December 2009
Prof Daniël Louw is a leading academic and teacher in the Christian practice of pastoral care.
He addressed the joint meeting of SAAP and Hospivision on 17 October 2009 on the topic “Illness and the meaning of life”. The following is a summary of his presentation.
Our main problem in life is not death, but how to live our lives. A person’s quality of life determines the nature and character of his death. Unfortunately there is no manual for the servicing and care of the human soul - there is no short recipe for caring for the sick.
The being-function of people requires the skill of being with people. We need a liturgy for terminal care and death. The question is: “Who will sit with the deceased?”
Even in death there is the vivid presence of life. Death can be seen as a window into the presence of the Living God. The Bible never says that the soul leaves a corpse – the eternal and immortal soul is received by God through the resurrection.
Christianity’s core issue is understanding life in terms of the resurrection of Christ, through Christian reflection.
Man as being
The pastoral worker addresses the being-function of people. It is of little value to just repeat the clinical aspects of the medical doctor’s viewpoint. Apart from the bodily aspect, the therapist has to address the three dimensions of the mind:
The affective aspect requires us to probe into the terminal patient’s emotional state by establishing immediacy and contact.
The cognitive aspect includes the discussion of the disease with the patient.
The conative aspect includes the will and intention of the patient.
David Barton said “Dying and death of patients is a blatant confrontation on the part of the caregiver with his own mortality.” He has authored several books, including Dying and Death: A Clinical Guide for Caregivers (1977) that can assist the therapist.
Pastoral care is characterised by the anthropological approach that can utilise the total network of human relationships. It addresses norms and values (ethos) that includes ethics (the normative framework) as well as aesthetics (beauty) as exemplified in the Hebrew Torah that describes the will of God in our lives.
There is a sense of aliveness in the process of dying, even in the terminal stage. The patient should learn to separate himself from the unsatisfied expectations and the outstanding issues of the unfulfilled life.
The quality of death is determined by the quality of life in terms of the make-up of the human being. This is described by attitude and aptitude. In Col 2 Paul says that we must have the same attitude that is in Christ.
Should illness be explained?
Genesis describes how God created man as a living being. The quality of my life is determined by God’s covenant in my life. People feel the need for an explanation of illness and loss.
The basic question in spiritual care is: What is my image of God? The pastoral worker must be equipped to deal with questions such as: How do I understand suffering as the will of God? How do I integrate loss and bereavement within the reality of present relationships?
If you deny the body and the illness, you cannot be healed. You do need to cry. To try and placate people with “do not cry, your loved one was a flower plucked for God’s garden in heaven” is nonsense.
We can state categorically that illness, loss and death is not the will of God.
Ministers that create an explanatory God-image is on dangerous ground. We should rather focus on our covenantal relationship with God. Rather than using our explanation of the will of God as ideology, we should live with unconditional love, following Jesus’s teaching that we should love our enemies.
An image of God
The appropriate God-image is important as God’s true nature is displayed in how He cares for His people, including the hungry, the prisoners and those that are weak.
Historically the Christian church developed an image of God based on the Roman empire’s image of a powerful Caesar, rather than the God of love that guarantees my safety. It is not easy to continue to serve a God of power in the midst of pain and suffering, and of death and dying.
The pastoral caregiver must assist us in our quest in the liturgy of life that strives towards integration and healing, rather than the disintegration of illness and disease. The caregiver must help the patient to integrate the various aspects of the affective, cognitive and conative, to assemble the pieces of the puzzle.
The approach of treatment in hospitals tends to be fragmented across the various disciplines. For example, the radiologist, pathologist and surgeon interpret the technical information about your well-being without ever sharing that information with the patient.
Pastoral care tries to restore human dignity in the presence of God. It strives to achieve wholeness by bridging the gaps, interpreting the information for the patient, by connecting and networking the various relationships. It helps the terminally ill to understand “what is happening with my soul?” As Christians we believe that a human being is his soul, he doesn’t merely posses a soul.
The experience of trauma
The patient’s reaction in the immediate experience of trauma can be portrayed in of the following framework:
The framework differentiates disintegration and integration; as well as being active or passive in the midst of trauma.
The patient that is not in control and who is passive may be riddled with guilt and anxiety. If he is more active it may lead to frustration, which is a killer of life.
The patient that achieves integration and acts with responsibility experiences creativity, growth and change. He can have confidence and humour in the midst of a terminal illness.
Grief is the emotional response to the issues attached to loss. Mourning is the task of grieving – there is work to be done. Integrate this act into all the situations of life.
Abnormal grief is to replace the loss in an artificial way, such as remarrying too quickly.
Neurotic grief is when the mourner becomes the victim of his grief.
The dynamics of relational life
The concept of soul is a relational issue: We are commanded to love God, love our neighbour and love ourselves.
Relationships exist in a flux of emotions – it is the dynamic of being human and experiencing life. This wholeness of soul extends to marriage, family and the community.
This is illustrated in the following diagram that evaluates how expectations, needs and role functions are fulfilled:
The horizontal axis represents the experience of emotions as Distance versus Nearness.
The vertical axis represents commitment and direction, with the poles of Support and Power.
Distance: The unfulfilled person experiences disappointment in life. Disappointment is “the virus of the human soul” that leads to distance rather than nearness. The person experiences rejection and frustration at the losses such as failing health and ageing. He finds it difficult to die – there is aggressiveness, anger and pain. Anxiety further destroys the meaning of life and results in guilt. The human being that did not “function as designed” therefore experiences helplessness and despair in the last hours of his life.
Nearness: The human being whose expectations in life were met has intimacy and security. He is acknowledged as a human being and is unconditionally accepted. He is connected to fellow man and experiences life as a safe space. This should be especially true of the Body of Christ, the church. Unfortunately this is not true about the church in general! In identity formation, the human being’s character is revealed through response to life. Intimacy is associated with healing and wholeness.
On the Power-Support axis, the quality of personal convictions and belief systems results in a positive God-image, that is contrasted to the need for constant support.
Paul states that “if anyone is in Christ, he is a new creation; the old has gone, the new has come” (2 Cor 5:17). The believer is resurrected into a new life in Christ. The new person experiences resurrection life in terms of being who he is, not in terms of his achievements. The theology of affirmation restores human dignity. Paul states “through the grace of God I am who I am” (1 Cor. 15:10).
The person that achieved Nearness and Power experiences the fruit of the Spirit: You are patience, love, kindness, etc. similar in the way that a rose is a rose – it does not try to be a rose. If you live the fruit of the Spirit you are a beautiful soul.
The pastoral care worker should help people to learn to live in wholeness in order to grief, mourn and die in quality.
The diagram illustrates the various options for coping with loss and dying. The believer can have hope, as his identity in Christ cannot be lost. His certainty lies in the faithfulness of God and in the covenantal nature of his relationship with God, rather than in his emotions.
Hope is a new state of being and not wishful thinking. Gratitude is the best indicator of a whole soul. To be thankful in every situation is an active process. 
Viktor Frankl said that life is beautiful when he observed the setting sun in the muddy puddles in the German concentration camp. He survived the Nazi death camp by his spiritual strength and will to live and thus became a living proof of the main thesis of his philosophy: one can live only for so long as one’s life has meaning.
Healing is determined by the quality of the choices made in life. The more choices you see in your situation, the more meaning will become available.
