A HISTORY OF CAREGIVING
by Dr. Brendan Cavanaugh
The Pilgrim Project
Dorval, Montreal, Quebec, Canada
All Rights Reserved by Brendan Cavanaugh
Montreal, Quebec, Canada February 2005
This text is published for the volunteers of The Pilgrim Project. It is meant to be one of the texts that accompany the PILGRIM PROJECT’S volunteer training program.
WEEK 1 : Historical Issues
History of Caregiving, History of the Hospice Movement, History of the Pilgrim Project
Week 2 : Medical Issues
Cancer, Multiple Sclerosis, Alzheimer’s, AIDS
Week 3 : Psychological Issues
Loss, Grief, Recognition, Principles and Responses to Grieving, dynamic chart of human emotions, normal grieving and pathological of grieving.
Week 4 : Philosophical Issues
Cultural meanings given to death, an interpretation of death, afterlife, characteristics of afterlife, meaning of life questions.
Week 5 : Religious Issues
Meaning of Religion, Meaning of Church, Religious doctrines, practices of organized Religions, personal religious values. Meaning of Suffering.
Week 6 : Social Issues
History of Social service, Quebec Social Service Structure, The importance of the Social Worker, the role of non-profit community organization (Pilgrim) within the organized social structure of Quebec Social Service. The Rules
(A summary of A History of Caregiving)
Our History is the story of our antecedents. History is a dynamic set of events with a vector; it points towards us. ‘Those who do not attend to history are condemned to repeat it’. History is an interpretation of background. Who you are, where you came from, what influences have affected you, these are all factors that modify the historical meaning the role of human Caregiving (as opposed to the professional services of Medicine, Nursing and Social Service) in our society.
Caregiving has a long and complicated history. But there are certain themes that repeat themselves throughout its history. In order to understand what caregiving means in our age, it is necessary to understand some of the historical events that have colored the connotation of the word. When people say “Caregiving”, they have not only the simple denoted meaning of ‘being there for someone who needs to be taken care of’ in their mind, they also have within them, and of which they are more or less aware, the connotations of a lifetime of nuances, both conscious and unconscious, which color and shape their own understanding and use of the word.
Some of the themes revealed by the study of the history of caregiving may be surprising. Those that the author of this text has considered to be especially significant might be summarized as follows:
1. Caregiving is rooted in the human impulse to protect one’s intimate family. In symbolic terms, one speaks of the “the sanctity of the hearth”. Something 'sacred' is something set-aside for safe keeping becasue it is special. The hearth, the 'bosom of the family' are sacred, because they are supposed to be special places of safety set-aside from the hostile world.Taking care of your own family is what every human being is expected to do; and behind that natural behavior lies the natural effect of physical touch, that is, the naturally bonding resulting directly from the affectonate touch among family members. It is this human impulse that that lies behind all forms of hospitality. People generally believe, sometimes fiercely, in taking care of their own family –but some cultures then dictate: “and no one else!” Part of their notion of the protection of the closed circle of their family implies protection from outside threats from strangers, whatever their character.
2. The natural impulse to take care of one’s family members, when extended beyond the home to the stranger is what we mean by ‘Caregiving’. Sometimes Caregiving goes beyond the security and sanctity of the personal home, as when the act of caregiving is expanded to include those who are not part of the family but are guests in the home. People come into the home as guests. And the security and sanctity of the home is normally expected to be extended to protect them. It is a natural social value. It is a matter of honor and self-respect as much as it is a matter of social responsibility to take care of the non-family member who finds themself at the hearth of a family not their own.
3. Caregiving, as in the public sense we know it today, historically was a deliberate choice of Christians specifically based upon the teaching of Jesus. There are those to whom the caregiver reaches out to provide the same level of personal, attentive care that is rooted in natural human attitudes and the natural experience of a mother and a father towards their children. The act of extending caregiving beyond the hearth, beyond the home to the stranger – was the revolutionary social concept of jesus Christ introduced first to the Middle East and then to Western humanity and from there to the whole world through the Catholic Church (which curiously does not choose to take much credit for it.). The adoption of the basic Christian principle of Caregiving requires courage and self-discipline to face the dangers implicit in venturing beyond the front door of the home. This is not a natural impulse, this is a moral value introduced by a moral teacher, and accepted under the title of Christian charity. Historically, that is, caregiving is an extension of a natural impulse to care for the non-family stranger, outside the home, on the basis of the moral teachings perceived to be the Word of God.
4. Historically, the explicit extension of act of caregiving has usually been the chosen vocational activity of an individual. That choice and the enormous energy that has driven the lifestyle it implies has usually stemmed from two points. The first is nature: a recognizable personality characteristic of a specific individual: the intellectual, emotional and physical inclination to take care of another person. The second source is supernatural: within the Catholic tradition – that is, that choice to provide caregiving was accepted, recognized, justified and promoted on the social basis of Catholic theological values. The exercise and promotion of this choice was clearly evident in the heroic practice of caregiving by individual persons, usually drawn from the common level of society. Frequently, but not always, these individuals were formally religious individuals, that is, they belonged to a Catholic religious group. Their activity often led to the founding of social institutions.
5. Hospitals are a Catholic social invention. The more general factor is that within the Western tradition of civilization, institutionalized caregiving, that is, what today we regard as the hospital system, is the direct and explicit result of the specific charitable projects of some of the early Christians of Rome. These individuals took the exhortations of Jesus to “care for the sick” and “bury the dead” and “comfort the grieving” to heart and founded the first ‘hospitality centers’. These centers were then systematically promoted by the early Catholic church, and finally evolved away from the church and into the present day civil and secular hospital system, which is mostly composed of secular technological centers in which caregiving is not a primary consideration, if there is any official place for it at all.
6. Historically speaking, caregiving, in this formal sense, was a pious, and often heroic, spiritual practice of particular individuals usualy counted among the common people, the laity and relgious, of the Catholic Church. But this pious practice of individual caregivers was repeatedly and systematically undermined, and opposed by high-ranking Catholic churchmen. The history of caregiving reveals that time and time again high-ranking church officials intervened with the intent to stop the direct caregiving work of individual Christians, who were usually but not always religious women. The repeated opposition of church authority to caregiving, the absolute lack of any real support from the hierarchy, and failure of the clergy to promote caregiving gradually sapped the energy of this pious practice of caregivers in ecclesiastical history. The churchmen usually managed to imprison those who tried to be caregivers behind cloister grilles and thus, with complete indifference to the needs of the common people, inhibited and eventually destroyed the pious practice of caregiving that the members of the early church had tried to give people.
7. Martin Luther’s theology theoretically undermined the original Catholic religious motivation of caregiving. His intervention led to the moral and physical degradation of the hospital system, and finally forced the state to take control of the hospital system and medical care in general. Martin Luther’s theological views dealt the deathblow to the practice of Christian caregiving. As a result of his teaching, the hospital system was reduced to a shambles. Hospitals, formerly havens of humane caregiving, became dreaded denss of filth, indignity, horrific treatment and early death. The void in religious values, the social tragedy and the healthcare crisis perpetrated in the name of Martin Luther was made even more tragic because Martin Luther had nothing to put into its place.
8. In principal, the material institutions of caregiving were rescued. The rescue was a political solution to an annoying political problem rather than a moral act of rectitude by England’s Henry the VIII. Bowing to public pressure, Henry placed the stinking remnants of the three major hospitals of England into the reluctant hands of the Mayor of London. Thus hospitals passed into the hands of the state where they largely remain today. As a result of spreading Protestantism, the state was faced with the public demand to rescue hospital service from the deadly mire it had become.. It had to do so without the motivating support of Catholic theology, and in a context of the social void created by the developing Protestant ethic, and finally in the face of growing cultural secularism and religious pluralism. It ended by initiating the contemporary development of the pattern of secular hospitals, staffed and run for profit by the medical community and largely supported by the state and heavy corporate investments. No one has ever accused the state or corporations of genuinely caring for individual people.
9. In the face of all these developments, caregiving has been pushed back to its original position: free person-to-person, individualized caregiving, outside of institutionalized settings, by individual persons, sometimes grouped within a community organization. Caregiving is regrettably not assumed to be the provance of Medicine (although there are some genuinely caring physicians), nor of Nursing (although there are some genuinely caring nurses), nor of the Hospital (which has become a very high-priced technology center which has no official room for caring), nor of Social Service (which has become a highly bureaucratized and money based civil service (although there are some genuinely caring social workers). The opposition to caregiving has been transferred to the state. For self-oriented reasons the state attempts regulation of caregiving but in a desultory fashion. And today caregiving faces some degree of threat from the more or less litigious character of North American society.
10. Caregiving has been returned to its roots. Caregiving today is practiced as the free extension of the natural impulse in an individual person to care for another human being. It is the action of individual persons, some motivated by natural impulse, and others still motivated by theological or other moral values. Caregiving is largely practiced outside the formal service of the church as well as of medicine, nursing, social service and hospitals. (Although it may be practiced by religious, doctors, nurses and social workers as well as regular people.) It is ignored by some institutions, tolerated by other institutions, and sometimes welcomed by yet others. The exercise of caregiving is, perhaps, most evident in individuals who choose to provide caregiving to the sick and dying under the protection of various community service programs.
11. Various efforts have been made to revive caregiving, although its focus has been on caring for the dying. In recent history, the work of Dr. Cecily Saunders in England, who founded St. Christopher’s Hospice for the dying, gave rise to the Hospice Movement. Exposé books such as Dr. Elizabeth Kubler-Ross’ On Death and Dying focused public attention on the lack caregiving in hospitals and other more or less medical institutions. Today there are many publications and books on Caregiving. In spite of the inculcated general indifference of the state and its politicians to caregiving, there are other independent Hospices; there are imbedded Hospices in hospitals, such as Dr. Balfour Mount’s Palliative Care Unit (PCU) at the Royal Victoria Hospital in Montreal, Quebec, Canada; and there are community based Hospice Programs such as Dr. Brendan Cavanaugh’s The Pilgrim Project, based in Dorval yet serving the Island of Montreal for the last thirty years. These are mere concrete examples. Such groups of caregivers in various settings exist throughout North America. Similar groups likely exist in Europe but they fall outside the scope of this text. Pilgrim is one example of the fact that caregiving is still a moral practice among us and caregivers, although in limited supply, are still exercising their gentle service to the sick and dying among us. As a group, these caregivers represent one of the hidden and limited non-renewable treasures of any society. We need to treasure them.
12. The immense network of focused caregiving that constitutes the helping community of North America. Caregiving found a degree of focused motivation in the myriad self-help and focused support groups that blanket the North America social service scene. The natural impulse to help, even divested of its religious motivation, still moves individuals to dedicate themselves to the support of others. Taking a cue from the ‘scientific’ orientation adopted by social work in the wake of the bankruptcy of the caregiving system initiated by Luther, the natural inclination to take care of others tended to find satisfaction in the establishment of a vast network of peripheral support groups serving specifically identified segments of the suffering community. These groups of focused service were soon abandoned by the historical choice of Social Service to focus on broad bureaucratic social goals, such as ‘the elimination of ignorance, poverty, war and mental illness, rather than direct service goals to the sick and suffering. The choice was considered to be more efficient.