Supporting the restless patient from the viewpoint of the pastoral carer

Calmness is one of the meaningful foundations on which both the religious and the meditative or spiritual inner life rests. Before beginning to meditate or pray – as religious and spiritual teachers have known for thousands of years – we must first reflect and concentrate inwardly in order to distance ourselves from everyday events, gather strength and create a calm, quiet mood within ourselves. Then we can turn to the content of a prayer or meditation (1). The more this calm mood is created, the more successfully it is possible to enter into prayerful or meditative activity.

Different meditative techniques have developed in the present, often rooted in the Buddhist tradition. As "mindfulness", they do not directly connect to a specific religious practice. Rather, they are used as an exercise to control stress and exhaustion (2). People who practise these exercises regularly over a longer period of time more often achieve a certain degree of self-control over their emotions or greater equanimity in dealing with stressful or tense life situations. A growing number of scientific studies are documenting the physiological and psychological effectiveness of mindfulness and meditation.

In palliative care, restlessness is a common and therapeutically challenging symptom. After clarifying its cause, particular significance accrues to help such as meditation and prayer (3).

Pastoral care for the restless patient

Anxiety and restlessness – including directly at the threshold of death – often overwhelm the dying person. Such states are not always consciously and clearly expressed by those affected. The physical factors that contribute to restlessness must be recognised and treated as well as is possible, as must the psychological causes.

When pastoral carers – ministers, deacons or those in spiritual care – are called to the bedside to accompany people on the palliative care ward or even at home, questions arise: was the person concerned religiously oriented, or perhaps someone who meditates and is used to and has experience in spiritual practice? As a pastoral carer, we try, for example, to connect to meaningful experiences that came with life and that were perceived as positive in the biography. In this way the topic of suffering and dying can be discussed and worked on in a trustful conversation.

But we can also reflect on the quality of calmness in a completely new way. Here it is important not to be "infected" by the patient's restlessness. It is only out of our own calmness that the possibility of helping the patient develops. Speaking calmly, even softly, can be helpful. The patient does not seek distraction in these conversations but new perspectives and can feel the empathy and will to offer helping support.

The following meditation, which comes from anthroposophy, is often an essential aid to developing inner calm:

I bear calm within myself, 
I bear within myself
The forces which strengthen me.
I want to fill myself
With the warmth of these forces,
I want to pervade myself
With the power of my will.
And I want to feel
How calm spreads
Through all my being
When I strengthen myself
To find calm as
The force within me
Through the power of my striving. (4)

If conversations can be held with restless patients, the attempt is worthwhile to consciously approach the problem or worry together. This enables them to experience that their own strength are sufficient to a certain extent to be able to withstand the problem or worry. In doing so, it is indispensable that the pastoral carer themselves has the conviction: You can do it! There are forces slumbering within you that make it possible to deal with this problem, worry or fear.

Trust between patients and pastoral carers does not develop by itself. It takes time, often several visits, to build this up. If we then succeed in building trust through conversation, interest and attentiveness, we can draw on this bridge in moments of restlessness. Bridges of trust can be built regardless of religious conviction or meditative inner life. Here the "skill" of the pastoral carer in dealing with people plays a major role.

Another aspect in dealing with the restless patient is to take into account their surroundings and their family members and relatives. Stressful or successful human relationships can contribute to aggravating or ameliorating restlessness. It is important to discuss the patient's suffering and fears with the patient's relatives, provided that the patient agrees. This opens up a wide field of work for our pastoral care. If relatives ask for verses with which they can convey their positive thoughts and support to the patient, the following prayer-like meditation is suitable:

Spirits of your souls, active guardians, 
May your wings carry
Our souls' petitioning love
To the human beings here on earth committed to your care,
That, united with your might,
Our petition shall shine in help
For the souls whom it seeks with love. (5)

This meditation can also be spoken in the singular and thus be addressed to a single sick relative.