Article

Belief

Care

Creed

4 December 2024

4 min read

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

14 March 2023

5 min read

How to encourage a second nature of virtue

Cultivating virtue could make you cheerful. Andrew Davison explore the benefits. The first in a five part series for Lent.

Andrew Davison

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

Kenny Eliason on Unsplash.

Lent is upon us: the season to cultivate virtue. In that old-fashioned word, ‘virtue’ – so unpromising, even dismal in tone – lies so much of what Christianity wants to commend in its vision of a moral life. Even if Christian ethics enjoys a dour impression in the popular imagination, the tradition known as ‘virtue ethics’ places its emphasis on happiness, not being miserable, and on having a good disposition, not primarily on following laws. It’s all about having a good disposition – on being the sort of person to whom goodness comes naturally, even under taxing circumstances – and that as the basis for happiness. For the virtuous person, a virtuous response has become second nature: spontaneous, easy, and cheerful.

The idea of virtue as ‘second nature’ draws on Aristotle’s idea of habit. Over time, he thought, we settle into certain ways of being and reacting: into certain ways of behaving, responding, and relating to others. That can be for good, in which case we call that habit a virtue, but also for ill, in which case we call that a habit a vice.

'We are cultural, linguistic, and moral, and we have to learn and practice those things that make us human.'

We are creatures of habit, which makes us a strange sort of creature. We are born very much still a work in progress. All sorts of other organisms can perform their most characteristic actions more or less from birth. Contrast us. We are cultural, linguistic, and moral, and we have to learn and practice those things that make us human. In many important respects, what or who an infant will become remains an open question.

Aristotle put this pithily:

‘The virtues arise in us neither against nature, nor simply by nature. Rather, our very nature is to acquire them, and it is in that way that our nature reaches completion.’

Our nature is to be open, those works in progress. Inevitably, we acquire habits, one way or another, for better or worse. Habits are like a sediment that is laid down over time. Or – perhaps better – habits are like the course that river cuts through sediment or soil. The river cuts the course, but eventually the course directs the river. Acts lay down habits, then habits shape acts.

'We don’t become better or worse primarily by thinking hard about it; we become better or worse according to the way we act.'

That offers a bracing and distinctive view of what it means to be moral. For one thing, it shifts the emphasis away from motives, psychology, and an inner realm of the mind. We don’t become better or worse primarily by thinking hard about it; we become better or worse according to the way we act. Good deeds beget good habits, which beget further good deeds; bad deeds beget bad habits, which beget further bad deeds. That’s a good reason to make Lent a time for doing things (and maybe also not doing things, although virtue ethics will tend to think that action is important, and that we best drive out bad habits with good ones).

Virtue ethics has a lively place for reason, and we will come to that in the next article in this series (on the all-important rational virtue of prudence), but it’s also a remarkably bodily tradition. Virtue is almost as much laid down in one’s bones and sinews as in one’s brain. There is a ‘muscle memory’ to virtue, as also to vice. Imagine rescuing a child from an oncoming bus. It belongs to virtue in that situation for the body to move before the mind can catch up, or at least the conscious, deliberating mind. The child is snatched from danger in a pre-conscious whirl. The first well-formed thought to cross the mind of our virtuous protagonist might well be ‘Goodness, look what just happened?’

Virtue is at both home with dramatic responses in dramatic circumstances, but also disinclined to dramatize itself. The same person who reacted so bravely, and on instinct, faced with the child and the oncoming bus, is also likely to say ‘What else was I going to do? No big deal.’

The strength in virtue

The word virtue relates to the Latin with the word for strength. Virtue is strength of character. Virtue fills out what humanity can be. We might be born a work in progress, but that progress can go better or worse, depending on whether that human life is fulfilled in virtue, or hampered by vice. To fall into vices is to live an attenuated life, the glory of our humanity tarnished. To rise to virtue is to live a life of the kind of splendour of which a human being is capable.

Christianity has things to say about the crookedness of our tendency towards doing wrong, but rarely has it denied that we are still capable of making choices that are either better or worse, of performing better or worse actions, and of being formed, as a consequence, into better or worse people. Virtue isn’t the whole Christian story. It might not even be half the story, but it’s an indispensable part.

Offering common ground

Virtue perfects nature, as far as nature goes, but that isn’t the main part of that Christian story. It goes on to say that grace elevates humanity to a state beyond its wildest natural imaginings: to ‘participation in the divine nature’ and being a son or daughter of God. (There will be much more on all of that in other posts on this site). But, while that comment puts virtue in its place, it’s still an elevated place. If you are sympathetic to Christianity, but standing somewhat outside the door of the church, the traditions of thought and practice around virtue might offer common ground: common, both because they are about making the best of a humanity that we share, and common because so much of the thinking about them has been carried out across and beyond confessional lines, the great example being the place of Aristotle – an ancient Greek pagan – in all of this.

The virtues

Aristotle singled out four primary virtues. They are prudence (or practical wisdom), justice, courage, and moderation. To these, the church added three from St Paul: faith, hope, and love. We will think more about each of these in the weeks ahead, as we journey through Lent, and onto Easter.

Who is the honest man?
He that doth still and strongly good pursue;
To God, his neighbour, and himself, most true.
Whom neither force nor fawning can
Unpin, or wrench from giving all their due.

Whose honesty is not
So loose or easy, that a ruffling wind
Can blow away, or glittering look it blind.
Who rides his sure and even trot,
While the world now rides by, now lags behind.

Who, when great trials come,
Nor seeks, nor shuns them, but doth calmly stay,
Till he the thing and the example weigh.
All being brought into a sum,
What place or person calls for, he doth pay.

Who never melts or thaws
At close temptations. When the day is done,
His goodness sets not, but in dark can run.
The sun to others writeth laws,
And is their virtue: virtue is his sun.

George Herbert

'Constancy '(selected stanzas)