counseling model: creating a healing environment in hospitals

Patient Education and Counseling 36 (1999) 81–89

Counseling model: creating a healing environment in hospitals

1 ,*Shirley Firth

24 West End Terrace, Winchester, Hants SO22 5EN, UK

Received 11 March 1998; received in revised form 4 April 1998; accepted 5 May 1998

Abstract

There are ways in which more holistic approaches to medicine can be achieved through the establishment of alternativehospitals and health-care centers, as has happened in the United States, and changes in midwifery and care for the dyingthrough a more compassionate approach and the use of prescriptive music. Transformations of medical care in TheNetherlands are also taking place, with existing hospitals gradually developing more patient-centered approaches andorganizations like the Helen Dowling Institute providing tailor-made forms of psycho-social counseling for those with cancerand life-threatening illness. 1999 Elsevier Science Ireland Ltd All rights reserved.

Keywords: Hospital; Healing; Midwifery; Holistic; Music ; Birth; Death

1. Introduction and soul was recognized as being as fundamental ascare for the body. Technology was a valuable tool,

In October 1997 the second ‘Hospital as a Temple and orthodox medicine had greatly reduced, amongConference’, on the theme of ‘Creating a Healing other things, perinatal deaths, but there was a dangerEnvironment’, was held at the magnificent Congress that the care for the mind and soul could be thrownCenter near the great sand dunes of the western away when the focus was on managed care. HeNetherlands [1]. As the delegates from all over concluded with the words of Confucius, ‘‘It is betterEurope and the Americas gathered in the circular to light a candle than to curse the darkness’’.hall, a former chapel with symbolic stained glassdesigns below the domed ceiling, Dr. Bart van derLugt (NL) set the context of the Conference. He said 2. The return of the priest–physicianthat the aim should be to harmonize and integrate allaspects of care so that the importance of the mind ‘‘The return of the priest–physician: finding the

inner healer’’ was the theme of the first plenary talkby Fay Loomis (US). Her own inner journey had*Corresponding author. Tel. / fax: 1 44-1962-852028; e-mail:taken a radical turn as she had struggled to find [email protected]

1 way through chronic fatigue syndrome, and sheShirley Firth is a writer and freelance lecturer on death,bereavement and multicultural issues. asked the questions, ‘‘Why do we have troubles?

0738-3991/99/$ – see front matter 1999 Elsevier Science Ireland Ltd All rights reserved.PI I : S0738-3991( 98 )00089-5

82 S. Firth / Patient Education and Counseling 36 (1999) 81 –89

How do we find healing? Is the priest–physician 3. Finding the inner healerwithout or within?’’ [2]. The word ‘health’ is relatedto ‘holiness’, which leads us to the sacred journey In the second address on the ‘‘Return of thewithin. Illustrated by magnificent slides, Fay took us Priest-Physician,’’ Dr. Evarts Loomis (US), de-on a journey through time and space looking at the scribed as ‘‘The Father of Holistic Medicine,’’ spokeways different cultures and periods have searched for of his own journey to move beyond technologicalhealing and wisdom through myths, symbols, rituals medicine to the heart: ‘‘It is too bad to build aand art. The hero has to find his way into the mystic beautiful motor and never turn the electricity on’’.spiral of the Self, the source and center of his being, Physicians had to make the inner search and healto find the answers. She focused in particular on the themselves. He quoted Browning‘s poem aboutEpic of Gilgamesh, in which the hero figure, whose releasing ‘The imprisoned splendor’, which we alljourney to fight evil and find eternal life lost him his had within. His experience working as a doctor incompanion, Enkidu, but resulted in kingship and the Newfoundland, his admiration for Albert Schweitzer,‘‘power to find and to lose, to be the darkness and who said there was no such thing as an incurablethe light of mankind’’. The Greek god Hermes was illness, and his work with the Friends Servicethe god of medicine, and Fay saw links with Egypt Committee in North Africa and China, had alland the Jewish Enoch. Hermes saw a blinding light contributed to his search for a deeper understandingcontaining a vision of the Universal Mind, and he of the concept of holistic medicine since he had firstbecame the scribe of the gods. He vanquished, but heard the words in his mind, ‘‘Treat the wholedid not kill the dragon passions of ignorance and person’’. He set out to consult people of vision, suchperversion. The snake /dragon under his foot repre- as the pediatrician Hassenberg in The Netherlands,sented regenerative power, the kundalini energy, Roberto Assagioli, Carl Graf Durkheim, Klausflowing through to the forehead, and the mastery of Thomas, and Paul Tournier, who contributed to histhe emotions, body and mind. Philosophers as far insights.apart as Plato, Lao-Tsu and the Buddha recognized Eventually, in 1958, he set up Meadowlark asthe need for balance and harmony to find the answer America’s first holistic healing center whichto suffering. The holistic approach was exemplified ‘‘pioneered the concept of health as a re-establish-at the Asclepion at Epidauros, where those coming to ment of homeostasis of body, mind and spirit ratherbe healed had all their physical, mental, ritual and than fighting illness’’ [3]. The primary role in thespiritual needs met. In the center was the abaton, healing process was to be played by the patient, withwhere the guests incubated their dreams, and where the doctor as facilitator and guide. The patients werethey were visited by the gods or a snake which ‘guests’, and the staff wore no special gowns orprovided the cure. In addition to purification in the uniforms. Patients had to keep dream journals andtholos they were also expected to give thanks in the were taught how to approach dreams and understandtemple. The coiled snake, the symbol of the god and their significance. He felt many people had beenhis healing knowledge, represented the healing of the over-drugged, so there was an emphasis on diet andmind and body. nutrition grounded in the produce of their own bio-

In the present age the personal relationship be- dynamic farm, and the ‘energy medicines’ oftween the healer and the sick, and between the homeopathy and acupuncture were used. He said thatindividual and his or her creator has been lost. Fay, we cannot assume in the huge field of energy thatthrough chronic fatigue syndrome, had recognized surrounds us that we can only give reality to thosethat her illness was an opportunity for spiritual and things that we see.personal growth. Even the genes of an individual cell Meadowlark closed in 1991, but the philosophycan profit by experience, and the meaning or signifi- under-girding the concept of holistic medicine hascance of an event can actually create change, accord- had a profound influence throughout the world.ing to Larry Dossey. Change is perpetual, and, as Loomis found that his center was modeled on theMeister Eckhart pointed out, ‘‘if you want to become ancient sanctuary of Asclepias. Patients had tosomeone else, you have to stop being who you are’’. recognize their need to be cared for, have time to

S. Firth / Patient Education and Counseling 36 (1999) 81 –89 83

find out what they needed most for themselves, go warmth, closeness and love are thought to be associ-through a stage of purification, have time for con- ated with sexual behaviors which are dangerous iftemplation, putting together what was learned, and inappropriate and indicate a betrayal of trust, yethave a vision or dream. Loomis also discussed the how can healing take place without them? He wasHermetic laws which held that everything was mind, concerned that the approach to cancer was oftenthat there was a correspondence between everything belligerent, partly because of the influence of drugabove and below, that energy consisted of vibrations, companies. Even the Simontons used to use aggres-and had to take into account laws of polarity, sive imagery for cancer. We need to warm cancer torhythm, cause and effect, and gender. In an accom- death, taking, e.g. the damaged breast in our armspanying article he cites Edmund Spencer: ‘‘For of and singing to it, warming, healing, using ourthe soul the body form doth take: for soul is form imaginations.and doth the body make’’. Water is essential. Hospitals are dry places without

an ounce of water. We can only weep a handful oftears, and men cannot cry. If we really feel for a

4. The wisdom of dying patient we must cry sometimes. We need tears as weneed laughter. We need lubrication—if there is none

Dr. Michael Murphy (Canada), a psychiatrist in sex there is pain and friction. We need Baptism towhose work had influenced the philosophy behind wash the soul or the spirit. There are also thingsMaia in The Netherlands, focused on the wisdom of which should be thrown into the river so that we candying and the practice of wisdom [4]. Every hospital let them go.should be a sacred place with ‘‘Whatever happens, Air enables us to breathe. If our relationships areall will be well’’ written above the door instead of impermeable they cannot breathe. When we hear wedriving death underground. Like both previous have cancer we hold our breath. Many people alwaysspeakers, Michael had also found inspiration in hold their breath, but we cannot live with batedGreece after a sense that he had ‘fiddled enough’ breath. Meditation is about breathing life in andwith various schemes and projects which did not letting it go.seem to provide the kind of revolution of care that he Earth provides groundedness, and many doctorswas seeking. In Epidauros he learned that one had to and nurses are not grounded, either physically or atbe prepared for the healing dream—no one should the level of soul. On medical rounds the retinue ofenter without preparation. We are not prepared to be medical doctors talk to one another, but patients andhealers or to be healed. relatives need the staff to sit down with them.

Fundamental to our healing is our relationship to Finally, we need to have and to give space. Peopleothers. Two people in a relationship need to be need someone to witness them lovingly. Birth andcocooned in a gossamer thin thread that wraps the death should both be witnessed. Nurses are taught torelationship around. The Native American sacred be rescuers rather than witnesses, which does nottalking stick illustrates this process. Whoever holds involve taking action. As parents we tend to givethe stick speaks the truth and it is then passed around instructions rather than witness our children. Mostto the next person until it is circulated in silence. families are closed with an iron curtain fence to keepAwkward at first, we begin to open up and it goes others out. The cocoon, instead of being permeable,deeper until it weaves a gossamer around the group. is closed which does not allow feelings of rage orThe gossamer of love also has to be permeable, anger to seep out. Tears would mean that peopleallowing things to come in and out. Most relation- drowned. Our most important relationship is withships in families and between doctors and patients ourselves. If that is unsound we cannot have oneare not permeable. with anyone else. If the medical staff are told to

There are five elements to healing. First of all is ‘‘Love thy neighbor as thyself’’ they may end upfire. Murphy had abandoned orthodox psychiatry doing so—which is not at all. Most religions offerwhich lacked warmth and fire because it had become cocoons for believers which do not allow stuff frommedicalized and biologically orientated. Fire, the outside, yet if any religions were really true


everyone would believe the same thing. If they are 5. Making your health care dreams come trueclosed they are not a healing force, and cannot reallyhelp people cope with the terror of death. Hunter ‘Patch’ Adams (US) is a doctor, a clown

Murphy was critical of the way anatomy is taught. and a revolutionary. Behind the colorfully outrage-Eager, warm-hearted students just starting training ous clothes and the zany humor lies a deep sensitivi-begin with a relationship with a dead person. Only ty and a profoundly moral outlook on medical care.McMasters has had the courage to throw out Hospitals should be fun, but they should also beanatomy. It would be far better to give students a places which address care in ‘one package’. He wasliving case from the outset and send them off to dissatisfied with orthodox medicine from his days inexplore different aspects, e.g. of diabetes. It is more medical school: ‘‘the first time I turned away aimportant to teach them about death, the one thing patient my soul wanted to die. I did not want towe do not rehearse. We need to give ourselves time co-exist with rude medical doctors’’. In 1971 Patchto visualize our own death, and work with the death and a few colleagues founded the Gesundheit Insti-of those near us. Imagine saying goodbye to your tute. The house /hospital was open 24 h a day, allmother, choosing someone to be the mother and through the year, and hundreds of patients pouredsaying what is needed. Express the pain, say, through, living with Patch and his family, over a‘‘Thank you and bless you—your eyes, hands and period of 12 years. The heart of the house was theheart. When I bless you, I bless my mother, and you kitchen table. To counteract the greed inherent inwould feel that you were my mother’’. We need to American medical care they gave free care, as theysay to dying patients, ‘‘I want to give you a blessing, did not want to be owed anything. There were nowill you give me a blessing?’’ One of the most insurance forms, and they refused to become in-sacred events he had known was the dying moments volved in malpractice. This was the politics ofof his friend and patient Bob, who, with his wife, vulnerability—a temple does not have malpracticewas creating a loving cocoon enclosing their daugh- insurance. In the first 9 years of his hospital /hometers and other close friends. Each person spoke to no staff left, even though they were unpaid and hadBob about their awe and love for him, and described to earn outside. By sharing this life they madetheir experiences of death. After such a loving death service a vibrant vital force. They made house callsthere may be tears but there can also be laughter and and got to know the patients well, replacing thechampagne. typical 7–8-min slot with an initial interview lasting

Another patient, an elderly woman in the 4 h taking place informally in the home, playing poolemergency room, refused an essential leg amputation or gardening: ‘‘either you tell me or I probe’’.because she had had a beautiful life and wanted to Confidentiality needs replacing with openness fordie. She called her two daughters and the staff tried healing. Only by opening up, e.g. childhood incest,to create a beautiful atmosphere. She was asked if can one put it into perspective. ‘‘I just want to beshe had any pictures of her former days. One of the with people and enjoy it. The magic of being adaughters advised against it as her mother would not physician is that . . . if they perceive you care, theystop talking. She did sit talking with the doctors and will let you into their lives in ways that you cannotnurses, and the next day died peacefully. dream’’ [5]. The vast majority of patients are sad,

Murphy raised the question of how we can bring lonely and afraid, whereas it is possible to have asuch a loving environment into the emergency room. healthy, happy, vibrant and exuberant life, even on aAs one workshop participant observed, everybody death bed. A professional clown can get people towants to change the earth but nobody wants to do the work together to make it fun.dishes. It is not just the ill who need loving care, but Our future in global terms depends on how we livethe care givers and the doctors. He concluded with with each other. If you could build a hospital exactlyan example from Percy, who had asked students to as you wanted, what would you build? Patch isdescribe a building. When they said they didn’t know raising funds for his ideal hospital, integrating educa-how, he suggested they started by describing a stone. tion, the arts, farming, and alternatives such asOne should start simply, asking what is the patient’s homeopathic medicine in harmony with allopathicneed? medicine. The dream he has is of a hospital located


on land which has a forward thinking school and system, be the highest subversive possible in yourpermaculture. The hospital building should look work and make it look like it is fun, not as if it hurtsfunny, like something out of Disneyland or Monty you. Live that thing that you want—it is juicy!’’Python, to show what it means to laugh at a building.Arts have to be included, but nowadays they have tobe labeled a ‘therapy’ to legitimize them—one has 6. Blessing way into birth‘go for a walk therapy’, or for Punk Rockers, ‘nailstherapy’. Places to create costumes, paint and act On Sunday the focus shifted to the specific issuesneed to be included, adding the label ‘therapy’. He of birth and death. Dr. Raven Lang (US), a pioneerhad an ulcer patient, an auto mechanic who drank in restoring the practice of midwifery in the Unitedand smoked heavily and beat his wife. Patch told States, began with an illustrated talk on the Blessinghim to bring the whole family and his friends to Way into birth, based on Native American life-cyclecamp in the grounds or stay in the tree houses or rituals [6]. The rituals that many modern Americanscaves for 10 days. The mechanic needed help in are creating are an attempt to bring values relating togiving, so Patch contacted churches to get poor family and community, spirit and nature back intopeople to bring in their cars, which the mechanic lives which have been preoccupied by materialisticwould fix free and teach them car maintenance at the values stressing image and success. Nowhere was thesame time. This both healed him and taught him lack of connectedness more apparent than in birth-community. ing, where, despite scientific advances, America had

He wants to build a school for medical students a shockingly high infant mortality rate. Midwiveswith 40 beds for patients. His applications for money were also disappearing from the birthing scene.are always refused, but he is funded by a few When Raven gave birth to her first child in 1967 itwealthy eccentrics and by poor people. Now a film is was assumed that birth had to take place in hospital,being made about his life with Robin Williams attended by strangers and always accompanied by aplaying Patch. The irony is that Patch needs $16 doctor and drugs to dull the pain and the mind. Yetmillion, which he cannot get and Williams will be obstetricians like Grantly Dick Reed and Lamaze,paid $20 million ‘‘to be me’’. People accuse him of and Sheila Kitzinger had visions of a different kindbeing ‘‘some kind of communist’’, or some of his of childbirth which did not require medication andcomplimentary healers being ‘‘some kind of quacks’’ involved the full participation of both parents.or say, ‘‘people will take advantage of you’’. How do With the social revolution of the late 1960s andyou create what you want, make a revolution? Both 1970s many young people were questioning politicsdesire and design are necessary. Desires are not and marriage, and a few women dared to give birthmeasured by reasonability and practicality, and have at home, although those who assisted them wereto be expressed in optimistic language. threatened by the medical establishment. In 1970

Why talk of the hospital as a temple? Why not the Raven attended the birth of the baby of a pioneeringearth as a temple? How can one bring about univer- woman in her home, accompanied by an idealisticsal friendliness? And spread this to schools and young physician (who, Raven noted wryly, did nothomes? Whenever Patch has seen parents and chil- last long in his idealism). The pregnant woman wasdren fighting he changes into clown clothes and they anointed, given a foot bath and their blessings asstop—he reckons he has stopped 40–50 beatings. ‘‘It each woman brought a song, dance and symbol,is such an inexpensive way to make people smile— offering a gift. By the end of the day fear was nocheaper than Prozac. Once people laugh they become longer an issue as the day had created a feeling ofvulnerable. The most revolutionary act you can offer trust that all would be well. The collective intentionin the world today is to be happy. It is a shame of the group was a cohesive force which created arevolution is spoiled on the young. When you are palpable change in her attitude and the birth was oneolder you want to seduce and convert people’’. Now of surrender and joy.many doctors, after seeing and hearing Patch, write Such rituals owe much to Native American tradi-saying they now work for 1–2 days for nothing. He tions, such as the Navajos, who believe the purposeconcluded by saying, ‘‘If you are going to stay in the of life is to live in harmony between individuals, the


Creator and nature. They have many such blessing having heard about the new gravity position inceremonies, in which spirits are called upon to bless midwifery, she shut the door, got into bed and heldlife-cycle rites, illness and even mental disturbance, him until he died. Instinctively she sang Gregorianbless the crops and call down rain. There is a moving chant because she knew it, it was beautiful and hadritual at puberty to welcome a young woman into stood the test of time. The moment the patient had awomanhood, which acknowledges the profound tran- witness his contractions were different.sition she is going through. This involves her whole It was difficult to discuss this with anyone, but herfamily, each with his /her role to play, lasting from young colleagues realized there was more to do thansunrise to sunrise. Such rituals gave us lessons for empty bedpans; one could be on call in a new way.conscious living and mindful transitions—how many She had been involved in a parish in which thepeople are as transformed as a mother giving birth? whole community responded, in which each dyingIn reinventing rituals we can draw on other tradi- person was treated as somebody’s son or daughter,tions, bringing songs and music chosen by the parent or lover, yet here the reaction to death was toparticipants who can be students, family, and carers put the body in a bag immediately and disinfect theand friends. Intention is important, drawing on the room so that a new patient could come in.spirits or ancestors. But the woman needs to feel her Ten years after embarking on an academic musicown power, allowing the warrior to emerge. The career she obtained the Cluniac Monastic documentsdance of birth is awesome, with death inherent in it, on caring for the ill and dying. The opening lineso the woman must be prepared for the pain she must says, ‘‘when monk or nun knows his or her time hasendure and the stamina she needs. come it is your obligation and privilege to tell the

Raven became skilled at seeing where future members of the community’’. It was understood asproblems might lie and could change the course of labor. The care of the body and cure of the soul wereevents by circumnavigating negative outcomes, but part of the same thing; someone could die and yet bethis took time. Dreams helped Raven understand healed on the death bed. In 1992 she was invited toproblems which might arise over the birth, and it leave a safe job and go to Missoula, Montana, tooccurred without complications. Raven gave several open a new school of Music Thanatology, whichexamples of a blessing way, concluding with a attracted students from all over the United States.moving set of slides showing a blessing way, in They began their clinical practice with one referringwhich the mother received gifts and poured hot doctor and one nurse. Now there were over 90boiled water into everyone’s hands as a symbolic physicians involved in referrals, plus nurses, socialsharing of pain. workers, chaplains; even the dying self-refer. It has

been seamlessly integrated into the entire medicalpractice in Missoula, and there are graduates as far

7. When the hospital becomes a sanctuary afield as Austria and Scotland.It is not distraction therapy, but a deep relationship

From a blessed birth we moved to a blessed death. between the harmonic content of music and circulat-Dr. Therese Schroeder-Sheker’s Chalice of Repose ory systems. The basis of the work is to do withproject (US) began unexpectedly, when as a young interior life, not to do with procedures, and it couldnurse’s aid in a geriatric home she found herself in a not be carried out without the daily practice of prayerroom with a terrified man dying of advanced em- and meditation. The vigil is always begun in silence,physema [7]. The institutional attitude was: ‘‘we can with the singer /musicians positioning themselvesdo nothing, so turn on the TV and close the door and with one harp on the left and one on the right. Eachleave them alone’’. She said, ‘‘it never occurred to graduate makes a statement of intention to attend tome to be a revolutionary. What I did was out of a the dying with prescriptive music. The music mustsense of empathy, which has not yet been stamped be phrased with where the patient is, synchronizing itout. It was a matter of paying attention to someone to the breath and pulse, with extraordinary effect. Itbaring his soul. He knew he was dying—all I did turns the intensive care unit from chaos to a san-was pay attention’’. She heard the death rattle, and ctuary for completion. It helps to alleviate distress


and fear and enables them to let go. The person is the right track. He recalled the astonishment on theanointed from head to foot with sound, even if s /he faces of the doctors. Now he feels committed tois in a coma. The person receives rather than hears, letting people know about psycho-oncology—everyso that even if s /he is hard of hearing the vibrations cancer patient should know about it.of the music can have an effect. There is a decreased He founded the Assagioli foundation with twoneed for morphine and analgesics. When the person other professors who also had cancer, and they setis to be removed from life support or intubation, the out to show the medical world that there was moreplaying is not just for the dying but the whole than chemotherapy, radiotherapy and surgery to thefamily—death is no longer a failure but a family treatment of cancer. He recognized that mainstreamexperience. Physicians have begun showing up at the technology was necessary, but it could only cure thedeath bed, touching the patients, and the nurses have organ, not the person.been profoundly affected. None of this changes the Hospitals were big white blocks, and people wentfact that death exists, but it becomes integrated into in frightened. But why did everything have to besociety. white? How could one change the atmosphere and

allow time for communication between doctors,nurses and patients? Good communication, attention

8. Creating a healing hospital environment and ‘being there’ for the patient was 50% of thecure. If care of the mind and body was not inte-

In the final session Prof. Dr. Rob Wesdorp (NL) grated, it was more difficult for the body to recover.and Ren Sluis (NL) spoke about creating a healing He wanted to see a more comfortable atmosphere,environment in The Netherlands. Wesdorp had been with small outpatient rooms with someone there toill in 1988, but had denied that he had cancer. He offer tea and coffee. The telephone should behad light chemotherapy but did not slow down, but unplugged during consultations, and the beeperswhen he had to have a bone marrow transplant in switched off so total attention is given to the patient,1993, he had to acknowledge he had cancer. His life and time organized in such a way that there waswould now be different and shorter. He realized that more for everyone. In the oncological out-patienttraditional medicine had nothing to offer, and then clinics an oncological nurse should go with theheard about the Helen Dowling Institute in Rotter- patient to X-rays. He felt grand clinical roundsdam. Here the philosophy was to stimulate self- should be cut, and be an opportunity for doctors andhealing potentials. It was recognized that the emo- patients to talk quietly. Nurses play a key role intional problems of patients with cancer were a caring for the whole patient and need more training,normal reaction to a serious threat, a result of and more time, to do so. They should be trained tolooking death in the eye, not a psychiatric problem. be aware of all the fear and negative energy in theTreatment was based on experiential and existential hospital. He concluded by asking whether thereforms of therapy developed to help normal people might be a place for psychic cleansing. Silence orexperiencing an existential crisis. The Institute pro- meditation rooms were essential where both medicalvided tailor-made forms of psychosocial counseling staff and patients could go to recharge their energy.where personal issues were taken seriously and Ren Sluis addressed the same issues from theclients were encouraged to desire behavioral and practical perspective of an expert in business econ-life-style changes and develop new priorities. omics and accountancy. He is a general director,

Wesdorp had been very skeptical about going to a involved with two hospitals, Merwede Hospital, incounseling program, but after three sessions felt Dordrecht and Sliedrecht. He saw hospital and healthmore at ease. It was easier to accept he was going to care as the people’s business, and wanted to changedie, but found it very difficult to imagine saying gradually from an efficiency, input-oriented approachgoodbye to the children. After 6 months he stopped towards effectiveness and an output-oriented ap-working, recognizing that the groove he was in had proach, in which solutions for patients were morecontributed to his cancer. Now, after 2 years with no important than health care products. When the Dor-treatment, he has no tumor and realizes he was on drecht general hospital, with 396 beds, was com-


pleted in 1989, it was efficient, clean and monumen- meetings, encouraging each person to tell a story,tal, with an emphasis on cure, professional standards while others just listen, so that a healing could occur.and an attitude related to input. Five years later the To enable people to have a conscious and preparedemphasis had changed from illness to health, to death, it was useful to imagine one’s own death. Hepersonal support instead of professional aid; the took the large number of participants through anatmosphere was warm instead of cold, and music exercise imagining their own increasing weaknesswas installed instead of silence. Since 1987 he had and debility to enable them to confront death and bealso had a connection with a hospital in Ghana. more understanding of others.When the paramount chief came it became clear On Sunday, workshops were led by Raven Lang,what warmth and pleasure was possible in interac- Therese Schroeder-Sheker, and Dr. Caryle Hirsh-tions with a different culture. For the last 2 years the berg, the latter speaking on ‘‘The role of hope’’hospitals have organized special days, for the pa- [8,9]. Raven explored the blessing way further,tients, the hospital workers, and New Year’s Day for speaking about her experience of re-establishingthe volunteers. In Sliedrecht the colors were trans- midwifery in California. She had been horrified atformed from cold to warm; the furniture was com- being given a huge episiotomy herself without beingfortable instead of functional and there was now a asked, and began to explore what natural childbirthwelcoming atmosphere of care both for patients and was like. Her first obstetricians’ conference had beenhospital workers, with the latter wearing colored filled with obscene jokes told by male doctors, whichsashes and paper flowers to inject some humor and made her, and the other women present, revolted, butfun into the atmosphere. In September 1997, the also aware that the men had not been trained to bemission statement was rephrased to say that the aim respectful. She was concerned that in the late 1960swas ‘‘To contribute to the betterment of the health of 6–7% of births were cesareans, now it was 35%,the individual patient to support the patient in finding with 90% epidurals. The Netherlands had muchan acceptable level of quality of life to show respect, better statistics and, with Britain, lower mortalitywarmth and service’’. At first it seemed too emotion- rates. She demonstrated the song that she and otheral, and the changes took time and diplomacy, midwives sang together and with pregnant women,

Ren described the organizational requirements to and the group gathered around a pregnant participantmake the changes, involving discipline, logistics and and sang to her, laying on hands. Michel Wysmansthe right sort of information. Time needed to be and Dr. Adriaan Visser, of the Maia Foundation, ledsaved for patient care, with smaller dedicated units, groups on ‘‘A strategy for creating more healingworking in teams with coaching rather than instruc- hospital environments’’, Dr. Edel Maex of the Helention, and flexibility. More direct patient support was Dowling Institute (NL) on Existential Therapy, andaimed at, with co-workership rather than hierarchy. William Yang of the Tabor-House (NL) on ‘‘AnThere was a paradox between the high-tech, cure- Inner and Outer Journey to Mount Tabor’’.oriented approach of many hospitals and the kind of The conference was interspersed by musical medi-institutions patients needed, which was care and tations by Therese Schroeder-Sheker, demonstratingsupport oriented. her gift for bringing peace and calm. Patch Adams

and Susan Parenti gave a performance of poetry andclassical music, which ranged widely from Shakes-

9. Workshops peare and Frost, Bach and Schuman, to modern poetsand Irving Berlin.

During Saturday afternoon workshops were led byEvarts and Fay Loomis, Patch Adams and MichaelMurphy on the themes of their talks. Michael 10. ConclusionMurphy explored the theme of restoring the soul tomedicine, allowing the feminine side to re-emerge. In a few moments of dialogue, at the end of theHe said we had to live the work, doing it on second day, Bart van der Lugt suggested that manyourselves. But it was also important to have family problems could be solved by doing nothing and


[2] F Loomis. Illness as opportunity: learning from chronicoperating less. Sluis responded by saying what everyfatigue syndrome’. Reflections, 1997. In: The Hospital as apatient wanted to hear: that s /he did not have to beTemple: Creating a Healing Environment, Conference pa-

operated on or have chemotherapy. Bart felt that one pers, Leeuwenhorst Congrescentrum, Noordwijkerhout, Oc-should not give chemotherapy unless it was really tober 1997.useful to interfere. It should be possible to say ‘‘Go [3] EG Loomis, N Oliver, Rainville. Meadowlark: a healing and

growth experience. Reflections, 1997. In: The Hospital as ain peace, take this opportunity to end your life in aTemple: Creating a Healing Environment, Conference pa-holistic way’’.pers, Leeuwenhorst Congrescentrum, Noordwijkerhout, Oc-

For this writer, the contrast between the insights, tober 1997.imagination, humanity and love shown by the speak- [4] M Murphy. Dying to know. In: The Hospital as a Temple:ers and other participants, and the reality of what Creating a Healing Environment, Conference papers,

Leeuwenhorst Congrescentrum, Noordwijkerhout, Octoberoften goes on in hospitals was brought home sharply1997.by three brief stays as an in-patient in a British

[5] H Adams, M Mylander. Gesundheit, Caring People. Inter-National Health hospital shortly after the conference. view: Doctor Patch Adams, 1993. In: The Hospital as aNo-one sat down with the patients, not even with the Temple: Creating a Healing Environment, Conference pa-severely anorexic teenager on a drip, whose parents pers, Leeuwenhorst Congrescentrum, Noordwijkerhout, Oc-

tober 1997.told her, on Christmas Eve, that they would not be[6] R Lang. Mother Roasting. Mothering, 1987. In: The Hospitalable to visit her the next day; nor with the emaciated

as a Temple: Creating a Healing Environment, Conferenceyoung woman with cancer and lupus, whose opera- papers, Leeuwenhorst Congrescentrum, Noordwijkerhout,tion had been postponed for a second day, although October 1997.she had been deprived of food and drink for 2 days [7] T Schroeder-Sheker. Chalice of Repose, Program Guide. In:

The Hospital as a Temple: Creating a Healing Environment,in preparation for it. Although the corridors andConference papers, Leeuwenhorst Congrescentrum, Noor-nurses’ stations had been decorated, these wards haddwijkerhout, October 1997. Rosa Mystica, In Dulce Jubilo,

nothing to indicate it was Christmas, although on recorded music, Sounds True. 1997, cited in Chalice ofChristmas Day there would be some celebrations. To Repose, Program Guide. In: The Hospital as a Temple:know that such centers as Meadowlark and Gesun- Creating a Healing Environment, Conference papers,

Leeuwenhorst Congrescentrum, Noordwijkerhout, Octoberdheit have existed, that there are practitioners such as1997.the Loomises, Adams, the van der Lugts, Murphy,

[8] C Hirshberg, B O’Regan. Spontaneous Remission: an Anno-Lang, Schroeder-Sheker, Wesdorp and others trans- tated Bibliography. Sausalito, CA: Institute of Noetic Sci-forming birth, living and dying; and individuals such ences 1993.as Sluis, Wysmans, Visser and others restructuring [9] C Watson. Remission mission: in search of why some people

survive. Santa Cruz Sentinel, 14 April 1995, cited in Theactual hospitals, gives much needed hope and optim-Hospital as a Temple: Creating a Healing Environment,ism for the future.Conference papers, Leeuwenhorst Congrescentrum, Noor-dwijkerhout, October 1997.

References

[1] The Hospital as a Temple: Creating a Healing Environment,Conference papers. Leeuwenhorst Congrescentrum, Noor-dwijkerhout, NL, October 1997.

counseling model: creating a healing environment in hospitals

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