Are Pastoral Counselors Effected By Your Own Fears of Death?

Medical Caregivers and Their Own Preconceived Notions About Death

The way doctors treat terminally patients may be due to their own fear of the grim reaper
The way doctors treat terminally patients may be due to their own fear of the grim reaper
In counseling it is always taught to keep one’s own preconceived notions or past out of the objective judgement during a session with a patient.  The same should hold true for medical caregivers.  This represents a large portion of doctors, nurses, social workers and even pastoral counselors.
While counselors and social workers recognize the psychology behind death, many doctors are not trained in emotional caregiving.  They tend to not treat the emotional symptoms but only the physical ones.  Treating the disease overtakes treating the wholeness of the human person.
With these things in mind, doctors need to also look at themselves–and this goes for nurses and counselors as well.  What ideas do you have on death or the terminally ill?  Do patients suffering in a cancer ward remind you of a lost loved one, or does the scent of death terrify you to such an extent, you cannot face them?
Maybe you feel if you avoid the issue of death with patients, you will not have to discuss it in length with them.  Kubler Ross in many of her studies noticed such behaviors from doctors and nurses who confidently felt the patient did not demand long and detailed accounts of their condition.  However,  upon review, Kubler Ross discovered that the  patients sensed the discomfort of the doctors and nurses and decided not to discuss death because of these attitudes.
So the reality was that many patients played off the emotional indifference or fear of the doctors and nurses.  These terminally ill patients then lost a critical element of treatment for their own emotional well being.  Instead of dealing with their own fears, these doctors and nurses avoided these fears by avoiding the patients they swore to help.
With such lack of pastoral training and difficult fears of their own, many medical caregivers are unable to treat emotional symptoms of grief or simply talk to the patient.
This can only be overcome via education but also facing one’s own fears of death and understanding patients and why they react or do not react to certain things.  Anger, indifference, compromise and denial are all reactions or better yet symptoms of grief when someone learns of impending death.  Doctors and nurses need to overcome their own fears so they can treat these emotions as well as they treat physical symptoms of a disease.
If you are interested in Pastoral Thanatology Certifications, please reveiw the program.
Mark Moran, MA

Cultural Diversity in Care Giving

Caregivers Need to be Culturally Sensative to Their Patient’s Needs

Cultural sensativity is important in primary care
Cultural sensativity is important in primary care
As the world has become smaller, interaction with other creeds, cultures and races has become more prevelant in all aspects of life.  Caregiving is no exception as doctors, nurses, pastoral counselors and other caregivers find themselves in direct contact with different cultures who demand and deserve certain care.
Within the area of grief, it is essential, according to John Bowlby, that we understand cross-cultural ideals, especially in grief to better provide the vital care patients need.  Rituals, mourning, and family interaction varies from culture to culture and  health care providers need to respect these particular cultures in their  treatment.  By becoming educated with the basics of religious and cultural ideals a care provider can be better equipped to treat his/her patient.  Yet, before generalizations enter into one’s mind, the caregiver must also realize that there are deviations from the norm and not to expect certain reactions from a particular group merely because of their background.
Unfortunately, they did not teach this in medicial school and sadly, it may not have even been considered important but only an after thought.  However, as trained caregivers who aspire to a certain level of professionalism, it is important to be educated in regards to the world and potential patients.

The “House” Syndrome

Photo property of Kristin dos Santos: Hugh Laurie who plays the notorious and brilliant Dr. House, always right but never culturally sensative
Photo property of Kristin dos Santos: Hugh Laurie who plays the notorious and brilliant Dr. House, always right but never culturally sensative
The lack of bedside manner by many caregivers has given rise to pastoral caregivers to become a crossroad between patient and provider, but the “cultural malpractice” by primary providers still remains a concern.  Doctors and many health care providers seem to care only about the healing of the body or the cure of the disease instead of the treating the entire person.  This “House” syndrome, from the celebrated television drama, is only too many times the norm.  The doctor is more concerned with the puzzle and relates very little to the humanity or cultural diversity of the individual they are treating.
Primary caregivers need to understand the spirituality and the culture of each patient.  This is why it is so important for primary providers to do spiritual assessments of patients.  This can be done by a simple conversation with the patient or with the family.  In this assessment, you can become familiar with how the person views life and what religious affiliations he/she has.  Also in doing this, a doctor can treat the whole of the person.  A patient who is beyond saving, sometimes wants someone to pray with them.  Although doctors need to keep a certain distance to maintain objectivity, there are certain times when praying with a patient may be acceptable, especially if requested or both share the same faith.   Spiritiual assessments not only help the doctor become more sensative to the cultural element of the patient but also enables the doctor to be more than a guy in a “white coat” but also a fellow human being who cares.
If you are interested in Pastoral Care Giving, please review the program.
(Information for this article was found in “Helping Grieving People-When Tears Are Not Enough” by J. Shep Jeffreys)
Mark Moran, MA, GC-C, SCC-C

Who Cares About the Pastoral Caregivers?

Pastoral Care for the One Who Cares the Most

The vocation and task of care usually falls to the spouse who then becomes the primary caregiver
The vocation and task of care usually falls to the spouse who then becomes the primary caregiver
My grandmother cared tirelessly for my grandfather and as his health gradually deterioated he became more needy in his everyday activities.  Fortunately for my grandfather, my grandmother was a nurse and knew how to care for someone who was gradually becoming less and less physically capable.  Her energy level was amazing and my grandfather through the final two surgeries received top notch care and affection.  After my grandfather’s eventual death, my grandmother finally slowed down some herself, almost as if her body knew she no longer was needed everyday.   Still alive, still moving, but now with a cane, my grandmother showed her own pastoral and emotional care for my grandfather through the fulfillment of her vow-“in sickness and health”.
Many primary caregivers are not as energetic or well trained in end of life care as my grandmother, however, even my grandmother showed the tired face and burnout that accompanies caring for a loved one.  This can be twice as draining on someone with little knowledge or training to care for the sick.  The constant pressure and beat of the drum that pushes the primary care giver to doctor visits, prescription and medication study, dosage delivery, feeding, cleaning and the emotional realization that the one you love is going to die soon is overbearing.
Professionals recognize this as caregiver grief.  This type of grief not only affects the primary caregiver emotionally over the loss but it also strips from them the loss of a future and loss of freedom.  The vacation that was once planned by a couple is now forever gone as a faithful wife tends to a crippling disease that is killing her husband.  Or, that special 50th wedding anniversary will not become a reality because one’s wife will not live to experience the 49th one.  In addition, the loss of freedom strips the primary caregiver of the ability to go to the movies, or visit others at a picnic.   Gradually, the vocation of caregiving for their loved one, forces these people to give up on extra curricular activities because the demand of care is so overwhelming.  This was not only the case with my grandmother, but also my other grandmother who also gives up much of her time and energy for care of her husband.  How many times do we see our loved ones becoming burnt out because we will not take that simple step to offer an hour or two of our day?
Pastoral counselors need to let the primary caregivers know that it is alright to be tired and it is alright to take time off.  Pastoral counselors need to emphasize occasional relief through other family members or respite care.  Respite care is available within hospice and can help the primary caregiver have a few days to him or herself.  The National Family Caregivers Association sometimes helps charitablly with the fees for hospice in this service.
Who holds the hand of the primary caregiver?
Who holds the hand of the primary caregiver?
Most importantly, pastoral caregivers need to let the primary caregiver know that is alright to feel emotions of guilt, resentment and anxiety at times towards the dying loved one.  These are natural emotions and do not mean that one does not love or wish to not care for one’s dying partner or parent.
In fact, after the death of a terminally or chronically ill person, sometimes the primary caregiver is known to have some relief.  Not in a relief that the one they love has died but a relief that they have performed their duty with courage and devotion and that their loved one is now free from suffering.
With these things in mind, who cares about the primary caregiver?–everyone should.
If you are interested in Pastoral Care Education, please review the program.
Mark Moran, MA, GC-C, SCC-C

Pastoral Thanatology and Islam

Islam and Pastoral Thanatology

Islam while a Monotheistic creed does pose a challenge for a Western counselor.   The Pastoral Thanatologist, however, can meet the needs of the Islamic suffering by covering the general aspects of paradise and a good and just God; a God that is the same and shared by all monotheistic traditions as the God of Abraham.   Still, a slight understanding of Islamic death and eschatology can be of great benefit when counseling a Muslim who is about to die.
Upon approach of death of a Muslim, verses of the Quran are read to remind the person of his faith.   At the moment of death, ritualistic purification is necessary.  These rituals play a pivotal role in Islam and at the moment of death such rituals continue to play an important role.  One such ritual is the washing of the body.  This ritual is conducted by a professional washer who recites part of the Quran.  After completion of this, the body is wrapped in a white shroud and taken to the Mosque.  There a service is conducted with readings from the Quran and other rituals. 

Photo by: Antonio Melina/Agência Brasil.   The photo shows Muslims praying
Photo by: Antonio Melina/Agência Brasil. The photo shows Muslims praying
Within 24 hours, the body is prepared for burial.   The body then is laid in a wooden coffin facing Mecca.  Practices such as embalming or preservation or forbidden since the theology of Islam believes the body should return to the ground as quickly and naturally as possible.   During the following months after death, the family continues to pray for the deceased begging for his or her intercession before God.
The Eschatology of Islam contains many common principles with other Monotheistic religions.  The theme of life after death, judgment and resurrection of the body are shared within the Muslim community.  Ideas of reincarnation and other Eastern ideals are rejected.   Upon judgment of the soul, it is either condemned to a life of bliss or life of torment.   Some believe the “fire” can be temporary for purgation while some others are in doubt whether the fire is eternal.  In regards to heaven, Muslims believe it is the reward of the just, but, according to some, can still be attained by those who suffer purgation.   Regardless, all Muslims believe the soul returns to the grave whether to exist in a state of bliss or a state of misery until the end day.  Upon that day, the souls undergo a general judgment and enter into the “garden” of paradise or enters into the “fire”.   Again, the eternal nature of the “fire” is an open debate among Muslims.   Some literalistic Muslims refer to the bridge that must be crossed on that judgment day.  The souls of the just across a wide bridge across the fire to the garden.  They are beckoned by the Prophet, Mohammad.  While the souls of the unjust have a narrow bridge as sharp and narrow as that of a sword.   Upon this day, the souls are finally granted their reward or punishment.
In understanding these slight differences of eschatology and death, Western pastoral counselors can better comfort the grieving and suffering people of the Islamic world.  Whether it be to the one who is about to die or the family that surrounds him or her, an understanding of the Quran and eschatology of Islam would always be appreciated by those in need and anguish. 
Mark Moran, MA

Last Rites and Pastoral Counseling

Pastoral Counseling and Last Rites

Pastoral Thanatology calls for a strong understanding of the rituals and spiritual aspects that surround death.  One particular care falls under the sacramental nature of the Blessing of the Sick.  While primarily a Catholic sacrament known as Last Rites or Extreme Unction, all Christian circles can appreciate the necessity of pastoral guidance and the presence of the Holy Spirit that encompasses it.  The necessity of grace that gives clarity, forgiveness, certainty, and peace to the dying  

A priest administering Last Rites
A priest administering Last Rites
person  is administered by the priest or minister via the power of the Holy Spirit.   This is materialized in the sacrament of the Anointing of the Sick.
Again, while Protestant circles, do not agree in this sacramental nature of the anointing, it can be agreed, they do believe in the grace that is poured upon the dying person to accept Christ and prepare the person for his entrance into heaven.  This should suffice in a general agreement that prayer, blessing, and other symbolisms are beneficial to the person-if not on a spiritual level, at least at a psychological level.  The remainder of this article, however, will focus on the sacramental nature and grace of this Catholic sacrament to better describe its principles.  In this regard, Catholic and non-Catholic pastoral counselors can both benefit, if not in practice, but at least in comprehension of the sacramental theology.
The sacraments of the Catholic Church span the life of those in the Mystical Body of Christ.  Each sacrament has a particular sacramental grace that performs a particular function.  Baptismal grace is a sanctifying grace that removes the stain of Original sin, makes one a child of God and an heir to heaven; it gives life.  Confirmation’s sacramental grace strengthens the growing soul and gives it the particular graces to become a solider of Christ.   The Eucharist as a sacrament feeds the soul.  Reconciliation heals the soul.  Matrimony and Holy Orders particularly deal with life choices and supply the soul with the necessary graces to serve God as a married person or an ordained minister.   The sacramental nature of the Anointing of the Sick also serves the life span of the person, namely in danger of death or at the ultimate moment of death.
As a sacrament, Anointing of the Sick, feeds the soul a variety of graces pertaining to the function of the sacrament.  First, it is a healing sacrament.  It can heal physically, but generally and most of the time, it heals spiritually.  With this particular function, it can carry a sanctifying element for the soul.  It can restore the divine life in the soul lost via grave sin.  The anointing of the oil, blessing, and prayers can also serve as a strengthening.  The sacramentals or holy objects or rituals utilized are mere manifestations of the spiritual renewal going on beyond human sight.   The soul is not only healed but strengthened by the Holy Spirit with the virtue of faith and hope; faith in Christ and hope in Christ that his promises will be fulfilled.   Hence this sacramental grace produces a calming effect on the soul, allowing the soul to free itself from anxiety and doubt.  This sacramental grace also produces a calmness that protects the soul and claims it as one of God’s children, warding off the howls of the evil one.
As a pastoral counselor, one will come across the miraculous manifestations of this sacrament.  You will experience the peace, the love, and the presence of the Holy Spirit in the room.  You will sense the peace that replaces the anxiety, the certainty that replaces the doubt and the courage that replaces the fear.   For these reasons, one should not so easily dismiss the sacramental benefits of the Anointing at all levels; spiritual, physical, emotional and psychological.  If not Catholic, pastoral counselors should utilize some of the techniques and prayers from this ritual and utilize it.  These rituals will enhance the presence of the Holy Spirit and aid you in preparing the person for death or healing them completely. If you are interested in Pastoral Thanatology, please review the program.
 Mark Moran, MA, GC-C, SCC-C