When I told people that I was going to do my practicum with people who are dying I felt like an alien. And yet death is a part of the life process. Death is something that touches every individual and family but the reality is that we live in a contemporary death denying culture. To confirm this fact, numerous expressions are used to describe dying. To conceal fear of death people use euphemisms like, “gone to meet his or her maker”, “gone on to a better place”, “passed on” and numerous other expressions that do not engage the word “died”. The idea of doing my practicum at a hospice excited me because it was a new domain for me. I was ready and eager to apply theories learned into a practical setting. My placement experience provided me insight that as a social worker one is never better prepared to deal with death of a client or even one’s impending death. I watched clients grapple with mental and emotional turmoil that comes with having a terminal illness and my religious perspective shifted. While working with individuals who are dying can be complicated and stressful, it provided potential to bring countless personal and professional rewards which helped me challenge my own mortality.
Philip Aziz Centre is a home hospice created as an alternative discourse addressing service users’ needs beyond gender or medical diagnosis. Services provided include practical, physical, emotional and spiritual support for people living with HIV/AIDS, cancer and other life threatening illnesses. Because bureaucracy is one of the tools of development that organizes and structures operations of any efficient agency, my placement is no exception. Autonomy of both worker and client is carefully regulated in relation to specific rules of behaviour. Hence, the importance of analyzing the potential impact organizations may have to exert power and influence on employees and clients (Handy, 1997). My placement agency like any other hierarchical bureaucracy provides both social care and social control.
During my first few weeks, I recall being sceptical and uncomfortable about the spiritual component. This was because of an incident that happened a few weeks into my placement. I was assigned to work with the Chaplain to organize a retreat for a group of terminally ill clients who access spiritual care services from the agency. I started to increasingly feel uncomfortable when the Chaplain started to make unreasonable demands on me; that she wanted to pray for me. Ogbor (2001) contends corporate culture can be used to reinforce informal norms and can become an expectation on the part of employees that would be otherwise lost (p.594). Indeed, I felt lost in this religious dilemma and felt like I was in what Ogbor refers to as “psychic prison”. A mechanism often constructed by individuals to protect against internal tensions. It occurred to me that I was not only losing my “sense of self” but my identity was being manipulated through the prayer rituals.
Couzen (2005) citing Foucault states that through norms individuals can be programmed by social institutions. This is because once there is dominance normalization makes dominance invisible. Hence, I found myself assimilating into the assigned organizational religious cultural values and norms. When I reflected on the theories of corporate hegemony, I became aware of the intersections of whiteness and the cultural imposition that was taking place. Why was I succumbing to what appeared as religious indoctrination? Was I being manipulated? Institutional patterns operate as techniques of power and domination (Ogbor, 2001). The imbalance of power was emotionally unsettling. Using Foucault’s work to examine self-regulation, I take full responsibility for self-regulating and being complicit in my own domination. My failure to be critical about ideological practices that went against my personal beliefs and values gave the Chaplain permission to legitimize and enforce the prayer rituals. Thus, techniques of domination intersect with self to produce what Foucault describes as “governmentality”.
The self-imposed surveillance constituted a form of “internalized panopticon” (Ogbor, 2001). As a result, self-oppression and conformity was hindering my project of freedom. My consciousness was provoked by this realization. The harboured angry feelings turned me into an ugly person. Unable to contain the anger, the situation exploded into a nasty confrontation with the Chaplain. Imagining that the Chaplain perceived me as a transgressor requiring to be saved by religion, I became what Zimbardo (1971) describes as a “dangerous prisoner”. I lashed out at the Chaplin; yelling and accusing her of trying to be self-righteous and ethnocentric. I regret this verbal altercation because it was not professional on my part. In retrospect, I realize that the factors influencing my angry reaction ran deeper and were political. I felt that as a person of colour, the Chaplain was using the historical colonial weapon of religion to save me from myself. I grew up during the apartheid and religion was shoved down my throat from childhood until high school. Religion then was used as an ideological tool to teach Africans morals and civility. Thus, the very idea that the Chaplain may have been reproducing my painful colonial past made my blood churn.
It is through such learning processes that my individual colonial past and fears manifest into a defence mechanism. This defence mechanism often times projects the deep colonial scars that lie deep inside. Now, I am aware that the residue of what happened in the past can mar my social interactions. For the most part, I have spent my life focussing on my painful colonial experiences of being treated as the “Other” and reacting negatively. I am aware that when a white person speaks I find myself analyzing every single word just to ensure that there are no racial connotations. This is a problem because it means that I enter into this conversation with strong biases and prejudice. I realize the need to look beyond my physical and psychological trauma in order to move forward. Nonetheless, I am encouraged by Bell Hooks (1990) thesis in “Choosing the margin”. Through practice, I have learned that we choose our marginal identities but are not confined to these rigid positions. I admit that I have to change the way I speak. My language should not bind or fence in my dominator. Because words have meaning, I have to engage in meaningful and respectful dialogue.
When the conflict with Chaplain escalated, I recalled the words of one of my professors in College that: conflict was healthy and a normal part of any human relationship. I knew that allowing conflict to escalate can limit opportunities to engage in open and respectful dialogue. But, for some strange reason, I allowed the conflict to fester for too long. I lost the learned key conflict resolution principles of using the “I” statements rather that “you” statements. In fact, I cast blame on the Chaplain and turned myself into a victim; a principle we learned in the first year that it did not exist because power is everywhere. A fact I later disproved by exercising negative power through yelling at the Chaplin. Lessons from Foucault came into focus that power is not always repressive because it is relational. Eventually, I took ownership of my role in this particular conflict, an opportunity that enabled me to step back from the emotional attachments that went with the religious disagreement.
This introspection allowed me to seek help from my Faculty Field Supervisor. It was after my meeting with my Faculty Supervisor that I began to reflect on my own behaviour in the whole process. I took ownership and apologized to the Chaplain for behaving in an unprofessional manner. I was able to convey to her my feelings about the situation and the matter was resolved amicably. She in turn apologized because she had not realized the implication of her behaviour. She immediately stopped bringing the idea of “praying for me” in our work relationship; a decision that I appreciated because it allowed my individuality and growth in my practicum. I must admit that this conflict was a driving force for my improved performance in my practicum. My relationship with the Chaplain turned into a healthy and positive experience which led to better team decisions and more creative ideas.
My Faculty Adviser helped me realize the importance of taking a step back before reacting. In our meeting, I recall him advising me to use a critical reflective approach as a tool to resolve practice dilemmas in a constructive way. This useful advice was turned a somewhat poisoned environment into an amenable situation. Through dialogue this situation was resolved and my relationship with the Chaplain became cordial. In fact, she became one of the people I sought advice from as I encountered my clients struggling with the meaning of life after a terminal diagnosis. Through this experience, I gained insight into my workplace, my colleagues and myself. I was able to identify my own assumptions and biases about religion which was interfering with my professional practice. I have learned that spirituality is an essential component of the bio-psycho-social framework particularly in palliative care. Identifying spiritual assets and strengths can help clients cope with or solve problems.
The conflict with the Chaplain was pivotal in my self-awareness and consciousness raising as I pursued my journey with Grace, a fifty year old woman battling terminal cancer. My journey with Grace (pseudonym) gave me prose to think about the meaning of life. As a social worker, my client taught me that when a life threatening illness such as cancer confronts us, it is the realities of death and questions about life that prompt us to step back from our lives including theory. Ironically, my perspective on realities of implications of a terminal illness emerged from spiritual and philosophical orientation. It became evident that the end of life was one of the most important times for a social worker to address spirituality. In this process, I discovered that spirituality is an essential yet undeveloped component of cultural competence.
My interaction with my client led me to examine spirituality as a form of cultural competence. Spirituality represents a potential influence on emotional well-being of the cancer patient as well as the family members or caregivers. As Grace’s cancer progressed she confronted me with a myriad of questions. When Grace said why me? Why now? My social work textbooks could not provide practical solutions. What do you tell someone asking you why she is dying? At that moment, I realized that cancer causes not only physical but mental, emotional and spiritual suffering. I discovered that some clients find safety in discussing spiritual issues with a social worker because of the profession’s lack of alignment with a specific religious or spiritual base (Healy, 2001). However, as a social worker, I felt challenged because my training does not incorporate the topic of spirituality as part of service provision. But, through our interactions, Grace was able to teach me that spirituality was in fact a significant part of one’s cultural identity and can be a source of healing.
Healy (2001) provides helpful account of benefits of spirituality in palliative care. My experience at Philip Aziz made me aware of the importance of spirituality in social work practice. Healy argues spiritual issues are often apparent in palliative care and require social work to extend practice which may at times be limiting because of opposition by some proponents who argue that religious and spiritual care are incompatible with the image of modern profession (p.85). The incident described above, allowed me to reflect on my own practice and confusion arising from my failure to understand the difference between spirituality and religion. Working with Grace raised my consciousness in understanding that spirituality refers to search for meaning and mutually fulfilling relationships. Religion on the other hand is often an organized activity for the expression of faith. This distinction helped me to be reflexive and draw on social work theory to come up with creative solutions to help my client.
I was able to explore a broad range of practice options for my client. For example, conducting a needs assessment helped to identify my client’s strengths and capacities that were evidently invisible because of my resistance to spirituality as a form of intervention. Despite the fact that cancer was ravaging her body, Grace was able to let me know that her priority need was working on spiritual distress she was experiencing. Integrating spirituality in my work practice presented incredible effective cross cultural communication techniques in palliative care. Using the strength perspective framework, she was able to articulate her hopes for the future in our relationship. I discarded my idea of seeking to remedy her personal cancer pathology and focussed on her need. Our relationship blossomed until Grace died peacefully on February 26, 2010. Because Grace was Jewish, I had the honour to be invited by the family to what is called a “Shiva”, an occasion for family and close friends only. I learnt that in Judaism, a person mourns for a relative in seven stages. The mourners sit on low stools throughout that period to symbolize the mourner’s awareness that life has changed. The low chairs shows desire to be close to the earth in which the loved one was buried.
Finally, I concluded that social work and spirituality had much to learn from each other. I learnt that death is central to the meaning of human life and provides a backdrop against which life is lived. Throughout this process, my greatest learning outcome came from understanding that as a social worker my role is not to work miracles but to provide support and actively listen. To help people discover their own strength rather than an attitude of rescuing them. I will value taking fifteen minutes of my every day to reflect on how my actions negatively or positively impact everyone I come into contact with. This reflective process will enable me to avoid pointing fingers to other but at myself and find ways to change whatever needs to be improved.