by Vimala Inoue

When we feel hostile toward the person we are trying to love and care for,
we need prayer as a way to forgive ourselves and give ourselves time to
let kind feelings revive within us.

When people are caught up in a maelstrom of suffering, they pray to be relieved of their pain and released from that suffering. In the same way, when we see the suffering of someone else, our hearts grieve and we pray that the person's suffering will be relieved. In such a situation, while we are of course hoping that the other person's distress will be alleviated, we are also wishing for a return to peace of mind for ourselves. In this essay, I would like to examine prayer as an expression of the feelings of a person who is empathizing with the spiritual pain of someone else by keeping watch over the sufferer and hoping the pain can be eased.

In actual situations where spiritual care is being given, quite often keeping watch is the only care possible, although caregivers may be feeling aggrieved at the client's pain. Even though caregivers may be aware of and embrace their own spiritual pain, which arises from being able to do nothing but keep watch, just the act of empathizing with the client - not avoiding the person but staying with him or her - constitutes a kind of prayer that transcends words and defies description.

This kind of prayer, which arises when the client is not left alone but is watched over by someone sharing the sufferer's presence, creates a kind of contained space or vessel of warmth and security. Within this spiritual vessel of security, clients (even if unconscious) can reencounter themselves on a deep level, call into account the meaning of their lives, and search for words and images appropriate to their own personal truth. Meeting with one's true self, attempting to accept that truth, and groping toward an appropriate expression of that truth constitute the client's prayer.

Such prayers are improvised, unlike the formulaic or ceremonial prayers of religion, and can be seen as prayers of spiritual meaning.

Origins of the Hospice Movement

Such spiritual care has its origins in the hospice movement. Dame Cicely Saunders (1918 - 2005) is recognized as the founder of the modern hospice movement (she was elevated to knighthood in 1979). She set up the first modern hospice, Saint Christopher's Hospice, in London in 1967. Starting out as a nurse and qualified as a medical social worker, she became a doctor and studied the pain-relieving qualities of morphine. Ms. Saunders established the hospice movement based on three principles: (1) effective pain relief, (2) a team approach enabling whole-person/patient care aimed at a better quality of life for the patient, and (3) ongoing educational activities involving research and sufficient communication of results among staff to provide care suited to the individual needs of patients.

The practical implementation of the hospice movement consists of communication and care for patients based on these principles and is not dependent on the existence of buildings or other facilities. Spiritual care is an important part of whole-person/patient care stemming from these principles of the hospice movement and has in recent years attracted considerable attention.

The word hospice is derived from the Latin term hospes, which encompasses the meanings of both guest and host. Hospes expresses in just the one word the entire set of cyclical human relationships that involve giving and receiving, welcoming and being welcomed. Because there are those who receive, we can give, and I think that ideal care and communication occurs when the person receiving the care can do so without feeling ashamed or belittled. In this, many caregivers entrust themselves to the spirit of Christianity that recognizes the existence of God within other people and considers service to others acts of devotion to God. In such a situation, prayer directed at the God recognized within other people will be embodied as the performance of actual service and care.

Prayer as Vessel for Embracing Ambivalence

In a different direction, the word hospes is also related to the word hostis, meaning enemy. When we attempt to accept other people just as they are, their existence effects a change in us, and we become a different person compared with who we were before. This can give rise to anger and aggressive impulses. Somehow, we come to regard as an adversary the person we were trying to accept and welcome. This internal battle of emotions is an unavoidable destiny for people involved in the work of trying to help others.

When we feel hostile toward the person we are trying to love, when we want to get away from or even harm the person, I think we need prayer as a way to forgive ourselves and give ourselves time to let kind feelings revive within us.

We have both the desire to be kind and the desire to hurt, the desire to be close and the desire to run away, but I believe that we can find a vessel or space in which we can catch, hold, and keep an eye on this kind of polarized emotional energy. In psychology this space is called an environment for accepting ambivalence, in Buddhism it is regarded as seeing things as they really are from the viewpoint of the Middle Path, and in Christianity it is expressed as an awakening to the love of God that forgives human sin.

Wisdom and powers of insight that are joined by loving-kindness are expressed in religion as compassion, the love of God, or unconditional love; these things are indispensable for prevailing in the emotional battlefield that is inevitably encountered in the work of caring for other people, and exercising them can be thought of as prayer. This is a kind of life-protecting prayer not unlike embracing, calming, and protecting from harm a small child who is throwing a terrific tantrum.

Those who care for others cannot survive harrowing clinical drama without this kind of prayer: by prayer in this context I mean approaching the client with a pure heart, understanding and accepting the client as he or she is, and tolerating both a reality that does not accord with your own wishes and your own imperfect self.

Care as True Expression of Human Nature

From child care to terminal care - from the time the spirit enters the body until the time it leaves - people cannot survive without accepting the care of others. Compared with other animals, human infants are born relatively undeveloped, meaning that we are born into a state of absolute dependence and will be able to survive into maturity and acquire language and culture only if we receive care from other people. This was the evolutionary strategy developed by our species.

Professionals who give spiritual care in the course of watching by the deathbed come to hold the opinion that the human spirit has a tendency to try to solve any unsolved problems as the end of life approaches. These problems can usually be placed in five categories: (1) finding the meaning of life, (2) forgiving oneself and forgiving others, (3) saying "thank you" to those who have given one support, (4) saying "I love you" to loved ones, (5) saying good-bye.

The problems of clients who are exhibiting spiritual pain can often be identified by referring to these five categories in an attempt to see whether there remains something unresolved between the client and his or her family or friends. The spiritual pain that can prevent caregivers from being able to draw close to their clients' pain or cause them to burn out also tends to originate in these same kinds of unresolved life issues.

People can take good care of others only to the extent that they can take good care of themselves. The five categories mentioned above also serve to indicate in what areas we need to take good care of ourselves, take good care of others, and live better lives.

Dr. John Bowlby (1907-90), a British psychiatrist and psychoanalyst who advocated "attachment theory" in regard to the relationship between mother and child, said that the process through which an individual's personality is built up is the most important factor regulating how he or she will react later on in life to adverse conditions, especially rejection, separation, and loss. I find this suggestive of the connections between the beginning and ending of life.

If caring for others is an important part of being human, the spirit that gives rise to feelings of mutual sympathy and concern and acts of hands-on care must also be arising from the working of life itself rooted in true human nature. Working in the field of spiritual care has led me to think that prayer is in fact the working of the spirit rooted in this way in true human nature.