THEORETICAL STUDIES
doi: 10.1111/scs.12149
An envisioning about the caring in listening ˚ . Lindstro € m PhD, RN (Professor) Camilla A.-L. Koskinen PhD, RN (Lecturer) and Unni A Department of Caring Science, Abo Akademi University, Vaasa, Finland
Scand J Caring Sci; 2015; 29; 548–554 An envisioning about the caring in listening The purpose of this article is to make visible further dimensions and uncover an envisioning about the caring in listening in the field of caring science, which may improve the care for the suffering human being, the patient. Eriksson’s caritative theory of caring constitutes the starting point for this search for knowledge, while the research method is realised by a hermeneutic reading based on the philosopher of hermeneutics, Gadamer’s thought. The research is realised by a reading of Fyodor Dostoyevsky’s literary works. The literary characters Sonia in Crime and Punishment and Alyosha in The Brothers Karamazov, uncovers patterns of meaning-bearing units towards the caring and the interpretation of a more profound envisioning about the caring in listening. The uncovering and interpretation show that patients in their suffering long to meet a caregiver who listens without the least condemnation in their eyes and demeanour.
Introduction Studies show that the listening to narratives of patients’ illness and suffering is in itself a caring act which supports the patients’ process of cure and recovery. It is through listening to the patients’ stories that the patients can become integrated and engaged in the caring process and take responsibility for their own health (1–4). With a theoretical starting point in the theoretical framework and the basic values of the tradition of caring science based on Eriksson’s caritative theory of caring and through hermeneutic reading and interpretation of Fyodor Dostoyevsky’s classic texts, the purpose of this article is to contemplate, reflect on and make visible further dimensions about the caring in listening. When choosing Eriksson’s caritative theory of caring as a theoretical framework for the search of knowledge, we take as our point of departure clearly expressed basic assumptions and basic concepts for the research (5).
Correspondence to: Camilla A-L. Koskinen, Department of Caring Science, Abo Akademi University, Po Box 311, FIN-65101 Vaasa, Finland. E-mail: [email protected]
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Patients need a listening caregiver who shows compassion and who has the courage to remain in the struggle of suffering and to carry the patients through insupportable pain, guilt and shame. Through listening, it is possible to reawaken a numb heart, to take individuals who have gone through a good deal of suffering, from darkness, degradation, unendurable pain to the light and to awaken their zest for life and joy to live. Listening renews, delivers and transforms human beings so that they can begin to find a new direction in life and start living a life in accordance with their own fundamental order, purpose, essential decision and individuality. Listening takes patients out of their loneliness and unbearable suffering into communion and a life worth living. Keywords: listening, Dostoyevsky.
caring,
hermeneutic
reading,
Submitted 16 August 2013, Accepted 23 April 2014
According to Eriksson (6), love and charity are the fundamental concepts for all caring, for alleviating human suffering and serving life and health. Our research originates in the assumption that the human being is fundamentally an entity of body, soul and spirit; that the caring communion is a basis for all humanity and forms the context of meaning of caring; and that caring is something human by nature (not tied to specific profession). The concept ‘patient’ in its original sense is a suffering human being and we believe that it is necessary to better understand suffering human beings in their ontological context, their constant becoming and living. A caring communion is the inner context and basis for the inner desire to care, the context that gives power and meaning in caring and an intimate relationship with deep understanding. We are dependent on another in a relationship between a human being and an abstract other (some form of God or higher Power, and an image of reality in which existence and transcendence relate to each other). The caring communion requires an encounter in time and space, an absolute lasting presence that is characterised by hospitality, openness, warmth, closeness, rest, respect and honesty. ‘In the act of caring, the suffering human being, the patient, is invited and welcomed to © 2014 Nordic College of Caring Science
Caring in Listening caring communion, where the patient’s suffering can be alleviated through the act of caring in a drama of suffering that is unique to every human being.’ (1: 180) It presupposes a conscious effort to be with the other and a willingness to create possibilities for the other. The notion of caring as something natural and original means that caring is more than a nursing care process: caring represents a kind of caring without prejudice that emphasises patients and their suffering and desires. When caregivers welcome patients to the caring communion, they can experience having served and cared for someone in a special way. Reflected against Eriksson’s caritative theory of caring (5), this present study takes as its starting point that listening is something fundamentally human for human existence and one’s innermost being. According to Koskinen (7), listening is a complex phenomenon, and in the meeting with suffering human beings acquire a contextspecific meaning. Listening and narrating are inextricably linked in the sense that narrating also implies listening to oneself in a caring communion. Listening to life itself and to oneself elicits a responsibility to serve the other humbly, authentically, respectfully, willingly, generously and courageously, to invite the unique other into a caring communion. Listening offers up a space for patients’ stories that can arouse a possibility for them to listen to their own innermost being. A leading thought in this caring theory of listening is that listening has the function to protect the dignity of each human being and in this way to see human beings’ inner potential to shape their own lives and attain health, while the violation of said dignity can extinguish an individual’s will and desire to live. The aim and motive for further research from this theoretical starting point of caring science and this preunderstanding about listening have been to find a more profound envisioning about the caring in listening in the field of caring science which may improve the care for the suffering human being, the patient.
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feel hope and comfort that are seen as significant prerequisites for their recovery and inner healing even when bad results can be expected. Patients can then start putting pieces of their lives together again and create for themselves a new belief in the future or a new vision of life. Hope gives patients courage to face the future (1, 3, 11). When patients begin to understand what it entails to be a suffering and struggling human being, they are able to find a meaning in life despite their illness and pain. By regaining a sense of participation, they are able to examine their own lives, rediscover their own inner strengths and with renewed energy move forward in their lives (3, 12, 13). Lindahl (14) believes that it is through telling their illness narrative that the patients can begin to see and create an image of what is really important in life. Listening to patients not only brings understanding for themselves but also for their being part of a larger common story and a common world with a common meaning. According to Rehlings (13), it is through listening that feelings of loneliness are overcome and in its place a sense of ‘we’ power, along with an acceptance of common human conditions – an acceptance of the struggle that confronts all human beings in the presence of serious illnesses – are created. Guenther (15) believes there is something healing in expressing feelings and memories in community; telling the story brings relief and removes burdens. The story becomes a dwelling, a safe place in which to live and grow despite painful experiences and feelings. In this dwelling, patients find a sense of inner peace and hope also in the midst of life’s chaos. Listening affects and reshapes, brings new insights and heals wounds (9, 16). Previous studies show that listening brings inner peace, belief in the future along with hope and courage to face suffering and to transform one’s life to obtain health, purpose in life and quality of life. From this understanding, our intention is to uncover a new envisioning about what is caring in listening through the reading of classic texts.
Dostoyevsky’s classic texts as material Previous studies The search began by reading previous research which highlighted the caring in listening. Studies show that when caregivers listen, patients’ blood pressure drops, anxiety and fears diminish, suffering is alleviated and the patients are provided with a better quality of life (1–3). When patients are allowed to tell their illness narrative and to express their feelings in words, new possibilities open up for them to work through their own feelings, to learn to know themselves and to discover new aspects of themselves and thereby find new ways to be and live in order to attain health and improve their quality of life (8–10). According to Leseho and Block (11), listening helps patients retain and regain the courage to live, to © 2014 Nordic College of Caring Science
Historically, the reading of classic texts have given us a richer perspective on ourselves as human beings by widening our picture of reality and it has also given us new perspectives on our own existence. Classic texts were written by prominent writers who in their time created something new and wrote texts that made visible universal knowledge of a lasting, artistic and cultural value. According to Eriksson (17), human reality is often portrayed in great classic narratives. Classic texts may uncover the enigmatic and what has often been forgotten, excluded or repressed. The Russian novelist, Fyodor Dostoyevsky’s (1821–1881) life was marked by much suffering and grief; he lost his mother in his teens, later also his first wife and his son, and he suffered from severe
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epilepsy and lived much of his life with economic distress and abuse. But it was the 10 years of his life in prison and exile, the cruel prison conditions with suffering and humiliation, that made him ready for his great contribution as a writer. Dostoevsky’s view of humanity is marked by the Siberian doctrinal years, and he observed and was especially moved by his fellow-prisoners, and despite the cruel conditions of confinement he remained good and pure in heart (18, 19). Dostoyevsky’s texts are profound depictions of individuals as passionate characters that illustrate human beings’ unique tendency to ask themselves the vital questions of existence. Dostoyevsky’s classic texts bring us face to face with questions about life; we learn about life and in encountering literary characters we are able to reflect on our own existence, suffering and encounter other realities. Dostoyevsky’s texts show a genuine interest in giving us a better understanding of suffering human beings and of our relations to others. The texts are seen to move readers with a power that awakens their own vulnerability and compassion for others. Dostoyevsky’s texts may therefore revive our willingness to safeguard the common good of life, interpersonal communion and a better world despite evil and indifference. The texts also exhibit an existential and transcendent dimension that does not turn a blind eye to a reality that reaches beyond the directly visible empirical world. This is the basis for choosing Dostoyevsky’s literary classic texts, ahead of other major writers’ works, as the material for hermeneutical reading. Within caring science research, reading is a way of interpreting texts to better understand human beings, caring and suffering. According to Koskinen and Lindstr€ om (20), classic narratives can rediscover and transmit existential and ontological issues, awaken our responsibility to serve suffering human beings, and in this way continuously create new possibilities for caring.
The hermeneutical reading methodology The hermeneutical methodology in this study is inspired by the philosopher of hermeneutics Hans-Georg Gadamer’s thought (21). Alternative methodologies to hermeneutics could have been a research tradition of literature and medicine or classical structuralist narratology. Especially for hermeneutic research is the interpretive work, hermeneutical reading as method is a lingering and dialogic activity, contemplation and interpretation in a constant movement, where a researcher’s personal dedication of the unfamiliar is transferred to and deepens his or her own understanding. According to Gadamer (21), abstract thinking is a natural and obvious precondition of clinical activity and an evidence-based form of research that opens up for a deeper insight. In a realty which carries the attributes of mystery, one finds something of the deepest potential of caring, as a way of
living, a mode of being, an ontology. According to Prasad (22), reading and interpretation do not consist in shaping the text to fit in a straightjacket of categories and constructions. Nor does reading consist in placing oneself as interpreter in the author’s position because the interpreter cannot possibly achieve the same historical situation in which the author found him- or herself at the time of writing. Interpretation always represents more than what the author intended with the text and is therefore not just a reproductive activity but also always a productive one. According to How (23), we understand a classic text through the meaning it has for us today and through the statements it makes regarding our tradition. A characteristic feature of this methodology is that it is the point of departure in one’s own tradition that guides the uncovering, which precedes the interpretation towards a new envisioning. New understanding is created infinitely, and new sources always reveal unforeseen relations of meaning when the reader enters a process where private subjectivity is left aside for the purpose of partaking or sharing in a common meaning. According to Koskinen and Lindstr€ om (20), it is by taking a position towards the text and by posing new questions to the text and by allowing the text to speak that the researcher can rest in the text and trust that the text can open up and uncover a new envisioning or a different understanding. Hermeneutic reading is a method of working where the researcher, through lingering reading, reflects and carefully uncovers to reach below the surface of the text which reveals patterns of meaning-bearing units or prominent fragments that lead to the deeper layers of knowledge about human beings and the fundamental order of reality. This path of uncovering asks for the reader’s openness and sensitivity to make the text into one’s own world and to let the text raise a sense of wonder about what to do as caregivers. The researcher as reader has lived the texts, have been drawn in, felt both the suffering and the caring, and have been touched by the deep human drama that is played out in them. Dostoyevsky’s classic texts have been incorporated into this research through a movement where the part has been interwoven with the whole. The reading has begun with a first reading of ten selected literary works of Dostoyevsky. After the first reading, an interest was awakened to follow the literary characters, Sonia from Crime and Punishment (24) and Alyosha from The Brothers Karamazov (25), because of their ethical position and actions in relation to suffering human beings and their testifying to and portraying the caring in listening. In the next reading, separate larger text units were extracted. After that, repeated reading acts of lingering reading and reflection begun, as the researcher slowly uncovered patterns that reflected the contours of what was meaningful in relation to the topic of listening. Interpretation begins when Dostoyevsky’s texts in themselves did not directly © 2014 Nordic College of Caring Science
Caring in Listening respond to the caring in listening. The patterns of meaning-bearing units were interpreted to form presuppositions about the caring in listening. The reading, a sensitive uncovering and interpreting, lastly ends in dedication and cultivation of caring science and a more profound envisioning about the caring in listening relevant for clinical practice.
Patterns of meaning-bearing units in Dostoyevsky’s classic texts The meaning-bearing units are described in this article by following the literary characters Sonia and Alyosha. What unites the meek, humble and gentle Sonia and the virtuous servant and brother, Alyosha, is that they have grown up in a home with a drunken father who has lived an unrighteous life and who has constantly humiliated everyone else. The two drunkards, Marmeladov and Fyodorovich, self-pityingly recount their longing for compassion and not being judged. With this important insight, they have a message for us that each human being must have somewhere to go, must have someone to whom they can turn. For every man must have somewhere to go. Since there are times when one absolutely must go somewhere! (24: 15) What he needed was to feel that there was another man, an old and tried friend, that he might call him in his sick moments. (25: 108) With tears in his eyes and with great tenderness, Marmeladov relates the story of the unselfish and comforting daughter Sonia and the importance of her human compassion and empathy. Sonia does not reproach, nor does she merely talk, but acts self-sacrificingly inspite of the fact that her father drinks up her money she had earned unselfishly and with all humility (7, 24). Nor does Alyosha show any trace of contempt for his drunken father. He is always kind, displaying a natural, candid affection no matter how little the father may seem to deserve it. The father was completely taken aback because he felt he had lived all his life in sin and righteousness. Alyosha’s presence gives the father a stitch in his heart merely by being there for him, seeing and hearing everything, without a condemning word (7, 25). The father proclaims: ‘. . .though you’re like an angel, nothing touches you. . . I feel that you’re the only creature in the world who has not condemned me.’ (25: 26).
Sonia It is to Sonia that the poor student, Raskolnikov, feels compelled to go after he has committed his crime, after having killed his landlord. He has chosen Sonia for his confession, because she is the only one he has; he needs her and asks her to go with him as he cannot live © 2014 Nordic College of Caring Science
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without her insatiable compassion. In turn, Sonia is frightened by Raskolnikov’s suffering; her heart beats and shudders in the most unbearable way. But yet she sits down quietly beside him. She observes him with compassion, she muttered in distress, looking intently at him and her body trembles as she says: ‘Oh, how you are suffering!’ (24: 401). Sonia does not leave Raskolnikov when she sees how much he is suffering. There is no hint of abomination of or disgust with Raskolnikov in her. A feeling flows through Raskolnikov’s heart, a feeling that he has not experienced in a long time and that makes him soften. Despite his resistance, his eyes stream with tears. With hope, he looks at Sonia and says: ‘Then you won’t leave me, Sonia? he said, looking at her almost with hope. No, no, never, nowhere! cried Sonia. I will follow you, I will follow you everywhere. Oh, my God! Oh, how miserable I am! . . .Why, why didn’t I know you before!’ (24: 403). Sonia listens intensely, confusedly, and takes pains to really understand Raskolnikov’s explanation. Naively and timidly, she realises that she does not understand, but she asks him to continue to talk and assures him that eventually, deep down, she will be able to understand everything. After Raskolnikov has been allowed to tell her his story, everything suddenly appears more strange, wondrous and wonderful. Sonia embodies the inexorable judgment, the decision that Raskolnikov no longer can take back, namely his need to talk about his crime and suffering. When he has confessed, Sonia encourages him to fall down and kiss the ground that he has stained. She then exhorts him to bow before the whole world, and loudly tell all that he has killed, because then God will return his life to him. He will accept his suffering and in this way attain atonement (7, 24). Sonia had been Raskolnikov’s only way out when he needed to see a human being who would follow him where his destiny took him. He realised that it was her tears and her fear that he needed in his suffering. He needed something to hold on to and had to see a human being. He was moved when he saw her tears, his heart contracted and he asked himself why she cries and why she cares about him. He thought that Sonia would be his nurse. In his hopelessness and anxiety, he threw himself over the possibility of a harmonious, new and complete sensation. It affects him like an attack, and a spark blazes up within him and causes everything to catch fire. Everything within him softens and the tears start streaming down his cheeks. He falls down on the ground, bows before the earth and kisses this dirty ground with pleasure and happiness (7, 24). Sonia follows Raskolnikov during his imprisonment and witnesses his gradual rebirth to a new life and a new future. He is born again and he knows it, he can feel it to the full in all of his renewed being. ‘Life had stepped into the place of theory and something quite different
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would work itself out in his mind.’ (24: 535). When one heart encompasses infinite sources of life for the other heart, life replaces dialectics and something completely new is able to struggle its way to expression. He observes his fellow-prisoners and is astonished over how loudly they laugh, how highly they value and love life, he knows and feels the boundless love with which he will make up for all the suffering (7, 24).
Alyosha The youngest of the Karamazow brothers, Alyosha, ends up on a new, unknown and fated path in the world of the monastery, which he sees as the ideal way out for his soul to escape from the darkness of worldly evil reigning at home to the light of love. In the monastery, he meets the starets, the Elder Zossima, who makes a very strong impression on him and who seems inspiring and redeeming through his personality and dignity. Zossima opens his doors for all who seek him for the purpose of unburdening their hearts and who seek advice and comfort from him in their souls: he has received many disclosures and confessions, and people who have met him have attained meekness, self-mastery and freedom. ‘Alyosha noticed that many, almost all, went in to the elder for the first time with apprehension and uneasiness, but come out with bright and happy faces.’ (25: 31). According to Zossima, human dignity should always be respected because a humane treatment can bring great joy, lead to salvation and renew a human being. Human love, gentleness, brotherly participation with the ill individual is often what human beings need more than medicine; being able to feel authenticity in good words and kindness is an expression of true charity. A few kind words may suffice to bring spiritual rebirth, and a goodnatured and happy face can bring great joy. Zossima stands out for Alyosha as a unique phenomenon, and in his heart lies the secret of life’s rebirth for all. For Alyosha, the starets’ cell entails a refuge from worldly cares and darkness. The calmness and peacefulness in the cell is a source that brings edification and joy, stillness and peace when the heart aches. In this connection, Alyosha begins to believe in his essential decision to believe in that which comes into existence from within himself. Through pausing and calmly contemplating, he became filled with an uncontrollable urge to love his fellow beings with joy and devotion (7, 25). It is to Alyosha that his brother Dmitri comes when the time has come for his confession. His whole life has been a mess, chaotic, and he knows that Alyosha is the only one who does not laugh at him and his secret, his confession. Dmitri does not want anyone to rummage about in his soul or torture him with trifling matters. He says he needs an angel on earth who listens, understands and forgives. Alyosha listens anxiously and attentively to
a burning heart’s confession. He understands that a new person will eventually appear because Dmitri longs and thirsts for resurrection, renewal and a happy resolution to his destiny. Dmitri wants to start a new and honest life, he wants resurrection, to be completely new and reborn, and he feels as though he has the strength to overcome all suffering. All he has to do is to repeat to himself each moment: ‘I think I could stand anything, any suffering, only to be able to say and to repeat to myself every moment, I exist.’ (25: 703) Even if he will suffer a thousandfold, he exists and is alive. Even if he sits in a tower, he still exists, he can see the sun, and if he cannot see the sun he still knows that the sun exists because that is all of life (7, 25). Alyosha’s other brother, Ivan, maintains that even if he grievously suffers, no other person can know how severe his suffering is. He has begun to like Alyosha and would gladly talk to and be good friends with him as he is the only one he has in this world. When Alyosha wants to know what his dear brother does for a living, he says that it is enough for him to know that Alyosha is there so that he will not lose his will to live. Alyosha is delighted that Ivan has such a lust for life and that he expresses the thought that one should love with one’s inner self, with all of one’s innermost being: ‘. . .one longs to love with one0 s inside, with one0 s stomach. You said that so well and I am awfully glad that you have such a longing for life.’ (25: 270) Alyosha believes that everybody must learn to love life in this world, to love life more than its purpose, because love must unconditionally come before logic; not until then can one understand the meaning of life (7, 25).
Presuppositions about the caring in listening The patterns of meaning-bearing units in Dostoyevsky’s classic texts are subsequently interpreted to gain presuppositions and thereby new envisioning about the caring in listening. The texts (7, 24, 25) reveals that human beings’ listening to their innermost room make possible the ability to, at times, carry within themselves an essence of the whole, they can feel a calm and peaceful source of the good within themselves and attain redress, reconciliation, forgiveness and edification. In peaceful moments, when ardent feelings visit the soul of human beings, their hearts fill with joy and rapture, their souls with freedom, calm and peace. When the heart aches and is tormented, when life causes human beings unbearable suffering, they must talk to a chosen other who listens to them and who, with the agony and tears of love and compassion, is someone who listens without condemnation in their demeanour; a human being whose gaze shows gentleness and a noncondemning attitude. Human beings, in their struggle of suffering, long to reveal the secret of their hearts to someone who, by © 2014 Nordic College of Caring Science
Caring in Listening listening, can now and then carry the burden of the one who is suffering. Listening is to be alive to the miraculous source of power with which human beings can overcome pain, and even if they suffer, know that they exist and live. Through listening it is possible to reawaken a numb heart, to take individuals who have gone through a good deal of suffering from darkness, degradation and unendurable pain to the light and a new life. Listening aids individuals to reach the light of truth in their lives. Listening renews human beings, delivers and transforms them so that they can begin to find a new direction in life to start living a new and true life. Listening gives birth to that which is completely new, which struggles, allowing life to win and a new future to dawn. Listening awakens the desire, the thirst for and the joy to love life itself. When two individuals listen to each other and when one of the hearts encompasses infinite sources of life for the other heart, loneliness is transformed into communion and an interpersonal love that can overcome suffering and cause love for life to be reborn.
A caring science dedication and cultivation From a caring science tradition, the results make visible the importance of listening to suffering human beings, in particular, to our patients. According to Lindahl (14), patients often have a hunger for telling their story and thereby form a true picture of their illness and suffering, and what is important in life. By reading Dostoyevsky’s texts (24, 25), one may come to the understanding that suffering human beings long for the caregivers’ compassion, agony and tears; according to Thorne et al. (3), patients are highly grateful for the compassion that caregivers show and to see the caregivers’ compassion helps the patient to hold on to their hope and courage. The results show the importance of creating a space where patients can be heard and meet a caregiver that listens and takes an active part in the patients’ understanding of themselves and their view of life so that they can together create a trustful dwelling, a safe place in which to live and grow, despite painful feelings of suffering, guilt and shame (9, 16, 24, 25). When the illness, suffering and distress become too painful and unbearable to bear alone, patients need to find caregivers who do not show the least condemnation in their eyes, caregivers who, by their listening attitude, carry the patients. This is when a caring communion occurs that gives patients the courage to listen to their own innermost feelings and to affirm suffering as an inseparable part of life. This makes patients capable of holding on to and to regain the courage to live and hope as important prerequisites for recovery and inner healing. The patients
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are now capable of listening to that in their innermost being which can be discerned as proper, right and true to allow it to begin to germinate and grow. According to Eriksson (26), it is this affirmation of suffering that seizes and overwhelms the innermost depth of human beings so that the inner tone and the fundamental values that they wish to celebrate may sound to sustain and purify them. By affirming their suffering, patients are given courage to listen to the struggle of suffering that heals and leads them towards a greater and greater oneness and whole. The source of healing is within the patients themselves, while caregivers may carry and guide them to find and gain their meaning and fundamental order of life. According to Koskinen (7), it is precisely in those moments when patients and caregivers are affected and shaken by the patients’ story that the patients are given new strength to take their lives seriously, are able to listen to the longing and desire of their own hearts and to follow the fundamental order of life. Patients are able to cling to their chosen course in life and listen to tones that convey joy and zest for life. This means that illness and suffering also can be seen as a gift or a prize for pausing and for sincerely listening to one’s own heart and in that way be able to choose a positive attitude and go-ahead spirit in the lifelong journey with oneself. Love for life itself awakens resources for a new zest and a thirst for life, new strength and freedom to be and act in accordance with their own essential decision and individuality. Listening gives patients the strength to examine their lives, piece together parts of themselves and slowly look forward with a new belief in the future or a new vision of life. (cf 1, 3, 12, 13) Listening as caring alleviates suffering, gives new life and opens up new ways to live a life worth living in which each day is precious.
Acknowledgement The authors would like to thank Marinella Rodi-Risberg PhD for translating and revising of the English text.
Author contributions Camilla Koskinen, PhD was responsible for the idea of the study conception/design, data collection, analysis work and drafting of the manuscript. Professor Unni A. Lindstr€ om contributed with constructive and valuable comments in editing the article.
Funding Funding was not obtained. The authors declare that there is no conflict of interests.
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18 Linner S. Dostojevskij. Helgonbild och livsmystik (Dostoyevsky. Saints Picture and Life Mystery). 1982, Bokf€ orlaget Atlantis, Stockholm. 19 Berdjajev NA. Om Dostojevskij (translated to English, Dostoevsky, 1934, translated to Swedish by Andersson, G.) 1992, Artos, Skellefte a. 20 Koskinen C, Lindstr€ om U A. Hermeneutic reading of classic texts. Scand J Caring Sci 2013; 27: 757–64. 21 Gadamer H-G. Truth and Method. 1999, Continuum, New York. 22 Prasad A. The contest over meaning: hermeneutics as an interpretive methodology for understanding texts. Organ Res Methods 2002; 5: 12–33. 23 How AR. Hermeneutics and the ‘classic’ problem in the human sciences. Hist Hum Sci 2011; 24: 47–63. 24 Dostoyevsky F. Crime and Punishment. (Prestuplenije i nakzanilje 1866, translated to English by Garnett C; Brott och straff, translated to Swedish by Bj€ orkegren H, 1979). 1914, http://ebookbrowsee.net/crimepunishment6x9-pdf-d663952945 (last accessed 29 January 2014) 25 Dostoyevsky F. The Brothers Karamazov. (Bratia Karamazovy 1880, translated to English by Garnett C; Br€ oderna Karamazow, translated to Swedish by Dahl S, 1986). 1912, http://ebookbrowsee.net/karamazov6x9pdf-d57366910 (last accessed 29 January 2014). 26 Eriksson K. The Suffering Human Being (English transl. of: Den lidande m€anniskan. 1994 Liber F€orlag), 2006, Nordic Studies Press, Chicago.
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doi: 10.1111/scs.12149
An envisioning about the caring in listening ˚ . Lindstro € m PhD, RN (Professor) Camilla A.-L. Koskinen PhD, RN (Lecturer) and Unni A Department of Caring Science, Abo Akademi University, Vaasa, Finland
Scand J Caring Sci; 2015; 29; 548–554 An envisioning about the caring in listening The purpose of this article is to make visible further dimensions and uncover an envisioning about the caring in listening in the field of caring science, which may improve the care for the suffering human being, the patient. Eriksson’s caritative theory of caring constitutes the starting point for this search for knowledge, while the research method is realised by a hermeneutic reading based on the philosopher of hermeneutics, Gadamer’s thought. The research is realised by a reading of Fyodor Dostoyevsky’s literary works. The literary characters Sonia in Crime and Punishment and Alyosha in The Brothers Karamazov, uncovers patterns of meaning-bearing units towards the caring and the interpretation of a more profound envisioning about the caring in listening. The uncovering and interpretation show that patients in their suffering long to meet a caregiver who listens without the least condemnation in their eyes and demeanour.
Introduction Studies show that the listening to narratives of patients’ illness and suffering is in itself a caring act which supports the patients’ process of cure and recovery. It is through listening to the patients’ stories that the patients can become integrated and engaged in the caring process and take responsibility for their own health (1–4). With a theoretical starting point in the theoretical framework and the basic values of the tradition of caring science based on Eriksson’s caritative theory of caring and through hermeneutic reading and interpretation of Fyodor Dostoyevsky’s classic texts, the purpose of this article is to contemplate, reflect on and make visible further dimensions about the caring in listening. When choosing Eriksson’s caritative theory of caring as a theoretical framework for the search of knowledge, we take as our point of departure clearly expressed basic assumptions and basic concepts for the research (5).
Correspondence to: Camilla A-L. Koskinen, Department of Caring Science, Abo Akademi University, Po Box 311, FIN-65101 Vaasa, Finland. E-mail: [email protected]
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Patients need a listening caregiver who shows compassion and who has the courage to remain in the struggle of suffering and to carry the patients through insupportable pain, guilt and shame. Through listening, it is possible to reawaken a numb heart, to take individuals who have gone through a good deal of suffering, from darkness, degradation, unendurable pain to the light and to awaken their zest for life and joy to live. Listening renews, delivers and transforms human beings so that they can begin to find a new direction in life and start living a life in accordance with their own fundamental order, purpose, essential decision and individuality. Listening takes patients out of their loneliness and unbearable suffering into communion and a life worth living. Keywords: listening, Dostoyevsky.
caring,
hermeneutic
reading,
Submitted 16 August 2013, Accepted 23 April 2014
According to Eriksson (6), love and charity are the fundamental concepts for all caring, for alleviating human suffering and serving life and health. Our research originates in the assumption that the human being is fundamentally an entity of body, soul and spirit; that the caring communion is a basis for all humanity and forms the context of meaning of caring; and that caring is something human by nature (not tied to specific profession). The concept ‘patient’ in its original sense is a suffering human being and we believe that it is necessary to better understand suffering human beings in their ontological context, their constant becoming and living. A caring communion is the inner context and basis for the inner desire to care, the context that gives power and meaning in caring and an intimate relationship with deep understanding. We are dependent on another in a relationship between a human being and an abstract other (some form of God or higher Power, and an image of reality in which existence and transcendence relate to each other). The caring communion requires an encounter in time and space, an absolute lasting presence that is characterised by hospitality, openness, warmth, closeness, rest, respect and honesty. ‘In the act of caring, the suffering human being, the patient, is invited and welcomed to © 2014 Nordic College of Caring Science
Caring in Listening caring communion, where the patient’s suffering can be alleviated through the act of caring in a drama of suffering that is unique to every human being.’ (1: 180) It presupposes a conscious effort to be with the other and a willingness to create possibilities for the other. The notion of caring as something natural and original means that caring is more than a nursing care process: caring represents a kind of caring without prejudice that emphasises patients and their suffering and desires. When caregivers welcome patients to the caring communion, they can experience having served and cared for someone in a special way. Reflected against Eriksson’s caritative theory of caring (5), this present study takes as its starting point that listening is something fundamentally human for human existence and one’s innermost being. According to Koskinen (7), listening is a complex phenomenon, and in the meeting with suffering human beings acquire a contextspecific meaning. Listening and narrating are inextricably linked in the sense that narrating also implies listening to oneself in a caring communion. Listening to life itself and to oneself elicits a responsibility to serve the other humbly, authentically, respectfully, willingly, generously and courageously, to invite the unique other into a caring communion. Listening offers up a space for patients’ stories that can arouse a possibility for them to listen to their own innermost being. A leading thought in this caring theory of listening is that listening has the function to protect the dignity of each human being and in this way to see human beings’ inner potential to shape their own lives and attain health, while the violation of said dignity can extinguish an individual’s will and desire to live. The aim and motive for further research from this theoretical starting point of caring science and this preunderstanding about listening have been to find a more profound envisioning about the caring in listening in the field of caring science which may improve the care for the suffering human being, the patient.
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feel hope and comfort that are seen as significant prerequisites for their recovery and inner healing even when bad results can be expected. Patients can then start putting pieces of their lives together again and create for themselves a new belief in the future or a new vision of life. Hope gives patients courage to face the future (1, 3, 11). When patients begin to understand what it entails to be a suffering and struggling human being, they are able to find a meaning in life despite their illness and pain. By regaining a sense of participation, they are able to examine their own lives, rediscover their own inner strengths and with renewed energy move forward in their lives (3, 12, 13). Lindahl (14) believes that it is through telling their illness narrative that the patients can begin to see and create an image of what is really important in life. Listening to patients not only brings understanding for themselves but also for their being part of a larger common story and a common world with a common meaning. According to Rehlings (13), it is through listening that feelings of loneliness are overcome and in its place a sense of ‘we’ power, along with an acceptance of common human conditions – an acceptance of the struggle that confronts all human beings in the presence of serious illnesses – are created. Guenther (15) believes there is something healing in expressing feelings and memories in community; telling the story brings relief and removes burdens. The story becomes a dwelling, a safe place in which to live and grow despite painful experiences and feelings. In this dwelling, patients find a sense of inner peace and hope also in the midst of life’s chaos. Listening affects and reshapes, brings new insights and heals wounds (9, 16). Previous studies show that listening brings inner peace, belief in the future along with hope and courage to face suffering and to transform one’s life to obtain health, purpose in life and quality of life. From this understanding, our intention is to uncover a new envisioning about what is caring in listening through the reading of classic texts.
Dostoyevsky’s classic texts as material Previous studies The search began by reading previous research which highlighted the caring in listening. Studies show that when caregivers listen, patients’ blood pressure drops, anxiety and fears diminish, suffering is alleviated and the patients are provided with a better quality of life (1–3). When patients are allowed to tell their illness narrative and to express their feelings in words, new possibilities open up for them to work through their own feelings, to learn to know themselves and to discover new aspects of themselves and thereby find new ways to be and live in order to attain health and improve their quality of life (8–10). According to Leseho and Block (11), listening helps patients retain and regain the courage to live, to © 2014 Nordic College of Caring Science
Historically, the reading of classic texts have given us a richer perspective on ourselves as human beings by widening our picture of reality and it has also given us new perspectives on our own existence. Classic texts were written by prominent writers who in their time created something new and wrote texts that made visible universal knowledge of a lasting, artistic and cultural value. According to Eriksson (17), human reality is often portrayed in great classic narratives. Classic texts may uncover the enigmatic and what has often been forgotten, excluded or repressed. The Russian novelist, Fyodor Dostoyevsky’s (1821–1881) life was marked by much suffering and grief; he lost his mother in his teens, later also his first wife and his son, and he suffered from severe
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epilepsy and lived much of his life with economic distress and abuse. But it was the 10 years of his life in prison and exile, the cruel prison conditions with suffering and humiliation, that made him ready for his great contribution as a writer. Dostoevsky’s view of humanity is marked by the Siberian doctrinal years, and he observed and was especially moved by his fellow-prisoners, and despite the cruel conditions of confinement he remained good and pure in heart (18, 19). Dostoyevsky’s texts are profound depictions of individuals as passionate characters that illustrate human beings’ unique tendency to ask themselves the vital questions of existence. Dostoyevsky’s classic texts bring us face to face with questions about life; we learn about life and in encountering literary characters we are able to reflect on our own existence, suffering and encounter other realities. Dostoyevsky’s texts show a genuine interest in giving us a better understanding of suffering human beings and of our relations to others. The texts are seen to move readers with a power that awakens their own vulnerability and compassion for others. Dostoyevsky’s texts may therefore revive our willingness to safeguard the common good of life, interpersonal communion and a better world despite evil and indifference. The texts also exhibit an existential and transcendent dimension that does not turn a blind eye to a reality that reaches beyond the directly visible empirical world. This is the basis for choosing Dostoyevsky’s literary classic texts, ahead of other major writers’ works, as the material for hermeneutical reading. Within caring science research, reading is a way of interpreting texts to better understand human beings, caring and suffering. According to Koskinen and Lindstr€ om (20), classic narratives can rediscover and transmit existential and ontological issues, awaken our responsibility to serve suffering human beings, and in this way continuously create new possibilities for caring.
The hermeneutical reading methodology The hermeneutical methodology in this study is inspired by the philosopher of hermeneutics Hans-Georg Gadamer’s thought (21). Alternative methodologies to hermeneutics could have been a research tradition of literature and medicine or classical structuralist narratology. Especially for hermeneutic research is the interpretive work, hermeneutical reading as method is a lingering and dialogic activity, contemplation and interpretation in a constant movement, where a researcher’s personal dedication of the unfamiliar is transferred to and deepens his or her own understanding. According to Gadamer (21), abstract thinking is a natural and obvious precondition of clinical activity and an evidence-based form of research that opens up for a deeper insight. In a realty which carries the attributes of mystery, one finds something of the deepest potential of caring, as a way of
living, a mode of being, an ontology. According to Prasad (22), reading and interpretation do not consist in shaping the text to fit in a straightjacket of categories and constructions. Nor does reading consist in placing oneself as interpreter in the author’s position because the interpreter cannot possibly achieve the same historical situation in which the author found him- or herself at the time of writing. Interpretation always represents more than what the author intended with the text and is therefore not just a reproductive activity but also always a productive one. According to How (23), we understand a classic text through the meaning it has for us today and through the statements it makes regarding our tradition. A characteristic feature of this methodology is that it is the point of departure in one’s own tradition that guides the uncovering, which precedes the interpretation towards a new envisioning. New understanding is created infinitely, and new sources always reveal unforeseen relations of meaning when the reader enters a process where private subjectivity is left aside for the purpose of partaking or sharing in a common meaning. According to Koskinen and Lindstr€ om (20), it is by taking a position towards the text and by posing new questions to the text and by allowing the text to speak that the researcher can rest in the text and trust that the text can open up and uncover a new envisioning or a different understanding. Hermeneutic reading is a method of working where the researcher, through lingering reading, reflects and carefully uncovers to reach below the surface of the text which reveals patterns of meaning-bearing units or prominent fragments that lead to the deeper layers of knowledge about human beings and the fundamental order of reality. This path of uncovering asks for the reader’s openness and sensitivity to make the text into one’s own world and to let the text raise a sense of wonder about what to do as caregivers. The researcher as reader has lived the texts, have been drawn in, felt both the suffering and the caring, and have been touched by the deep human drama that is played out in them. Dostoyevsky’s classic texts have been incorporated into this research through a movement where the part has been interwoven with the whole. The reading has begun with a first reading of ten selected literary works of Dostoyevsky. After the first reading, an interest was awakened to follow the literary characters, Sonia from Crime and Punishment (24) and Alyosha from The Brothers Karamazov (25), because of their ethical position and actions in relation to suffering human beings and their testifying to and portraying the caring in listening. In the next reading, separate larger text units were extracted. After that, repeated reading acts of lingering reading and reflection begun, as the researcher slowly uncovered patterns that reflected the contours of what was meaningful in relation to the topic of listening. Interpretation begins when Dostoyevsky’s texts in themselves did not directly © 2014 Nordic College of Caring Science
Caring in Listening respond to the caring in listening. The patterns of meaning-bearing units were interpreted to form presuppositions about the caring in listening. The reading, a sensitive uncovering and interpreting, lastly ends in dedication and cultivation of caring science and a more profound envisioning about the caring in listening relevant for clinical practice.
Patterns of meaning-bearing units in Dostoyevsky’s classic texts The meaning-bearing units are described in this article by following the literary characters Sonia and Alyosha. What unites the meek, humble and gentle Sonia and the virtuous servant and brother, Alyosha, is that they have grown up in a home with a drunken father who has lived an unrighteous life and who has constantly humiliated everyone else. The two drunkards, Marmeladov and Fyodorovich, self-pityingly recount their longing for compassion and not being judged. With this important insight, they have a message for us that each human being must have somewhere to go, must have someone to whom they can turn. For every man must have somewhere to go. Since there are times when one absolutely must go somewhere! (24: 15) What he needed was to feel that there was another man, an old and tried friend, that he might call him in his sick moments. (25: 108) With tears in his eyes and with great tenderness, Marmeladov relates the story of the unselfish and comforting daughter Sonia and the importance of her human compassion and empathy. Sonia does not reproach, nor does she merely talk, but acts self-sacrificingly inspite of the fact that her father drinks up her money she had earned unselfishly and with all humility (7, 24). Nor does Alyosha show any trace of contempt for his drunken father. He is always kind, displaying a natural, candid affection no matter how little the father may seem to deserve it. The father was completely taken aback because he felt he had lived all his life in sin and righteousness. Alyosha’s presence gives the father a stitch in his heart merely by being there for him, seeing and hearing everything, without a condemning word (7, 25). The father proclaims: ‘. . .though you’re like an angel, nothing touches you. . . I feel that you’re the only creature in the world who has not condemned me.’ (25: 26).
Sonia It is to Sonia that the poor student, Raskolnikov, feels compelled to go after he has committed his crime, after having killed his landlord. He has chosen Sonia for his confession, because she is the only one he has; he needs her and asks her to go with him as he cannot live © 2014 Nordic College of Caring Science
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without her insatiable compassion. In turn, Sonia is frightened by Raskolnikov’s suffering; her heart beats and shudders in the most unbearable way. But yet she sits down quietly beside him. She observes him with compassion, she muttered in distress, looking intently at him and her body trembles as she says: ‘Oh, how you are suffering!’ (24: 401). Sonia does not leave Raskolnikov when she sees how much he is suffering. There is no hint of abomination of or disgust with Raskolnikov in her. A feeling flows through Raskolnikov’s heart, a feeling that he has not experienced in a long time and that makes him soften. Despite his resistance, his eyes stream with tears. With hope, he looks at Sonia and says: ‘Then you won’t leave me, Sonia? he said, looking at her almost with hope. No, no, never, nowhere! cried Sonia. I will follow you, I will follow you everywhere. Oh, my God! Oh, how miserable I am! . . .Why, why didn’t I know you before!’ (24: 403). Sonia listens intensely, confusedly, and takes pains to really understand Raskolnikov’s explanation. Naively and timidly, she realises that she does not understand, but she asks him to continue to talk and assures him that eventually, deep down, she will be able to understand everything. After Raskolnikov has been allowed to tell her his story, everything suddenly appears more strange, wondrous and wonderful. Sonia embodies the inexorable judgment, the decision that Raskolnikov no longer can take back, namely his need to talk about his crime and suffering. When he has confessed, Sonia encourages him to fall down and kiss the ground that he has stained. She then exhorts him to bow before the whole world, and loudly tell all that he has killed, because then God will return his life to him. He will accept his suffering and in this way attain atonement (7, 24). Sonia had been Raskolnikov’s only way out when he needed to see a human being who would follow him where his destiny took him. He realised that it was her tears and her fear that he needed in his suffering. He needed something to hold on to and had to see a human being. He was moved when he saw her tears, his heart contracted and he asked himself why she cries and why she cares about him. He thought that Sonia would be his nurse. In his hopelessness and anxiety, he threw himself over the possibility of a harmonious, new and complete sensation. It affects him like an attack, and a spark blazes up within him and causes everything to catch fire. Everything within him softens and the tears start streaming down his cheeks. He falls down on the ground, bows before the earth and kisses this dirty ground with pleasure and happiness (7, 24). Sonia follows Raskolnikov during his imprisonment and witnesses his gradual rebirth to a new life and a new future. He is born again and he knows it, he can feel it to the full in all of his renewed being. ‘Life had stepped into the place of theory and something quite different
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would work itself out in his mind.’ (24: 535). When one heart encompasses infinite sources of life for the other heart, life replaces dialectics and something completely new is able to struggle its way to expression. He observes his fellow-prisoners and is astonished over how loudly they laugh, how highly they value and love life, he knows and feels the boundless love with which he will make up for all the suffering (7, 24).
Alyosha The youngest of the Karamazow brothers, Alyosha, ends up on a new, unknown and fated path in the world of the monastery, which he sees as the ideal way out for his soul to escape from the darkness of worldly evil reigning at home to the light of love. In the monastery, he meets the starets, the Elder Zossima, who makes a very strong impression on him and who seems inspiring and redeeming through his personality and dignity. Zossima opens his doors for all who seek him for the purpose of unburdening their hearts and who seek advice and comfort from him in their souls: he has received many disclosures and confessions, and people who have met him have attained meekness, self-mastery and freedom. ‘Alyosha noticed that many, almost all, went in to the elder for the first time with apprehension and uneasiness, but come out with bright and happy faces.’ (25: 31). According to Zossima, human dignity should always be respected because a humane treatment can bring great joy, lead to salvation and renew a human being. Human love, gentleness, brotherly participation with the ill individual is often what human beings need more than medicine; being able to feel authenticity in good words and kindness is an expression of true charity. A few kind words may suffice to bring spiritual rebirth, and a goodnatured and happy face can bring great joy. Zossima stands out for Alyosha as a unique phenomenon, and in his heart lies the secret of life’s rebirth for all. For Alyosha, the starets’ cell entails a refuge from worldly cares and darkness. The calmness and peacefulness in the cell is a source that brings edification and joy, stillness and peace when the heart aches. In this connection, Alyosha begins to believe in his essential decision to believe in that which comes into existence from within himself. Through pausing and calmly contemplating, he became filled with an uncontrollable urge to love his fellow beings with joy and devotion (7, 25). It is to Alyosha that his brother Dmitri comes when the time has come for his confession. His whole life has been a mess, chaotic, and he knows that Alyosha is the only one who does not laugh at him and his secret, his confession. Dmitri does not want anyone to rummage about in his soul or torture him with trifling matters. He says he needs an angel on earth who listens, understands and forgives. Alyosha listens anxiously and attentively to
a burning heart’s confession. He understands that a new person will eventually appear because Dmitri longs and thirsts for resurrection, renewal and a happy resolution to his destiny. Dmitri wants to start a new and honest life, he wants resurrection, to be completely new and reborn, and he feels as though he has the strength to overcome all suffering. All he has to do is to repeat to himself each moment: ‘I think I could stand anything, any suffering, only to be able to say and to repeat to myself every moment, I exist.’ (25: 703) Even if he will suffer a thousandfold, he exists and is alive. Even if he sits in a tower, he still exists, he can see the sun, and if he cannot see the sun he still knows that the sun exists because that is all of life (7, 25). Alyosha’s other brother, Ivan, maintains that even if he grievously suffers, no other person can know how severe his suffering is. He has begun to like Alyosha and would gladly talk to and be good friends with him as he is the only one he has in this world. When Alyosha wants to know what his dear brother does for a living, he says that it is enough for him to know that Alyosha is there so that he will not lose his will to live. Alyosha is delighted that Ivan has such a lust for life and that he expresses the thought that one should love with one’s inner self, with all of one’s innermost being: ‘. . .one longs to love with one0 s inside, with one0 s stomach. You said that so well and I am awfully glad that you have such a longing for life.’ (25: 270) Alyosha believes that everybody must learn to love life in this world, to love life more than its purpose, because love must unconditionally come before logic; not until then can one understand the meaning of life (7, 25).
Presuppositions about the caring in listening The patterns of meaning-bearing units in Dostoyevsky’s classic texts are subsequently interpreted to gain presuppositions and thereby new envisioning about the caring in listening. The texts (7, 24, 25) reveals that human beings’ listening to their innermost room make possible the ability to, at times, carry within themselves an essence of the whole, they can feel a calm and peaceful source of the good within themselves and attain redress, reconciliation, forgiveness and edification. In peaceful moments, when ardent feelings visit the soul of human beings, their hearts fill with joy and rapture, their souls with freedom, calm and peace. When the heart aches and is tormented, when life causes human beings unbearable suffering, they must talk to a chosen other who listens to them and who, with the agony and tears of love and compassion, is someone who listens without condemnation in their demeanour; a human being whose gaze shows gentleness and a noncondemning attitude. Human beings, in their struggle of suffering, long to reveal the secret of their hearts to someone who, by © 2014 Nordic College of Caring Science
Caring in Listening listening, can now and then carry the burden of the one who is suffering. Listening is to be alive to the miraculous source of power with which human beings can overcome pain, and even if they suffer, know that they exist and live. Through listening it is possible to reawaken a numb heart, to take individuals who have gone through a good deal of suffering from darkness, degradation and unendurable pain to the light and a new life. Listening aids individuals to reach the light of truth in their lives. Listening renews human beings, delivers and transforms them so that they can begin to find a new direction in life to start living a new and true life. Listening gives birth to that which is completely new, which struggles, allowing life to win and a new future to dawn. Listening awakens the desire, the thirst for and the joy to love life itself. When two individuals listen to each other and when one of the hearts encompasses infinite sources of life for the other heart, loneliness is transformed into communion and an interpersonal love that can overcome suffering and cause love for life to be reborn.
A caring science dedication and cultivation From a caring science tradition, the results make visible the importance of listening to suffering human beings, in particular, to our patients. According to Lindahl (14), patients often have a hunger for telling their story and thereby form a true picture of their illness and suffering, and what is important in life. By reading Dostoyevsky’s texts (24, 25), one may come to the understanding that suffering human beings long for the caregivers’ compassion, agony and tears; according to Thorne et al. (3), patients are highly grateful for the compassion that caregivers show and to see the caregivers’ compassion helps the patient to hold on to their hope and courage. The results show the importance of creating a space where patients can be heard and meet a caregiver that listens and takes an active part in the patients’ understanding of themselves and their view of life so that they can together create a trustful dwelling, a safe place in which to live and grow, despite painful feelings of suffering, guilt and shame (9, 16, 24, 25). When the illness, suffering and distress become too painful and unbearable to bear alone, patients need to find caregivers who do not show the least condemnation in their eyes, caregivers who, by their listening attitude, carry the patients. This is when a caring communion occurs that gives patients the courage to listen to their own innermost feelings and to affirm suffering as an inseparable part of life. This makes patients capable of holding on to and to regain the courage to live and hope as important prerequisites for recovery and inner healing. The patients
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are now capable of listening to that in their innermost being which can be discerned as proper, right and true to allow it to begin to germinate and grow. According to Eriksson (26), it is this affirmation of suffering that seizes and overwhelms the innermost depth of human beings so that the inner tone and the fundamental values that they wish to celebrate may sound to sustain and purify them. By affirming their suffering, patients are given courage to listen to the struggle of suffering that heals and leads them towards a greater and greater oneness and whole. The source of healing is within the patients themselves, while caregivers may carry and guide them to find and gain their meaning and fundamental order of life. According to Koskinen (7), it is precisely in those moments when patients and caregivers are affected and shaken by the patients’ story that the patients are given new strength to take their lives seriously, are able to listen to the longing and desire of their own hearts and to follow the fundamental order of life. Patients are able to cling to their chosen course in life and listen to tones that convey joy and zest for life. This means that illness and suffering also can be seen as a gift or a prize for pausing and for sincerely listening to one’s own heart and in that way be able to choose a positive attitude and go-ahead spirit in the lifelong journey with oneself. Love for life itself awakens resources for a new zest and a thirst for life, new strength and freedom to be and act in accordance with their own essential decision and individuality. Listening gives patients the strength to examine their lives, piece together parts of themselves and slowly look forward with a new belief in the future or a new vision of life. (cf 1, 3, 12, 13) Listening as caring alleviates suffering, gives new life and opens up new ways to live a life worth living in which each day is precious.
Acknowledgement The authors would like to thank Marinella Rodi-Risberg PhD for translating and revising of the English text.
Author contributions Camilla Koskinen, PhD was responsible for the idea of the study conception/design, data collection, analysis work and drafting of the manuscript. Professor Unni A. Lindstr€ om contributed with constructive and valuable comments in editing the article.
Funding Funding was not obtained. The authors declare that there is no conflict of interests.
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