|Being a Compassionate Presence|
In April 2009, Rigpa organized an international conference in Ireland entitled Compassion and Presence: Spiritual Care for the Living and the Dying.
The conference set out to explore how caregivers of all kinds can find spiritual and contemplative resources to support themselves in their work, and enhance the care they give to their patients.
As a pioneer of hospice care for more than thirty years, and one of the founders of Rigpa’s Spiritual Care Education Programme, Christine Longaker had been asked to lead the opening session of the spiritual care conference in Killarney, south-west Ireland. When she stood up to address her audience of five hundred healthcare professionals and carers, however, she was forced to admit that she was unable to give them a satisfactory definition of spiritual care.
In other conference settings, such an admission might have been a cause for concern, but she pressed on. “It is impossible to come up with one definition of spirituality and spiritual care that we all agree with,” she said, “and if you think about it, that makes sense, because we are all coming from different places. We all have different life experiences and understandings of spirituality and spiritual care.
“Not being able to define it and fix it into a nice conceptual box is actually a good thing, because there is more space to see what it is in the moment, with the person we are with, rather than our concept of what it should be.”
Over the following two days, speakers from a wide variety of disciplines, professional backgrounds, medical specialties and trainings offered their own perspectives on spiritual caregiving. Sister Stanislaus Kennedy, a Catholic Sister of Charity who has worked with the homeless and disadvantaged in Ireland for many years, said spiritual care was about caring for someone “in a deeply human way... compassionately and, above all, with a deep respect.”
Dr Ira Byock, a palliative care physician and author from New Hampshire, USA, said: “In one sense, I don’t think there is such a thing as spiritual care. There is just care of whole persons... I begin by listening. If you are able and prepared and can listen, people will show you their spirituality.”
As Dr Tony Bates, the founder of Headstrong, a youth mental health charity in Ireland, pointed out: “It is not to disregard the need for care in a very practical, physical way, but something more is needed.”
The work of Rigpa’s Spiritual Care Education Programme, which hosted the conference, is inspired by the vision that Sogyal Rinpoche set out in The Tibetan Book of Living and Dying. Writing in 1992, he called for a more compassionate approach to the way in which we care for the living, and for the dying.
The conference was timed to celebrate the opening of Rigpa’s new Spiritual Care Centre, Dechen Shying, at Dzogchen Beara on the south-west coast of Ireland; and it came at a moment when the importance of spiritual care is being increasingly recognized in all areas of healthcare, particularly among those caring for people who are suffering from serious illness, or approaching the end of their lives. This was reflected by the presence in Killarney of consultants, doctors, nurses, nuns, priests, chaplains, psychiatrists, psychologists, counsellors, pastoral care workers, therapists and home carers, who had travelled from as far away as Australia, Japan, North America and Saudi Arabia to attend.
In his keynote address on the opening morning, entitled 'The Heart of Compassion', Sogyal Rinpoche focused on a theme that continued throughout the conference. “If we truly want to help others, we must first help ourselves,” he said. “We can begin, first of all, by getting to know our own minds.”
As he described the great benefits of meditation, Rinpoche showed that the twin subjects of the conference, compassion and presence, were inextricably linked. “As we connect with the purity of our inherent nature through meditation practice, what is revealed is our fundamental goodness, our good heart. Kindness, compassion and love simply exude. And the more we integrate the practice mindfully in our lives, the more we will find that not only are we in touch with ourselves, but completely in touch with others.”
One of the main aims of the conference was to offer caregivers practical tools and advice to support them in their work, where they often face stressful conditions, long hours and challenging interactions with patients and colleagues.
Speakers led workshops on a range of issues affecting carers, such as communication, burn-out and how to support patients’ families. Sinead O’Toole, a lecturer at University College Dublin’s School of Nursing, spoke about stress and compassion fatigue; Dr Susan Delaney, a clinical psychologist who works for the Irish Hospice Foundation, addressed the subject of compassionate self-care; and Rosamund Oliver, a psychotherapist and spiritual care educator, led a session on deep listening.
The workshops were also designed to give delegates the opportunity to experience meditation and other contemplative practices, and to show how these practices might benefit both the carers themselves, and those in their care. Christine Whiteside, who leads the team at Dzogchen Beara that offers spiritual support to people facing terminal illness or bereavement, introduced the practice of tonglen, from the Tibetan Buddhist teachings on training the mind in compassion (lojong). Andrew Warr, a senior Rigpa instructor, presented loving kindness meditation, and Christine Longaker and Sister Stanislaus Kennedy also led guided meditations.
Jon Kabat-Zinn highlighted the importance of being mindful and aware in all aspects of one’s life as he presented his pioneering work in bringing mindfulness-based techniques into the mainstream of medicine and society. Describing the gathering in Killarney as 'revolutionary', he said: “This conference is all about presence. It is not so easy to actually 'show up', even in your own life, never mind for another person...
“There are an infinite number of moments when we only see what we want to see, and we don’t see what we don’t want to see. We don’t even see our patients, because all we see are our concepts of them, our negative emotions towards them, our fears. None of that’s a problem, if you are aware of it. If you are not aware of it, it can sink your boat and actually cause harm to the patient—and you won’t even know it’s happening. This is why awareness is so fundamental. Without awareness, we have no idea who we are or what we are doing, even if we are extremely well-trained and competent.”
The Centre for Mindfulness in Medicine, Health Care and Society that Jon Kabat-Zinn founded in 1979 at the University of Massachusetts Medical School has served as the focal point for the application of mindfulness in many different settings. A Buddhist practitioner in the Theravada and Zen traditions, Jon Kabat-Zinn has worked with cancer patients, drug addicts, prisoners, lawyers, businessmen, Olympic athletes and US army veterans, to name just a few.
Clinical and scientific studies—some of which he presented during the conference—have shown that mindfulness can be extremely effective in the treatment of stress, depression, pain and addiction. Millions of dollars a year are now spent on research into the clinical applications of mindfulness, and mindfulness-based programmes have sprung up all over the world. As one speaker observed: “If these techniques were a pill, they would create a megabucks market.”
Some of the speakers described how their own spiritual practice had helped them to support patients who were sick or dying. Dr Ann Allegre, a Rigpa student who is medical director at Kansas City Hospice in the US, said: “My morning practice gives me a little bit of peace to carry into my day. It gives me the tools so that I can move through my fear and help others in ways that are suitable for them, so that I can figure out how to be present for them.”
Ursula Bates, a clinical psychologist from Dublin, led a session on how mindfulness can be integrated into the workplace. In response to a question about what to do when you cannot make your voice heard in a team, she provided a glimpse of how she applied meditation in her working life.
“This is a point that’s actually tearing the health service apart—where we begin to project our own dis-ease and stress out into a team. I meditate in the corridors as I move between my patients, and I live as radically as I can in the moment. I think we really need to try and do this in the health service. As your richness develops within, as you’re nurtured by your own meditation, and as your compassion develops, these problems disappear. These are not real problems, these are illusions.”
Several of the speakers in Killarney were specialists in palliative care, an approach that aims to improve the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering.
The term 'palliative' was first used in the 1970s by Dr Balfour Mount, a Canadian cancer surgeon. Inspired by Elisabeth Kübler-Ross’s groundbreaking book, On Death and Dying, and the pioneering hospice work of Dame Cicely Saunders, Dr Mount set up a ward dedicated to care for the dying at Montreal’s Royal Victoria Hospital. He has been described as 'the father of palliative care in North America'. Dr Mount is a patron of the Spiritual Care Centre at Dzogchen Beara, and he was also the conference patron.
Dedicating his talk to Dr Mount, who was not able to attend, Dr Gian Borasio observed that when he started his medical studies in Germany in 1980, palliative medicine was virtually an unknown concept. As a sign of the progress that has been made since then, three new professorships are being established this year at the Interdisciplinary Centre for Palliative Medicine at Munich University Hospital, of which Dr Borasio is a co-founder. The professorships will be in paediatric palliative medicine, social work in palliative care, and, perhaps most significantly, spiritual care.
As well as presenting studies and statistics, Dr Borasio and his fellow speakers told personal stories about the people they had cared for, and shared what they had learned from them. Palliative care, they said, could not be limited to the relief of physical symptoms. It was, explained Dr Ira Byock, about “treating what makes sense, what is reversible, what supports a meaningful quality of life as defined by the person and their family, but also not abandoning people to figure out how to live fully through the end of life; helping in that regard as well, getting beyond the avoidance or denial of dying that really diminishes the fullness of life.”
As the conference closed, speakers and delegates alike departed with a sense of optimism for the future. Dr Tony O’Brien, medical director of Marymount Hospice in Ireland, who chaired the opening day, said: “People were constantly approaching me saying how much they had enjoyed the conference, how valuable it was, and how we had achieved such a wonderful balance in the programme, and a sense of inclusion. I believe that you achieved something particularly special and memorable, and gave a voice to many who are striving in their own workplace to create a greater awareness of the spiritual needs of our patients and their families.”
Dr Ciaran O’Boyle, Professor of Psychology at the Royal College of Surgeons in Ireland, who gave a presentation on quality of life, said: “I found the mix of presentations and the interfacing of Buddhist and western thinking absolutely absorbing and it has given me a lot of food for thought. I think that a lot of people, myself included, received not only academic and professional gifts, but personal gifts in the form of insights and reflections. It was an honour to be there.”
The conference marked a significant step forward for Rigpa’s Spiritual Care Education Programme. The programme has offered training to thousands of healthcare professionals over the past sixteen years, in Ireland and around the world, but it had never organized an event on this scale, for such a wide audience. Sister Stanislaus Kennedy, who described the gathering as 'a great spiritual renewal', said: “This would not have happened five years ago, and I’m not sure it would have happened anywhere else but here, organized from Dzogchen Beara. Somehow they managed to reach out in such a way that people responded with a full heart.”
Delegates said they had found the conference to be energizing, uplifting, transformative and enriching. Some were inspired to take up meditation for the first time, or to introduce meditation sessions at the hospital where they worked. A psychologist working with young people suffering from cystic fibrosis said: “I have found it so difficult to know how to be with people who die young. There’s no intervention or text I can hide behind as a psychologist. I feel I’m starting on a journey now towards learning how to be with these young people. Thank you!”
Dr Gian Borasio described the conference as “a very important milestone in the effort to bring awareness of spirituality and spiritual needs back into modern medicine.” He said: “It was there centuries ago, but it got lost through the advent of technological success, and now we are slowly bringing it back again... This conference is a very important first step.
“At the end of this journey, it will be regarded as a self-understanding professional competence of every physician and healthcare professional to be sensitive to spiritual needs. It is now accepted that healthcare professionals need to be sensitive to cultural issues, gender issues and psychosocial issues. To put spiritual issues on the same level, not just in palliative care but throughout medicine, is the goal that will be ultimately reached, and this conference is an important milestone on the way to that.”
First published in View, August 2009