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Five basic modes of being with another

Article · June 1991

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 Caring:
The Compassionate Healer

Delores A. Gaut
Madeleine M. Leininger
Editors

ÍÍÖ.C;

Center for Human Caring

National League for Nursing Press • New York

Pub. No. 1 5 - 2 4 0 1

- Wl
 4

Five Basic Modes of Being with Another

Sigridur Halldorsdottir

W h e n t h e w e a k a n d the o r p h a n e d
are d e p r i v e d of j u s t i c e
all t h e f o u n d a t i o n s o f t h e e a r t h
are s h a k e n .
Ps. 82.3-5

L e i n i n g e r ( 1 9 8 8 ) m a i n t a i n s t h a t caring i s t h e essence o f h u m a n i t y , a n d t h a t i t
i s e s s e n t i a l for h u m a n g r o w t h a n d survival. S h e c o n t e n d s that care i s o n e o f
the most powerful and elusive aspects of our h e a l t h and identity and must be
t h e c e n t r a l f o c u s o f n u r s i n g a n d the h e l p i n g a n d h e a l i n g p r o f e s s i o n s . S i m i l a r l y ,
R o a c h ( 1 9 8 8 ) c l a i m s that care i s the b a s i c c o n s t i t u t i v e p h e n o m e n o n o f h u m a n
e x i s t e n c e a n d t h u s o n t o l o g i c a l i n that i t c o n s t i t u t e s m a n a s m a n . S h e p o i n t s
o u t that all e x i s t e n t i a l s u s e d t o d e s c r i b e D a s e i n ' s s e l f h a v e t h e i r c e n t r a l l o c u s
i n c a r e . R o a c h states, " W h e n w e d o n o t care, w e l o s e o u r b e i n g a n d care i s t h e
way b a c k t o b e i n g . C a r e i s p r i m o r d i a l , the s o u r c e o f a c t i o n a n d i s n o t r e d u c i b l e
to s p e c i f i c a c t i o n s " ( 1 9 8 7 , p. 1 5 ) .
A l t h o u g h R o a c h ( 1 9 8 4 ) c l a i m s that c a r i n g i s t h e h u m a n m o d e o f b e i n g , s h e
w o n d e r s h o w c o n v i n c i n g t h e view i s that c a r i n g i s t h e n a t u r a l e x p r e s s i o n o f
what is authentically h u m a n w h e n there is so m u c h evidence of lack of caring,
b o t h w i t h i n our personal e x p e r i e n c e s as well as in the society a r o u n d us.
R o a c h p o i n t s o u t that w e live i n a n age w h e r e v i o l e n c e i s c o m m o n p l a c e a n d
where atrocities are c o m m i t t e d against i n d i v i d u a l s and c o m m u n i t i e s every-
w h e r e . T o c o m p o u n d t h e e f f e c t o f s u c h v i o l e n c e o n the b r o a d e r social body,
m a n y i n c i d e n t s e n t e r o u r living r o o m s t h r o u g h the press, radio, a n d t e l e v i s i o n
often as quickly as they occur.
A s a r e s u l t , m o d e s o f b e i n g w i t h a n o t h e r i n o u r w o r l d involve b o t h c a r i n g
and uncaring dimensions. What, then, are the basic modes of being with
a n o t h e r ? B y analyzing t w o o f m y o w n s t u d i e s o n c l i e n t s ' ( p a t i e n t s ' and stu-
dents') perceptions of caring and uncaring e n c o u n t e r s (Halldorsdottir, 1989,
1 9 9 0 ) , as w e l l as r e l a t e d l i t e r a t u r e , I have d e t e r m i n e d that t h e r e are five b a s i c
m o d e s o f b e i n g w i t h a n o t h e r : life-giving ( b i o g e n i c ) , l i f e - s u s t a i n i n g ( b i o a c t i v e ) ,
life-neutral (biopassive), life-restraining (biostatic), and life-destroying (bio-
cidic) (see F i g u r e 4 - 1 a n d T a b l e 4 - 1 ) .
In this c h a p t e r , I will d e s c r i b e the five b a s i c m o d e s of b e i n g w i t h a n o t h e r
t h r o u g h examples of caring and uncaring e n c o u n t e r s in hospitals as,experi-
enced by former patients, my coresearchers i n the f o r m e r study ( H a l l d o r s -
dottir, 1 9 8 8 ) . T h e p h e n o m e n o l o g i c a l p e r s p e c t i v e o f qualitative r e s e a r c h t h e o r y
g u i d e d t h e m e t h o d o l o g i c a l a p p r o a c h t o t h e s t u d i e s analyzed, i n v o l v i n g t h e use
o f t h e o r e t i c a l sampling, i n t e n s i v e u n s t r u c t u r e d i n t e r v i e w s , and c o n s t a n t c o m -
p a r a t i v e analysis.
N i n e f o r m e r p a t i e n t s p a r t i c i p a t e d i n t h e f o r m e r study and data w e r e c o l -
lected through 18 in-depth, open-ended interviews. Nine former nursing
s t u d e n t s p a r t i c i p a t e d i n t h e l a t t e r study a n d data w e r e c o l l e c t e d t h r o u g h 1 6
in-depth, open-ended interviews. In both studies, interviews were tape-
r e c o r d e d a n d t r a n s c r i b e d v e r b a t i m for each p a r t i c i p a n t .
T h e e x c e r p t s u s e d f r o m the f o r m e r study will b e r e f e r r e d t o a s " m o d e s o f
b e i n g w i t h a p a t i e n t , " a n d for the sake of clarity, t h e f e m i n i n e will be utilized in
r e f e r e n c e to the n u r s e , t h e m a s c u l i n e in r e f e r e n c e to the c o r e s e a r c h e r / p a t i e n t /
client. I n the text, however, "nurse" and "coresearcher/patient/client" can

CARING

Life-giving Biogenic
Life-sustaining Bioactive
Life-neutral Biopassive
Life-restraining Biostatic
Life-destroying Biocidic

UNCARING

Figure 4-1
The Caring/Uncaring Dimension or Continuum
 Table 4-1
Five Basic Modes of Being with Another
L i f e - d e s t r o y i n g (biocidic) m o d e o f b e i n g w i t h a n o t h e r i s a m o d e w h e r e o n e
d e p e r s o n a l i z e s the o t h e r , d e s t r o y s j o y o f life, and i n c r e a s e s t h e o t h e r ' s v u l n e r a b i l i t y . I t
c a u s e s d i s t r e s s and despair, a n d h u r t s and d e f o r m s the o t h e r . It is t r a n s f e r e n c e of
negative energy or darkness.

L i f e - r e s t r a i n i n g (biostatic) m o d e o f b e i n g w i t h a n o t h e r i s a m o d e w h e r e o n e i s
i n s e n s i t i v e or i n d i f f e r e n t to the o t h e r and d e t a c h e d f r o m the true c e n t e r of the o t h e r . It
c a u s e s d i s c o u r a g e m e n t and d e v e l o p s u n e a s i n e s s i n the o t h e r . I t n e g a t i v e l y a f f e c t s
e x i s t i n g life in the other.

L i f e - n e u t r a l ( b i o p a s s i v e ) m o d e o f b e i n g w i t h a n o t h e r i s a m o d e w h e r e o n e d o e s not
a f f e c t life in the o t h e r .

L i f e - s u s t a i n i n g (bioactive) m o d e of b e i n g with a n o t h e r is a m o d e w h e r e one

a c k n o w l e d g e s the p e r s o n h o o d o f the o t h e r , s u p p o r t s , e n c o u r a g e s , a n d r e a s s u r e s the
o t h e r . It g i v e s the other s e c u r i t y a n d c o m f o r t . It p o s i t i v e l y a f f e c t s life in the o t h e r .

L i f e - g i v i n g ( b i o g e n i c ) m o d e o f b e i n g w i t h a n o t h e r i s a m o d e w h e r e o n e a f f i r m s the
p e r s o n h o o d of the other by c o n n e c t i n g w i t h the true c e n t e r of the o t h e r in a l i f e - g i v i n g
w a y . I t r e l i e v e s the v u l n e r a b i l i t y o f t h e o t h e r and m a k e s the o t h e r s t r o n g e r a n d e n h a n c e s
g r o w t h , r e s t o r e s , r e f o r m s , and p o t e n t i a t e s l e a r n i n g and h e a l i n g .

r e f e r t o b o t h males and f e m a l e s . E v i d e n c e f r o m l i t e r a t u r e , t h a t has a b e a r i n g

on this m a t t e r , also will be given.
The life-destroying, or biocidic, mode is the most inhumane mode of b e i n g
w i t h a n o t h e r in the list as given a n d is r e p r e s e n t e d by v i o l e n c e in all its f o r m s . It
means hurting, harming, or deforming the other. T h i s destructive mode mani-
fests i n n u m e r o u s ways: making people dependent or fostering infantilism;
being threatening; involving m a n i p u l a t i o n , coercion, hatred, aggression, and
h u m i l i a t i o n ; involving v a r i o u s k i n d s o f abuse; and o f t e n i n v o l v i n g a n e v i d e n t
lust f o r p o w e r , followed by d o m i n a n c e and d e p e r s o n a l i z a t i o n o f t h e , o t h e r .
H a r d h e a r t e d n e s s o r c o l d h e a r t e d n e s s also may b e p r e s e n t h e r e . This mode of
b e i n g w i t h a n o t h e r m o s t o f t e n c h a n g e s the o t h e r t o t h e w o r s e , t h e h a r m d o n e
d e p e n d i n g o n the o t h e r ' s s t r e n g t h t o e n d u r e . It involves the transference of
n e g a t i v e e n e r g y or d a r k n e s s to t h e o t h e r . It is the f r o s t the h u m a n f l o w e r has a
h a r d t i m e e n d u r i n g w i t h o u t l o o s i n g its luster, its p e t a l s , its leaves, its v e r y life.
I n m a n y r e s p e c t s , the h i s t o r y o f h u m a n k i n d i s n o t a p o s i t i v e a f f i r m a t i o n o f
the s a n c t i t y o f h u m a n life a s R o a c h (1987) has rightly pointed out. There
seems to be no end to h o w destructive and b r u t a l the h u m a n b e i n g can be.
R o a c h also a r g u e s that p e r h a p s t h e greatest t h r e a t a g a i n s t h u m a n life i n o u r
age lies i n t h e e r o s i o n o f s e n s i t i v i t y t o w a r d its v a l u e , p a r t i c u l a r l y w h e r e t h e
t a k i n g o f h u m a n life b e c o m e s p a r t o f e v e r y d a y e x p e r i e n c e . R o a c h c l a i m s that
t h e p u b l i c at large has b e c o m e less a n d less s e n s i t i v e to all o v e r t k i l l i n g s —
genocide, fratricide, homicide, suicide, and feticide.
 As described, the life-destroying, or biocidic, mode of being with a patient is
the most severe f o r m of i n d i f f e r e n c e to the patient as a person, involves
harshness and inhumanity, and is characterized by various forms of inhumane
a t t i t u d e s . A l t h o u g h I will n o t tell t h e i r e n t i r e s t o r i e s h e r e , f o u r out o f the n i n e
coresearchers i n the study u n d e r d i s c u s s i o n h a d a b i o c i d i c experience. Of
t h o s e f o u r c o r e s e a r c h e r s , t h r e e a s k e d m e w h e t h e r I h a d s e e n " O n e Flew o v e r
the C u c k o o ' s N e s t " a n d c l a i m e d t h a t t h e i r n u r s e w a s v e r y m u c h like n u r s e
R a c h e t a s p o r t r a y e d i n that f i l m . N o n e o f the c o r e s e a r c h e r s k n e w each o t h e r .
W h i l e all coresearchers held a u n a n i m o u s p e r c e p t i o n that u n c a r i n g en-
c o u n t e r s w i t h nurses were very discouraging and distressing experiences for
t h e m a s p a t i e n t s , t h e i r r e a c t i o n s t o s u c h e n c o u n t e r s w e r e m a n y sided. S e v e r a l
major themes were identified in their accounts: initial puzzlement and dis-
belief; which is followed by anger and resentment. Because of the patient's
v u l n e r a b l e c i r c u m s t a n c e s , h o w e v e r , t h e p a t i e n t i s m o s t o f t e n u n a b l e t o act o u t
feelings o f a n g e r a n d r e s e n t m e n t , a n d t h e s e s t r o n g n e g a t i v e feelings s e e m t o
develop into despair and helplessness.
B e i n g u n c a r e d for i n a d e p e n d e n t s i t u a t i o n d e v e l o p s feelings o f i m p o t e n c e ,
a s e n s e of loss, a n d a s e n s e of h a v i n g b e e n b e t r a y e d by t h o s e c o u n t e d on f o r
caring. If on top of that t h e p a t i e n t is t r e a t e d by t h e n u r s e as if s o m e w h a t less
t h a n h u m a n , the p a t i e n t ' s f e e l i n g s s o o n d e v e l o p i n t o f e e l i n g s o f a l i e n a t i o n and
identity loss. T h e p a t i e n t feels he has no value as a p e r s o n , that he is i n d e e d
less t h a n a p e r s o n : "a side of b e e f , " "an o b j e c t , " or "a m a c h i n e . " F u r t h e r m o r e ,
experiencing uncaring increases the patient's own feelings of vulnerability
w i t h i n t h e h o s p i t a l setting.
Numerous coresearchers alluded to the t h r e a t o f d e h u m a n i z a t i o n w i t h i n
today's h o s p i t a l s . I t was t h e i r u n a n i m o u s p e r c e p t i o n that t h e y felt v u l n e r a b l e
a n d i n n e e d o f c a r i n g w h e n t h e y w e r e i n the h o s p i t a l . S o m e s u g g e s t e d this
m a k e s p a t i e n t s m o r e s e n s i t i v e t o c a r i n g and u n c a r i n g . O n e such f o r m e r pa-
tient stated:

I would expect that people being ill makes them vulnerable, so that when
they have an uncaring transaction, like someone treats them rudely, they
are more deeply wounded in that circumstance than if they were healthy
and walking the street and someone on the corner said something stupid or
insulting. I mean that they can shrug off and ignore, but here they are sick
and in need, and probably feel weak in spirit, and weak in body, and so it
hits home harder, any such transaction hurts them more.

O t h e r coresearchers related that they perceived u n c a r i n g as a t r a n s f e r e n c e

o f n e g a t i v e e n e r g y that a f f e c t e d t h e i r w e l l b e i n g a n d delayed o r e v e n p r e -
vented their recovery. This perceived negative effect on well being andhealing

to
 is illustrated time and again i n t h e i r a c c o u n t s . Furthermore, it was their
u n a n i m o u s p e r c e p t i o n that t h e u n c a r i n g e n c o u n t e r s m a d e s u c h a n i n d e l i b l e
i m p r e s s i o n o n t h e m , and h a d a l o n g e r lasting e f f e c t t h a n c a r i n g e n c o u n t e r s ,
that they tended to be both acid edged and memorable experiences.
S o m e c o r e s e a r c h e r s r e f e r r e d t o the " m e m o r i e s o f u n c a r i n g e n c o u n t e r s " a s
scars, a n d a l t h o u g h they s e e m to be t r y i n g to u n d e r s t a n d or m a k e s e n s e of t h e
e x p e r i e n c e t h e y are m o s t o f t e n still angry, and even have nightmares about
the n u r s e s p e r c e i v e d t o b e u n c a r i n g . S o m e coresearchers identified h o w the
u n c a r i n g e x p e r i e n c e p r o m p t e d t h e m t o t h i n k a b o u t u l t i m a t e realities vis-a-vis
death, a f f e c t e d t h e i r view o f the h o s p i t a l , a n d h o w i t c o n t i n u e d t o e v e n d i c t a t e
their d e c i s i o n s w i t h i n the h e a l t h care system today.
A l t h o u g h m o s t c o r e s e a r c h e r s had tried t o f o r g i v e the u n c a r i n g n u r s e , s o m e
coresearchers related that that was probably more a result of f o r g e t f u l n e s s
than forgiveness. T h e s e c o r e s e a r c h e r s s o m e t i m e s e x p r e s s e d a l o n g i n g t o re-
t u r n a n d c o n f r o n t the u n c a r i n g n u r s e , if, for n o t h i n g m o r e , than to relieve
t h e m s e l v e s o f t h e i r anger. A t t h e s a m e t i m e , h o w e v e r , t h e y realized that t h e
nurses perceived to be uncaring were probably unaware of their i n f l u e n c e s on
the p a t i e n t s a n d w o u l d , t h e r e f o r e , n o t r e c o g n i z e t h e i r s t o r i e s .
H i l d e g a r d of B i n g e n , a r e m a r k a b l e t w e l f t h - c e n t u r y a b b e s s , s c i e n t i s t , artist,
p o e t , m u s i c i a n , a n d m y s t i c , talks a b o u t the d r y n e s s o f c a r e l e s s n e s s a n d i n j u s -
tice. S h e c l a i m s that d r y n e s s a n d c o l d n e s s t o g e t h e r m a k e h a r d n e s s o f h e a r t
a n d that d r y i n g u p d e s t r o y s o u r c r e a t i v e p o w e r s , m a r k i n g the e n d o f all g o o d
w o r k s , a n d the b e g i n n i n g o f laziness and c a r e l e s s n e s s . S h e m a i n t a i n s t h a t i f w e
lack a n i n f u s i o n o f h e a v e n l y dew w e will b e t u r n e d i n t o d r y n e s s and o u r s o u l s
will w a s t e away. F r o m H i l d e g a r d ' s p o i n t o f view, t h e u l t i m a t e u n c a r i n g o c c u r s
w h e n w e b e c o m e cold a n d h a r d e n e d t o i n j u s t i c e . Hildegard (1985) wrote to
one churchman: " W h e n a p e r s o n loses the f r e s h n e s s o f G o d ' s p o w e r , h e i s
t r a n s f o r m e d i n t o the d r y n e s s o f c a r e l e s s n e s s . H e l a c k s t h e j u i c e a n d g r e e n n e s s
o f g o o d w o r k s a n d the e n e r g i e s o f his h e a r t are s a p p e d a w a y " (p. 6 4 ) .
The life-restraining, or b i o s t a t i c , mode of b e i n g w i t h a n o t h e r involves nega-
tively a f f e c t i n g life i n the o t h e r b y r e s t r i c t i n g o r d i s t u r b i n g the e n e r g y a l r e a d y
existent in the other. It means being insensitive or indifferent to the o t h e r ,
causes d i s c o u r a g e m e n t , and d e v e l o p s u n e a s i n e s s i n t h e o t h e r . I t o f t e n i n v o l v e s
imposing one's o w n will upon the other, dominating and controlling the
other. It s o m e t i m e s appears as fault-finding, anger, blaming, accusing, and
being unfriendly. I t i s that v e r y c o l d n e s s a n d s t r o n g w i n d the h u m a n f l o w e r
has a h a r d t i m e e n d u r i n g .
The life-restraining, or biostatic, mode of being with a patient involves the
p a t i e n t f e e l i n g s t r o n g l y that the n u r s e d o e s n ' t care a n d i s b l i n d t o his f e e l i n g s
b y way o f n e g a t i v e f e e d b a c k f r o m n u r s e to patient. Here, the n u r s e o f t e n
treats t h e p a t i e n t as a n u i s a n c e , that is, if it w e r e n ' t f o r t h e p a t i e n t t h e n u r s e ' s
life w o u l d be a lot easier. T h e p a t i e n t starts to feel t h a t he is b o t h e r i n g t h e
n u r s e w h e n a s k i n g for h e l p , a n d f i n d s the n u r s e o f t e n c o l d a n d u n k i n d , a n d
the n u r s e ' s p r e s e n c e d e s t r u c t i v e i n s o m e way. T h i s n u r s e a p p r o a c h i s p a r t l y
i l l u s t r a t e d i n the f o l l o w i n g a c c o u n t s .

The second one [uncaring nurse] was cold, and I can at least give her that
much because I interacted with her enough. The first one, I would just say
I was . . . what. , 7
I don't know, a piece of dust on the floor, I mean, I
can't, I was a b o t h e r *• . . T h e people in that room were j u s t b e d s , that's
all, you know, beds. She had prescriptions, she had a checklist of what she
had to do, you know, your heart, etc., and that's all it was, for everybody,
not just for me, you know.

I had experiences of being in another ward for three days, and there was a
tremendous high percentage of noncaring nurses. Actual!}, this is a nice
description saying noncaring nurses, they were completely like
cold . . . cold human beings, like c o m p u t e r s . It's like, sometimes I was
worried, I was . . . was wondering if they really even noticed that I
was there.

D o s s e y ( 1 9 8 2 ) asserts t h a t a p a t i e n t - a s - o b j e c t a p p r o a c h to care d e l i v e r y is
d e s t r u c t i v e b e c a u s e i t v i o l a t e s t h e o n e n e s s a n d w h o l e n e s s that are n e c e s s a r y
for healthy, viable living s y s t e m s . S i m i l a r l y , G a d o w ( 1 9 8 5 ) has p o i n t e d o u t t h a t
i n a d d i t i o n t o the d o m i n a t i o n b y a p p a r a t u s and b y e x p e r t s t h a t c a n a c c o m p a n y
the use of t e c h n o l o g y , p a t i e n t s c a n be r e d u c e d to o b j e c t s in a m o r e f u n d a m e n -
tal way t h a n by the use of m a c h i n e s : in the view of t h e b o d y as a m a c h i n e .
G a d o w states, " s u c h r e d u c t i o n o c c u r s b e c a u s e r e g a r d f o r the b o d y e x c l u s i v e l y
as a s c i e n t i f i c o b j e c t n e g a t e s t h e validity of s u b j e c t i v e m e a n i n g s of t h e p e r s o n ' s
experience. Those meanings are categorically n o n e x i s t e n t in the scientific
o b j e c t " (p. 3 6 ) . F u r t h e r m o r e , G a d o w ( 1 9 8 8 ) has p o i n t e d o u t t h a t the e x e r c i s e
o f p o w e r always i n c r e a s e s t h e v u l n e r a b i l i t y o f the o n e o v e r w h o m i t i s e x e r -
c i s e d , n o m a t t e r w h a t b e n e v o l e n t p u r p o s e the p o w e r s e r v e s .
T h e life -neutral, or biopassive, mode of b e i n g w i t h a n o t h e r o c c u r s w h e n o n e
i s d e t a c h e d f r o m the t r u e c e n t e r o f the o t h e r and w h e n t h e r e i s n o e f f e c t
on t h e e n e r g y or life of t h e o t h e r . T h i s lack of r e s p o n s e , i n t e r e s t , and affect
derives f r o m i n a t t e n t i v e n e s s or i n s e n s i t i v i t y to the o t h e r . It refers to the lack of
a p o s i t i v e or caring a p p r o a c h r a t h e r t h a n the p r e s e n c e of s o m e t h i n g d e s t r u c -
tive. A l t h o u g h it has no real e f f e c t on t h e life in the o t h e r , it s o m e t i m e s creates
a f e e l i n g of l o n e l i n e s s , b e c a u s e t h e r e is no m u t u a l a c k n o w l e d g m e n t of p e r s o n -
hood, no person-to-person contact. Furthermore, many seem to experience
this a p a t h e t i c i n a t t e n t i o n n o t o n l y a s lack o f care b u t a s n o n c a r i n g o r u n c a r i n g .

HX
 The fundamental characteristic of the ii/e-neutrai, or biopassive, mode of
being with a patient is p e r c e i v e d apathy, w h i c h r e f e r s to t h e a p p r o a c h in w h i c h
the n u r s e is p e r c e i v e d to be i n a t t e n t i v e to p a t i e n t s a n d t h e i r s p e c i f i c n e e d s .
T h e c o r e s e a r c h e r s e m p h a s i z e d t h a t t h e n u r s e s e e m e d t o care a b o u t the r o u -
tine, t h e tasks s h e was s u p p o s e d to p e r f o r m , b u t n o t a b o u t t h e p a t i e n t as a
p e r s o n . T h e n u r s e i s s o m e t i m e s p e r c e i v e d b y the p a t i e n t a s i n s e n s i t i v e , a b s e n t -
minded, tired, dissatisfied i n her j o b , o r l a c k i n g i n s o m e c a r i n g quality, for
example, w a r m t h of voice. Furthermore, the c o r e s e a r c h e r s perceived these
nurses as either unwilling, or unable, to c o n n e c t with, or develop attachment
to, the p a t i e n t . T h e c o r e s e a r c h e r s ' p e r c e p t i o n s o f d e t a c h m e n t are s e e n clearly
in t h e i r a c c o u n t s . In fact o n e c o r e s e a r c h e r s t a t e d , " A a h m . . . the way she
l o o k e d at you . . . like you are n o t a p a r t of h e r w o r l d ... or that she
d o e s n ' t w a n t t o a t t a c h — y o u c a n feel that t h e r e i s n o e m o t i o n a l a t t a c h m e n t
there."
B e r m e j o ( 1 9 8 7 ) asserts that a p e r s o n is e s s e n t i a l l y c h a r a c t e r i z e d by a n e c e s -
sary o p e n n e s s t o a n o t h e r . He c o n t e n d s that a p e r s o n closed in u p o n and
w i t h d r a w n i n t o his o r h e r self, h a r d l y d e s e r v e s the s t a t u s o f p e r s o n , f o r this
w i t h d r a w a l , h e a r g u e s , goes c o u n t e r t o t h e v e r y c o r e o f m a n ' s b e i n g , w h i c h i s
c l a m o r i n g first for a n o p e n i n g , a n d t h e n , b a s e d u p o n t h a t o p e n i n g , f o r a total
gift of self to a n o t h e r . B e r m e j o states, "A r e j e c t i o n of this e s s e n t i a l , radical
opening and the ensuing personal communion would u n a v o i d a b l y have a
c r i p p l i n g e f f e c t o n the f u l n e s s o f t h e h u m a n p e r s o n . A m a n h a l f o p e n i s o n l y
h a l f a m a n " (p. 4 6 ) .
H i l d e g a r d o f B i n g e n ( 1 9 8 5 ) states i n o n e o f h e r m a n y b o o k s t h a t t o o o f t e n
h u m a n a c t i o n s are w e a k a n d l u k e w a r m a n d e m e r g e f r o m p e o p l e w h o are m o r e
asleep t h a n a w a k e . S h e claims t h a t i n this way p e o p l e " m a k e t h e m s e l v e s w e a k
and poor w h o do not wish to be busy about justice or a b o u t rubbing out
injustice o r a b o u t paying b a c k t h e i r d e b t s . " C o m m i t m e n t to justice, s h e in-
sists, w o u l d w a k e p e o p l e f r o m t h e i r sleep a n d w o u l d p u t zeal b a c k i n t o t h e i r
lives a n d w o r k .
Similarly, M a t t h e w Fox ( 1 9 8 5 ) has p o i n t e d o u t that t h e t h e m e o f spiritual
m a t u r i t y a s w a k e f u l n e s s has b e e n e x p r e s s e d i n religious l i t e r a t u r e t h r o u g h o u t
the w o r l d . H i l d e g a r d also m a k e s a c o n n e c t i o n b e t w e e n w i s d o m a s w a k e f u l n e s s
and folly a s s l e e p f u l n e s s . I n the G o s p e l p a r a b l e , t h e w i s e v i r g i n s s t a y e d a w a k e ;
the f o o l i s h fell asleep. I n H i l d e g a r d ' s t e r m s , w e c a n n e v e r c l i m b t h e m o u n t a i n
o f h e a l i n g , c e l e b r a t i o n , j u s t i c e m a k i n g , a n d c o m p a s s i o n i f w e d o n o t care, i f w e
are n o t c o m m i t t e d , i f w e are i n d i f f e r e n t a n d d o n o t f i g h t i n j u s t i c e .
The life-sustaining, or bioactive, mode of b e i n g with another involves
benevolence, g o o d will, genuine kindness and c o n c e r n , beneficence, and
kindheartedness. I t i s p r o t e c t i n g life, r e l i e v i n g s u f f e r i n g , k e e p i n g p r o m i s e s ,
respecting the other, and a c k n o w l e d g i n g the other's h u m a n h o o d . T h a n k i n g

Y3
 a n d p r a i s i n g a n d a c o n t r a r y d i s l i k e o f c o n s t r a i n i n g o t h e r s are i n v o l v e d h e r e .
I n d e e d , t h e r e e x i s t s the h e a r t f e l t w i s h t o d o n o h a r m . C o m f o r t i n g , e n c o u r a g -
ing, consoling, strengthening the other, and continuing to support the
energy already present in the other adds other dimensions to the bio-
active m o d e .
The life-sustaining, or bioactive, mode of being with a patient means that the
nurse is skillful, k n o w l e d g e a b l e , c o m m i t t e d t o the p r o v i s i o n o f p e r s o n a l i z e d
care, a n d k n o w s h o w t o s a f e g u a r d the p e r s o n a l i n t e g r i t y and dignity o f t h e
patient. This special kind-of nurse approach, which includes compassionate
competence, genuine concern for the patient as a person, undivided attention
when the nurse is with the patient, a n d sober cheerfulness, is w h a t I call profes-
sional nurse caring (Halldorsdottir, 1990).
W h e n t h e n u r s e s u c c e e d e d i n giving this k i n d o f p r o f e s s i o n a l c a r i n g , it
p r o m o t e d feelings of trust in patients, w h i c h facilitated the d e v e l o p m e n t of
attachment b e t w e e n patients and nurses. I t i s p r e c i s e l y this a t t a c h m e n t t h a t
f o r m s t h e b a s i s o f a l i f e - g i v i n g p r e s e n c e w h e r e o p e n n e s s a n d the t r a n s f e r e n c e
o f p o s i t i v e e n e r g y , w h i c h a f f e c t s t h e o t h e r i n a p r o f o u n d way, p r e d o m i n a t e s .
This life-giving or biogenic mode of b e i n g w i t h another is the truly h u m a n
m o d e o f b e i n g a n d i s r e p r e s e n t e d b y h e a l i n g love. T h i s m o d e involves l o v i n g
b e n e v o l e n c e , r e s p o n s i v e n e s s , g e n e r o s i t y , mercy, a n d c o m p a s s i o n . A t r u l y life-
giving p r e s e n c e o f f e r s the o t h e r i n t e r c o n n e c t e d n e s s a n d allows for the e x p a n -
sion o f t h e o t h e r ' s c o n s c i o u s n e s s a n d f o s t e r s spiritual f r e e d o m . It involves
b e i n g o p e n to p e r s o n s a n d giving life to the very h e a r t of m a n as a p e r s o n ,
c r e a t i n g a r e l a t i o n s h i p of o p e n n e s s a n d r e c e p t i v i t y yet always k e e p i n g a c r e -
ative distance of respect and compassion. The t r u l y life-giving o r b i o g e n i c
p r e s e n c e r e s t o r e s well b e i n g a n d h u m a n dignity. It is a t r a n s f o r m i n g p e r s o n a l
p r e s e n c e that deeply c h a n g e s m a n . F o r the r e c i p i e n t t h e r e i s e x p e r i e n c e d a n
i n r u s h of c o m p a s s i o n , o f t e n like a c u r r e n t .
Regarding the life-giving or biogenic mode of being with a patient, one
c o r e s e a r c h e r said this a b o u t the f u n d a m e n t a l d i f f e r e n c e b e t w e e n c a r i n g a n d
uncaring: " I ' m n o t sure h o w t o p u t i t o t h e r t h a n ' p e r s o n a l r e l a t i o n s h i p , ' t h e
sense i s s o m e h o w that y o u r spirit a n d m i n e have m e t i n the e x p e r i e n c e . A n d
the w h o l e idea t h a t t h e r e is s o m e b o d y in that h o s p i t a l w h o is with me, r a t h e r
than w o r k i n g on m e . "
A n o t h e r c o r e s e a r c h e r e x p l a i n e d i t this way: " Y o u k n o w , t h e r e i s that k i n d
of b o n d i n g , that k i n d of f e e l i n g of . . . n o t i n t i m a c y b u t at least connection,
t h e r e has b e e n a c o n n e c t i o n m a d e w i t h that p e r s o n , a connection which I
c o u l d t h e n f o l l o w - u p on, you k n o w , I w o u l d feel f r e e to do s o . "
F r o m c o r e s e a r c h e r s ' a c c o u n t s , i t i s a p p a r e n t that this b o n d i n g o r c o n n e c -
tion also involves a creative distance of respect and compassion, a dimension of
p r o f e s s i o n a l a t t a c h m e n t w h i c h has t o b e p r e s e n t i n o r d e r t o k e e p caring i n t h e
p r o f e s s i o n a l d o m a i n . It is also clear t h a t d i m e n s i o n s in t r u e p r o f e s s i o n a l c a r i n g
d e p e n d o n t h e d e p t h o f a t t a c h m e n t d e v e l o p e d . P r o f e s s i o n a l a t t a c h m e n t devel-
o p m e n t c a n be c o n c e p t u a l i z e d as a process i n v o l v i n g five phases: initiating
attachment, or reaching out; mutual acknowledgment of personhood; acknowl-
edgment of attachment; professional intimacy; and negotiation of care (Hall-
dorsdottir, 1990).
This professional nurse-patient relationship is in many ways unusual. T h e
following two accounts provide poignant illustrations:

She fostered a working relationship between the two of us, as I said impor-
tantly as equals, and fostered a sense of i n d e p e n d e n c e for your own
growth, your personal growth to the point where you didn't need her in that
role anymore.

In most other relationships what you want is some sort of deepening of the
ability to communicate or the commitments so that the relationship is
ongoing, that is, you want to perpetuate the relationship whereas in nursing
and teaching the ideal thing is like parenting, what you want to do is to
enable the client to graduate, that is, to leave. The best thing that could
happen is that the patient is able enough to stop being a patient. Well, that
is a peculiar thing in a relationship, that is, you are hoping for it to stop, for
it to be no reason to continue, and then to be able to say goodbye with
blessings, so that makes it unusual, I think, as a relationship.

T h e c o r e s e a r c h e r s ' a c c o u n t s i l l u s t r a t e clearly their c o n c e p t i o n s o f h o w car-

ing positively i n f l u e n c e s the p a t i e n t ' s ability t o r e c o v e r . S o m e coresearchers
a r t i c u l a t e d the r e l i e f that they s e n s e d w h e n they felt c a r e d f o r a n d h o w that
d i m i n i s h e d a n x i e t y and gave t h e m t i m e t o c o n c e n t r a t e o n g e t t i n g b e t t e r . S o m e
c o r e s e a r c h e r s actually r e f e r r e d to c a r i n g as m e d i c i n e of s o r t s . O n e said, y

The purpose of the friendliness and the caring is focused on a particular

professional activity and a particular very short period in the life of the
patient and designed to it's another form of medication of sorts. It's
part of the healing, part of the getting the patient better, and it's creating
the climate for the patient getting better.

S o m e c o r e s e a r c h e r s e m p h a s i z e d t h a t c a r i n g a f f e c t e d h e a l i n g t h r o u g h t h e psy-
che o f the p e r s o n . O n e said,

I think the effect on the psyche of a person is very much a part of the
healing, because I believe in treating the whole person, treating them as

HS
 body, mind, and spirit, not just the body alone but the three of them
combined, and if their psyche is being damaged or uncared for, then how
can their body get well?

I t i s a p p a r e n t f r o m t h e data t h a t t h e n u r s e - p a t i e n t a t t a c h m e n t i s p e r c e i v e d
by the patient as a t h e r a p e u t i c or healing relationship. It seems that profes-
sional c a r i n g m a k e s h e a l i n g m o r e p r o f o u n d , m o r e r a p i d , a n d b e t t e r i n t e r n a l -
ized if it is p r o v i d e d , a n d it d e f i n i t e l y m a k e s t h e p a t i e n t feel b e t t e r h e a l e d .
In a d d i t i o n , t h e data m a k e s e v i d e n t that the p a t i e n t ' s r e a c t i o n s to profes-
sional c a r i n g are quite positive. T h e professional nurse gets to know the
p a t i e n t as a u n i q u e individual and treats that individual accordingly. She
c o m m u n i c a t e s to the p a t i e n t in a w a y t h a t m a k e s h i m feel fully a c c e p t e d as a
n o r m a l h u m a n b e i n g , a n d l e g i t i m i z e d as a p e r s o n a n d as a p a t i e n t . T h i s h e l p s
t h e p a t i e n t to feel all right a b o u t h i m s e l f a n d his h o s p i t a l stay. Professional
c a r i n g also s e e m s to give the p a t i e n t a s e n s e of h o p e a n d o p t i m i s m , e n c o u r a g e -
m e n t and reassurance. To feel c a r e d for also gives the p a t i e n t a sense of
security. All this d e c r e a s e s the p a t i e n t ' s anxiety, i n c r e a s e s t h e p a t i e n t ' s c o n f i -
dence, a n d p o s i t i v e l y affects t h e p a t i e n t ' s sense o f well b e i n g a n d healing.
F r o m c o r e s e a r c h e r s ' a c c o u n t s , i t i s e v i d e n t that they w e r e , a n d still are, very
grateful for t h e i r c a r i n g e n c o u n t e r s ; e v e n if the o n l y o n e , it is a pleasant
m e m o r y t h a t they c a r r y away f r o m t h e i r h o s p i t a l stay.
Life f l o w s t h r o u g h the life-giving p e r s o n like a river a n d t h e r e is a t r a n s f e r -
e n c e o f positive energy, strengthening, inspiring, comforting, enlightening,
a n d i n v i g o r a t i n g t h e o t h e r , b r i n g i n g joy, h o p e , trust, c o n f i d e n c e , and p e a c e .
T h i s life-giving p r e s e n c e is greatly e d i f y i n g f o r the soul of t h e o t h e r . It in-
v o l v e s d y n a m i s m , m o v e m e n t , a n d g r o w t h . It is a h e a l i n g e n e r g y of u n c o n d i -
t i o n a l love. It is the heavenly s u n s h i n e and n o u r i s h m e n t the h u m a n flower
n e e d s in o r d e r to g r o w a n d d e v e l o p , to l e a r n a n d to heal.
E x a m i n e d i n t h e o l o g i c a l p e r s p e c t i v e , this g r o w t h - p r o m o t i n g f l o w o f posi-
tive e n e r g y f r o m t h e v e r y c e n t e r o f t h e l i f e - g i v i n g p e r s o n i s a " d i v i n e " e n e r g y
of l o v e a n d light, w h i c h has its s o u r c e in a p e r s o n a l , living, a n d life-giving
God. F o x ( 1 9 7 9 ) c o n t e n d s t h a t c o m p a s s i o n i s a f l o w a n d o v e r f l o w o f the
fullest h u m a n and divine energies b o r n of an awareness of the i n t e r c o n n e c t -
e d n e s s o f all c r e a t u r e s b y r e a s o n o f t h e i r c o m m o n c r e a t o r . T h e preciousness
of the h u m a n being and the i n h e r e n t dignity of each p e r s o n is explained by
A r c h i m a n d r i t e S o p h r o n y (1977) w h o states, " W h e n o u r spirit c o n t e m p l a t e s
in itself the 'image and likeness' of G o d , it is c o n f r o n t e d w i t h the infinite
grandeur of man, and not a few of u s — t h e majority, p e r h a p s —are filled
w i t h dread a t o u r a u d a c i t y " (p. 4 4 ) . H e f u r t h e r c o n t e n d s t h a t i n the D i v i n e
Being the hypostasis constitutes the i n n e r m o s t esoteric principle of Being.
Similarly, i n t h e h u m a n b e i n g , the h y p o s t a s i s i s t h e m o s t i n t r i n s i c f u n d a m e n -
tal. A s S o p h r o n y s t a t e s ,

Persona is the hidden man of the heart, in that which is not corruptible
. which is in the sight of God of great price (I Peter 3.4) — t h e raosf
precious kernel of man's whole being, manifested in his capacity for self-
knowledge and self-determination; in his possession of creative energy; in
his talent for cognition not only of the created world but also of the Divine
world. Consumed with love, man feels himself joined with his beloved God.
Through this union he knows God, and thus love and cognition merge into
a single act. ( 1 9 7 7 , p. 4 4 )

Again from a theological perspective, those w h o have gained perfection in

caring are c a l l e d saints. Dumitru Staniloae (1987), a p r o f e s s o r of d o g m a t i c
theology, p r o v i d e s a c l o s e r l o o k at saints. He e x p l a i n s h o w t h e g e n t l e n e s s and
f i r m n e s s o f the m a n o f G o d , his p o w e r t o c o m f o r t and his p o w e r t o i n c i t e , his
n e a r n e s s a n d yet his d i s t a n c e , are all t h i n g s r o o t e d in t h e t r a n s c e n d e n t love
of G o d , which c o m e s close to us in him. Staniloae claims that in the p e r s o n of
the saint, b e c a u s e of his availability, his e x t r e m e a t t e n t i o n to o t h e r s , a n d by the
alacrity w i t h w h i c h h e gives h i m s e l f t o C h r i s t , h u m a n i t y i s h e a l e d a n d re-
newed. Staniloae states,

The saint always radiates a spirit of generosity, of forbearance, of attention

and willingness to share, without any thought for himself. His warmth
gives warmth to others and makes them feel they are regaining their
strength, and lets them experience the joy of not being alone the saint
immediately creates an atmosphere of friendliness, of kinship, and indeed
of intimacy between himself and others. In this way he humanizes his
relationships and leaves on them a mark of genuineness, because he him-
self has become profoundly human and genuine, (p. 3)

Staniloae concludes,

The saint shows us a human being purifie.d from the dross of all that is
less than human. In him we see a disfigured and brutalised humanity set
to rights; a humanity whose restored transparency reveals the limitless
goodness, the boundless power and compassion of its prototype—God
incarnate. It is the image of the living and personal absolute Being who
became man that is re-established in the person of the saint. By being so
truly human, he has reached a dizzy height of perfection in God, while

HI-
 remaining completely at home with men. The saint is one who is engaged
in ceaseless, free dialogue with God and with men. His transparency
reveals the dawn of the divine eternal light in which human nature is to
reach its fulfilment. He is the complete reflection of the humanity of
C h r i s t , (p. 7)

T h i s life f o r c e , o r h e a v e n l y s u n s h i n e , c r e a t e s the ideal c o n d i t i o n s for t h e

h u m a n f l o w e r to germinate, sprout, b l o o m , a n d b e a r fruit. It is a p o s i t i v e
c r e a t i v e e n e r g y t h r o u g h w h i c h h u m a n i t y i s h e a l e d and r e n e w e d .

ONE FAMILY

F a t h e r o f love
f o u n t a i n of life a n d s o u r c e of light
A dry seed that I am
give that I may dwell in y o u
a n d m o i s t e n e d b y the dew f r o m h e a v e n
b e c o m e a f r u i t of y o u r e v e r - l i v i n g love.

Mother o f love
venerable rose and q u e e n of tenderness
A h u n g r y child that I am
give that I may rest against y o u r b r e a s t
a n d n o u r i s h e d b y y o u r c h e r i s h i n g love
b e c o m e filled w i t h l o v i n g k i n d n e s s .

B r o t h e r o f love
divine p a r t n e r , guide a n d c o m p a n i o n
An u n w o r t h y s i n n e r that I am
f l o o d m y s e n s e s w i t h t h e l i g h t o f y o u r love
and sanctified by your gracious brotherliness
give that I may f l o u r i s h in y o u
my most dulcet morning.

S i s t e r of love
w h i t e lily in the c l o i s t e r of k i n d n e s s
A m a t u r e w o m a n that I am
w i t h l o v e let me serve y o u
and in our long white gowns
let u s i n j o y a n d p u r i t y o f h e a r t
celebrate our sisterhood.

Sigridur Halldorsdottir

Hi
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