Class Theological Analysis Projects

"Caring for Individuals
as a Group:
A Theological Analysis of Care of the Elderly in Nursing Homes"

By Vicki Oman

Caring for the Elders in Our Society

Reflections: On caring for the “individuals” in nursing homes

Theological Analysis: A vision of caring through mutual knowing

What is “a valuable life”?: A theological poem

References for this project

Theological Analysis:
A vision of caring through mutual knowing

Reaching Toward Beauty

Hyacinthe Hill

Your love declines. You, thinking little lines
around my eyes are fallen lashes, try
to brush them off. I do exfoliate.
In this autumn of my being, parts of me
fly, like tossed and wintry-blasted leaves.
I don’t regret their passing. I must work
to make a clean and crystal-perfect form.
I, the alchemist, and I, philosopher’s stone,
have sacrificed the fat, and froth, and fur
of youth, to walk through fire, leap in the dark,
swim inward rivers, pray at a wailing wall.
The wrinkles, sags, the greying hair are earned.
You mourn like a child over a broken doll.
Only the core of this crone was ever real.

(Martz, 92)

I Don’t Understand

C. Mary Austin
(written in the aftermath of the tragic death of a teenager)

This Life
This Death
This fragile humanity
So very alive
Suddenly no more
What meaning in life
Where is God?
Young life so cruelly extinguished
Old life vacuous
Unknowing
And unknown
What were you years ago?
You who sit and gesture
Torment on your face
You grasp my hand
and I am helpless
In the face of your anguish
Where is God?
Where is God in your confused mind
Your inability to communicate
You pluck obsessively at your skirt
Revealing stocking tops
Undignified
Skirts that once children tugged
Legs that once danced and ran
Where is your life?
Where is God?
Young life extinguished
Old life lingering?
Is your life meaningless?
Do you know pleasure?
I only see torment in your toothless face.
So where is God?
I don’t understand
I only know that he is here
With the depth of my being
I know he cares and
Suffers too
That Christ is in you
Nailed to a cross
But I don’t understand.

(Austin, 123-4)

Where is God?

It is difficult to make sense of aging, both as an elder and as a loved one or caregiver. Elders feel estranged from others and from society, and loved ones also feel isolated and estranged from the experiences of their loved one. Can God be present in such despair and isolation? Karl Rahner describes God, the God which we understand, as distant and unattainable. This must be the feeling of an alienated elder, or a confused caregiver. The God who we have conceived in our minds somehow is not present for us in these struggles; in our search for meaning and in our isolation from each other and from the familiar we feel isolation from God. However, Rahner encourages entering fully into this despair, and embracing it. There, he believes, one will find and know the presence of the true God. (Rahner, “God”, 218) This theology, it seems, is “good news” for individuals who are isolated in nursing homes and who suffer from dementia. These folks have lost most of the aspects of their material life which were important to them: family, friends, home, life roles, income, and sometimes memory and ability to communicate. These losses seem to distance us from the God we are familiar with, the God we worshipped and prayed to our entire lives. For Rahner, this very distance is what can free us to truly know God’s presence, if we are able to free ourselves from anxiety (which can be difficult in a setting with little control and so much loss and loneliness).

Rahner also presents experience of God as unified with experience of self. He presents self realization as occurring in the context of relationships with other people. “The original objectivity of experience of self necessarily takes place in the subjectivity of its encounters with other persons in dialog, in trustful and loving encounter.” (Rahner, “Experience”, 225) For Rahner, experience of self, of neighbor, and of God are three parts of a whole. These three aspects “mutually condition” one another. (Ibid., 226) If one has lost or found oneself in a neighbor, then one has found God.

Marjorie Hewitt Suchocki is a process theologian who also sees the possibility of meaning, and finding God, in being alone. She has a different idea of the nearness of God. For Suchocki, God’s self is represented in the totality of the world and as the world changes the changes become a part of God, so that the world and God are always in relation, both in its present form and in its possibilities. This makes God an intimate part of the past, present, and future of the world. (Ibid., 36) This intimacy does not assume that we can feel the constant presence of God. Suchocki acknowledges that we have three levels of relation. We relate on a “daily” level to others, yet we have a “depth” level of yearning and loneliness, which these daily relationships somehow cannot fill. This loneliness can be the point at which the “hidden” God, which we do not experience in everyday life, can enter into one’s awareness. (Ibid., 50) She does differentiate “aloneness”, which can be meaningful, from “loneliness”, and recognizes that loneliness can create a lack of meaning, and can accompany “devaluing relationships” and isolation even while in the presence of others. (Suchocki, 52) Even in this negative, isolating experience, Suchocki believes that the contrast between the infinite nature of God and the “variable finite relations” of loneliness can bring the hidden presence of God into awareness. As in Rahner, this perceived distance from God can lead to increased awareness of God.

However, for Suchocki God is in our future – the “aim” of our existence. Her relational view of God includes the view that we are being “pushed” by God to relate to others and to our world, thus sharing our “inward” God. “the inward presence of God turns to the outward presence of God, for the God who is present to us is present to others as well. The God who guides us guides others also; the God who cares for us cares also for others. The whole world is touched by God, and therefore the world can mediate God’s presence to us. Divine presence pervades finite presence, launching us into the world again, for its good and for ours. Meaninglessness fades, crowded out by presence, and presence-human and divine –insists upon and achieves the meaning of love.” (Ibid., 61)

Rahner, also focuses upon the importance of relationships to others, especially for the sick. He places some responsibility upon the individuals receiving care, viewing illness as a “task”. “..I think it is both hard and at the same time liberating to regard the sick person as open to an appeal, as capable of action, and to tell him that he can still give his heart in confidence, resignation, in love for the other, even in the midst of his distress, and, if he does so by God’s grace, it will liberate him and alone make his sickness what it really ought to be.” (Rahner, “On Illness”, 143)

Through these theologians, we begin to understand that there can be some meaning in isolation and in suffering. We also learn that it may be a mistake to focus only on how the caregiver relates to the resident. Perhaps the key to healing caregiving relationships lies in the mutuality of the relationship.

A Vision of Mutual Caring

Martin Buber, in I and Thou, defined two types of relation: I-Thou, and I-It. I-It relations are subject to object relations, where a subjective being relates to an object. I-Thou relations is a relationship between two subjective beings, who are active subjects. In this relationship, the two subjects don’t just “know about” each other, but “know” each other in a mutual, reciprocal way. Buber refers to God as the “Absolute Thou”, and his examination of relationships also explored this as a way to relate to God. (McGrath, 247) Somehow, even the most well-intentioned caregivers fall into the I-It pattern of relating to residents of nursing homes. For Buber, the I-It knowledge is “indirect, mediated through an object, and has a specific content”. (Ibid.) In nursing homes, we often know about the resident we are caring for through the chart or through the change of shift report. We have specific tasks and responsibilities which we must carry out within a certain amount of time, and we must be goal-oriented in order to succeed. There is usually little time for more than the “specific content” our jobs define. It takes commitment to shift to an I-Thou framework, for several reasons. To know the resident we care for (vs. knowing about the resident) we may be opening ourselves up to experience some of their pain and suffering; it is a frightening prospect. If we view the resident we care for as an active subject, it may mean that care will take longer, and may be performed differently. Most caregivers want to keep their jobs, and part of the requirement is being able to manage the workload which is assigned. It takes a special individual in a supportive environment to make the shift from I-It to I-Thou.

To acknowledge the resident as “Thou” is the first step to reciprocity. Paul Tillich referred to objectifying recipients of care as harming “their self-awareness as person”. In his discussion of pastoral care, John Patton refers to Paul Tillich’s The Theology of Pastoral Care. Patton’s view is that it is important to understand each individual’s context before providing pastoral care. He supports his view with Tillich’s perspective that care is “essentially mutual”. “In most acts of taking care of someone, it is possible for the person who is the object of care also to become a subject…(Caregiving) is one act, not two, and only because it is one act is real care possible.” (Patton, 100)

Application

What does this analysis mean for Mary? (Please refer to “Reflections”.) Is it possible that Mary came to know the God which is hidden from those of us who are caught up in the many aspects of our finite lives? Could the loneliness and emptiness of her existence as she was restrained in her room have had some meaning? Did her lack of social relationships interfere with her knowing God? Her life was not entirely devoid of interaction, and I do remember one experience of mutuality which I had with Mary, during that lonely time. Sweet, cheerful Mary had become very withdrawn, and was essentially non-verbal, but I would often sit by her side and talk to her as I worked. She rarely responded, but she would usually look at me or met my eyes. I sat down on her bed in the midst of my chores for that afternoon, to prepare her toiletries and towels for her evening care. I was blue, for some reason which has escaped my memory, and I was not very talkative. Mary reached out, touched my face, and softly sang, “Toot-de-toot-de-toot-de-do!”. That is the last time I remember her verbalizing anything, and it was in the context of providing care for me.

What about Joan? (Please refer to “Reflections”.) She experienced some I-Thou relations, with the staff who recognized her personal needs, and in her positive interactions with the Director of Nurses, who frequently conversed with Joan with a sincere interest in her journey and her experiences. The Director of Nurses learned from Joan, and grew from her experience of knowing her. This relationship was truly reciprocal, and Joan did provide care for the Director of Nurses. Joan also experienced many dehumanizing, distancing and loneliness-producing interactions with overworked an hurried staff members. Is it possible that God, who was present in both circumstances, reached and comforted her in her final days?

I have presented the landscape of nursing home care as vastly improved, but not perfect. I deeply desire a “more perfect” system, and I become frustrated with the situation which exists. I wish for an environment which provides more opportunity for mutuality and reciprocity, where God can be more perfectly known in relationality. Is it possible that God’s power and perfection still reaches these residents who are in an imperfect system? Could it be that the “windows” of the experiences I have described are enough for God to “shine through”? I view these nursing home residents through the assumptions of my experience. The varieties of experiences of God, in so many varied contexts, is so much greater than my own that I must not restrict God’s power.

Can this society learn from the lessons of mutuality and I-Thou relationships? Can we as a group learn to see the elderly and institutionalized members of society as individuals with richly varied experiences and circumstances? Can we learn that these people may have experiences in their lives today that we can only dream of someday attaining? Would this influence the debate over who in our society is valued, who is worth our resources, and who should control the decisions regarding the future of our elders?

It may seem farfetched, but the lessons learned from theology can be applied to “real life”. Every group, whether it is a group of nursing home residents, nursing home staff members, elderly individuals, policy makers, or the general population, every group is made up of individuals. One individual caregiver can make all of the difference in the life of a nursing home resident; that caregiver can represent God in their reciprocal relationship. One individual in society can be the voice for the unrecognized population; that individual can remind the others of where we can find God.

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