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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.   

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5 min read

Should you be ashamed of yourself?

Shame powers cancel culture, yet its historic role is guarding community boundaries. Henna Cundill takes an in depth look at shame - and empathy.
The word 'SHAME' spray painted onto a grey hoarding in lime green paint.
Anthony Easton/flickr: PinkMoose, CC BY 2.0, via Wikimedia Commons.

“Put on this dunce’s cap and go and stand in the corner!” cries the teacher, and immediately we are transported to a scene that takes place in a schoolroom of centuries past. Likewise, if nowadays we were to see a woman being led down the street wearing a scold’s bridle, we might assume that there was a very odd sort of party going on; we might even intervene or phone the police. Why? Because these are not the scenes of 21st century Britain. We don’t do public shaming anymore – at least, we like to think we don’t.  

But the truth is we very much do; in fact, shame is essential, at least to a certain degree. For a group to survive with any sense of collective identity and purpose, something has to prevent each person within that group from becoming too greedy, or too lazy, or too dishonest. That something is often the fear of being shamed, not even punished – just shamed. It doesn’t feel nice to be judged and found wanting, or to fear that you might be. 

Think back to the last windy day when your recycling bin blew over – did you experience a passing moment of concern about the public pavement acrobatics of your wine-bottles, cake boxes and ready-meal trays? No need to blush – your neighbours probably rushed out ahead of you to hide their own multifarious sins. Studies have long shown that installing self-checkouts at supermarkets dramatically increases the purchase rates of “stigma items” such as alcohol and unhealthy foods. Oh, the things we do when we think no one is watching… 

So, shame is, on one level, a functional tool which does the essential job of guarding the life and boundaries of a community. Perhaps one or two of us still eats a little too much and drinks a little too much, but shame is one of the things that keeps most of us from going too far, too often – or at least the threat of shame tends to discourage. As Graham Tomlin has recently explored – we still live in a society that equates over-indulgence with a lack of virtue.  

It’s one thing for shame to guard certain moral boundaries (as long as we can all agree what they are) but we’re in a troubling place with the social ones. 

However, when an individual does step out of line, then the shaming process has two modes of presentation: exposure or exclusion, sometimes both. This is most clearly seen in a court of law, where an offender is first ceremonially declared to be guilty (exposure) and then is subsequently sentenced (exclusion) – often “removed” from society, at least for a while, via a custodial sentence or a curfew. In this very clear way, shaming plays a functional role for the well-being of society as a whole.  

But these two prongs of the shaming process can also happen in rather dysfunctional ways, some of which are dangerously subtle. We fear the recycling bin disgorging its contents because there is a certain social shame in being seen to consume too much junk. Fine. But what about the teenager who is compelled into a cycle of disordered eating because a schoolfellow has pointed the finger and said the dreaded word, “fat”? Likewise, many people love a chit-chat, and the fear of being excluded from a social group usefully prevents most of us from being too fixed on one topic, or from appearing inattentive or impolite. But in my research with autistic people, some have shared that they feel shamed out of social groups entirely simply because “chit-chat” is not right for them. Some have a language processing delay, others find “small talk” a bit confusing and inane and would rather talk about something specific. It’s one thing for shame to guard certain moral boundaries (as long as we can all agree what they are) but we’re in a troubling place with the social ones. Some of this shaming doesn’t sound very functional, not if the wellbeing of society is supposedly the goal.  

The inverse of shame is empathy. Where shame excludes, empathy shows attentiveness. 

Perhaps the saltiest example of this problem is the now infamous “cancel culture”. I know – even I can’t believe I would risk bringing that up as a writer, that’s how charged this debate has become. But de-platforming, boycotting, or publicly castigating someone for the views that they express – these are shaming activities, an attempt to render an individual exposed and excluded. It can be a very tricky argument as to whether this counts as functional shame, guarding the wellbeing of society, or dysfunctional shame, guarding little more than social norms.  

We ought to try and take it on a case-by-case basis, but even then, sometimes what one person takes as a moral absolute another person sees as a social choice. At the same time, those who hold dearly to certain moral absolutes sometimes lose sight of the societal impact of what they say. The result can be a strange kind of war, one where there is virtually no engagement between two opposing factions, and the only weapons are a string of press releases and a whole lot of contempt. Eventually, often regardless of there being no engagement and no progress, both sides vigorously declare themselves to be the winner.   

Jesus once said a strange thing when he was talking to a crowd. He said: “Settle matters quickly with your adversary who is taking you to court. Do it while you are still together on the way.” In other words, “Just have a chat first,” says Jesus, “and see if you can’t come to terms.” It was part of a much longer discourse where he also told the crowd to “love your enemies” – and this with the kind of love called agape, a love which favourably discriminates and chooses someone – very much the opposite of shaming them.  

For my own research I have looked in depth at the shaming experience, and one of the conclusions that I come to is that the inverse of shame is empathy. Where shame excludes, empathy shows attentiveness. Where shame exposes an individual, empathy draws them into discussion. To empathise with someone is not to agree with them, but it is to recognise they are human just the same, and that through openness and dialogue it is possible for people, even those who have very different experiences of the world, to explore each other’s perspectives. The end point of that exploration may not be agreement – it might still be everyone back to their corners. But in the process no one has been shamed, no one exposed or excluded, no-one othered or dehumanised.  

Of course, it is far easier to point the finger, to expose someone to the court of public opinion, and then to turn one’s face away, nose in the air, mouth clamped shut in an apparently dignified silence. On the surface this seems like the elegant response – live and let live – but in fact it is not: to designate someone as not worthy of attention is to very publicly inflict shame. We might as well clamp them into a scold’s bridle and lead them down the street. And, as we do so, let’s hope it’s not a windy day – or if it is, let’s be sure that we have firmly tied down the lids of our recycling bins.   

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