What do religious people think about unconsciousness

by Erhard Weiher

In the following, I will initially not argue specifically Catholic, perhaps not specifically Christian, but rather religious-spiritual. People had to cope with illness, dying and grief at all times - there is no need for a specific therapy that would make dying "better", for example. Such life events obviously need a life interpretation (cf. for example stress research, A. Antonowsky's salutogenesis and the results of modern research on closeness to death. According to this, people close to death fall back on transcendent resources - not controlled by consciousness. It sees looks as if the ability to interpret transcendently is anchored in the brain).

The initial question of my considerations is: How does the level and the language of spirituality fit into the medical world?

Dying, coping with illness and dealing with crises can be described as learning processes. People have to react to events in life and process them and incorporate them into their lives. I am starting from the 3 learning functions: THINK / FEEL / DO: People react with THINK / FEEL / DO to influences / events in their life in order to cope with them.

THINKER: People who react to crises and loss with thinking, who try in perplexity to 'think together' the disturbed world again.
TUER: People who react first with activity, who try to overcome the impotence, go from doctor to doctor ....
FEELER: People who are the first to react with their feelings, let their feelings run free.

Important: These are initial reactions; where the individual starts is the result of his or her personal learning pattern. Most of the time, those affected are soon able to include the other learning functions as well. All parts are important, none of them may be devalued ("it's only in the head ...").

Society and its medicine also react with these channels:
The main channels are THINKING and DOING:
"Medicine: Scientific concepts: THINKING and translating them into objective actions (OP, medication).
"For a long time, nursing was only defined by TUN - physically caring for the patient and following the instructions of the medicine. In the meantime, however, nursing science is in the process of overtaking this understanding and developing nursing as a profession in its own right.

THINKING / FEELING / DOING are arranged in an endless loop: All parts in this loop are important. (Fig. 1)
In the clinic, the professional's first approach is often just THINKING or DOING; the FEEL area is not provided, not provided in the system, not provided in the roles, but is available for the individual persons. This is a problem that triggers a lot of criticism, including a lot of unjust criticism, because the individual role bearers are not allowed to go beyond the limits of their roles. Society demands and promotes the most effective and objectively controllable methods against illness and death. THINKING / scientific concepts and effective DOING are considered to be the most beneficial approaches to combating the disease.

A world of concepts and associations can be developed for each of these reactions:
THINKING: Scientific models, looking at something objectively and medically (an object is created by working out the subject-independent structure (i.e. independent of specific personal space / time and individual-life-historical circumstances) and leaving out the subjective part). The doctor naturally also brings his human experience into his actions, his knowledge of people (psychology, philosophy, religion ...).
FEELING: That is the inner world, the experience, personal pictures, life story, memories, values, dreams ....
DO: Act instrumentally, treat, maintain, - but also: understand the body as the house of the soul and establish relationships.
This chain of associations applies to the hospital world.

But there is also an anthropological-spiritual world of associations: Thinking is not occupied by medicine, but people also have other thinking concepts in dealing with illness and life crises, e.g .:
THINKING: Religious, spiritual and philosophical concepts, worlds of symbols, holy scriptures, knowledge of life. People think about illness, life, life story.
EXPERIENCE: Personal symbols, spiritualities, memories, personal values ​​.... Nowadays the images of life are very individualized: Everyone can and must form their own picture of life and death. In the past, religions offered a common outlook and common values.

An important step in this basic model is:
THINK / FEEL / DO - it cannot be alone, it is not enough to understand and accompany people in crises. What they need, say and express about themselves, you also need the SPACES.

(1) First space: ACCOMPANYING, the connection between FEELING and DOING. Accompaniment is not activism - not just acting (e.g. medically) but empathetic presence and getting involved in the process of the other. Really turn to the suffering of the other, not bypassing it by talking, listening or acting. Active listening. Relationship to the sick and dying, not: "Cheer up - it'll be fine". But perceive feelings and accept them, do not evade, do not speak out of feelings .... There is a long tradition of accompanying practice, lots of literature and opportunities for further training. This also includes conducting a conversation, but also, for example, basic stimulation, the touch of a person. That is not to be explained here, it is about spiritual accompaniment. But: accompanying is the basic qualification, spirituality does not ignore it, pious speech that is supposed to talk away and cover up the suffering is a malpractice.

There is already a spiritual dimension in human encounter. The loving care and attitude of the helpers creates a space for the patient in which he can experience himself valued - beyond his old age, his deficits, his confusion ... beyond. But also valued with, for example, his often difficult to bear expressions, the depression, the resignation, with his unsightliness, his smell, his being alien to himself. This acceptance can be a symbol that the patient can also interpret as acceptance by God and holy powers.
So in the attitude of the helpers there is already spirituality that the old person can feel, which can therefore have an effect on how he lives with old age, illness, and frailty. -

(2) Second space: THE SYMBOLIZATION
- that is, the connection between personal experience and general life concepts.
An example: A patient says: "Just imagine - two weeks ago I was still working in my garden".
This patient leaves traces in her words, in gestures, in the way she emphasizes or ignores something that she expresses and shows from within. It is important to pursue these traces, these traces are not only laid by patients with the pastor, but with all helpers. A comprehensive encounter with people takes place in the spaces in between. For example, when a child comes home from school, they say, "Mom, when is there food?" The child does not directly say "I am hungry" (feeling), but instead encrypts his statement. The statement is coded, the listener has to decode it; E.g. the child can mean "I'm hungry" or "I want to play something beforehand" or "I look forward to seeing Dad when he comes to eat" etc.
What could the traces of the patient mean in the example with the garden?

In this statement I would like to differentiate between four dimensions (according to G. Hartmann, Lebensdeutung, 1993):
"The SACHDIMENSION:" I have a garden, that is a lot of work, now the snowdrops are sure to bloom ... ".
"The EMOTIONAL DIMENSION:" I'm worried that with this illness I will be able to work in it again, at my age ... ".
"The IDENTITY DIMENSION: I am - I can do that, it is important to me, there I feel competent (in the hospital / old people's home: incompetent, cut off, not being anyone). Concern whether it is still the one with this disease.
"SPIRITUAL DIMENSION: The garden expresses something of
the order of life
the goodness of things: growth / taste / seasons / creation / rhythm,
"Everything is good" (P.L. Berger),
You get a parable for life, growth and decay, life as a gift ....

Which of these applies to this patient, the pastor / companion must find out in a feedback process (e.g. pastor / nurse: "Is this your little paradise?").
SYMBOLIZATION is the possibility, but also the art of spiritual development.
Thesis: Every weather, every object, every feeling, etc. can become a symbol (dream, picture on the wall, saying, picture on the bedside table of the family, grandchildren, surgical wound, body, sport, etc.). When talking to clients / patients, it is important to accept their meaning. But also "hear" the ambivalences, e.g. on the topic of sunset: That can mean peace, beauty, vacation, but also night, passing away, mourning - or both at the same time.
Or the picture of the grandson on the bedside table: "So much life!": They are young. I am proud of her, life goes on. But also: I'm old, I'm getting less, see the end, life balance.

Symbols, images, terms have a SMALL TRANSCENDENCE: "This is important to me", the patient interprets himself: "This is how I see myself", he transcends the real world. Symbols mean a deeper perception, they point beyond themselves.
But symbols have a wider range of meanings: They are charged with meanings from the history of mankind, literature, psychology, everyday life, human knowledge: grandchildren / house / garden / hiking / eating ... have a spiritual meaning and undershoot. That is the MEDIUM TRANSCENDENCE (e.g. garden: I take part in the order of life, in the order of the world or: there I learned what effort and sweat mean).

The spiritual guide holds out the symbol to the patient: "Is that it?" Does my key match your lock? Does it unlock something for you (e.g. "Your little paradise?"; The patient gets tears in her eyes: as a sign of happiness and possibly sadness at the same time). The trace could also lead to something else: too big a garden, overwhelmed, too much work, and I've worn myself out. Then perhaps a spiritual answer could be "thorns and thistles".
The second intermediate space challenges us to connect personal experience (FEELING REICH), personal history with human knowledge (THINKING); thus bring the "small symbols" into relation with the "big ones" of (religious) wisdom.

The companion is not just a mirror for the patient ("oh yes, you could still work in the garden two weeks ago?" Or: "I know that, I also have a garden"). He also not only addresses the feelings ("and now you are sad that you ..."), but the companion already brings a transcendence with him. As a representative of society, he brings with him transcendence: "The pastor, the nurse, the doctor should hear what I, the patient, can do, what is important to me is who I am". Spirituality has a FIELD DYNAMIC: In the field of the pastor and the hospital, a certain level of spirituality wakes up. The field dynamics that the pastor brings along triggers a different spirituality communication than that of the doctor or the nurse. For the patient, for example, the doctor also has the role of wise man or priest (who announces the end of life or guarantees him many years to come). In the field dynamics of the pastor, the GREAT TRANSCENDENCE comes into resonance. The conversation, the symbol, has in the background the horizon of the holy, of God, of the eternal, of a higher reality or power.

Meaning helpers interpret life in the horizon of the whole. Religion interprets life beyond short-term interests in the sacred horizon (the garden is not only food, enjoyment, romance, work, ecology ..., but also security, creation, creature, thus - also religiously - interpreted reality).
The sense helpers also indicate through the way in which they summarize and appreciate ("this is sure to be your little paradise"), which places the garden in the larger horizon. Meaning helpers help with life interpretation and search for meaning. They don't make the sense or the interpretation, they just help you find it. Even when it comes to the distance to the good, i.e. when the patient lacks something or cannot do something at the moment, then his longing, his sadness, his inner connection with what he longed for are important for the interpretation of his situation. The helper has achieved his goal when "the heart burns". The symbols that he opens up with the patient are like depot syringes, they have a depot or retard function: They stay with the patient even when the helper leaves. The patient can stay in this symbol, continue to meditate on it, further develop it for himself and thus further develop his own self-image. Bring the secret with you and unlock it for you, that is pastoral care in the broadest sense. But it has to become music in you (patient): the music (the symbolic content) outside has to become a secret inside.

The human being does not only symbolize when he is ill or has unconscious conflicts (Sigmund Freud), but because he is human: he symbolically communicates what moves him deeply, the essentials of the person. It not only symbolizes because otherwise it would have no words or because it would like to hide. He symbolizes because he wants to express more about himself than to say facts. Likewise, the human and religious wisdom that the helper brings with him is the deepest thing that we can give him: There is meaning and danger in it, the good and the bad in life is caught and interpreted. This of course presupposes the art of the helpers, the spirituality helpers, to deal with the patients' symbols in a helpful and in-depth manner and not to misuse the symbols, hurt them, or misinterpret them for their own purposes. The very individual spiritual figure of a person appears in the personal symbols. Therefore, it is also important to appreciate the 'small', often inconspicuous or shamelessly expressed symbols, especially of old people.

(3) The third space is ENTERING. In other words, the connection between HUMAN-RELIABLE CONCEPTS and concrete DOING and expression. There are realities of life that cannot be "accompanied":
Starting with the major transitions: birth, being a child, growing up, partnership, marriage, dying, death. All of this cannot be explained, but only accessible,

up to grief paths and death processes that cannot simply be "accompanied" (e.g. insomnia all night, loss of appetite, etc.).
Religion places these great transitions and the passages of life in the blessing of a 'completely other'. As a helper, I only give guidance: I accompany you to the gate - you have to go the way yourself. But the rite is a kind of cloak, food. The rite makes transitions accessible, including the death zone. How the mother makes the transition into the night accessible for her child in the evening, through a story, a gesture, a sign of the cross. The wisdom of religion says: Your path, still unknown through a ritual, leads into the mystery of all life. For what you have to go through, we have a model passage, the rite. Your path is general (concept of humanity) and personal, you have to do it yourself. However, every rite must be preceded by the symbolization, the 'charge': only then is the connection to the great transcendence celebrated. Religious rituals are not therapeutic rituals. Therapeutic rituals complete a psychological process, religious rituals open up a path that the companion no longer has in hand, but entrusts to someone else.

To bless means: my little life is brought before a higher power. For example the sign of the cross, prayer, communion, blessing, last rites, travel blessings .... This is a specific task of pastoral care. Nurses and doctors have different rituals of their own (helpful and preventive). Committing also applies to comatose or confused patients. Often they make the sign of the cross, even if they have previously lay there as if unconscious, a tear comes, their lips move. Religious activity awakens the religious horizon: it activates human knowledge, which is interpreted spiritually.

(4) This model still has a space: The CENTER. First of all, this is the 'hole' that people feel when they are sick or in the face of dying. "Why ?" - ask people in a crisis. The middle is the unavailable, the not feasible. People ask: what is the meaning of my life now? The centering center is missing, they are only felt in parts. At the same time, there is the question of the unifying center that makes thinking / feeling / doing a whole. The CENTER is the hole and at the same time the wheel hub around which everything revolves, THE SECRET OF THE PERSON, and at the same time the meaningful center, the HOLY REALITY.

But how can one talk about meaning? As a helper, I cannot give meaning to the patient. My thesis is: SENSE QUESTION and IDENTITY QUESTION are linked to one another. (Fig 4)
The meaning is tied to the design locations: These are the moments of human identity. These are e.g. body, gender, social relationships, home, house, environment, property, occupation, hobby, vacation, memories, values; mental or spiritual horizon.
IDENTITY is the bundling of all moments of identity. In the event of illness or "moving" to a nursing home, the bundle of moments of identity breaks apart: I am no longer who I once was.

Searching for meaning is: I put identity drafts and self-drafts into the world and see whether there is a meaningful answer to it. It is not enough to give a thing just one meaning, I also have to look for and find the meaning, reality also gives me the answer to my meaning and self-conceptions. The meaningful response is important.
There is a SENSE IN THE FOREGROUND: normal life (e.g. that I can go to work every day).
There is a SENSE IN THE BACKGROUND: Who am I in front of the world background / cosmos / all-one / spirit / higher power ....
Man looks for a background that embraces everything ("in the end everything is good"). Want to understand each other in the whole of the world, even if I am missing something (in my moments of identity). Nowadays everyone has their own "window" for this sense as a whole.
The FIRST IDENTITY is: Everyday identifications (today I drive to the office, look after people, have a house, grandchildren ...).
The DEEPEST IDENTITY is: The secret of the person, the innermost SELF, which still has a meaning even when moments of identity disappear in the event of illness or death.

SENSE IN THE BACKGROUND means: That there is any resonance between the self-designs and reality (meaning response). The "sun" in the background makes the foreground of life visible. The sacred horizon enables life to be fulfilled and to have comprehensive meaning as a whole. Religion is a "lens" that has to be polished well, that can bundle all, including the dark rays of life, in a meaningful way.

It is important: the methods do not close the hole, they do not fill it up (mourning, parting, dying), but rather they result in a hermeneutic process for the path: symbols are dynamic, different stations on the path need different symbols. Symbols stimulate a process of discussion.

SPIRITUALITY is: How man experiences and shapes the relationship to this meaning / life secret. That means how he experiences the meaning and how he evaluates the meaning response (whether he finds himself abandoned, desolate, facing blind fate or has trust, quiet joy, feels distant from God, is confident, complains ...).

EVERYDAY SPIRITUALITY is: the everyday creation of meaning (e.g. "garden" is: good order or "life's trouble" etc.).
FAITH-SPIRITUALITY is: To get in touch with the sacred reality (e.g. the patient's garden - the paradise of religion).
In this way the hole can become a source (R. Smeding) from which a person can live. The source is not a fixed package, but rather it opens up history, it opens up as you walk. (Fig. 5)

Every religion helps to heal, every spirituality is good as long as it results in a good, life-enhancing, trustworthy flow. It can be a "small" tribal religion with a shaman as a priest or it can be a "great religion" that tries to interpret humanity with all the contradictions in the cosmos. The secret can be interpreted in many ways. People have different windows to this mystery.

A few summary points at the end.
With the MODEL OF THE IN-BETWEEN SPACES, I want to show that people do not only express themselves through the familiar channels THINK / FEEL / DO and deal with old age, illness and grief. In these interstices it is by far not only pastoral care that is competent:
ACCOMPANYING is a basic qualification for all helping professions.
BEGEHEN is a dimension of all professions - whereby nursing, medical therapists, old people's homes ... have their own forms of rituals. Pastoral care has special rituals (ritual acts and rites).

Likewise with SYMBOLIZING: patients symbolize because they give meaning to their lives. Companions help decipher and appreciate these symbols and then affirm, correct or deepen them to 'give back' to the patient as his own resource.
Pastoral care seeks access to the inner system of the patient through these channels ACCOMPANY / ENTER / UNDERSTAND and through this it can help people to find their resources in dealing with old age, illness, dying and grief. All helping professions can take up this, listen, let it unfold and thus strengthen this inner system of self-assurance.

Pastoral care makes this very special, it even actively stimulates this resonance, brings it up consciously and helps the patient to deepen his perspective and expand his processing space with the help of the larger horizon. She even brings out the great human and religious symbols and looks with the patient to see whether they deepen his "little" symbols and give them their own strength. She looks to see if she can connect the small to the big symbols, so that the strength and wisdom deposited in the religious symbols can fertilize their own symbols and give them an effective carrying capacity even in the event of illness, crisis and death.

So: All helpers can give spiritual help - by listening to the spiritual undershoots of the patients and paying tribute to them with them. You don't have to be a theologian, but a careful listener and companion and a person who himself understands something of the wisdom of life (of paradise, of the grandchildren, of art, etc., everyone has his own talent). Old people, the sick and the dying do not need therapy in the sense of psychotherapy; People have grown old at all times, even without receiving special therapy. But they need helpers who are attentive on the spiritual level.
We know from stress research that this dimension of 'spirituality' has its own quality and is an indispensable aid in life and in death.

The aim is not to treat aging, but to make being old accessible to those affected with the help of accompaniment, symbolization and rituals, which are vessels for spirituality. Such accompaniment means:
The "widening of the wings of man", not wanting to carry himself (R. Smeding). The spiritual forces are demonstrably the most deeply anchored, to the last effective and strong abilities in humans. So that the patient can find himself in good pictures of life and put his life balance in a good "container". "Committing" is also death support; ritual engagement, not everything has to be discussed, not everything has to be worked through and made conscious. Sometimes it just has to be done and represented. The rituals of religions (and the rituals of care and other therapeutic services) have their own symbolic content and they mean something to the patient that can often not be expressed in any other way. So not everything has to be done consciously and worked through! On the contrary: we also meet people who cannot express themselves and cannot work through and yet we bring the great horizon - in the end: the sacred horizon - with us, in which all life and death are.


E. Weiher, More than accompanying - a new profile for pastoral care in the field of medicine and nursing,
Mainz, 1999
E. Weiher, Religion, Mourning and Consolation - Pastoral Care at the Limits of Life. Mainz, 1999
Erhard Weiher, born 1941, dipl. phys. et theol.
Training in topic-centered interaction (TZI), therapeutic pastoral care and grief counseling (R. Smeding), advanced training for clinical and pastoral professions, cath. Pastor at the University Clinics in Mainz.