirst, beyond the physical desire to drink? In his book, Living in Wonder, writer Rod Dreher argues that humans are made to be spiritual, and that a critical sixth sense has been lost in a “society so hooked on science and reason”. We humans crave love in our deepest selves; we have an insatiable thirst for everything which lies within – and beyond – ourselves. Auschwitz survivor Viktor Frankl, who was later appointed professor of psychiatry at the University of Vienna, became convinced that human beings have a basic “will for meaning.” “The striving to find a meaning in one’s life,” he wrote, “is the primary motivational force in man.”

In the harsh sun of a Middle East day, an ancient story of a man and a woman encountering each other at a water well illustrates this dual thirst for water and meaning. The man, Jesus, thankful for a drink of water given to him at the well by an outcast Samaritan woman, said that “Everyone who drinks this water will be thirsty again, but whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life.” In that midday sun, such imagery made a powerful statement.

Being mindful of spiritual thirst when drinking water is something also captured in a Ghanaian proverb and pictured perfectly in the many birds that drink by gravity, so tipping their heads back when they swallow.

“Even the chicken, when it drinks,

Lifts its head to heaven to thank God for the water”.

Unsatisfied thirst is part of the human condition, we long for something more; it’s living proof of our immortality, says French poet Charles Baudelaire. Despite his Olympic success, athlete Adam Peaty said that society didn’t have the answers he was seeking, and that a gold medal was the coldest thing to wear. He “discovered something that was missing” when attending church for the first time, and now has a cross with the words “Into the Light” tattooed across his abdomen, symbolizing his spiritual awakening. We are more than mechanical machines with physical needs. We are rather gardens to tend in a dry and thirsty land, with souls in need of intensive care.

Explainer

Creed

Virtues

17 March 2023

4 min read

Where the good, the true, the human, and the real meet

In the second of his series on virtue, Andrew Davison explores the underrated virtue of prudence as the ability to live aligned with the grain of the universe.

Andrew Davison

Andrew works at the intersection of theology, science and philosophy. He is Canon and Regius Professor of Divinity at Christ Church, Oxford.

A carving tool is pressed into a groove in wood.

Photo: Dominik Scythe on Unsplash.

A full human life is a virtuous one, and vice versa. In the second of these eight discussions of virtue, starting in Lent and moving into Easter, we come to the first of the virtues, namely prudence. It’s not a common word today, but you simply can’t have virtue without it, at least according to such luminaries as Aristotle and Thomas Aquinas. Prudence, Aquinas recalls, is:

‘the mother, custodian, and moderator of the virtues.’

That’s because, for him, prudence is nothing less than the meeting point between the good, the true, the human, and the real.

'That to act well – to be virtuous – is to act rationally.'

Thomas Aquinas

Virtue, as we saw last time, is all about being fully and characterfully human. Human beings are ‘rational animals’, as Aristotle put it, so to be fully and characterfully oneself, someone has to act rationally, to the fullest extent that she is able. (This is also a tradition that has fiercely upheld the humanity and worth of people with disabilities, including mental disabilities.) There is something deeply counter-cultural about placing that sort of emphasis on reason. Isn’t fulfilment about following our desires, with rational interrogation just getting in the way? Moreover, we’ve lived through decades in universities where reason has been treated with suspicion (that’s the technical term), as ultimately an expression of power or some vested interest, such that ‘truth’ more about the speaker than what is spoken about. In contrast to that, Aquinas insists that to act well – to be virtuous – is to act rationally.

‘Reason is an openness to the reality of things’

Thomas Aquinas

That, however, is no cult of abstract or rarefied reason, nor the preserve of some intellectual elite. For one thing, while reason is important, it’s also secondary. Reason matters because of reality. To be virtuous is to live with the grain of how things are: with the grain of being human, of being in a human community, and with the grain of the universe more generally. The place of reason in virtue, according to Aquinas is not so much for its own sake, but because reason is an openness to the reality of things. Second, the rationality of prudence is a matter of keen-sightedness, especially in keeping two things in view, and coordinating between them: moral principles, and the contingencies of the situation to hand. Such clarity of vision is by no means limited to the highly educated, nor is primarily to be learned from books. It is picked up from good examples, and a well-honed common culture. Third, prudence is a virtue – a ‘second nature’, as we saw in the previous article – and that is as much about the honing of instinct, as anything else. It ends up as much a matter of the body as of the soul. It is about being a rational animal, so it shapes us as animals, and not only as minds.

To be virtuous is to be prudent – to be practically wise and rational – because of the need to attend to reality, and work with its grain, not against it. A good life is lived in a way that’s in-keeping with human nature, and with nature more widely, so as to flourish within it. That’s not simply a matter of living sensibly, although that’s also not a bad start, since living sensibly is also harder than we might think. We don’t naturally always make healthy use of the good things of life – food, sleep, sexual intimacy, responsibility, or authority – as good sense would suggest.

On fraught territory

The association of prudence with the reality of things, especially with the shape of human nature, is fraught territory. Human beings are prone to read all sorts of morally charged things into nature, some of them deeply flawed. Even the great Aristotle thought that some human races were ‘obviously’ and ‘naturally’ slaves. He also bequeathed the idea that human nature at its most authentic is male, such that women turn up when a foetus doesn’t develop along those, better, lines. All of that once seemed natural, which is a problem, but it doesn’t invalidate the place of prudence among the virtues, and the place of reason in a well-lived life. It makes careful use of prudence and reason all the more important.

On the good life

Reflecting on what a healthy, flourishing human nature is like, and a healthy, flourishing society, is a tricky business. That’s why it calls for life-long growth in the virtue of prudence: getting better at knowing what that looks like, knowing it more and more instinctually, and in being able to weigh up what it demands in any particular situation, rapidly in some cases. We won’t all agree on what a flourishing life looks like, individually or community, but there may be room for agreement in on the idea that a good life – a virtuous life – involves following that path, which is to say, the path of prudence.