The Crisis of Care: Affirming and Restoring Caring Practices in the Helping Professions

A review by Eric NewellApril 10, 2002The Crisis of Care is moving away from the technological, managerial aspect of caring. The need is to restore the concern and compassion for the need of the care receiver. Persons care for the wrong reasons. If it is not the aspect of filling the prescribed attention to a patient, very often there is the one who is interested to help or assist because they feel a sense of moral commitment or the sense that it will make them feel good. The editors quote Wuthnow's survey report that 42% of Americans were interested giving themselves for the benefit of others. The percentage dropped to 15% when asked if they were willing to sacrifice to help another person." (1994, p.23)"From the time we were children, we were told by our parents and our grammar school teachers to "Pay Attention!" Even though we have grown inured to this injunction and shrug it off, there are few things in life more important." (1994, p. 28) Restoring those concerns for the individual, the context of their situation and what it is that needs to be protected for the care receiver is important.Steven Covey in his writing cautioned against responding to the "Tyranny of the Urgent". In "The Crisis of Care," the chapter, "Teach Us to Care and Not to Care," says the caregiver who offers standardized responses to the needs or responds to that which gives only immediate relief, is not giving the full extent of care. There needs to be the caregiver who is will not only to pray for the receiver only, as an immediate answer to the problem, but who is willing to take the time to teach the receiver how to pray. This awareness of how to pray helps the person begin to understand that value can be found even in the experience of their suffering. Creating a context of care, listening and reducing isolation are all important in care giving. It is not enough to know the facts about a person or even the facts about their situation. The concern is that one knows the issues and reasons, which surround those facts. This is important whether it involves the student in the school or the patient wrestling with the quality of life. "From a theological standpoint, any notions of caring we might have grow out of our divine vocation, to reflect in our lives together in the world the character of God, manifest in his covenant love, (the compassionate behavior of God)."Phillips and Benner blend the use of narrative, dialogue and instruction to emphasize the strengths and weaknesses in present day care giving. The reoccurring issues of finding the context, the willingness to listen and the autonomy of the care receiver emphasize the point of the writing that care giving needs to move beyond the mechanical and technological response.

Phillips and Benner have edited nine narratives written on "redesigning the structures and processes of our public caregiving institutions in order to better facilitate practices of caring," (vii) an excellent resource for those in the helping professions and for those who care. The narratives are actual circumstances with real people who practice within the caring professions. The authors invite the reader to examine the narratives in terms of the practices of care illustrated by them (vii). Because the narratives are written by practitioners and theorists who are experts in their field (10), each has spoken out against the objectification and commodification of persons and practices that mask contemporary helping professions (11). These are examples of the experts. Robert Bellah, a sociologist, argues for a rich, interpersonal world as he pleads for Americans to listen and see, by adopting an ethic of responsibility, of moral discourse, instead of control and commodification (13). Patricia Benner, a professor of physiological nursing, advocates that, "effective caregiving requires more than intent or sentiment. It requires skill and knowledge and being in relation with others in ways that foster mutuality, empowerment, and growth" (45). As a pastor and theology professor, Eugene H. Peterson describes the difference between genuine caring and control veiled as caring. Dr. Peterson believes that we are meant to open out toward our neighbors and open upward towards God, and that we can be whole and healthy humans only to the degree that we do this (69). Pediatrician E. Dawn Swaby-Ellis states that "whatever the competing factions my challenge is the same: to be effective, efficient, and empathic" (84). Furthermore, she believes that caring for patients must come out of true concern and love for them (90). Her personal caring relationship with her patients was deeply validated by her exposure to the biopsychosocial model proposes by George Engel and expanded by Paul Tournie to include the spiritual dimension. Although, Dr. Swaby-Ellis praises many of her teachers, she declares the Holy Spirit to be her greatest teacher. "It is one thing to be a Christian who wishes to live a life of obedience to God by showing love to mankind. It is another thing to integrate our faith into the fabric of our being so that our actions mirror our spiritual belief" (93). To Anna Richert, an educator, all teaching practice must help kids to grow through caring. Although there are increasing challenges and dangers educators deal with daily as they attempt to care by teaching in urban chaos, still "children need care and they also need to learn to care for one another. Ultimately they need to learn to care for themselves" (109). I agree with Richert that fundamental to teaching children to care is the fact that children "need to feel and be safe" which includes "needing to trust others, and having a sense that others believe in them" (109).

Insightful, humane, challenging, reflective, and practical are words that describe, The Crisis of Care: Affirming and Restoring Caring Practices in the Helping Professions, edited by Susan Phillips and Patricia Benner. The nine chapters followed the format of a story narrative followed by a pertinent and complimentary discourse. Phillips wrote: "Teaching, nursing, medicine, psychotherapy, and pastoral ministry are written of from the inside in terms of excellent practice" (vii). Inevitably, "care is relational, creating more than we expect and at other times showing us the limits of `helping'" (10). Phillips' book is a positive example of how ritual and relationship can fuse to embrace the unique personhood of students, patients, clients, and parishioners; thereby, humanizing what has been viewed as merely objective clinical processes and procedures. The distinguished practitioners and scholars who contributed stories and essays are to be commended for their efforts in providing authentic care themselves and in sharing their insights. The stories are powerful. A Holocaust descendant's anxiety is relieved because the psychotherapist heard with an inner ear, the patient's real and heretofore unexpressed need. Attention to the not said and the unseen on the part of the caregiver is of terrific value when providing care. An abortion case is reviewed with some of the multiplicity of implications that are involved. "Sammy," a six years old Amish boy, kicked by a mule, is restored to health. The preparation of a simple meal and the opportunity to learn the history of an African-American woman's family (Ambrosia Jones) helped pave a road to recovery. Death by choice in a chapter of the same name is provocative. Blake's story is about the unattractive child. It presents the compassionate value of a mother's love, and reveals a doctor's openness to in-seeing and in-hearing, and thereby some profound learning occurs. Mrs. Clark's paralysis and the visiting male nurse's ritual and relationship pastoral care story are inspiring. The insights are powerful. Benner wrote: "If we were able to replace our disease care system with caring practices that foster illness prevention and health promotion so that clinical wisdom could be fostered from caregivers and receivers alike, we would alter dramatically how we are spending our health care dollar" (59). Eugene Peterson described the pastor's task: "Pastors identify God in the action, God in the language" (74). Peterson's challenge was to learn when to care, and not to care. The Atlanta, Georgia pediatrician, Dr. E. Dawn Swaby-Ellis learned: "My greatest teacher in learning how to care has been the Holy Spirit" (93). Clinical Psychologist Mima Baird echoed the sentiment by contributing: "To care is to listen; to hear is to care" (96). Teacher Anna Richert noted that it lies within the ability to make authentic connections that the capacity for care is enhanced, and by implication, the significant educable

The Crisis of Care is an insightful examination of the state of care in the helping professions. The editors argue: "... that examining our exemplary caring relationships can prompt us to redesign the structures and processes of our public caregiving institutions in order to better facilitate practices of caring" (1994:vii). Utilizing essays from practioners and scholars, the editors have collected narratives and scholarly discourses that address the practice of care in various helping fields and from the perspective of various academic disciplines. While the reader may not fully agree with positions taken by various writers concerning such issues as euthanasia, abortion, and the philosophic basis of ethics, the writing on the whole is good. The narratives frequently touch a sentimental chord. One good example is W. Thomas Boyce's "Beyond the Clinical Gaze" (1994:144-148). Eugene H. Peterson's essay "Teach us to Care and not to Care" is brilliant (1994:66-79). Peterson challenges the reader to not defile the holy. Joel B. Green's essay "Caring as Gift and Goal: Biblical and Theological Reflections" was also outstanding (1994:149-167). Green covered much biblical and theological ground clearly and with keen insight. Robert N. Bellah's "Understanding Caring in Contemporary America" was awesomely insightful (1994:21-35). He explores the themes of placing caring over exploitation and placing attention over distraction. While, to me, some of the narratives and essays were not as excellent as those I mentioned, on the whole the book is worth reading. I recommend it.