A BUDDHIST CHAPLAIN’S MINISTRY IN END OF LIFE CARE: INTEGRATING “BEING” AND “DOING”, PRESENCE AND COMPASSION.
BY PIERRE ZIMMERMAN, MS –MARCH 2011
A BUDDHIST CHAPLAIN’S MINISTRY IN END OF LIFE CARE: INTEGRATING “BEING” AND “DOING,” PRESENCE AND COMPASSION
“Love and death are the greatest gifts that are given to us; mostly they are passed on unopened.” Rainer Maria Rilke, Portrait of an Artist as a Young Man
OVERVIEW
Chaplains are becoming more and more important in healthcare systems due to a growing elderly and dying population, a shortage of priests and clergy, a rising trend in spiritual practices and many changes in the healthcare infrastructures and delivery systems. Chaplains are required to undergo rigorous training in psycho-social, practical, emotional, ethical and spiritual disciplines to assist and meet the needs of the patients in transition and dying.
The author will discuss the complex environment and context in which chaplains function. The effectiveness of chaplains comes primarily from not only their religious/spiritual heritage and specific technical skills, but also their character formation and the personal awareness of how their attitudes, values, strengths, weaknesses and assumptions affect their pastoral formation. These particular inner qualities, which are aspects of “being”, are required to create inter-personal relationships that allow for deep meeting and provide us ways to be fully present with people so that they can be seen and heard.
We may not have the answers to the existential questions of life and death any more than the dying person; it is not our solutions or answers that matter but rather putting forth and holding questions that generate genuine engagement. Rainer Maria Rilke wrote: “The point is to live everything. Live the questions now. Perhaps then, someday in the future, you will gradually, without even noticing it, live your way into the answer” (1979, p. 125).
The author is going to explore the essential components, competencies and practices needed to efficiently and with pro-social qualities facilitate and integrate healing and serve the patients, their families and the professional staff. These attributes are not abstract ideals, split from the body and daily life, but grounded in core conditions of practice, congruence, acceptance and empathy.
The essential qualities and elements of integration for “presencing,” giving no fear and providing compassionate care in end of life, are:
1. Taming the Mind
Coming to terms with suffering
Awareness of impermanence and temporal integration
Practicing mindfulness
2. Training the Mind
Living one’s precepts
Understanding non-dualistic mind
Cultivating bodhicitta
3. Opening the Heart
Developing emotional intelligence
Exploring spaciousness Building resiliency
Not being attached to outcome
Creating pathways of engagement
CONTEXT
Let’s first look into the context in which chaplains are functioning and how they are potentially influenced and affected by it while engaging with people as they approach the end of life.
Elder Population Growth and Impact
Over the next 20 years the “baby boomers” will grow to become a population of millions of people who will use more and more healthcare services and high cost procedures. By 2030, the number of people in the US over 65 is expected to exceed 70 million, with 90% of them having at least one chronic condition. Over 70% will have two or more coexisting conditions, and 25% of these will also be diagnosed with a mental illness (Wacker, 2002).
In July 2010 the population of people over 60 was larger than the working population, a historical change with no precedent since 1948, after World War II. With the financial market’s downturn and lost retirement income, many elderly people cannot afford standard nursing home care or assisted living quarters. Regardless of the situation, some will want to live forever and try many procedures aimed at extending life beyond the expected years of old age. A rising number of people want to be taken care of in their home or residence and are considering dying at home, even though their children or other family care givers cannot tend to them because of work obligations. While some of the elderly population, baby boomers in particular, seem to be more health conscious than before, high healthcare costs are incurred for people over 75 years of age with a plethora of acute and chronic physical conditions and ailments. This will not only put a financial and manpower strain on the present healthcare systems and models of care, but drain existing reimbursement streams, such as Medicare, Medicaid and private insurance, and may eventually require our society to re-evaluate the distribution of resources of care and determine who will benefit.
It will also raise ethical dilemmas that have been ignored or put on the back burner until recently, in particular the right to choose when to hasten or end one’s life, where, how to proceed and who can participate in those decisions.
Cultural Views on Aging and Dying
Most people know they will die at some point, just not when or how, and it seems that a lot of effort is in place in our society to forget that our time is limited and that our life is very precious. “Who the hell wants to live forever? Most of us apparently; but it’s idiotic,” wrote Truman Capote in his essay “Self Portrait” (1974, p. 406). Even with the possibility that we may add years to our lives by slowing aging with scientific discoveries in the years to come, the trouble with immortality is that it is endless.
There are many institutionalized distractions and an obsession with youthfulness through advertising campaigns for remaining young, looking good at all times and turning a profile towards a future that ought to last forever. The techniques of cosmetic surgery face lifts, tummy tucks and breast implants allow people to look and feel younger, thereby creating the illusion of having slowed down the aging process. Genetic engineering also offers hope for finding new ways to control diseases and live longer, “happier” lives. We get caught up in the lucrative technologies of youth and longevity, be it more vitamins, more exercise, anti-depressants or invasive surgeries. It may be that few of us can imagine anything important enough to suffer or die for and we have lost our awareness of our mortality.
When life is not lived as a quest for the meaning and values that prepare it for death, it becomes more and more empty. In an attempt to fill our lives and this emptiness, we become dependent on technologies, interventions and institutionalized distractions.
Many are unable to feel the necessity of taming their mind, creating spiritual ideas or gaining knowledge of the soul and continuity with their ancestors.
As a tortoise lives inside the dead cells that make up its shells, we dwell meta- psychologically in our ancestors; in a deeper sense they are the culture in which we are protectively contained. Having lost our sense of the soul, we tend to view death as extinction and attempt to find the significance of our lives in the transitory events and fashions of the day -- the “fifteen minutes of fame” that Andy Warhol assured us will be ours – perhaps as a function of the increasing rapidity of change and the often meaningless communications in our modern world.
It is not until a crisis, illness, war or an accident happens that people come to terms with the inevitability of life ending slowly or abruptly, that people face their mortality and potentially look into the meaning of their life’s actions and experiences and what is of utmost importance.
We tell ourselves stories about having a “good death” or a “dignified death” or possibly a “no fail death” assisted with powerful drugs or some suicidal way out so as to not suffer or not have to depend on others, particularly our family members. Besides the stories we are telling ourselves, there are the many stories our culture tells us and our healthcare institutions have created.
In the healthcare arena death is still looked upon as a failure by many physicians and hospitals, as demonstrated by the focus on mortality rate percentage outcomes and studies, comparing hospitals across the nation and the world. Attempts to keep people/patients alive is seen as worthwhile since it might advance the science of prolonging life, often without consideration of the patient’s lack of quality of life or the patient’s and family’s wishes. On the other hand, very often family members are complicit in the attempts to extend their relatives’ lives, particularly when there is no “Do
Not Resuscitate” (DNR) or “Do Not Intubate” (DNI) policy in place.
Death in our culture is something that is not spoken of or not honored as a passage from life as we know it to another realm, regardless of what the belief systems might be on after-life. There are, of course, rituals and services that honor the person who died and their accomplishments, maybe their loving kindness, spirit and soul, but there are very few courses or preparatory models to explore the meaning of death and how to transition from one world to another, peacefully and without regrets. We cannot, however, know how to live life to the fullest without becoming intimate with the ultimate teacher of impermanence.
Trends in Religious Practices and Spirituality
Today’s model of end of life care chaplaincy must be attuned to the patients, whether they are persons who consider themselves religious, spiritual, atheist or agnostic. The vehicle for making sense of life, death and what and how we should think and behave revolves around religion and spirituality.
The process of uncovering meaning in our lives is both personal and subjective, and seems, for most people, to rely on the workings of their internal world and what they value highly, which usually stems from beliefs in a supreme being or a higher power, the nature of life, our place in the universe and ultimately our purpose.
Religion and spirituality are often used interchangeably in common discourse, but there are some differences between them. The term religion comes from the Latin
“religio” and means “to bind together again.” Religion seems to be organized around schools of thought and belief systems that are based on specific scriptures espoused by a community of believers and followers united by a shared faith.
Spirituality can have a broader base of belief systems that may include holistic components such as spirit, mind and body elements, a certain life orientation and life style focusing on discipline, devotion, a unifying force and life principle. It might or might not include a belief in a supreme being. It is most of the time used to describe the human capacity to meet limitations, to find meaning and richness in life and to trust a greater power.
Regardless of differences, religion and spirituality both identify a relationship between the human spirit and the divine spirit or something greater than the self.
Some of the fringe “new age” kind of spirituality can be a trap in the sense that it is usually an orientation or version of “be what you can be,” or selfish self-actualization for one’s own benefit only, a phenomenon that has been coined by Chogyam Trungpa Rinpoche, one of the earliest and most influential Tibetan Buddhist teachers in this country, as “spiritual materialism.”
Carl Jung added a psychological perspective to spirituality, describing it as a lifelong process in which we seek to develop the wholeness of our personality by coming into a relationship with a larger reality. Often we look for the “spirit of the place,” where beyond our fears and desires we can find our deepest sources of wisdom, power, creativity and altruism. There is a deep yearning from every being to drink from the well of peace and happiness.
However we look at it, spirituality is not quiet contemplation apart from the rest of our lives; it is the growth and development that seems to come from our connection with others and takes on a transcendent meaning. Looked at it functionally, spirituality helps people to deal with crisis, fears, loss and limitations and also to enhance the richness of life and appreciation and awe at the beauty of the universe and human experience. It has as its purpose to move people towards well being, giving them a sense of connection, belonging and nurturing.
What has changed tremendously in the past few decades is the incongruence between the religious authorities’ teachings and messages and their behaviors that do not seem to align with what is being professed. There have been many accounts of flagrant violation, abuse and unethical practices, particularly in the Christian community, that have gone unanswered for too many years. This along with the exclusion of women in the ministry and celibacy for priests has disillusioned many practitioners who feel betrayed by the clergy’s behavior and don’t believe in blind faith, seeing the church as being out of touch with the needs of the flock and time. Great grief is felt by older parishioners who are seeing their churches being closed due to a shortage of clergy, financial woes of covering large brick and mortar spaces and high utility costs. They feel “displaced” from their familiar, long time existing communion space and the younger generation that is not interested in the “antiquated rituals” and schedule of traditional worship.
As a result many, old and young, have abandoned their church, and are looking for other communities or practices to find meaning and purpose. Some have been resorting to and seeking more fundamental faith groups that appear to bring stability, or are looking for meaning with alternative ways of worship, mysticism and devotional circles. One of the fastest growing groups is Buddhist, based on many different schools of thought, derived from the east and west.
In palliative care, spirituality is an inherent human trait and death is an inevitable and normal event within the life of every family. Families receive basic information about grief and making space and time to mourn. Responding to family members’ suffering, when a patient is not expected to survive, chaplaincy support extends to offering suggestions for interacting, gentle touch, spending time and encouraging consonant ways of completing relationships and saying goodbye to the dying person, allowing for the religious/spiritual orientations of the individuals.
Changes in Healing and Healthcare
With the advent of managed care and systems of care mergers and consolidation, primary care physicians, the local healers of the times, saw their practices lose referrals and revenues to a new breed of physicians, specialists called hospitalists. They are based in and hired by a hospital. They have more manageable work shifts and tend to all patients regardless of their special needs. No matter what the physician’s specialty is, people are these days often no longer known as individuals but as patients, seen for an average of 15 minutes, answering several questions around body functions and physical symptoms while the physician inputs responses in a computer.
Healthcare is the highest regulated service industry and has tended to be very diagnostically and reductionist oriented, focusing on curing symptoms and illness and sick care rather than providing healthcare, preventative medicine and addressing wellness. It was plagued by antiquated information systems until just a few years ago, and still has very few compatible systems between different health organizations.
Reimbursement and insurance companies have designed and standardized algorithms to determine levels of care, what procedures and interventions are appropriate and when they will reimburse for services rendered, outsourcing behavioral, pharmaceutical and billing services to organizations miles away or on other continents.
Allopathic medicine still struggles in including complementary disciplines for lack of sufficient evidence based data. Apprehension and concerns about liability issues around the potential detrimental impact of combining two different streams of remedies are common and such approaches lack support from and are blatantly frowned upon by the cash and patent rich pharmaceutical companies.
There are challenges in finding physicians, nurses and nurses’ aides for hospitals as well as for nursing homes, given the tough schedules, many faceted functions of the jobs and gaps in personnel. The most prominent medical schools, however, have not seen a decline in enrollment but have swelled their ranks with many more foreign students and an encouraging new trend of women, who tend to make up more than half of the first year students.
There are some changes in the horizon combining more models of body/mind integration through mindfulness, for instance, giving cancer and cardiac patients more control in their recovery process and looking at the strength of multidisciplinary team approaches to include psycho-social components. Reiki practitioners are assisting palliative care physicians in bringing comfort and reducing pain to terminally ill patients even though the Catholic Church has forbidden Catholic health systems to provide reiki treatments because “Catholics trusting Reiki operate in superstition, the no man’s land”
(USCCB, 2009).
Reintroducing the old ways of “doctoring” through palliative care and hospice services has helped manage patients’ pain levels and ease suffering. These approaches address the whole person through fostering a team approach, addressing not only the physical but also the psycho-social, moral, cognitive, developmental, emotional and spiritual elements of the patient. Palliative care attempts to put the patient, the preservation of personal opportunity and family, which is not necessarily restricted to relatives by blood or marriage, front and center rather than providers or reimbursement systems, and appears to be antithetical to critical care.
In the last ten years or so there has been more focus on death and dying and exploration of pain and suffering due to controversy or attempts to understand it, starting a well needed dialogue. Political controversy has risen about elder suicide and physician assisted suicide, “the angels of death” or “promoters of a culture of death” who do not use CPR, hydration, intubations or other disproportionate interventions that will in fact not improve the quality of life. Yet palliative care professionals are comprised in the majority of the most pro-life group of clinicians who do both: help people to live fully and also die well.
There is a growing trend of physicians doing house calls “with a new version of a black bag that includes a mobile X-ray machine and a device that can perform more than
20 laboratory tests at the point of care…and using a cellular broadband connection to the same electronic record system used by other physicians in offices and hospitals”
(Landers, 2010). Older patients often see these home visits as a gesture of caring and are nostalgically reminded of an era when house calls were common. Whether these new health delivery models will grow on a large scale or stagnate with a few participants will be the judges’ determination, influenced by governmental, national and institutional policies (Medicare/Medicaid managed and bundled care), lobbying groups as well as physician and AARP members’ interest.
ROLE OF CHAPLAINS
Where do chaplains fit in this context of a large, broken, often cost managed rather than care managed and technologically/scientifically oriented healthcare system, a growing elderly and dying population, a shrinking pool of clergy, nurses and doctors and more and more people wanting to die at home?
Let us look first at a brief history of chaplains.
History
St. Martin of Tours, living in the 3rd century, aspired to serve God but was required to join the army at the age of 15. In the winter of 337AD, riding in the country near the city of Amiens, in what was then known as the country of Gaul (now France), he noticed a beggar destitute of clothing. He cut his military cloak into two equal halves and gave one to the freezing beggar. The word “chaplain” comes from the word cappelanus
(Latin), denoting someone who wore St. Martin’s cloak, and was of service to the poor and those in need. The word also comes from the old French root word “chapdelaine,” a large cape made out of coarse wool that covers the whole body.
It was only in the late 17th century that the term chaplain was coined for those who ministered soldiers of different faiths in each regiment of the US Army. For many years, chaplains were not practicing in large numbers, as is more the case today; patients usually had their personal minister, rabbi or priest come and visit them at the hospital.
Today most priests, pastors and rabbis are busy managing several clusters of parishes or religious communities rather than just one congregation and may not be able to find the time to provide hospital or nursing home visits.
Military chaplains are embedded with the troops or stationed in barracks as members of the military forces, providing spiritual services and counseling to those who need support during war and in peace time. In the last few years the number of secular chaplains for civil or military purposes has increased tremendously and there has been a remarkable surge of applicants since the increase of hospice services availability and the devastating 9/11 incident. Many schools, seminaries and clinical pastoral education
(CPE) programs have experienced higher enrollment in the past ten years and curriculums are becoming more stringent and rigorous.
Training and Credentialing
The Association for Clinical Pastoral Education (ACPE) certification process is comprehensive and its approach is broad based and inclusive; it covers psychological, spiritual, therapeutic, cultural and family systems and ethical issues in dealing with patients and family members who are experiencing catastrophic physical changes, emotional and spiritual distress and often need many interventions.
Four CPE units are required to apply for the certification examination, with a total of thirty-six hundred hours of clinical work if chaplains are interested in working within a health system. At present hospice services and home care agencies do not require certification; however a push for credentialing with a focus on end of life care is in motion and will more than likely be required in the next few years.
Recently, the ACPE White Paper in book form called Professional Chaplaincy:
Its Role and Importance in Healthcare, edited by Larry Vandercreek and Laurel Burton
(2001), was put together by a collaborative of interfaith chaplains, ministers and rabbis. It was designed to show hospitals’ company executive officers, board members and other key decision makers the importance and many benefits of having chaplains become part of the multidisciplinary healthcare team. Many studies and surveys in the White Paper are reflected in the Standards of Care and explain and substantiate the need for chaplains with an increasing sicker patient population and staff reductions in hospital settings.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandates a spiritual assessment for patients who enter a healthcare system but does not stipulate the content of the documentation, at least not for now. It plans to come up with specific requirements in the next few years. Hopefully new assessment tools will be developed that include qualitative and quantitative data to better assess the patients’ personhood and spiritual needs and add support to existing in-house quality improvement systems.
Chaplain Functions and Role
The focus has changed from just developing skills to assessing and activating people’s resources during crisis times. Chaplains facilitate coping skills in people adjusting, accepting and integrating health catastrophes into the fabric of their lives. They pray with people in emotional distress, and use ritual for healing, supporting and guiding people. Chaplains can make effective use of their religious/spiritual heritage and training as well as knowledge of behavioral sciences when ministering to people.
The repertoire of technical skills needs to be increased, with elements such as group dynamics, group leadership and brief lifestyle counseling skills, trauma resiliency training, community involvement, grief counseling and peer consultation. More than ever chaplains are becoming the ones to participate more fully in the enhancement of the patient’s emotional well being and attainment of peace of mind.
In palliative care, the team of professionals works together not only to reduce patients’ physical pain but also their suffering around the wrap-around issues of loss of personhood. A popular saying goes, “pain is non-negotiable, suffering is optional.”
Suffering, which is of a mental and emotional nature, does not respond as easily or as fast as medication does for symptom reduction. Suffering warrants more than symptom reduction, usually including targeting long term, unresolved “issues in the tissues,” which often become a focus in spiritual counseling.
The Buddhist chaplain’s principal core trust with every human being translates into the simple motto “I will not abandon you,” which entails being and staying with the whole person; it is different from the physician who manages primarily the physical pain, and the nurses or social workers who manage the dispensation of medication and resource allocations.
Many people who are answering the chaplain’s call have gone through major personal challenges and transformation with a desire to serve a greater good. They understand how the beliefs and religious practices contribute to a person’s sense of well being, in addition to the mental suffering and emotional and spiritual distress, particularly in the midst of dying.
Splitting the cloak as St. Martin did serves as a reminder to all caregivers to be loving, present, compassionate yet wise enough not to freeze in the cold or burn out through “idiot compassion” or pathological altruism. Those who show empathy out of their own co-dependent needs of rescuing others usually fail to show compassion over an extended period of time and omit self-care. The story of St. Martin is a powerful metaphor for those who choose to become chaplains today, helping others and at the same time tending to their own needs in order to be able to serve unconditionally.
Chaplains have to exemplify qualities of diligence, depth of character, authenticity and kindness. They balance performing their functions and skills by bearing witness to suffering, combining work and self-care, clarifying intentions and letting go, having empathy with and compassion for, embracing a spirit of “not knowing” and being guided by what emerges in the moment.
The essence of being present is acquired through the understanding of one’s own and others’ suffering, realizing the impermanence of all phenomena and the need for temporal integration, practicing mindfulness and taming our unruly minds, adhering to a strict code of ethics or precepts, practicing non-dualistic thinking, and cultivating bodhicitta, pro-social qualities and emotional intelligence.
INNER CHAPLAIN FORMATION; TOWARDS BEING
“There is more to the ‘I’ than one can see.” (Anonymous)
As in any other profession, it takes technical skills to be a chaplain and we have to maintain our functions as chaplains in order to serve the spirit of people. At the same time we have to deconstruct our powerful identity drivers and be cognizant to focus not only on bringing relief but also to not contributing more harm, to bring about healing and transformation. In end of life care we meet people usually at their tipping point between finding meaning for themselves and/or fighting the impossible, unchangeable odds of death. Their suffering is always present while living and either becomes amplified or released, or both, in their last months, hours or minutes.
One can only face in others what one can face in oneself. How do we aspire and look at everyone with fundamental impartiality, evoke the geography of the heart and show up again and again, without well formed agendas and specific outcome expectations? Is it possible to live a life free of suffering? We are exposed to so much of it in assisting people in end of life care that it is essential for us as chaplains to be present with our own suffering, our own views and perspectives on death, impermanence, the feeling of separation from others and the emptiness we experience at times. In order to do that we need to work on our interior landscapes, observe and notice headwinds and tailwinds and evidence vigorous and consistent efforts in our own spiritual, emotional and physical self-care.
Awareness of our own affect, thought processes and developmental influences needs to be the hallmark of spiritual caregivers. We need to call on our inner teacher wisdom and principles that we acquire through engaging in the following practices: meditation, self-discipline, skillful means and authentic and undefended presence.
We strive to live within our precepts, practice mindfulness, emotional intelligence and pro-social qualities to meet with the ambiguous, the unexpected and inconceivable.
Others’ suffering can only be eradicated by working first from within ourselves, by integrating beliefs and practices in our lives in order to be present and available to offer the gift of assistance in the transformation of the mind and heart of those we come in touch with.
Let us explore what suffering is, how we can reduce it and lessen the burden of it.
Taming the Mind
Coming to terms with suffering
“Everything that the human race has done and thought is concerned with assuagement of suffering. One has to keep this in mind if one wishes to understand spiritual movements and their development.” Albert Einstein
According to most theologians, suffering is the experience of any kind of pain and distress with the four following themes: loss and grief, injustice and oppression, self- hatred and guilt, and lastly, physical suffering. Suffering is the price we have to pay for our limitations. It is related to one’s personhood and is the result of the breakdown of interdependence.
Two basic questions must be asked about suffering in order to give it meaning:
1) What causes it and how can it be eliminated?
The Buddha’s first practical teachings after his awakening were the four noble truths:
There is suffering.
There is creation and cause of suffering.
There is a remedy for suffering and well being is possible.
There is a vehicle that leads to refraining from doing the things that cause us to suffer.
The trajectory for well being, even in the midst of illness and death, can best be attained through the cultivation of the noble eightfold path or at least some of the following elements, which are:
Right View and Right Thinking which show us the basis for suffering,
Right Speech, Right Action and Right Livelihood which help us lessen our suffering, and
Right Mindfulness, practiced along with Right Diligence and Right Concentration, which will help us face suffering with courage and give rise to insight.
Each of the eight elements is contained within all the other seven when we are healthy and alive. Before we look at solutions for relieving the problem of suffering or focus on fixing it, we must first draw from Buddhist cosmology and logic, which describe three different kinds of suffering: a) The first one is “the suffering of suffering,” which is the most obvious one. It includes: physical and mental suffering, such as anxiety, fear and unhappiness, sickness and aging, losing a job, having a motor vehicle accident, going through a divorce or having one’s house burned down by fire. It also includes the suffering of disappointment, not wanting something and getting it and not being able to get rid of something one does not want. b) The next level of suffering is “the suffering of change,” which is stimulus-driven states of pleasure and gratification that depend or are conditioned by events or other people and are always subject to change. In Buddhist psychology, we are interested in the sources of suffering, not merely effects, and through practice, understand that everything we experience is unsatisfactory, that circumstances are not the cause of suffering, only our responses to the circumstances and underlying afflictions are. c) The third level of suffering is “the pervasive suffering of existence or conditioned thinking,” the fundamental suffering of profound vulnerability which derives from the habitual way in which we identify closely with the elements of our body, our thoughts and our ambitions: the “I, me, and mine” theme world that is the principal propulsion into experiencing mental afflictions and suffering. From early childhood on we are told and pushed to “become somebody,” which fosters and supports the cultivation of cherishing one’s body, thoughts and emotions, in order to be self-sufficient, independent, and to compete and become productive citizens. This fundamental drive has to be, in many painful ways, reversed, so that we become nobody as we gain more insight into the nature of reality and happiness.
The central thread and diagnosis of our human condition is that the sources of all our suffering are mental and emotional afflictions, which affect us in three primary ways:
1) Through delusion or ignorance, the idea of seeing the self as inherently existent, an autonomous concrete being.
2) Through attachment or desire, this entails superimposing desirable qualities upon something or a person. Often by idealizing them we create an impossible representation that we cling to.
3) Through anger or hatred, the natural complement of attachment, with its superimposed strongly undesirable qualities.
Once we recognize these afflictions, we notice that external circumstance and other human beings merely act as catalysts to evoke something in us that is already within us, whether pleasurable, unpleasant or neutral. Thus in any discussion of suffering, we contemplate the Eight Mundane Concerns considered in Buddhist psychology to be causal, namely:
*pain and comfort,
*suffering and happiness,
*fame and disgrace,
*praise and blame, Looking for or pushing away any of the Eight Mundane Concerns seems to be a lesser burden than the drowning into despair and lack of meaning so often experienced by people who are ill or dying. Being confronted with the end of everything as we understand it is a karmic turbo-charge onto the road of suffering.
People who receive palliative care, says Dr. Eric Cassel (2010), a pioneer in the field, “…feel their intactness and integrity threatened and disintegrating…their suffering is personal, unique and these characteristics are also the points of intervention because the demoralization symptoms are a human state, not a pathological one.”
Terminal illness is devastating and constantly shapes the person’s life like a swelling river shapes the land after a rain storm; or the catastrophic illness moves in our house unexpectedly like a thief, taking up permanent residence in the body. Along with the attic and the basement clearings there are consciences to be wiped clean and relationship repairs to be undertaken. It can be a teacher, a curse, a blessing, an enemy.
Every plan is subject to the body’s unpredictability and life becomes very narrow and small, forcing one to engage the body as a partner towards the last dance, the whirling into the territory of darkness.
Everything that was given meaning is under attack and the worst kind of suffering is an existence that is merely a burden or lacks a future without any compass or clear solution. The person is not just “a patient” who needs to be provided with relief for physical symptoms only; there is no visible or invisible dividing line between the body, mind and spirit. Patients struggle to integrate all those elements and often lean on the integral support of a chaplain. The Buddha told the parable of two arrows. He gave the example of a man wounded by a poisoned arrow and said: “When touched with a feeling of pain, the ordinary, uninformed person sorrows, grieves, and laments, beats his breast, feeling distraught. So he feels two pains, physical and mental. He is not only being shot with one arrow, but two.”
If consenting to have the arrow removed, the person insisted on knowing the name and occupation of the person who shot it, the place where it was manufactured, whether it was a designer arrow or not and what type of bow it was, he would die before learning the answers. The crucial thing for this person is to be treated and prevent complications and infections. We add to our suffering when we focus on the arrow.
Those rare people who do not resist physical pain and do not experience fear feel only one arrow. Most of us who experience the first arrow also add a layer of emotional suffering through resistance, anguishing over pain and experiencing aversion, which is like being shot with another arrow.
What might seem at first as a solid mass of misery is in fact changing from moment to moment and what is left is often simpler and much less intimidating than we think; although not necessarily so when one is told “you are not well presently and things are not getting any better,” a euphemism for dying.
When we investigate the nature of suffering, we eventually notice what our relationship to it is. We realize that all the emotions and narrative stories that go with it are seen for what they are, part of the rich manifestation of the canvas of living, and in that seeing, these stories often go into abeyance or become less impressionable over time. It is only in the present moment that we can cultivate the mental stability that is required to practice non-preference for the conditions of our lives.
2) How do we do we cultivate mental stability when one’s precious life or someone else’s is at stake?
“Approach what you find repulsive, go to the places that scare you, help the ones you cannot think you can help, let go of anything that you are attached to.” This is what the famous Tibetan yogini Machig Labdron’s teacher said when she asked what she needed to do in order to be free of suffering (as cited by Chodron, 2008).
It takes skills, a presence of mind and heart, sound communication, the ability to stay with suffering, to hold the space and provide a container for people in, most often, a cold and sterile hospital or nursing home warehousing environment of broken bodies and spirits. As chaplains we can only effectively be present by standing in the groundlessness of being human, facing everyone’s suffering in an unmediated way, continuously walking in the ground of spaciousness, trying to understand one’s own vulnerability, wounds and blind sights.
We can take to heart Viktor Frankl’s deep understanding from his experiences as a concentration camp prisoner when he came to realize that “He who has a why to live for can bear with almost any how” (Frankl, 1984). That why can be a representation of so many impressionable things in end of life, such as faith in a transcendent force, acceptance of the limitations of our bodies, following one’s inner voice, letting go of everything and everyone and welcoming reconciliation with everybody. But how does this “why” help us cultivate trust in the significant, limitless, ungraspable and vast realm of all pervading change?
Impermanence and temporal integration
“Everything flows; you can’t step in the same river twice.” Heraclites
It is with wholeheartedness and unrestricted acceptance of the truth of impermanence, the unavoidable and the inconceivable in us that we can, interestingly enough, trust ambiguity, insecurity, uncertainty and the mystery of death. It is very much so the designated way for us as chaplains to be present with those who are facing loss, are dying or in the midst of it.
Bertold Brecht in his play The Mother wrote: “Do not fear death so much, but rather the inadequate life.” It is very natural to fear death if we have not given it much thought. It is very sad if we do not know how to live life fully and ignore the possibility and presence of all kinds of little deaths within and all around us. We ultimately need to come to terms with the realization of constant change and integrate the reality of death in our own lives in order not to recoil from our tenderness, vulnerability, universal commonalities and basic humanity.
Dying is simply part of being human, but the majority of people become worried about appearance, dependence and embarrassment at loss of dignity. Relief of physical suffering is always possible, but relief of persistent personal and emotional pain is a much more complex problem in challenging situations. The mental anguish of approaching death and the emotional despair of the potential loss of everything one cherishes are far more debilitating. When someone is confined to a bed and diminished by illness, his sense of identity is in jeopardy and crumbles under the “certain” probabilities of impending doom.
When someone is told “nothing more can be done” and her intellectual capacities are preserved, she usually does not feel that she can be helped or can muster up hope to adapt to unwanted change. She might or might not have the capabilities to come to terms with unresolved issues, complete relationships or get her affairs in order.
Personhood hinges primarily on personality traits such as temperament, personal habits, cultural background, social life and relationships with others. A person’s past and future, as well as beliefs, ethical values and interior life are critical aspects of his or her personhood. People act out elements of their personhood all the time in their daily life and activities. When catastrophic or terminal illness manifests and alters the many colors of the prisms of their life, their personhood is inevitably under siege and the many dark facets of suffering appear.
Personhood is characterized by strengths or virtues, says Erik H. Eriksson (1963); they are emerging from the resolution of crises at the different life cycles, which he describes the following way:
Hope during infancy,
Will during early childhood,
Purpose during play age,
Competence during school age,
Fidelity in adolescence,
Love in young adulthood, Care in middle adulthood,
Wisdom in old age.
In his terms, it is never too late to hope, to acquire will, purpose, skills and self- discipline; to make commitments and learn to sustain them and to care for others; to see one’s life in perspective. Each of these strengths usually builds on the previous ones and is impacted by struggles and conditions left unresolved.
In adulthood people may replicate and resort to earlier stages of development in relation to identity, autonomy and purpose. During and after the decline of health, movement and geographic mobility in mid-life or old age, the crises of identity, intimacy and generativity recur as they did earlier in our lives. These become a central challenge during end of life care. Having to give up one’s identity, resist being classified as a
“nobody,” or even worse a burden, is debilitating and discouraging. When longevity is threatened there is a need to reexamine and re-address identity confusion, isolation and the sense of uselessness: Am I still the person I have spent a lifetime becoming and is it possible to be that same person? If I am no longer who I thought I was, who am I now? What is the purpose of living? Who will care about me and love me now?
When we overlook the truth of impermanence we have a tendency to grasp onto the pleasant things, people, situations, experiences and try to create a comfortable environment and hold on to it at any cost. And yet everything we know changes constantly: our body’s cellular structure changes every seven years, the seasons come and go, what is up must come down, stillness is followed by movement, people and situations are unpredictable, what is found gets lost, fame can turn into disgrace, retirement savings can disappear in an instant, every relationship eventually ends in separation, countries go to war and so on: nothing that is understood by the mind can have everlasting life.
The proverbial saying goes: “Nothing is more permanent than change.” And yet at the level of personal experience, particularly emotionally, we have a deep-rooted aversion to change and we resist this basic fact. Good feelings don’t last; neither do unpleasant feelings. A thought is just a thought and not the totality of who we are, and yet we continuously live as if who we are and everything that exists in the world is a solid and everlasting entity. The Buddhist way encourages us to cut the ties of certainty so that we can be free from our limited means of relating. We then can gradually relax from the reality of change and the grandiose belief that we can manage to avoid uncertainty. We so insist on maintaining the illusion of security and thereby create more harm.
The Buddha’s principal message at the Vulture Peak Mountain Sermon, to paraphrase or summarize, was that holding on to anything goes against wisdom. The late
Dilgo Khyentse Rinpoche, a Tibetan master and beloved teacher, said that “the everyday practice is simply to develop a complete acceptance and openness to all situations and emotions, and to all people, experiencing everything totally without mental reservations and blockages, so that one never withdraws” (Rinpoche, 1990).
Chaplains are well advised to wipe away their preconceptions and have a direct relationship with the immediacy of whatever experience they face. It could be as simple as, for instance, when the clinical on-call beeper goes off for a category 1 trauma, to locate the direction of the emergency department immediately and head there, open- minded. Or it could be as heartbreaking as being with a grieving family who was just told by the resident that their dearest and loveliest fourteen year old child who hung himself
“passed on.”
We die little deaths all the time, each moment when embracing impermanence.
But ultimately when we die with our last breath, who is it that dies? Insofar as I identify with my body, which is a combination of flesh, bones, blood, body fluids, marrow, sinews, am I this body that becomes ill through external disturbances or internal elements? Is it just my body that is going to die? If I am identifying with memories, desires, feelings, mental events, who dies?
As Homo sapiens, we are conscious of our consciousness, and understand that all formed things perish, that every birth ends in death, that death is certain, but the time and circumstances are not fixed. This means that we cannot truly say that we are independent and free, and this realization causes a lot of suffering. Death is in essence the most obvious and radical testimony of impermanence, held at bay by an extensive and elaborate system of personal and institutionalized distractions.
Death can be experienced as the ultimate joke on all of us if we do not have a strong connection to family, friends, the land and our ancestors who preceded us and relatives who will be born into generations to come. We must do what Joanna Macy
(2010) calls the “work that reconnects us.” The meaning and value derived from being part of something larger than we are, which lasts longer than we do, lays bare the spiritual core of our humanity in response to the terrifying and awe-inspiring mystery of death.
The bedrock of spirituality is the truth of impermanence, the practice of letting go and actualizing the relational dimension. This is the wider frame of reverence for life and its preciousness, where there is space for affirming love, both given and received, and feeling moved by grace.
So, when and how can we free ourselves from the ingrained tendency to get caught up and preoccupied with our sensory experiences and our thoughts, knowing that they do not last? Although the body may be hurting, do the heart and mind have a different kind of freedom? What do we learn and how do we recognize that all we experience is simply the play of our own mind? Do we need to control our mind?
Practicing mindfulness
“You can see a lot just by watching.” Yogi Berra
Often we are preoccupied and so self-absorbed that we do not pursue inquiry the way Aristotle proposed when he stated that “the unexamined life is not worth living.”
What deserves our attention and for what purpose? What is our mind? Can we make peace with it? How?
Let us look at a few definitions that might help us understand the structure, process and benefits of a contemplative discipline.
The definition of mind is, according to Dan Siegel, a UCLA psychiatrist: “an embodied and relational process that regulates and monitors the flow of energy and information” (2009) and is not to be confused with the brain, which is a mechanism that assists the monitoring and regulating functions.
He also coined the word mindsight, which is “the kind of focused attention that allows us to see the internal workings of our own minds. It helps us to be aware of our mental processes without being swept away by them and moves us beyond the reactive emotional loops we have a tendency to get trapped in. Mindsight allows us to examine closely, in depth and detail the processes by which we think, feel and behave” (Siegel,
2010).
Mindfulness is moment to moment awareness, with attention and intention, without judgment, according to Jon Kabat-Zinn, who started the Mindfulness Based
Stress Reduction Program (MBSR) at the University of Massachusetts Medical School some thirty years ago.
Given all these definitions as a basis for understanding mindfulness and meditation, we can invite ourselves to become more intimate with the workings of our mind and emotions in a way that generates insight. Meditation gets us in touch with our bodies so that we are not just walking “talking heads.” Meditating is not just about feeling good, it is about having a relationship with who we are in the present moment, without judgment, self-flagellation, deception, rationalization; just honoring what appears in our body and comes to mind.
With practice we can let go of old harmful, habitual patterns and emotional or mental afflictions and work toward authentic experiences that transcend the limitations we impose on ourselves and others. Mindfulness or meditation is a practice of being fully alive and strengthening the central axis of our way of being so that we do not walk around unconscious in the midst of our waking life. Any given moment we accept the actuality of things as they are, good, bad or neutral, we can heal and transform ourselves and we can behave with integrity, kindness and intentionality. There are four main qualities cultivated when we meditate that are important in relating with all life situations, not just while sitting on a cushion. They are, according to the American Buddhist nun Pema Chodron (2008):
*steadfastness,
*clarity of mind,
*experiencing our emotional stress, and
*insight into the nature of reality.
When we practice meditation on a regular basis we strengthen our ability to be steadfast with ourselves, as a mountain, no matter what kind of weather surrounds it, remains immovable. Wherever our attention is directed -- aching body, sleepiness, boredom, irritation, novel ideas, bad memories, disappointing relationships -- we observe and acknowledge what surfaces, without featuring or choosing any of the occurrences of perceptions, cognition, emotions or sensory experiences in the field of awareness.
Meditation is about the ability to be present with everything that appears around us and in us, not about attaining an ideal state of mind or getting rid of our thoughts. It is just sitting with the whole spectrum of probabilities and possibilities, not being moved or swept away by it all. Our intention is to become less driven by unexamined motivations.
We are not trying to continuously ride the crest of the waves; instead we every so often plunge into the depth of understanding and taste the salt and value of impermanence.
Continuous practice, even if it is for half an hour in the morning and evening, produces clear seeing, meaning, we become more and more honest with ourselves and have less self-deception. When we dissociate or space out rather than become spacious, we gently bring our minds back to steadiness, to being in the moment, and rely on an anchor like the breath, which can be used anytime, no matter where we are. The breath is the golden filament between life and death, the mind and the body, and comes from a
Greek word meaning “spirit, that which infuses life.” We are not trying to get rid of anything, not our unpleasant thoughts, defenses, our goals, expectations, self-criticism, creativity, bravery or neutrality. Going nowhere, doing nothing, nothing to eliminate or illuminate, we are just focused on being human, and being intimate in the moment with this adventure we call life.
We sit simply to bring our attention to our emotions; like clouds moving about in the sky, we note their content, the charge they might carry and their evanescent and passing nature. Instead of getting swept away through internal conversations, we stay with the felt experience, let go of the elaborate story lines and yield with the energy, neither acting it out nor repressing it and embrace the wisdom that is in all of us. With intention we rest in awareness and notice the moment of its arising, the moment of its lingering and the moment of its passing away. No more, no less, just trusting the beginning, middle and end.
Meditation is paying attention non-conceptually, non-judgmentally and gaining insight into what is and the impermanence of everything, emerging out of the play of boundlessness. We let go of judgment through practice. Through meditation there is a greater ability to develop discernment so we can differentiate our unique streams of awareness, which helps in reducing ruminating and addictive thoughts or behaviors, repetitive destructive emotions and impulsivity. It honors the interior life, enhances intimacy and is self-regulating. We know through research that the brain is an anticipatory machine, and that we can by the simple act of labeling the thought (“thinking”), the emotion (“frightened”) or feeling (“warm inside”) in the moment, activate and thereby calm the part of the brain called the insula. That part of the brain has bilateral pathways as well as a map of the entire body. Given our stated definition of the mind, it indicates that we can regulate and monitor our neural pathways and alter the central nervous system’s wiring, particularly the para-sympathetic one, thereby increasing the fundamental properties of slowing down the flow of energy, neuroplasticity and resilience, and our capabilities of flexibility and adaptability to whatever presents itself (Siegel, 2010).
Those who practice meditation regularly have shown an enhancement in the left frontal activity of the brain, which reflects an” approach state” in which we move toward experience rather than away from it. Most recent research affirms that neuroscience has a rich commitment to comprehend the relation between the brain and experiences.
Meditation practices also “appear to reflect changes and activation in the anterior cingulated cortex and dorsolateral prefrontal areas” (Cahn and Polich, 2006, p. 200).
Contemplative neuro-science knows that the brain is embodied; an essential notion for understanding the bi-directional pathways that communicate between the brain and the whole body, particularly with the heart during the expression of loving-kindness and compassionate states. Our meditation practice helps transform our emotional traits, creates neuronal-plasticity, meaning that we can change our thinking and view and therefore influence our neuronal receptors and gene expression which becomes altered due to our experiences and how we relate to them.
Contemplative practices exert effects on: *the brain “through emotion regulation, working memory, cognitive control, and activation of specific somatic maps, and in
*and the body through symptom reduction, immune function enhancement and up and down gene regulation” according to Davidson (2010).
While we need more evidence based data to validate the benefits of mindfulness, we know from first hand experience that it helps us delve into suffering that might not be able to be fixed, or into moments of incredible tension with no visible resolution. We can welcome the unexpected visitors: ambiguity, uncertainty, blame, conflicts, complications, intractable problems, and illusions of control and the impermanence of our knowledge.
“The purpose of meditation is to eliminate negative traits in our mind and to promote our natural good qualities,” says Chokyi Nyima Rinpoche (2002). Realizing this may cause us to behave with greater integrity, purpose and meaning. We then, through ongoing practice and cultivation, eventually experience more internal coherence.
Training the Mind
Living one’s precepts
“For the moment, what we attend to is reality….” William James, The Principles of
Psychology
I want to present the backbone, the support of moral ethics which allows us to achieve mental stabilization and calm abiding and stand erect, tall and vulnerable, with our belly fully exposed as one of the few mammals on earth to do so.
The fundamental precepts that we follow and try to fully embody are necessary to kindle the light of insight. “Precepts are guidelines that steer us in a direction where we cause no harm because they regulate our mental continuum, the social order and cultural expectations and pull aside the curtain that makes visible our norms and beliefs,” says
Roshi Joan Halifax (2010). They are a body of realization of our view, values and guidelines of our awakening, and a compass in the midst of chaos, suffering and when the energy of our calling fades away.
By taking the precepts to heart we clarify our intentions, direct our motivation and center our aspiration. As Buddhist chaplains we claim the precepts in an official ceremony, take refuge in the teachings of the Buddha and receive a name from the lineage of teachers and students who have followed the way. We take a public stance in honoring our commitment without stepping into concrete or trying to pull ourselves up by our bootstraps!
How can we be connected to all and know that life is interdependent with everyone? How can we fully understand that everyone’s life is precious? How can we let others in our world without judgments, likes and dislikes? Can we take refuge in the awakened nature of all beings, the ocean of wisdom and compassion and humbly practice awareness of thoughts, behavior and speech?
By espousing the precepts, we commit to a culture of nonviolence, a just economic order, inclusiveness and a life based on truthfulness and equal rights between all. As chaplains our goal is to cultivate intimacy and direct experience effortlessly, refrain from killing the mind of compassion, be aware of abundance rather than scarcity and encounter each person with respect and dignity. We continually strive to accept unconditionally what each moment has to offer, formulate no lack or excess in expression, study the self and forget the self, let go of the mind of poverty and honor our life as an instrument of peacemaking.
It is important to feel that sense of gravitas once we answer the bodhisattva’s call and enter the field “of walking side by side with each being we encounter.” The techniques for disciplining ourselves physically, verbally and mentally help us to avoid the inveterate propensities we have to fall back on habituated thinking and act out harmful behavior.
Precepts help mitigate the effects of anger, delusion and attachments, particularly in healthcare settings, which Jon Kabat-Zinn labels as “suffering magnets.” There, many different and necessary functions and difficult decisions manifest constantly in a silo or in plain view, where conflicts surface regularly, consequently creating suffering and moral distress for everyone involved: patients, family members and staff.
How can we stay in our bodies without wrapping a distorted story around it?
How can we stand in the central axis of our being and not let stuff stick when it gets thrown at us?
Understanding non-dualistic thinking
The Buddha gave us a story to illustrate the point of dualistic thinking. He spoke of a man sleeping in his boat that is floating on the water in heavy morning fog and who wakes up when being hit by another boat. The man immediately screams and shouts at the other boat but realizes that no one is in it; it is just a boat that was not moored. It is so with us most often: feeling disconnected, ready to immediately look for another being to direct our energy towards, blame them for our misfortune so that we can justify our existence at their expense or at the very least express our righteous indignation.
One of the first guiding precepts in China that helped shape early Buddhist practitioners’ way into the world was actually one simple single precept: “Do not create separation.” The duality refers to a separation of our perception into some feeling of
“self” and some feeling of “other.” These two concepts, subject and object, cannot exist without the other. The seeds of suffering are actually present in the selfish emotions that flow from dualistic thinking.
Clinging to duality creates the platform from which we react to objects and people with either attachment or anger. In the absence of the dualistic perspective there is no way to generate a negative emotion. Hope stems from attachment and fear stems from aversion or anger. The only way to be at peace is to go beyond the dualistic clinging that allows those emotions to take root.
Our preferential mind, however, is not in neutrality: we have likes and dislikes and even though circumstances are neutral, we most often take a stance against or for something, against or for someone. We may at times divide issues for what is believed to be a good or beneficial reason and with solid logic -- at least we hope so. Most often we resort to blame, resentment and justification, and are focused on being right rather than entering in relationships.
We have however choices and can use our voice internally and externally by being assertive, owning our feelings, using “I” language (introjections) instead of “you”
(projections), stating our needs clearly, using strategies that enrich all involved and at the same time develop clear boundaries. We know to distinguish between observations and assessments because knowing the difference resolves breakdowns in communication or reduces misunderstandings.
Observations are descriptions that an organization or individuals have agreed upon as factual and they are either true or false. Assessments are statements that express the opinions, judgments, interpretations, projections or attributions of someone. They can be valid or invalid. We need to consistently listen to assessments and distinguish whether they were observations or opinions, and not argue about assessments as if they were observations.
We also need to distinguish feelings from thoughts and requests from demands so that we become accountable, understand response-ability and trust authentic relationship.
Conflict and miss-understanding usually occur because of lack of clarity, confusing needs with strategies, and wearing bullet proof garb when exhibiting passive or aggressive speech and behavior.
We can gradually move away from dualistic thinking by cultivating bodhicitta and pro-social qualities.
Cultivating bodhicitta
Someone saw Mullah (a well respected holy man) Nasrudin searching for something on the ground. “What have you lost, Mullah?” he asked.” “My key,” said the
Mullah. So they went both down on their knees and looked for it. After a time the other man asked, “Where exactly did you drop it?” “In my own house.” “Then why are we looking here?” “There is more light here than inside my house.” (From The Exploits of the Incomparable Mullah Nasrudin, by Idries Shah) Bodhicitta is a great light inside our house that dispels the darkness of ignorance and confusion. It is the backbone of Buddhism, the precious universal mind, stretching as far as space, limitless. It is sometimes compared to the greatest medicine or ultimate remedy for curing afflicting emotions. When we cultivate bodhicitta we become full of service to all without discrimination, seeing the whole person and situation as it is, seeing with soft eyes. As bodhisattvas we do not get carried away by all the undesirable conditions that arise or the different types of suffering and obstacles we encounter; everything becomes the ground of practice, “the directionless direction.”
Bodhicitta means that we cherish the whole world more than the self; we orient ourselves entirely to becoming more and more an effective emissary of service. It is the ultimate paradox of wishing happiness for others and thereby finding happiness in oneself. It is the crown jewel of spiritual practice. It is recognizing that all sentient beings have Buddha nature: not only do they all want happiness and freedom from suffering, but they can achieve it.
Our heart can reach out, expand and embrace all Buddha natures and make that heartfelt affirmation that is life transforming which launches us in the bodhisattva fields where nothing is devoid of participation.
Our work is to be a stable presence, which we can cultivate through several strategies. I mentioned one earlier by describing steadiness in mindfulness practice, the ability to focus our attention in a way that is highly stable, unwavering and resolved.
Another one is to investigate the capabilities of our minds and the ability to look deeply into our internal landscape, figure out how to get out of the patterns of our habituated thinking and have deep mind sight. We can become more familiar with the psycho-physical aspects of dying and have a panoramic mind that is receptive and non-judgmental through the following four gates.
They are the immeasurable qualities we cultivate with clarity and continuity in order to enter deep realization and new modes of existence in our spiritual practice, which always takes place within the context of our lives.
The first one, called loving-kindness, is a friendly way of behaving, a fundamental yearning for happiness for oneself and all beings. The very quality of Buddha nature is that of inexhaustible love, but that has been obscured by conditioning and so we learn to direct a heartfelt yearning of wellness and happiness for all beings. The number one adversary for loving-kindness is hatred, ill will, anger or contempt and the near enemy is desire/attachment, a state of mind in which we are not concerned with someone else at all. The distant enemy is malice, when we use our power to hurt someone and belittle them. Any time those are present in the mind we cannot experience or feel loving- kindness.
Erich Fromm indicated that love is the absence of fear, that love has no attachments and that love is eradicating unwholesome afflictions that create separateness.
We can use the following phrases to let loving-kindness flow forth and direct our mind:
May I and all beings be free of enmity. May I and all beings be free of afflictions. May I and all beings be free of anxiety. May I and all beings be well and happy. May this be true. May it become so.
The more we practice loving-kindness, the more we become tolerant and embody a wholesome sense of well-being, gentleness of heart and spiritual maturation, patience being the greatest protection for this spiritual practice. Compassion is the second immeasurable quality and implies that we are caring tremendously about the suffering of others, as if it were our own. It is complementary to loving-kindness but focuses on beings who are suffering and for whom happiness is a forgotten state. The vision is for the person who is suffering to be free of it, that no one needs to suffer and that there is always potential to be free.
The near enemy of compassion is grief and the far enemy is cruelty. Grief is an all consuming burden and has a heavy disempowering quality; and cruelty, which originates in a deluded state of mind, is harsh but impossible when compassion is present. When being cruel, it is hard to dehumanize someone without doing it to oneself and when grieving, dwelling in sadness has nothing to do with compassion; buoyancy, lightness and strength do. Compassion is not a spiritual luxury; his Holiness the Dalai Lama says that compassion is a necessity for human society to survive. May all beings be free of suffering and the sources of suffering. May they irrevocably be free of this suffering, not just temporarily. May all adversity be transformed into spiritual growth.
Next we have empathetic joy, which simply implies that we rejoice in the well being of others. Wherever there is happiness, joy and some virtue, we delight in it, rather than focusing on cynicism, contempt or jealousy. The near enemy is frivolity, which does not have any depth; the far enemy is cynicism or despair, which is mutually exclusive with empathetic joy.
Finally we have equanimity or impartiality. Equanimity is based on altruism and service because we realize that our well being is related to others. The near enemy is indifference and the far enemy is revulsion and attraction, in which our heart rejects some and reaches out to others. Kindness and compassion are states of mind that are very clear and clean and help us in having an impact on others by our unmitigated presence. This kindness and concern inspires confidence in the patient, who is then able to relax, be more at ease in her difficult situation and allow trust to arise. Often that trust can engender the opportunity for a more rapid recovery or, for the dying patient, some temporary or lasting relief. Since compassion is basic to our nature, we can train in removing the obscurations that impede our mind and relax in this ground of being.
Consistent practice of focusing on and cultivating the four immeasurable qualities allows us several benefits:
- Attentional balance and executive control through the development and sustainability of effortless attention, listening from the heart, prioritizing and being in touch with patients and their surroundings.
- Emotional balance and regulation.
- Cognitive control by regulating or overriding our habitual responses, fostering flexibility, insight and reappraising negative situations from a healthier perspective.
- Improved capacity to stay healthy and resilient through reduction of stress and having compassion for our immune and central nervous systems through balance, combining contemplation, reflection and physical and mental activities.
Being and doing are inseparable for coherence and integration in the service of people in transition from this life as we know it, into the mystery of death. We have to come to terms with pain and suffering in such a way that we do not go into empathic arousal or fall in the trap of pitying the patient or personalizing the suffering. Chaplains have to be able to integrate the suffering of their own life experiences, have a contemplative practice as well as certain ethical disciplines like the precepts to build a strong back of equanimity and a soft front of compassion to welcome all the people in their cloak.
When we delude ourselves about the true nature of our experiences or become attached to others, we not only hurt others but we also harm ourselves, become distressed or incapable of meeting the enormous amount of suffering we encounter and retreat in
“doing” and busy-ness, rather than being present and aware.
Opening the Heart
Practicing emotional intelligence
Chaplains need many traditional competencies to perform their tasks and duties, such as visiting people, providing assessments, charting, responding to calls, engaging in rituals, assisting other staff and performing so many other functions that are essentially in the domain of “doing.” “Doing” is no less important than “being”; they both complement each other.
I would like to propose and focus on some of the essential competencies that are less tangible or perhaps less discussed in the traditional role of a chaplain in end of life care.
The first and most prominent one has to do with intelligence, the fundamental tool with which we explore and know critically our external and internal worlds. One kind of intelligence is emotional intelligence and its measurement seems to be far more important than intellectual intelligence in predicting whether we will be successful, satisfied in life and in delivering good care when assisting people through major life changes and faith shifts.
While intellect is obviously an important aspect of the mind, it is primarily concerned with cognitive processes such as memory, imagination, conceptualization, logical reasoning, comprehension and evaluation. Emotion, on the other hand, is the state of a person, which includes physiological, mental, instinctual and behavioral aspects.
Emotional intelligence, according to Daniel Goleman’s definition, is “the capacity for recognizing our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and our relationships” (Goleman, 1997, p. 317).
The model of emotional intelligence is founded on five basic competencies applicable to ourselves and others: awareness, acceptance, regulation, cultivating insight and appropriate expression.
Let us look at some of the charged emotions that we encounter most often with people in end of life care. I will attempt to look at the potential challenges they might present, their generative capabilities and the opportunities they tend to manifest. Each emotion occurs along a spectrum from pleasure to pain. Any emotion can be an opportunity for growth or a source of suffering because of its self-validating force; but the important realization is that there are no bad or good emotions.
Love is the principal source of emotion. If something is not significant enough we don’t feel emotion; when someone is very important we will experience a strong emotional response. Sometimes we repress emotions or we decide to feel them; what is really fascinating though is that we always have the option to choose the intensity with which we are willing to experience each one of them. If we choose not to honor emotions and close ourselves to the experience, we very often undergo emotional black-out, which tends to manifest in three ways: stoic indifference, emotional arousal or dissociation and passionate explosion. Yet neither extreme reaction nor non-reaction serves us well. As we most often know, although usually neglect to address, we have to eventually welcome the pain in order not to become a pain, hopefully sooner than later, avoiding additional “arrows” into our too soft or too thick skin.
Let me describe a few of the most common emotions that we as chaplains come across and meet and welcome in ourselves and others.
*Sadness is one of the most common emotions experienced due to the imminent loss of life. Sadness is sorrow, mourning, as the heart turns inward to protect itself. Melancholy and misery slip into one’s being as a permanent syrup of hopelessness and pessimism.
When people allow themselves to experience ultimate loss and face the unknown, they can come to understand the ephemeral manifestation of life as well as experience the tenderness of the heart and vulnerability of their body.
People may become stuck against all odds, listless, voiceless, and deeply depressed or discover that which is ever-permanent: the impossible task of obtaining and maintaining everything we want. With sadness also comes fear about the loss of all we value, and fear invites us to potentially investigate many unfamiliar areas. Eventually, and we always hope so, they might accept more easily that all who are born will also die.
*Anger is a combination of sadness and fear around the irreparable, uninvited loss of one’s life. Only after much contemplation can someone find solace in having done everything possible to live a meaningful life. There might be grave difficulties in calmly accepting and gracefully handling life coming to an end. This might instead lead to outbursts, depression and the loss of existential meaning, and very often a combination or all of them. Maybe the angry person can come to accept with compassion and peace that she did her best within the limitations of her actions. Self-compassion, when truly felt, always softens or melts our judgment of ourselves and others; it diminishes the charge of anger that can potentially destroy, in an instant, years of internal work.
*Guilt is anger directed towards oneself. We may believe that suffering happens because we transgressed our limits, which caused unwanted consequences. It is narcissistic energy by nature and calls for apologies where expressions of remorse show true caring for the person at the receiving end. It is important to ask for forgiveness, which is so essential for anyone, but particularly for people who are dying and opt to travel light on their journey towards incomprehensible territory. By intentionally acting to resolve things, people can regain a feeling of peace and dignity. Forgiveness tends to lift people out of the well of self-contempt, rumination, obsession and separation.
*Pride manifests when we know ourselves to be seen as somebody truly special and valuable, way above the low expectations of the “tribe” and always wanting to be held in high esteem. When conscious of it’s presence we know that it requires a tremendous amount of energy! When people are close to death, with little autonomy and control, many feel that inner security, self-esteem and self-worth are hard to come by and, needless to say, do not often experience pride. Nonetheless patients can, with help and patience, come to discover that the consciousness that they are is far more spacious than that which they believe themselves to be. *Shame is the fear of making public anything that counters the image we like to project.
It stems from a state of devaluation and inferiority, the fear of not being “good enough,” which seems so prevalent in our culture. According to Dr. Aaron Beck lack of self- esteem is at the root of negative effects of emotion. He asserts that most depressed patients are characterized by feeling the four D’s: defective, defeated, deserted and deprived (Beck, 1989). Many patients at the end of life experience shame for things left undone or harm they created for their loved ones. Once patients realize that all shame is based on false self-identification and delve deeper into their basic nature they can potentially let go of doing something to be valuable, and instead direct themselves to become and express the value and unique beauty they embody.
There are many benefits to being aware of our emotions, and understanding their energy, and the potential for working with them or suffer the cost of ignoring them. As chaplains we want to pay attention to our own bodies and the felt sense when we are experiencing one of the above mentioned emotions, so that we can immediately be aware of how we get triggered and how wide or contracted our window of tolerance becomes.
We thereby lessen our chance of becoming emotionally distressed, hyper- or hypo- aroused, or shut down, or passing on to others the residual effects of long-unresolved emotional deregulation, and therefore create more suffering for our peers and patients.
Exploring spaciousness
One day, two monks came upon a river bank and saw a woman who was afraid to cross the turbulent waters. The older monk lifted her up and carried her to the other shore.
About an hour later or so the younger monk said, “I can’t believe that you touched a woman, it is against our rules and precepts!” The older monk replied, “I let her go a long time ago, why are you still carrying her around in your mind?”
How do we invite our mental states to integrate buoyancy and expansiveness?
Presence has no expectations. It is totally reliable, and in order to assist others to withstand change we have to open our hearts. Difficulties are part of life, so is dying, and we need to develop strength to bounce back when a situation is not too favorable.
Developing our awareness, we observe and welcome whatever crosses the field of our consciousness and give it some room, not leaning into action right away. If we want to have livestock control we give it a vaster pasture, say Tibetan cattle herders; it is not much different with our mind: we opt to give it more spaciousness.
We can use Greg Kramer’s Insight Dialogue model (2007), which suggests that we pause, relax, open and let emerge what surfaces in our interior world before responding, without judgment, embracing the deeper meaning under the surface movements of the mind.
Our work is to pull away the veil that makes our ethos less available, and instead trust the web of relationships we are surrounded by and check out not only the immune system of the patient but the professional team and the family members as well.
Building resilience
Care giving can affect both physical and emotional health. We delve into suffering that cannot be fixed sometimes and witness moments of incredible tension.
What allows us to remain visible? How are we able to keep coming back and stay present in such moments of despair? What comes up within our selves? Critical curiosity is needed to find out how things will unfold and whether things will come to some resolution. One of the reasons we entered the field of chaplaincy is to live with radical uncertainty. The choice we have is to stay in the present moment, enhance our skills of discernment between their suffering and ours, attend to both, and stay in the “not knowing” frame of mind or what we call beginner’s mind, which means that we are not being attached to any fixed idea about anyone. We then can “bear witness” by being fully present to what is and include everything that arises in our experience.
It is living with our heart wide open, an all encompassing heart, an aliveness that we bring into our practice, wherever we are, and going to the edge while having the capacity to drop and rise above it all. We are working with people who carry high levels of toxicity and our job is to be cognizant of it, not only focusing on bringing relief, but figuring out how we can stop contributing to the downward suffering cycle, interrupt it and bring about healing and transformation.
There are many trouble spots or pitfalls for caregivers who work with people who are dying. Sometimes we have unpredictable, often unconscious ways of coping or responding that may be disturbing and may present additional challenges to the dying person and others surrounding them. Some become heroic, with an attitude that they are the only ones who can help others; they “know what is best,” directing and bossing everyone around and giving orders as to what should be happening. Some may treat patients as if they are completely incompetent, not letting them have control over the things they can possibly figure out themselves, manage or want to. We can easily become attached to the importance of our roles, or hide behind them for fear of suffering or dying. Worst of all is to be unable to give space to the dying person because we feel we are needed every minute, or to insist on our selfish need of emotional contact, expecting loads of gratitude or potential rewards. Empathy “with,” by itself, can lead to symptoms of burn out and moral distress, whereas compassion “for” will not allow for over-enmeshment in the patient’s life.
As chaplains we can enter the dangerous territory of spiritual inflation, thinking we know exactly what is spiritually needed for the person who is dying, or have specific expectations about how they should die. There is nothing further from the truth. If anything, we learn to become patient and humble when allowed to accompanying others on their journey of mystery, and realize that most often help is not needed or at least not in the way we would like to provide it. It is no wonder and not by pure chance that so many people die when their loved ones have left the room to get a bite to eat or the staff has stepped out to respond to another call.
Every small act of kindness and compassion we generate brings spaciousness because everyone we meet is fighting a great battle. We do what we can, knowing that we have very little control in life, with death or another person’s suffering.
Not being attached to outcome
Can I take responsibility for meeting people seriously and not take myself seriously?
Our best visits are those in which we get out of the way, stop impressing ourselves or others, let go of our goals, agendas and best intentions and meet the patient in the superficial and the mundane realms as well as during the deepest levels of doubt or epiphany. We come to realize how our own conditioning of doing a good job is unnecessary when we are truly present with another’s wishes, perceptions, fantasies or remorse.
Our ministry is to welcome the whole range of thoughts, emotions and meaning that present themselves in the moment of our engagement and to validate them. There is no need to rescue, or defend one’s pastoral authority or for that matter forfeit one’s beliefs. The best outcome with any visit is for us to be in presence, empty minded, firmly rooted in the central axis of our being.
Creating pathways of engagement
“If you came here to help me, don’t bother! If you came here to share your liberation with mine then we can walk together.” This beautiful quote is from an indigenous woman after the tsunami disaster. (Lori Leich, March 2009)
Sometimes statistics help us to focus on what is transpiring in a healthcare setting so that we can potentially come up with intelligent and productive interventions.
Life End Institute (LEI), Missoula, MT, conducted a survey of 1,200 community members which revealed that 92% of the respondents said that being at peace spiritually would be important at the end of life. A national Gallup survey (October 1997) suggested that 54% want human contact and to be able to share their fears and concerns, 47% expressed a desire to hold hands or touch, yet only 44% indicated that prayer would be important. The most shocking response showed only 36% of respondents felt the presence of a clergy person would actually be comforting for them at such a time. This is, needless to say, not too comforting a revelation for chaplains and hopefully progress has been made since then!
How do we meet each being as Buddha and self? How do we befriend our uncomfortable self? Can we let the dying person lead?
Conceptual schemas help us remember the path, reminding ourselves that all beings are moving toward liberation at different velocities. There are many techniques to elicit engagement but they all require us to ask many questions.
How do we discern core issues beneath the underlying and presenting issues?
How does an action plan guide us and not blind us? How do we become aware of the parallel stories and how they connect to our own stories?
A) Autobiographical narratives
“I had my nails done, how do you like them?” “They are beautiful!” responded the staff member. These were a hospice patient’s words addressing the staff after she had a manicure. She died an hour later (Lynn and Harrold, 2001, p. 10).
There is no map for making the most out of stories, but sometimes a brief compliment or dialogue can be the cheapest wonder drug. No matter what surfaces, we merely listen or acknowledge what surfaces. Words fill the space between the listener and the one who talks, and every once in a while we can ask more questions. They are rarely epic stories; sometimes though, the villain is the disease and the patient is the hero, or sometimes it is the doctor or another caregiver. Stories are not material to be analyzed, they are the beginning flow of relationality and we become an empathic witness, barely facilitating the coherence of those stories. Patients usually think and talk about their personal history within the context of the medical information they have been told and try to make sense of it. Clinicians talk facts and often patients miss the importance of the cues they receive. Most of the times just hearing a word like cancer, they will miss any and all subsequent information.
At some point in the progression of their disease they need to tell their stories of despair, separation and intense loneliness, their complete dehumanizing dependence on others for basic functions. They sometimes acknowledge their anger and hurt and come to believe that they are worthy of forgiveness. We express compassion for them so that they can tell their narratives, their acts of generativity and unique gifts as well as stories focusing on medical facts, unresolved personal issues and deficiencies.
Healing often comes from the act of storytelling, the continuous and dynamic search for meaning. The patient’s act of telling and our act of listening are themselves bearers of comfort and dignity. Suffering dwells in the space between the words and sometimes even beyond language, but stories most often have great power to bring forth insight, love and compassion, and suffering diminishes or ceases when it takes on meaning.
Our role may be to launch questions so that the searchlight of the patient’s neo- cortex might reveal and discover memories, experiences and tales long forgotten. Some of the questions could be: Tell me where you were born, what was it like there and then? What will serve you best? What other story lines have you given up that no longer make sense? What is alive in you right now? Who were your benefactors and do you have any now? Would you do anything different given what you know now? Usually the illness is placed in the context of the whole story. We need to accept the story as it emerges, real or not, symbolic or not. We are not information brokers in that moment. We enter the interpreter’s world: state what we have heard, what the central theme might be and how the story weaves together, if we say anything at all. Once in a while we have to elicit their words so we can align with their stories and recognize them in their personhood.
As we remain curious, we do not always need to accept the first response; sometimes we can facilitate more depth: How is this conversation going for you? Are the questions I am asking guiding the conversation in a direction that is working for you? Are there questions you would like to ask me that I have not yet asked?
These few questions invite an alignment of our voices, inviting what others are able and willing to share. Often long time troubling issues, deeply felt and unexpressed emotions that have been muted or removed from the surface of daily lives become visible and emerge in ways they would never have at any other time. Stories do not always have to become conduits for consolation. It is rewarding to see them as reflections and reconciliations with life as a mystery and not just a problem, and to witness as the narrator is able to let them go, little by little, and go beyond self.
As staff we have to connect but not become enmeshed in the stories or triggered by a patient’s narrative. However, we cannot afford to disconfirm our own emotional charge about some element that surfaced in the conversation and is felt in our body during emptiness of thoughts. We want to stay away from patterns of dis-regulation and work from our resource points, not deficit points. Silence is receiving growing attention in our noisy lives and can be generative, opening space for a few words that either weigh heavily, or are cherished and treasured.
Sometimes no words are necessary to be expressed and in those moments we can provide a “hands on practice” such as reiki, letting the hands do all the talking and receiving if they are willing.
Reiki practitioners follow five guiding principles: just for today I will live the attitude of gratitude, I will not worry, I will not anger, I will do my work honestly, and I will show love and respect for every living being. These energetic principles permeate the space between and within the practitioner and the patient and allow for wholeness that both so desire. It is also a way to give our tongues a rest and move the energy in a quiet and powerful way.
B) Helping people regain their spiritual dimension
Self Portrait
It doesn’t interest me if there is one God or many gods. I want to know if you belong or feel abandoned. If you know despair or can see it in others. I want to know if you are prepared to live in the world with its harsh need to change you. If you can look back with firm eyes saying this is where I stand. I want to know if you know how to melt into that fierce heat of living falling toward the center of your longing. I want to know if you are willing to live, day by day, with the consequence of love and the bitter unwanted passion of your sure defeat.
I have heard, in that fierce embrace, even the gods speak of God. -- David Whyte, Fire in the Earth
Most people with a serious illness want to reclaim the spiritual dimension, make peace with themselves and those around them, forgive and ask for forgiveness, actualize compassion to the extent they can and let go of the unnecessary stuff that has little meaning when the breath becomes more laborious, weaker and weaker. While not everyone is fortunate enough to be moved and lifted up from such a harmonious and peaceful internal launching platform, many strive for it.
How do we create safe space for diversity of race, gender, sexuality and faith? How do we reflect a patient’s readiness to surrender and embrace their dreams, metaphors, beliefs? How do we connect with every patient’s spiritual dimension?
Spiritual care is defined as “the aspect of humanity that refers to the way an individual seeks and expresses meaning and purpose and experiences their connectedness and significance to self, others, the moment, nature, the earth and the sacred” (by the committee comprised of Roshi Joanne Halifax and her colleagues, Betty Farrell and
Christina Puchalski) (Puchalski, C., et al., 2009).
This is a broad definition that includes many elements that anyone, even someone of little faith, can subscribe to and find aspects in that bring instances of tolerance and peace, moments of freedom, and that can become a bridge to the unfathomable, unthinkable matrices or indices of the transcendent, wisdom and bliss. Spirituality and religion cannot be compared or contrasted; they really complement each other. Yet both are based on beliefs, faith and rituals for the search of meaning, safety, solace, belonging and refuge by individuals when fearful, adrift, lost or dying.
Beliefs are an integral part of spiritual care and are based on the metaphysic infrastructure of our cognitive understanding of the world. They are usually assumptions of what is true and are given to us by an “authentic” authority, jelled into the formal statement of a doctrine. They are not thoughts that waiver; they strengthen our core so that we can walk on the path of liberation, with faith to complement our beliefs in order not to become too contracted and narrow minded.
Faith is the trust in the mysterious and is based on reliance of an external locus of control; it is also our covenant. It is a force lying below the stratum of reason and is fueled by the intention to integrate the self into the sacred order of living. It leads us toward the scope of things as they are, a world without flaws, where rarities of mystery are glowing softly around us, brighter than the mind can grasp. Faith helps us abstain from arrogance, spurs devotion towards a life of service and often surprises us with flickers of wisdom. It is not about critical knowledge but the attempt of the heart to risk and initiate affection and inter-action with our fellow human beings. It has a medicinal quality when applied in the context of anxiety, astonishment, doubt and perplexing groundlessness.
Liturgy is comprised of rituals and sacred texts that evolve around our beliefs, faith and spirituality, and speaks of deep truths and seals common bonds. Sacred texts in all spiritual venues are elaborate and extensive with many leading songs and stories that reveal the mundane and transcendent, showing us ways to navigate our daily life with all its joys and woes. Liturgy sometimes brings back memories of earlier days when the heart had its reasons that reason did not always understand and innocence allowed for communion with a world filled with light, ceremonies, scents and colors.
For quite a few patients, the last moments of their lives seem to bring light, peace and even bliss while they are surrounded by loved ones, prayers, music or deeply held silence.
CONCLUSION
We have looked at the “being” and some of the “doing” aspects of chaplaincy in end of life care. Both elements are differentiated aspects that need to be integrated for chaplains’ well being so that they can serve the people they assist with depth of character and kindness. Flexibility, adaptability, coherence, curiosity and stability are elements that bring together infinite possibilities of presence within the context and journey of end of life care.
Chaplains need a certain balance between the extremes of wanting to save everyone and abandoning a few who don’t necessarily move them or are difficult to relate to. Presence is defined as drawing from that inner place or source within ourselves with the ability to be available without any preconceived ideas or intentions, as a rope that becomes untied unravels just as it must in its unraveling, untangling the tangle. We can suspend our judgments, tolerate the “don’t know mind” and shift our awareness through attention from the hub, our Buddha-nature, to the rim of the wheel of life, and back again and again. The faith shifts we witness in others and ourselves are associated with beauty, revelation, vital energy, quieting the mind, where the normal flow of thoughts ceases and the usual boundaries between self and world dissolve.
Presence has the deep quality of full consciousness and awareness in the present moment, of being open beyond one’s preconceptions or needing immediate solutions to make sense of it all. Inner chaplaincy requires letting go of old identities, the need to control. Instead we participate in a larger field force. Our abilities become an expression of the capacity to go deeper within, sense an emerging reality and act in harmony with it.
The inward bound journey lies at the heart of all creativity and resonates with everyone’s inner knowing when we move to seeing from both, the whole and the parts.
The chaplain path is a noble and humble one that requires us to welcome anything that comes our way. It requires a well balanced make-up that comes with the maturity of an older soul and the openness and curiosity of a child. Nothing is too vast to wonder at or too small to ignore or discard. The motto “I will not abandon you” demands that we stand on solid ground with open arms to welcome all, as well as take time out to nourish ourselves through practices that revive the body, mind and heart. We are the boundary spanners weaving the thread between the mundane and the sacred, the subjective and scientific, ethics and spirituality, and taking on the role of key communicators among the patient, professional staff, families, and the community.
We use discernment to follow our inner voice and call on discipline to say yes to the rhythms of our heart, the heart being, as John O’Donahue (2008) claims, “a place of arrival and departure within the body…where all the wearied blood arrives … to be refreshed and renewed…it is the place of ending that is always a new beginning” (p.
104). He continues: "A compassionate heart never need carry the burden of judgment, a forgiving heart knows the art of liberation, and a loving heart awakens the spirit of possibility and engagement with others.”
Tibetan and Chinese cultures do not have words that distinguish between mind and heart, and new neuroscience research seems to support the close correlation between mind and relationality. The more we work with people who are transitioning from what we know as life to the unknown we call death, the more we understand the benefits of integrating all elements around us and within so that we may celebrate their wholeness and meet the unlimited possibilities of presence, listening, welcoming cries of suffering and sighs of relief, and the breadth of devotion and grace.
I said to the wanting creature inside me: What is this river you want to cross? There are no travelers on the river-road, and no road. Do you see anyone moving about on the bank, or resting? There is no river at all, and no boat, and no boatman. There is no towrope either and no one to pull it. There is no ground, no sky, no time, no bank, and no ford. And there is no body, no mind! Do you believe there is a place that will make the soul less thirsty? In that great absence you will find nothing. Be strong then and enter into your own body; There you have a solid place for your feet. Think about it carefully! Don’t go off somewhere else! Just throw away all thoughts of imaginary things, Stand firm in that which you are.
Kabir (Ecstatic Poems)
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