Monday, October 21, 2019

Arthur Kleinman on the “Soul of Care”

This week is Spiritual Care Week, which means that all around the world organizations and institutions are recognizing the spiritual care providers and the spiritual care that's given through professional chaplaincy and pastoral counseling within their communities.

Started in 1983 as “Pastoral Care Week,” this global celebration of spiritual care takes place every year in the last week of October. This year marks this special week's 34th anniversary.

As a palliative care chaplain in a hospital setting, my work is all about spiritual care. And it just so happens that my birthday occurs within Spiritual Care Week! How appropriate is that?

In celebrating Spiritual Care Week here at The Wild Reed I share an excerpt from The Soul of Care by Arthur Kleinman, a wonderful and powerful book that I'm currently reading. I find Kleinman's understanding of care to be one that very much resonates with my experiences as both a professional chaplain and as a human being who seeks to be a living embodiment of Divine Presence in the world.


Care is a human development process. Often in our society, boys are raised to be careless, girls to be careful. It takes a long time for adolescent and young men to learn to care about others and then become caring, and at last give care. While the social pressure and cultural expectations of women to be carers is much greater, it doesn't mean care is natural or easier for them. Women develop as carers too, Care is centered in relationships. Caregiving and receiving is a gift-sharing process in which we give and receive attention, affirmation, practical assistance, emotional support, moral solidarity, and abiding meaning that is complicated and incomplete. Care is action, practice, performance. Often it is reaction. A constant reaction to the needs of others and ourselves under difficult conditions and in different contexts. Care is accompanying someone through their experiences of alarm and injury. It is assisting, protecting, thinking ahead to prevent further difficulty.

Care is also about the vital presence – the liveliness and fullness of being – of both the caregiver and the care recipient. Acts of caring call that presence out from within us. Care does not end with death but involves actively caring for memories. I learned that caregiving entails moments of terror and panic, of self-doubt and hopelessness – but also moments of deep human connection, of honesty and revelation, of purpose and gratification.

I also learned how far the domain of caregiving extends beyond the boundaries of medicine. Caregiving is perhaps the most ubiquitous activity of human beings, and it can be the most demanding, at times discouraging, one. It is also the existential activity through which we most fully realize our humanity. In the humblest moments of caring – mopping a sweaty brow, changing a soiled sheet, reassuring an agitated person, kissing the cheek of a loved one at the end of life – we may embody the finest versions of ourselves. It can offer redemption to the caregiver and the person to whom he is giving care. Care can offer wisdom for the art of living.

Caregiving is hard, sometimes tedious, unglamorous work, but it resonates with emotional, moral, and even religious significance. Understanding the meanings that arise from the practical work of care may help us to meet the challenges of sustaining it, and of enduring its many trials, and also may strengthen us to face the other tests that life brings. Those challenges are increasing. I believe we are living through a dangerous time when high-quality care is seriously threatened among families, in the health professions, in our hospitals and aged care homes, and in our society at large. Amid the hardness, hate, violence, and cynicism that fuel politics today, an anti-caring ethos prevails, and undermined by funding that scarcely touches the need, care can be wrongly portrayed as softness and sentimentality. It is neither. Care is the human glue that holds together families, communities, and societies. Care offers an alternative story of how we live and who we are. But it is being silenced and diminished in value, in the United States and around the world, sacrificed on the altar of economy and efficiency, demanding more and more of families and health care professionals with fewer and fewer resources, and threatening to displace meaning in health care. The moral language of human experience, of people's suffering and healing – the bedrock of our common experience – is being stifled, and at worst will be lost.

We must be prepared to ask uncomfortable questions of ourselves, to challenge the assumptions of our institutions and the premises of the "health care debate." It is time to act. This volume is my testament about caregiving and why it matters most.

– Arthur Kleinman
Excerpted from the prologue of his book, The Soul of Care:
The Moral Education of a Husband and a Doctor

pp. 3-5

See also the previous Wild Reed posts:
World Hospice and Palliative Care Day
Chaplaincy: A Ministry of Welcome
Interfaith Chaplaincy: Meeting People Where They're At
Spirituality and the Healthcare Setting

Image: A sculpture on the grounds of Emmaus Nursing Home in Port Macquarie, Australia, where my father Gordan Bayly lived the last two months of his life earlier this year. (Photo: Michael J. Bayly)

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