The cyclone derives its powers from a calm center. So does a person.
—Dominic of Calaruega
My mother, in the end stages of dementia, received in-home hospice care for 5 months. I made it a point to be there every Friday morning when our hospice nurse, Moira, made her weekly visit. I would ask her questions about the dying process, what I should look for and how I could make Mom more comfortable. On one occasion I explained to Moira that Mom seemed very restless and the morphine was not doing much good. “What was your Mom’s favorite music when she was young?” Moira asked. I showed Moira a picture of my mother in her 1920’s flapper costume and recounted how much Mom loved the “Charleston,” her favorite dance. The following week, Moira brought a tape of Charleston dance selections that I played when Mom seemed agitated. It worked—in fact, every now and then Mom would faintly smile amidst her new calm.”
Moira was born and raised in Ireland where she attended nursing school before emigrating to the US. She and I compared notes about our work in nursing. She shared many funny stories about working in hospice nursing which I found surprising. She was so good at caring for the dying, a part of nursing from which I had purposely distanced. Moira helped me understand the dying process and taught me the signs of impending death. She accurately predicted the week of my Mother’s death. She attended my Mom’s funeral where I finally got the courage to ask, “How do you deal with the stress of death and dying every day? How does it not drive you to despair?” I will never forget her response, in that deep Irish accent, “Every mornin’ before I go to work, I sit in my favorite chair, close my eyes and say a prayer. Then, I open the daily newspaper to the ‘Irish Sports Page’ and read every listing.” “What is the Irish sports page?” I asked. “It’s the obituary pages, my dear. It helps to know that we will all be listed there someday”
Medical and nursing professionals cannot avoid stress, but its effects do not have to be totally negative. Moira’s approach to hospice work illustrates that even amid the suffering, maybe even because of it, one’s appreciation of life’s meaning and all it holds may become even deeper, enhancing our compassion.
How medical and nursing professionals perceive their work, the events that take place in the course of a day, and the people they encounter along the way make all the difference. Due to this, an increasing number of health care professionals are turning to aspects of the wisdom literature of the major religions as a resource to maintain a sense of psychological perspective. In addition, research and publications confirming the spirituality/religion (R/S) and health dynamic have grown exponentially in recent years. These publications explore the R/S—health connection of patients, significant others, and clinicians.
In a systematic review of 3000 articles published from 1872 to 2010, Koenig,1pp1–3 examined the relationship between R/S and health. This analysis yielded specific clinical implications with respect to spirituality and care:
• Medical decisions made by physicians are often influenced by their own R/S beliefs particularly with respect to the use of pain medications, abortion, vaccinations, and contraception, but physician beliefs are not discussed with patients.
• The standards set by hospital accrediting bodies and government organizations such as the Center for Medicare Services require that medical and nursing professionals respect patients’ values and beliefs including R/S.
Koenig concludes that the combination of R/S and health has moved into the mainstream of health care. It is therefore necessary for medical and nursing professionals to have knowledge about the interface between R/S and health to enhance not only patient care but self-care as well.
Pargament, a respected researcher in this area, points out that “every religion offers a set of cognitive reframing mechanisms to help individuals conserve a sense of meaning in life in the face of what may seem to be senseless, unbearable or unjust.”2 According to Hood et al.3 religion also helps people regain a sense of control that helps them cope and adjust when they are faced with difficult situations. Herbert Benson,4 a cardiologist, studied the practices of world religious and secular groups. He found that nearly every human civilization employed practices, often religiously oriented, to quiet the mind and relax the body. He studied the effects of these practices on physiological parameters. He coined the term “relaxation response” to describe the physiological changes he observed, such as decreases in respiratory rate, heart rate, and metabolism during states of relaxation. Benson’s research is now focusing on the long-term results of practicing meditative/relaxation techniques. The mind–body effects of these practices include the activation of genes that control metabolism, stress, and the aging of the body and the quieting of genes that control the body’s immune system.5
Despite the mounting evidence, there remains a caution or, at the very least, a hesitancy about discussing where this fits in the life of medical and nursing professionals. This is understandable if we speak of religion with its canons; this is a very private area in everyone’s life. Johnston-Taylor6 asserts that in the last few decades, concurrent with societal trends, nurses have embraced the concept of spirituality while avoiding discussions of religion, even though spirituality can be considered the personal aspect of religious experience. Johnston-Taylor’s book, Fast Facts About Religion for Nurses: Implications for Patient Care,6 lists the basic tenets of major religions and the clinical implications of such beliefs so that the nurse can interact more effectively with patients, always respecting the patient’s beliefs.
Beyond religion, with all that it offers some people, there is the broad sense of spirituality or faith that is an outgrowth of one’s beliefs about life. This can have an impact not only on how we process potentially stressful events but also on how we interact with patients. For our purposes here, we mean “faith” in the broadest sense of the term.
The Sanskrit word for faith is visvas, which literally translated means “to have trust, to breathe freely, to be without fear.” Being able to offer yourself, your colleagues, and your patients’ encounters marked by such psychological space can make all the difference. It is irrelevant whether we say that the approach is based on our faith, attitude, outlook, or the more inclusive term inner life.
The inner life or interior life is what spiritual figures point to as a place where ego strength, simplicity, freedom, and truth flourish. It is the place in which deeply felt needs are experienced and addressed; these include
“The interior life” includes those psychological and spiritual factors that provide us with inner strength, a sound attitude, and a sense of honesty or transparency. Different traditions encourage various approaches to strengthen or deepen the inner life.
Our “interior,” “inner,” or “spiritual” life must take into account the needs and tendencies of the whole person. In addition, each of us as individuals is unique and therefore must respond in accord with his or her own uniqueness. Yet, even though this be the case, in the broad sense, there are several attitudes/behaviors as well as individual and communal actions that are capable of nurturing the “spiritual” dimension of life.8pp11–12
Included among them, the ones that do have great psychological value and are therefore of interest to us here—whether we are persons of a specific faith or not—are silence and solitude, friendship and community, humor and laughter and listening and reflection.
These four essential elements of the core spiritual practices have especially sound psychological value for persons seeking to be centered in life in a way that helps them learn from the necessary stresses in life and avoid the unnecessary ones. However, the basis of the four essential elements is a recognition that, as Heschel notes, the inner life “requires education, training, reflection, contemplation. It is not enough to join others; it is necessary to build a sanctuary within, brick by brick.”9 Otherwise, we will be drawn to settle for so little in life and call this “practicality.” In a similar vein, Heschel also cautions, “People are anxious to save up financial means for old age; they should also be anxious to prepare a spiritual means for old age. . . . Wisdom, maturity, tranquility do not come suddenly when we retire.”10p79
This latter quote by Heschel surfaces periodically as we face our own challenges, darkness, stress and changes in working as medical and nursing professionals In other words, achieving wisdom, maturity and tranquility requires personal effort and asks that we be clearer on the following:
The steps to achieving a deeper and more resilient self requires an awareness of the four key aspects of the inner, interior, or spiritual life. And the first one, silence and solitude, is especially important.
Silence and Solitude
The value of silence and solitude is recognized for its purely psychological worth due to the work of psychiatrist Anthony Storr. In his work On Solitude, he notes the following:
Modern psychotherapists, including myself have taken as their criterion of emotional maturity the capacity of the individual to make mature relationships on equal terms. With few exceptions, psychotherapists have omitted to consider the fact that the capacity to be alone is also an aspect of emotional maturity.11p18
From a spiritual standpoint, long before Storr and other mental health professionals wrote positively about silence and solitude, all the major religions emphasized the value of taking out time to retreat from activity. This is clearly reflected in the writings of contemporary spiritual figures. For instance, Henri Nouwen, a spiritual writer (and incidentally also a psychologist), notes in his book Way of the Heart that silence and solitude are the furnace in which transformation takes place.12p20
In his book The Tibetan Book of Living and Dying, contemporary Buddhist author Sogyal Rinpoche frames such periods of silence as “meditation.” He points out that slowing down the pace of our lives by ensuring we have time to stop, breathe, and see how habits and compulsions have quietly strangled us is essential. He writes:
We are already perfectly trained . . . trained to get jealous, trained to grasp, trained to be anxious and sad and desperate and greedy, trained to react angrily to whatever provokes us. We are trained . . . to such an extent that these negative emotions rise spontaneously, without our even trying to generate them. . . . However if we devote the mind in meditation to the task of freeing itself from illusions, we will find that with time, patience, discipline, and the right training, our mind will begin to unknot itself and know the essential bliss and clarity.13p56
He then goes on to say the following:
The gift of learning to meditate is the greatest gift you can give yourself in this life. For it is only through meditation that you can understand the journey to discover your true nature, and so find the stability and confidence you will need to live, and die, well. Meditation is the road to enlightenment.
Our lives are lived in intense and anxious struggle, in a swirl of speed and aggression, in competing, grasping, possessing, and achieving, forever burdening ourselves with extraneous activities and preoccupations. Meditation is the exact opposite.13p57
Orthodox Rabbi Aryeh Kaplan expresses a similar positive sentiment regarding meditation in his book Meditation and Kabbalah. He acknowledges the fact that technique is similar throughout different world religions and points out that there is a lack of awareness of this tradition of meditation among practicing Jews:
Many people [also] express surprise that the Jewish tradition contains a formal meditative system, that, at least in its outward manifestations, does resemble some of the Eastern systems. This resemblance was first noted in Zohar, which recognized the merit of the Eastern systems, but warned against their use.
The fact that different systems resemble each other is only a reflection on the veracity of the technique, which is primarily one of spiritual liberation. The fact that other religions make use of it is of no more consequence than the fact that they also engage in prayer and worship. This does not make Jewish worship and prayer any less meaningful or unique, and the same is true of meditation. It is basically a technique for releasing oneself from the bonds of one’s physical nature. Where one goes from there depends upon the system used.14p3
Whether we are Buddhist, Muslim, Jewish, Christian, Hindu, or not religious at all, though, the point is that when we speak about time in silence and solitude, or formal meditation, there is a benefit—especially for those working in the intensity of health care today.
In The Wooden Bowl, Clark Strand, a former Zen Buddhist monk, wrote about taking out time for meditation even though you are no longer holding onto a religious or philosophical ideology:
All I wanted in the first place was to find the simple truth about who we are and how we ought to live. . . . I asked myself one question: Was there a way for people to slow down and experience themselves, their lives, and other people in the present moment. . . . The only thing [meditation] requires is that you be willing to remain a beginner, that you forgo achieving any expert status. . . . In other words, it requires you to maintain a spirit of lightness and friendliness regarding what you are doing. It’s nothing special, but it works.15pp2–3
In extolling the value of being a meditative person—whether you are religious or not, does not matter in his mind—Strand goes on to say what he believes it offers all of us:
Perhaps you have had the experience of waking well-rested on a Saturday morning. Your mind is alert, but you have not yet begun to think about the day. The sun is shining in the yard and all around you is perfectly clear morning light. That alertness sustains itself without even trying. You may not even notice it except for the feeling of being rested and ready for the day.
The experience of meditation is something like that. When you meditate you are not trying to have any particular experience. You are simply awake. After having counted your breath from one to four for several minutes, quite without having aimed at that experience, you start to feel a kind of clarity and space surrounding each number as you count. It feels a little like having enough space to think, enough room to move and breathe, or simply “be.”16p96
The benefits are certainly there if we approach such a place, not with a sense of duty, but as a time for returning to our self; it will become a gentle place of reassurance, reassessment, and peace. Time spent in silence and solitude on a regular basis can affect us in the following ways: