PASTORAL CAREGIVERS TRAINING MANUAL 2017

Pastoral caregivers training manual 2017

Integrating Practice, Spirituality. Theology, and the Ethical dimensions of pastoral work

DEVELOPED BY FREDERIK B O NEL

 

 

 

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TABLE OF CONTENTS

1        Module 1: Sessions 1-3………………………………………………………………………………………………………..  27

2        Welcome!…………………………………………………………………………………………………………………………….. 27

2.1       Introduction of facilitator……………………………………………………………………………………………………….. 27

2.2       Time schedule……………………………………………………………………………………………………………….. 27

2.3       Donation box…………………………………………………………………………………………………………………. 28

3        Challenge of new beginnings………………………………………………………………………………………………. 28

3.1       Primary aims!…………………………………………………………………………………………………………………. 28

3.2       Course approach:………………………………………………………………………………………………………….. 28

3.2.1       Structured – Unstructured……………………………………………………………………………………….. 28

3.2.2       Interactive – discussion…………………………………………………………………………………………… 28

3.2.3       Safe and unsafe………………………………………………………………………………………………………. 29

3.3       Values (not rules) for the course……………………………………………………………………………………. 29

3.3.1       Respect…………………………………………………………………………………………………………………… 29

3.3.2       Confidentiality………………………………………………………………………………………………………….. 29

3.3.3       Affirmation……………………………………………………………………………………………………………….. 29

3.3.4       Integrity……………………………………………………………………………………………………………………. 29

3.3.5       Values the group wants to add………………………………………………………………………………… 29

3.4       Rules:…………………………………………………………………………………………………………………………….. 30

4        Settling in…………………………………………………………………………………………………………………………….. 30

4.1       Breathing exercises……………………………………………………………………………………………………….. 30

4.1.1       Breathing the presence of God?……………………………………………………………………………… 30

4.2       Small Group discussion (with your partner)…………………………………………………………………… 31

4.3       Looking after yourself (taking authority to look after yourself)………………………………………… 31

4.4       The here and now………………………………………………………………………………………………………….. 31

4.4.1       Small Group discussion (with your partner)…………………………………………………………….. 31

5        Time of Discernment (on your own) (10 minutes)………………………………………………………………… 31

5.1       Dwelling in the Word……………………………………………………………………………………………………… 31

5.1.1       Psalm 30…………………………………………………………………………………………………………………. 31

5.2       Sharing with partner/ Listening to partner………………………………………………………………………. 32

6        SESSION 1: Foundations of pastoral care…………………………………………………………………………… 33

6.1       Care delivery to vulnerable people………………………………………………………………………………… 33

6.2       Being present………………………………………………………………………………………………………………… 33

6.3       To let go…………………………………………………………………………………………………………………………. 33

6.4       A spirit of Humility………………………………………………………………………………………………………….. 34

6.5       The facilitation process………………………………………………………………………………………………….. 34

6.6       A wholistic and integrated approach………………………………………………………………………………. 34

7        Understanding the context of hospital pastoral ministry………………………………………………………. 35

7.1       The origin………………………………………………………………………………………………………………………. 35

7.2       Training?……………………………………………………………………………………………………………………….. 36

7.3       Hospital context……………………………………………………………………………………………………………… 37

8        Small Group Discussion (with partner)………………………………………………………………………………… 38

9        Daily Closing Ritual……………………………………………………………………………………………………………… 38

10          Task (Homework)…………………………………………………………………………………………………………….. 38

11          SESSION 2: Pastoral conversation………………………………………………………………………………….. 38

12          Daily ritual………………………………………………………………………………………………………………………… 38

12.1         Losses and gains……………………………………………………………………………………………………….. 38

12.2         Living mindfully…………………………………………………………………………………………………………… 38

12.3         Time of discernment…………………………………………………………………………………………………… 39

12.3.1         Dwelling in the Word – John 15……………………………………………………………………………. 39

12.3.2         Sharing with and Listening to your partner…………………………………………………………… 39

12.4         Homework feedback…………………………………………………………………………………………………… 39

12.5         Learnings and parking questions………………………………………………………………………………… 40

13          Pastoral Conversation (1)………………………………………………………………………………………………… 40

13.1         Basic awareness – Being visible, tuned in and attentive…………………………………………….. 40

13.2         It is all about the other person and not about you………………………………………………………. 40

13.3         People have inner resources……………………………………………………………………………………… 40

13.4         Be aware of any form of stereotyping our own minds may create………………………………. 40

13.5         Dealing respectfully with differences in conversation…………………………………………………. 41

13.6         The physical position you take in conversation (SOLER)…………………………………………… 41

13.6.1         (S) Squarely (45 degrees)……………………………………………………………………………………. 41

13.6.2         (O) Open Posture………………………………………………………………………………………………… 41

13.6.3         (L) Lean……………………………………………………………………………………………………………….. 41

13.6.4         (E) Eye contact…………………………………………………………………………………………………….. 41

13.6.5         (R) Relaxed………………………………………………………………………………………………………….. 41

13.6.6         Creating Context………………………………………………………………………………………………….. 41

13.7         Reflect on your conversation………………………………………………………………………………………. 41

14          Active listening…………………………………………………………………………………………………………………. 42

14.1         Listening to verbal messages (peoples’ stories)…………………………………………………………. 42

14.2         Listening to non-verbal messages………………………………………………………………………………. 42

14.2.1         Non-verbal messages can “leak” important information……………………………………….. 42

14.2.2         Be careful not to overinterpret non-verbal messages…………………………………………… 42

14.3         Emphatic listening………………………………………………………………………………………………………. 43

14.4         The Shadow side of listening……………………………………………………………………………………… 43

14.5         Complicated “hearing”………………………………………………………………………………………………… 43

14.6         Listening to yourself……………………………………………………………………………………………………. 43

15          Practical exercises (groups of two/three )………………………………………………………………………… 44

16          Reading and listening to the Bible (Part 1)……………………………………………………………………….. 44

17          Closing Ritual…………………………………………………………………………………………………………………… 45

18          Homework:……………………………………………………………………………………………………………………….. 45

19          SESSION 3: Hospital Etiquette (Ethos of Hospital visiting)………………………………………………. 45

20          Daily ritual………………………………………………………………………………………………………………………… 45

20.1         Losses and gains……………………………………………………………………………………………………….. 45

20.2         Living mindfully…………………………………………………………………………………………………………… 45

20.2.1         Breathing and/or mindful exercises……………………………………………………………………… 46

20.3         Time of discernment…………………………………………………………………………………………………… 46

20.3.1         Dwelling in the Word: John 15……………………………………………………………………………… 46

20.3.2         Sharing with and listening to partner……………………………………………………………………. 46

20.4         Learnings and parking questions………………………………………………………………………………… 46

20.5         Homework feedback…………………………………………………………………………………………………… 46

21          Hospital Etiquette and hospital functioning………………………………………………………………………. 46

21.1         Understanding ward structures…………………………………………………………………………………… 46

21.2         Know the wards………………………………………………………………………………………………………….. 47

21.3         Confidentiality…………………………………………………………………………………………………………….. 48

21.4         Being part of a team…………………………………………………………………………………………………… 48

21.5         Be loyal………………………………………………………………………………………………………………………. 48

21.6         Referrals are normal in team activities……………………………………………………………………….. 48

21.7         Patients are in a vulnerable situation………………………………………………………………………….. 49

21.8         The sister is in charge of the ward……………………………………………………………………………… 49

21.9         Washing of hands……………………………………………………………………………………………………….. 49

21.10      Do not sit on a patient’s bed……………………………………………………………………………………….. 49

21.10.1      Why is it not acceptable to sit on a patient’s bed?……………………………………………….. 49

21.11      Requests for help……………………………………………………………………………………………………….. 49

21.11.1      Take care not to interfere with any apparatus………………………………………………………. 50

21.12      Patients in isolation room (not something that happens often)…………………………………… 50

21.13      Do not overstay your welcome……………………………………………………………………………………. 50

21.14      Be careful of what you say in the presence of a comatose patient……………………………… 50

21.15      Wards rules regarding child patients…………………………………………………………………………… 51

21.16      Cases of sexual abuse & neglect……………………………………………………………………………….. 51

21.17      (Over)Involvement………………………………………………………………………………………………………. 51

22          Summary: Hospital Departments……………………………………………………………………………………… 51

23          Group activity…………………………………………………………………………………………………………………… 51

23.1         Feedback to the group……………………………………………………………………………………………….. 51

24          Possible stages after a cerebral insult or brain injuries…………………………………………………….. 51

24.1         Comatose state…………………………………………………………………………………………………………… 52

24.2         Vegetative state………………………………………………………………………………………………………….. 52

24.3         Minimal Conscious State (MCS) is a partial conscious state:……………………………………… 52

24.4         Next stage is functional communication or object use………………………………………………… 52

24.5         Locked-in syndrome……………………………………………………………………………………………………. 52

25          Breaking bad news…………………………………………………………………………………………………………… 53

25.1         Determine (or acknowledge) your own feelings………………………………………………………….. 53

25.2         Determine if you’re the right person to break the news………………………………………………. 53

25.3         Practise what you’re going to say……………………………………………………………………………….. 54

25.4         Try to find a physical setting that is comfortable and private………………………………………. 54

25.5         Choose the “best” time possible…………………………………………………………………………………. 54

25.6         Assess the situation before sharing news…………………………………………………………………… 55

25.7         What does the recipient of the news already know?…………………………………………………… 55

25.8         Again, the importance of context………………………………………………………………………………… 55

25.9         Preparing the person for bad news…………………………………………………………………………….. 56

25.9.1         Identify the emotion(s)…………………………………………………………………………………………. 56

25.9.2         Decide what to do next………………………………………………………………………………………… 57

25.10      Be helpful without disempowering the reCipient…………………………………………………………. 57

25.11      Your role in the future (as the deliverer of bad news)…………………………………………………. 57

26          Group activity…………………………………………………………………………………………………………………… 58

26.1         Feedback to the group……………………………………………………………………………………………….. 58

27          Reading and listening to the bible (Part 2)……………………………………………………………………….. 58

28          Way ahead……………………………………………………………………………………………………………………….. 60

28.1         Do you feel emotionally comfortable and at peace?…………………………………………………… 60

28.2         Hospital visits……………………………………………………………………………………………………………… 60

28.3         Attend modules 2 to 5………………………………………………………………………………………………… 60

28.4         Do eight visits with an experienced person………………………………………………………………… 60

28.5         Get a name tag with your name on it………………………………………………………………………….. 60

28.6         Administrative information for people interested in Hospital Care………………………………. 60

29          Daily Closing ritual……………………………………………………………………………………………………………. 61

30          Homework………………………………………………………………………………………………………………………… 61

31          MODULE 2: SESSIONS 4-6…………………………………………………………………………………………….. 61

32          Welcome!…………………………………………………………………………………………………………………………. 61

32.1         Introduction of facilitator……………………………………………………………………………………………… 61

32.2         Time schedule…………………………………………………………………………………………………………….. 62

32.3         Donation box………………………………………………………………………………………………………………. 62

32.4         Primary aims!……………………………………………………………………………………………………………… 62

32.5         Values (not rules) for the course…………………………………………………………………………………. 62

32.5.1         Respect……………………………………………………………………………………………………………….. 62

32.5.2         Confidentiality………………………………………………………………………………………………………. 62

32.5.3         Affirmation……………………………………………………………………………………………………………. 62

32.5.4         Integrity………………………………………………………………………………………………………………… 62

32.6         Values the group wants to add…………………………………………………………………………………… 63

32.7         Rules:…………………………………………………………………………………………………………………………. 63

33          Daily ritual………………………………………………………………………………………………………………………… 63

33.1         Losses and gains……………………………………………………………………………………………………….. 63

33.2         Living mindfully…………………………………………………………………………………………………………… 63

33.3         Breathing and mindful exercises…………………………………………………………………………………. 63

33.4         Time of discernment…………………………………………………………………………………………………… 64

33.4.1         Dwelling in the Word – Hebrews 1:1-4…………………………………………………………………. 64

33.4.2         Sharing with and Listening to your partner…………………………………………………………… 64

33.5         Homework feedback…………………………………………………………………………………………………… 64

33.6         Learnings and parking questions………………………………………………………………………………… 64

34          SESSION 4: Illness and hospitalisation……………………………………………………………………………. 64

35          Facing illness anD different worldviews……………………………………………………………………………. 64

35.1         Illness a common denominator in all cultures……………………………………………………………… 64

35.2         Illness in an African context………………………………………………………………………………………… 65

35.2.1         The Integrated vs the dualistic worldview…………………………………………………………….. 65

35.2.2         Broken ties and relationships must be “healed”…………………………………………………… 66

35.2.3         Non-analytical vs over-analytical approach to life………………………………………………… 66

35.2.4         Time as an event…………………………………………………………………………………………………. 66

35.2.5         Illness provokes suspicion……………………………………………………………………………………. 67

35.3         Illness and modernist society and culture…………………………………………………………………… 67

35.3.1         Emphasising achievement – Illness as a sign of failure……………………………………….. 68

35.3.2         being blind to the influence of lifestyle…………………………………………………………………. 68

35.3.3         Mechanistic view (the sum of the parts equals the parts)…………………………………….. 68

35.3.4         Over-technologising…………………………………………………………………………………………….. 68

35.4         Role Play……………………………………………………………………………………………………………………. 68

36          the Effect of Illness on patients………………………………………………………………………………………… 69

37          The effects of pain……………………………………………………………………………………………………………. 69

38          Approaching a patient to provide pastoral care………………………………………………………………… 70

38.1         Role play…………………………………………………………………………………………………………………….. 71

39          Reading and listening to the bible (4)……………………………………………………………………………….. 71

40          Daily Closing ritual……………………………………………………………………………………………………………. 72

41          Homework………………………………………………………………………………………………………………………… 72

42          SESSION 5: the Pastoral conversation……………………………………………………………………………. 74

43          Welcome!…………………………………………………………………………………………………………………………. 74

44          Daily ritual………………………………………………………………………………………………………………………… 74

44.1         Losses and gains……………………………………………………………………………………………………….. 74

44.2         Living mindfully…………………………………………………………………………………………………………… 74

44.2.1         Breathing and mindful exercises………………………………………………………………………….. 75

44.3         Time of discernment…………………………………………………………………………………………………… 75

44.3.1         Dwelling in the Word – Hebrews 1:1-4…………………………………………………………………. 75

44.3.2         Sharing with and Listening to your partner…………………………………………………………… 76

44.4         Homework feedback…………………………………………………………………………………………………… 76

44.5         Learnings and parking questions………………………………………………………………………………… 76

45          Conversation……………………………………………………………………………………………………………………. 76

45.1         The client as expert…………………………………………………………………………………………………….. 76

45.2         Resist the urge to give answers………………………………………………………………………………….. 76

45.3         the patient determines the agenda……………………………………………………………………………… 76

45.4         Keep the client at the centre of the conversation………………………………………………………… 77

45.5         Reflective listening……………………………………………………………………………………………………… 77

45.6         Listen for relationship patterns……………………………………………………………………………………. 78

45.7         multiple problems and focused attention…………………………………………………………………….. 78

45.8         If you open or start anything, you must also close or end it………………………………………… 78

45.9         Be aware: Not everyone has problems or is unhappy………………………………………………… 78

46          Starting a conversation in the hospital……………………………………………………………………………… 78

46.1         Introduce yourself……………………………………………………………………………………………………….. 78

46.2         Give the reason for your visit:…………………………………………………………………………………….. 78

46.3         Allow time for the client to take in what you are saying………………………………………………. 78

46.4         Acknowledge the patient as a person…………………………………………………………………………. 79

47          Practical exercises – role play:…………………………………………………………………………………………. 79

48          What makes a conversation “pastoral”?…………………………………………………………………………… 79

49          Reading and listening to the Bible (Part 5)……………………………………………………………………….. 79

50          Daily Closing ritual……………………………………………………………………………………………………………. 80

51          Homework………………………………………………………………………………………………………………………… 81

52          SESSION 6: The role of faith, scripture and prayer………………………………………………………….. 81

53          Daily ritual………………………………………………………………………………………………………………………… 81

53.1         Losses and gains……………………………………………………………………………………………………….. 81

53.2         Living mindfully…………………………………………………………………………………………………………… 81

53.3         Breathing and mindfulness exercises…………………………………………………………………………. 81

53.4         Time of discernment…………………………………………………………………………………………………… 81

53.4.1         Dwelling in the Word – Hebrews 1:1-4…………………………………………………………………. 81

53.4.2         Sharing with and Listening to your partner…………………………………………………………… 82

53.5         Homework feedback…………………………………………………………………………………………………… 82

53.6         Learnings and parking questions………………………………………………………………………………… 82

54          The role of faith, Scripture and prayer……………………………………………………………………………… 82

55          Reflecting on faith in times of suffering?…………………………………………………………………………… 82

55.1         Difference between Biblical faith and positive thinking……………………………………………….. 82

55.2         Whose faith are we talking about?……………………………………………………………………………… 83

55.2.1         What about “our” faith?………………………………………………………………………………………… 84

56          The Bible and illness………………………………………………………………………………………………………… 85

56.1         OT understanding of illness………………………………………………………………………………………… 85

56.1.1         Linear view of Proverbs: Cause and effect…………………………………………………………… 86

56.1.2         the Complicated view of Ecclesiastes………………………………………………………………….. 87

56.1.3         Suffering as preparaton for something better………………………………………………………. 87

56.1.4         Spirits and demons………………………………………………………………………………………………. 88

56.1.5         The suffering servant…………………………………………………………………………………………… 89

56.1.6         Summarising………………………………………………………………………………………………………… 89

56.2         NT understanding of illness and suffering…………………………………………………………………… 89

56.2.1         Christ’s suffering………………………………………………………………………………………………….. 89

56.2.2         Suffering of believers…………………………………………………………………………………………… 89

56.2.3         The Influence of demonic powers………………………………………………………………………… 89

57          The role of scripture and prayer……………………………………………………………………………………….. 90

57.1         Using The bible in different ways………………………………………………………………………………… 90

57.1.1         Paraphrasing the text…………………………………………………………………………………………… 90

57.1.2         Meditative reading……………………………………………………………………………………………….. 90

57.1.3         Narrative approach………………………………………………………………………………………………. 90

57.1.4         Comforting and consoling…………………………………………………………………………………….. 90

57.1.5         Doxology……………………………………………………………………………………………………………… 90

57.2         Inappropriate uses of the bible in a pastoral context…………………………………………………… 91

57.2.1         Giving a mini-sermon…………………………………………………………………………………………… 91

57.2.2         In a coercive way…………………………………………………………………………………………………. 91

57.2.3         Making false promises…………………………………………………………………………………………. 91

57.2.4         Lecturing on morals or moralising………………………………………………………………………… 91

57.2.5         Dogmatic instructions…………………………………………………………………………………………… 91

57.2.6         Legalistic and prescriptive……………………………………………………………………………………. 91

57.3         Psalms that are useful………………………………………………………………………………………………… 91

58          Prayer in a pastoral context……………………………………………………………………………………………… 91

58.1         Acknowledge the context……………………………………………………………………………………………. 92

58.2         Praying for the patient or with the patient?…………………………………………………………………. 92

58.3         Prayer as communication, and thus also communion, with God………………………………… 92

58.4         Prayer as a gesture of dependence……………………………………………………………………………. 92

58.5         Prayer and healing……………………………………………………………………………………………………… 92

58.5.1         Prayer as wrestling with God……………………………………………………………………………….. 92

58.5.2         Prayer as intercession…………………………………………………………………………………………. 92

58.5.3         Prayer as doxology – thanksgiving and praise…………………………………………………….. 92

58.6         Problematic prayers……………………………………………………………………………………………………. 92

58.6.1         Arrogance…………………………………………………………………………………………………………….. 92

58.6.2         Parade of power/ force…………………………………………………………………………………………. 92

58.6.3         Prayer as an acquired technique…………………………………………………………………………. 92

58.6.4         Prayer in order to be seen by others……………………………………………………………………. 93

58.6.5         Prayer as a psychological tool……………………………………………………………………………… 93

59          Theological reflection on the theodicy question (Part 1)…………………………………………………… 93

59.1         Why we spend time on this issue……………………………………………………………………………….. 93

59.2         Can we link God to life expectancy?…………………………………………………………………………… 94

59.3         Harari’s Dualism…………………………………………………………………………………………………………. 94

59.4         Reframing:………………………………………………………………………………………………………………….. 95

59.4.1         Reframing the “why” question………………………………………………………………………………. 95

59.4.2         Reframing our theological approach…………………………………………………………………….. 96

59.5         Theological juggler……………………………………………………………………………………………………… 98

59.6         How do we think about God?……………………………………………………………………………………… 99

59.6.1         God’s heart………………………………………………………………………………………………………….. 99

59.6.2         God is not the author or origin of evil…………………………………………………………………… 99

59.7         The corporate character of suffering…………………………………………………………………………… 99

59.8         Learning to endure suffering…………………………………………………………………………………….. 100

59.9         The already-but-not-yet concept……………………………………………………………………………….. 100

59.10      Keeping many balls in the air!…………………………………………………………………………………… 101

60          A life of surrendering: being content………………………………………………………………………………. 101

61          Reading and listening to the Bible………………………………………………………………………………….. 102

62          Extra reading: Confessions of the reformed tradition:…………………………………………………….. 102

63          Daily Closing ritual…………………………………………………………………………………………………………. 103

64          Homework……………………………………………………………………………………………………………………… 103

65          MODULE 3: SESSIONS 7-9…………………………………………………………………………………………… 104

66          Welcome!……………………………………………………………………………………………………………………….. 104

66.1         Introduction of facilitator……………………………………………………………………………………………. 104

66.2         Time schedule………………………………………………………………………………………………………….. 104

66.3         Donation box…………………………………………………………………………………………………………….. 104

66.4         Primary aims!……………………………………………………………………………………………………………. 104

66.5         Values (not rules) for the course………………………………………………………………………………. 104

66.5.1         Respect……………………………………………………………………………………………………………… 104

66.5.2         Confidentiality…………………………………………………………………………………………………….. 105

66.5.3         Affirmation………………………………………………………………………………………………………….. 105

66.5.4         Integrity………………………………………………………………………………………………………………. 105

66.6         Rules:……………………………………………………………………………………………………………………….. 105

67          Daily ritual………………………………………………………………………………………………………………………. 105

67.1         Losses and gains……………………………………………………………………………………………………… 105

67.2         Living mindfully…………………………………………………………………………………………………………. 105

67.2.1         Breathing and mindful exercises………………………………………………………………………… 106

67.3         Time of discernment…………………………………………………………………………………………………. 106

67.3.1         Dwelling in the Word – psalm 73……………………………………………………………………….. 106

67.4         Sharing with and Listening to your partner……………………………………………………………….. 107

67.5         Homework feedback…………………………………………………………………………………………………. 107

67.6         Learnings and parking questions……………………………………………………………………………… 107

68          SESSION 7: Bereavement and grief………………………………………………………………………………. 107

68.1         a process of loss often starts with “change” as the catalyst……………………………………… 108

68.2         Cultural dynamics in Bereavement…………………………………………………………………………… 108

68.3         Primary and secondary loss……………………………………………………………………………………… 109

68.4         Complicated grief……………………………………………………………………………………………………… 110

69          Approaches to loss…………………………………………………………………………………………………………. 110

69.1         Stage/ Phase Model…………………………………………………………………………………………………. 110

69.1.1         Shock stage: Initial paralysis on hearing the bad news……………………………………… 110

69.1.2         Denial stage: Trying to avoid the inevitable……………………………………………………….. 111

69.1.3         Anger: a Frustrated outpouring of bottled-up emotion……………………………………….. 112

69.1.4         Bargaining stage: Seeking in vain for a way out………………………………………………… 112

69.1.5         Depression: the Realisation of the inevitable……………………………………………………… 113

69.1.6         Testing stage (new stage added by some researchers)…………………………………….. 113

69.1.7         Acceptance stage: “Finally” finding the way forward………………………………………….. 114

69.2         The dual process view of loss…………………………………………………………………………………… 114

69.3         Adaptive Model…………………………………………………………………………………………………………. 115

69.4         Grief task model……………………………………………………………………………………………………….. 116

69.4.1         Accepting The reality of the death……………………………………………………………………… 116

69.4.2         Experience the emotional pain of death…………………………………………………………….. 116

69.4.3         Celebrate the memories of your loved one………………………………………………………… 117

69.4.4         Acknowledge and deal with contradictory emotions…………………………………………… 117

69.4.5         Letting go…………………………………………………………………………………………………………… 117

69.5         Dealing with loss (Summary)……………………………………………………………………………………. 118

69.6         The acronym TEAR(s) summarises the aims of grief work:……………………………………… 118

69.7         Making use of a person’s energy levels……………………………………………………………………. 118

70          Children and death…………………………………………………………………………………………………………. 118

70.1         Toddlers: 18 months – 3 years…………………………………………………………………………………. 119

70.2         Preschool: 3-5 years…………………………………………………………………………………………………. 119

70.3         Primary school age…………………………………………………………………………………………………… 120

70.4         Late primary school………………………………………………………………………………………………….. 120

70.5         Summary: Dealing with grief in children……………………………………………………………………. 120

71          Reading and listening to the Bible………………………………………………………………………………….. 120

72          Daily Closing ritual…………………………………………………………………………………………………………. 121

73          Homework……………………………………………………………………………………………………………………… 121

74          SESSION 8: Pastoral Conversation (2)………………………………………………………………………….. 121

75          Daily ritual………………………………………………………………………………………………………………………. 122

75.1         Losses and gains……………………………………………………………………………………………………… 122

75.2         Living mindfully…………………………………………………………………………………………………………. 122

75.2.1         Breathing and mindfulness exercises………………………………………………………………… 122

75.3         Time of discernment…………………………………………………………………………………………………. 122

75.3.1         Dwelling in the Word – psalm 73……………………………………………………………………….. 122

75.4         Sharing with and Listening to your partner……………………………………………………………….. 124

75.5         Homework feedback…………………………………………………………………………………………………. 124

75.6         Learnings and parking questions……………………………………………………………………………… 124

76          How relevant is my story (experience) to the conversation?………………………………………….. 124

77          Pastoral conversation Roleplay……………………………………………………………………………………… 125

78          Important markers for conversation……………………………………………………………………………….. 125

78.1         Again: Clarification of your role…………………………………………………………………………………. 125

78.2         Accept yourself for who you are……………………………………………………………………………….. 125

78.3         Caregiving and our emotions……………………………………………………………………………………. 125

78.4         Distinguish between facts and emotions…………………………………………………………………… 126

78.5         Pastoral dimensions of conversation………………………………………………………………………… 126

79          Case studies………………………………………………………………………………………………………………….. 126

80          Reading and listening to the Bible………………………………………………………………………………….. 127

81          Daily Closing ritual…………………………………………………………………………………………………………. 127

82          Homework……………………………………………………………………………………………………………………… 127

83          SESSION 9: Questions of faith and suffering (2)……………………………………………………………. 127

84          Daily ritual………………………………………………………………………………………………………………………. 127

84.1         Losses and gains……………………………………………………………………………………………………… 127

84.2         Living mindfully…………………………………………………………………………………………………………. 127

84.2.1         Breathing and mindfulness exercises………………………………………………………………… 128

84.3         Time of discernment…………………………………………………………………………………………………. 128

84.3.1         Dwelling in the Word – psalm 73……………………………………………………………………….. 128

84.4         Sharing with and Listening to your partner……………………………………………………………….. 129

84.5         Homework feedback…………………………………………………………………………………………………. 129

84.6         Learnings and parking questions……………………………………………………………………………… 129

85          Theological reflections on faith and suffering…………………………………………………………………. 130

85.1         How is God acting in this world?………………………………………………………………………………. 130

86          Reading and listening to the bible………………………………………………………………………………….. 134

87          Daily Closing ritual…………………………………………………………………………………………………………. 134

88          Homework……………………………………………………………………………………………………………………… 135

89          MODULE 4: SESSIONS 10-12………………………………………………………………………………………. 136

90          Welcome!……………………………………………………………………………………………………………………….. 136

91          Introduction of facilitator…………………………………………………………………………………………………. 136

91.1         Time schedule………………………………………………………………………………………………………….. 136

91.2         Donation box…………………………………………………………………………………………………………….. 136

91.3         Primary aims!……………………………………………………………………………………………………………. 136

91.4         Values (not rules) for the course………………………………………………………………………………. 136

91.4.1         Respect……………………………………………………………………………………………………………… 137

91.4.2         ConfidEntiality……………………………………………………………………………………………………. 137

91.4.3         Affirmation………………………………………………………………………………………………………….. 137

91.4.4         Integrity………………………………………………………………………………………………………………. 137

91.5         Rules:……………………………………………………………………………………………………………………….. 137

92          Daily ritual………………………………………………………………………………………………………………………. 137

92.1         Losses and gains……………………………………………………………………………………………………… 137

92.2         Living mindfully…………………………………………………………………………………………………………. 137

92.3         Breathing and mindful exercises………………………………………………………………………………. 138

92.4         Time of discernment…………………………………………………………………………………………………. 138

92.4.1         Dwelling in the Word – Romans 8:18-30……………………………………………………………. 138

92.4.2         Sharing with and Listening to your partner…………………………………………………………. 139

92.5         Homework feedback…………………………………………………………………………………………………. 139

92.6         Learnings and parking questions……………………………………………………………………………… 140

93          SESSION 10: Facing death and dying – the terminally ill………………………………………………. 140

93.1         Living before we die………………………………………………………………………………………………….. 140

93.2         Process of Dying………………………………………………………………………………………………………. 140

93.3         Basic needs of the terminally ill patient…………………………………………………………………….. 141

93.3.1         Basic physical needs…………………………………………………………………………………………. 141

93.3.2         Psychological needs………………………………………………………………………………………….. 141

93.3.3         Social needs………………………………………………………………………………………………………. 141

93.3.4         Spiritual needs…………………………………………………………………………………………………… 141

94          Dying and fear………………………………………………………………………………………………………………… 142

94.1         Psychological fear – Thanatophobia…………………………………………………………………………. 142

94.2         Religious fears………………………………………………………………………………………………………….. 142

94.3         Fears for the next of kin……………………………………………………………………………………………. 142

94.4         Fear and anxiety………………………………………………………………………………………………………. 143

94.5         Children and fear………………………………………………………………………………………………………. 143

95          Role of the pastoral caregiver………………………………………………………………………………………… 143

95.1         Bringing calmness to the patient, family and situation………………………………………………. 143

95.2         Dealing with feelings of guilt……………………………………………………………………………………… 144

95.3         Facilitating verbal and non-verbal communication……………………………………………………. 144

95.4         Challenges for the pastoral worker…………………………………………………………………………… 144

96          Telling the “truth”……………………………………………………………………………………………………………. 144

96.1         What is “truth”?…………………………………………………………………………………………………………. 145

96.2         the patient and family give the cue…………………………………………………………………………… 145

96.3         The balancing-act…………………………………………………………………………………………………….. 145

96.3.1         The Bell-curve philosophy (Nothing is one hundred percent)…………………………….. 146

96.4         Respect for the patient and family’s ‘rights’………………………………………………………………. 147

96.5         Do as little harm as possible…………………………………………………………………………………….. 147

96.6         Not what You say, but how you say it……………………………………………………………………….. 147

96.7         Difficult situations……………………………………………………………………………………………………… 147

96.8         What to tell children………………………………………………………………………………………………….. 148

97          Case studies………………………………………………………………………………………………………………….. 148

98          Reading and listening to the bible………………………………………………………………………………….. 148

99          Daily Closing ritual…………………………………………………………………………………………………………. 148

100       Homework……………………………………………………………………………………………………………………… 149

101       Suicide/ self-death (“selfdood”)………………………………………………………………………………………. 149

101.1      Warning signs…………………………………………………………………………………………………………… 149

101.2      Voluntary euthanasia/ Suicide with assistance…………………………………………………………. 150

101.3      Assisted dying – Dr Sean Davison……………………………………………………………………………. 151

101.4      Taking your own life………………………………………………………………………………………………….. 154

102       SESSION 11………………………………………………………………………………………………………………….. 155

103       Daily ritual………………………………………………………………………………………………………………………. 155

103.1      Losses and gains……………………………………………………………………………………………………… 155

103.2      Living mindfully…………………………………………………………………………………………………………. 155

103.3      Breathing and mindful exercises………………………………………………………………………………. 155

103.4      Time of discernment…………………………………………………………………………………………………. 155

103.4.1      Dwelling in the Word – Romans 8:18-30……………………………………………………………. 155

103.4.2      Sharing with and Listening to your partner…………………………………………………………. 156

103.5      Homework feedback…………………………………………………………………………………………………. 156

103.6      Learnings and parking questions……………………………………………………………………………… 156

104       Pastoral conversation 3:…………………………………………………………………………………………………. 156

104.1      Important markers for pastoral conversations…………………………………………………………… 156

104.1.1      Be clear about your role…………………………………………………………………………………….. 156

104.1.2      Learn to distinguish between facts and emotions………………………………………………. 156

104.1.3      Do not jump to conclusions………………………………………………………………………………… 157

104.1.4      Pastoral dimensions…………………………………………………………………………………………… 157

104.1.5      Self-disclosure by pastoral workers……………………………………………………………………. 157

104.2      Challenging the patient…………………………………………………………………………………………….. 159

104.2.1      When and what to challenge……………………………………………………………………………… 159

104.2.2      Challenging confusing stories or responses………………………………………………………. 159

105       Practical exercises. Case studies…………………………………………………………………………………… 160

106       Mental health………………………………………………………………………………………………………………….. 160

107       Discussion: suicide (self-death)……………………………………………………………………………………… 161

108       Daily Closing ritual…………………………………………………………………………………………………………. 163

109       Homework……………………………………………………………………………………………………………………… 164

110       And what about the devil?……………………………………………………………………………………………… 165

110.1      The early church……………………………………………………………………………………………………….. 165

110.2      Whose devil?……………………………………………………………………………………………………………. 166

110.3      Our Sinful nature………………………………………………………………………………………………………. 170

110.4      Psychiatric illnesses………………………………………………………………………………………………….. 171

110.5      Demon experts…………………………………………………………………………………………………………. 172

111       SESSION 12………………………………………………………………………………………………………………….. 174

112       Daily ritual………………………………………………………………………………………………………………………. 174

112.1      Losses and gains……………………………………………………………………………………………………… 174

112.2      Living mindfully…………………………………………………………………………………………………………. 174

112.3      Breathing and mindful exercises………………………………………………………………………………. 174

112.4      Time of discernment…………………………………………………………………………………………………. 174

112.4.1      Dwelling in the Word – Romans 8:18-30……………………………………………………………. 174

112.4.2      Sharing with and Listening to your partner…………………………………………………………. 175

112.5      Homework feedback…………………………………………………………………………………………………. 175

112.6      Learnings and parking questions……………………………………………………………………………… 175

113       Depression – Major Depression…………………………………………………………………………………….. 175

113.1      Who becomes depressed?……………………………………………………………………………………….. 176

113.2      Symptoms of depression:…………………………………………………………………………………………. 176

113.3      Types of Depressive disorders…………………………………………………………………………………. 177

113.4      Understanding the biological aspects……………………………………………………………………….. 178

113.5      Why do we become depressed?………………………………………………………………………………. 180

113.6      Treatment…………………………………………………………………………………………………………………. 180

113.7      your role as a pastoral careworker……………………………………………………………………………. 181

114       Practical exercises – Case studies…………………………………………………………………………………. 181

115       Daily Closing ritual…………………………………………………………………………………………………………. 181

116       Homework……………………………………………………………………………………………………………………… 182

117       Handout: Dealing with anger………………………………………………………………………………………….. 182

117.1      All people show anger………………………………………………………………………………………………. 182

117.2      Dealing with our anger……………………………………………………………………………………………… 182

117.3      Effects of anger………………………………………………………………………………………………………… 182

117.4      Where does anger comes from?………………………………………………………………………………. 183

117.5      Allowing our anger to show………………………………………………………………………………………. 183

117.6      Summary:…………………………………………………………………………………………………………………. 183

118       Handout: Basic approaches to conflict management……………………………………………………… 184

118.1      Power-based approach…………………………………………………………………………………………….. 184

118.2      Rights-based approach…………………………………………………………………………………………….. 184

118.3      Interest-based approach…………………………………………………………………………………………… 184

118.4      Facilitating conflict…………………………………………………………………………………………………….. 184

118.4.1      Who is right?……………………………………………………………………………………………………… 184

118.4.2      Focusing on the problem – not the person…………………………………………………………. 185

118.4.3      Past, present and future…………………………………………………………………………………….. 185

118.4.4      All parties must declare themselves…………………………………………………………………… 185

118.4.5      Clarify issues……………………………………………………………………………………………………… 185

118.4.6      Keep listening…………………………………………………………………………………………………….. 185

118.4.7      The Way we speak…………………………………………………………………………………………….. 185

118.4.8      Determination and finding a solution………………………………………………………………….. 186

118.4.9      Letting go…………………………………………………………………………………………………………… 186

119       MODULE 5: SESSIONS 13-15………………………………………………………………………………………. 187

120       Welcome!……………………………………………………………………………………………………………………….. 187

120.1      Introduction of facilitator……………………………………………………………………………………………. 187

120.2      Time schedule………………………………………………………………………………………………………….. 187

120.3      Donation box…………………………………………………………………………………………………………….. 187

120.4      Primary aims!……………………………………………………………………………………………………………. 187

120.5      Values (not rules) for the course………………………………………………………………………………. 187

120.5.1      Respect……………………………………………………………………………………………………………… 188

120.5.2      Confidentiality…………………………………………………………………………………………………….. 188

120.5.3      Affirmation………………………………………………………………………………………………………….. 188

120.5.4      Integrity………………………………………………………………………………………………………………. 188

120.6      Rules:……………………………………………………………………………………………………………………….. 188

121       Daily ritual………………………………………………………………………………………………………………………. 188

121.1      Losses and gains……………………………………………………………………………………………………… 188

121.2      Living mindfully…………………………………………………………………………………………………………. 188

121.3      Breathing exercise……………………………………………………………………………………………………. 188

121.4      Time of discernment…………………………………………………………………………………………………. 190

121.5      Dwelling in the word Matthew 25:34-46……………………………………………………………………. 190

121.5.1      Sharing and listening to your partner…………………………………………………………………. 191

121.6      Homework feedback…………………………………………………………………………………………………. 191

121.7      Learnings and praking questions……………………………………………………………………………… 191

122       SESSION 13: SELF-CARE FOR THE PASTORAL WORKER………………………………………. 191

123       Universe victim theory……………………………………………………………………………………………………. 191

124       Stress…………………………………………………………………………………………………………………………….. 192

124.1      Symptoms of stress………………………………………………………………………………………………….. 192

124.2      Stress: Villian or vital?………………………………………………………………………………………………. 192

124.3      Dealing with stress……………………………………………………………………………………………………. 192

124.3.1      The way I respond to stressors………………………………………………………………………….. 192

124.3.2      Self-care…………………………………………………………………………………………………………….. 193

124.3.3      Practice forgiveness…………………………………………………………………………………………… 193

124.3.4      Be positive…………………………………………………………………………………………………………. 193

124.3.5      The acceptance of limitations…………………………………………………………………………….. 193

124.3.6      Balance……………………………………………………………………………………………………………… 193

124.3.7      Spiritual life………………………………………………………………………………………………………… 193

125       Practical exercises – case studies…………………………………………………………………………………. 193

126       Sabotage yourself………………………………………………………………………………………………………….. 194

127       The role of healthy boundaries ……………………………………………………………………………………… 196

127.1      Why talk about “boundaries”?…………………………………………………………………………………… 196

127.2      Types of boundaries…………………………………………………………………………………………………. 197

127.3      Healthy and unhealthy boundaries…………………………………………………………………………… 198

127.4      Boundary confusion………………………………………………………………………………………………….. 198

127.5      Fine line……………………………………………………………………………………………………………………. 199

127.6      Be aware of boundary breakers……………………………………………………………………………….. 199

127.6.1      Controllers………………………………………………………………………………………………………….. 199

127.6.2      Manipulative controllers……………………………………………………………………………………… 200

127.6.3      Compliant controllers…………………………………………………………………………………………. 200

127.7      Dealing with boundary issues…………………………………………………………………………………… 200

127.7.1      Acknowledge the issue………………………………………………………………………………………. 200

127.7.2      Acknowledge what drives our boundary issues…………………………………………………. 200

127.7.3      Setting appropriate limits……………………………………………………………………………………. 200

127.7.4      Legitimate wants and needs………………………………………………………………………………. 201

127.8      Drivers of boundary issues……………………………………………………………………………………….. 201

127.8.1      Inner boundary problems…………………………………………………………………………………… 201

127.8.2      The fears in our lives………………………………………………………………………………………….. 201

127.8.3      The struggle to let go…………………………………………………………………………………………. 202

127.8.4      Love as a driver…………………………………………………………………………………………………. 202

127.8.5      Misplaced trust…………………………………………………………………………………………………… 203

127.8.6      Ignoring consequences……………………………………………………………………………………… 203

127.9      Healthy boundaries…………………………………………………………………………………………………… 203

127.10        Obstacles against healthy boundaries…………………………………………………………………… 203

127.11        Summary………………………………………………………………………………………………………………. 204

128       Closing Ritual…………………………………………………………………………………………………………………. 204

129       Homework……………………………………………………………………………………………………………………… 204

130       Handout: Questionnaire – Who am I?……………………………………………………………………………. 204

131       SESSION 14………………………………………………………………………………………………………………….. 205

132       Daily ritual………………………………………………………………………………………………………………………. 205

132.1      Losses and gains……………………………………………………………………………………………………… 205

132.2      Living mindfully…………………………………………………………………………………………………………. 205

132.3      Breathing exercise……………………………………………………………………………………………………. 205

132.4      Time of discernment…………………………………………………………………………………………………. 206

132.5      Dwelling in the word Matthew 25:34-46……………………………………………………………………. 206

132.5.1      Sharing and listening to your partner…………………………………………………………………. 207

132.6      Homework feedback…………………………………………………………………………………………………. 207

132.7      Learnings and parking questions……………………………………………………………………………… 207

133       Pastoral Conversation……………………………………………………………………………………………………. 207

133.1      Dealing with tension………………………………………………………………………………………………….. 207

133.1.1      The tension between determinism and hope……………………………………………………… 207

133.1.2      The tension between good and evil……………………………………………………………………. 208

133.1.3      The tension between beauty and ugliness…………………………………………………………. 208

134       Practical exercises – case studies…………………………………………………………………………………. 209

135       Ethical pointers (pro’s and con’s)…………………………………………………………………………………… 209

135.1      Mercy rather than malice………………………………………………………………………………………….. 209

135.2      Absolute sanctity of life…………………………………………………………………………………………….. 209

135.3      reflecting on death……………………………………………………………………………………………………. 210

135.4      The right to human dignity and quality of life…………………………………………………………….. 210

135.5      meaning of life………………………………………………………………………………………………………….. 210

135.6      Individual in society…………………………………………………………………………………………………… 211

135.7      The epistemology of ethics (how do we know)?……………………………………………………….. 211

135.7.1      Cognitive (what?)……………………………………………………………………………………………….. 211

135.7.2      Conative (Why?)………………………………………………………………………………………………… 211

135.7.3      Functional and instrumental Questions (How?)…………………………………………………. 211

135.7.4      Telic question (What is the end purpose?)…………………………………………………………. 211

135.7.5      Contextual question…………………………………………………………………………………………… 212

135.7.6      When question…………………………………………………………………………………………………… 212

135.7.7      What are the consequences?…………………………………………………………………………….. 212

135.7.8      Hermeneutical process (How do i interpret the information?)…………………………….. 212

135.7.9      Summary……………………………………………………………………………………………………………. 212

136       Closing Ritual…………………………………………………………………………………………………………………. 212

137       Homework……………………………………………………………………………………………………………………… 213

138       Handout: Organ transplantation and religion………………………………………………………………….. 213

139       Overview………………………………………………………………………………………………………………………… 213

140       History of organ transplants……………………………………………………………………………………………. 214

141       Do organ transplants make sense?……………………………………………………………………………….. 215

142       The processs of declaring brain death……………………………………………………………………………. 216

142.1      The “riddle” of brain death………………………………………………………………………………………… 216

142.2      Misjudgement of brain death…………………………………………………………………………………….. 217

142.3      Brain stem………………………………………………………………………………………………………………… 218

142.4      What causes brain death?………………………………………………………………………………………… 218

142.5      Brain death is not the same as a persistent vegetative state……………………………………. 218

143       Religious beliefs…………………………………………………………………………………………………………….. 219

143.1      Traditional African religion………………………………………………………………………………………… 219

143.2      Islamic rulings on organ transplant donation…………………………………………………………….. 219

143.3      Judaism and organ donation…………………………………………………………………………………….. 220

143.4      Buddhism and organ donation………………………………………………………………………………….. 221

143.5      Hinduism and organ donation…………………………………………………………………………………… 222

143.6      Sikhism and organ donation……………………………………………………………………………………… 222

143.7      Shintoism and organ donation………………………………………………………………………………….. 223

143.8      Organ donation and christianity………………………………………………………………………………… 224

143.8.1      Catholic church………………………………………………………………………………………………….. 225

143.8.2      Lutheran church…………………………………………………………………………………………………. 225

143.8.3      baptist church…………………………………………………………………………………………………….. 225

143.8.4      Presbyterian church…………………………………………………………………………………………… 225

143.8.5      United Methodist Church……………………………………………………………………………………. 225

143.8.6      Assembly of God church……………………………………………………………………………………. 226

143.8.7      Wesleyan church……………………………………………………………………………………………….. 226

143.8.8      Greek orthodox church………………………………………………………………………………………. 226

143.8.9      Seventh day adventist church……………………………………………………………………………. 226

143.8.10        AME & Zion church (African Methodist episcopal)………………………………………….. 226

143.8.11        Church of the brethren……………………………………………………………………………………. 226

143.8.12        Mennonite church…………………………………………………………………………………………… 226

143.8.13        Church of Christ, scientist (Christian science)………………………………………………… 226

143.8.14        Episcopal church or Anglican church………………………………………………………………. 227

143.8.15        Jehovah’s witnesses……………………………………………………………………………………….. 227

143.8.16        Mormon (The church of Jesus Christ of latter day saints)……………………………….. 227

143.9      Summary………………………………………………………………………………………………………………….. 227

144       Philosophical ethical decisions……………………………………………………………………………………….. 228

144.1      Payment for organs?………………………………………………………………………………………………… 228

144.2      The importance of consent……………………………………………………………………………………….. 229

144.3      Difficult decisions of the distribution of scarce organs………………………………………………. 230

145       Theological and ethical considerations…………………………………………………………………………… 230

145.1      The body as a useless shell……………………………………………………………………………………… 231

145.2      Holistic understanding of the human being………………………………………………………………. 231

145.3      Theological paradigms……………………………………………………………………………………………… 231

145.3.1      Creation and re-creation…………………………………………………………………………………….. 231

145.3.2      What about the “soul”…………………………………………………………………………………………. 232

145.3.3      Being human……………………………………………………………………………………………………… 233

146       Pastoral issues………………………………………………………………………………………………………………. 233

146.1      Dealing with people in crisis……………………………………………………………………………………… 233

146.2      Certain time constrints………………………………………………………………………………………………. 234

146.3      Unnatural situation……………………………………………………………………………………………………. 234

146.4      Interaction between pastoral caregiver and medical staff…………………………………………. 234

147       SESSION 15………………………………………………………………………………………………………………….. 236

148       Daily Ritual…………………………………………………………………………………………………………………….. 236

148.1      Losses and gains……………………………………………………………………………………………………… 236

148.2      Time of discernment…………………………………………………………………………………………………. 236

148.3      Dwelling in the word Matthew 25:34-46……………………………………………………………………. 236

148.3.1      Sharing and listening to your partner…………………………………………………………………. 237

148.4      Homework feedback…………………………………………………………………………………………………. 237

148.5      Learnings and parking questions……………………………………………………………………………… 237

149       SESSION 15: END OF LIFE QUESTIONS…………………………………………………………………….. 237

149.1      Assisted dying/ Euthansia (Genadedood)………………………………………………………………… 237

149.1.1      Active euthanasia and voluntary assisted dying…………………………………………………. 237

149.1.2      Passive euthanasia……………………………………………………………………………………………. 237

150       Closing of Course…………………………………………………………………………………………………………… 238

150.1      Learnings………………………………………………………………………………………………………………….. 238

150.2      Issues parked during session…………………………………………………………………………………… 238

150.3      Evaluation of all five modules…………………………………………………………………………………… 238

151       AGAPE MEAL ……………………………………………………………………………………………………………….. 238

151.1      Opening prayer (PS 136)………………………………………………………………………………………….. 239

151.2      Togetherness……………………………………………………………………………………………………………. 240

151.3      Acknowledgement…………………………………………………………………………………………………….. 240

151.4      We confess………………………………………………………………………………………………………………. 241

151.5      Silence……………………………………………………………………………………………………………………… 241

151.6      Symbols……………………………………………………………………………………………………………………. 241

151.7      Sharing……………………………………………………………………………………………………………………… 242

151.8      The dedication for service………………………………………………………………………………………… 242

151.9      Prayer……………………………………………………………………………………………………………………….. 242

151.10        Closure………………………………………………………………………………………………………………….. 242

152       Bibliography 01………………………………………………………………………………………………………………. 243

152.1      Extra references organ transplantation:……………………………………………………………………. 249

153       Bibliography 02………………………………………………………………………………………………………………. 250

153.1      Date Created:        Date Saved: 11/07/201711/05/2017…………………………………………… 255

 

 

Module 1: Sessions 1-3

“We are struggling with the dark side of God like Jacob at the Jabbok River. But, when the morning comes we are limping but blessed” – Jurgen Moltmann

1       Module 1: Sessions 1-3

2       Welcome!

This is the beginning of our journey together. We need to work with each other to get the maximum out of this journey and to grow as persons. The end point to which we are heading is only roughly defined, and not set in stone. The process we will follow, however, is hopefully defined quite clearly and will not be uncertain.

As members of a group, we will disagree with one another from time to time. This should not damage our common purpose – to be of service to those in need of care

Task: Find a friendly looking stranger, with whom you think you will be able to share, as a partner for today only.

2.1      Introduction of facilitator

  • Facilitator of the course: Frederik Nel

Task: Large group discussion:

What do you know about the facilitator, or, have heard, or are curious to know?

2.2      Time schedule

09:00 – 10:30 – Ready, Steady

10:30 – 11:00 – Tea

11:00 – 12:30 – Go …

Task: Group appoints a timekeeper for the day/module

Timekeeper will (a) remind the facilitator and group 10 minutes before a break or end of the day of the time and (b) switch on the kettle for coffee 5 minutes before the break.

2.3      Donation box

A voluntary donation of R100 for each Module (3 days).

3       Challenge of new beginnings

This course – every module, every session and topic – will be a new beginning. To make the most of it will require from us on the one hand to focus our attention, but on the other hand also an attitude that is relaxed and going-with-the-flow. Focusing means that we try to leave other distractions where they belong (at home, at work, in the car, in our bag) and the go-with-the-flow attitude means being open to experiencing something new and maybe even different.

3.1      Primary aims!

  1. Learning opportunity: Acquiring new knowledge, or reconnecting with and refreshing knowledge you already have.
  2. Skills training: Listening, questioning, reflecting, interpreting.
  3. Theological reflection: Thinking about God’s presence in the group and in our interactions with others.
  4. Growth opportunity: Being in a group always creates new opportunities for personal challenges and growth.
  5. Spiritual sharpening: Each opportunity to reflect on God’s presence while we are with other people is per se an opportunity to sharpen our spiritual awareness.

3.2      Course approach:

3.2.1    Structured – Unstructured

The course has a clear aim, but is also flexible enough to adapt to the needs of the group. The aim of the course is to model the importance of healthy boundaries. Our boundaries might be so solid and fixed that we block out too much. Or, our boundaries might be so open and weak that everything is allowed through and we then face the danger of burnout. What we need is a healthy balance.

3.2.2    Interactive – discussion

  1. In the group, we should strike a balance between allowing enough time for interactive discussions and completing the aims for the day.
  2. All questions and contributions are important.
  3. Certain discussions may, however, be more useful rather than completing the task for the day, so feel free to ask questions and take part in the discussions.
  4. Depending on time constraints some discussions, contributions and questions will be parked – which means we will write these down to discuss them later rather than immediately. The idea is not to park a question or contribution because it is unimportant, but because it might fit in better with other discussions.
  • Task: Appoint a “parking attendant” to write down these questions/contributions and remind the facilitator later that they need attention.

3.2.3    Safe and unsafe

  • Learning and group environments are often experienced as “unsafe” environments.
  • Learning opportunities confront us with the possibility of change when our understanding of and insight into the topics under discussion grow and new, alternative views are being put forward.
  • We must allow our comfort zones to be challenged for effective learning to take place.
  • A safe environment helps us to be open to learning, but an environment can also become so comfortable that we stay in our safety zone. If there are no challenges, no learning will take place. We will all work together to find enough common ground to feel safe, but we will also bring forward enough challenges so that growth can take place for those who are ready for something more challenging. This brings us to the topic of “values”.

3.3      Values (not rules) for the course

There is a distinction between rules and values. Values are the foundations on which rules are built. Rules may change with the times and are influenced by cultural practices. When we confuse the two we may end up fighting for and against certain things that will not be worth the energy used. The most basic values are the same across all cultures and age groups.

Parenting and working with young people has challenged all of us to constantly define what those values are that we really need to imprint on others and what the rules are that we can negotiate and renegotiate.

3.3.1    Respect

Respect for each other, including differences in viewpoints, cultures, beliefs, gender, social circumstances, languages etc.

3.3.2    Confidentiality

Confidentiality is actually an example of respect.

Caregiving is not the same as being enmeshed in another person’s life. It is a way of being with another without making the other dependent on us, the carer.

3.3.3    Affirmation

Affirm the positive we see in each other and also accept the affirmation others give us.

3.3.4    Integrity

Honesty, trustworthiness, openness …

3.3.5    Values the group wants to add

3.4      Rules:

  1. Musical chairs: You are not allowed to sit next to the same person the next day.
  2. Please wear your name tags.

4       Settling in

4.1      Breathing exercises

“Beter kontak met jou lyf maak dit vir jou moontlik om met ’n groter deel van jou binnewêreld in kontak te kom sodat jy self meer teenwoordig is in die hier en nou van die saamkuier.” (Nicol 2016:91)[1]

Breathing exercises have many benefits. To mention only a few:

  1. They help us to become aware of the moment, to focus on the here and now.
  2. They make us aware of our bodies, and promote the integration of our emotions, spirit and body.
  3. It is physically healthy to breathe deeply to increase the oxygen flow in our blood.
  4. They release tension.

4.1.1    Breathing the presence of God?

BREATHING YAHWEH: (A reflection written by Fr Richard Rohr)

I cannot emphasize enough the importance of the Jewish revelation of the name of God. As we Christians spell and pronounce it, the word is Yahweh. In Hebrew, it is the sacred Tetragrammaton YHVH (yod, he, vay, and he). I am told that those are the only consonants in the Hebrew alphabet that are not articulated with lips and tongue. Rather, they are breathed, with the tongue relaxed and lips apart. YHVH was considered a literally unspeakable word for Jews, and any attempt to know what they were talking about was “in vain.” As the commandment said: “Do not utter the name of God in vain” (Exodus 20:7). All attempts to fully think God are in vain. From God’s side, the divine identity was kept mysterious and unavailable to the mind. When Moses asked for the divinity’s name, he received only the phrase that translates “I AM WHO I AM” (Exodus 3:14).

This unspeakability has long been recognized, but now we know it goes even deeper: formally the name of God was not, could not be spoken at all—only breathed. Many are convinced that its correct pronunciation is an attempt to replicate and imitate the very sound of inhalation and exhalation. Therefore, the one thing we do every moment of our lives is to speak the name of God. This makes the name of God our first and last word as we enter and leave the world.

I have taught this to people in many countries, and it changes their faith and prayer lives in substantial ways. I remind people that there is no Islamic, Christian, or Jewish way of breathing. There is no American, African, or Asian way of breathing. There is no rich or poor, gay or straight way of breathing. The playing field is utterly levelled. It is all one and the same air, and this divine wind “blows where it will” (John 3:8). No one can control this Spirit.

When considered in this way, God is suddenly as available and accessible as the very thing we all do constantly—breathe. Exactly as some teachers of prayer say, “Stay with the breath, attend to your breath”—the same breath that was breathed into Adam’s nostrils by this Yahweh (Genesis 2:7); the very breath “spirit” that Jesus handed over with trust on the cross (John 19:30) and then breathed on us as shalom, forgiveness, and the Holy Spirit all at once (John 20:21-23). And isn’t it wonderful that breath, wind, spirit, and air are precisely nothing—and yet everything?

4.2      Small Group discussion (with your partner)

  • Task: What will help you to feel safe in this group?

4.3      Looking after yourself (taking authority to look after yourself)

Any coursework that includes emotional input could be emotionally disturbing. It is therefore important to realise that, as an adult, you are your own primary “protector”.

  1. You are the only one who can set the boundaries for yourself.
  2. Do only what you need to do, and share only what you are willing to share.
  3. Do not take criticism personally, but see it as a learning opportunity.

4.4      The here and now

4.4.1    Small Group discussion (with your partner)

  • Task: What did you leave behind (give up) to attend this course?
  • If there are things you struggle to leave behind and which prevent you from focusing on the here and now, think about the following questions:
    • What do you need to do to leave these things behind?
    • What can this group do to help you in this regard?
    • How can you support others in the group who have similar struggles?

5       Time of Discernment (on your own) (10 minutes)

5.1      Dwelling in the Word

Rus/Resting Luister/Listening Lewe/Living
  • Task: Reflecting and listening to the Word of God.
  1. This is an opportunity to reflect on where you are as a person.
  2. What is God busy doing in your life?
  3. What do you hear from God?

5.1.1    Psalm 30

1983 Afr Vertaling                                                            NIV Translation

30 ’n Psalm. ’n Lied vir die inwyding van die tempel. Van Dawid.

2Ek wil u lof verkondig, Here, want U het my gered en my vyande nie laat bly wees oor my nie.

3Here my God, ek het na U geroep om hulp en U het my gesond gemaak.

4Here, U het my gered van die doderyk, my aan die lewe gehou toe ek al op pad was na die dood toe.

5Sing tot eer van die Here, julle wat Hom getrou dien, loof sy heilige Naam!

6Waarlik, sy toorn duur net ’n oomblik, maar sy goedheid lewenslank. Gisteraand was daar nog trane en vanmôre lag ek al weer.

7Toe dit goed gegaan het, het ek wel gesê: “Niks sal my ooit laat wankel nie.”

8Deur u goedheid het U my op ’n veilige berg laat staan, Here. Maar toe U U aan my onttrek het, het ek baie bang geword.

9Ek het na U geroep, Here. Ek het U om genade gesmeek:

10“Watter voordeel is daarin my ondergang as ek die graf moet ingaan? Kan stof U loof? Kan dit u trou verkondig?

11Luister, Here, en  wees my genadig! Help my, Here!”

12Ek was in die rou, maar U het my van vreugde laat dans. U het my rouklere uitgetrek en vir my feesklere aangetrek.

13Daarom sal ek sing tot u eer; ek sal nie stilbly nie.

Here my God, vir altyd sal ek U loof!

1I will exalt you, O Lord, for you lifted me out of the depths and did not let my enemies gloat over me.

2O Lord my God, I called to you for help and you healed me.

3O Lord, you brought me up from the graveb you spared me from going down into the pit.

4Sing to the Lord, you saints of his; praise his holy name.

5For his anger lasts only a moment, but his favor lasts a lifetime; weeping may remain for a night, but rejoicing comes in the morning.

6When I felt secure, I said, “I will never be shaken.”

7O Lord, when you favored me, you made my mountainc stand firm; but when you hid your face, I was dismayed.

8To you, O Lord, I called; to the Lord I cried for mercy:

9 “What gain is there in my destruction,d in my going down into the pit? Will the dust praise you? Will it proclaim your faithfulness?

10Hear, O Lord, and be merciful to me; O Lord, be my help.”

11You turned my wailing into dancing; you removed my sackcloth and clothed me with joy,

12that my heart may sing to you and not be silent. O Lord my God, I will give you thanks forever.

 

5.2      Sharing with partner/ Listening to partner

  • Task: What does your partner hear in the text of the day?

Important: In the feedback session you are your partner’s voice to the group.

Session 1: Foundations of Pastoral Care

6       SESSION 1: Foundations of pastoral care

6.1      Care delivery to vulnerable people

People in need, especially those in hospital, are mostly very vulnerable. People who are at a vulnerable stage in their lives, such as being in hospital, are primarily in need of care. The spirit and heart of the gospel are respect for people (and the whole of creation). Pastoral care thus takes respect for others seriously and wants us to be supportive of the whole person in all his or her needs.

We do not visit the hospital to satisfy any need to be informed about the latest sensational news or to satisfy our curiosity about others’ suffering. But often, when people stop at vehicle accidents or stream to scenes of fire and other traumatic situations, it is to satisfy their own needs.

For us, however, our action of service to a person in need is our main witnessing tool. By caring, we show the love of Christ. But it is important that our hospital careworkers understand that we do not visit patients to evangelise them.

People with a strong need (calling) to focus on evangelising are encouraged to become part of one of the many evangelising teams available. Surely, we will also get opportunities in the hospital to share the gospel, but then it will be because patients indicate that that is what they need, rather than because we have set that as a goal.

6.2      Being present

Caregiving means that we focus on “being present”, to be an ear for others. This sounds simple, but for most of us it is often the most difficult thing to do. Most people are much better at giving advice rather than listening. Christians are often much better at praying and reading from the Bible than listening and being present.

Hospital care and support do not mean that we go around carrying a “ready-made parcel” which we wish to deliver from bed to bed. A hospital visit implies that we make ourselves available, not only physically, but also emotionally, to listen by being present. Presence is much more than physical presence. It means focusing on the other person’s needs while “forgetting” our own problems, needs, experiences, prejudices and baggage.

6.3      To let go

Part of the training of hospital care is not only to learn what to do, but also to leave behind our ideas about what we think we are going to do. This is the hardest part and the most difficult skill to master.

It is only with confidence in our own skills to listen and with the power of the Holy Spirit that we can let go of our pretentions that we are the experts in what others need and that we know what must be done. We have to let go of our own ideas about what will make another person’s life better. We are not the social worker, nurse, psychologist or doctor.

“When we have the courage to let go of our need to cure, our care can truly heal in ways far beyond our own dreams and expectations.” (Nouwen 1994:109)

6.4      A spirit of Humility

The ruling worldview today is success-orientated. We are pressured to show results. The danger is that this spirit of counting our successes has also influenced the way we think about our pastoral work. But there is a difference between being success-driven (on the one hand) and being accountable, or being held accountable, on the other hand, for our actions, use of time, energy, and resources. The need for, or practice of, measuring success in the disciplines around us in the hospital should not cloud (affect) our understanding of our own calling.

The Christian community often has its own way of seeking “success”. Examples of this success-driven mentality are found in well-meant questions: How many people have you brought to the Lord in the hospital? How many people have you healed in prayer? This emphasis on healing may be in fact be a subtle way to influence others to become part of the success-driven culture – a culture which cannot accept disability and death.

When we share our stories of interactions in the debriefing sessions, it is not to discuss our stories of success, but to learn from our mistakes; to encourage one another; and to celebrate God, who is working and changing people’s lives.

Our task as pastoral workers is to encourage people, to bring a message of hope, to listen, to acknowledge others’ humanness, to educate, and to be a “balm of the soul” (Jer 8:18-9:2). We should do it with great humility and acknowledgement that it is only the Spirit of the Lord that can transform and take away the veil that covers our sin and understanding (2 Cor 3:12-18). It is not our success.

6.5      The facilitation process

Some people’s reaction to the facilitator approach is that this approach makes it unnecessary to train people.

The understanding is that it is much easier to just dish out advice, read a passage from the Bible, and pray, than to be an expert facilitator who listens and facilitates a conversation.

This pastoral worker training course aims to develop facilitation skills that will help us to be respectful facilitators who share the love of Jesus Christ through the way we are with people in need. The purpose of pastoral training is not to isolate knowledge and skills from our faith, from who we are, or from what our message is.

6.6      A wholistic and integrated approach

Pastoral care takes into account the whole person, in all his or her dimensions: physical, emotional, and spiritual. Also taken into account are relationships in terms of all these dimensions with family, children, partners, colleagues, friends, pastors – and in this situation, caregivers. There are also other relationships within systems, such as those of the health, religious, economic, work, political, nature and cultural systems.

Another part of this is the important question about the patient’s relationship with his or her illness. How does he or she see and understand their illness physically, emotionally and spiritually? Does the patient have the ability to integrate the reality of the illness with his or her life and relationships with God, family and future? Is the illness an enemy, a friend, a nuisance, a hindrance, a challenge, a depressant, a growth opportunity, or is it victimising the patient? And what is the relationship of the family and church to the patient’s illness?

An integrated approach challenges the dualistic understanding of human beings that often prevails in society, especially among Christians and in churches. In this dualistic understanding, body and soul are separated – and a higher value is often put on the soul. The influence of the Greek philosopher Plato on the Western thought and interpretation of the Bible in this dualism is well known.

A more Biblical view is the non-dualistic thinking of human beings that emphasises the unity of the human person. Body and soul are only separable in thought but not in reality (Thatcher 1990:26). The description of a human cannot be reduced to only the mental, emotional, spiritual or physical state. A person is a person through the connections between all these dimensions – and also more than that. The philosopher Aristotle said that the whole is greater than the sum of its parts – which helps us to understand that what these different connections actually add up to when we put them together is greater – more – than their mere sum added up. We are primarily, and in the first instance, an integrated person, but it is the limitations of language and thoughts that often make it necessary for us to focus on only one section of who we are – body, spirit, emotions, intellect, and so on. But the mind as a physical organ does not in itself fully explain consciousness in human beings. In short: there are dimensions to the brain of a human which transcend the mere physical structure of the brain.

It is possible to look at this according to an analogy of the concept of unity in the incarnation of Jesus Christ. Theologically, the early church formulated definitions at Chalcedon which included that Jesus Christ is both truly God and truly human. The implication is that Jesus has the same “building” blocks of life (DNA and RNA) as all tother people, but this is not the full picture of who Jesus was. Jesus sees his own God-character as being embedded in his relationship with God the Father. In Jesus Christ we can see what true humanness is and what true personhood means.

The Chalcedonian statement that “Christ, like us in all things apart from sin”, helps us in our understanding of wholeness, of being fully whole. Salvation is closely related to “wholeness” or “being made whole”. Sin is the disruption or even destruction of our wholeness. The Greek verb sozein means “to heal” and “to save”, and is connected with sos/soas which means “whole” or “sound”.

7       Understanding the context of hospital pastoral ministry

7.1      The origin

The word “pastoral” refers to the shepherd motif in the Bible (Psalm 23; Psalm 80; Isaiah 40:11; 49:9, 63; Jeremiah 23:3; Ezekiel 34:31; Luke 15:4-6; John 10; 1 Peter 2:24-25) and is widely used to identify care. By using the word “pastoral” the emphasis is placed on action – by the church, on behalf of the Christian community, and in obedience to the Lord who calls the church community to care for others (Galatians 6:2; 1 Thessalonians 5:14; Romans 15:1).

Pastoral says something about the origin of care (Gerkin 1986:21), specifically care by the Christian community. Practising pastoral care is to understand that Jesus Christ sent us to be the bearers of His love, redemption and forgiveness. Christ was called and sent by the Father to become human. Which makes it clear that pastoral care characterises both a definite calling and of us definitely “being sent”. We are called and sent to creation in this world to represent God, Christ and the Holy Spirit.

Every day we take part in many different kinds of conversations. Some are formal and others informal. The conversation we have with our partner will differ from the conversation with our boss or employee. As a parent, the conversation we have with our children is different from the conversation between a teacher and his or her pupils.

In the church we also have different types of conversations, with the difference often depending on the particular situation and also influenced by how well the church members know each other. Your fellow church member could be your neighbour or your cousin. It could also be your boss, employee, banker, doctor or political opponent.

In all our conversations, we can and should allow something of the Christian character of us being sent tby God o be visible.

In obedience to the God who sent us, Christians go to people (members of the church; people of other faiths; people with no connection to any faith community), with a calling to bring the love of God to them. It is in answering the call of God that we make ourselves available to be sent to those who are in need, and that we create opportunities for pastoral conversations.

It is not the prayer or the scripture reading that makes it a pastoral conversation, but rather God – who called and sent us – who is the origin of this movement to serve others. We represent the Shepherd and the Kingdom of the Shepherd, without being the Shepherd, but we bring the love, caring, and understanding of the Shepherd.

7.2      Training?

The question is whether believers responding to being called and sent need formal training before they can reach out to others.

The answer is a yes and a no. Let’s think about the “no”. In obedience, all we need to do is to go in, depend on the Triune God, and respond to the needs of others. There are many examples of people who do wonderful work without any training or formal education.

So why do we do training in pastoral conversations? The answer is actually longer than you might expect!

Our understanding of God is central to such a discussion. We may also refer to this as our theological departure point. Expanding on the points already made, also note the following: God is not against this world or this creation, God is against sin.

God and creation are not two opposite positions. But God’s grace and our sinfulness stand opposite each other. Think about the following scenario: yesterday you had a headache and asked someone to pray for you. You felt better after the prayer, but this morning you again have a headache and now you feel better after taking a Panado.

When we put God and creation against each other we will say that it is prayer that is the work of God and Panado more likely the work of people (or science). But if we understand that the whole of creation belongs to God and that God is God of all creation, we will understand that God’s involvement does not stop the moment we make use of man-made interventions (such as Panado).

Sharpening our skills and using resources to understand the Bible do not exclude God or the Holy Spirit. A commentary on the Bible text connects the Bible student with the insights of other Christians and traditions. It widens the possibilities of interpretation of the text.

We know that God meets us where we are. Four thousand years ago God met the people of that time (Abraham), and God met those of two thousand years ago (Greeks and Romans), each within their culture. Jesus did not come in a red Ferrari when everyone else was walking or using donkeys. Two thousand years ago Jesus also did not come as a cave dweller when the people of that time had moved beyond the stage of living in caves.

We live in an age in which there is an enormous amount of knowledge available about communication. There are many different therapeutic models in action today. When we go to those in need as persons called and sent by God, this means we also need to get to know what some of the communication skills of our time are – and to use them.

Pastoral conversations are a response to being called and sent by God but our response is not only action coming from the faith community. It is also an informed response, taking into account modern communication skills and therapeutic skills.

7.3      Hospital context

The hospital context is that of a “professionalised’ context – but often over-professionalised. The over-professionalisation has created certain problems, i.e. patients and families feel disempowered, it creates dependency, can be experienced as manipulative, and patients can easily feel they are only numbers. Although many medical staff are not sensitive to the fact that they are part of this over-professionalised system, a growing number of nurses, doctors, and staff in other disciplines are well aware and sensitive to over-professionalisation. In many instances, professionalisation also brings more benefits than disadvantages to patients and families. You know, for example, that the staff are trained and registered with an appropriate professional body; you can expect a certain standard of knowledge and behaviour from the staff. You can expect confidentiality, privacy of information and high ethical standards.

This professionalised context is very necessary because the patient is in a vulnerable position and allows others to enter and know the most intimate physical and emotional aspects of their life in order to treat them. Hospital management has, by law, but also by conscience, the enormous task to protect the patient at this vulnerable stage in their life.

Although we may go and speak to our neighbour, fellow church members or colleagues without any training or knowledge, having only our own good intentions and belief in Jesus Christ, this is not appropriate in the hospital context. Training helps us to be better equipped for our calling by God in His having sent us into the world. Just as we all accept that to be able to read equips and enables us to be better in the proclamation of the gospel rather than staying illiterate. Through the ages the church has always put a very high premise on the training of its leaders in order to proclaim the gospel better.

8       Small Group Discussion (with partner)

  • Task: Your experience today.

9       Daily Closing Ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you will do differently in the future?
  4. Where is God at work?

10    Task (Homework)

  • What do you want to get out of this course?

 

Session 2: The Basic Pastoral Conversation B

11    SESSION 2: Pastoral conversation

12    Daily ritual

12.1   Losses and gains

12.2   Living mindfully

  1. What it means

“ … to wake up more vividly tot the present moment, … to stay calm(er) in the face of a crisis. It helps me now to be more attentive and present to others, and to live more intentionally, and less reactively, while remaining open to the possibilities of life. … it has helped me to recognise the insecure voice of my ego, which so often wants to control life with a vice-like grip, and to compete selfishly, and to make endless and dissatisfying comparisons with others.  Mindfulness have helped me to learn more about my Christian faith and in particular how the ego-driven ‘false sense of self’ can mask the true.” (Brian Draper 2016:2)

  1. Breathing and mindful exercises
  • Close your eyes
  • Focus on your feet and become aware of your feet.
  • Move the focus to your hands and become aware of your hands.
  • Reflect on being in the hands of God.
  • Now focus on your chest and experience how your chest is rising and falling, in and out.
  • Value your ability to breathe automatically without you having to think about it.
  • Shift the focus to your ears and try to hear and identify soft sounds.
  • Open your eyes. What do you see?

 

12.3   Time of discernment

12.3.1 Dwelling in the Word – John 15

John 15 (NAV)                                                                  (NIV)

15 “Ek is die ware wingerdstok en my Vader is die boer. 2Elke loot aan My wat nie vrugte dra nie, sny Hy af; maar elkeen wat vrugte dra, snoei Hy reg, sodat dit nog meer vrugte kan dra. 3Julle is alreeds reg gesnoei deur die woorde wat Ek vir julle gesê het. 4Julle moet in My bly en Ek in julle. ’n Loot kan nie uit sy eie vrugte dra as hy nie aan die wingerdstok bly nie; en so julle ook nie as julle nie in My bly nie.

5“Ek is die wingerdstok, julle die lote. Wie in My bly en Ek in hom, dra baie vrugte, want sonder My kan julle niks doen nie. 6As iemand nie in My bly nie, word hy weggegooi soos ’n loot en hy verdroog. Die mense maak sulke lote bymekaar en gooi dit in die vuur, en dit verbrand. 7As julle in My bly en my woorde in julle, vra dan net wat julle wil hê, en julle sal dit kry. 8My Vader word juis daardeur verheerlik dat julle baie vrugte dra en my dissipels is.”

 

15     “I am the true vine, and my Father is the gardener. 2 He cuts off every branch in me that bears no fruit, while every branch that does bear fruit he prunesa so that it will be even more fruitful. 3 You are already clean because of the word I have spoken to you. 4 Remain in me, and I will remain in you. No branch can bear fruit by itself; it must remain in the vine. Neither can you bear fruit unless you remain in me.

5 “I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing. 6 If anyone does not remain in me, he is like a branch that is thrown away and withers; such branches are picked up, thrown into the fire and burned. 7 If you remain in me and my words remain in you, ask whatever you wish, and it will be given you. 8 This is to my Father’s glory, that you bear much fruit, showing yourselves to be my disciples.

 

12.3.2 Sharing with and Listening to your partner

  • Task: What did your partner hear in the text.?
  • Feedback rule: Provide the group with feedback on what your partner has said to you.

12.4   Homework feedback

12.5   Learnings and parking questions

13    Pastoral Conversation (1)

13.1   Basic awareness – Being visible, tuned in and attentive

Attentiveness describes the way you need to be when you are with another person, while listening refers to the ability to capture and understand the message that person gives you. Attending to them, the attentiveness of being present, puts you in a position to listen carefully. Lllllll

13.2   It is all about the other person and not about you

  1. Our own problems, circumstances, and emotions may cause so much background “noise” that we cannot hear the other person’s story.
  2. Do not take “rejection” by a patient and/or family personally. Some patients and their families are in a space where they do not want “outsiders” or “strangers” to be involved. Accept that.

13.3   People have inner resources.

There is a natural tendency in most of us who do this type of training to think of ourselves as the “saviours” of others when we help them. Training may even add to the feeling that we are now the “experts” who know how to solve others’ problems. This tendency might result in us over-supporting adults in need. In all our actions of support and help we should remember that we do not want to make people dependent on us. Instead, our support should help people to discover even more of their inner resources.

Patients may already feel overwhelmed and helpless, and if we are not careful we might increase these feelings. And as pastoral workers, we may ourselves become overwhelmed by the circumstances of patients if we start thinking about them as helpless people.

13.4   Be aware of any form of stereotyping our own minds may create.

  1. Stereotyping is often created unconsciously and we might not be aware of it.
  2. One of the signs of stereotyping is using or thinking the words “us” and “them”.
  3. Stereotyping means we do not give people a fair chance to be who they are. We put them in a box and then deal with them from that perspective.

As a group we must help one another not to think about patients in stereotypical ways. When we hear another using a stereotype to describe a person, we should remind each other that this is not beneficial to a pastoral conversation.

The list of stereotypes is endless. Here are some examples:

  • Colour; ethnic background; language
  • Gender
  • Rural; urban
  • Rich, poor, middle class
  • Unemployed; employed
  • Type of illness – cancer; TB; HIV+

13.5   Dealing respectfully with differences in conversation.

The problem in a diverse society is not the diversity or the differences in opinion, but how we deal with the diversity and differences.

13.6   The physical position you take in conversation (SOLER)

13.6.1 (S) Squarely (45 degrees)

In Western culture, it is important to face another person.

13.6.2 (O) Open Posture

Avoid defensive postures, i.e. crossed arms.

13.6.3 (L) Lean

Adopt a slight inclination towards the person.

13.6.4 (E) Eye contact

Eye contact: (cultural differences)

13.6.5 (R) Relaxed

Natural behaviour.

13.6.6 Creating Context

“Words do not have any inherent meaning, they only make sense when we know the context in which they are used” (Wittgenstein 1953).

Context is not something abstract. We create the context for words, deeds, and meaning all the time. The moment we start to interact with another person a new context is being created. There is the context that exists when you were absent and the new context when you enter the room and start to say something.

According to Bateson there are three important contexts to keep in mind: Context of time, relationship and place.

13.7   Reflect on your conversation

  • What is my attitude towards this person?
  • How would I rate the quality of my presence?
  • In what ways am I distracted from giving my full attention to the person?
  • How could I be more effectively present to this person?
  • Do I listen with an open mind?
  • What is the context?

14    Active listening

Active listening is more than just being able to repeat the other’s words, it is a presence that captures and understands the message which that person conveys.

(i) listening and understanding verbal messages.

(ii) observing and interpreting non-verbal messages.

(iii)  Listening/ attending to the context.

(iv) listening to find entry points for a pastoral[2] conversation.

14.1   Listening to verbal messages (peoples’ stories)

People do not separate the stories they tell us into categories. Stories often become complicated and may leave us with too many threads to hold unto. A useful tool is to identify the following three dimensions of a story often interweaved with each other.

People’s experiences – that is, what happens to them.

People’s behaviour – what they do or refrain from doing.

People’s affects – their feelings and emotions.

14.2   Listening to non-verbal messages

  • Facial expression: smiles, frowns, fear, anxiety
  • Bodily behaviour: posture, bodily movements, gestures
  • Voice: tone, intensity, fluency
  • Autonomic physiological responses: quickened breathing, blushing, paleness
  • General appearance: grooming
  • Physical characteristics: fitness, weight, tiredness, energy
  • Clothing

14.2.1 Non-verbal messages can “leak” important information

A non-verbal message can:

  • “Confirm” what the person is saying.
  • “Deny” or “confuse” what the person is saying.
  • “Control” or “regulate” the conversation, i.e. by the person not inviting you to sit
  • Make it impossible to continue with the conversation, i.e. when the person is constantly looking at their watch, checking their cell phone, or keeping one eye on the TV.

14.2.2 Be careful not to overinterpret non-verbal messages

  • There may be very good physical reasons for the way the person behaves. This may be even more so in the hospital set-up, which is already an unusual one. The patient is also only a visitor there and not truly your host.
  • Make sure you notice things, but without making too little or too much of them.

14.3   Emphatic listening

“It means entering the private perceptual world of others and becoming thoroughly at home in it. It involves being sensitive, moment by moment, to the changing felt meanings which flow in this other person, to the fear or rage or tenderness or confusion or whatever that he or she is experiencing. It means temporally living in the other’s life, moving about in it delicately without making judgments” (Rogers as cited by Egan 1998:74).

Emphatic listening is thus selfless listening, it means to put aside our own concerns. We should put a lot of effort into making sure that we hear and understand correctly. Reflecting on what we hear is one way of checking whether we heard and understood correctly.

We are not machines, and our own concerns and context will influence what we hear and understand. But when we try, and make an effort, it is possible to listen and understand beyond our own context.

For emphatic listening the concept of “temporal living” is important. But we should also, after intense listening, be able to move on. We should not get stuck in the other person’s world.

14.4   The Shadow side of listening

  • Inadequate listening: being distracted, own thoughts intervening or blocking.
  • Evaluative listening: judging what the other person is saying as good/bad; right/wrong; acceptable/unacceptable; likeable/unlikeable; relevant/irrelevant.
  • Filters: cultural filters; or filtering through labelling.
  • Interrupting
  • Fact-centred rather than person-centred
  • Rehearsing: being concerned about your own response rather than listening carefully.

14.5   Complicated “hearing”

Listening can be very difficult because we easily filter out what another person says. We all know that “denial” is a very strong self-defence mechanism. A person may say something we are not ready to hear and we just don’t hear it, so it doesn’t register in our conscious mind.

Hearing may also be complicated further by conflict between the speaker and listener due to different belief systems, paradigms, philosophies and religious beliefs. To listen carefully when we differ in opinion from the speaker can become very tiresome.

14.6   Listening to yourself

Mindfulness helps us also to listen to our own feelings and emotions. It is valuable to reflect on what you felt during a conversation. Were you sad or excited, peaceful and content?  What happened in your body during the conversation? Did you relax or become anxious or even fearful?

15    Practical exercises (groups of two/three )

  • Task: Discuss you own personal experience of hospitals/doctors/operations
  • Feedback rule: Give your partner(s) feedback on what they said.

16    Reading and listening to the Bible (Part 1)

“Die gesag van die Bybel veronderstel uitleg …” (Smit 2006:).

Translation Carina le Grange The authority of the Bible takes interpretation for granted/ The authority of the Bible presupposes interpretation.

We know that, as Christians, we differ in our interpretations of the Bible. Also, often we tend to think that we take the Bible more seriously than the next person. Questions about the authority of the Bible (skrifgesag) are thus often the starting point in discussions on this subject.

But is it really true that the person who differs from me does not take the Bible as seriously as I do? When we read and listen to the Bible with others, it will help to accept or assume, as our departure point, that the authority of the Bible (skrifgesag) is also important to the other. Even though our interpretation of the text, the way we read it, and how we listen to it, may differ.

Thinking about and reading single Bible verses may already lead to specific interpretations that could differ in meaning from reading whole Bible books as a unit[3] and the Bible as a whole. For instance, reading the First Testament (Old Testament for Christians) as if there is no Second Testament (New Testament), and vice versa, make a definite difference in interpretation.

For many Christians it is in any case news to hear that the Bible as we know it today, with its different chapters, numbered verses and even headings in some translations, is a relatively modern concept.

An early version of the Bible, the Paris Vulgate, was divided into chapters by the Archbishop of Canterbury, Stephen Langton (1150-1228), for example.  And the present division of the text into verses occurred for the first time when Robert I Estienne (1503-1559), a scholar-printer, printed the Greek New Testament in 1551.

The first Bible in English to use both chapters and verses was the Geneva Bible, published shortly after this, in 1560. The verse division soon gained acceptance as a standard way to notate verses, and has since been used in nearly all Bibles in English and other languages.

The division of the Hebrew Bible into sections happened very early on. The Torah was divided in 154 sections – an aide for reading the whole over a 3-year period.

The late Ferdinand Deist, well-known Old Testament scholar, reminded us that the Bible was not a book of quotations. According to Deist, this is one of the basic problems in the way we use the Bible.

“Na my oordeel is dit een van die basiese probleme in ons Skrifgebruik, dat ons die Bybel behandel asof dit so ‘n boek vol nuttige aanhalings is” (1986:101).

(Translation Carina Le Grange: My view is that one of the basic problems we have in using the Bible is that we use it as though it is a book full of useful quotations.)

17    Closing Ritual

  1. What did you learn today?
  2. Is there anything that limits your learning?
  3. Did you learn anything that you will do differently in the future?
  4. Where is God busy working?

18    Homework:

  • Task: Determine your own needs as a person.
  1. Write down eight needs or wants.
  2. Determine which is a need and which is a want.
  3. Rate each need according to the level of importance it has to influence your happiness. One (1) means low impact, while a ten (10) means it has a very large impact on your happiness.
  4. Where is God already at work with regard to your needs and wants?

 

 

 

Session 3: The Ethos of hospital visiting & Breaking bad news

19    SESSION 3: Hospital Etiquette (Ethos of Hospital visiting)

20    Daily ritual

20.1   Losses and gains

20.2   Living mindfully

Mark Williams, emeritus professor in clinical psychology at Oxford University, describes mindfulness as “calmly abiding in the present moment” (cited by Brian Draper 2016:21). We know this is not so simple as our minds tend easily to be distracted. It may even be difficult to just sit still for a few seconds. This is where focusing on breathing can help us.

Breathing is one of the most fundamental rhythms of life. Doing breathing exercises as part of our daily routine can help us to establish a rhythm that includes both our mind and body. Breathing helps us to relax and become more aware of our self and what is happening around us. It settles our soul in the midst of a busy life schedule.

20.2.1 Breathing and/or mindful exercises

  • Sit comfortably in a chair, with a straight back and your feet on the floor.
  • Focus your attention on how you breathe in and out.
  • You are not trying to achieve anything more than just paying attention to how you breathe.
  • If your mind starts to wander, bring it back gently to your breathing.
  • Most of us become frustrated when our mind dwells on other issues rather than staying in the moment. Let the frustration go, you are not in a competition. You are busy practising a new skill and you have the rest of your life to work on it.

20.3   Time of discernment

20.3.1 Dwelling in the Word: John 15

 

Rus/Resting Luister/Listening Lewe/Living
  • Task: Reflecting and listening to the Word of God.
  1. Opportunity to reflect on where you are as a person.
  2. What is God busy doing in your life?
  3. What do you hear from God?

20.3.2 Sharing with and listening to partner

  • Task: What did your partner hear in the text of the day?

During the feedback session you are your partner’s voice to the group.

20.4   Learnings and parking questions

20.5   Homework feedback

21    Hospital Etiquette and hospital functioning

21.1   Understanding ward structures

  1. Nursing station in the ward:
  2. Bed arrangement in the ward: In wards with several beds, beds are numbered clockwise, starting with the bed closest to the door on the left. Hospitals use alphabetic or numeric numbering. The first bed to your left will be a/1, etc. In a six-bed ward, bed d/4 will be opposite bed c/3.

 

c       d

b       e

a       f

 

 

 

 

  1. Personnel in ward
  • A ward has a unit manager (known as a matron in the old days)
  • Sister in charge
  • Staff nurse
  • Nursing help (no epaulette)
  • Nurses in training

 

  1. Shoulder epaulette of a qualified nursing sister is maroon. Plus:
    1. Green – obstetrics & gynaecology
    2. Black – psychiatry
    3. Yellow – community health
    4. White/silver – training in administration

21.2   Know the wards

Wards in George Hospital (Thanks to Hentie Coetzee for writing up this information)

  • AG – A Block, 1st Floor            Psychiatric Ward
  • BG – B Block, Ground Floor   Medical & Surgical, Burns Unit
  • A1 – A Block, 1st Floor Day Ward, Family Medicine
  • B1 – B Block, 1st Floor               Orthopaedics, Urology, Family Medicine, Ophthalmology
  • A2 – A Block, 1st Floor             Medical (Internal Medicine), Physiotherapy & Occupational Therapy, Social Worker (Karen Steenkamp)
  • B2 – B Block, 2nd Floor               Surgical Ward
  • B3 – B Block, 3rd Floor             Neonatal Unit & Neonate ICU (premature babies) and Postnatal & Gynaecology
  • B4 – B Block, 4th Floor               Maternity Ward (Obstetrics)
  • CG – C Block, Ground Floor   Paediatrics (children up to 12 years old)
  • POPD – C Block, Ground Floor Paediatric Outpatient Department (next to CG)
  • Trauma – Ground Floor
  • Day Ward – Ground Floor (opposite Trauma Unit; patients do not stay overnight)
  • Renal Unit – Ground Floor
  • Chemotherapy – Ground Floor
  • Pharmacy – Ground Floor
  • X-Rays, Scans & Sonars – Ground Floor
  • Patient Administration – Ground Floor
  • Quality Control Manager (Pieter Moolman) Ground Floor

21.3   Confidentiality

  • Don’t discuss your patients with your family and friends. Even when there are good-news stories. It is up to the patients themselves to share their stories and we are not at liberty to share any stories in any way that we might like to.
  • Please don’t take photos, even if it is just for yourself.

21.4   Being part of a team

Being part of a team requires us to keep in mind a wider context. We should be willing to cross boundaries and not be sectarian in our approach. We should be willing to interact as spiritual supporters to patients in a scientific environment.

In the first instance, we are present in a universal spiritual role. The implication of this is that we are not a representative of our own denomination. It means that we have to make a distinction between giving spiritual care in general and the specific belief structures of our own denomination.

21.5   Be loyal

Please do not make negative comments about the hospital or any of the medical and other disciplines in the hospital.

If you feel there is anything that requires attention, bring it to the attention of people who can do something about it. George Hospital has a quality controller – Pieter Moolman, who investigates all complaints. Mediclinic has a public relations officer.

Things do go wrong in hospitals and if we or a patient we work with has a bad experience, it should be followed up. If necessary, raise the matter at our debriefing meetings and we can together approach the correct people to attend to it.

21.6   Referrals are normal in team activities

  1. If you encounter anything you feel uncomfortable about or believe is beyond your field of expertise, refer it.
  2. This does not mean that you should never extend your comfort zone to try new things. The basic principle is that nothing you do must be damaging to the patient and hospital. One way of trying new things is to get someone else to accompany and support you in your action.
  3. If you see a patient who is waiting to be transferred to Groote Schuur or Tygerberg Hospital, you can refer them to those hospitals’ pastoral care.

Sylvia Nene & Lize du Toit 021 938 4546 (TBH)

Mervin Meyeridricks 021 685 6034 (GS)

Jo-Anne Petersen 078 135 5291 (Karl Bremer)

21.7   Patients are in a vulnerable situation

  • Patients are vulnerable – physically, emotionally, spiritually and socially.
  • Caregivers are, in most cases, viewed as having “more authority” than patients.
  • Caregivers should in no circumstances misuse their position.

21.8   The sister is in charge of the ward

When you enter a ward, greet the secretary and introduce yourself to the person in charge. Make clear what the purpose of your visit is and ask for the necessary permission.

21.9   Washing of hands

Infection is an enormous headache for hospital management. It is a difficult risk to manage because the best practice would be to ban all visitors to the hospital – which is not practical.

“Healthy” people (those not in hospital) are an enormous infection risk to the sick patients whose immune system is often compromised. Hospital staff and visitors not only bring germs, bacteria and viruses to the hospital, but can also be the carriers of infection between different wards and patients.

Wash your hands when you enter a ward. We also suggest that pastoral caregivers consider buying a small bottle of waterless hand sanitiser/ disinfectant to take with them when they visit patients.

21.10         Do not sit on a patient’s bed

As a general rule it is better to sit rather than to stand and talk. Research shows that being physically at the same level as the person you are in conversation with improves communication. This should be balanced with the general rule that we do not sit on the bed of a patient.

21.10.1              Why is it not acceptable to sit on a patient’s bed?

  1. Visiting a patient in your capacity as a pastoral careworker makes you part of the professional team. To sit on the bed crosses that boundary.
  2. From a medical perspective:
    1. Patients may get hurt.
    2. There is a danger of interference with drips and catheters.
    3. Healthy (and ill) people are carriers of diseases, bacteria, and viruses.

21.11         Requests for help

Be careful about adhering to requests by patients to make them more comfortable. Obviously, especially as caregivers, this could create difficulties.

A good example is how a request for water from a patient may be one of many pitfalls. Who refuses water to a thirsty person? But the hospital set-up is different. A person may be awaiting a procedure and it is for their own safety that they may not drink water before an anaesthetic. There may also be medical reasons why a patient’s fluid intake is being monitored.

Always make absolutely sure that there is no sign at the patient’s bed saying “Nil per mouth”. If in doubt, do not to give patients anything to drink or eat without the permission of a medical staff member.

Patients may be diabetic, for example, (or being tested for a diabetic condition) and fruit, sweets or cooldrinks may need very careful monitoring.

21.11.1              Take care not to interfere with any apparatus

Patients’ requests are often very basic, i.e. to change the inclination of the bed, etc. If you are uncertain about anything, please check with the nursing staff.

21.12         Patients in isolation room (not something that happens often)

Under normal circumstances you will not be asked to visit patients in isolation. In 90%+ of cases the patient is in isolation not because he or she is a danger to others, but because we are a danger to the patient. We are carriers of all kinds of bugs that do not make us ill as long as our immune system is functioning normally.

Wash your hands before and after each visit. If you are uncertain about whether to wear a gown and mask or not, ask a staff member,.

Introduce yourself very clearly. The patient can’t see your face properly when you wear a mask  and may confuse you with medical staff members.

Do we touch a patient in isolation? Patients in isolation have an even greater need to be touched by other human beings. But we may carry germs that could cause the patient’s death. Speak to nursing staff to get clarity about what you are allowed or not allowed to do, before entering the isolation room.

21.13         Do not overstay your welcome

With patients in ICU or high care, your visits should be short, only 5 to 10 minutes at a time.

Ward visits should not be longer than about 20 minutes. If patients introduce topics that need long conversations, create a boundary by making it clear that there are limitations to the visit.

“You ask a very interesting question and I think we can talk about it for the whole day. Unfortunately I can only stay for another 20 minutes”.

21.14         Be careful of what you say in the presence of a comatose patient

Our knowledge about what people hear and understand when they are unconscious is limited. Therefore, we should always act as if a patient is awake, can hear and understand everything.

We should not say or discuss anything that we would be uncomfortable saying or discussing when the person is awake, or fully present.

21.15         Wards rules regarding child patients

Children are in need of even more protection. Thus, it is even more important to remember that it is not allowed to photograph children.

Children like sweets – but you should be very careful not to bring them anything you have not checked out with the ward sister. And be sensitive about handing out sweets to some but not others.

21.16         Cases of sexual abuse & neglect

Be careful to prevent making yourself vulnerable. If any incident happens that can be interpreted in a sexual way, inform the ward sister.

If a patient provides you with any information regarding a staff member, immediately contact the ward sister or other structures in the hospital, i.e. a social worker.

21.17          (Over)Involvement

Doing carework requires both a heart and the ability to draw boundaries. Providing support should not encourage patients to become dependent on us. We should not manipulate others to need us – or allow others to manipulate us.

22    Summary: Hospital Departments

  1. Medical (Internal Medicine) Ward
  2. Surgery Ward
  3. Orthopaedic Ward (Surgical)
  4. Maternity Ward (Surgical)
  5. Paediatric Ward (Medical)
  6. Burns Unit (Surgical)
  7. Cancer Unit (Surgical & Medical)
  8. ICU (Surgical and Medical)
  9. Emergency Unit
  10. Psychiatric Ward

23    Group activity

  • Task: With your partner of the day, share two things you think are important to keep in mind when you visit patients in the hospital.

23.1   Feedback to the group

 

24    Possible stages after a cerebral insult or brain injuries

Be careful how you assist the family of a patient with a brain injury. Families may jump to conclusions about any indication that the patient is responding to, for example, his or her name. Unfortunately, these responses may be very complex to interpret.

Research has shown, for example, a certain delayed brain “recognition” (response on the electroencephalographic recording) by patients in a Minimal Conscious State or with Locked-in Syndrome, as well as some people in a Vegetative State, to their own name. The researchers warn against an over-interpretation of the results, saying “… responses can be interpreted as an index of some preserved semantic processing … (but do) not necessarily reflect conscious perception …” (Perrin e.a. 2006:568).

24.1   Comatose state

Patient has no spontaneous eye opening and cannot be awakened by vigorous sensory stimulation. Can’t consciously hear, see or show emotion.

24.2   Vegetative state

Patient can evolve from a comatose state to a vegetative state. The eyes are open but they only show reflex behaviours. No evidence of self or environmental awareness. There is evidence of sleep-wake cycles. Limited capacity for spontaneous or stimulus-induced arousal. Possibility of limited orientation to sound and vision. Reflexive crying or smiling.

One of the traditional criteria for a person in persistent vegetative state (PVS) requires the presence of a sleep-wake cycle. More recent studies of patients in a state of permanent unconsciousness after brain damage, started to question sleep-wake cycle as a definite criterium, as it may exclude patients from being diagnosed as PVS just because they do not show a sleep-wake cycle.[4] Another study suggested that the origin of the brain damage may influence the circadian rhythm.[5]

24.3   Minimal Conscious State (MCS) is a partial conscious state:

“The minimal conscious state is a condition of severely altered consciousness in which minimal but definite behavioural evidence of self or environmental awareness is demonstrated.” (Giacino JT et al 2002:350-351).

Patient shows inconsistent reproducible evidence of awareness. Technically there are two categories – MCS- and MCS+. With MCS- there is awareness without any following of commands, and with MCS+ limited commands are followed. Can show some automatic movements; can hold or touch objects and even show attempts to verbalise words, but inconsistent. Show smiling and crying.

24.4   Next stage is functional communication or object use.

24.5   Locked-in syndrome

Patients with Locked-in Syndrome belong in a separate category. They are conscious; have sleep-cycles, can hear and see, but can’t communicate. They are aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking. The individual is conscious and sufficiently intact cognitively to be able to communicate with eye movements.

25    Breaking bad news

When we have to break bad news to someone else, we can only try our best. Often the circumstances in which we have to do this are not ideal. The setting and circumstances may be beyond our control and difficult to implement, but here are some suggestions to consider.

25.1   Determine (or acknowledge) your own feelings

If the person who breaks the news is a friend or related to the family, he or she will also be emotionally affected by the news. It can thus be just as difficult for the person breaking the news as for the receiver.

If you have to break the news, work through your own reactions before telling someone else. The news may affect you equally badly, and even if it doesn’t directly affect you, it may disturb you considerably. So, it is important to give yourself a chance to recover before you try to explain things to someone else.

For example, allow yourself some time to have a cup of coffee, a shower, or meditate or do deep breathing – or simply sit in a quiet place for a few minutes.

Once you’ve moved past the initial shock, and reflected on the news, it will be less intimidating to share. Accept your own emotions regarding the news.

25.2   Determine if you’re the right person to break the news

  1. If you’re a casual acquaintance who just happened to learn about the bad news early and by chance, seriously consider whether you are the right person to be the bearer of the news.
  2. We do not have an automatic right to share bad news on social media just because we happen to hear the news early.
  3. If the news relates to a death or other serious circumstances, allow family and close friends time to call or visit the people most closely affected before you jump in.
  4. There might be someone in the family who is more suitable and very capable to break the news. Your role is then to support that person.
  5. In certain professional contexts it might be your responsibility to break the news. A family member might, for example, ask you to break the news on their behalf.

If you think it would be helpful, ask a family member or friend of the bereaved family to accompany you.

25.3   Practise what you’re going to say

Preparation does not mean that we don’t trust the Holy Spirit. The Holy Spirit already helps us during the process of preparation to find the best way to do what we have to do.

Preparation will help you to formulate the words you’d like to use, but be prepared to remain flexible and ready to adapt to the other person’s cues (see below).

25.4   Try to find a physical setting that is comfortable and private.

  1. Sometimes it takes a lot of preparation to create the best set-up to share emotionally disturbing news. Unfortunately, hospitals and care centres do not take activities of care such as these into account when buildings are planned and spaces allocated.
  2. The worst thing you can do is to blurt the news out in a public space where there is nowhere for the recipient to turn to or sit down to cope with the aftermath of hearing it.
  3. Look for an area where there is at least a chair on which to sit rest and that has a low likelihood of being intruded upon by other people. Other things to do to improve the environment include:
    • Turn off all electronic distractions such as the TV, radio, music, etc.
    • Pull the curtains if this will improve privacy but don’t shut out too much light if it’s daytime.
    • Shut the door or pull across a screen or other item to create a private space for the two of you.
  1. If you break the news to people at home, try not to do it while you stand in the doorframe. Ask if you can move to a sitting room or place where both the other person and you can sit.

Obviously, they’ll already be alerted that something is up by your request to speak in private and the arranging of the private space. This help already as preparation to the news you are going to break.

25.5   Choose the “best” time possible

Sometimes waiting isn’t possible because the news has to be delivered immediately, before rumours go around. However, there are circumstances where it is possible to delay the bad news until the other person is both available and receptive.

Always wait for those to whom you are going to break the news to enter the room and sit down before starting.

Most people are better at receiving bad news during the day than at night. So, it may be wise to wait until the morning rather than waking someone up during the night. It makes more sense to allow people to sleep a few more hours rather than waking them at three o’clock in the morning to tell them news they can do nothing about.

News should be broken immediately when people are awake and waiting for news, or if there is any chance that they may hear it through other channels.

Examples: Parents who are awake, waiting up for their children to arrive, should be told immediately if something has happened to them. There is no benefit in waiting until the morning.

If your brother passes away in an accident at one o’clock in the morning and you know your eighty-year-old mother takes her sleeping pill at 9pm and sleeps until five in the morning, it might be better to wait until five or six in the morning before you tell her.

Social media creates problems in these circumstances. Many people seem to have an urge to immediately share everything they heard with the rest of the world. They want to be the first to let the world know something exciting happened and accidents and death are exceptionally exciting news for some.

The other side of the coin is that in the past, many people tried to keep bad news a secret and ended up feeling embarrassed. In our age of social media, it is nearly impossible to keep bad news a secret. But some people postpone informing others because of their own emotions. This is often the case with adults, who want to keep bad news a secret from their children.

If the news is of such import and urgency that it can’t wait for a “better time”, just take a deep breath and break up whatever else is going on by saying something like, “I need to speak with you, Jane, and I’m afraid it can’t wait.”

It is always better to convey bad news face to face. But in some urgent cases, news has to be imparted over the phone. It’s best to ask the recipient if they’re sitting down as you need to tell them something unpleasant. If you’re worried about how they might cope alone, suggest that they get someone else in the vicinity to support them.

Again, these questions would serve as preparation for receiving bad news.

25.6   Assess the situation before sharing news

Will the news be totally unexpected? What support is available? What is the medical and mental condition of the recipient? Do they live alone or with others?

25.7   What does the recipient of the news already know?

Before sharing the news, appropriate questions put to the family, friends or the person himself/ herself could help to create the context and build-up to the point where you share the news. See this as part of the preparation before sharing bad news.

Things to listen for include whether the recipient already has an inkling that bad news is expected and the presence of fear, anxiety, or worry.

News of death due to an accident might come “out of the blue” at that moment, but the family may sometimes tell you afterwards that the deceased was a dangerous driver or would often drink and drive – and that what happened is not totally a surprise to them.

25.8   Again, the importance of context

How bad is bad news?

Are you trying to tell someone that their cat died, or that you lost your job? Has a family member or close friend died? If the bad news relates to you (such as you losing your job) the effect will be different from news that relates to the recipient (such as their cat dying).

Your words and style of delivery depend on who you are, your relationship to the person you’re breaking the news to, and the context. Some key things to bear in mind when delivering bad news:

25.9   Preparing the person for bad news

  • Help the person to receive unexpected bad news with such phrases as: “I have some sad news to tell you”, “I’ve just received a call from the hospital. There has been an accident and…”; or “I’ve been talking to your specialist and…”, and “There is no easy way to say this but…”
  • Be gentle, but come to the point – this is easier on the person receiving bad news than beating around the bush.
  • Don’t ramble or make small talk.
  • Do not overwhelm the person with information.
  • Relay the news honestly and sympathetically. In certain cultures this means looking the person(s) straight in the eye and calmly saying what has happened.
  • If there has been an accident and someone has died, be direct, but gentle:
    • I’m so sorry to tell you this; Michael was in a terrible car accident.”

Give the person a little time to prepare emotionally for what you are going to tell them. After they have had a chance to take a breath to collect themselves, they might say, “What happened?” or “How is he?” Follow this up directly with, “I’m so sorry, but he was killed.”

  • While you are narrating the events, react to the other person’s emotions as they arise by acknowledging and addressing them.
  • Avoid using euphemisms or metaphors when delivering bad news.
  • Focus on good communication and an empathic response.

Even if you initially can’t gauge the other person’s feelings correctly or you bungle the delivery of the news, the most important part to remember in breaking bad news is how well you respond to the other person’s emotions.

25.9.1 Identify the emotion(s)

  1. a) These could include shock, fear, anger, disbelief, sadness, distress, or a combination of any of these and other emotions.
  2. b) Identify the cause of the emotions – usually this will be the bad news itself, but it could be more layered than this.
  3. c) Understand how the emotions are a result of what happened. Emotions appropriate to the circumstances should not be a worry to the caregiver.
  4. d) Do this by acknowledging their response, such as “This is a clearly a terrible shock” or “I can see that you’re really upset and angry about what has happened”, and so forth.
  5. e) Doing this lets the person know you get both their pain and any other reaction, and that you’ve tied it to the news they have just received without passing judgment, making any assumptions, or trying to minimise their emotions.
  6. f) If they respond with great anger and yell or behave angrily, remain calm – but take care not to place yourself in a position of being harmed.
  7. g) If they cry, be there to comfort them. If they become violent, seek help immediately.
  8. h) Realise that the recipient may remain silent, allowing the news to sink in. Place your arm around their shoulders and simply sit with them in a display of sympathetic solidarity.
  9. i) When comforting the person, keep social and cultural conventions in mind to avoid making the situation worse.

25.9.2 Decide what to do next.

The process doesn’t stop with the delivery of the bad news – also needed is a strategy for action afterwards.

Action can help prevent a person from going into a state of paralysis and shock, and could give them a sense of involvement or being able to do something to resolve, manage, deal with, or face the results of the bad news.

Ask a person, after some time has lapsed: “What are you going to do now?”.

25.10         Be helpful without disempowering the reCipient

Be careful not to take on tasks the person can manage by themself.

Make sure that what you do will be of real help and something the person can’t do by themself. The tasks you take on must also be what the person needs, and not because you feel the need to do something to keep yourself busy.

You can offer to take the recipient somewhere, or accompany them to visit the hospital, to gather belongings, go to the police, or whatever else is needed.

If the person wants to make tea, let them do it without helping. If they want to phone people, let them do it. Your task could include saying something like: “don’t you think it is better that we first sit and drink a cup of tea before you start phoning?” or “don’t you think we should first make a list of people we want to phone/sms/email, before we start doing it?”

25.11         Your role in the future (as the deliverer of bad news)

Clearly state your role, especially in relation to your involvement. If you’re a doctor delivering bad news about treatment, for example, you might outline the next steps and appointments for the patient’s continued treatment (although they may not remember much later).

Simply letting the person know when you’ll be around or back to check on them is useful.

Whatever promises you make to assist someone who has received bad news, be sure to follow through on what you said you would do.

Give the person your time where possible, and be accepting of their need to grieve where relevant.

26    Group activity

  • Task: Practise how to share bad news with the help of your partner of the day.

Use one of the following examples:

  1. Accident
  2. Suicide
  3. Drowning
  4. Violent attack

26.1   Feedback to the group

27    Reading and listening to the bible (Part 2)

We live in a wonderful time in which, worldwide, there is an intense hunger to understand the Bible. Many Christians don’t wait for someone else to tell them what the Bible says, they want to hear God’s voice in their life from God directly. We should encourage this movement. Reading and interpreting the Bible should never be limited to the formal study of the Bible, but should be a dynamic interaction between us and the written Word. This interaction with the Spirit leads us to understand God’s interaction with creation and with us personally.

Simultaneously, the Bible should also be studied in a formal way, to make sure that we use it not only in an emotional way, but also in a responsible way. Thus, reading with the aim of making formal interpretations should also be part of our interaction with the Bible.

Surprisingly enough, many Christians are ignorant of how the Bible came into existence.

The books in our Bible are collectively known as the “biblical canon”. The word “canon” comes from the Greek κανών, meaning “rule” or “measuring stick“. The old church fathers, after much debate over a period of time, eventually decided which books [from those in existence and available at the time,] they regarded as canonical.

The Old Testament (or First Testament), which the Christian church shares with the Jewish faith, also developed over time. In the fifth century BC the Jews acknowledged only what is known as the Law (Torah). This is the five books of Moses. By the third century BC the prophets (Isaiah, Jeremiah, Micah), also known as the Nebiim, and books like Joshua and Judges were included in the canon. A third part, known as the “writings” (Ketubim), which includes books like Proverbs, Ecclesiastes, Song of Songs and Esther, was included only in 90 AD at the Council of Jamnia.

There are seven books in the Old Testament around which there is some uncertainty (Tobit, Judith, Baruch, Wisdom, First and Second Maccabees, as well as additional verses of Daniel and Esther). These were accepted by the Diaspora Jews and form the Alexandrian Canon. They were written after the time of Ezra, and some were even in Greek. The Council of Jamnia did not accept them, but the Catholic tradition did – as what is called the “deuterocanon”. Luther and Calvin also rejected these books as part of the so-called apocrypha (which means hidden or obscure). These books were not included in Bibles of the protestant tradition, but they are included in the Catholic Bible.

When Jesus refers to Scripture, He refers to the Law and the Prophets. In Luke 24.44, Jesus makes a reference to Law, Prophets and Psalms. It seems that, in time, the Psalms became part of the Jewish canon. It is also important to understand that at the time of Jesus there were different Jewish groupings. The Sadducees, for instance, accepted only the first five books of Moses in the canon. Rabbinic Judaism eventually accepted twenty-four books as the Hebrew Bible, also known as the Tanakh. The Christian fathers also accepted these twenty-four books as canonical and they form part of the Christian tradition. There was also a Samaritan canon and a canon of the Ethiopian Jews.

The New Testament canon had its own development. The first attempt to form such a canon was around 140 AD by a person with the name of Marcion of Sinope. What is interesting is that Marcion did not believe that the Old Testament books should be part of the canon. He saw the God of the Old Testament as a different God from the one of the New Testament. Marcion’s views were not accepted by the early church, but the early church realised it was necessary to form a formal canon. The first list of books put forward in 170 AD included the books we have in the Bible today – except for Hebrews, James, 1 & 2 Peter and 3 John.

The term “New Testament” was first mentioned in 200 AD as a technical term by the theologian Tertullianus.

The first NT canon of twenty-seven books, similar to our Bible, was put forward in 367 AD by the theologian Athanasius of Alexandria in his Easter letter.[6] This was accepted in 393 AD by the Synod of Hippo Regius in North Africa and again in 397 and 419 AD at the Councils of Carthage. These councils were under the authority of St. Augustine. The Eastern church was not comfortable with the Revelation of John and included it as part of their Bible only in the fifth century.

It is important to understand how these councils function in the process of forming the canon. These councils did not create, authorise or determine the canon. They simply were part of the process of recognising a canon that was already there. The councils thus were declaring the way things had been and not the way they wanted them to be. It was the result of many years of God’s people reading, using, and responding to these books. (http://michaeljkruger.com/ten-basic-facts-about-the-nt-canon-that-every-christian-should-memorize-8-the-nt-canon-was-not-decided-at-nicea-nor-any-other-church-council/)

For whatever set of reasons, there is a widespread belief out there (internet, popular books) that the New Testament canon was decided at the Council of Nicea in 325 AD—under the conspiratorial influence of Constantine. This claim was also made in Dan Brown’s best-seller book The Da Vinci Code. Brown did not make up this belief; he simply used it in his book.

Martin Luther (1483-1546) questioned the validity of the books of Hebrews, James, Jude and Revelation as part of the canon. But his reservations were never accepted – although many Lutheran Bibles put these books at the back of the Bible.

Prof Hennie Stander (2003:193) makes the following interesting remark:

“Moderne gelowiges is geneig om the dink dat net boeke wat deur die Gees van God geïnspireer is, in die Bybel opgeneem is. Die interessante is dat kwessie van inspirasie nooit as maatstaf gebruik is nie. Die rede is dat enige boek wat geestelike waarhede bevat het, as geïnspireerd beskou is.”

Translated by Carina le Grange: Modern believers are inclined to think only books inspired by the Holy Spirit were included in the Bible. It is interesting that the matter of inspiration was never used as a criterion. The reason for that is that any book containing spiritual truths was considered to be inspired.

28    Way ahead

28.1   Do you feel emotionally comfortable and at peace?

Please make an appointment with me if there are any unresolved issues triggered by attending the course.

28.2   Hospital visits

  • We accept that not all people are comfortable with making hospital visits.
  • We invite you to make at least one or two visits in the company of more experienced people before taking a final decision.
  • If you are interested in becoming part of the team that makes hospital visits on a regular basis (one hour a week), the following process should be followed:

28.3   Attend modules 2 to 5.

28.4   Do eight visits with an experienced person.

28.5   Get a name tag with your name on it.

28.6   Administrative information for people interested in Hospital Care

  • Visiting George Hospital every Wednesday morning from 10:00 – 11:00
  • Meeting for prayer and problem discussions on the second and fourth Wednesdays of the month at 11:00 – 12:00.

29    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

30    Homework

Your Task: Connect with your emotions: Write one paragraph in your own words on:

 

  • I deal with personal pain in the following way …
  • I deal with death in the following way …

 

 

 

 

Module 2: Sessions 4-6

31    MODULE 2: SESSIONS 4-6

“Death bewilders all of us. Tragic deaths pound the core of our being, forcing upon us the deep question ‘Why?’ Tragedies mock shallow answers, driving us deeper into the mysteries of life.” (Shared from The Jesus Creed: Loving God, Loving Others; kindle.amazon.com).

“You will live on through your children, friends, and all who you touch during your life …” (Robert Lanza)

“People like us … know that the distinction between past, present and future is only a stubbornly persistent illusion.” (Einstein).

32    Welcome!

Task: Find a friendly looking stranger, with whom you think you will be able to share, as a partner for today only.

32.1   Introduction of facilitator

  • Facilitator of the course: Frederik Nel

32.2   Time schedule

09:00 – 10:30 – Ready, Steady

10:30 – 11:00 – Tea

11:00 – 12:45 – Go …

Task: Group appoints a timekeeper for the day/module

Timekeeper will (a) remind the facilitator and group 10 minutes before a break or end of the day of the time and (b) switch on the kettle for coffee 5 minutes before the break.

32.3   Donation box

A voluntary donation of R100 for each Module (3 days).

32.4   Primary aims!

  1. Learning opportunity: Acquiring new knowledge, or reconnecting with and refreshing knowledge you already have.
  2. Skills training: Listening, questioning, reflecting, interpreting.
  3. Theological reflection: Thinking about God’s presence in the group and our interactions with others.
  4. Growth opportunity: Being in a group always creates new opportunities for personal challenges and growth.
  1. Spiritual sharpening: Each opportunity to reflect on God’s presence while we are with other people is per se an opportunity to sharpen our spiritual awareness.

 

32.5   Values (not rules) for the course

There is a distinction between rules and values. Values are the foundations on which rules are built.

32.5.1 Respect

Respect for each other, including differences in viewpoints, culture, belief, gender, social circumstances, language, etc.

32.5.2 Confidentiality

Confidentiality is actually a sign of respect.

Caregiving is not the same as being enmeshed in another person’s life. It is a way of being with another without making the other dependent on us, the carers.

32.5.3 Affirmation

Affirm the positive we see in each other and also accept the affirmation others give us.

32.5.4 Integrity

Honesty, trustworthiness, openness …

32.6   Values the group wants to add

a)

  1. b)

32.7   Rules:

  1. Musical chairs: You are not allowed to sit next to the same person each day – pick a new partner.
  2. Please wear your name tags.

33    Daily ritual

33.1   Losses and gains

33.2   Living mindfully

Mindfulness is an awareness that we have deeper levels of being present. It is a wilful action  to connect with what is within us, our unique inner being, as well as with what is outside of us. For ages, already, and by using many different methods, people have been occupied with how to develop and grow this awareness. Contemplation, for example, was used by many of the old church fathers as a way to gain a deeper level of understanding of what was going on in themselves and others. For hundreds of years, monks have been setting aside regular slots of time for meditation and stillness – which are woven into the rhythm of the daily work schedule and communal activities.

Developments in neuroscience now provide us with a better understanding of how certain daily rituals can help us to cope better with tension and to find ways to grow. Additionally, this helps us to develop deeper levels of empathy.

On any given day, we operate at different levels of consciousness from moment to moment. And at each different level there will be a particular brainwave that is more dominant than the others. Brainwaves are created by synchronised electrical pulses emitted by the multitudes of neurons which communicate with each other. Brain activity can be measured with an electroencephalogram (EEG machine).

The beta brainwaves dominate our wakeful and day-to-day activities. They help us to be task-orientated, focused, alert, and solve problems. When we become stressed and have too much on our plate, our beta waves go into overdrive – and our body reacts by releasing more and more stress hormones such as adrenalin and cortisol.

33.3   Breathing and mindful exercises

“Practicing regular, mindful breathing can be calming and energizing and can even help with stress-related health problems ranging from panic attacks to digestive disorders.” (Andrew Weil, M.D.)

33.4   Time of discernment

33.4.1 Dwelling in the Word – Hebrews 1:1-4

(NAV)                                                                                 (NIV)

1 In die verlede het God baie keer en op baie maniere met ons voorvaders gepraat deur die profete, 2 maar nou, in hierdie laaste dae, het Hy met ons gepraat deur die Seun. God het Hom deur wie Hy die wêreld geskep het, ook erfgenaam van alles gemaak. 3 Uit Hom straal die heerlikheid van God en Hy is die ewebeeld van die wese van God. Hy hou alle dinge deur sy magswoord in stand. Nadat Hy die reiniging van sondes bewerkstellig het, het Hy gaan sit aan die regterhand van die Majesteit in die hoë hemel. 4 Hy is net so verhewe bo die engele as wat die Naam wat God Hom gegee het, voortrefliker is as hulle naam. In the past God spoke to our ancestors through the prophets at many times and in various ways, 2

but in these last days he has spoken to us by his Son, whom he appointed heir of all things, and through whom also he made the universe. The Son is the radiance of God’s glory and the exact representation of his being, sustaining all things by his powerful word. After he had provided purification for sins, he sat down at the right hand of the Majesty in heaven. So he became as much superior to the angels as the name he has inherited is superior to theirs.

33.4.2 Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

33.5   Homework feedback

Your Task: Connect with your emotions. In your own words and in one paragraph, write about  the following:

 

  • I deal with personal pain by …
  • I deal with death by …

 

33.6   Learnings and parking questions

 

Session 4 ILLNESS & HOSPITALISATION

34    SESSION 4: Illness and hospitalisation

35     Facing illness anD different worldviews

35.1   Illness a common denominator in all cultures

All people, of all cultures, ages and genders, have a lot in common in how they experience illness, pain and fear. The patient you visit may be of a different culture or language, but they experience emotions very similar to yours in times of sickness and pain.

It is important that you reach out to a patient according to their particular circumstances – but  while you simultaneously try to find the common denominators. It is quite possible for us to pay too much attention to the differences between us.

There is no “pure” culture, and now even less so than a century ago. People might also not act in ways that are culturally typical. The danger of stereotyping always lurks around the corner. Not all English-speaking people are the same, not all Afrikaans-speaking people are the same, and not all Xhosa-speaking people are the same. We know that, even within the same family, people can differ in their views.

The world has become “small” – because of improved methods of transport, communication, and due to the influence of TV. Millions of people live between cultures, with one foot in one culture and the other in another culture.

How we deal with any particular issue, and with illness and pain, may differ greatly.

35.2   Illness in an African context

Modernist individualistic thinking is described by the philosopher Descartes with the words cognito ergo sums (I think, therefore I am). As a worldview on life issues, it differs from the African community approach.

In an African context, the words would be cognatus ergo sum (I belong, therefore I am). Or in the generally known description of ubuntu: “A person is a person through other persons”. (See Saayman and Kriel 1992:35).

In Africa, illness has a place on the continuum of “illness – health” that would include the individual but also a cosmic dimension. It encompasses more than just the individual. Van Niekerk (1996:7) makes use of the image of a circle to describe the African worldview, but he uses an arrow to describe the Western worldview. The arrow symbolises a linear approach – it is directed at the future. The circle, however, symbolises the rhythm of seasons and an integrated understanding of the past, present and future, the living and the dead. What is important in the African context is to live in an integrated world.  The future is included in the present and the past. In Africa, community and the network of relationships are at the centre, with the individual functioning on the periphery. So, when an individual is ill, that illness also says something about the community and has an effect on the community.

35.2.1 The Integrated vs the dualistic worldview

Modern society, in an attempt to understand and explain things, increasingly and systematically developed into a dualistic society with clear distinctions between spirit and matter; living and non-living; dead and living; secular and sacred; body and spirit. This was further encouraged by a dualistic reading of the Bible, influenced by the dualism of the Greek philosophers.

In traditional African culture, many of these distinctions fall away. Society is not segmented into components such as medicine, sociology, law, politics, religion, etc. All of these – everything –  are in constant relationship with one another and the invisible world. These different components of society do not function according to their own, intrinsic nature, but according to their relationship with and position in the network of things.

In the Western way of thinking (because of linear thinking) it is difficult to keep opposites together, to allow them to co-exist. In the African understanding of life as a circle, opposites are easily incorporated into thinking or understanding. Going to hospital and also to the sangoma is not difficult or contradictory. Going to an African Independent Church when necessary and being a member of a traditional Western church is possible and acceptable.

 

35.2.2 Broken ties and relationships must be “healed”.

In the African context, illness is never merely a virus or bacteria, but is related to all your relationships, and with both the living and the dead. Illness means the societal order, equilibrium and harmony are disrupted and destabilised. Illness affects the family, clan, and society.

35.2.3 Non-analytical vs over-analytical approach to life

In the African context, life is lived despite pain and problems and despite the fact that there is often no visible solution. This means patience and adaptability are features of dealing with life.

In the Western context, much time is spent analysing life. In this modern understanding, the  manipulation of life is important. The result is that much energy is spent on attempts to analyse an illness medically, and in trying to change the circumstances and cards you were dealt.

In the light of African philosophy, bad times will not last forever and good times will come, just as summer will follow winter. Life and death are part of this understanding. The rituals of death are important and are experienced as a unification of our bodies with this world, and the beginning of a new birth. This cyclical understanding could lead to determinism: that what is necessary is first destruction, then something new and better will come.

The Western philosophy of development – constant improvement – often underlies the reluctance to prepare people to deal with pain, suffering, and death. This philosophy also emphasises performance, as well as the use of natural resources, to achieve imrovement.

35.2.4 Time as an event

In the African context time follows the cyclical understanding of life. What is important are the seasons, the sun and moon, and the natural rhythm of the earth. Live-giving stories, symbols, ritual and rhythm are more important than analysing problems and finding solutions.

In this cosmos, spiritual aspects are fully integrated with the concept of being human.

“The death of an individual is not seen as an isolated event in the life of one man. Nor is individual fertility separable from the regenerative promise of earth and sea. The sickness of one individual is a sign of, or may portend the sickness of, the world around him. Something has occurred to disrupt the natural rhythms and the cosmic balances of the total community” (Wole Soyinka 1976).

35.2.5 Illness provokes suspicion

Also in the African context the departure point for understanding illness is that it is not simply the result of a virus or bacterium, old age, or a defect in the genes or the body’s cells. It is not simply the result of natural causes. Illness “speaks” to the person, family or group – it brings a message and may also be a call to obedience.

The other side of this coin is that some other person or people caused your illness. Thus,  suspicion surrounds the cause of illness – such as, who is the agent that purposely intervened and caused the illness? This “agent” could be human (sorcerer); non-human (ghost, evil spirit); or supernatural (deity or other powerful being).

This does not mean that natural causes are always rejected, but what is important in this framework is to be sure whether there is someone, or some evil force, behind the illness.

Van Niekerk (1996) refers to research in 1995 on topics that people in African communities struggle with regarding illness:

  • Who caused my disease?
  • Why?
  • Who can protect me from witchcraft?
  • Do I have a natural or supernatural illness?
  • Who can help me to get rid of the demons that make me ill?
  • Should I pray or just use medicine.
  • Am I allowed to use contraceptives?

Van Niekerk refers to research by the well-known theologian Inus Daneel among independent churches, especially the Zionist, and themes discussed in these churches, such as:

  • Infertility that can be healed by prayer and ritual.

Exorcising evil spirits.

  • The healing effect of initiation into the group.
  • Illness and dreams.
  • The question of who causes illness.
  • The battle between the God of the Bible and demons.

35.3   Illness and modernist society and culture

Although we often think the concept of modern society refers to the Western world, we need to acknowledge that many traditional African societies are influenced or experience the results of scientific or modernist (late 16th to early 17th centuries) ways of thinking about life and death. The so-called Western world also still retains villages that function in very traditional ways. Neither Western nor Africa societies are homogenous. The same is true of Asian and other Eastern parts of the world.

South Africa is a good example of a complete mixture of how Western and African worldviews can complement each other within a single hospital. Our medical staff are trained in a modernist paradigm; our hospital buildings are modernist in layout; our administrative set-up is done from a modernist perspective. But many of our patients are born and live in traditional societies. In 2015, 35.2% of the South African population were still living in rural areas –showing a decline of 5% over 11 years.

35.3.1 Emphasising achievement – Illness as a sign of failure

In modern society the focus is on life, health, production, consumption, wealth, entertainment, achievement, and success. In this worldview, illness can have a stigmatising effect. This is the stigma of uselessness and futility, with the consequent possibility of being blamed for hampering the profits of an enterprise. Time costs money, so illness is seen as a waste of time.

In modern society people are often valued in terms of their production and contribution. There is a low tolerance for illness, and even more so for a mental illness such as depression.

35.3.2 being blind to the influence of lifestyle

The quick pace of modern society increases anxiety, leading to an increase in stress-related illnesses and psychosomatic symptoms. The mind-body connection in illness is not doubted. But this does not mean it is always possible to pin it down and know which part of the illness is physical and which part is psychological. This double-bind means modernist cultural thinking makes it difficult for people to see the link between illness and emotional pressures.

A dualistic way of thinking separates physical illness from lifestyle issues and emotional stressors.

35.3.3 Mechanistic view (the sum of the parts equals the parts)

In this modernist period of history, people and illness are often approached in a mechanistic way – as if a person functions like a machine. The implication is a linear approach to illness:

  • Diagnosis: identify the illness.
  • Finding the cause: if we understand what is happening in a specific cell, or can determine which virus or bacterium causes the illness, we can do something about it.
  • Finding a cure.
  • Problem solved.

The complexity of any illness and the multiple factors that contribute to it are frequemtly underestimated. Many members of the medical profession lack the ability to think holistically.

35.3.4 Over-technologising

Modern technology can lead to alienation between patients and medical institutions. Some patients experience hospitals as dehumanising. The effect of this is that patients do not fully co-operate with their treatment or, to their detriment, refuse treatment.

A holistic approach that incorporates the human aspect with technology would improve patient compliance. As pastoral care workers, we can bring the human aspect to the fore.

35.4   Role Play

Case Studies:

  1. An angry patient who is not allowed to go home for the weekend to attend a cousin’s funeral.
  2. A patient who complains about the long delay in receiving his/her test results because this delays the start of treatment.

36    the Effect of Illness on patients

There are many factors that influence patients’ experience of illness and hospitalisation. Some of these factors include their personality type, previous experiences, pain levels and emotional needs.

Some of the most common experiences of illness are: the daily routine is disturbed, isolation, uncertainty, anxiety, the loss of autonomy and independence, and a lack of privacy. The following are some of the resultant effects of illness and hospitalisation: disturbance in relationships; disorientation; guilt and frustration.

Patients can feel rejected by family and friends, but the opposite is also possible, namely that they feel over-visited and over-protected.

There are numerous causes of anxiety.

  • Hospital context
  • Prognosis
  • Family matters
  • Finances
  • Responsibilities
  • Treatment
  • Death

For some patients, illness brings many religious questions and uncertainty. A patient may have the need to discuss these with somebody – but not necessarily with a stranger. There are patients who complain that they become religiously overburdened. This happens when too many people give them religious advice, Bible texts to read, and want to pray for them.

One of the effects of hospitalisation or illness is the loss of short-term memory. Another common experience is confusion. These effects may worry the patient and/or the family. Confusion is common in the ICU and also among older patients. In their confused state, patients may say things that they can’t remember later; things which do not make sense or are disturbing for the family to hear.

There can be many reasons for confusion. Older people may show confusion because they now find themselves in a strange, new environment. It can also be the effect of new medication; or suddenly stopping medication taken for many years. High levels of anxiety can lead to a loss of short-term memory.

37    The effects of pain

“Pain is an important occasion for man to reflect upon God and the world” (Gerstenberger and Schrage 1977:103)

Many patients say they do not fear death – what they fear is pain. Individuals also react differently to the stimulus of pain. Some people have a higher pain threshold than others.

Pain is very difficult to treat, since it is not merely a physical response, but also an emotional response. Pain is located in our brain, and our experience of pain includes how we see things, how we think about the world, and our individual circumstances.

Pain presents itself on a wide spectrum. The pain we feel can be plotted and pinned down somewhere on this long line of possibilities. The most difficult of these possibilities are those at the extreme ends of the spectrum. At one end, there are people who believe any form of discomfort must be attended to immediately. They will make a big fuss over any form of discomfort, however small. At the other end are people who believe they must be strong and should not show any discomfort or pain.

38    Approaching a patient to provide pastoral care

Most of the following points are a summary of what has already been said in this course:

  1. Have the utmost respect for the patient and his or her worldview. The hospital is not the place to challenge a person’s worldview.

 

  1. Approach the patient holistically. Illness is only one aspect of the person. He or she is much more than their illness.

 

  1. One aspect which the pastoral worker brings is an emphasis on the restoration of relationships and relationship building.

Keep a balanced view, especially where relationships are concerned. Beware of taking sides – either for, or against, a specific party. Any information that either the patient or the family gives you may be only half-truths. Do not get involved in disputes between patients, family, friends and nursing staff.

 

  1. In our pastoral approach, the Biblical message of reconciliation is important.

 

  1. Attend to God-related questions very carefully, appropriately and in terms of individual circumstances. Examples of these questions are:

Where do you experience God to be in this illness?

Where is God in your everyday life?

What effect does this illness have on your relationship with God?

 

  1. The role of formal confession

The patient’s religious background plays an important role in terms of confession and it may be better to ask a priest from the patient’s specific tradition to attend to this.

 

  1. Symbols of faith.

Pastoral workers are the carriers of the symbols of our Christian Faith: Bible, prayer, cross, and communion. The way we present these symbols of faith is important.

 

  1. In word and deed, pastoral workers are the carriers of peace (shalom) and calm. When we leave a patient or ward, there should be greater calmness than when we entered.

 

  1. The task of the pastoral worker is to bring Biblical hope, not only a positive attitude.

38.1   Role play

One student takes the role of patient and another the role of pastoral worker. The patient says the following to the pastoral worker:

  1. “I experience God as very far from me.”
  2. “God says to me I will not get better, but will die in the hospital.”
  3. “I accept God’s promise that all illnesses will be healed.”
  4. “I think it is the devil that makes me ill.”

39    Reading and listening to the bible (4)

The New Testament was written in Koine Greek. The word “koine” denotes “common”, because this style of Greek was the language of the common man during the time of Christ.

Koine Greek came into use about 300 years before the birth of Jesus; it became an obsolete language about three centuries after Jesus’ death. We can say God employed normal language to reveal his mission to the world.

One of the factors we should keep in mind is the effect of reading the Bible in silence. The first hearers of the biblical text only hear the text through the voice of the person that read the text. Prof WS Vorster writes in 1988(8):

“Daar is tot dusver weinig aandag geskenk aan die bestudering van die Bybel ten opsigte van die feit dat die mense van die ou tyd nie stil gelees het nie, maar wel hardop … Ons leef in ’n boekkultuur en lees deesdae meesal stil.”[7]

Hearing the text and the different intonations of the reader’s voice can influence the way we interpret the text.

Reading certain parts of the New Testament presupposes a knowledge of the Old Testament. But it is possible to go even further. The NT in itself is already an interpretation of the OT (First Testament) in the light of Christ (Smit 2008:11). Some of the hearers in the NT were Jewish, although not all the hearers had a good knowledge of the OT. Through witnessing, sermons, letters and other forms of the written word, the authors of the NT were already interpreting the OT and the death, resurrection, and Second Coming of Christ to those hearers.

The interpretation of Scripture is thus not something new. Different ways of looking at the text are possible and different interpretations are common. But there are some limitations. A text is never so open to interpretation for there to be no limitations, and not all interpretations are the same.

Thus, we also cannot read the OT as if the NT does not exist.

“The New Testament picks up from the Old the theme that God intends, in the end, to put the whole creation to rights. Earth and heaven were made to overlap with one another, not fitfully, mysteriously, and partially, as they do at the moment, but completely, gloriously, and utterly”. (NT Wright 2006:217)

40    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

41    Homework

Read the handout that explains Isaiah 53.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Session 5 / Pastoral conversation (2)

“… every action is a communication and every communication is an invitation to other people to respond in some way.” (Hedges 2005:20).

“… the way we talk with clients affects how they come to describe themselves (and others).” (Hedges 2005:29).

42    SESSION 5: the Pastoral conversation

43    Welcome!

Task: Find a friendly looking stranger as a partner for today only, with whom you think you will be able to share.

44    Daily ritual

44.1   Losses and gains

44.2   Living mindfully

Our beta brainwaves are what we need to carry out the business of the day. But below the surface level of consciousness, we have the more relaxed alpha zone. This is the zone in which you operate when you are dropping off to sleep, happily sitting and staring out in front of you, when you garden, or spend time in meditation. This zone gives us a break from the “busy” beta waves. It is also necessary to enable us to become consciously aware of what happens deeper down in the subconscious and unconscious parts of our brain. Our theta waves, on the other hand, are associated with times of peak creativity as well as empathy and intuition.

It is widely accepted that we have both a conscious and an unconscious mind. Our conscious mind has to do with self-awareness. Consciousness is not located in a specific site in the brain, nor is it is easy to define. There are different groups of theories and definitions.[8] Writing about consciousness, M Scott Peck (1977:66) said that perhaps we should accept that we can define only things that are smaller than we are. Richard Rohr writes that “[c]onsciousness is as hard to describe as soul is hard to describe … perhaps because they are parts of the same thing”. (Cited by Draper 2016:34).

44.2.1 Breathing and mindful exercises

Sit quietly on a chair with both feet on the floor and your hands in your lap.

Focus your full attention on the physical act of breathing. Pay attention to and let your focus follow your breath as it allows air to enter your body through your nose and travel to your lungs.

Don’t try to do anything but to breathe normally – simply pay attention and be fully aware of the action. It doesn’t matter if your breathing is slow or fast, deep or shallow; it just is what it is.

Sharpen your attention to whether the air of inward and outward breathing is cool or warm, and notice where the breath travels as it enters and departs.

Notice that your lungs relax when you exhale. Allow your body to do what it does naturally. You will start noticing that each time you breathe in, your diaphragm and/or stomach expands … and each time you breathe out, these organs relax.

Again, don’t try to do or change anything – just be aware of the physical sensation of breathing in and breathing out. Even if you find that your thoughts start to intrude or wander, this is okay. Don’t worry, just pay attention to the thoughts, allow them to be, and gently bring your awareness back to breathing.

You can also do this exercise while lying in bed if you have difficulty falling asleep. It is a way of simply allowing yourself to develop a more mindful and conscious awareness of your body and its surroundings, its capacity to breathe, and to relax. When our breathing is relaxed, our muscles relax.

44.3   Time of discernment

44.3.1 Dwelling in the Word – Hebrews 1:1-4

(NAV)                                                                                 (NIV)

1 In die verlede het God baie keer en op baie maniere met ons voorvaders gepraat deur die profete, 2 maar nou, in hierdie laaste dae, het Hy met ons gepraat deur die Seun. God het Hom deur wie Hy die wêreld geskep het, ook erfgenaam van alles gemaak. 3 Uit Hom straal die heerlikheid van God en Hy is die ewebeeld van die wese van God. Hy hou alle dinge deur sy magswoord in stand. Nadat Hy die reiniging van sondes bewerkstellig het, het Hy gaan sit aan die regterhand van die Majesteit in die hoë hemel. 4 Hy is net so verhewe bo die engele as wat die Naam wat God Hom gegee het, voortrefliker is as hulle naam. In the past God spoke to our ancestors through the prophets at many times and in various ways, 2

but in these last days he has spoken to us by his Son, whom he appointed heir of all things, and through whom also he made the universe. The Son is the radiance of God’s glory and the exact representation of his being, sustaining all things by his powerful word. After he had provided purification for sins, he sat down at the right hand of the Majesty in heaven. So he became as much superior to the angels as the name he has inherited is superior to theirs.

44.3.2 Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback based on what your partner told you.

44.4   Homework feedback

Your Task: Connect with your emotions. In your own words and in one paragraph, write about  the following:

 

  • Isaiah 53

 

44.5   Learnings and parking questions

45    Conversation

45.1   The client as expert

The client is the expert on their own life and will ultimately take the decisions on what they need and how to live their life. We are only facilitators.

45.2   Resist the urge to give answers

We often call ourselves counsellors and see ourselves as people who bring specific knowledge to patients – who have less knowledge. The challenge for us, however, is to think of ourselves as facilitators only – who should resist the urge to provide answers to the many questions patients may have.

Patients and their families must find their own answers to the questions in their life. In their search for answers, we are willing to walk alongside and with them.

We should also keep in mind that, although we understand our task is to act as facilitators and listeners rather than to give advice, we are not objective outsiders. We wear a particular hat in these circumstances. With any question we ask; remark we make; action we take (or don’t take); even our mere presence, we convey or deliver a message to the client and family. They might also be looking at us to see whether we agree or disagree on certain subjects.

45.3   the patient determines the agenda

The pastoral conversation is described as an encounter (ontmoeting, or a meeting). An encounter differs from just a verbal conversation or discussion; it is an attempt to give of yourself to the other person. It is a respectful way of entering the other’s world. An example of this is found in John 4, where Jesus asks the Samaritan woman at Jacob’s well for water.

If we should go into this conversation with our own agenda, the danger is that we would not and could not create the necessary space for the patient in which to put forward his or her needs. There are patients who might be withdrawn, others who are not used to speaking to strangers, some who might be suspicious and even fearful. The solution is not to overwhelm them with our own conversation and questions.

The way in which we formulate questions should be open-ended and non-threatening. “I understand that I am a stranger to you and you might not feel comfortable speaking to a stranger. But I would love, if you feel comfortable in speaking to me, to hear more about where you come from.” This allows the patient to choose whether to tell you about his or her present circumstances, family and home, or their origin.

An example of a threatening and close-ended question is the following: “Do the nurses look after you well?” It is a closed question because the only answer the patient can give is just “yes” or “no”. It is an information gathering question only. It does not encourage conversation, which is necessary for an encounter to take place. It also has the potential to be a dangerous question for the patient. Would it be safe for them to give an honest opinion? What will be done with the information, how will it be used? Is the purpose of the question to check on the nursing staff?

45.4   Keep the client at the centre of the conversation

If the conversation moves away from the client or patient, it is your task to bring it back to them, as it is the patient who should be the centre of the conversation.

However, if it is the patient who constantly moves the attention away from their illness, situation or problems, it could be a sign that they are not ready for an in-depth conversation and need some “breathing space”. But it could also simply be the case that the patient is quite content with their circumstances and really feels like talking about other things rather than their illness.

If the patient asks you about yourself, answer, stay neutral and return to the client’s situation as soon as possible. Do not elaborate too much about your personal circumstances.

45.5   Reflective listening

This is the process of restating what has just been said, so that the client understands that you clearly understood and heard what they said.

To reflect back what the patient said, is not the same as just repeating their words. It requires careful listening to the patient’s emotions – because what should be reflected are the patient’s emotions.

Take great care in your interpretation of these emotions. Some people speak emotionally, but that is their style and is not always a true reflection of their emotions.

Example: Because of the way they normally speak (loudly, passionately, etc), some people may sound angry. If you then select “anger” as an emotion to reflect, you may miss the true emotion, which may be for example “sadness”.

45.6   Listen for relationship patterns

The pastoral conversation in the hospital is limited to listening and reflection of emotions. It is only when a trustworthy relationship is built that any form of questioning becomes appropriate. The type of questions then asked, is again based on careful listening – in this case to hear what relationship patterns exists in their life.

Example: “Who else knows that you feel this way?”; “who supports you?”; “how does that fit in with the way your family functions?”

45.7   multiple problems and focused attention

Ask the client which one of their (possibly many) problems is the most serious, or affects them most at that moment. Do not guess which one is the most important. If the person’s father recently died and he or she has lost their job or been diagnosed with cancer, it might be difficult for you to know which problem would be, for them, the most important at that moment.

45.8   If you open or start anything, you must also close or end it

Don’t create an opportunity for a person to share their feelings with you when you do not have enough time to listen. At the start of a conversation or visit, you could mention that you have only 15 minutes to spare – or that you have plenty of time.

Closing a topic does not necessarily mean that the patient has found a solution to the problem or an answer to the question.

Closing refers to the preparation for ending a conversation – by summarising some of the points discussed, and making a follow-up appointment if necessary.

45.9   Be aware: Not everyone has problems or is unhappy

Be open to the fact that some people are quite comfortable with and peaceful about their life and circumstances.

46    Starting a conversation in the hospital

46.1   Introduce yourself

Use the name by which you would like to be addressed. If you want a person to call you Mr/Mrs X or Pastor Y, then introduce yourself by that title.

46.2   Give the reason for your visit:

Example: “I am a pastoral worker who visit patients on behalf of the churches.”

46.3   Allow time for the client to take in what you are saying

If the patient is unknown to you, or did not expect you to visit, it might take some time before they are ready to assimilate what you are saying. Be relaxed and do not talk about too much at once. Check with the patient whether they are willing to have a conversation with you.

46.4   Acknowledge the patient as a person

Example: I don’t know if it is a good time for you for a visit? / Do you mind if I sit here with you for a few minutes?

Example: Is there anything you would like to talk about?

47    Practical exercises – role play:

  1. A 64-year-old man, who was told that morning that he has cancer at an advanced stage.
  2. A 25-year-old drama student with a neck injury after an accident, who is uncertain whether she will be able to continue her drama studies.
  3. The driver of a car who was not badly hurt in an accident – but whose child was killed.
  4. A patient in the burns unit with 25% burns on his body following a suicide attempt.
  5. A 75-year-old lady who has broke both her hips.

48    What makes a conversation “pastoral”?

“Pastoral care dissolves the boundary between the church and the world, since it mediates a love that knows no bounds. It is the opening of the body to the world …” (Campbell 1985:66).

With the term “pastoral” we convey a particular understanding of “why” we become involved in this conversation. We are doing it not just to keep ourselves busy, but because of a certain calling.

“[The word] ‘pastoral’ also refers to the care going out from the church or Christian community directed at all people and not only to the church community” (Nel 1996:6). As a pastor (servant) you represent God’s love, grace and care.

“We have all been told that grace is to be found in the universe. But in our human foolishness and shortsightedness we imagine grace to be finite. For this reason we tremble … But the moment comes when our eyes are opened, and we see and realize that grace is infinite. Grace, my friends, demands nothing from us but that we shall await it with confidence and acknowledge it in gratitude. Grace makes no conditions and singles out none of us in particular. Grace takes all of us to its bosom and proclaims general amnesty. See! That which we have chosen is given us, and that which we have refused is also, and at the same time, granted us. Ay, that which we have rejected is poured upon us abundantly.” (Karen Blixen, Babette’s Feast)

The pastor is aware of God’s presence in this encounter with the client/patient, and is alert to, or looks and listens for, signs from the client/patients that they would also reveal something of their own encounter with God.

49    Reading and listening to the Bible (Part 5)

The Bible we read today is a translation of the Koine Greek (NT); Hebrew (OT) and Aramaic (OT) texts. This is further complicated by the fact that many different manuscripts are available. Which manuscript is the most authoritative source and should be translated into our language?

One of the sources is known as the Textus Receptus and was put together by Desiderius Erasmus (1466-1536). He was a theologian, but also a scholar in Greek and Latin. He published the first Greek NT in 1516, after six months of intensive work on the text. He used about six different Greek texts, the oldest ones from the 10th century AD. For Revelation he used a manuscript from the 12th century AD. The last six verses of Revelation were missing from the manuscript, so he added them by translating the Latin Vulgate back to the Greek. There are people who still believe that the only source to follow is the Textus Receptus.

The text accepted by most scholars is the United Bible Societies text, also known as the UBS text. The reason for this is obvious if you compare it with the Textus Receptus. The UBS text is based on more than 5000 Greek manuscripts, some of them as old as the 2nd and 3rd centuries AD. The general rule is that older texts are closer to the original writers and thus more authoritative. The UBS text is the work of many people, who over many years put the text together according to very clear criteria. The research that went into the UBS text cannot be compared to what Erasmus, a lone person, was able to do in six months. The United Bible Society is not attached to a specific church stream and has no interest in putting together a text favouring the confessions of a specific church group. The fact that a group of researchers worked together also ensured an end result that does not reflect the views of only one person.

Any new translation of the Bible should be based on the best available source, and that is the UBS text. This means that if, in a newer or more recent translation, we find verses that are different from a translation based on the Textus Receptus, the newer translation, based on the UBS text, is the more authoritative text. There are people who do not accept newer or more recent texts because of a few omissions. These are not really omissions, however, because the newer text is in fact based on older documents. The fact is that later texts have actually had these (which are now again omitted) verses added to them, and that we are now closer to the original manuscripts. Examples of these changes can be found in Matt 24:36; Mark 7:15-17; 11:26; 15:28; Acts 8:37; 1 John 5:7-8; John 5:3-5; Eph 3:14, 1 Cor 13:3 (different reading that either means “flames” or “boast”)

The oldest manuscripts were written on papyrus, a plant growing wild in Egypt. The Egyptians started to use it about 3000 BC and by around 1000 BC it was in use all over Western Asia. It replaced the clay tablets first used to write on. There are about 127 biblical documents on papyri, dating from 200 to 600 AD. The next cluster of documents was written on parchment, made from processed animal skin (hide), which is known to have been in use from about 2000 BC, but became popular only from about 600 BC. There are about 318 Bible manuscripts written in capital letters on parchment. They are dated from 400 to 900 AD. Some of the best known ones are the Codex Rescriptus; Codex Alexandrinus, and Codex Vaticanus. Another 2 907 manuscripts are written in small and cursive letters and are dated between 900 and 1500 AD.

50    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

51    Homework

Read the handout explaining Ecclesiastes 3.

 

 

Session 6: /        The role of faith, Scripture and prayer.

52    SESSION 6: The role of faith, scripture and prayer

53    Daily ritual

53.1   Losses and gains

53.2   Living mindfully

Living mindfully is a way to deepen our spirituality. It is a way to help us to live from the true self, rather than the false self. The true self lives with a spirituality that maintains the tension between contemplation (being) and action (doing) in a perpetual two-way flow, one constantly enriching the other.

53.3    Breathing and mindfulness exercises

53.4   Time of discernment

53.4.1 Dwelling in the Word – Hebrews 1:1-4

(NAV)                                                                                 (NIV)

1 In die verlede het God baie keer en op baie maniere met ons voorvaders gepraat deur die profete, 2 maar nou, in hierdie laaste dae, het Hy met ons gepraat deur die Seun. God het Hom deur wie Hy die wêreld geskep het, ook erfgenaam van alles gemaak. 3 Uit Hom straal die heerlikheid van God en Hy is die ewebeeld van die wese van God. Hy hou alle dinge deur sy magswoord in stand. Nadat Hy die reiniging van sondes bewerkstellig het, het Hy gaan sit aan die regterhand van die Majesteit in die hoë hemel. 4 Hy is net so verhewe bo die engele as wat die Naam wat God Hom gegee het, voortrefliker is as hulle naam. In the past God spoke to our ancestors through the prophets at many times and in various ways, 2

but in these last days he has spoken to us by his Son, whom he appointed heir of all things, and through whom also he made the universe. The Son is the radiance of God’s glory and the exact representation of his being, sustaining all things by his powerful word. After he had provided purification for sins, he sat down at the right hand of the Majesty in heaven. So he became as much superior to the angels as the name he has inherited is superior to theirs.

53.4.2 Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

53.5   Homework feedback

Your Task: Connect with your emotions. In your own words and in one paragraph, write about  the following:

 

  • Ecclesiastes 3

 

53.6   Learnings and parking questions

 

54    The role of faith, Scripture and prayer

“Jesus doesn’t give hope by changing the jungle; he restores our hope by giving us himself. And he has promised to stay until the very end.” (Lucado Max 2001, Traveling Light)

55    Reflecting on faith in times of suffering?

The views that each one of us holds about “faith” may be very different, and depend on the theological background from which we come. As carers, we must be careful not to increase the burden the patient already carries. Therefore, it is important to reflect on our own views about faith.

55.1   Difference between Biblical faith and positive thinking

There is a difference between what the Bible calls “faith”, and positive thinking. We all know that positive thinking is very important and that people who think positively respond better to medical treatment. Positive thinking releases hormones that help our bodies to heal better.  (http://www.dailymail.co.uk/health/article-1340967/Why-positive-thinking-helps-body-heal-Knowingly-taking-placebo-makes-feel-better.html)

Biblical faith includes an element of positive thinking, but biblical faith is much more complex and should not be used as a form of positive thinking. To do so would put us in danger of misusing the word “faith” in an unbiblical way. Unfortunately, many of the messages people often give to others to encourage them are nothing but a mistaken understanding of the Bible and of faith.

Biblical faith is not the same as a positivist approach to suffering and uncertainty. Biblical faith and hope are not based on the belief that problems and suffering will just disappear. Biblical faith is not a way to ensure that God will favour and reward me more than the next person. At the centre of Biblical faith is the call to surrender to God.

55.2   Whose faith are we talking about?

At the centre of positive thinking is our own thinking – which is that we are personally responsible for our positive or non-positive way of thinking. Biblical faith is different, because faith is not something we have, it is something we receive.

At its deepest level, Biblical faith is based not on our faith, but on Christ’s faith.[9]

“Ons hoef nie ons sekerheid te bou of óns geloof nie, maar op Góds geregtigheid wat tot uitdrukking kom in Christus se geloof (sy trou, sy geloofwaardigheid). Soos Paul Althaus dit stel: ‘Of ek glo, dit weet ek nie, maar ek weet in Wié ek glo.’ Dit is juis wat ons geloof is: gegrond in Christus se geloof.” (Theron 2011:12).[10]

Christ is the only Righteous One with faith. Prof Theron explains that difficulties in translating the original Greek have often played a role in how we think about faith – when we think about it as something we have within ourselves.

Paul uses the expression “pistou Christou” in his letters seven times. The translation of this expression is problematic. Many translations read “faith in Christ” (geloof in Christus). But there is another possible translation that is favoured by eminent theologians (i.e. Richard B Hays; R Michael Allen) and which is also used in the 17th century King James translation. The “pistou Christou” is then translated as the “faith of Christ” (geloof van Christus/Christus se geloof).

Galatians 2:

King James translation                                                   NAV

16 Knowing that a man is not justified by the works of the law, but by the faith of Jesus Christ, even we have believed in Jesus Christ, that we might be justified by the faith of Christ, and not by the works of the law: for by the works of the law shall no flesh be justified. (Gal 2:16) 16En tog weet ons dat ’n mens nie van sonde vrygespreek word deur die wet van Moses te onderhou nie, maar alleen deur in Jesus Christus te glo. Ook ons het tot die geloof in Christus Jesus gekom, en dit is hoe ons vrygespreek is: deur in Christus te glo en nie deur die wet te onderhou nie, want geen mens word vrygespreek op grond daarvan dat hy die wet onderhou nie.

 

20 I am crucified with Christ: nevertheless I live; yet not I, but Christ liveth in me: and the life which I now live in the flesh I live by the faith of the Son of God, who loved me, and gave himself for me. (Gal 2:20) 20en nou is dit nie meer ek wat lewe nie, maar Christus wat in my lewe. Die lewe wat ek nou nog hier lewe, leef ek in die geloof in die Seun van God wat sy liefde vir my bewys het deur sy lewe vir my af te lê.

 

Galatians 3:

King James translation                                                        NAV

11 Clearly no one is justified before God by the law, because, “The righteous will live by faith.”d

 

Gal 3:22 But the scripture hath concluded all under sin, that the promise by faith of Jesus Christ might be given to them that believe. (Gal 3:22)

 

 

 

11 En dat niemand deur die wet by God geregverdig word nie, is duidelik; want die regverdige sal uit die geloof lewe.

 

22Maar volgens die Skrif is die hele wêreld vasgevang in die greep van die sonde; die belofte word dus vir die gelowiges vervul alleen op grond van die geloof in Jesus Christus.

 

Christ is the One, the only one, that is righteous and that has faith (Rom 3:10; 1 Peter 3). Christ’s faith and Christ’s righteousness is visible in his obedience to the Father – obedience to the death. Giving His life for us was an act of faith. Christ’s faith is a faith of trust in God, the Father. Doing the will of the Father was an act of faith.

55.2.1 What about “our” faith?

Our own faith is not something that exists in our mind only. We should not think about our faith without attaching it to Christ. Again, Theron refers to difficulties in translating the Greek word “eis”. If we take the same Galatians 2:16 (as above) as an example, we find in the Greek text “eis Christ” is translated as “in” Christ.

 

we have believed in Jesus Christ Ook ons het tot die geloof in Christus Jesus gekom

The best way of translating the “movement” indicated in the words “eis Christ”, is actually to translate it as “into Christ”, like “I jump into the water”. But this can’t be done in the Afrikaans language, because it does not differentiate between the words “in” and “into”.

A literal translation would be “we believed into Christ” and in Afrikaans “ons het in Christus in geglo”. (Joh 3:16 also uses the word eis).

The point is that our faith is a movement away from ourselves towards Christ. The way we should think about our faith is that it is not “our faith”, as such, but a “surrendering” (oorgawe) to Christ. Our “faith” is to give up all our thoughts on how we can justify anything, and then to find everything outside of ourselves in Jesus Christ.

Our faith is to come to rest, to find our rest, in Jesus Christ. We must learn to float when the currents in the sea take hold of us. We know that it is dangerous to struggle if we want to stay afloat. Biblical faith is to “float”. Our faith is now to live a life in Christ’s faith. It is Christ’s faith that saves us. Faith should not be understood as something we “do” – that would make it no different from the law.

Galatians 3:11:  En dat niemand deur die wet by God geregverdig word nie, is duidelik; want die regverdige sal uit die geloof lewe” (NAV)

11 Clearly no one is justified before God by the law, because, “The righteous will live by faith.” (NIV)

Faith is not faith in our faith – this is unbelief. Faith into Christ (surrendering myself) is knowing that it is not my faith, but the faith of Christ the Righteous that is the foundation of my salvation.

“Wanneer geloof ‘n kragtoer word waarmee ek myself probeer ophys tot in die hemel, hou dit juis op om geloof te wees” (Theron F 2011:54).[11]

Thus, faith is not merely a positive way of thinking – it is a way of looking at the world, through the eyes of Jesus Christ, the only Righteous One. It is through the eyes of faith that we see God at work, but is because the Spirit works in our heart and mind. Faith is a way of living. Faith is more than just a personal or individual action. It is deeply rooted in the community of faith, the body of Christ, which again finds its faith in the faith of Christ.

56    The Bible and illness

The Bible speaks about illness, suffering and death in different ways. The individual context and different cultures of Biblical authors also influence and affect the way we see illness. Illness and suffering have always been among the gravest problems confronted in human life. In illness, human beings experience powerlessness, limitations, and finitude. Every illness gives us a glimpse of the tentacles of death.

56.1   OT understanding of illness

In Biblical times, the best-educated people had a meagre understanding of human anatomy and physiology, and they knew even less about the nature of disease and its effect on the body. No one knew about bacteria and viruses.

In the Old Testament there are only a few references to physicians. These persons were most likely trained in Egypt. In those times, physicians were called upon to embalm the body of. For example, Jacob (Genesis 50:2). King Asa sought medical care from physicians for his diseased feet (2 Chronicles 16:12). Some non-medical references are also made to physicians (Jeremiah 8:22; Job 13:4 ). But it is unlikely that many trained physicians lived among the ancient Hebrews.

In many lands, at that time, priests were also assigned medical duties. This was true among the ancient Hebrews, where priests were the major providers of medical services. They were especially responsible for the diagnosis of diseases which could be a threat to the community (Leviticus 13:1 ). But priests in Israel apparently played only a small role in the actual treatment of sick people.

In the Old Testament, sickness was perceived as bound up with sin and evil.

A person in the Old Testament lives his sickness in the presence of God. It is before God that he laments his illness, and he implores God, Master of life and death, to bring about his healing (Cf. Ps 6:3; 38; Isa 38).

Illness becomes a way to conversion; God’s forgiveness initiates the healing (Cf. Ps 32:5; 38:5; 39:9, 12; 107:20). Faithfulness to God, according to his law, restores life: “For I am the Lord, your healer” (Ex 15:26).

The prophet senses that suffering could include the meaning of redemption for the sins of others (Cf. Isa 53:11). Finally, Isaiah announces that God will pardon every offence and heal every illness (Cf. Isa 33:24).

Illness was often attributed to sin or a spoken curse by an enemy. The understanding that illness and suffering are God’s punishment presupposes the idea of a legalistic view of God. For many, it was a way to justice and a condemnation for offences committed. The sufferer had failed to observe existing norms, whether it be of a cultic, social or ethical nature, and should be punished for the transgression. It is especially the psalmists who draw a causal link between sin and illness or suffering.

Ps 7:11 – God is a righteous judge, a God who is angry with sinners every day. Ps 7:12 – If the ungodly one doesn’t repent, God will sharpen his sword; he will string his bow and prepare it.

Ps 5:12 – Indeed, you will bless the righteous one, LORD, like a large shield, you will surround him with favour.

Ps 41:4 – “O Lord, have mercy on me; heal me, for I have sinned against you.” (NIV)

Ps 38:3: – Because of your wrath there is no health in my body; my bones have no soundness because of my sin. (NIV)

56.1.1 Linear view of Proverbs[12]: Cause and effect

Proverbs often use this direct connection between good deeds and blessings, on the one hand, and sin and punishment or suffering (like illness), on the other.

Pro 10:6 – Blessings come upon the head of the righteous, but the words of the wicked conceal violence.

Pro 10:16 – The labour of the righteous tendeth to life: the fruit of the wicked to sin.

Pro 3:7 – Do not be wise in your own opinion. Fear the LORD and turn away from evil. Pro 3:8 – This will bring healing to your body, and refreshment to your bones.

Pro 11:31 – If the righteous receive what they are due here on earth, how much more will the wicked and the sinner.

Pro 12:21 – No harm overwhelms the righteous, but the wicked overflow with trouble.

To understand a book of wisdom, such as Proverbs, we must also understand how this type of “wisdom” works. Its understanding of the world was that there is a definitive order in everything. Order is necessary to create harmony with the gods. Whoever lives in line with this order will be successful and healthy, and whoever steps out of line will suffer. The purpose of life is to discover this order and to live accordingly. The literature of wisdom helps you to understand the limits and the effects of stepping out of order.

From this resulted a deterministic worldview that sees, in detail, everything happening in heaven and on earth as having been predetermined for all eternity. Many Christians today still live with this view.

“Hierdie opvatting dat daar ‘n samehang tussen daad en gevolg is, het gaandeweg tot ‘n leerstuk verstar. Mense het naamlik begin dink daar daar uit voorspoed afgelei kan word dat goeie dade daaraan voorafgegaan het en dat teenspoed bewys dat die lyer gesondig het. Hulle het nie meer die moontlikheid oorweeg dat ‘n goeie mens ook kan swaakry en dat die sondaar ook kan voorspoed geniet nie. Dit beteken dat die idee van ‘n basiese orde in die wêreld en die skepping tot sy uiterste konsekwensie gedryf is en dat die wysheidsleraars begin dink het dat die orde soos ‘n meganiese onveranderlike uurwerk loop.” (JA Loader 1988:53-54).[13]

56.1.2 The complicated view of Ecclesiastes

The author of Ecclesiastes did not deny that there was some order in creation (Ecc 1:9; 3:1). He interpreted the order as something we cannot get a grip on or understand. For him it was something beyond our capabilities to understand. There is enough evidence that everything does not fit into such a dogmatic interpretation of the order:

Everyone shares the same experience (Ecc 9:2): a single event affects the righteous, the wicked, the good, the clean, the unclean, as well as whoever sacrifices and whoever does not sacrifice. As it is with the good person, so also it is with the sinner; as it is with someone who takes an oath, so also is it with someone who fears taking an oath. There are tragedies that affect everything that happens on earth (Ecc 9:3): and common events happen to everyone.

The author of Ecclesiastes makes us aware that not all the OT books understand life with the same prescriptive eye as Proverbs. We should be careful not to end up with a reductionist understanding of the Bible. The God of the Bible cannot be reduced to a single rule or statement.

56.1.3 Suffering as preparaton for something better

Does suffering always lead to something better at the end? There are several examples in the OT that create this impression.

The well-known story of Joseph is such an example, where his suffering at the hands of his brothers leads the way to the highest office of the state in Egypt. Job was also, eventually, triply compensated (Job 42:10-17).

Another well-known chapter is Isaiah 48.

Isa 48:4 – Because I knew that you are obstinate, and because your neck is an iron sinew, and your forehead is bronze, There is not one way for such an obstinate nation. Suffering!

Isa 48:10 – Look, I have refined you, but not like silver; I have purified you in the furnace of affliction. The end result is a nation that learn new ways.

Isa 48:15 – I – Yes, I! – have spoken; indeed, I’ve called and I’ve brought him, and he will make his path successful.

Isa 48:17 – “This is what the LORD says, your Redeemer, the Holy One of Israel: “I am the LORD your God, who teaches you how to succeed, who directs you in the path by which you should go.

God is not far removed from suffering. There is also another dimension to suffering in the OT. God call on Israel to seek justice, to encourage the oppressed and defend the fatherless and plead the cause of the widow (Isaiah 1:17).

Deut 32:4; Psalms 10:14-18; 12;6; 37; 82; 109

Psa 10:14 – But you do see! You take note of trouble and grief in order to take the matter into your own hand. The helpless one commits himself to you; you have been the orphan’s helper.

Psa 140:12 – I know that the LORD will maintain the cause of the afflicted, and the right of the poor.

56.1.4 Spirits and demons

There are many texts that give an indication the people of Israel feared demons, land spirits and evil spirits. In this they were no different from all the other nations around them. Demons and evil spirits were definitely a part of Israel’s world perspective. A fear of evil spirits was widely known among all the nations and can be found in their religions as well.

“In fact one can read the entire Old Testament as a kind of account of the struggle of the one, true, only powerful and merciful God against all possible alien deities and superstitious errors of his people Israel” (Gerstenberger & Schrage 1977:62).

It is necessary to make certain distinctions. There are superstitious beliefs in all cultures. The fear of evil spirits is widely known, and the more primitive and uneducated a community, the more prevalent are such fears. Evil spirits are often used as an explanation for the reason why certain bad things happen to people. This use of demons and evil should not be confused with the Devil or the Evil One. The devil as the opponent of Jesus, the destroyer, is a “person”, is a power that stands against the work of Christ.

If we take the above into account, only a few references to the devil as the evil one are actually in the Old Testament.

Some people refer to the goat in Leviticus 16:8-10, “Asasel” as a reference to a sin-offering to the desert demon “Asasel”. There seems to be no other indication than a mythological belief in the existence of a desert god with that name. Hebrew scholars and translators have suggested different explanations for the word. The most possible one is “complete removal”.

56.1.5 The suffering servant

Isaiah 53. See the exposition of Prof DH Odendaal 1982. Woord teen die Lig 2, 64-72.

56.1.6 Summarising

The OT is a mixed bag of messages with regard to God, illness and suffering. This might create uncertainty within some people – especially if we want Scripture to be a homogenous and positivistic document. However, there can also be another take on this and that is to enjoy the richness of the Bible and our tradition of faith.  The Bible also undermines our certainties and our comfort zones – and opens up for Israel, and for us, new possibilities of life with God. It is in our uncertainties that we rediscover God and grow in our amazement of who God is.

56.2   NT understanding of illness and suffering

56.2.1 Christ’s suffering

Mark 8:31

31 He then began to teach them that the Son of Man must suffer many things and be rejected by the elders, the chief priests and the teachers of the law, and that he must be killed and after three days rise again.

56.2.2 Suffering of believers

Share in Christ’s suffering (Acts 14:22; 9:16; Rev 13:10)

15 But the Lord said to Ananias, “Go! This man is my chosen instrument to proclaim my name to the Gentiles and their kings and to the people of Israel. 16 I will show him how much he must suffer for my name.”

Whoever has ears, let them hear.

10 “If anyone is to go into captivity, into captivity they will go.
If anyone is to be killed with the sword, with the sword they will be killed.”

This calls for patient endurance and faithfulness on the part of God’s people.

The book of Revelation described the attacks of Satan on the church and followers of Christ. The evil powers wanted to destroy the church of Christ. In the end, the message is clear that Christ is the conqueror. Between Christ’s first coming and his Second Coming, the followers of Christ will experience suffering and persecution.

56.2.3 The Influence of demonic powers

Jesus brings both illness and sin under the pardon of God (Mark 2:5).

Jesus acted against the demons as a sign of God’s love and mercy, and brings demons and illness under the dominion of the kingdom of God (Mark 5:19; Luke 11:20).

57    The role of scripture and prayer

A visit does not become a pastoral visit merely after Scripture is read and a prayer said. The visit is pastoral right from the beginning, whether Scripture is read and prayers are said or not. The work of the Holy Spirit does not start only at the moment when we open Scripture or start to pray. In all our words and actions, the Spirit of God is present.

Reading from the bible and praying are definitely important parts of a pastoral visit, but are not a sort of law unto themselves, but actions that relate to the visit. These two actions are also not like a “full-stop” at the end of a sentence.

Reading and prayer should:

  1. a) Comfort
  2. b) Stimulate faith
  3. c) Encourage
  4. d) Be directed towards healing (spiritually, emotionally, physically)
  5. e) Nurture faith and the person as a whole.
  6. f) Reconcile the person with God and others.

The biblical text must relate to the context of the listener. Important themes in the Bible that frequently relate to patients or people in crisis situations are:

  1. a) God’s faithfulness
  2. b) God’s presence
  3. c) God’s hope for resurrection

57.1   Using The bible in different ways

57.1.1 Paraphrasing the text

Using your own words when referring to a specific text.

57.1.2 Meditative reading

Especially the Psalms are useful.

57.1.3 Narrative approach

Making use of a Bible story or Bible figure.

57.1.4 Comforting and consoling

The Psalms are especially often helpful.

57.1.5 Doxology

Praise and gratitude towards God. Again, Psalms can be used.

57.2   Inappropriate uses of the bible in a pastoral context

57.2.1 Giving a mini-sermon

57.2.2 In a coercive way

“Your money or your life” (confession of sin will heal you)

57.2.3 Making false promises

“If you really believe, you will be healed”

57.2.4 Lecturing on morals or moralising

“Where did your disobedience get you?”

“If you stop drinking/smoking/stealing your life will be better”

57.2.5 Dogmatic instructions

Getting baptised will heal you.

57.2.6 Legalistic and prescriptive

Admonishing, when necessary, should take place only in relationships of trust and love and should happen only when the person is back at home.

57.3   Psalms that are useful

Psalm 6 & 139 Fearing imminent death
Psalm 41 The terminal patient
Psalm 42 Experiencing the future as dark and uncertain
Psalm 90 Experiencing mourning and grief
Psalm 102 A young person facing death
Psalm 71 An elderly person who feels confused
Psalm 55 Grieving about a broken relationship
Psalm 38 Brooding over past mistakes
Psalm 62 Sadness about the loss of personal status
Psalm 73 Unhappiness about a lack of personal success

58    Prayer in a pastoral context

It is possible for prayer to become merely a mechanical act. But that is not what we intend. In an impersonal God-human relationship, prayer becomes manipulation. Prayer is at the centre of this relationship and, due to its nature, is an encounter between us and God. Prayer is thus a relationship – and not a one-way talk shop where we force God to listen to us.

58.1   Acknowledge the context

Prayer should be grounded in the present circumstances of the patient. Acknowledge the needs of the patient.

“… we have the confidence to disclose any need to God – not in an attempt to manipulate him, but indeed to test our needs to God’s will.” (Louw D.A. Illness as Crisis and Challenge 1994:106).

58.2   Praying for the patient or with the patient?

Prayer should involve a patient if he or she is awake and able to communicate. Ask the patient what to pray for. The patient may also desire to take part in the prayer session.

58.3   Prayer as communication, and thus also communion, with God

Prayer can be a holy moment and more than just a list of requests we put before God. By its nature, prayer can become communion, without the bread and the wine.

58.4   Prayer as a gesture of dependence

In prayer we do not just inform God of what He already knows, or remind God of what He might have forgotten. Prayer is an acknowledgement and confession of a believer’s personal dependence on God.

58.5   Prayer and healing

  • Healing as a gift from God – and not a right.
  • Place the emphasis on God, and not on the healing power of God. Or, place the emphasis on the God of the blessing, and not on God’s blessing.
  • The “quality” of the prayer can’t be determined by the outcome.

“Not our wishes determine the answering of our prayers. Alone God’s kingdom determines the answers.” (JP Versteeg as cited by Louw 1994:106).

58.5.1 Prayer as wrestling with God

Prayer may not always consist of beautiful words, but can also be a deep, inner wrestling with our circumstances and God. We find this wrestling in many of the psalms.

58.5.2 Prayer as intercession

Praying on behalf of those who can’t pray.

58.5.3 Prayer as doxology – thanksgiving and praise

 

58.6   Problematic prayers

58.6.1 Arrogance

58.6.2 Parade of power/ force

58.6.3 Prayer as an acquired technique

Here the importance of a beautiful or well-formulated prayer comes to the fore.

58.6.4 Prayer in order to be seen by others

58.6.5 Prayer as a psychological tool

Use prayer to convince a person to do something.

59    Theological reflection on the theodicy[14] question (Part 1)

What follows is not a comprehensive discussion by far. It provides just a few markers in a big and complicated philosophical and theological discussion, that of the question why there is suffering in this world. And this issue can be approached in different ways.

The word “theodicy”, which is often used, describes the attempt to justify God in view of all the evil and suffering in this world (theos = God; dike = justice).

  • There is no single, systematic and consequential answer to the question of God and suffering in the Bible. There is no single verse or narrative in the Bible that gives the complete answer.
  • Through the ages, from believers and out of church traditions, different answers arose. Our answers are influenced by our understanding of Scripture; the way we read and interpret Scripture, and also our own experiences.
  • What follows is an attempt to share with you some of the thinking around theodicy to facilitate our thinking, reading and praying on this subject.
  • Natural or amoral suffering refers to suffering over which we have no, or very little, control – such as is caused by certain illnesses, or natural events like tsunamis or earthquakes. Moral suffering, on the other hand, is suffering caused by our own actions or decisions.

59.1   Why we spend time on this issue

The purpose is not to provide you with answers that you can give to patients in order to tell them how to think about God and suffering. Actually, the ideal is not to be drawn into a discussion on this with somebody you have only just met or who you might never see again.

The sole purpose is to help you to work out your own understanding of God and suffering, so that you will be more comfortable with it and at peace in your own heart when the issue is raised by patients.

The many different views on the subject mean that you will only be able to respond to the subject when you already have a relationship of trust and understanding with the person with whom you are going to discuss it.

59.2   Can we link God to life expectancy?

Often, people simplify issues by making remarks that link God directly with life expectancy. For many people it might bring some comfort after the death of a loved one if their thinking is it is “God’s will”. But this is a dangerous remark to make to others. For many people, it brings no comfort and can even have the opposite effect.

It is definitely not that easy to connect death with “God’s will” or “God’s plan”.

Example 1: Life expectancy highest in the Western Cape, also up nationally (Christina Goldbaum: Cape Times; Aug 2014)

“THE Western Cape has the highest life expectancy of all nine provinces, according to Statistics SA. The life expectancy for men in the province is 63.9 years, and women are expected to live to age 67.9. Nationally, the report found life expectancy stood at 61 years – an increase of nine years since 2005. Stats SA attributed the rise in life expectancy nationwide to two trends: a reduction in the infant mortality rate and a decrease in HIV/AIDS-related deaths. According to the report released a few days ago, the infant mortality rate fell from 58 deaths for every 1 000 live births to 34 infant deaths per 1 000 live births this year. The report stated that the decline in infant mortality points to an improvement in the general health and living standards of the population. The decrease in AIDS-related deaths from 51 percent of all deaths in 2005 to 31 percent of all deaths this year could, according to Stats SA, “be associated with the increased rollout of antiretroviral therapy”. In 2008, about 680 000 people were receiving antiretroviral treatment. Today, about 2.5 million people are treated through the national ARV programme”.

Do you have any theories on why life expectancy in the Western Cape is higher than in the rest of the country?

Example 2: In 2012 the United Nations said that there were roughly 316 000 living people over the age of 100. By 2050, medical technology will raise that number to more than three million (Sunday Times).

Why are people, in general, living longer?

Example 3:

According to the report, life expectancy at birth stands at 61 years, having increased from an estimated 52 years in 2005. The rise in life expectancy can be attributed to two important trends: first, the number of AIDS-related deaths is estimated to have decreased from 363 910 deaths in 2005 (51% of all deaths) to 171 733 deaths in 2014 (31% of all deaths). This can be associated with the increased rollout of antiretroviral therapy (ART). Second, the infant mortality rate (IMR) has fallen from an estimated 58 infant deaths per 1 000 live births in 2002 to 34 infant deaths per 1 000 live births in 2014. The decline in IMR points to an improvement in the general health & living standards of the population. (http://www.statssa.gov.za/?p=2973; posted 31 July 2014).

59.3   Harari’s Dualism

The historian Yuval Noah Harari (2014:245-248) is of the opinion that the easiest way to deal with the battle of good and evil is from what he calls a dualistic understanding.[15] Dualist religions belief in the existence of two opposing powers: good and evil. Then the solution to the question about why is there suffering simple – which is that there would seem to be an independent evil power loose in the world doing bad things. However, Harari says, dualists face the “problem of order” (2014:246) – which is what the common laws are that they obey and who decrees these laws when there is a battle between Good and Evil?

Harari questioned both the dualist and monotheists (Jews, Muslims, Christians) solutions to the question of suffering.

Monotheists have to practice intellectual gymnastics to explain how an all-knowing, all-powerful and perfectly good God allows so much suffering in the world. One well-known explanation is that this is God’s way of allowing for human free will. … If God knew in advance that a particular person would use her free will to choose evil, and that as a result she would be punished for this by eternal tortures in hell, why did God create her? Theologians have written countless books to answer such questions. Some find the answers convincing. Some don’t. What’s undeniable is that monotheists have a hard time dealing with the Problem of Evil. (Harari 2014:245-246).

It baffles Harari that so many monotheists adhere to the dualistic belief.

“… which, by the way, is nowhere to be found in the Old Testament.” (Harari 2014:247)

Although monotheistic beliefs conquered the world two thousand years ago and have ruled since then, they actually do so only by having absorbed dualistic beliefs and practices. This also helps them to address the problem of evil. In Harari’s view this “solution” of the monotheistic religions to the problem of suffering is not a good solution and he described it as syncretistic. This is the fusion of two or more originally different forms of religions or forms of belief.

“Sometimes no explanation is sufficient to account for suffering. The only decent thing is silence – and the sacraments.” – Thomas Merton

59.4   Reframing:

59.4.1 Reframing the “why” question

We all live with questions about “why” certain things happen to us or people close to us. Many people won’t pose this question in public, but will continue to wrestle with it privately. Prof Danie Louw challenges us to reframe the “why” question as “to what end?” (cf Louw DJ 1988. Pastoral Hermeneutics of Care and Encounter). In a later publication (Hoekom? Hoekom nié? 2006:54-55) he puts it as follows:

“Ons vraag in lyding moet dus nie die vermoeiende: Waarom? Wees nie, maar wel die bevrydende: Waartoe? Nie: hoekom ly ek nie?, maar: Wat maak ek met my lyding?” In suffering, our question should thus not be the wearying (or fatiguing): Why?, but instead the liberating: Where to (from here)? What am I doing with my suffering?

Louw wants to encourage us to make sense of our suffering. We know that there are some people who are in such a bad place in their suffering that they just don’t have the energy to make any sense of it. But others do find it possible to make sense of their suffering.

59.4.2 Reframing our theological approach

“The hypothesis underlying the twentieth century revolutions in physics, cosmology, theology and biblical hermeneutics, to name only a few fields, [is that they] together signify a basic shift from [a] Mechanical to a Holistic Paradigm”. (Martin, James 1987:371)

It is not easy, from a theological perspective, to make sense of suffering. It gets even more difficult if we think in a linear way. In linear thinking, we put our question and conclusions in a “straight line”, one after the other. We can also call it cause-and-effect thinking. In terms of science, we can call it the Newtonian model of looking at the world.

This way of thinking is important, it helps us to make many discoveries and even gets people to the moon. This is also the primary model used in Western medicine: making a diagnosis and finding a cure for a specific illness. In medicine, it has been tremendously successful, but we also know that there are illnesses that seem to be more complex.

This linear model is also not the appropriate model for theological reflection. And there is another way of approaching the theodicy question.

Since certain discoveries by Einstein (1879-1955) and others[16], the formulation of quantum theory and the description of the behaviour of subatomic particles as both particles and waves, a new understanding of time, space, matter, and cause and effect was born.  Capra (1983:66) describes it as follows:

In contrast to the mechanistic Cartesian view of the world, the world view emerging from modern physics can be characterized by words like organic, holistic, and ecological.  It might also be called a systems view, in the sense of general systems theory.  The universe is no longer seen as a machine, made up of a multitude of objects, but has to be pictured as one indivisible, dynamic whole whose parts are essentially interrelated and can be understood only as patterns of a cosmic process.

How do these changes in the sciences influence our understanding of the world? And what difference does it make?  Brown (1987) mentions the following prominent implications (below) which evolved out of these discoveries (note that different implications may overlap).

Ÿ The idea of complementarity:

The description of matter as both wave and particle is called complementary.  We now accept the fact that both light and matter behave either as particles or as waves.  It depends on how we observe them. This is in contrast to Newtonian thinking, in which there is an objective world independent from how we observe it.

Ÿ The questioning of linear thinking about cause and effect:

The law of causality is no longer applied in quantum theory (Heisenberg 1989:76). Heisenberg’s uncertainty principle teaches us that everything cannot be predicted precisely in the microphysical world. A is not always followed by B. The important thing is that the reason why we cannot predict with certainty has nothing to do with our lack of knowledge, but something to do with the particles itself. The more measurements the researcher takes to make sure that he or she will be able to predict the outcome, the more they might influence the outcome.  The deterministic idea of certainty is replaced by the idea of probability.

Ÿ Interaction and Wholeness: From the research of Einstein and of Podolsky and Rosen (also known as the EPR), it has become clear that photons communicate with each other. According to the Cartesian and reductionistic approaches, the best way to understand something is to break it into pieces and analyse every piece (known as reductionism). This approach is challenged.[17]  From quantum mechanics it has become clear that one cannot explain the way a system behaves by reducing it to its independent properties, because these properties interact with each other – and the properties and their interaction add up to more than the sum of their parts.  Brown (1987:86) puts it as follows:

The moral of the story is that ‘reductionism’ has limits.  One of the central assumptions of the Mechanical Philosophy was that nature could be understood by taking it to pieces, and that the operation of any system could be understood in terms of component parts with intrinsic properties which were independent of the rest of the system.  What we have now found out is that this idea has limits.  We have discovered that there are some things in nature which cannot be understood in this way, they must be treated as a whole.

Other implications mentioned by De Jongh van Arkel (1987:71-82):

Ÿ Duality replaces dualism

The dualism between mind and body and organic and inorganic cannot be defended any more.  It would seem that subatomic particles communicate with each other, which makes it difficult to keep on believing that mind and matter have nothing to do with each other.

Ÿ Time relativity

Time is seen as dynamic and not absolute (De Jongh van Arkel 1987:81-82).  Time is also not independent from other influences.  Space and time are very closely interwoven. Hawking (1988:173-174) is of the opinion that when we combine quantum mechanics with general relativity, a new possibility arises, namely that time and space might form a finite, four-dimensional space without boundaries.

Uncertainty is inherent in nature (Davies 1989:4). We have to learn to live with the uncertainty of not knowing and understanding everything. Not everything has a clear answer. As modern people, this is quite difficult for us.

The importance of a more holistic view of the world and universe becomes apparent.  This is the result of the new way of thinking about the universe and about reality.  It leads not only to a new scientific methodology, but also to an expanding concept of science. This may also lead to a new recognition of the importance of what is usually called the “spiritual dimension”. The divisions between human science and physical science became less stringent.[18]  Bosch (1991:353) puts it as follows:

A fundamental reason lies in the fact that the narrow Enlightenment perception of rationality has, at long last, been found to be an inadequate cornerstone on which to build one’s life.  The objectivist framework imposed on rationality has had a crippling effect on human inquiry; it has led to disastrous reductionism and hence to stunted human growth.

One more point which we can learn from the changes in scientific thinking is the importance of paradoxes (Capra 1988:28-29).  Paradoxes are the result of the way we perceive things (De Jongh van Arkel 1987:77). It is important to understand that many solutions lie in paradoxes.  There are many things which cannot be explained by only one premise.  Heisenberg (1989:30) tells the fascinating story of how, on the many evenings that he went for a walk, the particular question upon which he reflected time and again was: “Can nature possibly be as absurd as it seemed to us in these atomic experiments?”

 

59.5   Theological juggler

In reading the Bible, it would be helpful if our thinking could be more in line with Einstein rather than Newton – since that would enable us to keep more than one ball (thought) in the air, just like a juggler.

Keeping several balls in the air at the same time may be difficult, but it’s also rewarding since it widens our view of what we see and read. It seems as if the Bible has no problem with keeping different balls in the air. The mere fact that we have four gospels, not only one, is already an indication of the richness of the Bible.

The Bible describes many dimensions of God to us. It is not the Bible, but our own limitations around keeping different balls in the air that often leads to us thinking about God in terms of  “either” and “or”, rather than in an interrelated way.

For example:

  • God is present in everything that happens.
  • God is not the originator of everything that happens.
  • God as the Judge
  • God’s Righteousness
  • God as the Saviour and Comforter
  • God as powerful, but also vulnerable
  •  God as Servant and King
  •  God, who miraculously intervenes in nature but also allows nature to function according to the laws of nature.
  • God of creation, but also God of heaven.
  • God who cares about life and death.
  • God who is interested in our physical and spiritual wellbeing.

59.6   How do we think about God?

59.6.1 God’s heart

Romans 2:4: Or do you show contempt for the riches of his kindness, tolerance and patience, not realizing that God’s kindness leads you toward repentance? (NIV)

What we know about God is that God reveals his compassion for those who suffer by offering his Son Jesus Christ. We are certain about God’s involvement in suffering insofar as God uses suffering to display his caring love and presence.

59.6.2 God is not the author or origin of evil

1 John 1:5 This is the message we have heard from him and declare to you: God is light; in him there is no darkness at all

God is not responsible for evil. This leaves us with the difficult question: where does evil comes from? The short answer is that we don’t know.

“Enige poging om tot ‘n verklaring van die sonde te kom, probeer niks anders nie, sê Berkhouwer, as om ‘n sinduiding te gee aan die sinlose, om die irrasionele te rasionaliseer en om dit wat alleen wanorde kan beteken, te orden” (JJF Durand 1978:77)[19]

God is not neutral about evil.

Romans 2:9-11:  9 There will be trouble and distress for every human being who does evil: first for the Jew, then for the Gentile; 10 but glory, honor and peace for everyone who does good: first for the Jew, then for the Gentile. 11 For God does not show favoritism.[20]

God’s reign is not limited to those who follow Him. Several times in the OT God uses other nations to conquer Israel, and took the people of Israel into exile. This is then described as punishment for the sins of Israel. See especially the prophet Habakkuk.

59.7   The corporate character of suffering

Rom 6:23 For the wages of sin is death, but the gift of God is eternal life in Christ Jesus our Lord.

(Gen 3:16-19; Rom 5:12; 8:20-22; 1 Kor 15:56).

The Bible makes it clear that suffering results from our sinfulness as human beings and when we suffer, we must always investigate our own sinfulness (Heb 12:5). It is also important to understand the corporate character of suffering, since it affects the whole of creation – not only humans.

22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time (Romans 8:22).

As part of this creation we are guilty in a corporate way – but our suffering at the same time does not automatically imply that we, as an individual person, a family, or a country, are punished for a specific sin. We can also look to the many examples of people who live far from God, are believers, very successful, and who suffer a lot (Jer 12; Ps 37; Ps 73).

The Book of Job alerts us to the fact that we must be careful not to make any direct connections between suffering and personal sin. In John 9, for example, Jesus also makes it clear that we cannot correlate sin with disability.

59.8   Learning to endure suffering

It will be no surprise to discover the NT very clearly states that those who follow Jesus will experience suffering. Jesus prepared his disciples for what would come in Mk 8:31; 9:30; 10:32. In the book of Acts we read of the suffering of the followers of Christ. Paul refers to the trials and tribulation in his life (2 Cor 4:7; 6:6; 11:6) and warns Timothy about persecution (2 Tim 3:12).

Without making any attempt to glorify suffering, it seems clear that suffering could enrich our lives:

Though now for a little while you may have had to suffer grief in all kinds of trials. 7 These have come so that your faith—of greater worth than gold, which perishes even though refined by fire—may be proved genuine and may result in praise, glory and honor when Jesus Christ is revealed. (1 Peter 1:6-8) (NIV)

This does not mean, however, that we should belittle suffering or make light of it as being good for us.

59.9   The already-but-not-yet concept

There is a theological construct known as “the already but not yet”. We live in between times – between the period of the First Coming of Christ and the Second Coming of Christ. What happened on the cross has not yet found its fullness. Another way of putting it, is to say that the death and resurrection of Christ conquered, but did not destroy, the evil one. The destruction of evil will happen only with the Second Coming. Sin, destruction, pain and death were thus not fully destroyed at the cross, but only conquered. It is only in the future that we will share in the fullness of our redemption. An image often used to illustrate this is that of a vicious dog on a chain. It can still bite, but does not reign freely. Romans 8 puts it as follows:

18 I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. 19 The creation waits in eager expectation for the sons of God to be revealed. 20 For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope 21 that the creation itself will be liberated from its bondage to decay and brought into the glorious freedom of the children of God.

22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 23 Not only so, but we ourselves, who have the first fruits of the Spirit, groan inwardly as we wait eagerly for our adoption as sons, the redemption of our bodies. 24 For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what he already has? 25 But if we hope for what we do not yet have, we wait for it patiently.

26 In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us with groans that words cannot express. 27 And he who searches our hearts knows the mind of the Spirit, because the Spirit intercedes for the saints in accordance with God’s will.

The word “eschatology” describes something of this already-but-not-yet state. Eschatology reflects our attempt to keep our eyes on the past, present and future dimensions of God’s kingdom.

59.10         Keeping many balls in the air!

On the one hand, we wish to say that to God’s good creation, illness, suffering and death are strange and surely not what God willed for his creation, so did not originate from God.

It would seem that God, to some extent as punishment, has allowed us (the whole of creation) to live with our sinful choices.

The results (consequences) of our sinful choices are clearly visible in many forms of suffering.

On the other hand, while God seems to reign over evil, He also allows the agenda of evil to be carried out. But it seems, as if God uses evil also to make visible God’s own plan of love and justice.

This power of evil should not be underestimated. But this world is still under the reign of God.

60    A life of surrendering: being content

Philippians 4

11 I am not saying this because I am in need, for I have learned to be content whatever the circumstances. 12 I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. 13 I can do everything through him who gives me strength. 14 Yet it was good of you to share in my troubles.

 

11Ek sê dit nie omdat ek gebrek ly nie, want ek het geleer om my in alle omstandighede te behelp. 12Ek weet wat armoede is en ek weet wat oorvloed is; van alles het ek ondervinding: om genoeg te hê om te eet sowel as om honger te ly, om oorvloed te hê sowel as om gebrek te ly. 13Ek is tot alles in staat deur Hom wat my krag gee. 14Nietemin het julle goed gedoen deur my in my moeilike omstandighede by te staan.[21]

 

 

61    Reading and listening to the Bible

When we take our questions to the Bible we need to understand that the Bible is not like a reference book or handbook where you will find the answer under a specific heading.

Finding “answers” and “solutions” requires much from us in terms of deductions made and our interpretation of the Bible. The Bible provides different images of God. Israel discovered those different faces of God.

Also, not all texts in the Bible are fully in sync with each other. There is also a definite “growth” factor from the OT to the NT. König says the NT is richer than the OT. For example, in the OT only males are circumcised, in the NT males and females are baptised. Another example :in the OT only one day a week is set aside for rest (the Sabbath) but in the NT every day is the Sabbath.

In the NT there is even another significant development. The synoptic gospels (Mt, Mk, Lk), focus on the person of Jesus, the Son of man, His life and times before His death. But Paul’s writings make little reference to the person of Jesus. Paul’s focus is on the resurrected and the glorified Jesus. The theology of Paul thus has a completely different perspective than the theology written by the gospel writers, and even that of Peter. Peter and the Apostles still think and write from a strong Jewish perspective about Jesus and the law, and their theology focuses on the role of Jerusalem and local society. Paul, however, is much more radical in his views on the law and his focus on the wider world.

62    Extra reading: Confessions of the reformed tradition:

Belgic Confession (NGB) Article 13. The Doctrine of God’s Providence:

We believe that this good God, after he created all things, did not abandon them to chance or fortune but leads and governs them according to his holy will, in such a way that nothing happens in this world without his orderly arrangement.

Yet God is not the author of, nor can he be charged with, the sin that occurs. For his power and goodness are so great and incomprehensible that he arranges and does his work very well and justly even when the devils and wicked men act unjustly.

This doctrine gives us unspeakable comfort since it teaches us that nothing can happen to us by chance but only by the arrangement of our gracious heavenly Father. He watches over us with fatherly care. In this thought we rest, knowing that he holds in check the devils and all our enemies, who cannot hurt us without his permission and will.

For that reason, we reject the damnable error of the Epicureans, who say that God involves himself in nothing and leaves everything to chance.

The Heidelberg Catechism

Question 27. What do you understand by the providence of God?

Answer. The almighty and ever present power by which God upholds heaven and earth and all creatures, and so rules them that leaves and grass, rain and drought, fruitful and unfruitful years, food and drink, health and sickness, riches and poverty, and everything else, come to us not by chance but from God’s sustaining hand.

Question 28. How does the knowledge of God’s creation and providence help us?

Answer. We can be patient when things go against us, thankful when things go well, and for the future we can have good confidence in our faithful God and Father that nothing will separate us from God’s love. All creatures are so completely in God’s hand that without the divine will they can neither move nor be moved.

63    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

64    Homework

  • Your Task: Write down in your own words, how you understand the role of faith in illness.

 

 

 

 

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Third Module Sessions 7-9

65    MODULE 3: SESSIONS 7-9

66    Welcome!

Task: Find a friendly looking stranger as a partner for today only – with whom you think you will be able to share.

66.1   Introduction of facilitator

  • Facilitator of the course: Frederik Nel

66.2   Time schedule

09:00-10:30 – Ready, Steady

10:30-11:00 – Tea

11:00-12:45 – Go …

Task: Group appoints a timekeeper for the day/module

Timekeeper will (a) remind the facilitator and group of the time 10 minutes before a break or at the end of the day, and (b) switch on the kettle for coffee 5 minutes before the break.

66.3   Donation box

A voluntary donation of R100 for each Module (3 days).

66.4   Primary aims!

  1. Learning opportunity: Acquiring new knowledge, or reconnecting with and refreshing knowledge you already have.
  2. Skills training: Listening, questioning, reflecting, interpreting.
  3. Theological reflection: Thinking about God’s presence in the group and our interactions with others.
  4. Growth opportunity: Being in a group always creates new opportunities for personal challenges and growth.
  5. Spiritual sharpening: Each opportunity to reflect on God’s presence while we are with other people is per se an opportunity to sharpen our spiritual awareness.

66.5   Values (not rules) for the course

There is a distinction between rules and values. Values are the foundations on which rules are built.

66.5.1 Respect

Respect for each other, including differences in viewpoints, culture, belief, gender, social circumstances, language, etc.

66.5.2 Confidentiality

Confidentiality is actually a sign of respect.

Caregiving is not the same as being enmeshed in another person’s life. It is a way of being with another without making the other dependent on us, the carers.

66.5.3 Affirmation

Affirm the positive we see in each other and also accept the affirmation others give us.

66.5.4 Integrity

Honesty, trustworthiness, openness …

66.6   Rules:

  1. Musical chairs: You are not allowed to sit next to the same person every day – pick a new partner.
  2. Please wear your name tags.

67    Daily ritual

67.1   Losses and gains

67.2   Living mindfully

Mindfulness is an attempt to give our attention to what goes on around us, but specifically paying attention to the person(s) we are involved with. In our Information Age the overload of information which we face every day has made attentiveness a highly valued commodity. Jannie le Roux (a life coach) mentions a study that claims that the average person touches their cell phone 2617 times a day (email 30 March 2017, jannie@jannieleroux.co.za).

Attentiveness becomes a scare resource when we compete with technology for the attention of people we come into contact with. Year by year there are more things that distract us from our ability to pay attention. This has an effect on our relationships, our productivity, the depth of our thoughts, and even how deeply we are able to care for others.

Mindfulness is thus an attempt to help us, in the Information Age, to become more aware and to focus our attention. Being able to pay attention is necessary in all our relationships and before we start conversations with a patient.

Mindfulness as a way of living should help us to also become sensitive to the way we take part in this age of information overload. We must learn to think before we use Twitter, SMS services, WhatsApp, email and Facebook. The questions we should ask ourselves are: why do we share (what we share), and is it really of benefit to others? We can too easily become part of our society’s superficial sensationalism by injudiciously sharing information.

People who try to live mindfully are careful not to become part of the information overload society and are thus careful in how and when they use social media. Mindful living helps us to reflect on the value of the information we deal with.

We have to accept that modern society creates a lot of information. Unfortunately, not all of that information is useful – or even truthful. How we spread and share information requires some reflection and sensitivity on our part, as well as good judgement.

67.2.1 Breathing and mindful exercises

“Practicing regular, mindful breathing can be calming and energizing and can even help with stress-related health problems ranging from panic attacks to digestive disorders.” (Andrew Weil, M.D.)

67.3   Time of discernment

67.3.1 Dwelling in the Word – psalm 73

(NAV)                                                                                 (NIV)

God is vir Israel baie goed, vir dié wat rein van hart is.

2 Tog het ek daaraan begin twyfel,  ek het byna koers verloor, 3 want ek het die hooghartige goddeloses met afguns bejeën toe ek hulle voorspoed sien.

4 Hulle het geen kwellings nie, hulle is sterk en gesond, 5 hulle het nie sorge soos ander mense nie, hulle het nie teëspoed soos ander nie.

6 Daarom hang die trots aan hulle soos ’n halssnoer en kleef geweld aan hulle soos ’n kleed.

7 In die weelde van hulle voorspoed matig hulle hulle enigiets aan; 8 smalend stook hulle kwaad, hooghartig dreig hulle met geweld.

9 Hulle laster teen die hemel en beledig links en regs op die aarde.

10 Tog hang die volk hulle aan en drink gretig hulle woorde in.

11 Hulle vra: “Hoe sal God dit uitvind? Hoe sal die Allerhoogste dit weet?”

12 Dit is hoe die goddelose mense is! So gaan hulle ongehinderd voort om rykdom op te hoop!

13 Dat ek die kwaad vermy het en met ’n eed my onskuld verklaar het, het dus niks gehelp nie, 14 want elke nuwe dag het vir my teenslae gebring en elke nuwe môre straf.

 

15 Maar as ek so sou aanhou praat, sou ek dié verloën wat aan U behoort.

16 Daarom het ek diep nagedink om dit te verstaan en was dit vir my bitter moeilik 17 totdat ek in die heiligdom van God ingegaan en besef het wat die uiteinde van die goddeloses is.

18 U laat hulle op gladde plekke loop, U laat hulle ondergaan deur hulle eie geknoei.

19 In ’n oogwink word hulle iets afgrysliks, gaan hulle te gronde, tref ’n verskriklike einde hulle.

20 Net soos ’n droom wat ophou as ’n mens wakker word,  so verdwyn hulle, Here, as U ingryp.

21 Toe ek verbitter was en veronreg gevoel het, 22 was ek dom en sonder insig; soos ’n redelose dier het ek my teenoor U gedra.

23 Tog was ek nog altyd by U, want U vat my aan die hand. 24 U lei my met u raad en aan die einde sal U my in ere by U opneem.

25 Daar is niks in die hemel of op die aarde wat vir my meer beteken as U nie.

26 Al is ek afgetakel na liggaam en gees,  God is my sterkte; aan Hom behoort ek vir altyd.

27 Dié wat ver van U af is, gaan verlore, U vernietig dié wat aan U ontrou is. 28 Maar wat my aangaan,  dit is vir my goed om naby God te wees. Ek het die Here my God gekies as my toevlug! Ek sal van al u werke bly vertel.

Surely God is good to Israel, to those who are pure in heart. 2 but as for me, my feet had almost slipped; I had nearly lost my foothold.

3 For I envied the arrogant when I saw the prosperity of the wicked.

4 They have no struggles;

their bodies are healthy and strong.

5 They are free from the burdens common to man; they are not plagued by human ills.

6 Therefore pride is their necklace; they clothe themselves with violence.

7 From their callous hearts comes iniquity, the evil conceits of their minds know no limits. 8 They scoff, and speak with malice;

in their arrogance they threaten oppression.

9 Their mouths lay claim to heaven, and their tongues take possession of the earth.

10 Therefore their people turn to them

and drink up waters in abundance.

11 They say, “How can God know? Does the Most High have knowledge?”

12 This is what the wicked are like—  always carefree, they increase in wealth.

13 Surely in vain have I kept my heart pure;  in vain have I washed my hands in innocence.

14 All day long I have been plagued; I have been punished every morning.

 

 

 

15 If I had said, “I will speak thus,” I would have betrayed your children.

16 When I tried to understand all this, it was oppressive to me 17 till I entered the sanctuary of God; then I understood their final destiny.

18 Surely you place them on slippery ground; you cast them down to ruin.

19 How suddenly are they destroyed, completely swept away by terrors!

20 As a dream when one awakes, so when you arise, O Lord, you will despise them as fantasies.

21 When my heart was grieved and my spirit embittered, 22 I was senseless and ignorant;

I was a brute beast before you.

23 Yet I am always with you; you hold me by my right hand.

24 You guide me with your counsel, and afterward you will take me into glory.

25 Whom have I in heaven but you? And earth has nothing I desire besides you.

26 My flesh and my heart may fail, but God is the strength of my heart and my portion forever.

27 Those who are far from you will perish; you destroy all who are unfaithful to you.

28 But as for me, it is good to be near God.

I have made the Sovereign LORD my refuge; I will tell of all your deeds.

 

67.4   Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

67.5   Homework feedback

Your Task: Write down, in your own words, how you understand the role of faith in illness.

67.6   Learnings and parking questions

 

Session 7: BEREAVEMENT AND GRIEF

68    SESSION 7: Bereavement and grief

Working with patients means that you will be exposed to even more situations of loss than only your own. To be human is to experience loss. Our reaction to loss is grief. All losses produce some degree of grieving.

Bereavement is a period of sorrow that is caused by and follows loss, especially loss due to death, and which is accompanied by grief. Grief is a psychic state or condition of mental anguish or emotional suffering that is the result of (or the anticipation of) bereavement.  Mourning is often also a communal rather than an individual reaction to loss, which can include certain cultural protocols. A state can announce a time of mourning. The length of the time of mourning does not, however, determine how long an individual’s grief should last.

68.1   A process of loss often starts with “change” as the catalyst

A change in circumstances of any kind means that there has been a change from one state to another – which thus leads to loss of some kind, and this may bring about a grief reaction.

Change can be caused by death, illness, divorce, unemployment, pregnancy, promotion, marriage, retirement, completing school, moving to a new house (or area or town), etc. A change for the better may also cause grief. We can, strangely enough, even grieve over the loss of something bad.

CHANGE
LOSS
GRIEF

The intensity of the grief reaction is a function of how the loss – produced by change – is perceived. If a person perceives the loss as significant, then it is significant, irrespective of how other people perceive that same loss. If the loss is not perceived as significant, the grief reaction will be minimal or barely felt. An individual’s interpretation of the context determines the intensity of their emotions. The loss of a parking space upsets many people, but under normal circumstances, this should last for only 5 to 10 seconds. The after-effects of a car crash can take weeks, months, even years, before being worked through emotionally.

Significant grief responses that are unresolved can lead to mental, physical, and sociological problems. It can contribute to dysfunctional family life or personal behavioural problems.

Although we will be discussing certain phases of the grief process, it is important to understand the concept “phases”. Identifying different phases does not mean that we go through the process of grief in a specific sequence. It is possible that, initially, we could skip certain phases – or, we could repeat phases. In one month, one day or even in a single hour, we could also experience several or all of the phases.

68.2   Cultural dynamics in Bereavement

“… loss and its reconciliation constitutes one of the most culturally sensitive areas into which a crisis interventionist ventures. To say that one must tread lightly here and be very observant when dealing with cross-cultural loss …” (RK James & B E Gillard 2013:418)

While the grief process – the psychological and physiological response to loss – is the same in all cultures and societies, the process of bereavement and mourning is culturally based and may also over time change dramatically. For example, in England, a proper mourning period used to be up to four years (especially for those in the upper classes and royalty). World War I changed that. Women were then expected to work in factories or elsewhere and wearing dark dresses was consequently no longer always suitable.

Modern Western society can be described as having a death-defying or death-denying culture. Death reminds us of our vulnerability in spite of technological advances. An example of this development is the drive-by funeral homes in California, where you can view the body of the deceased without getting out of the car.

In the Muslim understanding of death, the emphasis is on “God’s will”. The mourner should accept the death and move on. As little time as possible should be spent in mourning in public and people are encouraged to take up their public functions immediately.

In Mexican society, “death acceptance” plays an important role. Mexicans are known for their famous “Day of the Dead”, when the dead are honoured with parades in a festive atmosphere.

For the African community in South Africa, bereavement is a prolonged process. Attending the funeral is very important, taking priority over other community, church and work responsibilities. Neglecting the dead means distancing yourself from the community and cutting yourself off from that support. Funerals are filled with reverence, respect, openly expressed grief, spiritualism, lots of singing, music and eating.

It is traditional in rural communities for the family to care for the corpse, lay out the body of the deceased and dig the grave by hand. The involvement of the family in this part of their cultural practice is, however, beginning to disappear. More and more, funeral parlours are taking over these duties, although in some communities, the closing of the grave by the family continues to be part of the tradition.

With the growth in cremation, traditional practices around the grave are also disappearing rapidly – including the sight of the grieving bereaved at the graveside.

68.3   Primary and secondary loss

A primary loss is often accompanied by a secondary loss. The death of a spouse (primary loss) may lead to the loss of financial security or sexual intimacy (secondary losses). Another example is the loss of a job (primary loss), which causes financial insecurity and reduces self-esteem and self-confidence (secondary losses).

An example of an ambiguous loss is that of a person who is physically absent, but emotionally present (such as a partner who works away from home; or a missing person). Conversely, a person can be physically present but emotionally absent (when dementia or psychiatric illness plays a role).

68.4   Complicated grief

Grief itself is not a psychological disorder, but it can become one when bereaved people are unable to move on and “complete” the majority of tasks associated with mourning.

It is very difficult to create a time frame within which people should be able to move on, but an unduly long mourning time (prolonged grief) is only one of the indications that we are dealing with a complicated grief process. In a complicated grief process, the bereaved is preoccupied with the deceased, and may experience intrusive images or thoughts about the death. These thoughts cause distress and impairment that could affect their mental and physical health.

Connected to complicated grief is traumatic grief, when the bereaved person was present at or in close proximity to the death of a loved one, and perhaps also witnessed the death. In most cases, these would have be violent, sudden and unexpected deaths. Signs of PTSD could also be present.

Another reason for complicated grief is what is known as “disenfranchised grief”. This is when people experience the loss of something meaningful – but they can neither acknowledge, or are prevented from acknowledging, it in order to grieve over the loss, nor will it be validated by others.

For example, it might be the loss of a partner in an unacknowledged relationship (gay or lesbian lover; extramarital affair) or cultural and societal norms that forbid, or do not sanction, a display of grief. We find that it is men in our society who are often prevented from showing their grief, or, that it is expected of professional people that they should not show grief. A person may also feel embarrassed to show that they grieve over the death of a pet.

69    Approaches to loss

69.1   Stage/ Phase Model

Elizabeth Kubler-Ross did research on terminally ill patients facing death and identified certain “experiences” among patients who had been given the news of their terminal illness. To what extent these stages (that she identified and named) could be applied to all forms of loss is a matter of debate, and other models of the grief process on offer are also well motivated and researched. Kubler-Ross’s “model” is a good starting point to gain an understanding of some forms of behaviour. However, it is not a blueprint and the word “stages” may wrongly give the impression that all people must go through all of these stages and in a specific order. This is not the idea. There are simply no stages of grief that would fit all persons, and her description was never intended to be a strictly linear, step-wise model.

69.1.1 Shock stage: Initial paralysis on hearing the bad news.

The bereaved:

  1. Does not respond – immobilisation. Unable to move – (for seconds, minutes and sometimes hours).
  2. Could become hysterical – or could become very quiet and emotionally numb.
  3. May nod and accept the news, and appear not to be troubled by it. Within themselves, however, they might have frozen out the news and it would not yet have really taken hold. To register and accept the news, they may need to be told several times.
  4. Could show evidence of shock externally, by way of physical reactions such as the paling of their skin, shortness of breath, or “freezing” physically.
  5. May believe: “No, not me” / “It can’t be” / “There must be a mix-up with the tests”.
  6. May embrace isolation to come to terms with the information and turn inwards.

Dealing with it:

  1. Show sympathy and acceptance.
  2. Share bad news in a private place.
  3. If this is not possible, try to find a place that is as private as possible to share the bad news. Especially so if you expect the bereaved to move swiftly towards the emotional stages. A safe space, as far away from the embarrassment of public spaces as possible; in the company of trusted friends or family and allowing for tears, can make a big difference.

69.1.2 Denial stage: Trying to avoid the inevitable.

  1. It is a way to protect ourselves.
  2. b) Makes it possible not to hear what is being said.
  3. c) Partial denial – when we are selective about information we hear and remember.
  4. d) Signs of denial in illness include: seeking alternative therapies; experimenting with drugs; frequently changing physicians and then not telling them about the diagnoses other physicians have made.
  5. e) People often “pretend” (consciously) that they have not been given the news, which means they effectively close their eyes to any evidence of distressing events or developments.
  6. f) Typically, people will continue with their life as if nothing has happened. A classic behaviour here is a “flight into health”, where previously perceived problems are suddenly seen as having miraculously fixed themselves.

Dealing with it:

  1. Create a safe environment – the more unsafe we feel, the bigger the need for denial.
  2. Do not play along or encourage denial (it strengthens it). The challenge is to support people without playing along with their denial.

For example: “they have taken the news/situation so well”.

From a religious perspective, it is important to carefully consider your response and not to confuse positive thinking with faith.

  1. Be consistent in what you say.
  2. Repeat specific, relevant and vital information a number of times.

69.1.3 Anger: a Frustrated outpouring of bottled-up emotion.

Many people are uncomfortable with feeling or expressing “anger” as an emotion. Anger can be an indication of how “powerless” people feel, but it can also actually be a sign that a person is taking control of his/her circumstances. This does not mean that destructive behaviour should be tolerated.

Anger is often expressed in an explosion of emotion, where the bottled-up feelings from the previous stages become evident in a huge outpouring of grief.

Anger tends to turn to blaming. Sometimes, nobody is spared and it is directed at:

  1. Staff and hospital.
  2. Those closest to the person affected.
  • God.
  1. Those who are not affected, or less seriously affected. The phrase “Why me?” may be repeated in an endless loop in the minds of patients. A part of this anger is thus, “Why not you?”

How to deal with it:

  1. Understand that anger and pain are often closely connected.
  2. Keep calm. Give people space, allowing them to rail and bellow. The more the storm blows, the sooner it will blow itself out.
  3. Be careful in how you respond to avoid increasing the anger. Any attempts to argue and convince the person not to be angry may only increase the anger.
  4. Anger that becomes destructive and dangerous for the person affected or others needs immediate intervention. Respecting a person or their emotions does not mean we have to tolerate abusive behaviour.
  5. Reframe anger (energy) into useful channels.
  6. Redirect energy in a meaningful way.
  7. Anger at God is common and it is best not to try to defend God or let the person feel guilty about it.

69.1.4 Bargaining stage: Seeking in vain for a way out

  1. Bargaining, generally speaking, is a step further than denial, where the possibility of death or an unfavourable outcome has become more of a reality. Although bargaining is different from denial, they are also closely connected, with the person still “negotiating” for the outcome to go “away”.
  2. Bargaining can be an expression of hope that the bad news is reversible and it can even be engaged in secretly. The person can make unrealistic promises to themself; about the person that is ill in bed; to family; to God, etc. Sometimes even a group of people or a whole family can make unrealistic promises.
  3. Bargaining can lead to guilt feelings if anyone involved is unable to keep a promise.
  4. Anger at God might develop when a person makes and keeps their promise – but still has to face death or another unfavourable outcome.

How to deal with it:

  1. Do not interfere unless the bargaining is dysfunctional. For example, if a person suddenly wants to give away their house to charity, it may be a sign of dysfunctional bargaining.
  2. Do not offer anyone false hope, and also do not dash their hope by, for example, pointing a person too strongly in the direction of the inevitable.
  3. Bargaining that fails may well tip a person into depression or anger.
  4. People should be left to do what they feel they must do. If bargaining is what they need to do, there is very little outsiders can do about it.
  5. Respect the person’s need to bargain. It often contains a component of faith, and the bargaining is often with God.
  6. Deal with the feelings of quilt.

69.1.5 Depression: the Realisation of the inevitable

Depression is often a sign that reality has struck home and is a position beyond denial.

  1. Depression might be evident from a number of passive behaviours.
  2. In the workplace, this could include physical absenteeism, long lunch breaks, and mediocre work performance.
  3. It is sometimes difficult to know whether a person’s behaviour is due to physical aspects of the illness (i.e. pain), or is an emotional reaction to the illness.
  4. The person may also experience episodes of being tearful and morose.
  5. A person’s world gets smaller, with their only concern being their immediate environment and concerns.
  6. Their insight into the illness and its effects on their circumstances might diminish and their ability to consider alternatives become limited.
  7. From the vibrancy of anger and bargaining, a person can sink into a swamp of despondency.
  8. Many people turn in on themselves, and away from any possible solution or help that others could give them.

Dealing with it:

  1. Acknowledge the mood. There is also something quite “normal” in being depressed when dealing with loss.
  2. Constantly evaluate the grade of depression and whether it is getting worse.
  3. People who are depressed often feel alone, but give out mixed messages. They do not want company, but they also want people to be present. Be sensitive to this aspect of depression. Leave them alone when that is what they need, but be available when they need you around.
  4. If depression deepens over a period of time, a referral for professional help may become necessary.
  5. Determine whether a person has a history of depression. If there is a history of struggling with depression, referral should happen immediately for this to be monitored.

69.1.6 Testing stage (new stage added by some researchers)

  1. Often, a certain reality eventually starts to break through and the person who has experienced the loss realises that they cannot forever remain in the condition of shock, denial, anger and depression. This may take hours, days, months or years to happen.
  2. During the testing phase, people test the water – by asking themselves, for example, “Am I ready to face certain realities and move on?”. As an experiment, a person may try certain things they have never tried before, or, not done in a very long time. In this way, a person starts taking very small steps forward.
  3. If the testing activity starts to succeed – even if only in some ways – it is found to be preferred to the phases of anger, denial and depression.

Dealing with it:

  1. Be available, but be careful not to interfere.
  2. The person should be very certain you will not judge them if the “experiment” does not work.
  3. Sometimes, individuals will “experiment” secretly. Don’t take it personally.
  4. Hand over as much control as possible to the person involved, as this gives them a lifeline of stability by which to pull themselves forward.
  5. Celebrate with them every positive step, however small it may be.
  6. Keep on providing encouragement, whether the “experiment” works or not.

69.1.7 Acceptance stage: “Finally” finding the way forward.

Each of these stages is part of a process and the process may not develop along a straight line. A person may show acceptance one day, and on the next day deal with anger again.

People often move between acceptance and non-acceptance. With time, you would expect the person to be showing acceptance more often than experiencing any of the other phases of the process of loss.

A person has not necessarily mastered the acceptance stage when they tell you that they accept the loss. Acceptance is something that becomes visible through the behaviour of a person and the tasks people do.

To reach acceptance, a person must know that things will never be the same again, but be willing to work with the new reality.

Acceptance typically becomes visible when people take ownership of both themselves and their actions. Example: A terminally ill person who has come to accept that their imminent death is inevitable, will start to sort out their will. A person who has lost their job will actively be seeking a new job.

In the acceptance phase a person starts doing things, takes note of the results and then changes their next actions, suitably in response to the outcome. Also, some kind of stability in behavioural and emotional responses often develops.

69.2   The dual process view of loss

This approach focuses on the movement in the experience of grief. It is called loss orientation and restoration orientation.

Loss orientation stressors are associated with the loss itself. People may ruminate about the loss and have emotional and behavioural reactions to the loss. People often oscillate between avoiding (for example by working very hard) and confronting the loss. This is normal and helps with the process of loss adaption.

Restoration starts when those who grieve start to come to grips with the consequences of the loss and adopt new roles and identities. This includes life changes and the engagement in new activities.

APPROACH
AVOIDANCE
LOSS
RESTORATION

The movement can be tracked through a series of waves with crests and troughs that become gradually more placid. A grieving person bounces back and forth between the loss and the restoration orientation; and at the same time deals with loss through approach and avoidance behaviour.

  • The main point is that grieving is not static or stable.

69.3   Adaptive Model

The two extreme points of dealing with grief are:

 

Intuitive grief (emotions)                                                                          Instrumental grief (cognitive)

 

 

Most people deal with loss by opting for a combination of these factors, and will grieve using a blended style.

One of the stressors is that people’s preference for either an Intuitive or an Instrumental approach could clash with those of others in the family. One person wants to get rid of the deceased’s clothes, while another wants to keep the clothes. One person wants to keep all the photographs of the deceased, while another wants to select only a few photos.

These stressors could further be exacerbated when confusion exists between strategies of coping and adaption. We might be coping with the situation, but that does not mean we are always ready to make any changes. Coping describes “getting along” or “bearing up”, while adapting means being able to engage in behaviour that would result in change. Such as, after the death of a husband, the wife sells the house, or moves into a new room in the house, or rents out a room in the house.

  • The main point is that people are different – and because their needs are different, they will go about dealing with loss differently.

69.4   Grief task model

The Grief Task model is proposed by several authors, including Susan J Zonnebelt-Smeenge & Robert C De Vries; as well as Braam Klopper. With this model, the emphasis is on different tasks that need to be completed. The order in which these are completed is not important.

What is highlighted is the ability to work through a variety of tasks to integrate the new reality of life – one without the person who died.

69.4.1 Accepting The reality of the death

In terms of what we can expect from people’s reactions to receiving news of the death of a loved one, we have already referred to shock, denial and bargaining as possibilities. Eventually, the reality of death must be accepted. That reality is that the beloved will not come back.

It is necessary to be kind, but firm about this fact. This is a reality and not something we can wish away. Avoid using euphemisms to describe death. Examples not to use: “he went home”; “we lost him”; “she went ahead”; “she only sleeps”; “she is not with us anymore”; “he is now in a better place”.

Allow people to make phone calls, answer the telephone, and share the news with others. Do not discourage them if they want to see the body, and go with them if they wish to do so or arrange for others to go with them.

69.4.2 Experience the emotional pain of death

Experiencing and accepting painful and negative emotions associated with the death of other people is an important task. The emotions we feel when we grieve are those we may feel every day, but they may be much more intense and last much longer. The most common emotions are: sorrow, anxiety, frustration, anger, feelings of guilt, and powerlessness.

A part of dealing with grief is to recognise each of these emotions and to allow yourself to experience them.

There are people in our society who may feel threatened by the emotions of others, mainly because they are affected by these and they would then have to deal with their own emotions. To safeguard ourselves against our emotions we often, in a subtle way, require others not to show their emotions. We use words like “control yourself”, or “this is enough crying for today”, to inhibit others from showing emotion.

An important task for the pastoral worker and others is to make it clear to bereaved people that they are allowed to experience emotional turmoil as part of the grieving process. It is also important to have a balanced view on the use of medication. Medication may be necessary, but should not be used to suppress emotions. There is a growing tendency for families to request more and more tranquillisers from doctors. Some doctors also comply too easily with these requests.

69.4.3 Celebrate the memories of your loved one

Although the life of a person may end, memories do not. We need to actively acknowledge this. What is required, is to move from the position of having had an interactive relationship with a person, to one of living with the memories of that person.

Identify those things about the person who passed on that you can celebrate. The habit, or convention, of speaking well of a person who has died makes some sense. And if we can find little to celebrate in the life of the deceased, we could make it our purpose to look for things from which we can learn, in order not to make similar mistakes.

In most cases, families would need more than just a funeral service to celebrate the life lost. It is important to mention the name of the deceased in conversations with their family. Talk about those things which the deceased favoured – or did not like – in conversations.

Families with adequate financial means sometimes create a special fund or provide money to be used as an award or prize in honour of something they know the deceased would have supported. Another option is to plant a tree in remembrance.

69.4.4 Acknowledge and deal with contradictory emotions

Many people have mixed feelings about a person who has passed on. The bereaved can feel deep sorrow and anger; sorrow and relief; feelings of guilt as well as relief. It is important to reach the point where those who are in mourning can speak positively as well as negatively about the person who died.

A healthy way of mourning is an acknowledgment of the different and opposing emotions we may have. It is also healthy to reach the stage where we can think about the person who died in a balanced way, remembering their positive as well as negative characteristics.

69.4.5 Letting go

This is the most difficult task. The funeral is the process in which the ties are cut with the body. But cutting emotional ties is more complex. The emotional energy invested in the deceased should decrease over time. But the “letting go” task does not mean that our memories of the deceased are wiped out. It means that the emotional ties are reduced and that emotions can once again be invested in other relationships and issues.

A part of this process, for those who stay behind, is for them to redefine who they are. It requires of them to redefine themselves as being independent of the deceased. A widow/widower, for instance, should start thinking about themselves again as a single person. Adult children who have lost their parents should start thinking of themselves as adults, and not orphans. What it means, is that those who survive the deceased must find meaning in a life without that person.

A part of this task is to determine personal interests and desires, and ways of going forward without the deceased. It will require adjustments to daily, weekly, monthly and even yearly activities.

69.5   Dealing with loss (Summary)

Each individual deals with loss differently. Pastoral workers should think dynamically about the reactions of a family, and not push for a one-size-fits-all approach. Each of the factors that influences a sick patient – physical, psychological, affective, cognitive, sociocultural, family structure and more – also plays a role.

  • It is impossible to put a time limit on grief.
  • The withholding or suppression of sadness is not necessarily a sign of problems.
  • An insistence on severing ties, or detachment, is not always necessary.
  • There are people who grieve over a loss for the rest of their life, especially loss through death of a beloved. We should expect the intensity of the grieving to change over time.

69.6   The acronym TEAR(s) summarises the aims of grief work:

T: To accept the reality of the loss

E: Experience the pain of the loss

A: Adjust to the new environment without the lost object

R: Reinvest in the new reality

69.7   Making use of a person’s energy levels

Different phases in the grieving process mean different levels of energy are needed by the person experiencing the loss. Grief work should take notice of these different levels and go with the flow of the person.

 

 

70    Children and death

Social circumstances can make quite a difference to a child’s view of death. Imagine a child growing up in a war zone, or who lives in a gangster area where they frequently come into contact with traumatic, violent deaths.

A balanced approach is important. On the one hand, children and their emotions should not be ignored. Children are not ignorant of what is happening and experience deep emotions.

On the other hand, we should not overreact by constantly checking on them, asking how they are feeling. We should allow them to find their own way of dealing with loss.

A healthy response would be to be open and honest with your children, and to avoid acting as if nothing had happened. We must be sensitive to their own process of making sense of the circumstances. Children don’t need to carry the emotional burden of adults who can’t cope with the situation.

Young children experience grief and go through a process of mourning appropriate to their age without necessarily being traumatised for life. If resources are limited, using more of the emotional and other energy to support the caregivers of a child may be wise. The better the caregivers deal with a situation, the better the child will be able to cope and adapt.

70.1   Toddlers: 18 months – 3 years

At this age, a child does not understand the difference between death and going away. A child of this age lives in an egocentric world and may easily think that they caused the death. Toddlers experience loss and may miss a person even without having a strong memory of that person.

Loss is distressing and toddlers can exhibit high levels of anxiety: acting out emotions through agitated and restless behaviour; excessive crying; thumb sucking, biting and tantrums.

70.2   Preschool: 3-5 years

Until about the age of 4, most children do not clearly understand death and the permanency of death. They still have an egocentric understanding of the world, although less so than the toddler.

They can show very literal thinking about death and concepts like heaven, such as: “Is there pizza in heaven?” and “Does Johnny get birthday cake in heaven?”. Pre-schoolers can easily say: “I wish Anne was dead”, because the implications of death are not clear to them.

Children sometimes play-act around an event, play “dead”, or copy the funeral. Adults, for whom this can be disturbing, may even forbid this play to continue. This is unfortunate, because it is in fact a very positive way for children to deal with their grief by acting out their observations and understanding.

Children in this age group are sensitive to changes in their daily routine and react to this. One reaction that can be expected, is separation anxiety. Children could become excessively clinging; wanting to be held; and not wanting to sleep alone.

Other reactions include anger; feelings of rejection and even extended periods of sadness. Be on the lookout for regressive behaviour, with children showing less independence, a renewed inability to dress themselves or to go to the bathroom alone; or they may revert to the eating habits of a toddler.

Other reactions may be withdrawal or mute behaviour; bed-wetting and night terrors.

70.3   Primary school age

The average child, at the age of seven, has a clear understanding of the irreversibility of death. There is often a factualness in children of this age that can be disturbing to adults. A child of 6 or 7 may explain the gory details of a death matter-of-factly, which may seem cold and uncaring. They might make insensitive remarks, such as “now that my sister is dead I want to move into her room”. Parents would often not yet be ready to contemplate changes of this kind.

A young primary school child may prefer to go to school and play with their friends rather than staying at home and taking part in the bereavement process. This should be accepted as their way of dealing with the loss and grief.

Signs to look out for are behavioural and academic problems at school. There could be numerous somatic complaints, like headaches, stomach-aches, dizziness and excuses not to have to go to school. Sudden aggressive behaviour and radical changes in eating and sleeping patterns can also be signs of their complicated grief process.

70.4   Late primary school

The implications of loss and the related long-term changes are now a sure reality. Anger and questions about the unfairness of life may already be part of the emotions the youngster has to deal with. Young people can also feel guilty that they are still alive and may feel life is meaningless. Mood swings can also be expected. This is a time during which children start to determine their own identity very strongly. They may be very judgemental towards those close to them – while seeing the person that died as a sort of saint.

70.5   Summary: Dealing with grief in children

  • Allow children to ask the same questions over and over, as this is sometimes their way of seeking and finding reassurance.
  • Do be aware that children may not show the same emotions as adults – but this does not mean that they are not grieving.
  • Children should be allowed to mourn at a pace and level appropriate to their developmental phase.
  • Children should not be forced to participate in mourning activities if they decline to do so, nor should they be excluded when they want to be included.

71    Reading and listening to the Bible

It can be difficult to interpret a text translated from another language, which has also been written in a different cultural context. We should be careful not to take it for granted that words that have the same sound necessarily have the same meaning. The same words can also have different meanings in different contexts.

Deist (1986:107), in his book Kan ons die Bybel dan nog glo? warns us against the method the old Jewish rabbis used. They believed that all the verses in the Bible (OT) form an organic unit and thus stand in a relationship with each other. This means that, in any one single verse, the whole is contained, and that the whole is also present in any one verse.[22]. The result of this view is that they saw all sorts of relationship between the different verses. They approached any problem by quoting the maximum number of verses. Sometimes it is very difficult to understand how the different verses are connected. This manner of using the Bible is still used by many Christians. We sometimes put together texts from different authors and eras as if they deal with the same issue, and pay no respect to the different backgrounds.

The reality is that humans face many issues for which there exists no direct Bible text to give us a direct answer. This does not mean that the Bible does not give us direction, as the Bible is a light that shines. In Jesus Christ we have the direction of God’s will. We know Christ’s attitude and can find direction in His attitude.

“Die Bybel het nie vir elke vraag ‘n antwoord nie, maar die Bybel kan, verantwoordelik gebruik, vir ons die weg aandui, die weg van God vir ons. Want ons glo dat die Bybel, mensewoord soos dit is, getuienis van die openbaring is en in die hande van die Heilige Gees, ‘n betroubare gids, ‘n onfeilbare gids is vir die lewe van die Kerk.” (Deist 1986:107).[23]

72    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

73    Homework

  • Your Task: Write a “sermon” for your own funeral.

 

 

 

Session 8: Pastoral Conversation (2)

74    SESSION 8: Pastoral Conversation (2)

75    Daily ritual

75.1   Losses and gains

75.2   Living mindfully

We easily lose our concentration when we get the feeling that we have lost control over our circumstances. It is at this point that we often make decisions that we are sorry about later. One way of dealing with overwhelming circumstances is to start counting – something you may have learned from your parents. But the (brain) trick is not to start counting from the number 1, but to count backwards. In many instances, just counting backwards from 5 to 1 or 10 to 1, will be enough to restore our equilibrium to a point that will allow us to take stock of our situation with some level of calm.

We can teach ourselves to start counting backwards even before we respond, in a conversation, to something that upsets us. It is also a useful method to employ before we make a difficult phone call or send a WhatsApp.

75.2.1  Breathing and mindfulness exercises

How do we cultivate mindfulness? A basic method is to focus your attention on your own breathing – a practice called simply “mindful breathing”. After setting aside time to practise mindful breathing, you’ll find it easier to focus attention on your breathing in daily life – an important skill to help us to deal with stress, anxiety, and negative emotions. It also cools us down when tempers flare, and sharpens our ability to concentrate. Evidence suggests that mindfulness increases the more we practise it.

The most basic way to do mindful breathing is simply to focus our attention on our breathing, to inhale and exhale. We can do this while standing up, but ideally we should be sitting or even lying down in a comfortable position. Our eyes may be open or closed, but we might find it easier to maintain the focus if we close our eyes. It helps to set aside a designated time slot for this exercise, but it could also help to practise it whenever we feel particularly stressed or anxious. A regular practice session of mindful breathing, in a non-stressful environment, should make it easier to use the technique in difficult situations.

Sometimes, especially when you try to calm yourself down in a stressful moment, it might help to start by taking an exaggerated, deep breath: inhale deeply through your nostrils (3-7 counts), hold your breath (2-5 counts), and exhale slowly through your mouth (4-7 counts). Otherwise, simply pay attention to each breath you take without trying to adjust your breathing; it may help to focus on the rise and fall of your chest or the sensation of air passing through your nostrils. As you do so, you may find that your mind wanders, or gets distracted by thoughts or bodily sensations. That’s okay. Just notice that it is happening and gently bring your attention back to your breathing.

Adapted from: http://www.mindful.org/a-five-minute-breathing-meditation/

75.3   Time of discernment

75.3.1 Dwelling in the Word – psalm 73

(NAV)                                                                                 (NIV)

God is vir Israel baie goed, vir dié wat rein van hart is.

2 Tog het ek daaraan begin twyfel,  ek het byna koers verloor, 3 want ek het die hooghartige goddeloses met afguns bejeën toe ek hulle voorspoed sien.

4 Hulle het geen kwellings nie, hulle is sterk en gesond, 5 hulle het nie sorge soos ander mense nie, hulle het nie teëspoed soos ander nie.

6 Daarom hang die trots aan hulle soos ’n halssnoer en kleef geweld aan hulle soos ’n kleed.

7 In die weelde van hulle voorspoed matig hulle hulle enigiets aan; 8 smalend stook hulle kwaad, hooghartig dreig hulle met geweld.

9 Hulle laster teen die hemel en beledig links en regs op die aarde.

10 Tog hang die volk hulle aan en drink gretig hulle woorde in.

11 Hulle vra: “Hoe sal God dit uitvind? Hoe sal die Allerhoogste dit weet?”

12 Dit is hoe die goddelose mense is! So gaan hulle ongehinderd voort om rykdom op te hoop!

13 Dat ek die kwaad vermy het en met ’n eed my onskuld verklaar het, het dus niks gehelp nie, 14want elke nuwe dag het vir my teenslae gebring en elke nuwe môre straf.

15 Maar as ek so sou aanhou praat, sou ek dié verloën wat aan U behoort.

16 Daarom het ek diep nagedink om dit te verstaan en was dit vir my bitter moeilik 17 totdat ek in die heiligdom van God ingegaan en besef het wat die uiteinde van die goddeloses is.

18 U laat hulle op gladde plekke loop, U laat hulle ondergaan deur hulle eie geknoei.

19 In ’n oogwink word hulle iets afgrysliks, gaan hulle te gronde, tref ’n verskriklike einde hulle.

20 Net soos ’n droom wat ophou as ’n mens wakker word,  so verdwyn hulle, Here, as U ingryp.

21 Toe ek verbitter was en veronreg gevoel het, 22 was ek dom en sonder insig; soos ’n redelose dier het ek my teenoor U gedra.

23 Tog was ek nog altyd by U, want U vat my aan die hand. 24 U lei my met u raad en aan die einde sal U my in ere by U opneem.

25 Daar is niks in die hemel of op die aarde wat vir my meer beteken as U nie.

26 Al is ek afgetakel na liggaam en gees,  God is my sterkte; aan Hom behoort ek vir altyd.

27 Dié wat ver van U af is, gaan verlore, U vernietig dié wat aan U ontrou is. 28 Maar wat my aangaan,  dit is vir my goed om naby God te wees. Ek het die Here my God gekies as my toevlug! Ek sal van al u werke bly vertel.

 

Surely God is good to Israel, to those who are pure in heart. 2 but as for me, my feet had almost slipped; I had nearly lost my foothold.

3 For I envied the arrogant when I saw the prosperity of the wicked.

4 They have no struggles;

their bodies are healthy and strong.

5 They are free from the burdens common to man; they are not plagued by human ills.

6 Therefore pride is their necklace; they clothe themselves with violence.

7 From their callous hearts comes iniquity, the evil conceits of their minds know no limits. 8 They scoff, and speak with malice;

in their arrogance they threaten oppression.

9 Their mouths lay claim to heaven, and their tongues take possession of the earth.

10 Therefore their people turn to them

and drink up waters in abundance.

11 They say, “How can God know? Does the Most High have knowledge?”

12 This is what the wicked are like—  always carefree, they increase in wealth.

13 Surely in vain have I kept my heart pure;  in vain have I washed my hands in innocence.

14 All day long I have been plagued; I have been punished every morning.

15 If I had said, “I will speak thus,” I would have betrayed your children.

16 When I tried to understand all this, it was oppressive to me 17 till I entered the sanctuary of God; then I understood their final destiny.

18 Surely you place them on slippery ground; you cast them down to ruin.

19 How suddenly are they destroyed, completely swept away by terrors!

20 As a dream when one awakes, so when you arise, O Lord, you will despise them as fantasies.

21 When my heart was grieved and my spirit embittered, 22 I was senseless and ignorant;

I was a brute beast before you.

23 Yet I am always with you; you hold me by my right hand.

24 You guide me with your counsel, and afterward you will take me into glory.

25 Whom have I in heaven but you? And earth has nothing I desire besides you.

26 My flesh and my heart may fail, but God is the strength of my heart and my portion forever.

27 Those who are far from you will perish; you destroy all who are unfaithful to you.

28 But as for me, it is good to be near God.

I have made the Sovereign LORD my refuge; I will tell of all your deeds.

 

 

75.4   Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

75.5   Homework feedback

Your Task: Write a “sermon” for your own funeral.

75.6   Learnings and parking questions

 

76    How relevant is my story (experience) to the conversation?

Many of our caregivers have personal experience of pain, trauma and life challenges. It is often observed that caregivers share their own experiences (stories) with the person in need of care. Personal experiences shape our understanding and can help to make us sensitive to the needs of others, giving us the heart for those in need.

Being a pastoral caregiver means we have made a choice to stand in a supportive role. Sharing our own experiences, in our role as caregiver, is strongly discouraged. The focus should be on the other person and not on our experiences. Often, the argument is that sharing is a good way to build rapport with the other person. This is debatable. No two situations are 100% the same. The connection we see between our story with that of the person in need is very subjective and may not even be relevant to them. The person in need may experience our sharing as a subtle way of manipulation.

The reason why we want to tell our own story is often to find relief ourselves from the tension and anxiety of what has happened to us. This means, in a subtle way, it is our needs, and not those of the patient, that take centre stage.

Our aim is to connect people with their own, inner sources of strength, rather than to put any emphasis on outside resources or on what happened to others and how they dealt with it.

We do not know for certain what the outcome will be of this patient’s challenge, sickness, or suffering. And the fact that you know of somebody who survived a similar event or illness, is no guarantee that this person will survive, or vice versa.

The type of hope we bring by telling our own story, or the story of others, may in fact be a false hope (what works for me, may not work for you) and moves the focus away from the person in need. The hope we should proclaim is not of “what works for me”, but a hope of resurrection that is strongly embedded in the death and resurrection of Jesus Christ.

77    Pastoral conversation Roleplay

  1. A diabetic whose leg is amputated.
  2. A 30-year-old mother of two children who is on dialysis three times a week.
  3. An 80-year-old man with pneumonia.
  4. A staff member who cares for a patient that is brain dead, and who admits to you that she does not know how to deal with the patient’s family – who are in denial.
  5. A student nurse working in the Emergency Unit for the first time and whose brother died in a car crash a month ago.

78    Important markers for conversation

78.1   Again: Clarification of your role

Your role is not to give advice, nor to generalise, moralise or solve all the problems the other person has. You are a facilitator who creates an opportunity and safe space for another to reflect on their story.  You bring the love, kindness and peace of our Lord Jesus Christ to the encounter through your willingness to listen and to be present.

78.2   Accept yourself for who you are

We have already referred to how important it is to accept the patient/client as a person with all their shortcomings and potential. It is also important to accept yourself as a person with your own shortcomings and potential. To make peace with ourselves is important if we want to be a good listener. Most of us are inherently “defensive” listeners. We unconsciously listen with the idea to correct the other, to defend our own positions, to have our own identity confirmed.

When we take up the position of caregiver, we should be able to move out of this defensive listening position. To do this we need to be comfortable with ourselves and who we are.

78.3   Caregiving and our emotions

As a caregiver, you will continue to have emotions and to experience better days and worse days (just like all other people). Before each visit to a patient, allow yourself a moment to reflect on the following:

How do I feel today?

How do I feel about going on this visit today?

Do I have any strong feelings about something that might be preoccupying me?

If you experience strong emotions, it is important to deal with them and then to put them aside before going into a consultation with a person.

We should find ways of dealing with our own emotions. I suggest the following:

  • Create a space where you can reflect on the emotion.
  • Give the emotion a name. It is important to recognise an emotion.
  • Accept the emotion as a reality, one that you can’t wish away.
  • Determine where it comes from. What is the source of this emotion?
  • Determine whether there is something you must do about the emotion.
  • Make an appointment with yourself by setting a time when you can again reflect on it.
  • Decide on a future plan regarding the emotion.

78.4   Distinguish between facts and emotions

For a pastoral worker, the focus is on the person’s emotions rather than the facts of the story that you are told. We do not need to have all the information to be supportive or to have a useful conversation. But if the person gives you only facts and show no emotion, it would be appropriate to ask what this situation or circumstances have done to him/her emotionally.

78.5   Pastoral dimensions of conversation

  • Listen carefully for connection points with Scripture, faith, spiritual experiences.
  • Do not jump to conclusions. Ask if you are uncertain what the person means by a certain statement or remark. The questions we ask should facilitate an open conversation and inspire the patient to think further.

For example: A patient may say he/she believes that God will help them.

“Tell me more about how do you think God will help you?”

“Are there other ways God can also help you?”

“Do you want to tell me of other times that God has helped you or somebody close to you”?

79    Case studies

1 A young quadriplegic patient (17 years old) on a ventilator who had broken his neck in a rugby match.

  1. A terminal patient, with her husband who sits next to her reading his Bible.
  2. A patient, in constant pain, who cannot afford a hip replacement, and who has received the news that he has been placed on the waiting list but will only be operated on in the next 3-5 years.

80    Reading and listening to the Bible

Dirkie Smit, in his book, Neem, lees! Hoe ons die Bybel hoor en verstaan (2006), explains how the theologian Johannes Calvin thought about the Bible (pp 47-53). Calvin understood that the Bible was a fully human and historic document, but believed this was God’s way to speak to us in a purely human way. “Gods Woord word dus mensewoord sonder om daarmee nie meer Gods se Woord te wees nie” (Smit 2006:52). [24] God is committed to speak to us through a human document, the Bible, in human language. We use our human senses to understand and interpret it. We need the living Christ and the work of the Holy Spirit in interpreting the Bible, because our best attempts are corrupted by our sinful nature. Reading and listening to the Bible is a gift of grace. It is the same God who sent his Son, and the Holy Spirit, who also gives us the Bible.

81    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

82    Homework

Your Task: In one paragraph, write down what you think are your strong points/ gifts in a pastoral conversation.

 

 

Session 9: Questions of faith and suffering (2)

This Session is an extension of previous Sessions, which already opened up the conversation regarding God and suffering.

83    SESSION 9: Questions of faith and suffering (2)

84    Daily ritual

84.1   Losses and gains

84.2   Living mindfully

Willem Nicol, in his book Oop vir die oomblik: Nader aan die hier en nou met die Here (2016) (it translates into Being open to the moment: Being closer to the here and now with the Lord), writes how important it is to live in the moment (2016:128). Living in the moment makes us aware of the situation around us and helps us to move beyond our own narrow world. Those who live in the moment will also be confronted with unknown situations. Living in this way also helps us to live with greater openness and the awareness that we cannot control everything around us.

84.2.1  Breathing and mindfulness exercises

In and out. In and out. Breathing is not about making progress or getting anywhere – and that is why it is important. Breathing isn’t focused on improving style, becoming more efficient, or rushing to reach the end of a daily respiration quota in order to be able to take a break. As long as we let it, breathing mostly just does what it does. Of course, something very vital is happening while we breathe – without it, we die. And any attempt to try and speed up, force, grasp, control or push away or escape our breathing process tends to just get in the way of the action. As in breathing, so in life – we can learn a lot from the natural rhythm, pace, and unfussiness of how the breathing process continues to do its work without making a big deal about it. (Adapted from: http://www.mindful.org/a-five-minute-breathing-meditation/)

84.3   Time of discernment

84.3.1 Dwelling in the Word – psalm 73

(NAV)                                                                                 (NIV)

God is vir Israel baie goed, vir dié wat rein van hart is.

2 Tog het ek daaraan begin twyfel,  ek het byna koers verloor, 3 want ek het die hooghartige goddeloses met afguns bejeën toe ek hulle voorspoed sien.

4 Hulle het geen kwellings nie, hulle is sterk en gesond, 5 hulle het nie sorge soos ander mense nie, hulle het nie teëspoed soos ander nie.

6 Daarom hang die trots aan hulle soos ’n halssnoer en kleef geweld aan hulle soos ’n kleed.

7 In die weelde van hulle voorspoed matig hulle hulle enigiets aan; 8 smalend stook hulle kwaad, hooghartig dreig hulle met geweld.

9 Hulle laster teen die hemel en beledig links en regs op die aarde.

10 Tog hang die volk hulle aan en drink gretig hulle woorde in.

11 Hulle vra: “Hoe sal God dit uitvind? Hoe sal die Allerhoogste dit weet?”

12 Dit is hoe die goddelose mense is! So gaan hulle ongehinderd voort om rykdom op te hoop!

13 Dat ek die kwaad vermy het en met ’n eed my onskuld verklaar het, het dus niks gehelp nie, 14want elke nuwe dag het vir my teenslae gebring en elke nuwe môre straf.

15 Maar as ek so sou aanhou praat, sou ek dié verloën wat aan U behoort.

16 Daarom het ek diep nagedink om dit te verstaan en was dit vir my bitter moeilik 17 totdat ek in die heiligdom van God ingegaan en besef het wat die uiteinde van die goddeloses is.

18 U laat hulle op gladde plekke loop, U laat hulle ondergaan deur hulle eie geknoei.

19 In ’n oogwink word hulle iets afgrysliks, gaan hulle te gronde, tref ’n verskriklike einde hulle.

20 Net soos ’n droom wat ophou as ’n mens wakker word,  so verdwyn hulle, Here, as U ingryp.

21 Toe ek verbitter was en veronreg gevoel het, 22 was ek dom en sonder insig; soos ’n redelose dier het ek my teenoor U gedra.

23 Tog was ek nog altyd by U, want U vat my aan die hand. 24 U lei my met u raad en aan die einde sal U my in ere by U opneem.

25 Daar is niks in die hemel of op die aarde wat vir my meer beteken as U nie.

26 Al is ek afgetakel na liggaam en gees,  God is my sterkte; aan Hom behoort ek vir altyd.

27 Dié wat ver van U af is, gaan verlore, U vernietig dié wat aan U ontrou is. 28 Maar wat my aangaan,  dit is vir my goed om naby God te wees. Ek het die Here my God gekies as my toevlug! Ek sal van al u werke bly vertel.

 

Surely God is good to Israel, to those who are pure in heart. 2 but as for me, my feet had almost slipped; I had nearly lost my foothold.

3 For I envied the arrogant when I saw the prosperity of the wicked.

4 They have no struggles;

their bodies are healthy and strong.

5 They are free from the burdens common to man; they are not plagued by human ills.

6 Therefore pride is their necklace; they clothe themselves with violence.

7 From their callous hearts comes iniquity, the evil conceits of their minds know no limits. 8 They scoff, and speak with malice;

in their arrogance they threaten oppression.

9 Their mouths lay claim to heaven, and their tongues take possession of the earth.

10 Therefore their people turn to them

and drink up waters in abundance.

11 They say, “How can God know? Does the Most High have knowledge?”

12 This is what the wicked are like—  always carefree, they increase in wealth.

13 Surely in vain have I kept my heart pure;  in vain have I washed my hands in innocence.

14 All day long I have been plagued; I have been punished every morning.

15 If I had said, “I will speak thus,” I would have betrayed your children.

16 When I tried to understand all this, it was oppressive to me 17 till I entered the sanctuary of God; then I understood their final destiny.

18 Surely you place them on slippery ground; you cast them down to ruin.

19 How suddenly are they destroyed, completely swept away by terrors!

20 As a dream when one awakes, so when you arise, O Lord, you will despise them as fantasies.

21 When my heart was grieved and my spirit embittered, 22 I was senseless and ignorant;

I was a brute beast before you.

23 Yet I am always with you; you hold me by my right hand.

24 You guide me with your counsel, and afterward you will take me into glory.

25 Whom have I in heaven but you? And earth has nothing I desire besides you.

26 My flesh and my heart may fail, but God is the strength of my heart and my portion forever.

27 Those who are far from you will perish; you destroy all who are unfaithful to you.

28 But as for me, it is good to be near God.

I have made the Sovereign LORD my refuge; I will tell of all your deeds.

 

 

84.4   Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

84.5   Homework feedback

Your Task: Write one paragraph of what you think your strong points/ gifts are in a pastoral conversation.

84.6   Learnings and parking questions

 

85    Theological reflections on faith and suffering

In a world of suffering, where does God stand as the holy, good and just God?. The question often asked is: “How can a just God allow so much suffering?” And when we deal with questions like these, it can become problematic when we do so in a manner that sounds as if we want to “justify” God’s actions (Romans 11:36).

After the death of his wife from cancer, someone tried to comfort CS Lewis with the words that he could be assured that his wife was “safe in the hands of God”. CS Lewis reacted as follows:

“But if so, she was in God’s hands all the time, and I have see what they did to her here. Do they suddenly become gentler to us the moment we are out of the body? And if so, why? If God’s goodness is inconsistent with hurting us, then either God is not good or there is no God: for in the only life we know He hurts us beyond our worst fears and beyond all we can imagine. If it is consistent with hurting us, then He may hurt us after death as unendurably as before it.” (Cited by Van Niekerk, AA 2005:129).

85.1   How is God acting in this world?

Consider this: I make a safe journey from Cape Town to George, but have one incident where a truck misses hitting me by millimetres. I witness to others that God protected me from having an accident. On another occasion, I travel the same route and have an accident. How should I understand God’s protection this time around?

Just like people in the time of the Bible, we are also faced with questions of God’s involvement in what happens to us and around us. Does God continue to be involved in directly acting in our lives and the world, and if he is, how is he involved and what does he do?  In what way is He present in what happens daily in this world and in our lives?

How do we acknowledge His continued involvement without holding Him responsible for the world’s suffering? Is He present only when good things happen? Where is He when bad things happen to good people?

In the Christian tradition, God’s actions are sometimes acknowledged along with the addition that some of His actions are “hidden actions”. The problem is, our eyes are blinded by our ignorance. Which means our sinfulness blinds us to God’s actions. Our sinfulness also makes us blind to God’s actions. At best, we view God’s action restrospectively, through the eyes of faith. This also means it is a very subjective view. I might see the hand of God in something that happened, but my fellow-believer might not see the hand of God in that same event.

Some people prefer not to deal with these kinds of questions, and instead say that their faith is like that of a child. To believe like a child is what the Bible requires from us, and certainly is the conclusion many people reach after struggling with these tough questions. Questions about God’s action or lack of action confront us with the mystery of who God is. All the same, it is necessary not to ignore these questions, and to acknowledge that the answers will not come easily for many people. Throughout the ages, believers, preachers, authors, and academics have wrestled with questions regarding God’s action (or lack of action).

The different views regarding God’s action in the world all have shortcomings and limitations. The two extreme views are, on the one hand, that of the reductionists, and on the other, that of the interventionists. Discussion of and debate about God’s actions can be summarised as follows (Thomas Tracy, cited by Conradie 2010:243):

  1. God can act directly by creating the world and by maintaining creation.
  2. God can act directly, but stays within the rules of nature. Here there is specific reference to God’s involvement at quantum level, where small variations can lead to microscopic results that can only be seen by the eyes of the faithful.
  3. God can act indirectly through a network of causal reactions, which follows in the wake of his original act of creation.
  4. God can act indirectly through the free will and action of people whose choices are influenced by God’s actions of love and presence.
  5. God can act directly by ignoring the rules of nature and transcending these rules.

There is reasonable consensus on the first, second and fourth approaches. The fifth approach is seen as being an interventionist view because it is of the opinion that God overrules nature. Number two causes the most debate among theologians. The question is whether God acts specifically to determine specific outcomes in history.

“In eietydse gesprekke oor die teologie en die wetenskap word enige gedagte dat God as’t ware van buite af ingryp in die geskiedenis en in die natuurwette wyd verwerp. So ‘n opvatting is intellektueel net nie geloofwaardig nie. Want wie glo dat God tóg in die geskiedenis inbreek, sal ook moet verduidelik hoe hulle daardie handelinge van God verstaan. Daarom word eerder gesoek na die wyses waarop God binne die reëls, wat God immers self daargestel het, kan handel. Die argument is dat die reëls self ‘n bepaalde openheid vertoon wat oorgenoeg ruimte vir God se handelinge laat.” (Conradie 2010:243-244).[25]

The debate becomes more cluttered when it goes beyond discussions of how God acts in maintaining creation, or how God acts through evolutionary process and progress. The question is about the possibility of God acting to change the course of history (intervention). This is not a strange question since, especially in the Old Testament, God’s actions play a role in the central stories of the exodus and exile. In the New Testament, we have the incarnation, death and resurrection of Christ, and what happened on the day of the Pentecost.

To what extent can we say that these interventions take place within the rules of creation? Take, as an example, an umpire who intervenes when players fight. The umpire intervenes within the rules of the game and should not act outside those rules of the game.

Reductionism is also a danger. The danger here is understanding God’s actions as nothing else than human actions. One possible outcome is that the levels of complexity are undermined by reducing them to a simpler level so that they can be understood. But, later debates, in which the latest developments in quantum theory are taken seriously, now help us to understand something of the complexity that is involved in dealing with large and small particles and atoms.

William R Stoeger (How God Acts) makes use of Aquinas’s distinction between primary and secondary causes for things to happen. According to this scheme, God is responsible for primary causes such as creation and re-creation. Secondary causes operate in the fields of science, physics and biology. God’s actions – the primary causes – can’t be empirically investigated. God can also work through – or is also present in – secondary causes, but does not cause the events to happen. In terms of the secondary causes, God works through his love and His presence.

Reductionists reduce primary causes to secondary causes, while the interventionists see no relationship between primary and secondary causes (Conradie 2010:244).

Our point of departure, when we reflect on God and what is happening in the world, is often embedded in a mechanistic cause-and-effect view of the world. And even when we try to use the cause-and-effect scheme of things, we should acknowledge that we are very limited in our ability to observe all the different influences on the world and our life.

The basis of our belief is that God acts by sending us His Son and the Holy Spirit. The resurrection, then, is one of the ultimate examples of God’s action.

What is clear to us is that God chooses to act through His Word and Spirit. The proclamation of the Word and reading and listening to the Word, are ways in which to share in God’s action. Many Christian traditions also acknowledge that baptism and the Holy Communion are ways in which God acts directly. For many Christians, the experience of Holy Communion are ways in which we can actively experience God’s involvement with us.

Unfortunately, in our need for instant change in personal circumstances together with a deep-rooted desire for the dramatic, we often look at these matters only to try and determine whether God is at work or not. But another element at play is our search for power. In all cultures and groups there exists the desire to find the power to be healthy, protect us against bad things happening and against evil powers. People look for political power, economic power, social power and definitely also spiritual power.

At its deepest level the gospel is about the life-changing impact it has on the lives of people and society. These changes in the heart and attitude are often not very dramatic or radical in the short term, nor would they move heaven and earth – or even mountains. Instead, God is present where people act against suffering – especially suffering due to evil acts perpetrated by humankind. God acts where we expose evil actions.

The most awkward thing for us is to see how God acts by using vulnerability. Gethsemane and the cross speak of the vulnerability of Jesus. Our deep-seated desire for power, rather than vulnerability, is one of the ways by which the Evil One covers our eyes to the presence of God in vulnerability.

The power of God’s action is shown at the cross, when he shows himself to be vulnerable. At the cross Jesus becomes the victim of suffering, due to the actions of evil powers. God does not act to prevent Jesus from suffering. We also have no doubt that God was present – but it was as the one who was vulnerable. Some theologians refer to God the Father’s hidden presence. The vulnerability of God, through the suffering of the Son, saved the world. “Christ helps us, not by virtue of his omnipotence, but by virtue of his weakness and suffering.” (Bonhoeffer, as cited by Conradie 2010:250).

The “power” of vulnerability is the opposite from the “power” used in politics, war and violence. Vulnerable power is the power of forgiveness, the power of solidarity with those in need, the power of unconditional love, and the power of patience.

Looking with eyes of the faithful, we can see that God acts notwithstanding what is happening with us and around us in this world. Because these actions are not interventionist, not coming from outside, but instead from inside, people. For example: Praying for rain may not result in rain, or, when it starts to rain it would be difficult to determine (impossible) whether the rain was sent directly by God or whether it would have rained anyway without the special prayers. Also, there could even be rain in parts of the world where there are no believers! Rather, God’s action should be seen in terms of how people support each other in times of drought, in how people’s hearts change when they see the suffering of others.

God’s actions are not mechanical. God works by convincing people through His Spirit to act according to His way and in support of others in their suffering, rather than by directly intervening or causing events; He works by influencing people to make changes rather than by forcing them to change through powerful actions that cause dramatic events.

The question that is constantly asked is: Where is God when people suffer due to illness, persecution, poverty, injustice, war, or natural disasters? There is no intellectual answer to the question. However, we acknowledge that God is already present in a powerful way in the form of the cross. We find evidence of this in the songs of Christian martyrs through the ages. This presence of God is not that of an additional power – which is how the interventionist would like to see it – but instead, in the way that He is always present when we are vulnerable.

Although it is against our nature, we should overcome the deep need to look for God’s actions in the form of miracles. This does not mean that we close the book on miracles, but they are not the primary way in which God acts. We should accept that our own interpretations are biased, limited and very subjective.

The more we look away from ourselves and our circumstances, the more will we develop an eye for God at work. God has a purpose with creation. That purpose is relationship (community) between us and the Triune God. Features of this relationship are mutual respect, compassion, joy and peace. God directs the cosmos in this direction without a blueprint detailing every step. The way God does this is through a “soft hand”, by changing the hearts and attitudes of people.

With the incarnation, death and resurrection of Jesus Christ, God intervenes in a much more dramatic way. God answers our prayers, but does not respond to our selfish desires and does not draw a line through the integrity of creation. God respects the integrity of creation; the laws of nature; and of chance. God, in his interaction with us, looks for a mutual relationship of respect and love. God’s actions do not exclude us. God does not take away the responsibility we, as humans, have. He includes us – so that we ourselves must make the peace deals; offer forgiveness for injustices done to us. In prayer, we acknowledge our own limitations; our own vulnerability; we surrender ourselves; express our desire that God will open our eyes, our minds, and will change our attitude. In prayer, we commit ourselves to be instruments for God’s actions. We also acknowledge that God’s way of working includes creating a space for us to act on God’s behalf.

86    Reading and listening to the bible

Prof Dirkie Smit (Neem Lees! – translating into Take and read!) views it as important that a growing number of theologians now emphasise the importance of reading the Bible as the Bible, and the acceptance that the Bible has a unique history and content (2006:168). The church needs the whole Bible, Old and New Testament, to hear this message. It means we read the Bible with an acknowledged presupposition that it is the revelation of the Triune God, which calls us and makes us part of His actions. To understand the content of the Bible we should accept the following suppositions: that God is Triune; that God speaks through the Bible; that God becomes known through the Bible, and that God calls human beings to follow Him and renew themselves.

Smit (2006:170-171) cited the well-known NT Wright who writes:

“The phrase ‘authority of scripture’ can make Christian sense only if it is a shorthand for ‘the authority of the triune God, exercised somehow through scripture’ … In particular, the role of the Bible within the church and the individual Christian life indicates three things which are of central importance. To begin with, it reminds us that the God Christians worship is characterised not least as a God who speaks. It means the idea of reading a book to hear and know God is not far-fetched, but cognate with the character of God himself. Second, it is central to early Christian instruction that we be transformed by the renewal of our minds (Romans 12:1-2). In other words, it is important that God’s transforming grace is given to us not least through enabling us to think in new ways. Again, this means that the idea of reading a book in order to have one’s life reordered by the wisdom of God is not counter-intuitive, but is cognate with the nature of Christian holiness itself. Third it reminds us that the God we worship is the God whose world-conquering power, seen in action in the resurrection of Jesus, is on offer to all who ask for it in order thereby to work for the gospel in the world (Ephesians 1;15-23). The idea of reading a book in order to be energized for the task of mission is not a distraction, but flows directly from the fact that we humans are made in God’s image, and that, as we hear his word and obey his call, we are able to live out our calling to reflect the creator into his world. Scripture’s authority is thus seen to best advantage in its formation of the mind of the church, and its stiffening of our resolve, as we work to implement the resurrection of Jesus, and so to anticipate the day when God will make all things new, and justice, joy and peace will triumph (Ephesians 1:3-23).”

87    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

88    Homework

  • Your Task:.

 

 

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Module 4 Sessions 10-12

89    MODULE 4: SESSIONS 10-12

90    Welcome!

Task: Find a friendly looking stranger as a partner for today only – someone with whom you think you will be able to share.

91    Introduction of facilitator

  • Facilitator of the course: Frederik Nel

91.1   Time schedule

09:00 -10:30 – Ready, Steady

10:30 -11:00 – Tea

11:00 -12:45 – Go …

Task: Group appoints a timekeeper for the day/module

Timekeeper will (a) remind the facilitator and group of the time 10 minutes before a break or at the end of the day, and (b) switch on the kettle for coffee 5 minutes before the break.

91.2   Donation box

A voluntary donation of R100 for this module (for the 3 days).

91.3   Primary aims!

Learning opportunity: Acquiring new knowledge, or reconnecting with and refreshing knowledge you already have.

Skills training: Listening, questioning, reflecting, interpreting.

Theological reflection: Thinking about God’s presence in the group and our interactions with others.

Growth opportunity: Being in a group always creates new opportunities for personal challenges and growth.

Spiritual sharpening: Each opportunity to reflect on God’s presence while we are with other people is per se an opportunity to sharpen our spiritual awareness.

91.4   Values (not rules) for the course

There is a distinction between rules and values. Values are the foundations on which rules are built.

91.4.1 Respect

Respect for each other, including differences in viewpoints, culture, belief, gender, social circumstances, language, etc.

91.4.2 ConfidEntiality

Confidentiality is actually a sign of respect.

Caregiving is not the same as being enmeshed in another person’s life. It is a way of being with another without making the other dependent on us, the carers.

91.4.3 Affirmation

Affirm the positive we see in each other and also accept the affirmation others give us.

91.4.4 Integrity

Honesty, trustworthiness, openness …

91.5   Rules:

  1. Musical chairs: You are not allowed to sit next to the same person every day – pick a new partner.
  2. Please wear your name tags.

92    Daily ritual

92.1   Losses and gains

92.2   Living mindfully

I referred in a previous module to the book by Willem Nicol, Oop vir die oomblik. Nader aan die hier en nou met die Here (2016). He explains how difficult, but also important, it is to have regular periods of quiet time (stilword tyd). Not time for Bible reading and prayer, but time to be quiet and do nothing. He makes the important point that the less time we think we have for such times, the more such time will be useful to us (2016:211).

There are those who say that all human beings have the following needs:

  1. The need to succeed in what we are doing, thus to achieve something – performance.
  2. The need to get away from all the hard work and to relax and enjoy life – ecstasy.
  3. The need for introspection, searching your hart – enstase/enstasis (contemplation of the self).

Society gives us ample opportunity to perform – achieve – and exprerience ecstasy. We have to create the space for introspection ourselves. We need quiet time to do this introspection and searching of our hearts. This means making time during which there will be no other agenda than to be busy with your own thoughts. This is necessary to move from a “human doing” to a “human being”.

“In die stilword waaroor ek hier skryf, beweeg jy vanuit die domein van doen na die domein van wees.” (Nicol 2016:212).[26]

This quiet time, being alone, helps our mind to learn more about our own heart and brings about an integration of the mind and heart. It is more difficult, in aloneness and times of quiet, to run away from ourselves, and in the process we experience healing and wholeness.

92.3   Breathing and mindful exercises

The way we breathe affects our whole body. Full, deep breathing is a good way to reduce tension, feel relaxed and reduce stress.

It is important for deep breathing in order to develop the full use of our lungs and get in touch with the rhythm of our breathing. It helps to put one hand on your abdomen and the other on your chest, and to notice how your hands move while you breath in and out. When you fill the lower parts of your lungs, the hand on you abdomen should move out, and the hand on your chest should remains still. Do this a few of times.

Now add a second step. Keep on inhaling into your abdomen, but also include the upper part, namely your chest. Now the hand on your chest must also move out. The hand on your abdomen will not move out as much.

Always inhale through your nose and exhale through your mouth.

  • Try morning breathing when you first get up in the morning to relieve muscle stiffness and clear clogged breathing passages. Then use it throughout the day to relieve tension in your back.

From a standing position, bend forwards from the waist, with your knees slightly bent and let your arms dangle, almost touching the floor.

As you inhale slowly and deeply, return to a standing position by unfolding upwards slowing, lifting up your head as the final step.

Hold your breath for just a few seconds in this standing position.

Exhale slowly.

Repeat the whole exercise by starting from the beginning again.

92.4    Time of discernment

92.4.1 Dwelling in the Word – Romans 8:18-30

(NAV)                                                                                 (NIV)

18Ek is daarvan oortuig dat die lyding wat ons nou moet verduur, nie opweeg teen die heerlikheid wat God vir ons in die toekoms sal laat aanbreek nie. 19Die skepping sien met gespanne verwagting daarna uit dat God bekend sal maak wie sy kinders is. 20Die skepping is immers nog aan verydeling onderworpe, nie uit eie keuse nie, maar omdat God dit daaraan onderwerp het. Daarby het Hy die belofte van hoop gegee: 21die skepping sal self ook bevry word van sy verslawing aan die verganklikheid, om so tot die vryheid te kom van die heerlikheid waaraan die kinders van God deel sal hê. 22Ons weet dat die hele skepping tot nou toe sug in die pyne van verwagting. 23En nie net die skepping nie, maar ook ons wat die Gees ontvang het as die eerste gawe van God, ons sug ook. Ons sien daarna uit dat God sal bekend maak dat Hy ons as sy kinders aangeneem het: Hy sal ons van die verganklikheid bevry. 24Ons is immers gered, en ons het nou hierdie hoop. Wat ‘n mens al sien, hoop jy tog nie meer nie. Wie hoop nog op wat hy reeds sien? 25Maar as ons hoop op wat ons nie sien nie, wag ons daarop met volharding.

26Die Gees staan ons ook in ons swakheid by: ons weet nie wat en hoe ons behoort te bid nie, maar die Gees self pleit vir ons met versugtinge wat nie met woorde gesê word nie. 27En God, wat die harte deurgrond, weet wat die bedoeling van die Gees is, want Hy pleit, volgens die wil van God, vir die gelowiges. 28Ons weet dat God alles ten goede laat meewerk vir dié wat Hom liefhet, dié wat volgens sy besluit geroep is. 29Dié wat Hy lank tevore verkies het, het Hy ook bestem om gelykvormig te wees aan die beeld van sy Seun, sodat sy Seun baie broers kan hê van wie Hy die Eerste is. 30Dié wat Hy daartoe bestem het, het Hy ook geroep. En dié wat Hy geroep het, het Hy ook vrygespreek. En dié wat Hy vrygespreek het, het Hy ook verheerlik.

18 I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. 19 For the creation waits in eager expectation for the children of God to be revealed. 20 For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope 21 that[h] the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God.

22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 23 Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies. 24 For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? 25 But if we hope for what we do not yet have, we wait for it patiently.

26 In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us through wordless groans. 27 And he who searches our hearts knows the mind of the Spirit, because the Spirit intercedes for God’s people in accordance with the will of God.

28 And we know that in all things God works for the good of those who love him, who[i] have been called according to his purpose. 29 For those God foreknew he also predestined to be conformed to the image of his Son, that he might be the firstborn among many brothers and sisters. 30 And those he predestined, he also called; those he called, he also justified; those he justified, he also glorified.

92.4.2 Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

92.5   Homework feedback

Your Task:

92.6   Learnings and parking questions

 

Session 10: facing death and dying

93    SESSION 10: Facing death and dying – the terminally ill

“What the dying fear most, is not death itself, but the process of dying” (Louw 1994:170).

The Western culture of the 21st century is described by some as a death-denying culture. Much is done to prevent death, and the act of dying is removed from and kept away from families and households. People die in hospitals, care centres and old age homes. Everything around the death, and the burial or cremation, is outsourced to professionals.

93.1   Living before we die

There should not be a disconnection between living and dying. Death is not only about death itself, but is also about life. A person’s understanding of life and the meaning – or lack of meaning – that life has for them, also influence the process of dying.

“It is important for pastoral care to help people to live, before they die” (Louw 1994:170).

93.2   Process of Dying

Each person’s illness develops in a different way. Some people are chronically ill for decades, some have a particular illness from childhood and grow up with it. The process, as explained by Barton, begins when the first questions about your health are asked by yourself or others. What follows is a typical scenario in which a state of healthiness exists – but when someone gets ill the next day. See Barton (1977:20-21)

  1. It all starts with health and the state of a person’s health.
  2. Experiencing symptoms or signs of illness
  3. Dealing with the health care system
  4. Diagnostic process
  5. Reporting of results
  6. Treatment phase
  7. a) Treatment out of hospital
  8. b) Treatment in hospital
  9. Possibility of improvement and relative health
  10. Decline of health
  11. Loss and incapacitation
  12. Acceleration of illness and process towards death begins
  13. Lingering or hanging on.
  14. Death
  15. Pronouncement of death
  16. Immediate response of loved ones
  17. Prolonged response of loved ones

93.3   Basic needs of the terminally ill patient

93.3.1 Basic physical needs

  • Proper pain management.
  • Attention to be paid to the general discomfort caused by confinement to bed or room.
  • Attention to be paid to the inability to feed themselves or drink fluids as needed.
  • Assistance required to use the toilet.
  • Assistance required with dental and mouth hygiene.
  • Assistance required with bathing and showering, or must be given a bed wash or bath.

93.3.2 Psychological needs

  • Fear of being helpless and loss of control over their life.
  • Anxiety is often caused by uncertainty over their fate.
  • Emotions often alternate between desiring contact with people and being left alone; a desire to live and a desire for the end to come soon; as well as denial and anxiety.
  • Loneliness: The final moments before death can produce a state of loneliness, even more so if those around you are not prepared to face your death with you.
  • A need for emotional understanding instead of emotional manipulation or advice: thus, the acceptance and recognition of the patient’s emotional needs, even when these do not make sense or are unrealistic.

93.3.3 Social needs

  • To be surrounded by caring people, without too much “mothering”.
  • The availability of company – but not a continuous flow of people or visitors.
  • Short visits.
  • Positive but realistic visitors.

93.3.4 Spiritual needs

  • These can sometimes greatly vary between different individuals. They are determined and influenced by culture, religious traditions and personality.
  • Can fluctuate between uncertainty and certainty.
  • Doubt, and even despair, can often feature.
  • Questions about life and death: “What if …”
  • Feelings of guilt.
  • Wishing to “go home”.
  • Music and prayer.

94    Dying and fear

94.1   Psychological fear – Thanatophobia

Thanatophobia, or the abnormal fear of death, is a relatively complicated phobia. It refers to the abnormal fear of death that a healthy person might have.

The idea of death raises uncertainty in many people. With uncertainty comes a normal measure of fearfulness. However, if the fear is so prevalent as to affect your daily life, then you might have a full-blown phobia.

94.2   Religious fears

When religious fears are put on the agenda, we as pastoral workers might feel that we are particularly well-equipped to deal with them. But we are in danger of not listening to the patient if we are too keen to resolve the struggles of patients with ready-made Bible verses in order to explain the road to heaven. The sad situation is that religious patients may fear death even more than people with no belief in an afterlife.

Many people’s fear of death is tied to their religious beliefs, particularly when they happen to be going through a period of questioning. Like the following: Is it safe enough to ask religious questions? Will people start judging me? With whom can I share my uncertainty and not face a sermon as a response to my uncertainty? The patient’s own understanding of God (Godsbegrip) may play an important role during this time.

Some people think that they know what will happen after death, but are worried that they may be wrong. Some believe that the path to salvation is very straight and narrow, and fear that any deviation or mistake could result in them being condemned for eternity.

Pastoral workers should develop an understanding of God’s saving grace that allow them to listen and comfort without pushing patients towards a narrow understanding of Gods actions.

94.3   Fears for the next of kin

Many people are not nearly as afraid of dying as the fear they have about what will happen to their families after their death. This appears to be especially common among parents, single parents and those who are carers of others. They might worry that their family would suffer financially, or that no one would be around to step in and care for their family.

The growing individualism in society makes this a growing concern. There is little hope, faith and trust in the extended family, the community or society playing a supporting and caring role.

94.4   Fear and anxiety

Fear of death is a natural reaction to the unknown. But it can prevent us from embarking on certain actions and influence our decisions.

Anxiety is the result of extreme fear and leads to physical symptoms such as the following:

  • Palpitations; chest pain; extreme chills; cold and clammy hands; stomach upsets or queasiness; frequent urination and diarrhoea; shortness of breath; sweating; dizzyness; tremors and twitches; muscle tension; headaches; fatigue; insomnia.

94.5   Children and fear

A child’s fear of death can be worrisome to the parent, but may actually be part of the normal developmental process. Ask the child to explain exactly what it is they fear. Children often have a particular image in their mind formed by what others have said, or of something they have seen on TV. It may not be death itself, but, for example, images of a bloody body that make them fearful.

Children generally lack defence mechanisms, the ability for religious interpretation and the understanding of death that help adults to cope.

Small children’s understanding of time is also not fully developed. We all know how difficult it can be to explain to a small child that a person who is going out would be back in an hour – or the next day. Death brings the opposite – a situation in which we need to explain that the person who died will never come back again.

Any easy explanation such as “Mummy is with Jesus” might not reduce their anxiety. It will all depend on the child’s understanding of where Jesus is. All explanations given to children should be constantly checked and rechecked with them as they grow older to prevent them harboring misconceptions.

Children may also receive different explanations about the death of a loved one from their friends and at their church (or even on social media) than those they received at home, leaving them terrified of what exactly it means to be dead.

95    Role of the pastoral caregiver

Our role will depend on the circumstances.

95.1   Bringing calmness to the patient, family and situation

Death and dying are just as common as giving birth. It happens every second. But society is often ill-prepared to deal with it. Caregivers are by definition those who not only think about life, but also about death – and should be be able to deal with death as normally as possible.

Although most of the time the actual time of death is a highly emotional moment, this does not exclude the possibility for it also to be a sacred moment. Our role is to acknowledge the emotions, but to carry over something of how special the moment is by our words and actions. We should bring calmness and stability to the situation and should not instigate any hyped-up emotions. Not many people are trained to deal with end-of-life situations. Often health workers are so focused (and trained) to cure, that they feel disempowered when death knocks on the door.

The calmness that pastoral caregivers bring should reflect the peace of the cross, resurrection and ascension of Christ. All our words, prayers and questions should reflect this calmness.

As pastoral workers we should be honest about unresolved issues of death in our own lives. To do that, we have to deal with our own understanding of death and also make peace with the deaths of those close to us.

95.2   Dealing with feelings of guilt

  1. Most people might have a heightened feeling of guilt associated with the person who passes away.
  2. Pastoral caregivers are well positioned to listen to these people’s feelings of guilt and to bring them the message of the cross and reconciliation.
  3. Guilt is a complex feeling, and it also demands of us to understand that some of the things that we feel guilty about, might in fact not be things that we should feel guilty about.
  4. Distinguish between false (unrealistic guilt) and true (realistic) guilt.
  5. There are people who are very good at dumping their feelings of guilt onto others, and sometimes in a very sophisticated manner. We should learn to identify the difference between genuine guilt and feelings of guilt that are dropped on us by others.
  6. Feelings of guilt can unfortunately also be used to manipulate others.

95.3   Facilitating verbal and non-verbal communication

Facilitate communication between the patient and family, and between the patient and family with God. Jesus Christ is an example of one who opens up all conversations (John 4).

95.4   Challenges for the pastoral worker

  1. Patient and family may not be known to the pastoral caregiver. There may be uncertainty about their spiritual background.
  2. Limited time to build any relationship.
  3. Uncertainty about where the patient and family are in the process of the patient’s circumstances (of dying or approaching death).
  4. Difficulty in knowing when would be a good time to see the patient – particularly in the hospital context, but also when the patient is being cared for at home.
  5. Pastoral workers’ own struggles with death and end-of-life issues.
  6. The danger is that pastoral caregivers will ritualise their involvement (using prayer and Scripture reading) and not individualise each situation to reach the patient.

96    Telling the “truth”

As die pasiënt in die laaste fase hoop opgee, moet dit nie gestimuleer word nie, en as hy in die vroeër fases steeds die hoop bly koester, moet dit hom nie summier ontneem word nie al lyk dit oënskynlik nie die moeite werd nie” (Venter 1972:103).[27]

How much “honesty” is appropriate? To what extent should carers be honest, open, realistic and direct with a patient and their family?

96.1   What is “truth”?

  1. The concept of “truth” in itself poses difficulties.
  • All our knowledge is interpreted knowledge.

In medicine, the concept of probability is deeply entrenched. Few things are absolute. But if you find that the probability is higher rather than lower that the outcome will be A rather than B, you should tell the patient and family that the outcome will be A.

In sickness we often work with a high factor of interpretation. Nobody knows for certain when will a person will die. Medical staff, however, are known to make predictions based on their own experience as well as research, and they might say “in the next week”, or, “in the next three months” someone would die. But no person is a machine and we know people react differently to treatment. Some people live many months longer than others, even though both were found to be at the same stage of cancer. People also respond differently to treatment.

  1. A hospital is not the same as a court of law – where the point of departure is that the information is “objective” and clear-cut. The law’s understanding of “the truth, the whole truth, and nothing but the truth” is different from the situation we deal with in a hospital.

To tell the “truth” to a patient is much more than just a judicial issue; instead, it is an interpersonal action. It is not about right and wrong, but about people’s hopes, dreams, preparation (for their approaching death), and about taking decisions.

96.2   the patient and family give the cue

It will be the patient and family that will lead us towards how much “truth” they can handle. Some patients and their families find themselves to be in a place where you can share the maximum amount of information with them. Some are clearly not in the kind of place where you can put all the information on the table.

The most difficult situations are those in which you are given mixed signs. When you are uncertain about how much information a patient and their family can handle, you should start with only the most basic information.

96.3   The balancing-act

  1. The balancing act consists of telling the truth without, at the same time, dashing all hope.
  2. Often, this means breaking the news piece by piece. Tell just enough, but not everything, to start with – until it becomes necessary to provide more information.
  3. Be careful to avoid information overload. (Giving news clouded with technical detail.)
  4. Wait for the person to ask a pertinent question, or wait until the next day.

Example:

If you tell the patient that he/she has cancer, that might be enough for that moment. On the next day you could discuss how severe the cancer is. On the day after that, you could discuss the possible outcome of the treatment.

  1. Do not say or confirm anything about which you are uncertain or know to be untrue. False hope is not really hope.
  2. Help patients and families to understand that each one of us is an individual, and although our bodies are structurally the same, the way our bodies deal with illness and respond to treatment is different.

96.3.1 The Bell-curve philosophy (Nothing is one hundred percent)

As a general rule of thumb, it is valuable to keep in mind the well-known bell curve. It explains some of the truths of life in a more philosophical than statistical way,.

A bell curve follows the 68-95-99 rule, which provides us with a convenient way to carry out estimated calculations. It is in effect a probability distribution.

  • Approximately 68% of all data lies within one standard deviation of the mean.
  • Approximately 95% of all data lies within two standard deviations of the mean.
  • Approximately 99.7% of the data lies within three standard deviations of the mean.

Surprisingly, there are many things that, roughly, fit into this model. In my pastoral experience I have used it (very unscientifically) as a rough indication to understand what remarks made by medical staff means.

For instance, if medical staff say they think a person has three months to live; I take that as a 68% chance they would be right, to within a few days; a 27% chance would be out by a few weeks; and a 4.3% chance means that their prediction would be out by many months, or even years.

96.4   Respect for the patient and family’s ‘rights’

  1. The word “rights”, in this context, does not refer to legal rights, but to the respectful acknowledgement that illness and death does not take away our humanity.
  2. As caregivers, we should respect the “right” of people to be able to work towards the completion of their life.
  3. People have the right to information to help them to take the necessary, informed decisions.
  4. People have the “right” to remain in denial, but they also need support to move on and speak, to discuss their future and approaching death.

96.5   Do as little harm as possible

  1. You can do harm by telling the “truth” and by withholding information. “Truth” will most possibly cause distress. Remember, however, that uncertainty also causes distress.
  2. What is imparted to a patient about his (her) illness should be planned with the same care and skill that are demanded by any potentially therapeutic measure” (Goldman 1995:63)

Example: When you break the news to someone that a loved one had died in a car accident, it is not necessary to tell them about the crash in detail.

96.6   Not what You say, but how you say it

  1. Before you speak, consider the way in which you are going to share the bad news.
  2. Select your words carefully.
  3. Be gentle in the way your share the information.
  4. Use understandable language: for example, refer to “cancer” – instead of using the technical term “carcinoma”.

96.7   Difficult situations

Sometimes, patients and their family will share information with you and specifically request that you should not shared it with others. This situation might developed after you have asked a direct question on a topic related to the information you are now being asked to keep secret.

  1. It is important to keep your integrity as a person.
  2. Acknowledge your limitations.
  3. Stay with the basic things. Focus on what is important.
  4. Reflect on your role as a caregiver and what is necessary to say or not to say.
  5. Make sure that you are not misleading anyone by the things you say.
  6. If people ask you not to share information, ask them why – and who would benefit if the secret was kept.

Example: The family may tell you in the great of confidence that the doctors have informed them nothing more can be done for the patient. The family then ask you not to share this information with the patient. This offers you an opportunity to discuss various matters with the family and to play a role as facilitator – and eventually to help the family to become more open and honest with each other.

Dying patients usually have a fairly good insight into their condition.

96.8   What to tell children

The following aspects play a role:

  1. The age of the children.
  2. The emotional maturity of the child.
  3. The support systems the child has.
  4. The family culture.

97    Case studies

  1. A staff member who admits to you that she does not know how to deal with the family of a patient – who she cares for – who is brain dead, because the family is in denial.
  2. A student nurse who lost her brother in a car accident a month ago and is now, for the first time, working in the Emergency Unit and.
  3. A young quadriplegic patient of 17 years old who is on a ventilator after he broke his neck in a rugby match.

98    Reading and listening to the bible

The truth of the Bible is a personal truth for those who read it and believe in the message of a God who cares for this creation, who calls people to share in His care for the whole of creation and who promises salvation. This is not the same as scientific truth that relate to facts or  historical accuracy, as is required by the modernist way of thinking on facts and history.

The truth of the Bible lies in the nature of what the Bible wants to be and wants to convey. It is a truth that cannot be separated from who God is, nor from the heart of God. It contains not isolated “facts”, but the heart of a faithful God that makes the Bible a faithful document for us to read, to listen to. It is a source that changes our hearts through the working of the Spirit.

The voice of God comes to us in the Bible through stories, poems, hymns, and parables and should be interpreted and reinterpreted, each in their own context. We must constantly be careful not to overtake the original meaning of a passage. It certainly is possible to find some measure of correlation between the issues in the Bible and those of our own time. It is also possible to ignore the context and purpose of the original text ,and to just interpret everything as if there were no cultural and historic differences.

The invitation to believers is to hear God’s voice in the Bible, in the time we live, but not to try and reimpose or reintroduce, exactly the same way of doing or thinking from that time to our times.

99    Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

100       Homework

  • Your Task: Reading Handout

 

Handout

101       Suicide/ self-death (“selfdood”)

Suicide is seldom a sudden, unpremeditated act” (Clinebell 1984:235)

Suicide crosses all boundaries – racial, gender and socio-economic. It affects males and females, married and single, wealthy and poor, young and old.

The South African Depression and Anxiety Group (SADAG) describes suicide as an unseen killer. At least 10% of all non-natural adult deaths and 9,5% in youth in South Africa, are ascribed to suicide.

According to the World Health Organisation (WHO), suicide is the second leading cause of death globally among 15 to 29-year-olds, with one person committing suicide every 40 seconds. For every person who dies by suicide, between 10 and 20 people attempt it.

Research by Prof. Lourens Schlebusch shows that there are at least 23 suicides a day in South Africa (September 2014) – about one every hour – and about 220 attempted suicides a day (The Star July 2013). Because of the stigma involved, suicide data may be underreported. There are no absolute statistics available.

Nearly two-thirds of all suicide victims are aged between 20 and 39 years. Males are four-and-a-half times more prone to suicide than females. About one in four South African teens attempts suicide.

It is estimated that 70 percent of those South Africans who have attempted suicide, have a mental health disorder.

Most suicidal people send out cries for help. But there is a small percentage who keep their thoughts very secret and to themselves. All suicide threats must be taken very seriously! Even if someone is only trying to manipulate others. It is not true that people who talk about suicide won’t kill themselves.

101.1         Warning signs

The warning signs aren’t always obvious, and may vary from person to person.

  1. Talking about suicide and death

For example, making statements such as “I’m going to kill myself,” “I wish I was dead” or “I wish I hadn’t been born”

Sometimes, there is a clear trail of the preoccupations of a person who died, with such signs being connected to death, dying or violence

  1. Preparing for suicide: getting the means to commit suicide, such as buying a gun or stockpiling pills
  2. Withdrawing: withdrawing from social contact and wanting to be left alone.
  3. Signs of mood swings: for example, being emotionally high one day and then feeling deeply discouraged the next.
  4. The person often expresses feelings of stuckness and hopelessness with their situation.
  5. Increased use of alcohol or drugs
  6. Change of normal routine: change in eating or sleeping patterns
  7. Acting self-destructively

Suddenly starting to drive recklessly. No longer doing homework or learning for tests.

  1. i) Unusual behaviour

1)     Giving away their belongings.

2)     Getting their affairs in order at a time that no other logical explanation exists why this is being done – except suicicde.

3)     Saying goodbye to people as if they won’t be seen again.

4)     Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the other warning signs listed above.

101.2         Voluntary euthanasia/ Suicide with assistance

The question on whether we, ourselves, should take the decision on when and how we die comes up from time to time.

There are people who experience a great pain and suffering and who take that decision to end their life. Many who are in this position are frequently not physically capable of ending their own life and need the assistance and physical support of another person to help them. This decision is normally the end result of considering different options, and is at base not an emotional reaction to their circumstances.

Constant developments in the field of medical science means that people live longer and longer today. For some, it does not necessary mean having what is called “quality of life”.

At the moment, South African legislation does not make provision for assisted death. An investigation in this regard was commissioned by President Nelson Mandela. No report nor any changes in legislation were ever finalised. We can expect more discussions in this regard in the years to come.

101.3         Assisted dying – Dr Sean Davison

http://mg.co.za/article/2013-03-28-00-granting-a-death-wish (Mail & Gardian 28 MAR 2013 THALIA HOLMES)

On Monday October 23 2006, Sean Davison, a forensics professor from the University of the Western Cape, described the condition of his 84-year-old mother: her body wracked with a progressive cancer, the diminutive white-haired psychiatrist with a quick mind and steel-blue eyes had refused to eat anything for the past 30 days and would drink only water. She had signed a living will requesting no antibiotics, no resuscitation and no attempts to make her eat.

“When I agreed to this, it seemed such a reasonable thing,” wrote Davison in his diary. “No one questioned her decision for a second. But no one could have foreseen the sight that is before me now. No one could have imaged her skin bruising and sticking to my fingers, the smell of her rotting flesh, a tongue that is completely decayed and bed sores that make you wince at their sight.

 “This is ghastly. Mum is literally falling to bits. What kind of sane person would keep their mother in a bedroom to rot to death? “This is horrific and sickening. How can this be happening?”

Desperate to die, Pat Ferguson had asked her GP to help her to end her life. Initially, he said he would do it. But later he reneged, balking at the repercussions of assisting a suicide. She had asked her best friend’s son. He said he “couldn’t do it”.

So now, in his mother’s book-lined home in a sleepy suburb in Dunedin, New Zealand, Davison, who had come to the country to be with his mother during her illness, lived the daily horror of watching her trying to starve herself to death.

“As I rearranged her pillow tonight, she pleaded, ‘No, put it on top of my face.’ I told her that a pillow was no way to die. Tears ran down her face. Mum has no morphine in her system now. I ask her clearly, ‘Do you really want me, your son, to be the person to give you your death wish?’ “She replied, ‘Please, I want you to help me die.’ And then, ‘You really are a good boy.’

“I have no choice,” he wrote, “but to do the unthinkable.”

In 2006, euthanasia was illegal in New Zealand, as it was in South Africa. It still is today. In fact, there are only a handful of countries that allow assisted dying, and they differ in their approaches. In Europe, it is allowed in Belgium, Luxemburg, Switzerland and the Netherlands. In the United States, it is allowed in Oregon, Washington and Montana.

Belgium and the Netherlands have the most liberal approach, allowing for the active euthanasia of people who qualify. In these countries, a medical professional can administer a lethal injection or dose of barbiturates without fear of legal repercussion. In contrast, Switzerland and the US only allow for assisted suicide. A doctor can provide the means, but the patient must take the final step to end his or her own life.

Assisted suicide candidates in the US are required to have lived in the state for a certain number of years before death. But Switzerland’s famous assisted suicide Dignitas organisation accepts candidates from any country, and has even been accused by Swiss politicians of cultivating “suicide tourism” owing to the international patrons it draws (there have been about 150 Britons euthanised there at last count).

Notwithstanding the few countries in which euthanasia is legal, the “right to die” debate is heating up in several countries across the world. In February, France’s medical ethics council outlined a “duty to humanity” to allow someone “suffering from an ailment for which the treatment has become ineffective” to die.

This month, Australian state Tasmania received more than 300 submissions arguing for and against legislation for voluntary assisted dying, proposed by Tasmania’s Premier Lara Giddings. This will be the second time euthanasia laws are being considered in the country. Physician-assisted suicide was legalised in 1995 in the Northern Territory, but was overturned by the country’s federal government in 1997.

The South African debate began 15 years ago. President Nelson Mandela engaged the South African Law Commission to carry out a project addressing end-of-life decisions. The result was the proposed End of Life Decisions Act — a Bill that was tabled in Parliament in 2000 but did not get further than that.

“For a decade it gathered dust on the desk of the then minister of health, Manto Tshabalala-Msimang,” said Willem Landman, executive director of non-profit organisation Ethics SA. It was never debated or opened for public comment.

‘Mum,” wrote Davison, “you always said how similar I am to your father. I’m not sure if you meant it or just wanted to believe it. This role has become a heavy one for me to bear. Now I do feel like your father, and you my dependent daughter. What would he do now? He was always there for you, yet here I am beside you, uncertain and unwilling. In your dying moments you see me for the first time hesitating to assist you.

“This is a terrible dilemma. No son should have to go through this.”

Most vocally opposing a law change is an 1 800-member strong doctor’s organisation called Doctors for Life. “There are very good reasons why the vast majority of the world’s medical organisations oppose the legalisation of assisted suicide, especially in developing countries,” wrote the organisation in a press release.

“Assisted suicide is a practice that is almost impossible to police, especially in a country like ours, with poorly functioning police and justice systems. It is then too easily abused, as numbers of good scientific studies have shown.”

Opposition doctors also believe that the threat is greater than an administrative one. To legalise assisted dying would be to embark on “a slippery slope”, they believe. Doctor Claude Newbury, former president of Doctors for Life, told the M&G in an interview last year: “Once the medical profession thinks it is permissible to kill anyone, then that society is on the slippery slope to Auschwitz. We are then using killing as a treatment.”

His concerns are highlighted by recent events in Belgium and Switzerland that suggest a broadening of accepted cases of euthanasia. In December, deaf 45-year-old identical twin brothers were euthanised in Belgium after discovering they would also soon go blind. They felt the agony at not being able to see one another again was “unbearable”.

Britain’s Daily Mail reported that an 80-year-old businessman from England planned to end his life soon at Dignitas because he suffered from dementia. Although 21% of Dignitas’s suicides are already committed by people who suffer from “weariness of life” rather than a terminal illness, the Briton (whose name is not publicly known) is the first candidate to be approved for assisted suicide with dementia as his only complaint.

As such cases are made more public, the ethical arguments become more steeped in controversy. And there is no sign of resolve: as Landman said, they always end in a “stalemate”.

The way to break the impasse, he said, is to consult the Constitution. “The only thing is to see what values and principles the Constitution allows. It allows things many people don’t agree with, such as polygamy and abortion,” he said, adding that, at last count, 70% of the country disagreed with abortion and yet it is upheld by the law. “Peoples’ religious ideals should not be the basis of this decision; the Constitution should.”

Pat Ferguson’s house, Dunedin, New Zealand, 7.30pm on October 25 2006: “There was no doubt now,” wrote Davison. “I prepared what I calculated would be a lethal drink of crushed morphine tablets. “I held it in front of her and said, ‘If you take it you will die.’ I wanted to be sure, so absolutely sure, that there was no hesitation. She answered ‘You are a wonderful son.’ I needed to hear it at that moment.

“I held the glass to her lips and gently poured the liquid into her mouth. She looked at me with a gentle smile. I said, ‘It is not how you planned it. It is not what I planned. This is an event that will live long after you die.’”

A year later, Davison decided to share his story by publishing his personal diary. Out of fear of legal prosecution, Davison’s New Zealand publisher, Chris Catley, convinced him to remove the direct confession from his book.

In September 2010, Davison was arrested and charged by the New Zealand police, about a year after his book, Before We Say Goodbye, was published by Cape Catley. The soft-spoken, self-effacing academic became the centre of a whirlwind of media attention.

A highly public police investigation ensued, and then a costly criminal trial. On the day of the judgment, a small group of supporters gathered outside the Dunedin court wearing T-shirts with the slogan, “Every mum should have a Sean”.

When handing down the sentence, High Court Judge Christine French told Davison: “Although in my view there was significant premeditation, you acted out of compassion and love and not for any personal gain.” He was an “exceptionally devoted and loving son”, but was still aware he was committing a crime. He was sentenced to five months’ house arrest in New Zealand for “procuring and counselling assisted suicide”.

“I never wanted to campaign for a cause. I just wanted to tell my story,” said Davison. Nevertheless,  in the year since he returned to South Africa after serving his time in New Zealand and as the face of Dignity SA, his life has become interwoven with the stories of others seeking advice and help.

Before work every morning and before bed every night, Davison listens to tales of suffering and death. “If I think of the last two weeks, every single night it’s been intensive bordering on counselling for a handful of people. I find myself starting to live their lives,” he said.

“Today I met a woman who is 99. She told me about her life. She’s only six months off getting to 100, and she says to her it’s no big milestone at all – she’s just had enough! She wants to die. And she says she doesn’t want to live just to keep people happy that she’s got to 100. Her brain is sharp, she’s right there, but the body’s just falling to pieces.”

101.4         Taking your own life

Not all forms of suicide are similar. Some people see suicide as a solution to the problems they face. Some people are severely depressed. Depression extinguishes all hope and makes it difficult to see any light at the end of the tunnel. People with depression need treatment.

There are those who experience severe physical pain and want to hasten the end of their life. The decision to end their life can come at a time when they need assistance from others. Others take the decision before they need much assistance. In August 2014 the parliamentarian, Mario Oriani-Ambrosini, terminally ill and in the last stages of lung cancer, hastened his imminent death by shooting himself.

The well-known writer Karel Schoeman ended his life at the age of 77. He left behind a farewell letter that reveals he had contemplated ending his life for a long time. He had tried at the age of 75 to do this, but was interrupted by circumstances. He then decided to try again at 77 and wrote a letter befor he did so in which he said:

“Thus it is necessary to tackle the matter meaningfully while I still have full movement, physical freedom and possess the spiritual clarity to make a logical decision … and carry it out effectively.

“The decision to take one’s own life is naturally a very personal one which I would not blindly advise anyone to take. For me, I am grateful to be able to make and follow through the decision.”

The South African Anglican archbishop, Desmond Tutu, long retired, indicated in 2014 that he would like to be allowed the option of dignified, assisted death.

 

 

 

Session 11

102       SESSION 11

103       Daily ritual

103.1         Losses and gains

103.2         Living mindfully

103.3         Breathing and mindful exercises

103.4         Time of discernment

103.4.1              Dwelling in the Word – Romans 8:18-30

(NAV)                                                                                 (NIV)

18Ek is daarvan oortuig dat die lyding wat ons nou moet verduur, nie opweeg teen die heerlikheid wat God vir ons in die toekoms sal laat aanbreek nie. 19Die skepping sien met gespanne verwagting daarna uit dat God bekend sal maak wie sy kinders is. 20Die skepping is immers nog aan verydeling onderworpe, nie uit eie keuse nie, maar omdat God dit daaraan onderwerp het. Daarby het Hy die belofte van hoop gegee: 21die skepping sal self ook bevry word van sy verslawing aan die verganklikheid, om so tot die vryheid te kom van die heerlikheid waaraan die kinders van God deel sal hê. 22Ons weet dat die hele skepping tot nou toe sug in die pyne van verwagting. 23En nie net die skepping nie, maar ook ons wat die Gees ontvang het as die eerste gawe van God, ons sug ook. Ons sien daarna uit dat God sal bekend maak dat Hy ons as sy kinders aangeneem het: Hy sal ons van die verganklikheid bevry. 24Ons is immers gered, en ons het nou hierdie hoop. Wat ‘n mens al sien, hoop jy tog nie meer nie. Wie hoop nog op wat hy reeds sien? 25Maar as ons hoop op wat ons nie sien nie, wag ons daarop met volharding.

26Die Gees staan ons ook in ons swakheid by: ons weet nie wat en hoe ons behoort te bid nie, maar die Gees self pleit vir ons met versugtinge wat nie met woorde gesê word nie. 27En God, wat die harte deurgrond, weet wat die bedoeling van die Gees is, want Hy pleit, volgens die wil van God, vir die gelowiges. 28Ons weet dat God alles ten goede laat meewerk vir dié wat Hom liefhet, dié wat volgens sy besluit geroep is. 29Dié wat Hy lank tevore verkies het, het Hy ook bestem om gelykvormig te wees aan die beeld van sy Seun, sodat sy Seun baie broers kan hê van wie Hy die Eerste is. 30Dié wat Hy daartoe bestem het, het Hy ook geroep. En dié wat Hy geroep het, het Hy ook vrygespreek. En dié wat Hy vrygespreek het, het Hy ook verheerlik.

18 I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. 19 For the creation waits in eager expectation for the children of God to be revealed. 20 For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope 21 that[h] the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God.

22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 23 Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies. 24 For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? 25 But if we hope for what we do not yet have, we wait for it patiently.

26 In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us through wordless groans. 27 And he who searches our hearts knows the mind of the Spirit, because the Spirit intercedes for God’s people in accordance with the will of God.

28 And we know that in all things God works for the good of those who love him, who[i] have been called according to his purpose. 29 For those God foreknew he also predestined to be conformed to the image of his Son, that he might be the firstborn among many brothers and sisters. 30 And those he predestined, he also called; those he called, he also justified; those he justified, he also glorified.

103.4.2              Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

103.5         Homework feedback

Your Task:  Handout to read: Suicide/ self-death (“selfdood”)

103.6         Learnings and parking questions

Session 11: Pastoral Conversation 3

104       Pastoral conversation 3:

104.1          Important markers for pastoral conversations

104.1.1              Be clear about your role

  1. a) Our role is not to give advice; to moralise; or to solve all the problems the other person might have.
  2. b) We are facilitators who create an opportunity and a safe place for another person to reflect on his/her story.
  3. c) We bring the love, kindness and peace of our Lord Jesus Christ through our willingness to listen and to be present.

104.1.2              Learn to distinguish between facts and emotions

The focus of the pastoral worker is on the person’s emotions rather than on the facts of the story. We do not need all the information (facts) in order to be supportive or to have a useful conversation.

If the person gives you only facts and show no emotion, it is definitely necessary to ask how the situation or circumstances has affected him/her emotionally.

What we want to hear is how the person feels. It is also helpful for the healing process for people to reflect on how they feel and to be able to find the  words to express their feelings – like sad, mad, happy, uncomfortable, excited etc.

The idea is not that we must insist on the person showing plenty of emotional reactions. Some need to be on their own before they show emotions. Allow people to do what is best for them.  It is enough if a person tells you that they are sad – it is not necessary for them to cry to show that they are really sad.

104.1.3              Do not jump to conclusions

  1. a) Ask when you need clarity.
  2. b) Be aware of your own preferences and underlying assumptions.

104.1.4              Pastoral dimensions

  1. a) Listen carefully to find points of connection with Scripture, faith, and spiritual experiences.
  2. b) Make sure, you understand correctly:

For example: when a person says he/she believes that God will help them, an appropriate question to ask the person would be what they mean when they say God will help them.

“How do you think about God’s help?” Or, “How would you know that God has helped you?”

“Do you want to tell me about other times that God has helped you or someone close to you”?

“How would you know that God loves you if you are not cured from the illness?” “How would you know that God loves you if He does not cure you from the illness?”

104.1.5              Self-disclosure by pastoral workers

Being a witness of what God has done for you, and your own journey with God, often comes naturally to Christians. God send us to witness in this world.

It is also an important part of an organisation such as AA and many other drug rehabilitation programmes. Through sharing the story of your life, you could motivate others. It also creates a context to create trust and helps to build relationship.

However, in the therapeutic relationship it is important to be very careful about when, how and what we share in telling our own story. There is a fine line between witnessing while we are in fact busy preaching, manipulating, and perhaps only putting ourselves centre stage.

A good witness of the gospel has the ability to remain quiet. Without saying a word, the carer already sends a message by way of body language, movement, their eyes, voice etc. The woman in Luke 7 overwhelms Jesus with her actions of love.

104.1.5.1          the Dangers of self-disclosure

Sharing our own story and experiences with the patient can be dangerous. It can change the position in such a way that the pastoral worker becomes the sharer while the patient is turned into the listener while the carer speaks – and not the other way around.

The conversation can lose its focus. The conversation can also be derailed. The client is not centre stage and their needs become secondary.

The pastoral worker’s over-eagerness to share their own story might make the kind of connections which could perhaps be irrelevant. Each situation is different. No two situations are the same, even when there are many similarities. But by telling your story you might imply sameness. The patient, however, could feel there are greater differences than similarities, in which case it may hamper the intended benefits.

The patient might even feel that you do not really understand their situation because you think your situation and action relate to their situation. The nett result could be that the pastoral worker’s story lets the patient feel disempowered. The patient might start to compare themselves with the caregiver. Patients might even begin to feel unsafe, rather than safe, in the presence of caregivers who speak about their own experiences too much. In such a case, a patient could become merely a listener, and not a partner in the conversation.

There are also real dangers that the pastoral worker could feed into their own exhibitionistic tendencies. Our most basic need is to put ourselves centre stage and to impress others. It is bizarre, but is also known that some caregivers have made up or fabricated stories – for no other reason than to get others to think that the pastoral worker understands the listener’s circumstances. The end result in these situations is that we lose the opportunity for genuine interaction.

104.1.5.2          the Benefits of sharing

If dealt with in a proper way, sharing their own stories could show the patient that pastoral workers are also human and struggle with the same issues. Then it creates the possibility of taking the conversation to a deeper level of sharing. It could confirm to the patient that the pastoral worker understands the situation.

104.1.5.3          the Markers of self-disclosure

To tell something about your own story and struggles might be of value under certain circumstances, as long as we adhere to some very clear criteria in this regard.

It is certainly not advisable at the beginning of the conversation, or even during the first few visits. It would give the wrong indication of our role as a pastoral worker. When we do see a person regularly, it would be inevitable to start sharing more of ourselves. But if we do this too early, it might become a pattern in these interviews for us always to share something. The client would then start to expect this and will wait for the moment in the conversation when we will share.

What is our motivation for sharing? Is it to bring ourselves to the fore? To upstage the patient’s story? Does it have anything to do with our own inner difficulty to contain our own emotions? Are we trying to say something to the patient in an indirect way? Why can’t we say it openly and directly? Are we busy manipulating the patient? Do we want the patient to feel sorry for us, or are we trying to impress the patient?

Ask yourself, will there a real benefit for the patient if I tell them my story?

If we can answer this last question in the positive, then we should remember to make our sharing or self-disclosure as selective and focused as possible. It should not distract from the patient’s needs and story. Our sharing should not burden the patient. The patient should not feel, afterwards, that the pastoral worker’s problems or emotions have become something they have to carry or worry about.

Sharing our story should be a “once off”, and we should not carry on about it in conversation after conversation, or make it a way of letting the patient know how they must solve their own problems. Our story should also be sensitive to differences in culture, gender, personality and circumstances.

104.2         Challenging the patient

In the development of a pastoral conversation, there could come a point when the pastoral worker feels that the patient should be challenged to think further, develop the way they are thinking about something or how they act or react. The pastoral worker should handle this with great consideration to the patient’s context. There should be a clear purpose, namely to make the patient aware of, and let the patient reflect on, their emotions, way of thinking, actions, behaviour, or attitude, etc.

Challenging questions are not meant to criticise the client, but to eventually broaden the comfort zone of the person. The way that you formulate the questions that will challenge the patient is important. Some people will flourish when receiving challenging questions, others will constantly react negatively, no matter how carefully you formulate them.

104.2.1              When and what to challenge

Do not challenge everything that can be challenged. Constantly challenging the other (patient) will erode the safe space you want to create for a conversation to take place. The purpose of challenging the patient is not for you to get better or more facts, but to make the client’s actions, behaviour and thoughts clearer to you – and the client.

104.2.2              Challenging confusing stories or responses

Carefully think whether getting greater clarity would make any difference to the conversation; whether challenging something would give you clarity and the client better insight into their own story.

Example: “I decided not to tell my wife that the pain is back, I don’t want her to worry about the cancer.”

Challenge: In a previous conversation, you emphasised that you kept no secrets from your wife and shared everything with her. How does it now feel to withhold such important information from her for weeks on end?

Challenges are not intended to determine right from wrong, but are attempts to help the patient to see further and understand more. For instance, when it becomes clear that the patient is not being honest with him or herself and is hiding behind something. Or when the patient or their family operate by using half-truths and do not see the discrepancies between what they say and what they do. Certain assumptions about life, others and institutions can also be challenged.

Indications of unnecessary dependency should be challenged. We all have the ability to grow through challenges.

105       Practical exercises. Case studies

  1. A 12-year-old with leukaemia, who is not responding well to treatment. You have to tell her that the treatment did not work.
  2. A 41-year-old male who was on dialysis in a state hospital, and who has previousy received a transplanted kidney. But after two years the kidney stopped working. He is not a candidate for a second kidney transplantation, or for dialysis.
  3. A 40-year-old woman who is diagnosed with untreatable cancer three months after the birth of her first and only baby.

106       Mental health

Our mental health has to do with our psychological well-being. It refers to our cognitive and/or emotional well-being. It is about how we think, feel and behave. Our mental health can affect our daily life, our relationships and also our physical health. This includes our ability to enjoy life and to attain a balance between the different aspects and activities in our life.

According to the WHO (World Health Organisation), mental health is:

“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

The WHO stresses that mental health “is not just the absence of a mental disorder”. We might not have a specific mental disorder, but even so could still struggle in terms of our emotional well-being. All of us face the potential of suffering mental health problems, young and old, male and female, all ethnic groups and all income groups.

We understand mental “disorders” here in its broader sense as describing biological disorders, which refers to any disability of the mind, brain or mental illness. This definition, also includes drug and alcohol dependency.

Some of the most common forms of mental disorders are:

Anxiety disorder and panic disorder

Obsessive-compulsive disorder

Post-traumatic stress disorder

Mood disorders like major depression; bi-polar depression; dysthymia

Schizophrenia group of disorders

It is a world-wide problem that governments and private medical aids underspend in the field of mental health – not only in terms of research, but also in terms of medicine and treatment facilities. In South Africa, about one in three people will suffer from some form of mental disorder during their life.

South African morbidity data indicate that mental disorders are the third highest contributor to the local burden of disease, after HIV and other infectious diseases. It was also found that a staggering 75 percent of people who live with mental disorders in this country do not receive the care they need.

In terms of hospital resources for psychiatry, South Africa fares better than many other African countries, with 2.1 beds per 100 000 of the population. But there is, like elsewhere in Africa, a serious shortage of mental health professionals, as the total personnel working in mental health facilities stands at 11.95 per 100 000. Of these, only 0.28 are psychiatrists, mainly in urban areas. (Vuyo Mkize, The Star July 2013)

The lack of treatment is due partly to a lack of facilities, but also to the attitude to, and lack of knowledge about, these conditions in communities.

107       Discussion: suicide (self-death)

21 Once more Jesus said to them, “I am going away, and you will look for me, and you will die in your sin. Where I go, you cannot come.” 22 This made the Jews ask, “Will he kill himself? Is that why he says, ‘Where I go, you cannot come’?” (John 8)

Suicide is the act of killing oneself voluntarily and intentionally. The Pharisees thought that when Jesus spoke about his death, He intended self-death.

There are several examples in the Bible of people whose actions lead to self-death. The reason(s) for this differed widely. A well-known example is that of Samson (Judges 16:18-31), whose act of self-death was a way to take revenge. “Please, God, strengthen me just once more, and let me with one blow get revenge on the Philistines for my two eyes.” (16:28). He ended up a hero through his action. But in today’s language, we would call him a self-death terrorist.

Then there is Saul (and his armour bearer). In 1 Samuel 31 we read:

The fighting grew fierce around Saul, and when the archers overtook him, they wounded him critically. Saul said to his armor-bearer, “Draw your sword and run me through,or these uncircumcised fellows will come and run me through and abuse me.” But his armor-bearer was terrified and would not do it; so Saul took his own sword and fell on it. When the armor-bearer saw that Saul was dead, he too fell on his sword and died with him.

Saul was unwilling to face the dishonour of being captured by the Philistines. It was probably also to the benefit of his nation to prevent their king from being captured. We can only speculate about the armour bearer’s reasons for following in the footsteps of his king. Saul and his armour bearer’s bones were eventually buried at Jabesh (31:16).

The self-death of Ahithophel is very interesting (2 Samuel 17). Ahithophel had given better advice than Hushai, but still, Absalom preferred the advice of Hushai. “14 Absalom and all the men of Israel said, “The advice of Hushai the Arkite is better than that of Ahithophel.” For the Lord had determined to frustrate the good advice of Ahithophel in order to bring disaster on Absalom.” The end result was actually the death of Absalom.

But Ahithophel was so discouraged by the rejection of his advice that he hanged himself. He was not rejected by his family because of this act and buried properly. “23 When Ahithophel saw that his advice had not been followed, he saddled his donkey and set out for his house in his hometown. He put his house in order and then hanged himself. So he died and was buried in his father’s tomb.”

From the NT the person that immediately comes to mind is Judas. For many, the act of self-death is closely connected to him who betrayed Jesus (Mat 27:3-10 & Acts 1:18-19): “5 So Judas threw the money into the temple and left. Then he went away and hanged himself.” (Mat 27).

In Acts 16:27-28 we have the story of the “jailer” who thought that Paul, Silas and the other prisoners escaped. Paul’s confirmation that they hadn’t escaped prevented the jailer from killing himself: 27 The jailer woke up, and when he saw the prison doors open, he drew his sword and was about to kill himself because he thought the prisoners had escaped. 28 But Paul shouted, “Don’t harm yourself! We are all here!” (NIV).

A few remarks regarding suicide.

In ancient times suicide was seen as a noble act. A brave action. The Greek philosopher Socrates administered his own death by willingly taking a potion of poison.

But what about the demand, in Exodus 20:13, that: 13 “You shall not murder.”

To obey this is much more difficult than it sounds. Murder could certainly be as close to us as the intention to harm your nearest. It is not “death” that is the problem, but the sinful heart of the murderer. Jesus explains it clearly in the Beatitudes: 21 “You have heard that it was said to the people long ago, ‘You shall not murder, and anyone who murders will be subject to judgment.’ 22 But I tell you that anyone who is angry with a brother or sister will be subject to judgment.” (Mat 5:21-22). It is also important to think about the commandments as a whole, not in a piecemeal way – taking a commandment here, then taking another commandment. We should understand the commandments as a unit (Mat 5:19).

There are people who say the problem with self-death is that it does not give you a last opportunity to confess your sins before you die (1 John 1:8-10). But this is a strange argument, since we do not know what the last thing could be that goes through the mind of any person. Many people die in an instant, without the opportunity to first confess their last sins.

Forgiveness (and salvation) is not a mechanical thing. Forgiveness is a way of living. Belonging to Christ is a relationship, and not like turning a switch on and off. Take, for example, the relationship between children and parents – it can be a difficult relationship, but it does not end just because they had a fight. 1 John 2:1-2 : “My dear children, I write this to you so that you will not sin. But if anybody does sin, we have one who speaks to the Father in our defence – Jesus Christ, the Righteous One. 2 He is the atoning sacrifice for our sins, and not only for ours but also for the sins of the whole world.”

Taking your own life is not a wise choice to make. Suicide is a drastic choice to make. It is also a decision that often has serious implications for those you leave behind.

For those who have never entertained the thought of suicide, it might be difficult to put themselves in the shoes of a person who thinks about it and even acts on it. Suicide is not a greater wrong than any other unwise action we contemplate and even carry out. And while it can be the result of unwise actions and sin in our lives, it can also be a call for help, or an act resorted to to make a statement.

For those who are merely spectators to these events, who merely look on, it might seem to be a selfish act as well as the act of a coward. Others might see it as a brave act. The reasons for suicide are numerous. Depression, circumstances, honour, selfishness, pride, emotional pain, physical pain, manipulation, as a call for help and understanding, etc. As Christians, we should not sit in judgement, but become the carriers of the grace of God. Judgement for all our sins, even those in our hearts, are in the hands of God.

When we talk about self-death, we should also include the many other actions and decisions that are harmful to our bodies and to others. At the most basic level, we should consider our lifestyle. Because the lifestyle we adopt can be an “acceptable” way of hurting ourselves and shortening our lives. For example, globally, lifestyle choices such as including too much sugar in our diet and getting too little exercise are responsible for the early deaths of many people.

“Type 2 diabetes comprises the majority of people with diabetes around the world 3, and is largely the result of excess body weight and physical inactivity.” (WHO:  http://www.who.int/mediacentre/factsheets/fs312/en/)

Diabetes is also a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputations. It will soon be the seventh leading cause for death. According to studies in the UK, diabetes type 2 can shorten our lifespan by up to ten years. The lifespan of persons living with diabetes 1 (which is not a lifestyle disease) has in the meantime actually improved with the use of better medication.

108       Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

109       Homework

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Handout Reading material

110       And what about the devil?

I often hear pastors trying to explain the death of a church member by making reference to the devil, saying: “The devil steals this person from us”. What I hear them doing is providing an explanation for death but without using one of the traditional answers for death, namely: “It is God’s will”.

A number of theological questions emerge from these types of remarks. Start with the fact that it is not possible to speak about the devil without also asking: “Where does sin comes from”?

In the understanding of life in pre-modern times, world views had developed in terms strongly associated with invisible powers in the air that rule the world and people’s lives. That became a way to explain the world, and what was happening, around us. These “invisible powers” later  became more visible with the creation of gods – such as the ancient Roman and Greek gods. And so the devil and its demons become the evil god.

People often developed strong ideas around these invisible powers, and, from time to time, the church also bought into this world view.

But from a theological view, evil is part of the creation – while God is more than creation, without a specific beginning or end, although involved in creation.

110.1         The early church

In gnostic thinking, there exists a lower demiurge (a being responsible for the creation of the universe) that is responsible for evil. Irenaeus, the early Church father (120-202 AD), refers to the devil as the origin of sin, in opposition to the idea of a demiurge. An early understanding had developed from other figures such as Hieronymus, Tertullian and Origens, and was probably based on 2 Peter 2:4 (which might refer to Gen 6:2, as well as being an allegorical interpretation of Isaiah 14:12) which was –  that the devil is a fallen angel.

The Middle Ages are known for the strong beliefs in devils, demons and witches. A law promulgated in 1484 by Innocentius VIII would allow the church to burn witches.

This period was followed by another during which there was little reference to the devil in theological literature. But this changed when the religious and church Reformer Martin Luther opened a thorough discussion about the role of the devil. He described the devil as an embodiment of the evil power that surrounds us and is in us.

Luther’s understanding of the devil as an evil power actually took a much more serious approach than that of the view held in the Middle Ages, which was that the devil is the great opponent of God and Christ. The devil was then viewed as the creator of an evil kingdom in opposition to the kingdom of God (John 12:31; 14:30; 2 Cor 4:4). Not only was the devil the main tempter in

this view, it was also the destroyer, with power that stretched unto death (Hebr 2:14).

But for Luther, the devil was never the equal of, or above, God. For him the force of evil is also not equal to the power of God as was suggested by the dualist approach of the Manichaen religious movement in the pre-Middle Ages. Luther instead believed that God uses the devil as an instrument of his wrath or anger (toorn) against the sinfulness of human beings.

This still leaves us with questions about suffering and death which strike creation but cannot be attributed to the actions and decisions of human beings. Luther did not want to give the devil the power that could be attributed to it if evil was seen to be responsible for these acts and, ultimately, for suffering in the world. For Luther there is only one ultimate power – God. [28]

Luther makes a distinction between the work of Satan and the work of God. God’s actions of wrath and the work of the devil may, on the surface, look similar, but are very different. God’s actions of wrath are directed towards the salvation of people in that they direct us away from our own selfishness, towards the graceful arms of God; while the work of the devil is about the destruction of creation. In Luther’s view, suffering is only temporary, with the purpose of leading to something better, while, for the devil, suffering is the whole purpose of its actions, the final destination. By looking at our suffering from a position of faith, we will be able to overcome the purpose Satan has with bringing about suffering.

Calvin’s approach in this matter was different and closer to that of Augustine. Calvin was strongly opposed to any form of Manchaen thinking. Thus, any attempt to argue about the existence of another primeval god that stands against Yahweh was unacceptable for Calvin. In his thinking, our sinfulness cannot be reduced to any spiritual power. According to Calvin, our sinfulness is also not an act of creation in that it was given to us, because this way of thinking would make God responsible for it. So where does sin comes from? For Calvin, our own hearts are the origin of our sinfulness. We must take responsibility for our sinfulness. He accepted that we are created with the possibility of making sinful choices – but that does not also mean that to sin was inevitable and unavoidable.

Any explanation that reduces our own responsibility for our sinfulness is unacceptable.

110.2         Whose devil?

At the extreme ends of the spectrum, there are those who do not believe in the existence of the devil, and those who not only believe, but also have an excessive, unhealthy interest in the devil.

In the OT, the role of the devil is very limited (Job 1 and 2; 1 Chronicles 21:1; Zechariah 3). Ezekiel 28 is more complicated. But it is widely accepted that this chapter is actually not about Satan, but about the king of Tyre, who was arrogant and thought he was a god.

The position of Satan in the OT and NT seems to be very different. The Satan of the OT seems to have free access to God (Job 1 & 2 and Zechariah 3). The “task” of that Satan is that of being a persecutor of the people of God before God. In 1 Chronicle 21, Satan misleads David. “Satan rose up against Israel and incited David to take a census of Israel”. For Israel, the belief in the Creator God was enough not to have to fear any evil powers, although they did acknowledge there were evil powers at work in other nations (Isaiah 34:14; Psalm 91:5-6).

In the time between the OT and the NT, several documents appeared that explained the devil and its origin in greater detail. It is important to remember that these documents were not given the status of Scripture, and while we take note of them, the information they contained is not accorded the same status by the Christian faith as information in the Bible.

An important Jewish document is 1 Henog. It has its origions in the period before Christ, although it was completed only some time after Christ. It describes Satan (Azazel) as an angel who rebelled against God. He and other “creatures of heaven” (“hemelwesens”), about 200 of them, had come down to earth to teach people how to sin – mainly through violence and by desiring what is wrong and forbidden. Another leader of this group was Semyaz, although Azazel was the main force behind it. They caused pain and destruction for those who followed them into the underworld. Satan, in the form of Azazel, was consequently ejected from Gods’s presence in heaven and cast out as a “fallen angel”. Another document, known as Jubilee and from about 150 AD, describes the leader of this group of evil spirits as Mastema (it means enemy). This leader, and a tenth of the evil powers, were allowed to harm human beings, while the rest of the evil powers were in confinement in the underworld.

In the time of the NT evil powers definitively played a major role player in the every-day lives of people. To safeguard cities, families and individuals against evil powers, many cultural traditions also  developed. Bad things were connected to the work of evil powers and all kinds of measures were taken as protection against those evil powers. In those times, there did not exist the kind of access to information as is the case with us today, and nothing was known about viruses, bacteria and even psychiatric conditions. In those times, illness was often explained in terms of the work of evil powers.

The NT provides us with little information to explain where the devil comes from. But in the NT the devil is in clear opposition to the work of Jesus (Mat 4). The authors of the NT also used different names to describe the devil and what it was doing. In Rev 12, the devil is a red dragon with seven heads and ten horns.  John (8:44) describes the devil as a murderer from the beginning and father of liars. The NT also does not always make a clear distinction between the “devil” and “evil powers”.

Jesus’ confrontation with Satan (Mark 1) in the desert (Mat 4 – tempter; Luke 4 – devil) set the stage for the ministry of Jesus. Interestingly, Jesus did not question the fact that the Satan could do the things it promised to do. What Jesus did challenge, was who really had the authority and who should be worshipped and obeyed.

The evil powers (demons) did acknowledge Jesus Christ (Mark 1:24; 5:7). God’s kingdom had arrived with Jesus Christ. It is remarkable how Jesus used just a word to drive away demons. This is very different from the actions of exorcists who need various kinds of rituals to get rid of demons. Jesus’ actions brought a message to the people of that time, and to us, that God has conquered the power of the evil.

Jesus introduced comprehensive deliverance from, and directed mainly at, death, sin and sickness. Here it is important to understand that it had to do with the power aspects of death, sin and sickness – the grip of the devil. There is also another aspect of the latter that requires attention, namely condition:

“Death, apart from being a power, can be simply a condition. Sin, too, can be simply a matter of wrong acts, and sickness an abnormal physical condition or deficiency” (König 1986:86).

It is worthwhile to note that most of the references to the devil, demons and evil spirits are in the gospels and refer to Jesus conquering these powers. This is understandable, because the gospels relate the events of the period before Jesus’ death, resurrection and ascension to us. The “strong man” in Matthew 12:29 refers to Satan, where Christ had come to “[tie] up the strong man”. The dead and the realm (or kingdom) of death (doderyk) was closely connected to the power of evil. As a general truth, we can say that death is the strongest weapon that evil possessed. Jesus’ healing and raising of the dead (Lazarus and the daughter of Jairus) were acts of preparation for his own death and resurrection. He intensified the fight against the evil powers in anticipation of his own death. He took his fight into the realm of death (1 Peter 3:19-20). To have risen from death, and his ascension, was a victory over death and thus also over the powers of evil.

“Do not be afraid. I am the First and the Last.  I am the Living One; I was dead, and behold I am alive for ever and ever! And I hold the keys of death and Hades.” (Rev 1:17-18)

The rest of the New Testament only sporadically refers to these powers (Paul and Peter). There is no infatuation, obsessions or fixation with the work of the devil. The letters of John explain that the reason why “the Son of God appeared was to destroy the devil’s work” (1 John 3:8). In Christ (anyone born of God) we are saved and the evil one cannot harm us (1 John 5:18).

There is also no indication that the followers of Christ could be possessed by an evil spirit. In Christ Jesus the followers of Christ have the Holy Spirit.

“Die Ou en Nuwe Testament vertoon geen beheptheid met praktyke soos duiweluitdrywings nie. Wanneer hierdie praktyke wel later binne die Nuwe Testament plaasvind, … dan word dit altyd op ‘buitestaanders’ uitgevoer; dit wil sê, op mense wat nog nie deel van die kerk is nie.” (Joubert, Van der Watt, Du Plessis 2009:33).[29]

To conquer the evil one and death does not mean the same as to destroy evil.[30] Evil still manifests itself in many forms. Evil has many different faces and is visible not only in supernatural forms. Certain structures – political and social – can embody evil (Rev 13 & 17) when it is in total opposition to the basic values of humanity. No rituals, amulets or magical formulas are necessary to defend Christians against the power of evil. Christ’s death and resurrection is the only weapon required.

“Die opgestane Christus se krag, soos vergestalt in die teenwoordigheid van die Heilige Gees, is ten alle tye die perfekte wapenrusting van gelowiges. Die Here se persoonlike teenwoordigheid is genoeg om die Bose weg te hou.” (Joubert, Van der Watt, Du Plessis 2009:34).[31]

Followers of Christ are also in the firing line of Satan. Sin (disobedience to God and listening to other voices) stands in opposition to the life-giving power of the Spirit (Rom 7; Gal 3-5). To sin is to turn our back on God’s grace. The devil constantly invites us to turn away from God and to become a slave to our own desires, self-importance, and selfish thoughts. To sin, in its deepest form, epitomises (or depicts) a broken relationship with God. It shows the devil has interfered with this relationship with God.

We should not underestimate how hard the devil shouts in our ear for us to disobey God, to follow our own selfish heart. The devil does this from a position of temporalness, there is a final battle ahead which it has already lost. Being conquered, although not destroyed, gives it a bit of scope – like a dog on a leash – but it is seriously handicapped and limited. The Second Coming will be the final moment of destruction for the devil. Then it will be destroyed –  not only defeated.

The devil’s defeat at the cross is already sufficient to free us from the bondage of sin (Heb 2; Rom 6 Col 2) and death (1 Cor 15). Even when tempted, believers are assured that there is a limit to what the devil can do (1 Cor 10:13): “No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it.” (1 Cor 10:13).

We have lived in the “end times” for the last two thousand plus years. The “end times” is that time between Jesus Christ’s first coming and His Second Coming. Christ’s incarnation forms the beginning of the end. Christ’s death and resurrection have as the result that the devil has lost its basic functions. It cannot, as in the time of Job, be a prosecutor of the followers of God, before God (Revelations 12; Romans 8:31-39). The devil has lost its control over death (1 Cor 15; Rom 8; Philippians 1). The devil lost its “home” in believers. Believers are now the living temple of God (1 Kor 3:16; 6:19; 2 Cor 6:19):  “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.” (1 Cor 6:19-20).

The devil lost its power through the work of Jesus Christ. The end times, which is a new dawn for creation, will be the last legs that the power of darkness (Rev 20) could find to stand on. This does not mean that the devil would not fight until the last moment. It will go ahead and mark its followers (Rev 13), but those who belong to God are already marked as God’s children and can hear the music coming from those who are already sharing in the victory (Rev 14). The devil will keep on making it difficult for the followers of Jesus Christ (2 Tim 2:26) and will try to mislead them (2 Cor 11:14; 1 John 4:1-2). Paul was, for example, aware of how the devil tormented him (2 Cor 12:7)

In short: on the one hand, it is important to acknowledge that there are powers in opposition to the work of Jesus Christ. These powers represent destruction and inhumanity, and never stop their attempts to (mis)lead us into sin – to disobey God. On the other hand, it is important to understand that these powers have limitations and that they are fighting a battle that was already won in Jesus Christ. Believers cannot be possessed by these powers.

110.3         Our Sinful nature

When we act selfishly and not according to the spirit, then it is not the devil that is at work, but our sinful nature, for which we should take responsibility. Galatians 5:

16 So I say, walk by the Spirit, and you will not gratify the desires of the flesh. 17 For the flesh desires what is contrary to the Spirit, and the Spirit what is contrary to the flesh. They are in conflict with each other, so that you are not to do whatever you want. 18 But if you are led by the Spirit, you are not under the law. 19 The acts of the flesh are obvious: sexual immorality, impurity and debauchery; 20 idolatry and witchcraft; hatred, discord, jealousy, fits of rage, selfish ambition, dissensions, factions 21 and envy; drunkenness, orgies, and the like. I warn you, as I did before, that those who live like this will not inherit the kingdom of God. 22 But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness, 23 gentleness and self-control. Against such things there is no law. 24 Those who belong to Christ Jesus have crucified the flesh with its passions and desires. 25 Since we live by the Spirit, let us keep in step with the Spirit. 26 Let us not become conceited, provoking and envying each other.

We can easily fall into a pattern of explaining away our responsibility by blaming the devil. We cannot explain everything that happens to us as part of the struggle between God and evil. Not the devil, but our own evil desires are the main culprit for the pain and suffering of the world.

The more we personify the devil as a “something” to fear, the more we look away from and deny our own role and responsibility. Acknowledgment of evil is appropriate, but what we should fear is what goes on in our own hearts.

110.4         Psychiatric illnesses

The main problem we have seems to be in the personification of the devil. The evil powers of the Bible are easily made into a personal demon.

In the time of the Bible and in the ages after that, people who behaved differently were often believed to be possessed by the devil. Although the devil is real to the believer, it is also important to get clarity about the difference between the work of the devil on one hand, and psychiatric illnesses on the other.

Until about the 15th Century, psychiatric illnesses were treated by the church.[32] But the close interconnection between a person’s spiritual and emotional well-being made the interaction with psychiatry important.

Unfortunately, there are people who often respond to anything mysterious or unknown with a theory about devil possession. Illnesses that are related to the functioning of the brain often feature high on the response monitors of such devil busters.

Over the last 100 years, but particularly in recent decades, as a result of the development of functional brain scans, our knowledge of what goes on in the central nervous system and the brain has constantly improved. Today there is a much better understanding and treatment for the conditions of epilepsy and schizophrenia. We now understand that people can become confused for medical reasons and that treatment is available for hallucinations, manic behaviour and psychotic behaviour.

The view is now, again, one of approaching the emotional, spiritual and physical aspects more holistically, rather than by focusing on isolated compartments within a person. Theology, through the actions of the church and with the help of the psychiatry and psychology professions, should adopt an integrated view of the human condition as a way to enable it to support and assist people in need.

Among the complex conditions with regard to mental health, count dissociative identity disorder (formerly multiple personality disorder) and dissociative trance disorder, also known as possession trance disorder. The latter, which has been found to share similar features with dissociative identity disorder, is a heavily debated by clinicians. The prevalence among females is also nine times higher than among males. Many of those diagnosed also have other, comorbid diagnoses, such as PTSD and borderline personality disorder.

This is a disorder of identity alternation that occurs during an altered state of consciousness. An alternate identity or identities are often wrongly attributed to possession by an external spirit, power, deity, or other person, rather than to internal personality states. These alternations are involuntary, distressing, uncontrollable, often chronic, and involve conflict between the individual and their surrounding social or work milieu (i.e., possession trance is pathological).

Some of the features of such a state are the following:

  • Loss of control over one’s actions.
  • Behaviour change or acting differently.
  • Loss of awareness of surroundings.
  • Loss of personal identity.
  • Difficulty to distinguish reality from fantasy at the time of the possession.
  • Change in tone of voice.
  • Wandering attention.
  • Trouble with concentration.
  • Loss of sense of time.
  • Loss of memory
  • Belief that one’s body has changed in appearance.

Part of the complexity is that certain versions of these disorders seem to appear more often in particular cultures and in particular circumstances. It is also not regarded negatively or considered to be pathological in all cultures, thus people might want to get into such a state. For example, voodoo possession in Haiti, and possession, or being in a trance, might even be desireable states to experience by shamantic healers in Brasilia or in some spiritist cults.

Although it seems, in the first instance, to be a spiritual condition, it might have a psychological or physical origin. It should be clearly differentiated from many forms of brain damage which may give rise to very similar symptoms. It is important to evaluate the person for the following conditions: dementia, delirium, major depression, post-traumatic stress disorder, head trauma, schizophrenia, alcoholism, epilepsy, and dissociative amnesia.

Joubert, Van der Watt and Du Plessis (2009;113-114), who accept the possibility of devil possession, give the following advice to help distinguish between a psychiatric disorder and possession by an evil spirit.

  1. In psychiatric disorders there will be a relationship between the main personality and the others.
  2. Demons never co-operate and do not respond to any form of therapy. There is no respect for the person.
  3. The voices in a demon-possessed person are never related to the personalities. All the personalities show hate and bitterness.
  4. The demon-possessed person has visions of human and non-human forms.

110.5         Demon experts

Unfortunately research on experts who help people with regard to demon possession is not encouraging. It seems as though most of these so-called experts are not able to distinguish between mass hysteria, their own emotional status, and psychiatric illness. It would seem that it is often the views and emotional state of the exorcists that determine the physical manifestation of the demon and the behaviour of the possessed person. Should a calm and peaceful person demand a demon to leave, then, when the demon leaves, the possessed person would also become calm. But when an emotional, highly strung exorcist shout and fight, the possessed person responds by creating many of those well-known scenes associated with this event, such as falling down, shouting, cursing and/or exhibiting weird movements.

It is thus important to be both theologically and psychologically aware when dealing with people who present with strange behaviour. Unfortunately, there is also a tendency not to take personal responsibility, but to blame the devil for negative behaviour and circumstances. Consequently, exorcism might become an easy way out from, and even a quick fix of, difficult emotional and psychological problems.

Using the devil as an explanation for all the suffering in the world is more complex than what it might look like at first sight. It offers an easy explanation, but over-simplifies the complexity of suffering. It also gives the devil status and power that is not Biblical.

 

 

 

 

 

 

Session 12

111       SESSION 12

112       Daily ritual

112.1         Losses and gains

112.2         Living mindfully

112.3         Breathing and mindful exercises

112.4         Time of discernment

112.4.1              Dwelling in the Word – Romans 8:18-30

(NAV)                                                                                 (NIV)

18Ek is daarvan oortuig dat die lyding wat ons nou moet verduur, nie opweeg teen die heerlikheid wat God vir ons in die toekoms sal laat aanbreek nie. 19Die skepping sien met gespanne verwagting daarna uit dat God bekend sal maak wie sy kinders is. 20Die skepping is immers nog aan verydeling onderworpe, nie uit eie keuse nie, maar omdat God dit daaraan onderwerp het. Daarby het Hy die belofte van hoop gegee: 21die skepping sal self ook bevry word van sy verslawing aan die verganklikheid, om so tot die vryheid te kom van die heerlikheid waaraan die kinders van God deel sal hê. 22Ons weet dat die hele skepping tot nou toe sug in die pyne van verwagting. 23En nie net die skepping nie, maar ook ons wat die Gees ontvang het as die eerste gawe van God, ons sug ook. Ons sien daarna uit dat God sal bekend maak dat Hy ons as sy kinders aangeneem het: Hy sal ons van die verganklikheid bevry. 24Ons is immers gered, en ons het nou hierdie hoop. Wat ‘n mens al sien, hoop jy tog nie meer nie. Wie hoop nog op wat hy reeds sien? 25Maar as ons hoop op wat ons nie sien nie, wag ons daarop met volharding.

26Die Gees staan ons ook in ons swakheid by: ons weet nie wat en hoe ons behoort te bid nie, maar die Gees self pleit vir ons met versugtinge wat nie met woorde gesê word nie. 27En God, wat die harte deurgrond, weet wat die bedoeling van die Gees is, want Hy pleit, volgens die wil van God, vir die gelowiges. 28Ons weet dat God alles ten goede laat meewerk vir dié wat Hom liefhet, dié wat volgens sy besluit geroep is. 29Dié wat Hy lank tevore verkies het, het Hy ook bestem om gelykvormig te wees aan die beeld van sy Seun, sodat sy Seun baie broers kan hê van wie Hy die Eerste is. 30Dié wat Hy daartoe bestem het, het Hy ook geroep. En dié wat Hy geroep het, het Hy ook vrygespreek. En dié wat Hy vrygespreek het, het Hy ook verheerlik.

18 I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. 19 For the creation waits in eager expectation for the children of God to be revealed. 20 For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope 21 that[h] the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God.

22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 23 Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies. 24 For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? 25 But if we hope for what we do not yet have, we wait for it patiently.

26 In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us through wordless groans. 27 And he who searches our hearts knows the mind of the Spirit, because the Spirit intercedes for God’s people in accordance with the will of God.

28 And we know that in all things God works for the good of those who love him, who[i] have been called according to his purpose. 29 For those God foreknew he also predestined to be conformed to the image of his Son, that he might be the firstborn among many brothers and sisters. 30 And those he predestined, he also called; those he called, he also justified; those he justified, he also glorified.

112.4.2              Sharing with and Listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

112.5         Homework feedback

Your Task:  Handout to read

112.6         Learnings and parking questions

 

Session 12: Depression

113       Depression – Major Depression

Well-known people such as Winston Churchill, Isaac Newton, Franz Kafka, Vincent van Gogh, and Diana, princess of Wales, were all depression sufferers.

Depression is often not well understood. Even in our time there is still much stigma associated with it. Some people think it is not a real illness (and that those who claim to be depressed are only lazy or unmotivated), while others think people with depression are abnormal, stupid or even crazy. In church circles, there are people who think it is caused by sin and the devil.

It is important to understand that when we speak of depression we are not referring to the everyday blues which everybody experiences from time to time. Technically, it is better to speak of a Major Depressive Episode (MDE) when it occurs. Many people still believe depression is not a real illness and would say something like “it is just something in your head”. Well that is true, except that this is said in a sarcastic way, and what they really mean by it is that, because it is in your head, it is not serious. But the head is part of our body, and when we have a stroke or tumour (in our brain), nobody thinks that is not important. So, when we say it has to do with an imbalance of particular neurotransmitters in our brain, people should take it just as seriously as any other imbalance, such as in our blood.

Partly, negative attitudes to depression have much to do with the difficulty in understanding it. The biological (medical) side of depression continues to hold many mysteries, although we know a lot more than a few decades ago. The brain is the most complex organ in our body. How it functions is still a field of continuous discovery. Depression is also more than only a medical condition.

113.1         Who becomes depressed?

Depression affects people of both sexes and all races, cultures and social classes. It is estimated that during the course of their lifetime, 20% of the population may suffer from major depression. It is reported that depression is twice as common in women than in men.

While depression is more common in adults, it occurs in at least two in every 100 children. Children are more likely to become depressed if they come from broken homes, have suffered abuse or neglect, or lost a parent early in life. Another contributing factor is childhood illness. Signs of apathy or not caring what happens often signify depression in children. Other signs of childhood depression include behavioural problems or eating disorders that lead to substantial weight loss or gain.

Schoolwork may deteriorate and previously boisterous and energetic children may become quiet and fatigued. When depression is suspected, the child should be evaluated by a person with appropriate knowledge.

Because ups and downs in moods are particularly common in adolescence, depression is often seen as a normal part of growing up. Although teenagers do experience depressed moods as a norm, clinically diagnosable depression certainly also occurs and affects five in every 100 teenagers.

Similar to “adult” depression, it can interfere with daily activities, and among others there might be a deterioration in academic performance, a loss of interest in friendships and decreased enjoyment in the usual activities and hobbies. Furthermore, depression is a major cause of suicide.

At the time of onset of puberty, adolescents usually also have to change schools and peer groups, which can also create problems. Depressive illness in adolescents is often accompanied by tobacco, alcohol and drug abuse as well as promiscuous sexual and risk-taking behaviour.

Depression may also follow bereavement, particularly if there is a family history of depression. Other severe stressors include physical or sexual assault.

113.2         Symptoms of depression:

Depression consists of a complex of symptoms that occur together although all the symptoms do not necessarily feature at the same time (and in the same person). A depressed mood is, in fact, only one of the symptoms. Others are:

  1. a) A persistent sad, anxious, or “empty” mood.
  2. b) The loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex.
  3. c) Feelings of hopelessness and pessimism.
  4. d) Feelings of guilt, worthlessness and helplessness.
  5. e) Insomnia, early-morning awakening, or oversleeping.
  6. f) Appetite and/or weight loss, or overeating and weight gain.
  7. g) Decreased energy, general fatigue and feeling run down.
  8. h) An increase in alcohol and drug use, but this isn’t a criterion for diagnosis.
  9. i) Thoughts of death or suicide; suicide attempts.
  10. j) Restlessness, irritability, and general hostility.
  11. k) Psychomotor retardation.
  12. l) Difficulty in concentrating, remembering, and making decisions.
  13. m) Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.
  14. m) Deterioration of social relationships.

113.3         Types of Depressive disorders

The best known is Major Depressive Disorder, diagnosed when at least five of the symptoms should below have been present for at least 14 days:

(1) A depressed mood most of the day, nearly every day. Alternatively, an irritable mood.

(2) Clearly diminished interest or pleasure in all, or almost all, activities most of the time and  nearly every day.

(3) Significant weight loss without being on a diet, or weight gain (e.g., a change of more than 5% of body weight within a month), or a decrease or increase in appetite.

(4) Frequent insomnia or hypersomnia.

(5) Frequent psychomotor agitation or retardation.

(6) Frequent fatigue or loss of energy.

(7) Feelings of worthlessness or excessive or inappropriate guilt.

(8) Diminished ability to think or concentrate, or indecisiveness, occurring frequently.

(9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide.

Another important condition is the persistent depressive disorder called dysthymia. It is often overlooked, because those affected often manage to function very normally on the surface, but in fact experience a chronic low mood over many years. It is less intense than the MDD and is a chronic illness. Making the diagnosis is quite difficult because a number of other causes for the low mood must first be eliminated.

Another, separate category is bipolar disorder. Until recently, it was thought that only a small percentage of people suffer from Bipolar Disorder. Research done in the last decade has changed that idea. It is difficult to treat because it is difficult to determine the base line. Some patients also like to be hippomanic (less severe than mania) and resist taking medication to counter it. Mixed episodes – where symptoms of both manic and depressive behaviour occur constantly but alternately and in short succession.

Bipolar I disorder can be diagnosed after a single episode of clear manic behaviour, even if no depressive episode has been determined to also have occurred.

Bipolar II is four times more common than bipolar I. It includes symptoms that are much less severe. These symptoms are called hypomanic symptoms. It is harder for people to become aware of, and to see Bipolar II in themselves, and it’s often up to friends or loved ones to encourage someone with this type of the disorder to get help. In bipolar 2 disorder, the manic episodes are more hypomanic in nature, but occur without any psychotic episodes. There are clear indications of major depressive episodes.

Cyclothymic disorder involves mood swings and shifts similar to bipolar I and II, but the shifts are often less dramatic in nature. Bipolar disorders not otherwise specified forms a general category and is applicable to people who experience only some of the bipolar symptoms. These symptoms are not enough to enable making a diagnosis of one of the other three types.

Women are specifically prone to depression after giving birth, which is known as post-partum depression. It is not different from the other depressions, but it is the name of the diagnosis that provides the indication of when the depression kicks in.

113.4         Understanding the biological aspects

Traditionally, it was believed that our emotions reside in our heart. Today we know that the brain is the centre of our emotions. New technologies used to investigate the brain have given us much more data, helping us to understand somewhat better what goes on. But it does not mean that our knowledge is complete.

The brain still leaves many mysteries unexplained. Brain imaging – such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) – permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track what changes are taking place while a specific region of the brain responds to various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.

In a simplistic way, we can say that while epileptic attacks are caused by the electric activity in our brain, depression is caused by the chemical activities of the brain. We have billions of neurons that communicate with each other. The nature of the communication changes or are influenced by many factors. We have “messengers” in our brain that carry information between the neurons. These messengers are called neurotransmitters. There are many different kind of neurotransmitters. So far, a few have been identified as specifically playing a role in depression. Three messengers in particular are involved in depression, namely serotonin, norepinephrine and dopamine.

Serotonin helps to regulate sleep, appetite, and mood, and inhibits pain. Research supports the idea that some depressed people have reduced serotonin transmission. Low levels of a serotonin by-product have been linked to a higher risk for suicide. Norepinephrine constricts blood vessels, raising blood pressure. It may trigger anxiety and be involved in some types of depression. It also seems to help determine motivation and reward. Dopamine is essential to movement. It also influences motivation and plays a role in how a person perceives reality. Problems in dopamine transmission have been associated with psychosis, a severe form of distorted thinking characterised by hallucinations and delusions. It’s also involved in the brain’s reward system, so it is believed to play a role in substance abuse. Glutamate is a small molecule believed to act as an excitatory neurotransmitter and to play a role in bipolar disorder and schizophrenia. Lithium carbonate, a well-known mood stabiliser used to treat bipolar disorder, helps to prevent damage to neurons in the brains of rats exposed to high levels of glutamate. Other animal research suggests that lithium might stabilise glutamate reuptake, a mechanism that may explain how the drug smooths out the highs of mania and the lows of depression over the long term.

A combination of electrical and chemical signals allows communication within and between neurons. When a neuron becomes activated, it passes an electrical signal from the cell body down the axon to its end (known as the axon terminal), where chemical messengers called neurotransmitters are stored. The signal releases certain neurotransmitters into the space between that neuron and the dendrite of a neighbouring neuron. That space is called a synapse. As the concentration of a neurotransmitter rises in the synapse, neurotransmitter molecules begin to bind with receptors embedded in the membranes of the two neurons.

http://www.health.harvard.edu/newsweek/what-causes-depression.htm#figure2

  1. An electrical signal travels down the axon.
  2. Chemical neurotransmitter molecules are released.
  3. The neurotransmitter molecules bind to receptor sites.
  4. The signal is picked up by the second neuron and is either passed along or halted.
  5. The signal is also picked up by the first neuron, causing reuptake, the process by which the cell that released the neurotransmitter takes back some of the remaining molecules.

Although we know that these chemicals are involved in the messaging process, it is not a simple matter of the levels of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life. With this level of complexity, you can understand how two different people might have similar symptoms of depression, but that the treatment that would work best for each of them, might differ entirely.

113.5         Why do we become depressed?

Many researchers spend their whole life trying to answer this question. It must already have become clear that the answer lies in a combination of many factors. Traditionally, we distinguished between external and internal reasons for depression. Today, we prefer not to make such a clear distinction. Regardless of how depression is initially triggered, it would seem that by the time any problems with the neurotransmitters have developed, the illness has already been engaged in a life of its own.

We know that genetic factors and environmental factors play a role. Stressors and emotionally difficult circumstances can also play a role. Among these, suffering, loss, and abuse have been identified. Some personality types are also more prone to depression. High stress situations increase the levels of the hormone adrenaline, which can increase the cortisol level. This results in the repression of the immune system, which make us more susceptible to infections and cancer and also has an effect on our brain. We know that high cortisol levels can lead to memory problems over a long period of time.

It seems as if emotional trauma can affect the natural biological ability of our brains to deal with events and thus make us more vulnerable. Certain hormonal changes in women can also play a role in depression. We now also know aging in itself is a factor that plays a role. This, again, may result from a combination of environmental factors, along with the brain becoming more vulnerable with aging. Certain illnesses and even medication can kick-start depression.

113.6         Treatment

Do all people suffering from depression need medication? What is the best treatment?

Most people today accept that a wholistic approach, involving medication and therapy plus life-style changes, are important. There comes a point where medication is absolutely necessary as part of the treatment. If a person goes to therapy and makes life-style changes but the depression shows no improvement, medication is important.

Many people with depression need medication before they can do therapy. Therapy is just such hard work that people with major depression just don’t have the emotional energy to deal with it. It is only after a few weeks or months of taking medication, and there is an improvement in the depression, that therapy can be added. There are similar problems – and reservations – with regard to life-style changes since it can be very difficult to get a depressed person to do exercises, stop smoking, or to get sufficient sleep at night.

From a religious point of view, it can be difficult to get people to pray as people often complain that they are praying “against the ceiling”. Depressed people might refuse to go to church as part of their withdrawal or because anxiety about large groups. They struggle to read the Bible or meditate because of a lack of concentration. It is only after treatment with medication and the improvement of the illness that spiritual formation becomes important.

113.7         your role as a pastoral careworker

It is of the utmost importance that, as pastoral careworkers, we are sensitive to the needs of those who struggle with depression. Although this training is not sufficient to train you as pastoral counsellors, you should be able to understand what effect depression has on people. You should also be more knowledgeable than the average person in the street.

You often find that people who are struggling physically and spiritually also suffer from depression. We stand with all people in their struggles and should not underestimate the extent of the struggle with depression, which, for some, is much more acute than the physical pain of an operation. Cheap spiritual advice, including saying something like “tomorrow the sun will shine again”, could in fact be distressing to those in the dark hole of depression.

114       Practical exercises – Case studies

  1. The family of a 16-year-old son who is DOA, after suicide.
  2. A young boy of nine years old who lost his mother. You have also lost your mother at the very young age of eight years.
  3. A woman (an ex-nursing sister) who was diagnosed with lung cancer a week earlier. Her husband is with her and they are both devastated.

115       Daily Closing ritual

  1. What did you learn today?
  2. Anything that limited your learning?
  3. Anything you would do differently in the future?
  4. Where is God at work?

116       Homework

  • Your Task: Reading Handout

 

Handout

117       Handout: Dealing with anger

117.1         All people show anger.

Anger is an emotion that all people know or experience. Children are known for their tantrums, which can be more than just anger and frustration as it can also be a manipulative tool. In adults, anger can also take different forms. Some people are known for their “passive” anger, which they might express through destructive action, especially in a relationship.

Sometimes a person will manage to live with great anger without showing it. The damaging effect of such anger is that over the long term, it is often more destructive to the angry person than to any other party. Many people also fear their own, and others’, anger.

Anger should not be confused with assertiveness. Assertiveness, where you stand up for yourself or for others, is an action and behaviour option, while anger is an emotion.

To react with assertiveness to a situation differs from an angry reaction. When you are assertive, you challenge the viewpoint of others without bullying or manipulation. In being assertive, it is possible to defend your convictions using reasonable arguments. You are also able to listen to the arguments of others. The response of others to your assertiveness could be an acknowledgment of you as a person. It is, however, very difficult to argue with an angry person, because everything happens on an emotional level and there is little reason.

117.2         Dealing with our anger

While we all know the emotion, and may even fear it, we should also understand that like all emotions, the problem is not the emotion itself, but how we deal with it. Self-discipline means to experience an emotion without allowing the emotion to take over your life.

It is possible to learn to control our emotions. This is not the same as not allowing emotions to exist, but to understand that destructive emotions need to be managed. We are more than our emotions.

If we tend to get violent when we are angry, we need help. We can also teach our children to experience anger without becoming violent and destructive. Unresolved anger can lead to subtly undermining others (as is the case with passive anger) and could eventually develop into hate for, or bitterness about, the other.

117.3         Effects of anger

Anger affects all our relationships. People tend to withdraw from those who have outbursts of anger. It can also lead to transference taking place, so that our anger is the cause of others’ angry response towards us. Decisions taken while angry are often not good ones – you can easily cut off your nose to spite your face.

117.4         Where does anger comes from?

Anger is actually a very complicated emotion and is often not taken seriously enough. Deep-seated anger is frequently closely connected to emotional pain. Showing emotional pain by expressing anger instead, could lead to very negative effects since people are more likely to respond to your anger rather than your emotional pain. Generally, we tend to be more sympathetically responsive to other people’s pain than to acts or expressions of anger.

Anger can be used to manipulate other people. Parents, friends, family and politicians often start listening to us only when we become destructive. Children, for example, can use anger to get what they want. Unfortunately, this could become a pattern, with some people going on to use anger in adult life in their attempts to manipulate people and situations.

Anger could also be a sign of frustration and convey a message of helplessness. Often, anger does not alleviate our feelings of helplessness, because it tends to be empowering only briefly. It is not an effective way of dealing with helplessness and is often self-destructive. In the long term, anger would likely bring about negative results more often than positive results for the angry person.

Some obvious forms of self-destruction are such as when people cut themselves or try to commit suicide.

117.5         Allowing our anger to show

To show your emotions openly and to tell somebody that you are feeling very angry could be healthy – and also imply that you are in contact with your feelings. To act out emotion by shouting at others, to hurt others (or yourself), to humiliate anyone, or to destroy anything, are evidence of a lack of self-control.

A measure of anger in children should, however, be tolerated since we cannot expect from them to be able to show the same sense of control or restraint over their emotions as adults. As they grow up, we can expect them to show greater control. It is also important to speak to them as soon as they are feeling less emotional again, by asking them to explain what makes them so angry. Children should be taught and allowed to tell parents that they are angry and upset and feel destructive. They (and their feelings) should be given the necessary attention before they feel the need to resort to destructive behaviour in order to receive attention – which is then also negative attention.

Destructive behaviour and outbursts in an adult should not be tolerated. When a person benefits from anger outbursts they tend to continue with that behaviour. Parents who jump to attention as soon as their child has an anger outburst, strengthen the behaviour. Governments who attend to an issue only after the outbreak of violence, is also giving the message that anger can actually change things.

117.6         Summary:

The following are important in dealing with our anger:

  • Be honest with yourself.
  • Acknowledge that you have a problem.
  • Try to identify the source(s) of your anger
  • Work on self-discipline
  • Let go of the past and look at the future. The past will not let go of us, we must ourselves cut that cord.
  • Acknowledge pain; make peace with yourself and others.
  • Look for the positive things in others and in yourself.

 

HANDOUT

118       Handout: Basic approaches to conflict management

118.1         Power-based approach

Those with the most power win when this approach is adopted. Power-based approaches take less time to facilitate than others. This often results in the “peace” lasting for only a short period before the conflict surfaces once again.

118.2         Rights-based approach

Legislation, rules, norms and values are used.

This brings in “objectivity”, but it may ignore the context and history that lead to conflict. The difficulty then is that you are dealing with the grey areas of conflict – where it is difficult to determine and establish the “rights” and “wrongs”.

118.3         Interest-based approach

The interests of a people, a family, an organisation, or a country, stand central.

An interest-based approach requires a lot of time and energy, but in the long term it often has a better outcome. It does not ignore the role of power in conflict or in peace, but sees power as something that results from taking seriously the interests of the different parties as well as the values and rules of society. This kind of power does not ignore the interests of any of the parties or misuse power for the benefit of only a few people.

118.4         Facilitating conflict

118.4.1              Who is right?

The challenge is to move beyond the point of “I am right and you are wrong”. Most conflict situations work with the premise that: “I am totally right and you are totally wrong”. The result is that parties fight for their own interest exclusively. In the real world there are many positions between the two extremes of right and wrong. In many cases, every side in the conflict will in some aspects be right, and in some they will be wrong.

What is important, is the acceptance of both the things about which we are right as well as those about which we are wrong.

118.4.2              Focusing on the problem – not the person

It requires emotional maturity to understand that the issue to resolve is actually one of “us against the problem” rather than “me against you”. This becomes even more difficult when the problem to resolve is caused by a person’s behaviour or actions. What all parties should then do is to tackle the problem, or the behaviour and actions that caused the problem, together and as one.

118.4.3              Past, present and future

The past and history is of great importance and cannot be ignored. No conflict exists in a vacuum. Unjust behaviour in the actions of the past need to be acknowledged as well as rectified. It is also necessary, however, not to get stuck in the past and to find a way of dealing with the past that satisfies all parties. To do that, a vision of the future is necessary – a future that would be different from the past. All action in the present should also be monitored carefully to make sure that past actions are not repeated.

118.4.4              All parties must declare themselves

It is important that all parties should clearly state where they stand and what the interests are that they represent. The more hidden agendas (of non-disclosure) there are, the longer will it take to get the real issues on the table to tackle.

To declare yourself is not exactly the same as making demands. It is to clarify you position, so that the other party can understand what and who you represent and where your demands and/or unhappiness come from. In conflict situations, we all represent certain interests.

118.4.5              Clarify issues

In order to make progress in dealing with conflict, it is required from all parties to be clear to a reasonale degree about the issues at stake. It creates frustration when, in dealing with conflict, some parties are themselves not sure what it is that they are angry about, frustrates them, makes them angry, and what they want to change. Uncertain parties might also be inclined to change their goals and might not negotiate in good faith.

118.4.6              Keep listening

It is difficult to listen when we disagree.

118.4.7              The Way we speak

Make use of “I” messages rather than “you” messages.

“You always …

“You never …”

118.4.8              Determination and finding a solution

It is necessary for all parties to be determined to find a solution – rather than to just focus on winning an argument. Solutions often mean accepting a “give” and “take” agreement.

118.4.9              Letting go

Unfortunately, there are some problems and conflicts where there cannot be a win-win solution. The only solution in these cases is to move on. Let go when necessary.

In the end, it is not always necessary to feel satisfied that you have reached a win-win situation. Relationship also includes our integrity as a person. It is of little value to “win” an argument, but to lose our integrity in the process. Our value as human beings should not depend on whether we win an argument.

 

 

 

 

 

 

 

 

 

 

Module 5 Sessions 13-15

119       MODULE 5: SESSIONS 13-15

120       Welcome!

Task: Find a friendly looking stranger as a partner for today only – someone with whom you think you will be able to share.

120.1         Introduction of facilitator

  • Facilitator of the course: Frederik Nel

120.2         Time schedule

09:00 -10:30 – Ready, Steady

10:30 -11:00 – Tea

11:00 -12:45 – Go …

Task: Group appoints a timekeeper for the day/module

Timekeeper will (a) remind the facilitator and group of the time 10 minutes before a break or at the end of the day, and (b) switch on the kettle for coffee 5 minutes before the break.

120.3         Donation box

A voluntary donation of R100 for this module (for the 3 days).

120.4         Primary aims!

Learning opportunity: Acquiring new knowledge, or reconnecting with and refreshing knowledge you already have.

Skills training: Listening, questioning, reflecting, interpreting.

Theological reflection: Thinking about God’s presence in the group and our interactions with others.

Growth opportunity: Being in a group always creates new opportunities for personal challenges and growth.

Spiritual sharpening: Each opportunity to reflect on God’s presence while we are with other people is per se an opportunity to sharpen our spiritual awareness.

120.5         Values (not rules) for the course

There is a distinction between rules and values. Values are the foundations on which rules are built.

120.5.1              Respect

Respect for each other, including differences in viewpoints, culture, belief, gender, social circumstances, language, etc.

120.5.2              Confidentiality

Confidentiality is actually a sign of respect.

Caregiving is not the same as being enmeshed in another person’s life. It is a way of being with another without making the other dependent on us, the carers.

120.5.3              Affirmation

Affirm the positive we see in each other and also accept the affirmation others give us.

120.5.4              Integrity

Honesty, trustworthiness, openness …

120.6         Rules:

  1. Musical chairs: You are not allowed to sit next to the same person every day – pick a new partner.
  2. Please wear your name tags.

121       Daily ritual

121.1         Losses and gains

121.2         Living mindfully

When we think of human beings as wholistic beings, it becomes clear that our spirituality cannot be isolated from our physical bodies. Our spirituality includes our bodies. Our bodies want to experience peace along with our minds and our spirit. The emphasis is on the importance of appropriate exercising, but also on our eating habits.

So, it is not surprising that people write about “mindful mealtimes”. What is suggested is an awareness of the 4 G’s of eating habits, which we should try to avoid:

Gorging – eating too much, e.g., having second helpings;

Grazing – eating between meals, e.g., unhealthy snacking;

Gulping – eating too fast, e.g., finishing before everyone else;

Gawking – not seeing and savouring your food, e.g., eating in front of the TV.

121.3         Breathing exercise

Diaphragmatic breathing: [33]

The diaphragm is the most efficient muscle of breathing. It is a large, dome-shaped muscle located at the base of the lungs. Your abdominal muscles help to move the diaphragm and give you more power to empty your lungs. Diaphragmatic breathing is intended to help you to use the diaphragm correctly while breathing, in order to:

  • Strengthen the diaphragm
  • Decrease the work of breathing by slowing down your rate of breathing
  • Decrease the oxygen demand
  • Use less effort and energy to breathe

Diaphragmatic breathing technique

  1. Lie on your back on a flat surface or a bed, with your knees bent and your head supported. You can use a pillow under your knees to support your legs. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm moving in and out as you breathe.
  2. Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.
  3. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible.

When you first learn the diaphragmatic breathing technique, it may be easier for you to follow the instructions while lying down. As you gain more practice, you can try the diaphragmatic breathing technique while sitting in a chair.

Diaphragmatic breathing while sitting in a chair:

  1. Sit comfortably, with your knees bent and your shoulders, head and neck relaxed.
  2. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move in and out [OR: up and down] as you breathe.
  3. Breathe in slowly through your nose so that your stomach moves outwards against your hand. The hand on your chest should remain as still as possible.
  4. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible.

You may notice that an increased effort will be needed to use the diaphragm correctly. At first, you’ll probably get tired while doing this exercise. But keep at it, because with continued practice, diaphragmatic breathing will become easy and automatic.

How often should I practise this exercise?

At first, practise this exercise for 5 to 10 minutes, about 3 or 4 times per day. Gradually increase the length of time you spend doing this exercise, and perhaps even increase the effort of the exercise by placing a book on your abdomen.

121.4         Time of discernment

121.5         Dwelling in the word Matthew 25:34-46

NAV                                                                                    NIV

34“Dan sal die Koning vir dié aan sy regterkant sê: ‘Kom, julle wat deur my Vader geseën is! Die koninkryk is van die skepping van die wêreld af vir julle voorberei. Neem dit as erfenis in besit, 35want Ek was honger, en julle het My iets gegee om te eet; Ek was dors, en julle het My iets gegee om te drink; Ek was ’n vreemdeling, en julle het My gehuisves; 36Ek was sonder klere, en julle het vir My klere gegee; siek, en julle het My verpleeg; in die tronk, en julle het My besoek.’37Dan sal dié wat die wil van God gedoen het, Hom vra: ‘Here, wanneer het ons U honger gesien en U gevoed, of dors en U iets gegee om te drink? 38En wanneer het ons U ’n vreemdeling gesien en U gehuisves, of sonder klere, en vir U klere gegee? 39Wanneer het ons U siek gesien of in die tronk en U besoek?’40En die Koning sal hulle antwoord: ‘Dit verseker Ek julle: Vir sover julle dit aan een van die geringste van hierdie broers van My gedoen het, het julle dit aan My gedoen.’

41“Dan sal die Koning vir dié aan sy linkerkant sê: ‘Gaan weg van My af, julle vervloektes! Gaan na die ewige vuur wat vir die duiwel en sy engele voorberei is, 42want Ek was honger, en julle het My niks gegee om te eet nie; Ek was dors, en julle het My niks gegee om te drink nie; 43Ek was ’n vreemdeling, en julle het My nie gehuisves nie; sonder klere, en julle het My nie klere gegee nie; siek en in die tronk, en julle het My nie versorg nie.’44Dan sal hulle ook antwoord: ‘Here, wanneer het ons U honger of dors of ’n vreemdeling of sonder klere of siek of in die tronk gesien en U nie gehelp nie?’45En Hy sal hulle antwoord: ‘Dit verseker Ek julle: Vir sover julle dit aan een van hierdie geringstes nie gedoen het nie, het julle dit aan My ook nie gedoen nie.’46En hierdie mense sal die ewige straf ontvang, maar dié wat die wil van God gedoen het, die ewige lewe.”

 

34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’

37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’

40 “The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’

41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

45 “He will reply, ‘I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.’

46 “Then they will go away to eternal punishment, but the righteous to eternal life.”

 

121.5.1              Sharing and listening to your partner

  •  Task: What did your partner hear in the text?
  •  Feedback rule: Provide the group with feedback on what your partner has told you.

121.6         Homework feedback

Your Task: Handout on Anger & Conflict

121.7         Learnings and praking questions

 

Session 13 Self-Care for the Pastoral worker

122       SESSION 13: SELF-CARE FOR THE PASTORAL WORKER

123       Universe victim theory

Why do you think the other line always moves faster than yours?

Whether you’re standing in line at the grocery store, or you’re trying to navigate your way through traffic, it always seems as if the other line is moving faster than your line. BBC Future explains that this has something to do with what we call illusory correlation. Illusory correlation exists to help us to make quick decisions based on limited information without doing a lot of mental maths. It means that, in comparing two things, we find them to be similar even when they’re not, like two lines at the grocery store. BBC Future explains:

“So here we have a mechanism which might explain my queuing woes. The other lanes or queues moving faster is one salient event, and my intuition wrongly associates it with the most salient thing in my environment—me. What, after all, is more important to my world than me? Which brings me back to the universe-victim theory. When my lane is moving along I’m focusing on where I’m going, ignoring the traffic I’m overtaking. When my lane is stuck I’m thinking about me and my hard luck, looking at the other lane. No wonder the association between me and being overtaken sticks in memory more.

“This distorting influence of memory on our judgements lies behind a good chunk of my feelings of victimisation. In some situations there is a real bias. You really do spend more time being overtaken in traffic than you do overtaking, for example, because the overtaking happens faster. And the smoke really does tend follow you around the campfire, because wherever you sit creates a warm up-draught that the smoke fills. But on top of all of these is a mind that over-exaggerates our own importance, giving each of us the false impression that we are more important in how events work out than we really are.

“Most of us experienced the gruelling boredom of waiting in a line. Not only are lines boring, they can also be aggravating, and stressful. Essentially, we tend to think we’re more important than others, and that’s part of the reason why we hate standing in lines to begin with. If nothing else, a better understanding of the psychology behind why you think other lines move faster than yours will help you deal with that a little better”

124       Stress

124.1         Symptoms of stress

Situations around us and in us cause us to show symptoms of stress:

  1. a) Physical: Rapid pulse rate; heightened adrenaline flow; increased sweating; the slowing of digestion; reduced immunity and immune response; increased muscle tension.
  2. b) Psychological: Panic, fear, emotion (such as anger)
  3. c) Behaviour: Fight, flight,

124.2         Stress: Villian or vital?

  1. a) We need stress to survive. Stress is vital for concentration and survival.
  2. b) Excess stress causes distress, and plays havoc with concentration and emotions.
  3. c) We cannot always change the environment – we cannot always escape stress stimuli.
  4. d) Finding a balance between good and bad stress.

124.3         Dealing with stress

124.3.1              The way I respond to stressors

How do I think and respond to stress? My attitude and response to stress are one of the essential building blocks in dealing with stressful situations. We tend to blame our circumstances for our feelings of being stressed. It is true that our environment and factors beyond our control often play a role. But we, ourselves, are the main drivers and source of the stress we experience.

  1. a) How do I see myself in this world (identity issues).
  2. b) My understanding and relationship with authority and power.
  3. c) Our desire for control.
  4. d) How we deal with loss and rejection.
  5. e) Success issues. What do I view as being a success?
  6. f) Guilt – realistic and unrealistic guilt.
  7. g) Perfectionism – dealing with the real and the ideal
  8. h) Ability to live with dichotomies, opposites, and opposing opinions.

124.3.2              Self-care

Self-care begins with our attitude towards others and ourselves.

124.3.3              Practice forgiveness

Forgiving others and giving others a second chance make us more relaxed.

124.3.4              Be positive

Although some people certainly have negative intentions towards us, such as a burglar or criminal, most people we interact with have positive intentions. People’s actions are shaped by their perspective of the world, but the reality of any one person may be very different from the reality of another. A single interaction between people is not enough to get to know each other. The map is not the territory and one page in a book is not the whole book.

How do you think about the world? Do we see the world as a dangerous place with more bad than good in it? A negative view of the world will make us more anxious.

124.3.5              The acceptance of limitations

There are limitations that we have to accept and live with. There are only 24 hours in a day. We have the body we have.

124.3.6              Balance

Closing ourselves off from other people and allowing other people to walk over us are the extreme points of this spectrum. In the next section the importance of healthy boundaries will be discussed.

124.3.7              Spiritual life

  1. a) God’s Kingdom does not depend on me. Working with God, not for God.
  2. b) Ability to find rest in God.
  3. c) Surrendering ourselves (an action of faith).

Handout: Willerm Nicol 2012. ’n Groter Dors, 202-228

125       Practical exercises – case studies

  1. A young boy of nine years old, who has lost his mother. You have also lost your mother at the very young age of eight years.
  2. A woman (an ex-nursing sister), who was diagnosed with lung cancer a week earlier. Her husband is with her and they are both devastated.

126       Sabotage yourself

I copied the following “article” a few years ago. Unfortunately I do not know what the original source is.

“People make mistakes.  A professor said that failure was the only feedback – and it hit me in my core.  What if it is?  What if we make too much of failure?  In fact, when we fail, falter and miss the mark, we have to realise that we are here for a purpose greater than ourselves.  We are to live out that purpose, every moment of the day.  When we fail in our lives, it is never the end.  Nothing can separate us from the reality of life’s purpose and greater sense of our being, not even failure itself.  When people fail it is the faith and hope within us that enables us to get up – even after numerous failures – and walk again.

Failure will happen as sure as the next sunrise and maybe you are just tired, fatigued and overloaded and feel unable to concentrate properly.  Maybe things have not worked out for you the way you planned and dreamed.  Maybe it is that time of year when everything is unwinding and coming to an end.  But we need to realise that failure is never random.  Failure by design is more like it.  First there is internal slippage, followed by deeds driven by the inner screams of life that have either never healed or have never been attended to. Internal resolutions rarely address the persistent obstacles that sabotage our efforts. What crops up prior to most failure is what we call “self debate”.  This is when we talk to ourselves about how life works for us.  But these messages that we give to ourselves become glass ceilings against which we bump our heads.

Grab a pen and paper.  Create four columns and, in the first three, write down the names of two or three people that you know of, either personally or in history, who have failed.  Next, try to identify four or five things that each person did not pay attention to, and which resulted in failure.  List these under each name.  Do you notice a trend or a pattern emerging?  Now write your own name in the last column.  Think of a time in your life when you failed.  Write down five things that you did not pay attention to that resulted in your missing the mark.  Compare your entries with the three examples and see if you can pick up any trends.

We have said that “self talk” or “self debating” internal resolution is what most people experience prior to and during personal failure.  Again, on your sheet of paper, create two columns.  As you read through the eight typical “self debating” arguments listed below, rate in the first column how often (always/sometimes/seldom/never) you use or have experienced these arguments.  In the second column, write down how intense these debates have been – “I feel this way 100% of the time, 60%, 30%. Not at all.”

  1. Self limitation.

The debate goes like this:  “Why expend all that effort and energy trying to exercise self-control or create a new habit when I know that I’m going to fail anyway?  Why bother?  Just let it slide, don’t expect too much and you won’t feel so bad when you don’t get it.”

  1. Personal distraction.

Life is tough enough and getting involved with reality is hard work.  So one of the ways in which we continue to distract ourselves is to focus on instant enjoyment without having to invest energy in creating solutions, investing in people and living life to the full.

  1. A driven life.

When we look at the lives of great prophets, we discover that they were never driven:  instead, they were drawn into the future because of the joy that was set before them. We should not chase after elusive concepts of joy (satisfaction/success).  Many people are driven – but when they accomplish things, they still experience it as non-achievement, amplifying their silent screams.  Striving for more, we constantly chase … after approval, business success, recognition, the sense of pleasing God.  Doing things better than others and proving to ourselves that “we can” is the kind of “self talk” that leads to ruined lives.

  1. Manipulating others.

This debate will ruin your life.  It will keep you busy with conflict and always wanting to win. You believe you’re in the right and constantly have to prove it.  And then when you don’t get your way, you play the shaming, sulking, angry, passive-aggressive games that manipulate people.

  1. I can do this myself!

Self-sufficiency and rugged individualism create a lifeless life.  This debate concludes that if I ask for help I am weak.  This debate is driven by pride.  As a result we live behind masks where there is no need to admit how weak we feel sometimes.

  1. I am a survivor.

This thinking will not only ruin your life but also your identity.  You don’t learn from any experience in life and or from what anyone else says, because it all about surviving.  You push to keep on slogging ahead as if you have to put up with almost anything.  We are not survivors and we are not victims.  We should be on an adventure, learning from everything as we intentionally explore new frontiers.

  1. I have to get it right.

This will destroy the joy, hope and contentment in your life.  Many people call this a commitment to excellence, but perfection is actually a flaw and is woven together with pride.  This makes us feel that if we do anything wrong, we are a big, fat failure.  Doing something and being someone are two different things.

  1. But nobody understands me.

“If only people understood me they would get off my back.  I’m trying my best given the circumstances.  Clearly people don’t understand that I also have demands in my own life.”  This thinking drives us to ignore advice.  We interpret it as criticism and it results in a lonely and self-protected life.

Once you have rated each of these debates, ask yourself:

*What if, instead of continuing to try and cope with life using a self-defeating pattern, I learn to deal with it?

* What would my life be like if I were not driven by these eight self-seeking and self-defeating debates?

* What if I stopped second-guessing myself and said:  “Let me do it and learn, and change?”

127       The role of healthy boundaries [34]

“Virtually everyone needs to understand boundaries and how setting them is essential to experiencing freedom in every area of life. Where boundaries fail, relationships fail, people hurt, and life performance suffers. Boundaries affect us psychologically, relationally, physically, and spiritually.” (Townsend 2011:9).

127.1         Why talk about “boundaries”?

“Any confusion of responsibility and ownership in our lives is a problem of boundaries.” (Cloud & Townsend 1992:27).

What are boundaries about? Boundaries describe our spheres of responsibility: what we are and are not responsible for.  (Cloud & Townsend 1992:60). We should accept that “made in the image of God” also means that we were created to take responsibility.

Taking on tasks and duties that are not your responsibility will not only burn you out, but may also have the effect that you unconsciously “help” others to neglect their responsibilities, while you, yourself, end up overburdened.

It is not that easy to describe what a healthy boundary looks like, because it differs from person to person and may also be influenced by culture. The image of a picket fence helps me a little bit in describing it, although I know images often have their own limitations.

For me, and in my culture, it would seem to be appropriate to fence off my property. This may not be true for everybody. In some cultures, people prefer not to fence in their property and house.

Any fence clearly sets a boundary, and for me, a picket fence (used to create that boundary) is a welcoming structure. I can continue to communicate with someone on the other side of the fence without leaving my own property. I can also open the gate and invite anybody in, or even ask someone to leave my property. It creates a boundary but it still gives me a view of what happens in the community around me.

We need to set mental, physical, emotional and spiritual boundaries in our lives, just as homeowners set up physical fences and walls around their properties. These boundaries should protect us without isolating us. They help us to deal with any overflow of information and stimuli. They also help us to see with greater clarity what our responsibilities are and what they are not.

There are also different levels of boundaries. We can fence off our property, but there is a second layer of fencing created by the walls of my house. Some houses also have more windows and doors than others, so that they are more “open”, rather than “closed in”, and this affects the level of that particular boundary. A prison, again, would be surrounded by a very different boundary than that which surrounds a house with its open windows and doors.

The boundaries we create should not isolate us from others, but rather protect us and keep us strong and dynamic. We have already referred to the fact that inadequate boundaries could trigger burn-out. People who experience burn-out often set this in motion themselves by isolating themselves. They then have less energy to become involved in the community.

Our skin is one of the best examples we have of a good boundary. It effectively prevents bacteria and viruses from entering our bloodstream. It allows us to sweat to cool off. Without sweating, we would overheat.

127.2         Types of boundaries

The types of boundaries that we must set constantly differ. Sometimes it will be necessary to set physical and geographical boundaries. It may also be necessary, as an extreme example, to get a restraining order against another person who might harm us. Or, as part of the process of boundary setting, we might be required to leave a household, marriage, company or even a town and a country.

When we close the doors of our house we make it clear to outsiders that they cannot just visit without first knocking on the door. They then have to wait for us to open it. One step further would be to lock the doors of our house as a form of protection.

Emotional boundaries are more difficult to set. They have to do with the protection of our inner being, and setting boundaries is a way to create space for ourselves and our emotions. Breaking off a relationship may be one way of setting an emotional boundary. When we kindly request a person not to raise a certain topic because it causes us emotional distress, we are also setting a boundary.

Setting boundaries in terms of time is something that we are confronted with daily. Setting a time boundary requires us to learn to say no to others when necessary, or to ignore certain stimuli.

The need for boundaries can develop over time. We may, in the beginning, enjoy a particular project. But the project can snowball and later require more of our energy than was envisaged at the beginning. Setting boundaries is a way to regain ownership of our lives and can be necessary at times.

Other boundaries to think about, for example, are those around eating habits; dealing with money; controlling our tongue or temper.

127.3         Healthy and unhealthy boundaries

Not all forms of boundaries are good. Unhealthy boundaries can increase depression, anxiety disorders, eating disorders, addictions, impulsive disorders, guilt problems, shame issues, panic disorders, marital and relational struggles (Cloud & Townsend 1992:28). Healthy boundaries allow us to keep certain things inside ourselves, and to keep others out.

Unhealthy boundaries can be either like (prison) walls, which keep too much out, or, they can be like a dilapidated fence, which keeps practically nothing out. A healthy boundary is something like a property with a picket fence – it is next to other properties and acknowledges that the owner, although fenced off, lives in community with others and not in isolation. Our boundaries should have gates and allow us to breathe.

127.4         Boundary confusion

There are many situations where different issues start to overlap, making it difficult to draw clear boundaries. This is the case not only in the lives of adults, but also children. One result of boundary confusion like this is that we may have too strict boundaries in situations where we should actually relax our boundaries. But confusion could also lead to a complete lack of boundaries at points where we need stricter boundaries. In short, the problem then is of not having boundaries when we need them, or, on the other hand, to have boundaries when we shouldn’t have them.

Parenting is one of the things we all struggle with. What we often see are parents who allow their babies and toddlers to do just as they like, but then introduce strict rules and boundaries when their offspring grow older, especially in their children’s teenage years.

Another kind of confusion happens when we set very strong boundaries for ourselves, but very weak boundaries for others. The way this plays out is that we always say yes when others ask something from us (weak boundary), but in return we never ask others for assistance (strong boundary) when we need help.

Children who are raised always to comply with adults do not become equipped to say no, should it ever be necessary. Children need to have the power to say “no”, even to an adult; or “I disagree”; “I will not”; “I choose not to”; “stop that”; “it hurts”. Other models of parenting include being permissive, with an anything-goes approach. Parents who cannot set limits for their children raise individuals who are unable to be emphatic, tolerate frustration or delay gratification. We need to explore the middle ground between authoritarian and permissive parenting (Judith Archer, Clinical Psychologist, Sunday Times 7/6/09).

Boundary confusion is also fuelled by double standards in parenting. For example, some parents apply double standards in their home – one for boys, and another for girls. Boys, for instance, may be allowed to stay out later than girls.

Parents are also sometimes inconsistent and reward children’s destructive behaviour. This interferes with the learning process of the child, in terms of what they should learn to believe and where to draw the line.

Unmet emotional needs in adults also hamper the healthy emotional development of children. Parents who do not respond to the real needs of their children; who are hypercritical, or absorbed in their own desires and needs, create uncertainty and confusion in their children.

127.5         Fine line

Parents should allow children to shoulder responsibilities appropriate for their age and hold them responsible for the consequences of their decisions. This will help children to develop a sense of establishing good boundaries themselves.

It is a lifelong process to develop a sense of establishing healthy boundaries, but starting early in life is helpful. Part of walking this delicate line is the ability to ask for help; to let others in; and to recognise our own needs. It is also one of developing the ability to notice others’ needs and respect others’ boundaries.

To toe this fine line should help us to enjoy safe relationships, in which there is give and take. Having good boundaries allows you to listen carefully to your partner’s story about a stressful day or their hurtful experience, and then be caring towards him/her in your response. The importance is to show care without taking responsibility for others’ emotional well-being.

Having bad boundaries result in non-responsive, ignorant attitudes towards others who are stressed and hurt. Bad boundaries can also lead to being over-responsive, to trying to solve the other person’s problems, trying to carry their pain and even to getting too deeply involved in the other’s struggles.

One of the learnings is that not all the help we receive or give is necessarily good for us or others.

127.6         Be aware of boundary breakers

127.6.1              Controllers

People who can’t hear when you say “no”. To them, “no” means “maybe”, and “maybe” means yes.

They just cannot accept others as they are. They attempt to change others, to make the world fit their idea of the way life should be.

It is interesting to note that, according to one of the theories about this phenomenon, serious controllers actually resist taking responsibility for their own lives – so they need to control others.

127.6.2              Manipulative controllers

They are less honest and upfront than the controllers. They try to persuade other people to cross their boundaries. They seduce others to carrying their (the manipulative controller’s) burdens. They use emotional language to persuade others and often deny their desire to control others.

They see others as responsible for their own struggles, but are on the lookout for someone to take care of them. They gravitate towards people with blurry boundaries who take on too many responsibilities and don’t complain about it.

127.6.3              Compliant controllers

Compliant people can actually be manipulative controllers – who hope that by being loving, they will receive love. It is caring with a hidden price tag attached. They are easily hurt when others can’t figure out the attached “price tag”.

Often, they are simultaneously the injurer and the injured. They hurt others but are also deeply hurt by others because of their own boundary problems. They typically set themselves up to get hurt.

They often isolate themselves from others. But then again, people also stay with them out of guilt. They often realise that people stay with them because they are pulling the strings. They then live in fear of being abandoned. Jealousy is often a feature of such a relationship.

127.7         Dealing with boundary issues

We all love a quick fix for whatever we struggle with. There is, however, no magic pill or medicine to deal with boundary issues. For most of us, it is something we have to deal with from day to day. It is possible to become better at establishing boundaries and to improve our skills in dealing with them if we are prepared to put in the necessary effort. This is a process –  and sometimes we will do better, and sometimes we won’t.

127.7.1              Acknowledge the issue

We have to acknowledge that dealing with boundaries is an important issue and we have be willing to work on the issue.

127.7.2              Acknowledge what drives our boundary issues

Although there may be several drivers of inaction in dealing with boundaries, the thing most people recognise as a driver is personal uncertainty.

127.7.3              Setting appropriate limits

Strict and uncompromising boundaries can hinder communication. At the same time, healthy boundaries can help communication. It can also help in the parenting process if children know what the boundaries are.

“Parenting with love and limits, with warmth and consequences, produces confident children who have sense of control over their lives.” (Cloud and Townsend 1992:43)

We often set inappropriate limits for others. To set limits for your children may be appropriate, but to set limits for other adults may be inappropriate. What we must set limits for, and take responsibility for, is our own exposure to people who behave poorly. We can’t change other adults or force them to behave in acceptable ways, but we can and should withdraw from them if they don’t respect our limits.

127.7.4              Legitimate wants and needs

There are legitimate wants and needs. It is important not to see legitimate wants as shameful and bad. But not all wants and needs should be seen as “legitimate”. For instance, not all households need the same number of bedrooms. A bigger family would need more rooms.

127.8         Drivers of boundary issues

127.8.1              Inner boundary problems

The core of our struggles about boundaries is located in our inner being, and eventually it will flow into our daily lives. A realistic view of who we are and what our shortcoming and talents are, is important. Accepting ourselves and an understanding of our needs and wants are also important.

We need to find a balance in our inner being, between those things that we can and should expect from others, and those things that they can and should expect from us. There should be a balance between the ability to give and to ask.

We must also learn to curb our impulses and desires and accept the concept of delayed gratification – accept that others can say “no” to us, not because they are against us, but because they have the right to draw their own boundaries. We must also learn to wait for our desires to be fulfilled instead of demanding immediate gratification. But we can also expect from others that they should curb their own impulses and desires and delay gratification.

It is also important to accept responsibility for our own life and the consequences of our decisions.

127.8.2              The fears in our lives

At times, we may experience rejection by other people. And this fear of being rejected is experienced strongly by most of us. It is this fear that can turn us into a people pleaser – always wanting to please others, even to the extent that we never say “no”, in order not to be rejected. The same fear may also cause us not to engage with others but instead to build walls around us. When there is no engagement, it means there is no possibility of rejection.

The fear of being alone can lead to us ending up in relationships that are not good for us, but which we endure for the sake of having company. Red lights go on when people say that “bad company (abusive company) is better than no company”.

The fear of failure can also cause us to build walls around ourselves and prevent us from engaging in meaningful relationships. Other fears which people experience are:

  • Hurting another person’s feelings
  • Abandonment and separation
  • Other people’s anger
  • Punishment
  • Being shamed
  • Being seen as bad and selfish
  • Being unspiritual OR Lacking spirituality
  • One’s own, overly strict and critical conscience
  • Unrealistic guilt

127.8.3              The struggle to let go

We are all in danger of establishing false boundaries based on false pride and a false ego. These false boundaries are not useful to us, they are also not sustainable and could even hurt us deeply. It is just as important, however, not to underestimate ourselves. Just as it is also a danger to overestimate what we can do. When we overestimate ourselves, we tend to put down false boundaries in the hope that nobody would “catch” us out on it.

It is important to develop the ability to let go of our own independence and the desire to want to do everything on our own. Doing this would enable us to open up about ourselves and to others. It would also allow us to face our own limitations and to acknowledge that “I can’t do everything”.

One of the limitations we should be able to accept is the fact that there are only twenty-four hours in a day. Most of us believe in the value of hard work. But taking on, for extended periods, more than we are capable of physically and emotionally, usually comes about because we refuse to acknowledge that we have reached our limit. We then tend to create a false boundary and close ourselves off from valuable advice from others. Not to let go then becomes an obsession. What is even more difficult when this happens, is that the things we are busy with are often for the benefit of others – family, community, clients. This gives us the excuse to carry on doing too much – because we believe we are helping others – even though we are in fact beginning to deplete our own emotional resources.

127.8.4              Love as a driver

Is it possible that we can love too much? Yes and no. The problem is not that we love too much, but that our love is sometimes based on particular premises that set up the possibility for us to become abused. This happens when love is based on our, or the other person’s, unsatisfied needs for attention as well as an unhealthy dependency. To love unconditionally does not mean that we should disempower ourselves and allow others (friends, partners, parents, children) to abuse us.

On the other hand, we can also set ourselves up to resist love in our lives. Loneliness can be the result of either resisting love, being over-critical, and/or being experienced by others as requiring a lot of attention – described as being “high maintenance” emotionally.

127.8.5              Misplaced trust

We can trust people who are not worthy of our trust too easily, or, we do not trust people who we should trust, who really are worthy of our trust.

127.8.6              Ignoring consequences

Overstepping boundaries happens when one or both parties in any kind of relationship ignore the consequences of their actions. It is often due to false optimism in one or both parties that everything will eventually be OK, irrespective what is done.

127.9         Healthy boundaries

It would seem that the Good Samaritan (Luke 10) is an example of a person with good boundaries. On his travels, he went out of his way to help the Samaritan in need, got others involved – and then he carried on with his travels.

A realistic understanding of our own limitations and the ability to let go, when necessary, is of great importance. Over-involvement often ends up in resentment – such as when we give more than what we had actually wanted to, or could, give.

We should try to be in touch with our feelings. Our feelings will tell us what goes on in our heart and will inform us about the state of our relationships. It means to take responsibility for our feelings and to own them. Others are not responsible for letting us feel OK. We need to work on our attitude. Our attitude is the orientation we have towards something.

We should know and own our belief systems, what the things are that we accept as true and which are usually the basis on which we negotiate our boundaries. We need to take responsibility for our choices. Making decisions based on others’ approval, or on the basis of our guilt feelings, will eventually breed resentment. Taking responsibility for the things we value and paying attention to them are important in boundary setting.

127.10      Obstacles against healthy boundaries

When we become better at implementing healthy boundaries, we should not expect everybody around us to welcome this development. This is a learning process for all the parties involved. The limit setter, as well as those opposed to the limits, will have to find new ways of dealing with the situation.

Some people, sometimes even those very close to you, might find it very difficult when you start to draw clear and healthy boundaries. You may even face the anger of parties who are not used to you saying “no” or drawing boundaries.

While we should be aware of our own self-centredness, we should also accept the self-centredness of others. Self-centredness means that we see others (the world) as an extension of ourselves and rewire of others that they must fit in with our desires, or that we are unhappy if they interfere with our world.

People who establish boundaries set limits, and they are thus interfering with our desires or those things that we feel we are entitled to. This makes us angry. A person who is angry with you for setting boundaries is, however, the one with the problem (Cloud & Townsend 1992:248). Allow the angry person his/her anger. But do not respond with anger. This is one of those situations where inactivity (not responding) is power.

127.11      Summary

Boundaries are not inherited, they are built (Cloud & Townsend 1992:64). This is an ongoing process.

128       Closing Ritual

  1. a) What did you learn today?
  2. b) Anything that limited your learning?
  3. c) Anything you would do differently in the future?
  4. d) Where is God at work?

129       Homework

     Your Task:

Complete the questionnaire “Who am I”

130       Handout: Questionnaire – Who am I?

  • What do people close to me say about me?

 

  • What does God say about me?

 

  • What drives me?

 

  • What makes me angry?

 

  • What lets me feel fulfilled?

 

  • What stresses me?

 

  • What gives me pleasure?

 

  • What must I live with that I can’t change?

 

  • Why can’t I change these things?

 

  • What can I change – but struggle to change?

131       SESSION 14

132       Daily ritual

132.1         Losses and gains

132.2         Living mindfully

When we think of human beings as wholistic beings, it becomes clear that our spirituality cannot be isolated from our physical bodies. Our spirituality includes our bodies. Our bodies want to experience peace along with our minds and our spirit. The emphasis is on the importance of appropriate exercising, but also on our eating habits.

So, it is not surprising that people write about “mindful mealtimes”. What is suggested is an awareness of the 4 G’s of eating habits, which we should try to avoid:

Gorging – eating too much, e.g., having second helpings;

Grazing – eating between meals, e.g., unhealthy snacking;

Gulping – eating too fast, e.g., finishing before everyone else;

Gawking – not seeing and savouring your food, e.g., eating in front of the TV.

132.3         Breathing exercise

Diaphragmatic breathing: [35]

The diaphragm is the most efficient muscle of breathing. It is a large, dome-shaped muscle located at the base of the lungs. Your abdominal muscles help to move the diaphragm and give you more power to empty your lungs. Diaphragmatic breathing is intended to help you to use the diaphragm correctly while breathing, in order to:

  • Strengthen the diaphragm
  • Decrease the work of breathing by slowing down your rate of breathing
  • Decrease the oxygen demand
  • Use less effort and energy to breathe

Diaphragmatic breathing while sitting in a chair:

  1. Sit comfortably, with your knees bent and your shoulders, head and neck relaxed.
  2. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move in and out [OR: up and down] as you breathe.
  3. Breathe in slowly through your nose so that your stomach moves outwards against your hand. The hand on your chest should remain as still as possible.
  4. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible.

You may notice that an increased effort will be needed to use the diaphragm correctly. At first, you’ll probably get tired while doing this exercise. But keep at it, because with continued practice, diaphragmatic breathing will become easy and automatic.

132.4         Time of discernment

132.5         Dwelling in the word Matthew 25:34-46

NAV                                                                                    NIV

34“Dan sal die Koning vir dié aan sy regterkant sê: ‘Kom, julle wat deur my Vader geseën is! Die koninkryk is van die skepping van die wêreld af vir julle voorberei. Neem dit as erfenis in besit, 35want Ek was honger, en julle het My iets gegee om te eet; Ek was dors, en julle het My iets gegee om te drink; Ek was ’n vreemdeling, en julle het My gehuisves; 36Ek was sonder klere, en julle het vir My klere gegee; siek, en julle het My verpleeg; in die tronk, en julle het My besoek.’37Dan sal dié wat die wil van God gedoen het, Hom vra: ‘Here, wanneer het ons U honger gesien en U gevoed, of dors en U iets gegee om te drink? 38En wanneer het ons U ’n vreemdeling gesien en U gehuisves, of sonder klere, en vir U klere gegee? 39Wanneer het ons U siek gesien of in die tronk en U besoek?’40En die Koning sal hulle antwoord: ‘Dit verseker Ek julle: Vir sover julle dit aan een van die geringste van hierdie broers van My gedoen het, het julle dit aan My gedoen.’

41“Dan sal die Koning vir dié aan sy linkerkant sê: ‘Gaan weg van My af, julle vervloektes! Gaan na die ewige vuur wat vir die duiwel en sy engele voorberei is, 42want Ek was honger, en julle het My niks gegee om te eet nie; Ek was dors, en julle het My niks gegee om te drink nie; 43Ek was ’n vreemdeling, en julle het My nie gehuisves nie; sonder klere, en julle het My nie klere gegee nie; siek en in die tronk, en julle het My nie versorg nie.’44Dan sal hulle ook antwoord: ‘Here, wanneer het ons U honger of dors of ’n vreemdeling of sonder klere of siek of in die tronk gesien en U nie gehelp nie?’45En Hy sal hulle antwoord: ‘Dit verseker Ek julle: Vir sover julle dit aan een van hierdie geringstes nie gedoen het nie, het julle dit aan My ook nie gedoen nie.’46En hierdie mense sal die ewige straf ontvang, maar dié wat die wil van God gedoen het, die ewige lewe.”

 

34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’

37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’

40 “The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’

41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

45 “He will reply, ‘I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.’

46 “Then they will go away to eternal punishment, but the righteous to eternal life.”

 

132.5.1              Sharing and listening to your partner

  •  Task: What did your partner hear in the text?
  •  Feedback rule: Provide the group with feedback on what your partner has told you.

132.6         Homework feedback

Your Task: Handout on Anger & Conflict

132.7         Learnings and parking questions

Session 14 Pastoral Conversation 4

133       Pastoral Conversation

133.1         Dealing with tension

From a theological perspective, to apply our minds requires us to deal with tensions that are inherent to ethical decision making.

133.1.1              The tension between determinism and hope

A creationist (skeppingsordeninge) view is deterministic in its belief that, from the start, God determined a certain order of things – in a fixed, structured plan according to which everything should happen. Creationists believe our task is to determine that order, after which we must try to live accordingly. Such an interpretation of the will of God (providence of God) provides these believers with what they believe is His blueprint for all of creation, which would allow us to know and understand God’s plans.

A result of this is that people tend not to take responsibility for their actions and decisions. From this develops an acceptance of their fate and the view that humans are victims of uncontrolled forces.

But from a re-creation perspective, God is at work in this world and includes us in His activity. From this perspective, the full being of Christ has an open-ended aspect to it. We focus on Christ as our archetype of true humanity, rather than on Adam who constantly pulls us back towards some lost ideal. Christ, however, beckons us forward into the “not yet” state [OR, condition], and we, the church, are with Christ, in a process that is constantly one of becoming (See Steve de Gruchy 1997:256-257). In an inexplicable way, God makes us, through Christ, co-creators of a new heaven and earth.

Some events in life are directly the result of our bad decisions and actions. We must take responsibility for that. But some tragedies cannot be explained. What we know, is that God wants the best for his creation and is with us in the struggle against evil and suffering.

Our hope is based on the Eschaton (Christ) and on the eschaton (the new heaven and new earth).

 

133.1.2              The tension between good and evil

Within Reformed Christian spirituality, good relates to the covenantal relationship God has with humans and the cosmos. This includes healing, wholeness, unconditional love, grace (unconditional acceptance), compassion, forgiveness, reconciliation and justice.

Evil stands for the resistance to grace and opposition to wholeness, peace and reconciliation. Evil destroys love with hatred and enmity.

133.1.3              The tension between beauty and ugliness

When beauty is seen as “prettiness”, we sing about “sweet Jesus” and try not to think about the suffering Christ. We do this when we would rather think of God only as King, and not as the suffering Servant.

But what it really means is that we fight against deformity, disability, vulnerability and death at all costs. Any form of imperfection becomes unacceptable to us. But the way in which we measure “success” are often questionable. In the medical field, the statistics are often rendered in terms of survival, but not quality of life. In the church, we have this false notion that bigger-growing congregations are “successful”.

To change that paradigm in approaching patients, would mean learning to live with death, with ugliness, and imperfections. This does not take away our responsibility to do the best we can, but creates a space in which we can learn to live with imperfections. (This is also something we should learn in the church).

Another way to look at things that are ugly (illness, death, sin, violence, disfigurement), is to see the opportunities for the unconditional love and unconditional acceptance of the other. The disasters and tragedies in life open up the opportunity for us to live as co-creators with God and to change this world and put up signs of the new heaven and the new earth.

134       Practical exercises – case studies

  1. A woman (an ex-nursing sister), who was diagnosed with lung cancer a week earlier. Her husband is with her and they are both devastated.
  2. A mother and father, whose first-born needed an operation within the first weeks after birth. The operation was a success and the family (and doctors) are in high spirits – but a few days later the baby suddenly and unexpectedly dies.
  3. A 30-year-old mother, who gave birth to twins after in-vitro fertilisation. One of the twins is severely deformed.

135       Ethical pointers (pro’s and con’s)

Pastoral workers should reflect on the ethical issues that patients and the medical fraternity are confronted with. We should be sensitive to the complexity of many of these issues.

135.1         Mercy rather than malice

Intention on its own is not enough of an indicator whether something should be done or not. What is important, is to ask the question “what is/was the intention of the action?”. There is a big difference between giving someone extra doses of morphine to reduce their pain but which may also suppress their breathing and hasten death, and, on the other hand, poisoning a person you hate.

135.2         Absolute sanctity of life

There are people (not always Christians) who believe in the absolute sanctity of life. Most people are selective in their thinking when it comes to the sanctity of life. Certain forms of taking life are, for most people, more acceptable than others. The most basic question is what we see as “life”. Is the killing of animals acceptable or not? There are people who also raise questions about other life forms, like bacteria and viruses. There are people who see the unborn child as a life that should not be taken. A biologist may say that life is already present in the sperm and egg cell even before conception, and so does not start with conception.

Throughout the centuries, some Christians have defended the death penalty and “a just” war, because the legitimate state is allowed to defend itself and its citizens. Most people who argue against abortion would allow for exceptions, i.e. when the life of the mother is in danger or if rape had originally led to the conception of the foetus.

The point is that the absolute sanctity of life is actually a very difficult concept to use consistently. But this does not mean that the Christian tradition does not care about life in all of its different forms.

135.3         reflecting on death

Death is not only a biological phenomenon, although the biological/physical dimension of death is the most obvious, indisputable, and irreversible aspect of it.

Death also has other dimensions (if we do not think mechanistically about death). There are also a spiritual dimension, the death of personhood, and who I am in relationship to others.

A person may, medically speaking, still be alive, but might already have experienced the death of their senses, of personhood, of humanity, in relationships, or have reached the spiritual end of their life’s experience, such as in “I am ready to die.”

135.4         The right to human dignity and quality of life

From a humanist perspective, “human dignity” is dominant in ethical thinking, and an absolute right.

The complexity of it is, however, that human dignity and quality of life are very closely connected. But our understanding of quality of life may differ widely. We can keep our dignity, even if we do not have everything we want.

From a Christian perspective, suffering is not such a strange concept, although this does not mean that we should go and look for suffering or martyrdom. But Christ suffered on the cross, and following in His footsteps may mean to suffer. From a Christian perspective, then, the absolute right to a good life without pain and suffering and with human dignity at all costs is questionable. Again, this does not mean that, as Christians, we do not respect human dignity, should not do our utmost best to defend human dignity, and that we should not fight for the prevention of pain and best care possible.

From the Christian perspective, hope is a way of living and it reflects our basic attitudes, disposition, and philosophy of life (Louw 2008:238). This hope is built on the faithfulness of God (Rom 8:24-25) and it is more than just a religious hope to be used only as an antidote for medical hopelessness (Louw 2008:239).

135.5         meaning of life

Western secular society is, to a great extent, a “death-denying society” with a strong belief in the power of science (and in medical treatment). Death is shifted to the fringes of society. People die out of sight in hospitals and old age homes, and even funerals are planned to be as unobtrusive as possible and take place as quickly as possible.

Indications are that Western society is also a “pain-denying society”, and even more so than a “death-denying society”. Between death and pain, death is the easier option.

The meaning of life is often found in success, happiness, material things, wealth and health. The quest, from a Christian perspective, is to find meaning in life even when the quality of life is not good. This does not mean that all pain and suffering should just be ignored, or that we should be quick to judge people who decide to end their life.

The pastoral task should also include the discussion on how to find meaning in life when our physical well-being is under attack, when the quality of life is questionable, when we are no longer in control and are dependent on others. There are times when we might have to surrender. Surrendering, which is one of the most difficult of conditions for us to accept, is embedded in the Christian faith.

135.6         Individual in society

The more individualistic a society becomes, the greater the lack of tolerance for others in need becomes. In an individualistic society, which is true of some of South African society and of Western Europe in general, there is a tendency to expect the state to take care of those in society who are vulnerable. If the state cannot do it, we prefer the vulnerable to just disappear.

The disabled, vulnerable, the sick and elderly, however, create the opportunity for society to learn to care for and look after one another. To stay alive, there is a price to be paid by those who have lost their independence and are suffering from pain, but a society’s duties should include caring for those who cannot do it themselves.

A healthy family life also includes caring for each other. Society should not place pressure on those whose quality of life is under pressure by promoting the belief that euthanasia is the only option open to them.

135.7         The epistemology of ethics (how do we know)?

The emphasis is on the importance of reflection and applying our minds, in a holistic way, to the decision we support. Asking the right and appropriate questions is in itself an ethical endeavour.

135.7.1              Cognitive (what?)

What are the available descriptive information and observations, the so-called “facts”, regarding the illness?

135.7.2              Conative (Why?)

What is the intention and driving-force (of the action)? Here, motivation, goals and belief systems play a role.

Does the end justify the means (finis sanctificat media)? Is it the best option for most people?

135.7.3              Functional and instrumental Questions (How?)

The answer can be primarily cognitive, based on reasonable arguments, but it can also be based on a particular philosophy or school of thinking. Included here, is the “mode question”. What will my attitude, inclination and sensitivity be in considering the questions and issues?

135.7.4              Telic question (What is the end purpose?)

What is the purpose? Is it appropriate and meaningful? For who is it meaningful – for the patient, family, society or the health carer?

135.7.5              Contextual question

The context – for the patient, and also overall – should be taken into account. What might be acceptable in one culture might not be acceptable in another culture.

135.7.6              When question

Is the timing appropriate?

135.7.7              What are the consequences?

Short-term and long-term.

135.7.8              Hermeneutical process (How do i interpret the information?)

Some people are very clear about where good starts, and where evil starts. But in the grey area of medical ethics, it is not always that clear-cut. From a theological viewpoint, it is also not always absolutely clear. The Bible, as a source for the Christian community, cannot be used as a handbook in all situations. Many modern medical decisions arise in a context that are completely different from those described in the Bible.

135.7.9              Summary

It is natural that we would want to determine the exact point of the beginning of life (abortion debate) and the end of life. [36]

We should refrain from thinking about life as “life at all costs”. To live means to be in relationships, to have hope. We are fully alive where other people love us unconditionally and accept us. It is also possible to breathe, but to be “dead”.

Death is more than the death of our organs or brain; it is more than just a biological event. Death has to do with the end of relationship with all of creation – family, friends, colleagues, pets, garden, etc. It is also possible to be dead, and still be alive in the memory of our loved ones and pets (we do not know about your flower garden, although we know that certain trees have pain reactions).

Hope is much more than the hope for healing. Unfortunately, as pastors, we are often guilty of reducing hope to healing (prettiness). I think that what we actually accentuate is not hope, but positive thinking. Hope is for the believer in Christ, whether we live or die. Hope is also to let go of the anxiety to be pretty (survive and be successful) and to find peace in your present circumstances. This is not the same as negativity, but it is facing reality.

136       Closing Ritual

  1. a) What did you learn today?
  2. b) Anything that limited your learning?
  3. c) Anything you would do differently in the future?
  4. d) Where is God at work?

137       Homework

     Your Task: Read Handout “Organ transplantation”.

 

ORGAN TRANSPLANTATION AND RELIGION

138       Handout: Organ transplantation and religion

Organ transplantation is an important issue to reflect on. In SA about 5 000 patients a year are waiting for organ transplants. The majority of them will die without it happening. We do only about 300 organ transplants a year because of the shortage of donors.

I believe these statistics exclude corneal transplants. Since its inception in 1975, the Eye Bank has supplied more than 22 000 corneas for transplants, with more than 90% of the operations successfully restoring the recipients’ vision. They have a waiting list of patients.

“The enemies we have to conquer in our battle to enhance the ‘quality’ and ‘quantity’ of life of our fellow human beings are ignorance, apathy, prejudice and fear. The weapons we have at our disposal are empathy, skill, dedication and perseverance. Fortunately these attributes are available in abundance in the whole community of transplant medicine.” (Dr Eduard Sevenster, ophthalmologist, Pretoria Eye Institute, Pretoria; Transplant News Vol 13 No 1 Issue 46 – March 2014).

Kidneys are by far the most in demand of all organs in South Africa. The diseases that contribute to the great need for kidneys include (genetic) hypertension, especially in the black population; diabetes (especially in the white and Asian populations); glomerulonephritis and pyelonephritis (inflammation of the kidneys); and inherited diseases such as polycystic kidneys. When disease causes kidney failure, dialysis treatment can take over the function of the kidneys, but a transplant is the ultimate aim for all end-stage kidney failure patients.

See the international organisation: The Transplant Society www.tts.org

139       Overview

There are two types of organ donation. The first is organs taken from a live donor. The second is cadaveric organ donation (using an organ harvested from a dead person). Live donation is only possible in certain, specific situations, and the donor is often a family member. An example of a live donor is when a family member donates one of their kidneys to another member of the family. This is possible because we can survive with a single, healthy kidney.

We also donate blood, because our bodies replace the lost blood through regeneration. Blood is technically not an organ, but a specialised connective tissue. But blood donation can be seen as an entry point for people to start thinking about organ donation.

In the case of a live donor, the donor needs to give their permission for the organ to be used. It is usually a situation in which there are many months of preparation, and families are normally quite clued-up and well informed about the process and consequences.

Most of the issues that people usually raise are those related to cadaveric donation, except in specific religious traditions for which the donation of blood is also an issue.

In the case of a cadaveric donation, everything happens fast. Families are confronted with a request to make available a part (or more) of their loved one’s body at the most difficult time of their lives, usually following a traumatic accident. Families have to deal with the loss of a love one and at the same time take a very important decision. Often families have never spoken about this before and they do not know how the person that passed away would have felt about it.

Before any vital organs (heart, lung, kidneys, liver) can be retrieved (harvested), the patient must be “brain dead”. Modern developments in medical science, such as in ventilators, mean assistance with breathing is possible or that breathing can be “taken over” and the heart can keep on beating in the case of a brain injury, even if brain functions have ended.

With the introduction of the concept of brain death, the definition of death is revisited. In medical terms a person is dead when his/her brain is dead and shows no functions whatsoever. This explanation goes beyond the understanding of many non-medical people. In the understanding of many non-medical people, a person is dead when their heart stops beating. Medically, however, it is possible to keep a heart beating artificially – but it is not possible to keep the brain going once the brain cells die.

Developments in twentieth century medicine made it possible that, when someone is brain dead, their breathing and heartbeat can be kept going artificially by a machine for a limited period of time. This is despite the fact that the person is actually dead.

It is during this limited period – when the breathing and heartbeat are kept going artificially – that vital organs can be removed to be transplanted into another person.

140       History of organ transplants

Blood transfusion led the way initially. When a method of preserving blood was discovered, as well as that there were different blood types, not all of them compatible with each other, blood transfusions became an accepted medical procedure. They were widely used during the First World War.

An important aspect that originally limited transplants was the issue of rejection – which is when the transplanted organ is rejected by the body of the receiver. Dr. Emmerich Ullmann experimented on dogs with kidney transplants in the early 1900s. He found that the closer the donor and recipient were genetically related, the longer the transplanted organ functioned. Human skin grafts were then attempted in the late 1920s. It was found that these could be performed between identical twins without the problem of rejection. In the early 1940s Dr. Peter Medawar and his team experimented with rabbits. They began to understand the immune system, which exists in higher animals and human beings. Antigens, on the surface of cells, enable higher organisms to recognise a foreign body. They stimulate the production of antibodies, which are important in fighting infection. This, however, also causes the phenomenon of rejection in organ transplants.

The more similar the tissues’ antigens of donor and recipient are, the less likely they are to recognise each other as alien bodies – which reduces the possibility of rejection. Tissue typing and matching are based on this. Rejection remains one of the main causes of failure in organ transplants because it is difficult to find completely matching tissues. New drugs (e.g. cyclosporine) greatly ease the rejection problem. Recipients, except in the case of a transplant between identical twins, need to take such drugs for the rest of their life.

The first successful transplant was a cornea transplant in 1905 by Eduard Zirm in the Czech Republic. In 1908 skin was transplanted from a donor to a recipient in Switzerland. A kidney was transplanted from a cadaver in the USSR in 1933. In 1950 the first successful kidney transplant was performed by Dr. Richard H. Lawler in Chicago, USA. In 1962 the first kidney was transplanted from a deceased donor (in the USA).

This was followed by several successful organ transplants. In 1966 the first successful pancreas transplant was performed by Richard Lillehei and William Kelly in Minnesota, USA. In 1967 the first successful liver transplant was done by Thomas Starzl in Denver, USA, and thus was followed the same year by the first successful heart transplant by Christiaan Barnard in Cape Town.

The research never stopped and in 1981 the first successful heart/lung transplant was done by Bruce Reitz in Stanford, USA. Now, we have hand transplants (1998); bladder transplants (1999); bowel transplants (2004); ovarian transplants (2005); face transplants (2005); and even penis transplants (2014).

141       Do organ transplants make sense?

In the early days of transplants, the success rate was much lower than it is today. But when do you stop and say that the costs and risks are not worth trying again and again? The success rate has improved tremendously over time, especially in the transplants of kidneys, hearts and heart-lung combinations.

Today, the transplantation of many organs from one person to another who are well-matched is quite successful, with the majority of recipients living five or more years. Kidney, cornea, bone marrow and skin transplants, for example, are now considered to be routine.

Heart, lung, heart-lung combinations, liver and pancreas (or pancreatic islets) transplants are also becoming more common. A human head transplant (also referred to as a body transplant) may be possible. In this case, though, the recipient would resemble a quadriplegic, because it would be impossible to connect the 100 to 200 million severed nerve endings.

In the case of a successful kidney transplant, however, the costs related to the transplant and the required drugs are less than the alternative of renal dialysis. The quality of life of the recipient is also better.

Experiments continue to be done to improve the technology and other possibilities related to transplants. For example, research is being done on human cell cultures, transplants from human foetuses, including brain tissue, and transplants from animals to human beings.

The latter include attempts to genetically design animals with organs that are less likely to be rejected by human beings. Some animal products (e.g. insulin and pig heart valves) are already used regularly. Research also continues to be done to improve artificial organs and other artificial aids to human functioning.

Since many people can benefit greatly from organ and tissue transplants in terms of the length and quality of life, the demand usually exceeds the supply. The costs related to some organ transplants are also very high. Therefore, many questions are raised today regarding how best to procure more organs, how to fairly distribute the limited resources, and whether all transplants should be covered by public funds.

142       The processs of declaring brain death

It is necessary to declare a person brain dead before any organs can be removed (harvested). A very detailed process must be followed before a person can be declared brain dead

A series of tests must be done to ensure not only that there is no possibility of recovery, but also that the brain has permanently and completely stopped functioning. Once the brain has ceased to function, the person is medically and legally dead.

Some organs (cornea and skin) and tissue can be retrieved after the heart has stopped beating. For the retrieval of other organs (heart, lungs, liver, kidney), however, it is necessary to maintain a certain minimum blood pressure rate and to keep oxygen in the blood at a particular level. Therefore, the body of the donor is given medication and kept on a ventilator. The ventilator is switched off only at the end of the procedure in the theatre where the organs are retrieved.

142.1         The “riddle” of brain death

Traditionally, death was determined by the heart and breathing having stopped. In most cases, there are still the criteria. The development of ICUs and ventilators changed that. In an ICU, it is possible to prevent the heart and breathing from stopping. In this context, death is defined in terms of the loss of brain stem functioning.

But in this same context the confirmation of death is also more complex since the heart is kept beating after the brain stem has stopped functioning. This is due to the use of a ventilator which allows the body (and the heart) to be artificially oxygenated. But when the brain stem has permanently stopped functioning this cannot be reversed, even in an ICU environment.

Brain death occurs when a person no longer has any activity in their brain stem and no potential for consciousness, even though a ventilator is keeping their heart beating and oxygen is circulating through their blood. When brain stem function is permanently lost, the person will be confirmed dead.

The functioning of the brain is central to what it is to be a living human being. It is the function of the brain to coordinate the way all the various organs of the body work together in the life of an individual. If the brain permanently stops functioning, this is the end of the integrated life of a human being, even though it may be possible, with machines, to keep some organs such as the heart and kidneys going.

142.2         Misjudgement of brain death

There are very few things in life that are one hundred percent sure and definite. Some people will say that “death” is the only thing we can be sure of. But when it is necessary to declare someone brain dead, it is necessary to be as sure as is humanly possible that the brain is not functioning any more.

Although rare, there are cases in which it may appear that brain death has occurred – but where it is not the case, such as with a drug overdose; in severe hypothermia when the body temperature drops below 28 degrees C; and during a diabetic coma.

There are thus very clear protocols which must be followed to rule out, as far as possible, human mistakes. Certifying a person “brain dead” requires strict clinical tests. Two experienced specialists have to determine, independently of each other, that permanent loss of all brain function has occurred. This is done by running particular, specified tests. Neither doctor may have any interest in any organ transplants that may follow.

A combination of clinical and blood tests as well as investigative scans[37] are used to confirm brain death. Every possibility that particular drugs and metabolic (of the body’s physical and chemical processes) conditions could play a role in mimicking brain death have to be ruled out. There also has to be a period of observation during which routine neurological (of the brain and nervous system) examinations do not find any evidence that the brain is working.

Brain death looks like a deep coma, but it is not a coma because there is the complete absence of all reflexes of the brain stem – which is that portion of the brain that connects with the spinal cord. The reflexes of the brain stem include breathing, coughing, gagging and responses of the eyes’ pupils to light.

Sometimes death is confirmed by evidence that there is a complete lack of blood flow to the brain. This often occurs with “brain death” since the brain swells inside the skull, and eventually the pressure becomes too high for blood to flow.

When the criterion of “brain death” is used, the official time of death is the time at which the final tests are done. If organ donation is to occur, the ventilator will not be turned off until the body is inside the operating theatre, which means the family and friends of the donor will not be present at that time.

(See http://www.nhs.uk/conditions/Brain-death/Pages/Introduction.aspx)

142.3         Brain stem

The brain stem is the lower part of the brain that is connected to the spinal cord. The brain stem is responsible for regulating most of the automatic functions of the body that are essential for life. These are: breathing, heart beat, blood pressure and swallowing.

The brain stem also relays all information to and from the brain and the rest of the body, which means it plays a fundamental role in the brain’s core functions such as consciousness, awareness and movement. There is no possibility of consciousness once brain death has occurred, and in combination with the inability to breathe or maintain bodily functions, this constitutes the death of the individual.

142.4         What causes brain death?

Brain death can occur when the blood and oxygen supply to the brain are stopped. This can be caused by several factors, including a heart attack (cardiac arrest) – when the heart stops beating and the brain is starved of oxygen; or a stroke – when the blood supply to the brain is interrupted by, for example, a blockage in one of your blood vessels, or the rupture of a vessel in the brain. Other causes include viral infections of the brain (encephalitis), a brain tumour and a severe head injury.

Of all these possibilities, a severe head injury, creates the most ideal circumstances in which a donor’s vital organs can be harvested and transplanted. The immediate damage to the brain in a head injury is often not immediately fatal and many a person ends up in an ICU where they are treated. The damage to the brain often develops over the following hours since bleeding might continue, with the result that the brain starts to swell.

142.5         Brain death is not the same as a persistent vegetative state

There is a difference between brain death and a persistent vegetative state (PVS), which can also occur after extensive damage to the brain. Someone in a PVS may show signs of wakefulness (they might open their eyes, for example) but have no response to their surroundings.

In rare cases, some patients may demonstrate some response that can be detected on a brain scan, but they will not be able to interact with their surroundings. However, the important difference between PVS and brain death is that a patient with PVS still has a functioning brain stem, therefore:

  • Some form of consciousness may exist in someone in a PVS.
  • A person in a PVS can breathe unaided.
  • A person in a PVS has a slim chance of recovering because the core functions of the brain stem are often unaffected, whereas a person with brain death has no chance of recovery as the body cannot survive without artificial support.

143       Religious beliefs

South Africa is a multicultural community. It is important that all members of our varied community feel assured that their views on organ and tissue donation and transplantation are respected. It is important that the practices of organ and tissue donation and transplantation take into account the cultural, ethical, spiritual and religious views of all those concerned. This need to respect different view points gives added importance to ensuring that each person makes a wise decision on donation.

A common question that arises when people are asked to donate organs and tissues of their loved ones is, whether it is compatible with their religious beliefs?”  Though answers may vary from one religion to another, research has found that the vast majority of religions do support donation and transplantation. The following is a summary of several major religions and ethnic traditions’ basic beliefs associated with organ donation:

143.1         Traditional African religion

Traditional African religion is not homogenic, based on cultural beliefs, and especially transmitted through oral traditions.

There is a strong belief in Supreme Being. God is never far away from an African understanding of the world. The ancestors are intermediaries and respect for ancestors are understood as respect of God. Ancestors are remembered, and include in decision making, but not really worshipped. Ancestors are important for protection and prosperity and is sometimes feared.

Life is communal. The individual is integrated with the community. Important ethical decisions should be discussed with a broad spectrum of people.

Health is harmony. Ill health is a sign of disharmony. The role of the ancestors is needed to create balance again. It is important to search for the hidden meaning for an event, “nothing in life just happens”.

Death is not the end of life. Death at an early age or before the completion of a task is viewed very negatively and not in the Divine Will. There is a belief that such a persons “soul is stolen” by witches. Rituals are important. Especially rituals around death is very important.

143.2         Islamic rulings on organ transplant donation

The religion of Islam strongly believes in the principle of saving human lives. Organ donation, like many other medical procedures, is permissible in Islam because it contributes to saving lives. Islam buries their dead within 24 hours.

This is consistent with the objectives of the Syari’ah (maqasid Syari’ah), which promotes human welfare and interest as well as the preservation of human life. Organ transplants belong in the same category as saving a life. The transplant may not bring harm to the donor. This is based on an Islamic legal maxim that states: “a harm cannot be removed in a way that leads to another type of harm”.

According to A. Sachedina,

“the majority of the Muslim scholars belonging to various schools of Islamic law have invoked the principle of priority of saving human life and have permitted the organ transplant as a necessity to procure that noble end”.

Islamic scholars made organ donations from a deceased person to a living one permissible if the deceased had consented to this while he/she was still alive, or if his/her next of kin had consented to it. The following are some fatwas on organ donation by Islamic jurists:

“Organs from the deceased can be transplanted to a patient, where the life of the recipient depends on the transplant, or if the continuation of the basic bodily functions of the recipient depends on the transplant. This is however, dependent on the deceased’s consent, or that of his next of kin after his death, or by the decision of the leaders of the Muslim community, should the deceased be unidentified, or does not have any next of kin.”

“It is permissible to transfer whole or part[s] of organs from a deceased to another person, if the need for such a transplant is critical. Live organ donation is also allowed if the recipient is in urgent need of the organ.”

Pledging to donate organs is strongly encouraged by Islam. This practice is in line with universal and humanitarian Islamic principles. These principles include rahmah, i.e., to show compassion, helping one another, and making continual (jariah) donations. Pledging organs is a practice that is imbued with the spirit of rahmah and compassion. A pledger will receive his/her rewards from Allah S.W.T., even if his/her organ has never been transplanted, as Allah rewards his/her good intentions and deeds which reflect the Islamic principles of rahmah and ihsan.

“Allah the Most Compassionate showers His compassion to those who show compassion. Show compassion to those on earth, and He in the heavens (i.e. God) will show His compassion to you.” (Hadith narrated by at-Tarmizi)

Islam also emphasises ta’awun (helping one another). Anyone who has a disease and needs an organ to continue living is definitely amongst those in need, and must be assisted by any means possible.

143.3         Judaism and organ donation

None of the major branches in Judaism bans organ donation. Judaism believes the dead must be buried as quickly as possible. Conservative, Orthodox and Reform authorities have all said that if the reason for a delay in the burial is to remove an organ that can save someone’s life, the action is justified. Indeed, some rabbinical authorities assert that Jews are required by their faith to sign donor agreements, owing to their duty to save those in need.

In Judaism there is a strong principle of not interfering with the body after death (kavod hamet). The question thus is whether organ donation is acceptable. Most scholars in Judaism agree that this principle should be read together with other important principles.

There are some Orthodox Jewish interpretations that forbid organ donation because it is viewed as mutilating a corpse, but this opinion is currently waning.

Generally, it is believed that if it is possible to donate an organ to save a life, it is obligatory to do so. In general, Judaism teaches that saving a human life takes precedence over maintaining the sanctity of the human body.

“If one is in the position to donate an organ to save another’s life, it is obligatory to do so, even if the donor never knows who the beneficiary will be. The basic principle of Jewish ethics – ‘the infinite worth of the human being’ – also includes donation of corneas, since eyesight restoration is considered a life-saving operation.”

The principle at play is “pikuach nefesh” – saving lives.

“This principle can override the Jewish objections to any unnecessary interference with the body after death, and the requirement for immediate burial.” (Judaism and organ donation: A guide to organ donation and Jewish beliefs).

It remains important that any further, unnecessary interference with the body after the removal of organs should be avoided, and interment should be expedited. For some Jews the “brain stem death” criteria are acceptable. But others will agree only to the removal of organs from a “non-heart-beating” donor.

“In all instances the principles of kavod hamet and pikuach nefesh would be considered, and in addition during the difficult decision process Judaism would also incorporate another principle, which must not be neglected: that of providing nichum aveilim – comfort for those who are bereaved.”

143.4         Buddhism and organ donation

There are no injunctions in Buddhism for or against organ donation. There are many different Buddhist traditions and organ donation is an individual choice:

Giving is the greatest of Buddhist virtues. The Buddha in a previous life gave his body to a starving tigress who could not feed her cubs. There are many such tales, and in some of them he even gave his eyes to someone who wanted them.

“What loss do I suffer to give an unwanted organ after my death to give another person life?” (Dr Desmond Biddulph, Chairman of The Buddhist Society)

It should be acknowledged that there are some Buddhists who have different views on the acceptability of organ transplants because for them the moment of death is defined according to criteria that differ from those of modern Western medicine.

The needs and wishes of a dying person should not be compromised by the wish to save a life. Where it is truly the wish of the dying person, the principles in Buddhism “to relieve suffering” and to “act with generosity” should be honored and organ donation accepted.

Where the wishes of the donor are uncertain, the teachings within the particular tradition to which the potential donor belongs should be accepted. Expert guidance should also be sought from a senior teacher within the tradition concerned.

“I would be happy if I was able to help someone else live after my own death.” (Dhammarati, Western Buddhist Order)

“Non-attachment to the body can be seen in the context of non-attachment to self and Buddhist teachings on impermanence. Compassion is a pre-eminent quality. Giving one’s body for the good of others is seen as a virtue.” (The Amida Trust)

“Organ donation is acceptable in Theravada Buddhism. It is a Buddhist virtue to generously extend help to other sentient beings and this covers the case of organ donation.” (Phramaha Laow Panyasiri, Abbot, The Buddhavihara Temple)

In summary: Buddhists believe that organ or tissue donation is a matter of individual conscience and place high value on acts of compassion. They emphasise the importance of informing family members about one’s wishes in relation to donation. Buddhists also honour those people who donate their bodies and organs to the advancement of medical science and to saving lives.

143.5         Hinduism and organ donation

Hindus are not prohibited by religious law from donating their organs, according to the Hindu Temple Society of North America. This decision would be an individual decision.

“Organ donation is in keeping with Hindu beliefs as it can help to save the life of others.” (The Late Mr Om Parkash Sharma MBE, President, National Council of Hindu Temples )

“I always carry my donor card with me. It says that my whole body can be used for organ donation and medical purposes after my death. I would like to encourage as many people as possible to do the same.” (The Late Dr Bal Mukund Bhala, Co-ordinator Hindu International Medical Mission, Former President Hindu Council UK )

“I believe in organ donation. If my body can help someone else live a better quality of life after my soul has vacated it, then it is good Seva.” (Mr Arjan Vekaria JP, President Hindu Forum of Britain)

There are many references in support of the concept of organ donation in Hindu scriptures. Daan is the original word in Sanskrit for donation, meaning selfless giving. In the list of the ten Niyamas (virtuous acts), daan comes third.

“Of all the things that it is possible to donate, to donate your own body is infinitely more worthwhile.” (The Manusmruti)

Life after death, which is an ongoing process of rebirth, is a strong belief of Hindus. The law of Karma decides which way the soul will go in the next life. The Bhagavad Gita describes the mortal body and the immortal soul in a simple way, comparing it to the relationship of clothes to a body:

“As a person puts on new garments, giving up the old ones, the soul similarly accepts new material bodies, giving up the old and useless ones.” (Bhagavad Gita chapter 2:22).

143.6         Sikhism and organ donation

Worldwide, there are 25 to 27 million Sikhs, which make up only 0.39% of the world’s population. Approximately 75% of Sikhs live in the Punjab province on the north Indian sub-continent, where they constitute about 60% of the state’s population. However, Sikhs only make up about 2% of the Indian population.

“Donation without reward is one of the characteristics of a Guru’s Sikhs. The life of Gurumukhi is useful because by their natural temperament they are donors. And why not donate an organ so another can live?” (Dr Jasdev Rai, British Sikh Consultative Forum (bscf)).

The Sikh philosophy and teachings place great emphasis on the importance of giving and putting others before oneself. Seva or selfless service is at the core of being a Sikh; to give without seeking reward or recognition and know that all seva is known to and appreciated by the Eternal. Seva can also be the donation of one’s organs to another. There are no taboos attached to organ donation in Sikhi, nor is there a requirement that a body should have all its organs intact at or after death. According to Sikhi, the soul migrates in a perpetual cycle of rebirth but the physical body is only a vessel on this long journey, left behind each time and dissolved into the elements.

Sikh Gurus devoted their lives to the benefit of humanity and some even sacrificed their lives looking after the welfare of others.

“Guru Har Krishen, our eighth Guru, gave his life helping sufferers during a smallpox epidemic. It is entirely consistent with his spirit of service that we consider donating organs after death to give life and hope to others… In my family we all carry donor cards and would encourage all Sikhs to do so.” (Lord Singh of Wimbledon CBE, Director, Network of Sikh Organisations UK).

The Sikh faith stresses the importance of performing noble deeds. There are many examples of selfless giving and sacrifice in Sikh teachings by the ten Gurus and other Sikhs: donating one’s organ to another so that the person may live is one of the greatest gifts and ultimate seva to humankind.

143.7         Shintoism and organ donation

Shintoism is the indigenous spirituality of the people of Japan. It comprises a set of practices to be carried out diligently. However, Shinto does not actually require a profession of the faith for one to be a practitioner of Shinto rituals. Shinto is sometimes seen by the Japanese as a way of life rather than a religion due to its historical and cultural significance. Due to the intertwined nature of Shinto and Buddhism, most “life” events are handled by Shinto and “death” or “afterlife” events are handled by Buddhism. It is typical in Japan, for example, to register or celebrate births at a Shinto shrine, while funeral arrangements are dictated by Buddhist tradition – although the division indicated here is not exclusive and absolute.

The Shinto faith is very much bound up with the idea of purity and the wholeness of the physical body. Because the body is impure after death, according to Shinto tradition, organ transplants are comparatively rare in Japan. Shinto traditions also state that tampering with a corpse brings bad luck.

“In folk belief context, injuring a dead body is a serious crime…” (E. Narnihira in his article, “Shinto Concept Concerning the Dead Human Body.”)

It is difficult to obtain consent from bereaved families for donation or dissection for the purposes of medical education or pathological anatomy. That is because Japanese families are concerned that transplants or dissection may injure the itai – the relationship between the dead person and the bereaved family.

This means that many followers of Shinto oppose the removal of organs from those who have just died, and would also refuse an organ transplanted from someone who has died.

143.8         Organ donation and christianity

The Christian faith is based upon the revelation of God in the life of Jesus Christ. Jesus taught people to love one another, and to embrace the needs of others. Organ donation can be considered by Christians as a genuine act of love.

Both Roman Catholicism and Protestantism support organ donation.

“The Methodist Church has consistently supported organ donation and transplantation in appropriate circumstances, as a means through which healing and health may be made possible.” Methodist Church UK

“Identifying specific faith groups and their beliefs and practice around organ donation provides a basis for discussion. We then need to share information on what faith groups believe in order to foster [a] better understanding of cultural norms. Disseminating more widely information on the cultural risk factors for kidney disease keeps people informed, assists in breaking barriers and engendering hope as people make better health choices which will positively impact their life” Sharon Platt-McDonald, Director for Health, Women Ministries and Disability Awareness for the Seventh-day Adventist churches in the British Isles.

To donate your organs is a very personal choice. The process of transplants is acceptable in terms of moral Christian law.

As Christians, we believe in eternal life and preparing for death should not be a source of fear. Nothing that happens to our body, before or after death, could impact on our relationship with God:

‘Neither death nor life, not anything else in all creation, will be able to separate us from the love of God that is in Jesus Christ our Lord.’ Romans 8:38-9

“Giving organs is the most generous act of self-giving imaginable.” (Rt. Revd Dr Barry Morgan, Archbishop of Wales, 2011)

In 2000, in his address to the 18th International Congress of the Transplantation Society, Pope John Paul II said:

“There is a need to instil in people’s hearts, especially in the hearts of the young, a genuine and deep appreciation of the need for brotherly love, a love that can find expression in the decision to become an organ donor.”

143.8.1              Catholic church

The Catechism of the Catholic Church explains:

“…organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity.

“It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.”

Catholics view organ donation as an act of charity, fraternal love and self-sacrifice. Transplants are ethically and morally acceptable to the Vatican. Pope John Paul II, in a statement, said:

“Those who believe in our Lord Jesus Christ, who gave His life for the salvation of all, should recognize the urgent need for a ready availability of organs for transplants a challenge to their generosity and fraternal love.”

“We encourage donation as an act of charity. It is something good that can result from tragedy and a way for families to find comfort by helping others. We do caution, however, that the organs are removed only after death and that people’s wishes are respected.” (Father Leroy Wickowski, Director of the Office of Health Affairs of the Archdiocese of Chicago)

143.8.2              Lutheran church

In 1984, the Lutheran Church in America passed a resolution stating that donation contributes to the wellbeing of humanity and can be an expression of sacrificial love for a neighbour in need:

“[We] call on “members to consider donating organs and to make any necessary family and legal arrangements, including the use of a signed donor card.”

143.8.3              baptist church

Organ transplants are generally approved when they do not seriously endanger the donor and when they offer real medical hope for the recipient. A transplant as an end in itself is not approved. It must offer the possibility of physical improvement and the extension of human life.

143.8.4              Presbyterian church

Presbyterians encourage and support donation. They respect a person’s right to make decisions regarding their own body.

143.8.5              United Methodist Church

The United Methodist Church has a policy statement with regard to donation. It states:

“The United Methodist Church recognizes the life-giving benefits of donation, and thereby encourages all Christians to become donors by signing and carrying cards or driver’s licenses, attesting to their commitment of such organs upon their death, to those in need, as a part of their ministry to others in the name of Christ, who gave His life that we might have life in its fullness.”

143.8.6              Assembly of God church

This church has no official policy with regard to donation. The decision to be a donor is left up to the individual. But donation is strongly supported by the denomination.

143.8.7              Wesleyan church

The Wesleyan Church supports donation as a way of helping others.  The church believes that God’s “ability to resurrect us is not dependent on whether or not all our part[s] were connected at death.”  it also supports research and in 1989 noted in a task force on public morals and social concerns that “one of the ways that a Christian can do good is to request that their body be donated to a medical school for use in teaching.”

143.8.8              Greek orthodox church

According to spokesperson Reverend Dr. Milton Efthimiou, the director of the Department of Church and Society for the Greek Orthodox Church of North and South America, the Greek Orthodox Church is not opposed to organ donation as long as the organs and tissue in question are used to better human life, i.e., for transplantation or for research that will lead to improvement in the treatment and prevention of disease.

143.8.9              Seventh day adventist church

Donation and transplantation are strongly encouraged by Seventh-Day Adventists. They have many transplant hospitals, including Loma Linda Hospital in California. Loma Linda specialises in paediatric heart transplantation.

143.8.10           AME & Zion church (African Methodist episcopal)

Organ donation is viewed as an act of neighbourly love and charity by these denominations. They encourage all members to support donation as a way of helping others.

143.8.11           Church of the brethren

The Church of the Brethren’s Annual Conference in 1993 accepted a resolution on organ and tissue donation in support and encouragement of donation:

“We have the opportunity to help others out of love for Christ, through the donation of organs and tissues.”

143.8.12           Mennonite church

Mennonites have no formal position on donation, but are not opposed to it. They believe the decision to donate is up to the individual and/or their family.

143.8.13           Church of Christ, scientist (Christian science)

The Church of Christ, Scientist takes no specific position on transplants or organ/tissue donation as distinct from other medical or surgical procedures. According to The First Church of Christ, Scientist in Boston, Massachusetts, Christian Scientists normally rely on spiritual rather than medical means for healing. Individuals are free, however, to choose whatever form of medical treatment they desire, including organ/tissue transplantation. But organ/tissue donation is a decision taken individually by church members.

143.8.14           Episcopal church or Anglican church

The Episcopal Church passed a resolution in 1982 that recognises the life-giving benefits of organ, blood, and tissue donation. All Christians are encouraged to become organ, blood, and tissue donors “as part of their ministry to others in the name of Christ, who gave His life that we may have life in its fullness”.

143.8.15           Jehovah’s witnesses

Jehovah’s Witnesses view an Old Testament prohibition against the “eating” of blood as meaning that blood from one person should never enter another’s body, even through a medical needle.

Jehovah’s Witnesses do not believe that the Bible comments directly on organ transplants; hence: decisions made regarding cornea, kidney, or other tissue transplants must be made by the individual. The same is true regarding bone transplants.

Jehovah’s Witnesses are often assumed to be opposed to donation because of their belief against blood transfusion. However, this merely means that all blood must be removed from the organs and tissues before being transplanted. (Office of Public Information for Jehovah’s Witnesses, October 20, 2005.) https://www.unos.org/donation/facts/theological-perspective-on-organ-and-tissue-donation/

143.8.16           Mormon (The church of Jesus Christ of latter day saints)

According to the Mormon religion, the question of whether a person should become an organ and tissue donor, or will their body to research after death, has to be answered from deep within the conscience of the individual involved. Those who seek counsel from the Church on the subject are encouraged to review the advantages and disadvantages of doing so, to implore the Lord for inspiration and guidance, and then take the course of action which would give them a feeling of peace and comfort.

143.9         Summary

It is not exactly clear what position the African religious grouping takes on organ and tissue donation or transplants, among other reasons because it is a very large grouping with diverse traditions.

The view of most Muslim commentators is that transplants are either charitable or required to preserve life. Buddhism and Hinduism leave this matter to the conscience of the individual, but the mainstream thinking in both faiths is that donating an organ is admirable as an act of compassion to others.

Broadly speaking, organ donation is accepted by the different religions. Not all religions are enthusiastic about it, but would still allow individuals to take the final decision.

Organ transplantation is comparatively rare in Japan because Shinto traditions has it that the body, once dead, is impure; also, tradition says that defiling a corpse brings bad luck to the person responsible.

Christian Science, in turn, does not ban modern medicine, as widely believed, but rather discourages healing by any means other than meditation and prayer, asking members to avoid professional medicine when possible. The practical result of this doctrine is that many Christian Scientists won’t donate or participate in transplantation. But strictly speaking, their faith does not stop them.

What the Jehovah’s Witnesses oppose is any movement of blood from one person to another: The faith does allow a “bloodless transplantation” if all blood is washed from the new organ and no transfusion is needed, but this is practical only in rare cases.

See also https://www.unos.org/donation/facts/theological-perspective-on-organ-and-tissue-donation/ for a more detailed discussion.

144       Philosophical ethical decisions

In medical ethics the four basic principles or duties are described as: autonomy; non-maleficence; beneficence and justice. In this regard, the book Medical Ethics, Law and Human Rights, edited by Keymanthri Moodley (2011), is excellent. A Kleinsmidt & MR Moosa discuss organ transplantation in Chapter 18 of the book (2011:281-290). Most of the following points are from their chapter.

144.1         Payment for organs?

The Declaration of Istanbul (2008) of The Transplantation Society and International Society of Nephrology condemns any commerce in organs.

One of the main arguments against payment for, or the sale of, organs is to guard against the inevitable situation where poor people would sell their organs to rich people. Not only is the possibility of exploitation very large, but there has been evidence of underpayment, abuse by intermediaries, and a lack of proper post-operative care for donors.

There are those who question an absolute ban and ask whether a well-regulated system would not be of more value.

There are also those who argue that the state should not take a paternalistic role by restricting what adult people may do with their own body tissue. On the other hand, there are those who point out that the sale of organs by the poor is not truly autonomous but arises out of the desperation caused by poverty.

From an ethical perspective, the question is how it affects people’s dignity if they have to sell their body organs or tissue. Some people argue that people do all sorts of undignified tasks for remuneration.

Exactly where the line should be drawn, if compensation is allowed, is also unclear. If you allow a donor the reimbursement of expenses incurred, for loss of income, or even the payment of funeral costs, how far removed are you from adding payment for the risks taken, and eventually, for the organ itself.

State paternalism is taken even further in China where organs have been harvested from people who are sentenced to death. In terms of the Chinese understanding of Confucian ethics, this offers an opportunity for redemption by performing a virtuous act through organ donation.

This raises questions about the possible abuse of the system, as well as expressions of concern about the Chinese justice system, including whether proper informed consent from families and prisoners is obtained.

Pressure on the Chinese government has led to an undertaking that organs would only be harvested if the immediate family of the donor could benefit from an organ transplant.

Most countries, with the exception of Iran, prohibits the sale of solid organs. In Iran there is a regulated system where people receive a government donor award if they donate one of their kidneys. Most cases concern living, unrelated donors. Foreigners are not allowed to participate in the programme either as donor or recipient.

144.2         The importance of consent

Most of the religions that support organ donation specify that the consent of the donor or the donor’s family should be sought. In most countries, this aspect of the requirement of consent is also legislated.

Many potential organs and tissue for transplantation (e.g. from brain-dead accident victims) are lost because people do not express their voluntary consent or inform their families about their wishes while they are alive. Because of this situation and the shortage of donor organs and tissue, other models of consent have been proposed, including presumed consent (UK). Presumed consent means that if there is no explicit objection to the donation of an organ, consent should be presumed to have been given.

Some people argue that unless the potential donor (an accident victim, for example), while alive, had given clear indications to the contrary, it would be ethical to presume that consent had been given since transplantation does not harm that donor after death – while it without doubt benefits others. In France, Belgium and some other countries, legislation is in place in terms of various forms of presumed consent. These include that people can, for example, opt out of organ donation by registering their intention not to be a donor.

Some of the countries that apply the “opt-out” system are Spain, Austria and Sweden. This system operates on the same principle of presumptive, rather than informed, consent. It is presumed that all citizens have consented to organ donation unless they have registered their opposition to donating organs.

Supporters of the “opt-out” system believe it is acceptable in terms of the principle of beneficence. This principle rests on the acceptance that organ recipients benefit tremendously. These benefits can’t be compared with the interests of the dead person – who benefits nothing in not donating his/her organs.

However, there is considered to be a danger that, in an “opt-out” system, those who opted out could be placed at the bottom of waiting lists for potential organ recipients. The opt-out system also depends on a fully informed public.

Where the transplant system depends on people signing donor cards while they are alive, the reality is that only a minority of those who die (and are deemed to be potential donors) have in fact signed donor cards. This is despite the fact that there are indications that many of those who do not legally sign a donor card are in favour of organ donation.

Questions raised about this opt-out approach include the following: Should minors and the mentally disabled be included? To what extent should health care professionals check to see whether a patient has an expressed wish not to donate? Concerns include the possibility of human ignorance and weakness being exploited (such as whether people are ignorant about the fact that they can opt out, or whether they are just too lackadaisical to do so).

In South Africa consent is seen as an important aspect of the process. Should the family of  a potential donor refuse consent, the process is stopped. It has its drawbacks. We have a tremendous shortage of organs to transplant because so many families refuse to give consent and also because many rural hospitals cannot deal with the management of a brain-dead patient until the organ transplant team arrives.

144.3         Difficult decisions of the distribution of scarce organs

If a specific person is in need of a number of healthy organs and several become available, should all these organs go to just that one person? Or should a number of different people in need of healthy organs benefit? Should a person whose first transplant failed be given a second organ, or should another person get their first chance? Should individuals who have abused their bodies by smoking, drinking, or though their diet, receive new organs? Or should organs be given only to those whose organs were damaged by illness? Is it appropriate to spend money, time, and energy on transplanting, for example, hands, or other appendages that are not essential to life?

Who has the moral right to make decisions about your body after death?

Who can “donate” the organs of those individuals who are unable to give consent? Is it possible to prevent the coercion of donors? When should the courts get involved in organ donation decisions? The questions go on and on.

145       Theological and ethical considerations

There was a time when some people viewed organ transplantation as an action that pushed the boundaries in medicine too far. Some feared the medical fraternity were “guilty” of “playing God”. Since then so many people have benefited from organ transplants that, for the informed, the practice is now close to normal.

Organ transplants cannot be seen in isolation from other medical-ethical questions. Developments in DNA technology and cloning open up new debates. But again the question is whether the biological and medical fraternities are “guilty” of “playing God”.

In the new debates, the questions are about life and the creation of “better human beings” and the “uniqueness of the human person”. In some theological circles one of the questions is: what happens in terms of the so-called “soul” of the new cloned being? The same question was also asked when the first heart transplants were done. Since then most people have adapted and refined their understanding of the connection between a so-called soul and the heart as a biological organ.

The fear of the unknown is human. But our fears should not overshadow our ethical thinking. What would be the next boundary to cross in the medical field?

145.1         The body as a useless shell

There are those in Christianity who have an ancient Greek classical understanding of the body – as something that is useless and without any value. When such an antagonistic understanding of the human body is held, organ donation would easily be supported because of the over emphasis on the spirituality of their faith – as opposed to, and more valuable than, the “useless” body. This negative view of the body would not be an acceptable or good reason to support organ donation and should be discouraged.

145.2         Holistic understanding of the human being

It is not merely a question of organ transplants or not, but rather about the total human being. The ethical question is in fact about how we care, respect and do not damage the dignity of the donor, the receiver, and all their extended relationships.

145.3         Theological paradigms

Certain theological themes influence ethical thinking.

145.3.1              Creation and re-creation

In Christian ethical discussions the focus can sometimes be on a creationist perspective, which means creation then becomes normative. This is very unfortunate. Creation is not irrelevant, but should not be separated from or prioritised over re-creation. The attempt to think about how things were originally, and then to re-create that situation, will always take us backwards to the past. We do not know how things were. When creation takes centre stage, Christian ethics often ends up being deterministic, perfectionistic, and legalistic.

Contradictions and paradoxes are ingredients of biblical faith. Christian faith is a “faith for the road”, it is a faith invited by God to journey with the Spirit in the direction of a re-creation.

From a Christian theological view, it is important to understand that “nature as such is not always the norm when moral decisions have to be made” (Louw 2005:316). A person born with a certain disfigurement is not doomed if he/she goes for plastic surgery. An infertile couple should be able to use the available treatment for infertility. In short, nature does not necessarily equal the will of God – the existing reality is not normative.

The focus of the New Testament is re-creation. The salvation on the cross; the resurrection; the Holy Spirit and the promise of a new heaven and earth should all be viewed in the light of re-creation.

Another way of thinking from a re-creationist paradigm is to emphasise the eschatology, (another way to refer to the end times). This will only be realised in complete fullness with His Parousia, the Second Coming.

From this perspective, to think ethically about human beings is to think in terms of who we already are in Christ. The implication is that we can’t just think about what we do, but should at the same time think about who we are. In theological terms, we would say the indicative determines the imperative.

What is fundamental, is who we are for one another, and not what we want to achieve through one another. Unconditional love and not duty is the Christian calling. Unconditional love is not based on discovering something loveable in our neighbour – instead it is love that opens itself up to those whom we would otherwise naturally say are not worthy of being loved and are hated or condemned.

145.3.2              What about the “soul”

Ministers of religion are often called “soul mechanics”. The understanding is often that it means that we should be busy with the “inner” parts of humans. Then again, some psychologists protest when pastors dig too deeply into the inner parts – because that is the domain of psychologists, who want to limit pastors to the spiritual domain of the inner life.

Many of these misguided notions (shared also by many pastors) are based on a very limited understanding of the concept of “soul”. It is a pity that the “soul” as a concept is often seen as something that is separate from the human body. The influence of the ancient Greek philosophers (Aristotle and Plato) on Christian tradition plays a major role in this regard.

A holistic reading of the bible opens up an integrated understanding of human beings. We are what Daniël Louw (2005:78) calls “ensouled bodies” and an “embodied soul”. One does not have a soul, one is soul in every fibre of one’s (human) being.

Following Platonic thinking, many people have a deep-seated conviction that the soul refers only to the inner world or the spiritual realm. But soul refers to life and its qualities – as can be understood in the Hebrew words (nephesh, kardia, nous) and Greek words (psyche, pneuma). Soul is not an inward substance, but the totality of life, inner and outer, within the presence of God (Louw 2005:79).

Soul should be understood as a systemic entity that can only be interpreted in terms of the dynamics of interactive and interrelated relationships. In modern times, the word “networking” is descriptive of this. Soul indicates a mode of being. This mode of being includes all the human functions, such as knowing, feeling (emotive) and believing (conative), and these are all both physical and qualitative. Qualitative aspects refer to the numerous dimensions – experiential, functional, behavioural, spiritual – that are beyond measurement in terms of being human. To be human means to be constantly busy with making and giving meaning, taking a stance in life, connecting with choices, driven by forces, making and breaking commitments, seeking direction, finding one’s vocation or being uncertain about one’s vocation; seeking spiritual enrichment or rejecting spiritual inputs, and so on.

It is important to keep in mind that questions on mortality and immortality comes to the fore in matters of spiritual reflection. Human beings do not possess immortality. Human beings, like the rest of creation, are vulnerable and mortal. It is only as an act of God’s faithfulness and grace that we are granted immortality (1 Cor 15:53).

The aim of the emphasis on the term “soul” above is to redirect attention to the urgent need for a holistic view of human beings. In theology, but also in other disciplines such as medicine and psychology, this holistic understanding is often absent. Unfortunately, due to greater and greater specialisation (which, however, also brings about important benefits and development) this shift in focus means we have lost track of the totality of being human as well as how humans are essentially interrelated with the rest of creation.

145.3.3              Being human

The concerns of Christian theology, along with other religions, include respecting the dignity of human beings and a just and fair distribution of resources.

Some groups in the Christian community think in dualistic terms and separate the spiritual and physical dimensions of life from each other. These groups tend to place too much emphasis on the harmful effects that the physical body and human nature could have on our spiritual lives.

Bur throughout the ages many readers of the Bible have also interpreted the Bible in a holistic way.

The Christian tradition (following Scripture) distinctly emphasises the importance of a social ethos that is focused on the need to take care of the other, the neighbour, the marginalised, the poor, the outcasts and the oppressed.

The dictum of Schrage (1988:83) goes some way towards explaining this:

“The neighbour in need is the only place where we find God in the world”

From a spiritual point of view, humans have rights and consequently Christians should take up issues of justice and dignity. Our fellow human beings become the face of God who is constantly calling on us to love unconditionally.

146       Pastoral issues

146.1         Dealing with people in crisis

In terms of organ donation, we are dealing with families who are experiencing trauma and loss. Families in these circumstances are under pressure to make important decisions very quickly.

Approach potential donors and their families sensitively. Provide the necessary personal and social support with regard to the grieving process. Consider rituals and possible services of remembrance and gratitude both before and after what is in reality the dissection of the human cadaver.

The language to use is the same as for an operation, which makes sense because the organs are removed in an operating theatre, but without an anaesthetist, because the person is dead. While medical staff may refer to “harvesting the organs”, which has connotations of “taking”, it might be more dignified to speak of “donation”, which connotes with “giving”.

Make an effort to find non-technical words to communicate with patients and family. Be honest and open without being harsh. Acknowledge to the family when you are uncertain about any answer to their questions or you don’t know the answers.

146.2         Certain time constrints

In the case of trauma, brain stem death leads to a fall in blood pressure and circulatory arrest. Time is thus of the essence in terms of any decisions that the family of a potential donor would have to take. The time available between harvesting an organ and transplanting it into the recipient is also limited.

The essence of pastoral support should be to balance, on the one hand, the pressure from medical staff not to lose out on the organs, and on the other hand, the needs of the family of the donor.

146.3         Unnatural situation

Although a person on a respirator may look as though he or she is alive, it is the ventilator that artificially maintains the breathing and heart beat. The ventilator will continue to run when the body is taken to the operating theatre for the organs to be removed and medical personnel will be in attendance. The surgery is equivalent to a major operation, with the exception that organs are removed.

Pastoral support for the donor’s family could include sharing information with them if they ask about what would happen in the theatre.

The organs are removed with great care. The operation is usually lengthy, depending on which organs need to be removed. Depending on the injuries the donor had suffered, the body is generally restored to a normal appearance after the organ is removed.

After the surgery is completed, the family may wish to spend time with their relative’s body. It is well recognised that spending time with the body is an important part of grieving.

146.4         Interaction between pastoral caregiver and medical staff

Organ donation creates a situation in which the quality of co-operation between the medical staff (doctors and nurses) and the pastoral caregiver is important. We occupy the “neutral” position in this process. But because we understand the medical process, we can create a space of safety between the interests of the families and of the medical staff.

It is also a stressful time for medical staff, especially the nursing staff of the ICU who have to carry the extra burden of monitoring a body while looking after other patients and dealing with the family of the donor.

 

 

Session 15

147       SESSION 15

148       Daily Ritual

148.1         Losses and gains

148.2         Time of discernment

148.3         Dwelling in the word Matthew 25:34-46

NAV                                                                                    NIV

34“Dan sal die Koning vir dié aan sy regterkant sê: ‘Kom, julle wat deur my Vader geseën is! Die koninkryk is van die skepping van die wêreld af vir julle voorberei. Neem dit as erfenis in besit, 35want Ek was honger, en julle het My iets gegee om te eet; Ek was dors, en julle het My iets gegee om te drink; Ek was ’n vreemdeling, en julle het My gehuisves; 36Ek was sonder klere, en julle het vir My klere gegee; siek, en julle het My verpleeg; in die tronk, en julle het My besoek.’37Dan sal dié wat die wil van God gedoen het, Hom vra: ‘Here, wanneer het ons U honger gesien en U gevoed, of dors en U iets gegee om te drink? 38En wanneer het ons U ’n vreemdeling gesien en U gehuisves, of sonder klere, en vir U klere gegee? 39Wanneer het ons U siek gesien of in die tronk en U besoek?’40En die Koning sal hulle antwoord: ‘Dit verseker Ek julle: Vir sover julle dit aan een van die geringste van hierdie broers van My gedoen het, het julle dit aan My gedoen.’

41“Dan sal die Koning vir dié aan sy linkerkant sê: ‘Gaan weg van My af, julle vervloektes! Gaan na die ewige vuur wat vir die duiwel en sy engele voorberei is, 42want Ek was honger, en julle het My niks gegee om te eet nie; Ek was dors, en julle het My niks gegee om te drink nie; 43Ek was ’n vreemdeling, en julle het My nie gehuisves nie; sonder klere, en julle het My nie klere gegee nie; siek en in die tronk, en julle het My nie versorg nie.’44Dan sal hulle ook antwoord: ‘Here, wanneer het ons U honger of dors of ’n vreemdeling of sonder klere of siek of in die tronk gesien en U nie gehelp nie?’45En Hy sal hulle antwoord: ‘Dit verseker Ek julle: Vir sover julle dit aan een van hierdie geringstes nie gedoen het nie, het julle dit aan My ook nie gedoen nie.’46En hierdie mense sal die ewige straf ontvang, maar dié wat die wil van God gedoen het, die ewige lewe.”

 

34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’

37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’

40 “The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’

41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

45 “He will reply, ‘I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.’

46 “Then they will go away to eternal punishment, but the righteous to eternal life.”

 

148.3.1              Sharing and listening to your partner

  • Task: What did your partner hear in the text?
  • Feedback rule: Provide the group with feedback on what your partner has told you.

148.4         Homework feedback

Your Task: Handout

148.5         Learnings and parking questions

Session 15: End of life

149       SESSION 15: END OF LIFE QUESTIONS

149.1         Assisted dying/ Euthansia (Genadedood)

Euthanasia means the deliberate act of choosing a painless death or bringing about death intentionally for the humane purpose of ending the agony of someone who is suffering from an incurable disease or injury, according to Louw (2008:325 note 149; referring to DK Clark et. al. 1996).

149.1.1              Active euthanasia and voluntary assisted dying

Active euthanasia or voluntary assisted dying means to actively initiate a process that would take a patient’s life or shorten the life of an already dying patient. The patient chooses the time at which death occurs.

149.1.2              Passive euthanasia

Medical developments have made it possible to keep people alive artificially for a long time and often much beyond their ability to stay alive unassisted. There is a sense in which passive euthanasia is, in most cases, different from active euthanasia (which is discussed above). In most cases, passive euthanasia would mean the withholding and/or withdrawal of active medical treatment – which may shorten life. It may also refer to the provision of medication such as morphine for the purposes of pain relief, but which could shorten life since such pain medication may also suppress respiration. However, this scenario is likely to occur only when very serious pain is experienced and there are no other ways of relieving the pain.

A patient might not be able to give their permission directly to set in motion the conditions for passive euthanasia to occur. But there could have been a series of decisions leading up to the actual withdrawal of active treatment – which may shorten the patient’s life. One of the very difficult decisions to take in medical care is at which stage alimentation (medically supported feeding) should be stopped. Most doctors would not support the withdrawal of fluids, although it is possible to hasten death (by a few hours) by reducing fluid intake to the minimum.

Turning off the respirator of a 92-year-old patient who had suffered massive brain bleeding may shorten his life by anything between a few hours and two days, for example. It is possible to argue that there are benefits to keeping the respirator going for another hour or a day. It may, for example, allow the patient’s family more time to get used to the imminent death of their loved  one. This argument would have to be weighed against how affected the family would be if, instead, they had to sit and wait for the death of their loved one. For many families it would also mean an increased financial burden.

The withdrawal of treatment is an often accepted practice as part of good medical care in the end-phase of life, especially because modern improvements in medical technology have, in many circumstances, made it increasingly difficult to die despite severe ill health or serious injury.

In South Africa, signing a Living Will to limit medical treatment under these conditions would not, however, overrule the decision of doctors – who are legally responsible for decisions on medical care. But this would not make a Living Will totally useless. It would give doctors in charge of patients’ care an indication of the patients’ thinking about end-of-life treatment when they can’t speak for themselves. It could also help family members when the doctor discusses treatment withdrawal with them.

150       Closing of Course

150.1         Learnings

150.2         Issues parked during session

150.3         Evaluation of all five modules

 

 

 

 

151       AGAPE MEAL [38]

Agape is the New Testament word for love. Although the origins of an agape meal in the early church are closely connected to the origins of the Lord’s Supper, over time the two services have become quite distinct. An agape meal is not a sacrament, like either the Lord’s Supper or a baptism. It has become a fellowship meal that rather reminds us of all the ordinary meals that Jesus ate with his disciples. What it expresses is the koinonia (community, sharing, fellowship) enjoyed by the family of Christ. When we now share in an agape meal, it serves as a celebration of our love for and fellowship with one another.

151.1         Opening prayer (PS 136)

Reader 1:

1     Give thanks to the LORD, for he is good.

Response by the group: His love endures forever.

2     Give thanks to the God of gods.

His love endures forever.

3     Give thanks to the Lord of lords:

His love endures forever.

4     to him who alone does great wonders,

His love endures forever.

5     who by his understanding made the heavens,

His love endures forever.

6     who spread out the earth upon the waters,

His love endures forever.

7     who made the great lights—

His love endures forever.

8     the sun to govern the day,

His love endures forever.

9     the moon and stars to govern the night;

His love endures forever.

23     to the One who remembered us in our low estate

His love endures forever.

24     and freed us from our enemies,

His love endures forever.

25     and who gives food to every creature.

His love endures forever.

26     Give thanks to the God of heaven.

His love endures forever.

151.2         Togetherness

Reader 2:

How good and pleasant it is for God’s people to live together in unity! (Ps 133)

Response of group:

We thank you Lord for the joys of our togetherness in Christ Jesus

For times of forgiveness and signs of acceptance

For the support that we receive form one another. It helps us to relieve one another’s burden.

We thank you for the love and fellowship with one another.

151.3         Acknowledgement

Reader 3: (Psalm 51)

1 Have mercy on me, O God, according to your unfailing love;

according to your great compassion blot out my transgressions.

2 Wash away all my iniquity and cleanse me from my sin.

3 For I know my transgressions, and my sin is always before me

Response of group:

We acknowledge

Our shortcoming and failures

Our lack of forgiveness

Our lack of openness

Our lack of sensitivity

151.4         We confess

Reader 4: (1 Cor 10)

31 So whether you eat or drink or whatever you do, do it all for the glory of God

Response of group:

We confess

That we tried to be better than others

That we were in too much of a hurry to really listen

That we acted with motives other than love

That we easily judge others

151.5         Silence

Reader 5:

To all who trust in God’s forgiveness, Christ promises courage and power, God’s presence in time of joy and sorrow. Life in God’s kingdom

Response of group: (Rom 8)

33 What, then, shall we say in response to this? If God is for us, who can be against us? 32 He who did not spare his own Son, but gave him up for us all—how will he not also, along with him, graciously give us all things? 33 Who will bring any charge against those whom God has chosen? It is God who justifies. 34 Who is he that condemns? Christ Jesus, who died—more than that, who was raised to life—is at the right hand of God and is also interceding for us. 35 Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword?

151.6         Symbols

Reader 1: (With Cross/ Bible)

Joh 19 So the soldiers took charge of Jesus. 17 Carrying his own cross, he went out to the place of the Skull (which in Aramaic is called Golgotha). 18 Here they crucified him, and with him two others—one on each side and Jesus in the middle.

Reader 2: (With candle)

John 12:46 I have come into the world as a light, so that no one who believes in me should stay in darkness.

Reader 3: (With bread)

John 6:32 Jesus said to them, “I tell you the truth, it is not Moses who has given you the bread from heaven, but it is my Father who gives you the true bread from heaven. 33 For the bread of God is he who comes down from heaven and gives life to the world.”

35 Then Jesus declared, “I am the bread of life. He who comes to me will never go hungry, and he who believes in me will never be thirsty.

151.7         Sharing

Reader 4:

He broke down the walls of separation. He made us one in Him. Through his reconciling love we share this meal with gratitude. May Jesus strengthen us. May He help us to serve and love one another. There is no end to his love and kindness.

Response of group:

Christ is our peace

151.8         The dedication for service

Reader 5: There are different gifts

Response: but it is the same Spirit who gives them

Reader: There are different ways of serving God

Response: but it is the same Lord who is served.

Reader: God work through different people in different ways,

Response: but it is the same God who achieves his purpose through them all.

Reader: Each one is given a gift by the Spirit,

Response: to use it for the common good.

151.9         Prayer

Eternal God, by whose overflowing love we are endowed with differing gifts of your Spirit for the service of the Gospel: look now on these, your servants, who we are to commission in your Name, that they and all your people may make your grace and glory known to all the world; through Jesus Christ our Lord. Amen

151.10      Closure

All together:

The festival of sharing is over.

God help us, to serve one another and to work for justice and peace.

Let your love for us be the power of our lives.

We commit ourselves to your unlimited love in Christ Jesus.

Amen

 

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Louw, J. P., & Nida, E. A. (Reds.). (1988). Greek-English Lexicon of the New Testament based on Semantic Domains (Vol. 1 & 2). New York: United Bible Societies .

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Lucado, M. (2001). Traveling Light . Nashville: Thomas Nelson .

Malan, F. (2013). Bestaan die hel regtig? In J. Van der Watt (Red.), 88 Kwelvrae wat Gelowiges Pla (ble. 125-126). Vereeniging : CUM.

Marais, F. (2007). God praat – leef luisterryk vir vergaderings. Handleiding vir gemeenteleiers op soek na God se agenda vir gemeentes. Wellington: Bybelkor.

McMinn, M. R., & Phillips, T. R. (Reds.). (2001). Care for the Soul. Exploring the Intersection of Psychology and Theology. Downers Grove, Illinois: IVP Academic. Herwin 02 2009

Moriarty, G. L. (Red.). (2010). Integrating Faith and Psychology. Twelve Psychologists tell their stories. Downers Grove, Illinois: IVP Academic.

Muller, J. (2000). Reis-geselskap. Die kuns van verhalende pastorale gespreksvoering. Wellington: Lux Verbi.BM.

Nicol , W. (2012). ‘n Dieper Dors. Ervaar die spiritualiteit van Johannes. Vereeniging: CUM.

Nicol, Willem 2016. Oop vir die oomblik. Nader aan die hier en nou met die Here. Wellington: Bybelkor

O’Murchu, D. (1997). Quantum Theology. New York, USA: The Crossroad Publishing Company.

Oosthuizen, P. (2007). Ontsnap van depressie. Kaapstad: Tafelberg.

Orsmond, E., & Botha, J. (Reds.). (2013-2014). Woord en Fees. Preekstudies en Liturgiese Voorstelle gebaseer op Kerkjaar. Jaar A. Stellenbosch: Communitas.

Peck, M Scott 2007. The road less traveled and beyond. Spiritual growth in an age of anxiety. London: Rider

Perrin, F., Schnakers, C., Schabus, M., Degueldre, C., Goldman, S., Bredart, S., . . . Laureys, S. (2006). Brain response to One’s Own Name in Vegetative State, Minimally Conscious State, and Locked-in Syndrome. Arch Neurol, 63, 562-569.

Piek, J. (Red.). (1981). Die Kind en die Hospitaal . Pretoria: HAUM.

Prins, S. J. (1971). Pastoraat en Psigiologie. Prinsipiele Oorwegings (Vol. Sielkundebiblioteek Vol 19). (A. S. Roux, Red.) Pretoria: J L van Schaik Beperk.

Punt, J. (2013-2014). Romeine 9:1-5. In Woord en Fees (ble. 231-233).

Roscam Abbing, P. J. (1964). Pastoraat aan Zieken. In M. H. Bolkenstein, F. J. Pop, & P. J. Roscam Abbing (Reds.), Praktisch Theologische Handboekjes (Vol. 24, bl. 212). S’Gravenhage, Nederland: Boekencentrum N.V.

Rossouw , P. J. (1983). Grondlyne van ‘n Pastorale Model – Gerben Heitink. Pretoria: NG Kerkboekhandel Transvaal.

Schulze, L. F. (1987). Geloof deur die Eeue. Pretoria: NG Kerkboekhandel.

Sittser, J. (2013). In die Stilte van Verlies. (E. Steyn, Verts.) Vereeniging: CUM.

Slabbert, L. (1999). Wanneer ‘n Geliefde Sterf. Die weg van droefheid na aanvaarding. Vereeniging: CUM.

Smit, D. J. (1981). 1 Korinthiers 11:17-34. In C. W. Burger, B. A. Muller, & D. J. Smit, Woord teen die Lig 4 (ble. 142-157). Kaapstad.

Smit, D. J. (1982). 1 Korinthiers 10:14-22. In C. W. Burger, B. A. Muller, & D. J. Smit, Woord teen die Lig (ble. 132-141). Kaapstad.

Smit, D. J. (1982). Die Prediking by die Nagmaal. In W. C. Burger, B. A. Muller, & D. J. Smit, Woord teen die Lig 4. Nagmaalsprediking (ble. 11-31). Kaapstad.

Smit, D J 2006. Neem, lees! Hoe ons die Bybel hoor en verstaan. Wellington: Lux verbi.BM

Spangenberg, Izak 2002. Perspectives on the Bible. God’s Word in ordinary language. Pretoria: Protea Book House. Translation of the Afrikaans edition Perspektiewe op die Bybel. God se word in mense taal 1998

Stone, H. S. (1976). Crisis Counseling. Philadelphia: Fortress Press.

Swanepoel, Francois A (Red). (1993). Lyding: Sinloos of Singewend? Muckleneuk, Pretoria: CB Powell-Bybelsentrum.

Theron, F. (2011). Gods geregtigheid en Christus se geloof. Oor die tekens van God se trou. Wellington: Bybel-Media.

Townsend, John 2011. Beyond Boundaries. Learning to Trust Again in Relationships. Grand Rapids: Zondervan

Van der Watt, J. e. (2013). 88 Kwelvrae wat Gelowiges Pla. Vereeniging: CUM.

Van Niekerk, Attie (1996). Anderkant die reenboog. Kaapstad: Tafelberg.

Van Niekerk, A. A. (2005). Geloof sonder sekerhede. Besinning vir eietydse gelowiges. Wellington: Lux Verbi.BM.

Van Niekerk, Anton A 2014. Geloof sonder sekerhede. Hoe kan ek nog glo? Kaapstad: Lux Verbi

Van Niekerk, E. A. (1984). Nie soos Mense sonder Hoop nie. Hoe om sterwendes en treurendes by te staan. Kaapstad: Lux Verbi.

Van Niekerk, R. (2002). Verlies, Pyn en die Verwerking Daarvan. Vereeniging: CUM.

Venter, C. J. (1972). By die Sterfbed. Potchefstroom: Pro Rege.

Ver Straten, C. A. (1988). A Caring Church. Through shepherding ministries. Grand Rapids, Michigan : Baker Book House.

Vosloo, W., & Van Rensburg, F. (Reds.). (1999). Die Bybellenium. Eenvolumekommentaar. Die Bybel uitgele vir eietydse toepassing. Vereeniging: CUM.

Vosloo, W., & Van Rensburg, F. J. (Reds.). (1999). Die Bybellennium. Eenvolumekommentaar. Die Bybel Uitgele vir Eietydse Toepassing. Vereeniging: CUM.

Willard, D. (1998). The DIVINE Conspiracy. Rediscovering our hidden life in God. London: Fount Paperbacks.

Wright, N. T. (2006). Simply Christian. Why Christianity makes sense. New York: Harper One. Herwin 08 2014

152.1    Extra references organ transplantation:

Organ Transplant In Islam. The Fiqh[39] of Organ Transplant. and Its Application in Singaporehttp://odc.hamad.qa/en/images/Islam_and_Donation.pdf

http://www.organdonation.nhs.uk/ukt/how_to_become_a_donor/religious_perspectives/leaflets/hindu_dharma_and_organ_donation.asp

http://thetransplantnetwork.com/faq/questions-about-donation/religious-views-on-organ-donation/

http://www.bbc.co.uk/religion/religions/shinto/shintoethics/organs.shtml

http://highschoolbioethics.georgetown.edu/units/unit2.html

http://www.nhs.uk/conditions/Brain-death/Pages/Introduction.aspx

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Jacobs, M. (1987). Swift to Hear. Facilitating skills in listening and responding (2 uitg.). London: SPCK.

Janse van Rensburg, J. (2007). Prediking uit die Ou Testament. Wellington: Bybel-Media.

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Jonker, W. D. (1976). Die Brief aan die Romeine. Kaapstad: NGKerk-Uitgewers.

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Jupp, P. C., & Rogers, T. (Reds.). (1997). Interpreting Death. Christian theology and pastoral practice. London: Cassell.

Konig, A. (2001). Fokus op 300 Geloofsvrae wat mense die meeste vra. Wellington: Lux Verbi.BM.

Konig, A. (2002). God, waarom lyk die wereld so? Wellington: Lux Verbi.BM.

Konig, A. (2006). Die Groot Geloofswoordeboek. Vereeniging: CUM.

Kubler-Ross, E. (1970). On Death and Dying. New York: Macmillian Publishing Company.

Louw, D. (2006). Hoekom? Hoekom nie? Waar is God wanneer ek ly? En waarom ly ek? Wellington: Lux Verbi. BM.

Louw, D. (2008). CURA VITAE. Illness and the healing of life in pastoral care and counselling. A guide for caregivers. Wellington: Lux Verbi. BM.

Louw, D. J. (1982). Pastoraat en Lyding. Enkele teologiese kernbegrippe met betrekking tot die lydingsvraagstuk as pastorale probleem (Vol. Teologie Aktueel No 1). Kaapstad: NG Kerk-Uitgewers.

Louw, D. J. (1984). Pastoraat in Eskatologiese Perspektief (Vol. Teologie Aktueel No 3). Kaapstad: NG Kerk-Uitgewers.

Louw, D. J. (1984). Teologie in Hoop. In Stellenbosch Teologiese Studies (Vol. 11, bl. 71). Kaapstad: NG Kerk Uitgewers.

Louw, D. J. (1985). Sin in Lyding. ‘n Teologiese besinning rondom kruis en opstanding. Kaapstad: Lux Verbi.

Louw, D. J. (1994). Illness as crisis and challenge. Guidelines for pastoral care. Halfway House: Orion.

Louw, D. J. (1998). Pastoral Hermeneutics of Care and Encounter. Cape Town: Lux Verbi.

Louw, J. P., & Nida, E. A. (Reds.). (1988). Greek-English Lexicon of the New Testament based on Semantic Domains (Vol. 1 & 2). New York: United Bible Societies .

Lubbe, G. (2008). Simply Ask! A guide to religious sensitivity for healthcare professionals. Florida Hills: Desmond Tutu Diversity Trust.

Lucado, M. (2001). Traveling Light . Nashville: Thomas Nelson .

Malan, F. (2013). Bestaan die hel regtig? In J. Van der Watt (Red.), 88 Kwelvrae wat Gelowiges Pla (ble. 125-126). Vereeniging : CUM.

Marais, F. (2007). God praat – leef luisterryk vir vergaderings. Handleiding vir gemeenteleiers op soek na God se agenda vir gemeentes. Wellington: Bybelkor.

McMinn, M. R., & Phillips, T. R. (Reds.). (2001). Care for the Soul. Exploring the Intersection of Psychology and Theology. Downers Grove, Illinois: IVP Academic. Herwin 02 2009

Moriarty, G. L. (Red.). (2010). Integrating Faith and Psychology. Twelve Psychologists tell their stories. Downers Grove, Illinois: IVP Academic.

Muller, J. (2000). Reis-geselskap. Die kuns van verhalende pastorale gespreksvoering. Wellington: Lux Verbi.BM.

Nicol , W. (2012). ‘n Dieper Dors. Ervaar die spiritualiteit van Johannes. Vereeniging: CUM.

O’Murchu, D. (1997). Quantum Theology. New York, USA: The Crossroad Publishing Company.

Oosthuizen, P. (2007). Ontsnap van depressie. Kaapstad: Tafelberg.

Orsmond, E., & Botha, J. (Reds.). (2013-2014). Woord en Fees. Preekstudies en Liturgiese Voorstelle gebaseer op Kerkjaar. Jaar A. Stellenbosch: Communitas.

Perrin, F., Schnakers, C., Schabus, M., Degueldre, C., Goldman, S., Bredart, S., . . . Laureys, S. (2006). Brain response to One’s Own Name in Vegetative State, Minimally Conscious State, and Locked-in Syndrome. Arch Neurol, 63, 562-569.

Piek, J. (Red.). (1981). Die Kind en die Hospitaal . Pretoria: HAUM.

Prins, S. J. (1971). Pastoraat en Psigiologie. Prinsipiele Oorwegings (Vol. Sielkundebiblioteek Vol 19). (A. S. Roux, Red.) Pretoria: J L van Schaik Beperk.

Punt, J. (2013-2014). Romeine 9:1-5. In Woord en Fees (ble. 231-233).

Roscam Abbing, P. J. (1964). Pastoraat aan Zieken. In M. H. Bolkenstein, F. J. Pop, & P. J. Roscam Abbing (Reds.), Praktisch Theologische Handboekjes (Vol. 24, bl. 212). S’Gravenhage, Nederland: Boekencentrum N.V.

Rossouw , P. J. (1983). Grondlyne van ‘n Pastorale Model – Gerben Heitink. Pretoria: NG Kerkboekhandel Transvaal.

Schulze, L. F. (1987). Geloof deur die Eeue. Pretoria: NG Kerkboekhandel.

Sittser, J. (2013). In die Stilte van Verlies. (E. Steyn, Verts.) Vereeniging: CUM.

Slabbert, L. (1999). Wanneer ‘n Geliefde Sterf. Die weg van droefheid na aanvaarding. Vereeniging: CUM.

Smit, D. J. (1981). 1 Korinthiers 11:17-34. In C. W. Burger, B. A. Muller, & D. J. Smit, Woord teen die Lig 4 (ble. 142-157). Kaapstad.

Smit, D. J. (1982). 1 Korinthiers 10:14-22. In C. W. Burger, B. A. Muller, & D. J. Smit, Woord teen die Lig (ble. 132-141). Kaapstad.

Smit, D. J. (1982). Die Prediking by die Nagmaal. In W. C. Burger, B. A. Muller, & D. J. Smit, Woord teen die Lig 4. Nagmaalsprediking (ble. 11-31). Kaapstad.

Stone, H. S. (1976). Crisis Counseling. Philadelphia: Fortress Press.

Swanepoel, Francois A (Red). (1993). Lyding: Sinloos of Singewend? Muckleneuk, Pretoria: CB Powell-Bybelsentrum.

Theron, F. (2011). Gods geregtigheid en Christus se geloof. Oor die tekens van God se trou. Wellington: Bybel-Media.

Van der Watt, J. e. (2013). 88 Kwelvrae wat Gelowiges Pla. Vereeniging: CUM.

Van Niekerk, A. (1996). Anderkant die reenboog. Kaapstad: Tafelberg.

Van Niekerk, A. A. (2005). Geloof sonder sekerhede. Besinning vir eietydse gelowiges. Wellington: Lux Verbi.BM.

Van Niekerk, E. A. (1984). Nie soos Mense sonder Hoop nie. Hoe om sterwendes en treurendes by te staan. Kaapstad: Lux Verbi.

Van Niekerk, R. (2002). Verlies, Pyn en die Verwerking Daarvan. Vereeniging: CUM.

Venter, C. J. (1972). By die Sterfbed. Potchefstroom: Pro Rege.

Ver Straten, C. A. (1988). A Caring Church. Through shepherding ministries. Grand Rapids, Michigan : Baker Book House.

Vosloo, W., & Van Rensburg, F. (Reds.). (1999). Die Bybellenium. Eenvolumekommentaar. Die Bybel uitgele vir eietydse toepassing. Vereeniging: CUM.

Vosloo, W., & Van Rensburg, F. J. (Reds.). (1999). Die Bybellennium. Eenvolumekommentaar. Die Bybel Uitgele vir Eietydse Toepassing. Vereeniging: CUM.

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Wright, N. T. (2006). Simply Christian. Why Chistianity makes sense. New York: Harper One. Herwin 08 2014

  • Date Created:                                                                                                     Date Saved: 12/12/201711/05/2017

C:\Users\Lenovo\Dropbox\FN Pastoraat\Kursusse\2017 Pastoraatkurus\Pastoral Caregivers Training 2017-05d.docx

Edited: 03/09/2013; 8/09/2014; 2015; 2016; 2017

 

[1] Translation Carina le Grange: Being in contact with your body enables you to be in contact with more of your inner world, so that you will be more present in the here and now when you are in community with others.

b Hebrew Sheol

c Or hill country

d Or there if I am silenced

a The Greek for prunes also means cleans.

[2] Entry point for pastoral conversation is the opportunity to ask the “God question”. In your understanding – where  and how is God present in this situation?

[3]  “En om versies te lees, beteken reeds om betekenis aan individuele dele toe te ken wat eintlik as dele van ‘n groot geheel betekenis het.” (WS Vorster 1988:9). (Translation Carina Le Grange): To read single verses presupposes giving meaning to individual parts which actually have meaning [only] as parts of the greater whole.

[4] See “Sleep cycle in patients in a state of permanent unconsciousness” Brain Injury Vol 16, 2002 – Issue 8

[5] See “Circadian rhythms in the vegetative state” Brain Injury Vol 23, 2009 – Issue 11

[6] Athanasius added the Book of Baruch and the Letter of Jeremiah in his Old Testament canon and omitted the Book of Esther.

 

[7] Translation: ‘Until now little attention has been paid to studying the Bible with regard to the fact that in olden times people did not read quietly, but out loud … We live in a culture of books and these days people mostly read quietly.

[8] One of the theories (higher order theory) says that consciousness is the brain looking at its own activity, the brain’s simulation of itself. Global workspace theories argue that consciousness exists when different parts of the brain connect with each other to share information. Biological theories, instead, look at a specific process or structure within the brain that creates consciousness, such as the oscillations of the signals between neurons.

[9] The following is based on the book by Prof PF (Flip) Theron: Gods geregtigheid en Christus se geloof. Oor die tekens van God se trou (2011, 47-53).

[10] Translation CL: “We do not have to build our certainty, or our faith, except on God’s justice which is expressed in the faith of Christ (his faithfulness/constancy, his trustworthiness). Paul Althause expresses it like this: ‘Whether I believe, that I do not know, but I know in Whom I believe.’ This, exactly, is what our faith is: it is anchored in Christ’s faith.”

d Hab. 2:4

[11] Translation CL: “When faith becomes a stunt by which I try to hoist myself up into heaven, that is exactly when it stops being faith.”

[12]Uit die wysheid is geen volledig etiese sisteem af te lei nie (PJ Nel The structure and ethos of the wisdom admonitions in Proverbs). “Geen poging moet aangewend word om ‘n leer op te bou oor alles wat die wysheid byvoorbeeld oor ‘rykdom en armoede’ sou sê nie. Ten diepste gaan dit in die wysheidsetos om die ‘vrees van die Here’” (Smit D J 1984 voetnota 5, pagina 143).  Translation CL: ““No attemps should be made to construct a ladder of everything that the wisdom proposes about ‘wealth and poverty’. In the ethos of wisdom, at its most profound, it is wholly about the ‘fear of the Lord’.” (Smit D J 1984 footnote 5, page 143).

A complete ethical system cannot be deduced from the wisdom.  (PJ Nel: The structure and ethos of the wisdom admonitions in Proverbs).

[13] Translation CL: “This belief that there exists a connection between action and consequence became a rigid dogma over time. Namely, people started to think it could be deduced from prosperity that it was preceeded by good deeds, and from adversity that it proved the sufferer had sinned. They no longer contemplated the possibility that a good person could also suffer, nor that the sinner could also prosper. This means that the idea of a basic order in the world and creation could be driven to its extreme consequences, and that the teachers of wisdom started thinking that this order operated by means of a mechanistic, fixed chronometer.”

[14]From the Greek theos (god) and dike (justice). Theodicy is an attempt to resolve the evidential problem of evil by reconciling the traditional divine characteristics of omnibenevolence, omnipotence, and omniscience with the occurrence of evil or suffering in the world. The term was coined in 1710 by German philosopher Gottfried Leibniz in his work, Théodicée, by way of various responses to the problem of evil, which had been proposed previously. The British philosopher John Hick, in his work Evil and the God of Love, identifies two major traditions: the Augustinian theodicy, based on the writings of Augustine of Hippo, and the Irenaean theodicy, which Hick himself developed, based on the thinking of St Irenaeus. The German philosopher Max Weber saw theodicy as a social problem, based on the human need to explain puzzling aspects of the world. The sociologist Peter L Berger argued that religion arose out of a need for social order, and theodicy developed to sustain it.

 

[15] “Another key dualistic concept, …, was the sharp distinction between body and soul, between matter and spirit.” (Harari 2014:248).

[16] Although Albert Einstein is the best known figure of the time, many other scientists played important roles, i.e. Max Planck; Niels Bohr; Louis de Broglie; Erwin Schrödinger; Wolfgang Pauli; Werner Heisenberg and Paul Dirac.

[17].     Because of certain limits of time and space, we will always divide things into smaller units to study them.  But we must be aware that in the process we lose something.  The ideal is to limit division as far as possible.

[18]. “Buitendien is die ou teenstelling tussen natuurwetenskaplike en geesteswetenskaplike metodes agterhaal. Vandag word ingesien dat elke territorium van die wetenskap van alle metodes gebruik maak” (Pieterse 1986b:66). Besides, the old opposites between the methods used in the natural sciences and in human sciences have been overtaken. Today it is accepted that each territory of science uses all methods.

[19] Any attempt to find an explanation for sin, Berkhouwer says, is nothing more than an attempt at making sense of the senseless, to rationalise the irrational and to order that which means only chaos. (Translation C le Grange)

[20]The Holy Bible : New International Version. electronic ed. Grand Rapids : Zondervan, 1996, c1984, S. Ro 2:5-11

[21]Die Bybel Nuwe Vertaling. electronic ed. Cape Town, South Africa : Bybelgenootskap van Suid-Afrika, 1998, c1983, S. Php 4:11-14

[22] “Dit wil sê dat elke deel op ‘n manier die geheel huisves en die geheel in elke deel aanwesig is” (Deist 1986:105) (Translated: This means that every part contains the whole – and the whole is present in every part.)

[23]  Translated by Carina le Grange: “The Bible does not have an answer for every question, but the Bible, used responsibly, can show us the way – the way that God wants us to take. Because we believe that the Bible, albeit the word of man, is the witness of revelation (evidence of the revelation) and, in the hands of the Holy Spirit, is a trustworthy guide, an infallible guide for the life of the Church.”

 

[24] Translation Carina le Grange: “God’s Word thus becomes the people’s word, but without it ever not being God’s Word.”

[25] Translation Carina le Grange: “In contemporary discussions about theology and science, any idea that God should step in and intervene, as it were, in history and the natural sciences is widely rejected. Such an opinion is intellectually simply not credible. Because whosoever insists that God does in fact intervene in history, would also have to explain how they understand those actions of God. That is why the quest is rather to find the ways in which God acts in accordance with the rules – which God, after all, has established. The argument is that the rules themselves display a specific openness that allows sufficient space for God’s actions.”

[26] Translation Carina le Grange: In the quiet time that I am describing here, one moves from the domain of doing to the domain of being.

[27] Translation C le Grange: If, in the last phases, the patient gives up hope, hope should not be revived, and should the patient continue to harbour hope in the early phases, he should not summarily be disabused of it, even if, ostensibly, it does not seem worth the trouble.

[28]  “Die ongeluk, lyding en dood wat ons tref, kan (dus) nie in die laaste instansie teruggevoer word na ‘n demoniese mag nie. Ons mag nie net die goeie as komende uit die hand van God aanvaar, maar nie die slegte nie. Dit is altyd God wat met ons handel, hetsy in toorn, hetsy in genade. Daarom beklemtoon Luther dat ongeluk, lyding en dood ook middels van God se genade kan wees (Durand 1978:32-33).

Translation: The catastrophe, suffering and death which befall us may (thus), in the last instance, not be attributed to a demonic power. We cannot only accept the good as having come from the hand of God and not also the bad. It is always God who is dealing with us, whether in his wrath or in his grace. That is why Luther stresses that accidents, suffering and death can also be vehicles of God’s grave.

[29] Translation C le Grange: The Old and New Testament show no obsession with practices such as driving out devils. When these practices do take place in the New Testament, … they are then always practiced on ‘outsiders’; that is to say, on people who are not yet part of the church.

 

[30] See Hebrews 2:14. The NAV (1983) translates katergeo as “vernietig” (destroyed). The Nuwe Direkte Vertaling translates it with “kon ontkrag” (disempower).

[31] Translation C le Grange: The power of the risen Christ, as embodied by the presence of the Holy Spirit, is at all times the perfect armour for believers. The Lord’s personal presence is enough to keep away Evil.

[32] “In die ou dae is alle psigiatrie beoefen deur die Kerk. Eers in die vyftiende eeu is die twee van mekaar geskei. Selfs vandag stel die teologie nog baie belang in die psigiatrie en/of sielkunde.” (Notes for Medical Students University Stellenbosch. Departement Psychiatry 1989:A1-8). In the old days, psychiatry was practiced by the Church. It was only after the 15th Century that they were separated from each other. Even today, theology has a great interest in psychiatry and/or psychology.

[33] The Cleveland Clinic Foundation:

http://www.psychology.uga.edu/sites/default/files/CVs/Clinic_Diaphragmatic_Breathing.pdf

[34] Based on the books: Cloud, Henry & Townsend, John 1992. Boundaries; Townsend, John 2011. Beyond Boundaries. Learning to trust again in relationships

 

[35] The Cleveland Clinic Foundation:

http://www.psychology.uga.edu/sites/default/files/CVs/Clinic_Diaphragmatic_Breathing.pdf

[36] Danie Louw (2005:308-309) comments that the abortion debate in a systemic approach is not about the question when does human life starts. It is about the relationship and mutuality of love-making; about the qualities of parenthood; it is about the relational space and environment of the foetus; it is about responsible decision making.

[37] Special investigations such as CT scans (computedtomography scans), in which X rays and a computer produce pictures of crosssectionsof the brain) and the four vessel angiogram (an X-ray test where dyes are put into 4 different arteries of the brain).

[38] Adapted from Church and Community Facilitation Network Manual pages 88-91

[39] Fiqh [fik]: the legal foundation of Islamic religious, political, and civil life.