The role of pastoral caregivers is to create an environment of concern and care to enable those receiving the care to build their religious life. The pastoral caregiver has to put the needs of his/her people in mind. He/she has to use the scripture and exhortation to encourage those in crisis to have the strength to meet the emotional and interpersonal task. Pastoral caregivers should take the time to sit and listen to the care recipient’s special needs and help them fulfill them. The most important is to communicate, and let them know that they are to be listened and helped. Care that is distant is inadequate and harmful. This kind of care contributes to the
feelings of unworthiness, and not accepted by anyone. Pastoral caregivers should bring hope and build ministries focused on pastoral care. As will be seen in Chapter four, the dying, the family of the dying, and the critically ill patient’s need warmth, relationship, and concerned interest in order to experience the goodness of the the end of their living. Pastoral care is involvement of care that helps the person emotionally to control himself or herself.
Dying people needs dignity and wholeness, in live, they need to feel accepted and forgiven, and to feel that they belong and are loved, need to be expressed in spiritual terms. Most people in need of pastoral care however, at some time in their lives have had relationship with a church or a religious body. They may have drifted from participation. At the time that they need pastoral care, they may feel that separation with great anger, great sorrow or both (dying patients and their loved ones deal with anger differently). These patients may want to talk about their fractured religious life, their beliefs and doubts, their anger and sorrow, their desire to relate to god in a meaningful way. In this way they may ask for a minister, to seek the possibility of reconciliation with god within the religious community before leaving this world. For some however, might be fear concerning the next life and their acceptability. The author’s experience with the dying people, while he worked as a hospital chaplain, for most dying people is seeking a sense of belonging and acceptance in this life before it ends. Pastoral care at end of life becomes an important tool to reach out not only to the dying but also to the family and the community as a whole.
A young woman in her early 20s was dying in one of the units the author covered While i was working as a hospital chaplain. Lupus attacked her, which was at final stage. Her mother informed the author that the patient was not converted, and she wanted the author go in and convert her. When the author assured the mother that he would visit with the patient, she was very relaxed that he accepted. This became ministerial starting point with the mother and her daughter (patient), who died a few weeks after. As a chaplain the author used the mother to reach out to the patient, and before she died, the mother was at peace that she will be in heaven. The author’s pastoral care was to both patient and the mother, which became a powerful tool to reach out to the family. In any caring relationship with one in need of pastoral care, the principal responsibility is to be open to individuals in order that they may reveal where they are in terms of dealing with their present attitude of the problem.
Being with persons who are dying and with their families does indeed remind us of the precious gift of life. Suddenly when we are confronted by the deadline of life, a time when life stops in death, there maybe a new perceptive that breaks into life. Time takes on new meaning when suddenly it is a lifetime that is limited. Values are re-examined. Losses that will hurt the most are the pre-occupation of the mind[1]. These are the questions that are raised in us by those who are dying and those anticipating their loss. The pastoral care of the pastor and the congregation needs to begin by allowing the Anxieties of this subject of death, dying and bereavement. Today many families don’t have close, frequent or continuous involvement with the one dying. Many families don’t like talking about death. Many have been isolated from the subject of death for too long.
Death has been an event ritualized in the funeral as a major event but what goes on before and what comes after the event. Kelly further says that “death should be brought into life if we are to receive help for living out life’s ending” (1992, 38). Pastors should care for the non medical needs of the dying; this includes the needs of The family too. This must be about four different levels all at once - emotional, ethical, religious, and spiritual. Many pastors - spiritual caregivers dash simply to identity the spiritual with the religious. Therefore, the pastor must be able to meet the needs of the dying and their family. This will mean talking about death, and the way forward. Stewart points out that, “the tradition of not talking about death with both the dying and their families needs to be consciously reversed, pointing out that also for pastors and pastoral visitors, it’s reversing the trend of talking, even of proclaiming the Gospel” (1984, 57). Since pastors are counselors, they should listen to the dying and their families in order for them to give help. Being present with the person in a manner that says we are ready to listen and help is part of what pastors and other caregivers should be doing. Thus pastors should avoid pre-occupying themselves with the business of praying for recovery, when the dying patient wants to talk about dying. If the patient is going to die and a pastor is telling him/her that we are anxious to listen, who will hear him? Will his/her faith help if spiritual caregivers can’t be with him/her in the faith? When the pastor is giving care to the dying and their family, he is not in submission to
them.
Care is not personal domination. When pastors encounter an individual who has experienced loss or is facing death, he/she can clearly say that “the grace of God abides in the individual” sometimes there is a tendency of thinking that it is good that it is not “I” who is in this mess. Care is not over permissiveness. Pastors may be so fearful of stepping on another’s toes that they veer to the other side and act like “bump on a log” (stewart 1984, 85). Then do they nothing at all. When pastors bring pastoral care and counsel to these kinds of people that are dealing with life crisis that lead to death, they bring values and norms into the context of listening, and they respond to the patient or the family out of context. Pastoral counsel is that he or she does not want life in a social limbo. Therefore, pastors are religious counselors who acknowledge certain values and recognize that the vales will influence the way we help other people. In a religious sense, care means nurture and cherishing - see john 3:16b-17 “for God sent the son into the world, not to condemn the world, but that the world might be saved through him.” As God himself did with us, humans not only love one another, but also keep that other in a special place in affections. To nourish is to feed and nurture another, whether as a mother with a child or a teacher with a student. The pastor counselor nourishes those that he or she is counseling. To nourish is thus to express tenderness toward another, as when holding the face of a beloved. It means that the counselor has to head saying that “i am so interested in you that i want to promote your best interests.”
Stewart points out that, “care means empathy exist a long side another person in a dialogical relationship. This means to be with the other, to stand with the other at the time of crisis or trouble. Pastoral counselors have recognized establishment of the empathetic bond as necessary before one is able to move within a helping relationship (1984, 91). “spirituality and care at the end of life may conjure up a variety of images, some not at the flattering, and further definition is required” (baird 2003, 155). The role of the pastor becomes that of a leader who leads people to meaningful grieving and sharing among themselves. The pastor, so to speak, is a professional who should be concerned in providing better care for the dying person (or already dead person) and their families. The pastor becomes a person involved in letting the people talk about death, dying, and bereavement. It is here that the pastor should encourage those mourning to share stories in ways that they all will know that they are human beings, have experienced life, death, and bereavement. The pastor does not approach the subject as clinician but a pastoral caregiver, who participates in the life process and helping people to express themselves in their philosophy of their feelings of being partners with each other in the journey of life and death. Stewart asserts that, “the Philosophy at this time is not a creed, but exploration and growing in bonds which will bring the grieving individual to believe in honoring the creed and philosophy of every man” (1984, 162). Those gathered to help with grieving should learn from the pastor that the dignity of person hood parents, families, workers, and will nurture the spirit of every person.
The work of giving spiritual care occurs originally and essentially within the spiritual caregiver who is referred to as a pastor or those taking pastoral responsibility. These Caregivers need to keep in mind the questions posed by the person they are counseling or And giving pastoral care. Baird points out that, “the caregivers’ central concern about the counselee might be how to lead the individual feel to supported,” adding that, “for the individual the essence of charity is found in human company” (2001, 168 -169). This is the duty of the pastor to his counselees. The pastor and the church’s role is to take leadership in supporting and developing options of care and counsel of the dying persons and their families.
Story telling as healing
Story telling is the expression of the warmth, better relationships, and connections, both intimate and more remote, in the world and beyond. The substances of these connections are food of the soul. A story told is like a weaving with some of the threads drawn from memories of our experiences and others created and colored by imagination. The memories that make up stories are like the patches of a patchwork. The stories may continue to be told when a loved one dies. Without these memories and story told, we are dead to the soul and disconnected to the real word. For an individual to be connected, murphy asserts that “all stories need to be told, not simply the ones that are deemed to be light and happy” (1999, 26). Stories therefore, can be used to address the normal crises people face daily such as illness and death transitions. Scholars have suggested that stories can also be developed during selective phases of counseling to facilitate the counseling process.
stories, function in the caring setting is to bring healing and wholeness to the lives of persons and families. The African American community is known to use stories to heal Their wounds as a community. For the African American, the stories suggest ways to Motivate people to action, help them recognize new resources, enable them to channel Behavior in constructive ways, sustain them in crises, bring healing and reconciliation in Relationships, heal the scars of memories, and provide guidance when direction is needed. However, Ashby laments that, “at the turn of the century, African Americans are living as Disconnected[2] as they have ever been since slavery” (2003, 103). Story telling is like soul theology, which makes up the faith story that under girds the stories used in any community in caring for others. How that faith story has brought healing and wholeness through storytelling to the lives of people is the subject matter here. The primary element in story telling that gives life meaning as the story is told is what
is hidden in the story, something that envisions hope in the midst of suffering and oppression. the “enigma”[3] element in story telling takes suffering and oppression very seriously without minimizing their influence in life. Relief, hope, and freedom are true realization. As seen in chapter one about the pastor as a counselor and his role. Pastors who understand the working drama of story telling can encourage those hurting to tell their story. Such pastors seek to help parishioners develop story language and story discernment in order to visualize the unfolding drama in their lives. This means that story telling and listening become central to the caring process. Life or at least conscious vital living depends on the telling of stories ( 1999, 24).
Faith stories have therapeutic functions as healing, sustaining, guiding, and reconciling. These can be viewed as a way of pastoral care and are very much part of the narrative approach. Stories thus do impact on people’s lives in characteristic ways: they can heal or bind wounds caused by disease or infection, make peace for those at the end of life, and they can provide guidance to those who make decisions, as well as facilitate reconciliation for those who have been alienated from others. A story will change only when told to a witness who gives it completes attention. The retelling of the story shortens the painful effect, lessens in intensity, and what remains is an imprint in the Imagination, or soul, that then becomes part of the life painting. Buckman in his book,"Don’t know what to say", points out that, “some people don’t talk because their friends never really listen, and in times of crisis, a good listener will create an atmosphere that’s Radically different” (1988, 15). Therefore, story listening is as important as story telling
for it involves empathy[4] hearing the story of the person involved in life struggles. Being
able to communicate that the person in need is cared for and understood by attending to the story of the person as he or she tells it.
Storytelling is a sacred event that speaks of spirit and soul; and while sacred events are beyond time and space, there are some settings that inspire storytelling. If stories are to be told, it is important that the storyteller be given the time and space to tell the tale in full. A model for listening and telling stories comes from the native African culture where the author of this paper originates. At a special gathering of the people, those assembled sit in a circle and elders share their stories. They tell the story in turns and the movement goes clockwise. In a more private setting as in family, the elder (father) shares his stories with the sons while the mother tells stories to daughters. These stories include what happens if either parent is dead, who in the family inherits what, among other stories. When stories are not told people break by harboring suffering and problems that they could have eased by sharing with others. Or still one departs the world by death and leaves his loved ones with guilt and in darkness that the departed did not communicate anything. Murphy adds that, “there are families that no one has ever told a complete story, and there has been no practice in listening and witnessing without passing judgment” asserting that, “the most import role in the telling stories in families is the role
Played by the witness”(1999, 34). Human beings need witnesses especially at the time of vulnerability, such as at death, and at many times in between. Family meeting is a sacred time for the family to gather when one of their members is dying so that each can tell his or her story. If storytelling and listening to those who are terminally ill or dying is so difficult as some would argue, why try it? Why is it worthy doing? What can one achieve by talking or listening to someone who is seriously ill? Buckman argues that, “in giving support and easing distress, both the donor and the recipient are rewarded. These actions have worth and the value because they strengthen one’s relationship with the other. They make new bonds between them. In many circumstances people talk to get what is bothering them out of their chests, and to be heard. There is relief to be found talking, which means that there is relief one can provide for the sick person by listening and by simply allowing them talk. Bottled up feelings may cause damage because, in many cases, people are ashamed of their feelings, particularly of their fears and anxieties. One of the greatest services one can do to a friend is to hear fears and stay close to the person in listening. By not backing away or withdrawing, one shows that one accepts and understands them” (1999, 13). This will help the patient/dying to get his or her sense of perspective back.
The crisis of loss through death creates feelings of interruption of important communication lifestyle, and sustained relationships that have been taken for granted. It is also a discontinuity in the existing narrative of life, because the experience of loss is the disruption of a narrative. The death of a loved one cuts short the life story one has been living. For many, death means fashioning a completely new story for one’s life. Patterns of interaction are disrupted by the death of a loved one, resulting in restlessness, inability to remain in one place, an aimless moving, continued search for something to do. As dower puts it, “ there is also lack of any capacity to initiate and maintain patterns of activity, for the grief sufferer discovers that many of the activities that were done with the deceased have lost there meaning” (2001, 37). When death strikes, it is wise for the living family members and friends to form a group, or a fellowship to help one another. Dower further observes that, “the group together with its leaders, (pastor, counselor, etc) will help to strengthen the support group for one another. All of the members will became facilitators of grief process among members of the family and the entire group. In the preparation service, the group will stimulate each other and express their feelings concerning the beloved family members already bereaved. The support group becomes a therapy system. The therapist job in this case is to help the grieved family finds their unique path through the grief” (dower 2001,37). Dower cautions that having a therapist doesn’t always mean doing it their way.
It means having one-on- one support as you do it your way. There is what used to be called the parent network, which provides strong emotional supports as well as help one another care for the family. This type of group understands the manifold problems, and receives input from other persons joining the group. The beauty of the group is that one does not have to become a client. The individual can utilize the serves in a way that serves his or her needs. After death many
families live in isolation feeling very lonely in their situation and not having anyone who truly listens and understands them. According to donnelly, “the need to reach out and not feel so isolated is extremely important” (1980, 190). It is in such circumstances of coming together that the group will discover that many of them may at some time have had bereavement in their lives too. This means that they automatically know what to do in terms of the crisis of loss. The idea would be to exploit many of those natural leanings and involve these persons in discussion groups surrounding such crisis. According to Kubler- Ross, “Members who have stayed in their local support groups years after the death of their loved one, listen sympathetically to the newly bereaved, vividly remembering how important it was to be patient, and offer them a phone number to use when the loneliness becomes unbearable”(1983, 235).
Today many new approaches have been initiated to help young grief-stricken families. (sources of helping in airing and resolving experiences)- share (kubler-ross 1980, 166). The group is called share and this is the purpose of the group. For the members who are bereaved to be able to share their feelings, the basic need of share is the comfort and mutual reassurance that those who have had an experience of loss in their families can offer each other. In this way the family has the opportunity to share their feelings and to receive understanding and support. Through the local share meetings, members can share their experiences, thoughts, and feelings. Those affected learn that the intensity and longevity of their felling are normal. Members gain a sense of wholeness when they realize their problems are not unique to them alone, but rather problems with which most bereaved families are struggling. In share healing is slow and promoted as those affected by the lose of a loved one gain insight and understanding, have an
opportunity to ventilate their feelings in an accepting atmosphere, and reach out to the other members of share who have experienced the same loss. Kubler points out that “what is important in this group is an acceptance of each individual”(kubler-Ross 1980,166). Another way to help the bereaved individuals in support systems is to help them dive right in the group and let them ask for what they need in the group setting. Is the Individual confused about the grief? Dower suggests that, “ongoing discussion with other people might help those grieving”(2001, 190). However, it is important to observe that at the time one is grieving over the loss of a loved one, the primary feelings are those of detachment. Most individuals at this time are lost from the real world, and to them nothing that is alive and part of this world looks real.
During grieving period, many affected people have the inability to concentrate on anything for any length of time. They hardly become absorbed in the conversation that the group is sharing. Nancy whose husband had died, observed that, “conversations with friends could hold my attention for only a short while.”(schiff 1977, 24). This may take a period of time before the
individual can begin to function with reasonable normalcy. It is during this time when individuals are withdrawing themselves from the real world, that the support group become important. Even though the pain of loss is great, the group helps begin the first step out of the cocoons of mourning and back to the land of the living. The group helps in taking some positive teps towards reality. Although each extreme bereavement response is tragic, individuals act differently. Some may remove themselves from the prime source of easing their hurt- the company of their fellowman thus group support becomes infective. Methods people use in coping or trying to cope with grief are as varied as people themselves. The support system may not be right for every individual experiencing loss. Some things however, can apply to most adults. For young people, and most adolescents, fear public displays of emotions. Their greatest fear is being perceived as different from their peers. But it has been suggested that the most helpful thing to do is to find them an opportunity to share their feelings with others. Experiencing thoughts and feelings to receptive peers and adults provides a sense of release - an opportunity to identify misconceptions and rectify them and help build and strengthen one’s support network (siegel 2002, 10).
It is important to note that many who lose a loved one, most times have the feelings that those who come in the name of support are patronizing them. The grieving persons may have questions whether those trying to help them really understand what they are feeling. It is true that some do not have an idea of what the grieving family is feeling. Many would make statements like, “god knew what he was doing.” At this time of grieving most people do not want to hear about god. Most people withdraw themselves to an extent that they may not want to talk about their religious experiences. Donnelly points out that, “doris who was grieving over the loss of her child avoided talking to people to an extent that she often would not answer the phone” (1992, 113).
The role of the support group is not to give answers as to why death has come to ap articular family but to support the grieving family as they mourn and grieve. The support group is in place to encourage the individuals mourning to open up and talk. This helps them relieve their emotions. The group becomes like a therapy group whereby individuals in the group can make statements to lead the grieving family to speak out. “Maybe there is something you want to say.” (donnelly1992, 113). Making an open question or statement this will help more than anything else because this will help the person mourning to pour oneself out. However, other times the affected families would want to stay away from people. They may feel that what they need most is to stay together, to encourage each other themselves. Some bereaved family members feel it sacrilegious to talk about their loved one death, while others wants to talk about it constantly. Under this kind of circumstance the support group may not know which way to more on. Bringing up the subject would upset The bereaved family. It is the duty of each support group to weigh the situation and act according to the needs of each situation. Some would want to go to parties, movies and other gatherings to keep themselves busy in the mind. Others would fear to bring the subject of death for they are afraid that family members would burst into tears. Many counselors agree that tears during grieving time are healthy. Kubler - ross asserts that, "most troubled are those whose support system is not available at a time of crisis” (1983, 41). Some grieving families would want to receive help from the works of their spiritual leaders, like pastors, imams, rabbis who take them to higher understanding of life and death without minimizing the nature of their agony and death loss.
There is no doubt that many people obtain worthwhile support from their religious beliefs throughout their lives. Christians, muslims, jews, buddhists, and others hold views of life and death that help them accept their own deaths with serenity and see the positive side to the loss of someone else. The role of the support group is simply as a catalyst, to share a moment, a tear perhaps, hope, and most of all to lend a listening ear. According to montgomery “those who belong to a group that is involved in sharing in the time of death crisis, together - a family, a work team, a local community - it can be helpful if someone initiates the chance for the members of the group to share the feelings”(1989, 120-121). Support group members are encouraged to talk about their feelings and reaction about the death crisis. One of the great fears among critically ill and dying patients is that pain uncontrolled may escalate beyond wildest imaginations, that one may cry out, and that loved one may not be able to recognize their pain. When people are in pain, there is no denying their discomfort. No matter what you hear, no matter what you believe, the person’s pain is real. A person’s pain and response to that pain is personal. The pain exists within the person’s own physical body and his or her own response is unique. All pain has a psychological component, no matter what is causing it. Pain is no stranger to humans and they have relieved it in a number of ways. Because of some life hreateningIllness, some people are probably stuck with pain but some people can exert a lot of control over how much, how intense and how it interferes with life. Some patients suffer in silence, determined to be staunch and brave; they may even try to conceal their pain. Some patients are embarrassed to complain (weelnosen 1996, 101). Pain relief is now moving in a newer direction, from a humane concern for the suffering of the dying to recognition that pain is actually unhealthy. Pain is stressful; it can inhibit improvement or recovery, limited activity, decrease appetite, and interrupt sleep, slow fighting the disease, raise blood pressure, and increase anxiety over future pain, thereby increasing pain, and depression that alters the immune system. Today pain is recognized as an ailment in itself with negative consequences. The author may want to look at pain treatment and as way to heal pain. The american pain society (aps)[5]contends that the medical community must become aggressive in treating the pain associated with fatal illness particularly since severe pain can couse patients long for death. The aps maintains moreover, laws must protect health professionals whose use of painkilling drugs unintentionally hastens a patient’s death (williams 2001, 69). Since it is the opinion of many that terminal illness is often accompanied by severe pain and other symptoms at the end of life, painkillers are advocated for administration even when death seems preferable.
According to marcia Levetown, pain and palliative care education consultant, houston texas, “no physician May be subject to disciplinary action by the board for prescribing or administering
controlled substance in the course of treatment of a person for intractable pain.” (seminar on whole person assessment, pain at the end of life, 2003). Pain and other symptoms at the end of life can usually be relieved if clinicians have the training and resources to focus on this goal, but current treatment often falls short of this goal. Patients can be reassured that in the occasional case where the best treatment cannot allow the patient to be alert and relatively comfortable, intravenous sedative can relieve all symptoms in the last days of life. Despite the best intensions of clinicians, pain and symptoms control is often suboptimal because the entire healthcare system has been designed around cure of diseases rather than palliative care. The world health organization (who) defines palliative care as: the active total care of patients whose disease is not responsive to curative treatment. Control of pain and other symptoms, such as psychological, social, and spiritual problems are paramount. The goal of palliative care is the achievement of
the best quality of life for the patient and family.
[1] See chapter two for more details of dealing with fears and concerns.
[2] Disconnection refers to the inability to come together for mutual support
[3] The hidden meaning in a story
[4] Empathy means attending to the person with our presence. Verbal responses to ommunicate that we have understood and are seeking to understand the person’s story as it unfolds.
[5] APS is the U.S. chapter of the international Association for the study of Pain, a group of clinical researchers investing the treatment of pain. Its 3,000 members including many of the leading basic and clinical researchers in the epidemiology, mechanisms, and treatment of acute and chronic pain caused by the range of human diseases.
feelings of unworthiness, and not accepted by anyone. Pastoral caregivers should bring hope and build ministries focused on pastoral care. As will be seen in Chapter four, the dying, the family of the dying, and the critically ill patient’s need warmth, relationship, and concerned interest in order to experience the goodness of the the end of their living. Pastoral care is involvement of care that helps the person emotionally to control himself or herself.
Dying people needs dignity and wholeness, in live, they need to feel accepted and forgiven, and to feel that they belong and are loved, need to be expressed in spiritual terms. Most people in need of pastoral care however, at some time in their lives have had relationship with a church or a religious body. They may have drifted from participation. At the time that they need pastoral care, they may feel that separation with great anger, great sorrow or both (dying patients and their loved ones deal with anger differently). These patients may want to talk about their fractured religious life, their beliefs and doubts, their anger and sorrow, their desire to relate to god in a meaningful way. In this way they may ask for a minister, to seek the possibility of reconciliation with god within the religious community before leaving this world. For some however, might be fear concerning the next life and their acceptability. The author’s experience with the dying people, while he worked as a hospital chaplain, for most dying people is seeking a sense of belonging and acceptance in this life before it ends. Pastoral care at end of life becomes an important tool to reach out not only to the dying but also to the family and the community as a whole.
A young woman in her early 20s was dying in one of the units the author covered While i was working as a hospital chaplain. Lupus attacked her, which was at final stage. Her mother informed the author that the patient was not converted, and she wanted the author go in and convert her. When the author assured the mother that he would visit with the patient, she was very relaxed that he accepted. This became ministerial starting point with the mother and her daughter (patient), who died a few weeks after. As a chaplain the author used the mother to reach out to the patient, and before she died, the mother was at peace that she will be in heaven. The author’s pastoral care was to both patient and the mother, which became a powerful tool to reach out to the family. In any caring relationship with one in need of pastoral care, the principal responsibility is to be open to individuals in order that they may reveal where they are in terms of dealing with their present attitude of the problem.
Being with persons who are dying and with their families does indeed remind us of the precious gift of life. Suddenly when we are confronted by the deadline of life, a time when life stops in death, there maybe a new perceptive that breaks into life. Time takes on new meaning when suddenly it is a lifetime that is limited. Values are re-examined. Losses that will hurt the most are the pre-occupation of the mind[1]. These are the questions that are raised in us by those who are dying and those anticipating their loss. The pastoral care of the pastor and the congregation needs to begin by allowing the Anxieties of this subject of death, dying and bereavement. Today many families don’t have close, frequent or continuous involvement with the one dying. Many families don’t like talking about death. Many have been isolated from the subject of death for too long.
Death has been an event ritualized in the funeral as a major event but what goes on before and what comes after the event. Kelly further says that “death should be brought into life if we are to receive help for living out life’s ending” (1992, 38). Pastors should care for the non medical needs of the dying; this includes the needs of The family too. This must be about four different levels all at once - emotional, ethical, religious, and spiritual. Many pastors - spiritual caregivers dash simply to identity the spiritual with the religious. Therefore, the pastor must be able to meet the needs of the dying and their family. This will mean talking about death, and the way forward. Stewart points out that, “the tradition of not talking about death with both the dying and their families needs to be consciously reversed, pointing out that also for pastors and pastoral visitors, it’s reversing the trend of talking, even of proclaiming the Gospel” (1984, 57). Since pastors are counselors, they should listen to the dying and their families in order for them to give help. Being present with the person in a manner that says we are ready to listen and help is part of what pastors and other caregivers should be doing. Thus pastors should avoid pre-occupying themselves with the business of praying for recovery, when the dying patient wants to talk about dying. If the patient is going to die and a pastor is telling him/her that we are anxious to listen, who will hear him? Will his/her faith help if spiritual caregivers can’t be with him/her in the faith? When the pastor is giving care to the dying and their family, he is not in submission to
them.
Care is not personal domination. When pastors encounter an individual who has experienced loss or is facing death, he/she can clearly say that “the grace of God abides in the individual” sometimes there is a tendency of thinking that it is good that it is not “I” who is in this mess. Care is not over permissiveness. Pastors may be so fearful of stepping on another’s toes that they veer to the other side and act like “bump on a log” (stewart 1984, 85). Then do they nothing at all. When pastors bring pastoral care and counsel to these kinds of people that are dealing with life crisis that lead to death, they bring values and norms into the context of listening, and they respond to the patient or the family out of context. Pastoral counsel is that he or she does not want life in a social limbo. Therefore, pastors are religious counselors who acknowledge certain values and recognize that the vales will influence the way we help other people. In a religious sense, care means nurture and cherishing - see john 3:16b-17 “for God sent the son into the world, not to condemn the world, but that the world might be saved through him.” As God himself did with us, humans not only love one another, but also keep that other in a special place in affections. To nourish is to feed and nurture another, whether as a mother with a child or a teacher with a student. The pastor counselor nourishes those that he or she is counseling. To nourish is thus to express tenderness toward another, as when holding the face of a beloved. It means that the counselor has to head saying that “i am so interested in you that i want to promote your best interests.”
Stewart points out that, “care means empathy exist a long side another person in a dialogical relationship. This means to be with the other, to stand with the other at the time of crisis or trouble. Pastoral counselors have recognized establishment of the empathetic bond as necessary before one is able to move within a helping relationship (1984, 91). “spirituality and care at the end of life may conjure up a variety of images, some not at the flattering, and further definition is required” (baird 2003, 155). The role of the pastor becomes that of a leader who leads people to meaningful grieving and sharing among themselves. The pastor, so to speak, is a professional who should be concerned in providing better care for the dying person (or already dead person) and their families. The pastor becomes a person involved in letting the people talk about death, dying, and bereavement. It is here that the pastor should encourage those mourning to share stories in ways that they all will know that they are human beings, have experienced life, death, and bereavement. The pastor does not approach the subject as clinician but a pastoral caregiver, who participates in the life process and helping people to express themselves in their philosophy of their feelings of being partners with each other in the journey of life and death. Stewart asserts that, “the Philosophy at this time is not a creed, but exploration and growing in bonds which will bring the grieving individual to believe in honoring the creed and philosophy of every man” (1984, 162). Those gathered to help with grieving should learn from the pastor that the dignity of person hood parents, families, workers, and will nurture the spirit of every person.
The work of giving spiritual care occurs originally and essentially within the spiritual caregiver who is referred to as a pastor or those taking pastoral responsibility. These Caregivers need to keep in mind the questions posed by the person they are counseling or And giving pastoral care. Baird points out that, “the caregivers’ central concern about the counselee might be how to lead the individual feel to supported,” adding that, “for the individual the essence of charity is found in human company” (2001, 168 -169). This is the duty of the pastor to his counselees. The pastor and the church’s role is to take leadership in supporting and developing options of care and counsel of the dying persons and their families.
Story telling as healing
Story telling is the expression of the warmth, better relationships, and connections, both intimate and more remote, in the world and beyond. The substances of these connections are food of the soul. A story told is like a weaving with some of the threads drawn from memories of our experiences and others created and colored by imagination. The memories that make up stories are like the patches of a patchwork. The stories may continue to be told when a loved one dies. Without these memories and story told, we are dead to the soul and disconnected to the real word. For an individual to be connected, murphy asserts that “all stories need to be told, not simply the ones that are deemed to be light and happy” (1999, 26). Stories therefore, can be used to address the normal crises people face daily such as illness and death transitions. Scholars have suggested that stories can also be developed during selective phases of counseling to facilitate the counseling process.
stories, function in the caring setting is to bring healing and wholeness to the lives of persons and families. The African American community is known to use stories to heal Their wounds as a community. For the African American, the stories suggest ways to Motivate people to action, help them recognize new resources, enable them to channel Behavior in constructive ways, sustain them in crises, bring healing and reconciliation in Relationships, heal the scars of memories, and provide guidance when direction is needed. However, Ashby laments that, “at the turn of the century, African Americans are living as Disconnected[2] as they have ever been since slavery” (2003, 103). Story telling is like soul theology, which makes up the faith story that under girds the stories used in any community in caring for others. How that faith story has brought healing and wholeness through storytelling to the lives of people is the subject matter here. The primary element in story telling that gives life meaning as the story is told is what
is hidden in the story, something that envisions hope in the midst of suffering and oppression. the “enigma”[3] element in story telling takes suffering and oppression very seriously without minimizing their influence in life. Relief, hope, and freedom are true realization. As seen in chapter one about the pastor as a counselor and his role. Pastors who understand the working drama of story telling can encourage those hurting to tell their story. Such pastors seek to help parishioners develop story language and story discernment in order to visualize the unfolding drama in their lives. This means that story telling and listening become central to the caring process. Life or at least conscious vital living depends on the telling of stories ( 1999, 24).
Faith stories have therapeutic functions as healing, sustaining, guiding, and reconciling. These can be viewed as a way of pastoral care and are very much part of the narrative approach. Stories thus do impact on people’s lives in characteristic ways: they can heal or bind wounds caused by disease or infection, make peace for those at the end of life, and they can provide guidance to those who make decisions, as well as facilitate reconciliation for those who have been alienated from others. A story will change only when told to a witness who gives it completes attention. The retelling of the story shortens the painful effect, lessens in intensity, and what remains is an imprint in the Imagination, or soul, that then becomes part of the life painting. Buckman in his book,"Don’t know what to say", points out that, “some people don’t talk because their friends never really listen, and in times of crisis, a good listener will create an atmosphere that’s Radically different” (1988, 15). Therefore, story listening is as important as story telling
for it involves empathy[4] hearing the story of the person involved in life struggles. Being
able to communicate that the person in need is cared for and understood by attending to the story of the person as he or she tells it.
Storytelling is a sacred event that speaks of spirit and soul; and while sacred events are beyond time and space, there are some settings that inspire storytelling. If stories are to be told, it is important that the storyteller be given the time and space to tell the tale in full. A model for listening and telling stories comes from the native African culture where the author of this paper originates. At a special gathering of the people, those assembled sit in a circle and elders share their stories. They tell the story in turns and the movement goes clockwise. In a more private setting as in family, the elder (father) shares his stories with the sons while the mother tells stories to daughters. These stories include what happens if either parent is dead, who in the family inherits what, among other stories. When stories are not told people break by harboring suffering and problems that they could have eased by sharing with others. Or still one departs the world by death and leaves his loved ones with guilt and in darkness that the departed did not communicate anything. Murphy adds that, “there are families that no one has ever told a complete story, and there has been no practice in listening and witnessing without passing judgment” asserting that, “the most import role in the telling stories in families is the role
Played by the witness”(1999, 34). Human beings need witnesses especially at the time of vulnerability, such as at death, and at many times in between. Family meeting is a sacred time for the family to gather when one of their members is dying so that each can tell his or her story. If storytelling and listening to those who are terminally ill or dying is so difficult as some would argue, why try it? Why is it worthy doing? What can one achieve by talking or listening to someone who is seriously ill? Buckman argues that, “in giving support and easing distress, both the donor and the recipient are rewarded. These actions have worth and the value because they strengthen one’s relationship with the other. They make new bonds between them. In many circumstances people talk to get what is bothering them out of their chests, and to be heard. There is relief to be found talking, which means that there is relief one can provide for the sick person by listening and by simply allowing them talk. Bottled up feelings may cause damage because, in many cases, people are ashamed of their feelings, particularly of their fears and anxieties. One of the greatest services one can do to a friend is to hear fears and stay close to the person in listening. By not backing away or withdrawing, one shows that one accepts and understands them” (1999, 13). This will help the patient/dying to get his or her sense of perspective back.
The crisis of loss through death creates feelings of interruption of important communication lifestyle, and sustained relationships that have been taken for granted. It is also a discontinuity in the existing narrative of life, because the experience of loss is the disruption of a narrative. The death of a loved one cuts short the life story one has been living. For many, death means fashioning a completely new story for one’s life. Patterns of interaction are disrupted by the death of a loved one, resulting in restlessness, inability to remain in one place, an aimless moving, continued search for something to do. As dower puts it, “ there is also lack of any capacity to initiate and maintain patterns of activity, for the grief sufferer discovers that many of the activities that were done with the deceased have lost there meaning” (2001, 37). When death strikes, it is wise for the living family members and friends to form a group, or a fellowship to help one another. Dower further observes that, “the group together with its leaders, (pastor, counselor, etc) will help to strengthen the support group for one another. All of the members will became facilitators of grief process among members of the family and the entire group. In the preparation service, the group will stimulate each other and express their feelings concerning the beloved family members already bereaved. The support group becomes a therapy system. The therapist job in this case is to help the grieved family finds their unique path through the grief” (dower 2001,37). Dower cautions that having a therapist doesn’t always mean doing it their way.
It means having one-on- one support as you do it your way. There is what used to be called the parent network, which provides strong emotional supports as well as help one another care for the family. This type of group understands the manifold problems, and receives input from other persons joining the group. The beauty of the group is that one does not have to become a client. The individual can utilize the serves in a way that serves his or her needs. After death many
families live in isolation feeling very lonely in their situation and not having anyone who truly listens and understands them. According to donnelly, “the need to reach out and not feel so isolated is extremely important” (1980, 190). It is in such circumstances of coming together that the group will discover that many of them may at some time have had bereavement in their lives too. This means that they automatically know what to do in terms of the crisis of loss. The idea would be to exploit many of those natural leanings and involve these persons in discussion groups surrounding such crisis. According to Kubler- Ross, “Members who have stayed in their local support groups years after the death of their loved one, listen sympathetically to the newly bereaved, vividly remembering how important it was to be patient, and offer them a phone number to use when the loneliness becomes unbearable”(1983, 235).
Today many new approaches have been initiated to help young grief-stricken families. (sources of helping in airing and resolving experiences)- share (kubler-ross 1980, 166). The group is called share and this is the purpose of the group. For the members who are bereaved to be able to share their feelings, the basic need of share is the comfort and mutual reassurance that those who have had an experience of loss in their families can offer each other. In this way the family has the opportunity to share their feelings and to receive understanding and support. Through the local share meetings, members can share their experiences, thoughts, and feelings. Those affected learn that the intensity and longevity of their felling are normal. Members gain a sense of wholeness when they realize their problems are not unique to them alone, but rather problems with which most bereaved families are struggling. In share healing is slow and promoted as those affected by the lose of a loved one gain insight and understanding, have an
opportunity to ventilate their feelings in an accepting atmosphere, and reach out to the other members of share who have experienced the same loss. Kubler points out that “what is important in this group is an acceptance of each individual”(kubler-Ross 1980,166). Another way to help the bereaved individuals in support systems is to help them dive right in the group and let them ask for what they need in the group setting. Is the Individual confused about the grief? Dower suggests that, “ongoing discussion with other people might help those grieving”(2001, 190). However, it is important to observe that at the time one is grieving over the loss of a loved one, the primary feelings are those of detachment. Most individuals at this time are lost from the real world, and to them nothing that is alive and part of this world looks real.
During grieving period, many affected people have the inability to concentrate on anything for any length of time. They hardly become absorbed in the conversation that the group is sharing. Nancy whose husband had died, observed that, “conversations with friends could hold my attention for only a short while.”(schiff 1977, 24). This may take a period of time before the
individual can begin to function with reasonable normalcy. It is during this time when individuals are withdrawing themselves from the real world, that the support group become important. Even though the pain of loss is great, the group helps begin the first step out of the cocoons of mourning and back to the land of the living. The group helps in taking some positive teps towards reality. Although each extreme bereavement response is tragic, individuals act differently. Some may remove themselves from the prime source of easing their hurt- the company of their fellowman thus group support becomes infective. Methods people use in coping or trying to cope with grief are as varied as people themselves. The support system may not be right for every individual experiencing loss. Some things however, can apply to most adults. For young people, and most adolescents, fear public displays of emotions. Their greatest fear is being perceived as different from their peers. But it has been suggested that the most helpful thing to do is to find them an opportunity to share their feelings with others. Experiencing thoughts and feelings to receptive peers and adults provides a sense of release - an opportunity to identify misconceptions and rectify them and help build and strengthen one’s support network (siegel 2002, 10).
It is important to note that many who lose a loved one, most times have the feelings that those who come in the name of support are patronizing them. The grieving persons may have questions whether those trying to help them really understand what they are feeling. It is true that some do not have an idea of what the grieving family is feeling. Many would make statements like, “god knew what he was doing.” At this time of grieving most people do not want to hear about god. Most people withdraw themselves to an extent that they may not want to talk about their religious experiences. Donnelly points out that, “doris who was grieving over the loss of her child avoided talking to people to an extent that she often would not answer the phone” (1992, 113).
The role of the support group is not to give answers as to why death has come to ap articular family but to support the grieving family as they mourn and grieve. The support group is in place to encourage the individuals mourning to open up and talk. This helps them relieve their emotions. The group becomes like a therapy group whereby individuals in the group can make statements to lead the grieving family to speak out. “Maybe there is something you want to say.” (donnelly1992, 113). Making an open question or statement this will help more than anything else because this will help the person mourning to pour oneself out. However, other times the affected families would want to stay away from people. They may feel that what they need most is to stay together, to encourage each other themselves. Some bereaved family members feel it sacrilegious to talk about their loved one death, while others wants to talk about it constantly. Under this kind of circumstance the support group may not know which way to more on. Bringing up the subject would upset The bereaved family. It is the duty of each support group to weigh the situation and act according to the needs of each situation. Some would want to go to parties, movies and other gatherings to keep themselves busy in the mind. Others would fear to bring the subject of death for they are afraid that family members would burst into tears. Many counselors agree that tears during grieving time are healthy. Kubler - ross asserts that, "most troubled are those whose support system is not available at a time of crisis” (1983, 41). Some grieving families would want to receive help from the works of their spiritual leaders, like pastors, imams, rabbis who take them to higher understanding of life and death without minimizing the nature of their agony and death loss.
There is no doubt that many people obtain worthwhile support from their religious beliefs throughout their lives. Christians, muslims, jews, buddhists, and others hold views of life and death that help them accept their own deaths with serenity and see the positive side to the loss of someone else. The role of the support group is simply as a catalyst, to share a moment, a tear perhaps, hope, and most of all to lend a listening ear. According to montgomery “those who belong to a group that is involved in sharing in the time of death crisis, together - a family, a work team, a local community - it can be helpful if someone initiates the chance for the members of the group to share the feelings”(1989, 120-121). Support group members are encouraged to talk about their feelings and reaction about the death crisis. One of the great fears among critically ill and dying patients is that pain uncontrolled may escalate beyond wildest imaginations, that one may cry out, and that loved one may not be able to recognize their pain. When people are in pain, there is no denying their discomfort. No matter what you hear, no matter what you believe, the person’s pain is real. A person’s pain and response to that pain is personal. The pain exists within the person’s own physical body and his or her own response is unique. All pain has a psychological component, no matter what is causing it. Pain is no stranger to humans and they have relieved it in a number of ways. Because of some life hreateningIllness, some people are probably stuck with pain but some people can exert a lot of control over how much, how intense and how it interferes with life. Some patients suffer in silence, determined to be staunch and brave; they may even try to conceal their pain. Some patients are embarrassed to complain (weelnosen 1996, 101). Pain relief is now moving in a newer direction, from a humane concern for the suffering of the dying to recognition that pain is actually unhealthy. Pain is stressful; it can inhibit improvement or recovery, limited activity, decrease appetite, and interrupt sleep, slow fighting the disease, raise blood pressure, and increase anxiety over future pain, thereby increasing pain, and depression that alters the immune system. Today pain is recognized as an ailment in itself with negative consequences. The author may want to look at pain treatment and as way to heal pain. The american pain society (aps)[5]contends that the medical community must become aggressive in treating the pain associated with fatal illness particularly since severe pain can couse patients long for death. The aps maintains moreover, laws must protect health professionals whose use of painkilling drugs unintentionally hastens a patient’s death (williams 2001, 69). Since it is the opinion of many that terminal illness is often accompanied by severe pain and other symptoms at the end of life, painkillers are advocated for administration even when death seems preferable.
According to marcia Levetown, pain and palliative care education consultant, houston texas, “no physician May be subject to disciplinary action by the board for prescribing or administering
controlled substance in the course of treatment of a person for intractable pain.” (seminar on whole person assessment, pain at the end of life, 2003). Pain and other symptoms at the end of life can usually be relieved if clinicians have the training and resources to focus on this goal, but current treatment often falls short of this goal. Patients can be reassured that in the occasional case where the best treatment cannot allow the patient to be alert and relatively comfortable, intravenous sedative can relieve all symptoms in the last days of life. Despite the best intensions of clinicians, pain and symptoms control is often suboptimal because the entire healthcare system has been designed around cure of diseases rather than palliative care. The world health organization (who) defines palliative care as: the active total care of patients whose disease is not responsive to curative treatment. Control of pain and other symptoms, such as psychological, social, and spiritual problems are paramount. The goal of palliative care is the achievement of
the best quality of life for the patient and family.
[1] See chapter two for more details of dealing with fears and concerns.
[2] Disconnection refers to the inability to come together for mutual support
[3] The hidden meaning in a story
[4] Empathy means attending to the person with our presence. Verbal responses to ommunicate that we have understood and are seeking to understand the person’s story as it unfolds.
[5] APS is the U.S. chapter of the international Association for the study of Pain, a group of clinical researchers investing the treatment of pain. Its 3,000 members including many of the leading basic and clinical researchers in the epidemiology, mechanisms, and treatment of acute and chronic pain caused by the range of human diseases.
