Spiritual pain is enmeshed in human history. In the dying, it is part of their total pain: physical, mental, social and spiritual. Spirit is beyond definition, but is a phenomenon that can be studied like any other. Spirit refers to inspiration, soul to depth, though both terms are often used synonymously. Spiritual characteristics include: life force; the essence of a person (an unchanging centre, meaning, depth, the numinous, relationship and intimacy); immortality (memories, spiritual experiences and near-death experiences); and levels of consciousness. Spirituality is common to all people of any or no belief. Religious distress is about problems relating to a pre-existing set of beliefs. Spiritual pain is recognized in physical and psychological symptoms, disorders of relationships, and specifically spiritual symptoms (meaninglessness, anguish, duality and darkness). Intuition and 'bifocal vision' (seeing symptoms both literally and symbolically) are needed in discerning spiritual distress. Effective help involves being present (attending, relating). Facilitating this process includes listening, reminiscence, imagery, finding meaning, letting go, touch, symbolism, rituals, prayer and contemplation.