Revista Brasileira de Geriatria e Gerontologia ISSN: 1809-9823 [email protected] Universidade do Estado do Rio de Janeiro Brasil Fernandes Costa, Mariana; Coelho Soares, Jorge Free as a butterfly: symbology and palliative care Revista Brasileira de Geriatria e Gerontologia, vol. 18, núm. 3, julio-septiembre, 2015, pp. 631-641 Universidade do Estado do Rio de Janeiro Rio de Janeiro, Brasil Available in: http://www.redalyc.org/articulo.oa?id=403842640016 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative http://dx.doi.org/10.1590/1809-9823.2015.14236 631 Free as a butterfly: symbology and palliative care RTICLES A RIGINAL O Mariana Fernandes Costa1,2 Jorge Coelho Soares2 Abstract The aim of this study was to investigate the relationship between butterflies and palliative care. A qualitative ethnographic study was performed, based on participant observation in two Oncology Palliative Care Services in Brazil and in Portugal. A literature review on the etymological and symbolic meaning of butterflies, followed by discussions with experts who have studied this insect and its presence in art, books and movies, was undertaken. Butterfly symbols vary from place to place and from people to people, and the semantics and representation of the insect are associated with various forms of life, culture, religion and belief. The constant and intriguing presence Key words: Palliative Care; of butterflies on the walls and windows of the hospitals studied has a significance for Death; Butterflies. palliative care. The metamorphosis of butterflies is symbolically associated with radical changes in human lives, with death perceived as a possibility for renewal. Therefore, the breaking of the cocoon is the death of the body, when the soul achieves freedom in the image of the butterfly. Thus, palliative care, in its theoretical philosophy and applied practice, assists and eases this process of change in the lives of patients and their families, without denying the death, pain nor suffering experienced by the elderly during an advanced disease. 1 Hospital do Câncer IV. Instituto Nacional do Câncer. Rio de Janeiro-RJ, Brasil. 2 Universidade do Estado do Rio de Janeiro, Instituto de Psicologia. Rio de Janeiro-RJ, Brasil. Correspondence Mariana Fernandes Costa E-mail: [email protected] 632 REV. BRAS. GERIATR. GERONTOL., RIO DE JANEIRO, 2015; 18(3):631-641 INTRODUCTION research project. During such research, I noticed that one image was repeated in palliative care Concepts and ideas about death and dying units: the butterfly. Wherever I looked, there have undergone a number of historical and they were, sometimes big and sometimes small, social changes over the centuries. Today, death but always extremely colorful, like a rainbow. suggests something painful for humans, and Sometimes they were accompanied by flowers, conjures up feelings of loss, the pain of grief, giving the idea of a garden. It is likely they a sense of finitude and the fear of an uncertain have been pasted onto walls and windows as future. It is a certainty that we will all die, and yet part of a strategy to “humanize” the hospital we live our lives without thinking about death. environment. But the images made me wonder, Witnessing the arrival of death is no longer a why butterflies? Undoubtedly there was a special custom in our society, and waiting for death is significance behind the use of these images. But difficult to bear. The exclusion of death and the what? These questions intrigued me enough to dying are cited as key features of contemporary lead me to investigate the relationship between society, highlighting the loss of autonomy of the the symbolism of butterflies and palliative care. individual and his or her non-participation in decision-making within the hospital.1 METHODOLOGY According to the World Health Organization, A qualitative ethnographic study was carried the palliative care approach improves the quality out in 2013, based on participant observation of life of patients and their families when faced in the field. Qualitative research involves an with problems associated with terminal illness, interpretive approach, in which the researcher through the prevention and relief of suffering by studies the phenomenon from within, seeking identifying, assessing and treating pain and other to identify the meaning of such a phenomenon physical, psychosocial and spiritual problems.2 while respecting the significance that people The crucial issue in palliative care is the quality attribute to it.5 of life in question, and not simply the amount of time an individual has left to live. The principles Field work is an essential part of qualitative of palliative care affirm life and treat facing death research.6 The institutions participating in the as a natural process; do not seek to postpone present study were the Hospital do Câncer IV or prolong death; provide relief from pain and (HC IV) of the Instituto Nacional de Câncer José other symptoms by integrating care and offering Alencar Gomes da Silva (INCA), Rio de Janeiro support so that patients can live as actively as (RJ), Brazil; and the Palliative Care Service possible, and help family members and caregivers (PCS) of the Instituto Português de Oncologia in the grieving process.3 Palliative care, then, seeks Francisco Gentil (IPO), Porto, Portugal. to “humanize” dying. According to Saunders,4 The study was approved by the Research it is important to ensure the care of the human Ethics Committees of NCA and IPO under being as a whole, promoting overall wellness and record numbers 462.858/2013 and 108/2013, maintaining dignity, so that he or she can live his respectively. or her death and not be dispossessed pf his or her own life. It is worthy of note that many patients The ease of access to the HC IV of INCA that in palliative care are elderly. I enjoyed, a result of my professional role as a nutritionist at this institution, allowed immersive The present study is an ethnographic essay study of this unit, its physical structure, staff based on Oncology Palliative Care Services in and patients, and how its palliative care strategy Brazil and Portugal, and forms part of a doctoral functions. I sought to perform a similar Free as a butterfly 633 observation at the IPO PCS, where I spent a new Osiris. The butterfly acquires an important period of 15 days as a visiting professional in the semantic significance, becoming the symbol of Nutrition and Food Service. An ethnographic a life that is constantly renewing itself, a sign of approach was used to describe the field of study, rebirth following death.10 identify the social scenario and contextualize the data collection, in order to provide continuity Symbolism of this kind is used in the Greek with the other phases of the study. myth of Psyche, who is drawn with butterfly wings, as well as in the frescoes of Pompeii, in While participant observation includes which she appears as a winged girl, similar to involvement in daily or routine activities in the a butterfly.8 The Greek term psych, from psyche, research stage, when researchers decide to study which means “breath, breath of life, soul”, a community considered to be well-known or forms part of a number of words in the Greek well-understood, they should realize that the language and later in many terms introduced dynamics of change lead to the inclusion of into international scientific language from the certain determinant factors hitherto ignored in nineteenth century onwards. The word psychology, 7 the network of social interaction. for example, means the “science of nature, human functions and phenomena of the soul or The first step in analyzing the relationship mind” in a definition dating from 1844.11 between butterflies and palliative care was to perform a review of literature on the etymological In works of art, Psyche is represented, together and symbolic meaning of butterflies. This was with Cupid, as a young woman with butterfly followed by meetings with experts in the study wings in the various scenes described in the of this insect and its presence in art, books and story.12 Such was Psyche’s beauty that Venus came movies. To deepen the symbolic connection to be jealous of her. The goddess ordered Cupid between butterflies and palliative care, the ideas to make Psyche fall in love with an evil-looking of Elizabeth Kübler-Ross were analyzed as a creature, but instead Cupid himself became her theoretical framework. lover. To keep their love secret, Cupid put her in a palace, but only visited her in the dark and RESULTS forbid her to try to see him. Driven by jealousy, Psyche’s sisters told her that he was a monster One aspect of the symbolism of butterflies is and would devour her. One night, Psyche used based on metamorphosis: the chrysalis is the egg a lamp to light the room so that see could see that contains the potentiality of a living being, Cupid when he was sleeping, but a drop of oil fell and the butterfly that appears from within it is from the lamp and woke him. As a consequence, a symbol of resurrection, a kind of emergence Cupid abandoned her. Alone and full of remorse, from the grave.8 In other words, the life stages Psyche sought her lover throughout the land, and of this insect, namely caterpillar, chrysalis and was set several challenges by Venus before she butterfly signify, respectively, life, death and could see him again. All the tasks were eventually resurrection, and as such represent the Christian completed except the last, which was to descend metamorphosis.9 The butterfly is, therefore, to Hades and bring back a box containing a associated with this natural phenomenon of dose of the beauty of Persephone.