boy playing flute
Music Is Hope

Love - and Its Absence - in the Caregiving Relationship

A Spiritual Perspective

(Continued from Part 1)

From the perspective of psychology it is not customary to advocate loving our patients; in fact, it is often considered dangerous. Psychology usually speaks of love in terms of transference and countertransference, an experience that has been “transferred” from another time and place. It is important to take transference factors seriously, since they are frequently present in our responses to others and in their responses to us. Caregiving can be perilous enough without ignoring these important signs of what may be happening in the caring relationship, underneath the surface of consciousness.

From a spiritual perspective this psychological point of view, while valid, is limited. Not only can we speak of love as a vital experience of the present moment, we must do so if we wish to understand how the caring relationship can heal. We therefore need to understand what love can mean in the context of this relationship. Clearly, it must mean something more than the awakening of infantile strivings that characterizes the transference.

In the Bible Paul has a lot to say about the experience of being loved, specifically being loved by God. “Anyone who loves God is known by him” (1 Corinthians 8:3), “Now I know only in part; then I will know fully, even as I have been fully known. And now faith, hope, and love abide, these three; and the greatest of these is love” (1 Corinthians 13:12-13). For Paul, to be loved is to be known: seen, heard, recognized, acknowledged, and valued. It all begins with knowledge, or as we might say today, awareness. The nurses’ aides who were not aware of Maureen’s distress clearly could not love her. When we practice awareness, we begin to practice love.

From a spiritual perspective, I believe we can say that love is the awareness of another’s individuality. The feeling quality that we associate with love is not what defines love; it is the result of love, which is the awareness of others on a very deep level. The awareness of which I am speaking is more than just the observation of someone’s surface characteristics, one’s virtues and flaws. It is a sense of a person’s essence, the soul of another, that person’s individuality, that indefinable quality which makes him or her absolutely unique and irreplaceable. When we become aware of another’s individuality we may not be able to describe it precisely; we may not be able to articulate just why we love that person. Still, we know it is love because awareness at this level brings out a warmth in us, a heartfelt benevolence toward that person, even though he or she may be a stranger. This is the love that Paul says “does not insist on its own way” (1 Corinthians 13:5); it is not tied by the strings of desire that complicate transference love. This love is non-self-interested; it does not seek anything in return, but is fulfilled in the act of loving itself.

This love is necessary in the caregiving relationship, because it is this kind of love that heals. In the presence of this love people feel that someone listens to them, cares for them, knows them. In the presence of this love people feel visible. Practicing this love is the most effective way to fight the alienation that leads to institutional depression. If people feel visible, they cannot feel alienated.

This love also heals the caregiver. The foundation of this love is awareness. We may begin to practice this awareness through the exertion of mental effort, but once this awareness becomes love we may experience an opening of the heart. We are changed: by allowing us to love them, the people whom we love bring us in contact with our own individuality, our own spiritual core. Love is a reservoir of energy that resists the pressures that tear us down and that lead to “burnout,” the caregiver’s form of institutional depression. If we love the people we care for, people who are frail and needy and only too happy to be loved, we cannot burn out, because we have a sense of purpose and a sense that we are doing God’s will by serving others. If we are fortunate enough to have the opportunity of caring for others, we must be very grateful to them for showing us what it means to love. People whom we encounter as strangers, with whom we have no prior connection, can teach us more about love than the members of our own family.

Jesus knew this and expressed it eloquently. He preached in the spirit of the Hebrew Bible, which tells us repeatedly to “love the stranger” (Deuteronomy 10:19). Jesus taught: “For if you love those who love you, what reward do you have? . . . And if you greet only your brothers and sisters, what more are you doing than others?” (Matthew 5:46,47). It is not difficult to love those who already belong to us. Everybody does this. Usually this kind of love is full of self-interest, ambivalence, and conflict. If we feel a call to the spiritual life, we will want to go beyond this love, to a love that heals us as well as the one we love by taking us beyond our self-interest.

Love of the stranger, spiritual, non-self-interested love, is a continuous journey that takes us to different levels of spiritual growth. It may begin simply with the effort to become aware of the differences of others, to respect those differences and not to be afraid of them. This is not easy, and sometimes it is exhausting. It always takes more energy to cross a bridge than to stay on the familiar side. It means learning to understand different languages, different gestures, different mannerisms, different needs, different ways of seeing the world. It means the willingness to set foot on foreign ground.

All this is part of our struggle to live the moral life, the life rooted in a love that crosses familiar borders. As we continue practicing this love, we may find something new beginning to happen. It is no longer purely a question of our own effort. Something, something beyond ourselves - we might call it a divine presence - opens our hearts, and we feel an outpouring of love toward people who were total strangers a moment ago. When we reach this point the sense of effort begins to dissipate. This “living flame of love,” which we cannot produce even through our most intense strivings, is implanted in our hearts by God in response to our own prayers and longings. At this point love gives us the energy to continue doing our job. We are in the hands of a greater power, which renews us and resists the frustration that always threatens to bring us to exhaustion. “Those who wait for the Lord shall renew their strength . . .” (Isaiah 40:31).

The path toward this fulfillment of love is never a straight line. We will know moments of frustration, discouragement, even hopelessness. What can we do for ourselves when this happens? It is important to cultivate a place of solitude within ourselves, where we can feel nourished by the love we are trying to express. Seen spiritually, our role as caregivers is to make others aware of God’s love through the love that we ourselves show them. We cannot do this unless we feel this love available to us as well. Can we feel reminded of God’s benevolence in the little kindnesses we show to ourselves? When we take refuge beside the still waters, can we sense God leading us there? If we cannot, we can long for it in prayer, just as we may long to know the love that enters our hearts and turns us with kindness toward others. Faith is the conviction that this love exists and is available to us even when we do not feel it. If we are willing to invest in this faith, the love must surely follow - this is what we are promised.

There is no greater support than the love we bring to our work. Standing on the foundation of our professional training, it provides us with the strength to bear the stresses of exposure to other people’s pain. Loving those we care for is a great gift - not a gift we give, but a gift we receive - given to us by God and by the strangers to whom we believe we are giving. If we have this love, we have a debt we can never fully repay to the people who receive our care.

It may seem that throughout the preceding discussion I have dwelt primarily on the negative. I believe there is a serious problem in our health care institutions, based on an absence of love in the caregiving relationship, and I do not wish to minimize it. Nevertheless I would not like to close without expressing my appreciation of the many good people who work in these settings, people like the nurse who bought a necklace for one resident to send to her disabled daughter, the nurse who sings nursery rhymes to her residents to help them sleep, and the social worker who always takes care to let me know when a resident has a special need that responds to music. These people make life in the institution just a little easier. I would have included more of their stories had I personally witnessed more. There are more than a few of these people, but there are not nearly enough.

Let us not take for granted the idea that “professional detachment” necessarily requires being cold and remote. Let us not even take for granted that doing a good job is sufficient. If the time ever comes for us to be living in an institution, what would we like to find there? How would we wish to be treated? Let’s see whether we can provide this ourselves, right here and right now.