Spirituality helps not only to live through death, but also to live life

Spirituality plays a crucial role in coping with the end of life. In addition to psychosocial support, the ”la Caixa” Foundation’s Comprehensive care for people with advanced illnesses programme provides spiritual care to accompany people with advanced illnesses and their families. The anthropologist Marta Morente and the theologian Arnaldo Pangrazzi reflect on the implications of spirituality at the end of life’s journey from a cross-cultural perspective.

When someone loses a loved one, the way they deal with that loss will differ according to their culture. It is not the same in Spain, Mexico or India. Understanding this diversity is fundamental to helping people at the end of life and those around them. This belief is central to the ”la Caixa” Foundation's Comprehensive care for people with advanced illnesses programme, which aims to help them emotionally and socially, but also spiritually. Its Psychosocial Care Teams (EAPS), which since they were set up in 2008 have helped almost 700,000 people with advanced diseases and their families, not only include psychologists, social workers and volunteers, but also pastoral agents.

These professionals try to facilitate the spiritual approach that many of their patients need. “Spirituality helps a lot, not only to live through death, but also to live life,” says social and cultural anthropologist Marta Morente. “I'm not saying that if you tell me I’m going to die tomorrow I won’t feel fear, confusion or sadness, but the panorama opens up and you have this feeling of fullness of life and of having prepared yourself for a good death, to die with greater peace and confidence.”

It is a spirituality that does not have to be linked to a religion. “I haven't met anyone who doesn’t fall in love with a sunset, a crackling fire, gazing at a newborn child or watching the sea and listening to the waves. And for me, those moments of stillness, when a person connects with a different perception of time, are also spirituality,” says Morente.

Arnaldo Pangrazzi, a pastoral health care theologian, agrees with Morente on the need to distinguish between spirituality and religious tradition. “Religious affiliation depends very much on geography. If you’re born in Portugal, you’re most likely Catholic. If you’re born in Egypt, you’ll probably be a Muslim. The place where you’re born identifies you with that religious tradition,” he explains. “Spirituality has a lot to do with a person’s history: the sensibilities and values they have internalised throughout their life and which now form their backbone, guiding them. Maybe these values were instilled in the family and then internalised. Perhaps someone is an artist and their way of reading life has a special touch of creativity. Another person might be very supportive and this value has permeated their relationships. Someone else might be very introspective and knows how to reflect deeply,” he says. And he concludes that “spirituality encompasses a very broad horizon: it has to do with a person’s intentionality, depth or capacity to rise above.”

From that spirituality, which can mean something different for each person, many people in advanced illness try to take stock. “What greatly relieves those living in the final stage of life is revisiting the past and seeing what they’ve done with their life. ‘I'm 34 years old and I’m dying, I’m 49 years old, I’m 75.’ It doesn’t really matter how many years you’ve lived, but what you’ve done with the time you’ve had. When you look back, are you happy? What projects have you accomplished? Have you been a farmer, a fisherman, a social worker? Another person has started a family or has grandchildren. Are they proud of them?” reflects Arnaldo Pangrazzi. However, he does not believe that success is necessary for that balance to be satisfactory: “I’ve met people who have failed at everything, but they’ve opened up, they’ve revealed the sense of failure. Accepting this truth is a point in your favour.”

And what about the emptiness a person leaves behind when he or she leaves? What is the best way to cope with grief? “The first piece of advice is to face reality. The loss has happened, you can’t live in fantasy or try to change the past,” the theologian believes. “You have to face what has happened and honour the person’s legacy through their values. Their presence is not in the ashes or in the cemetery, but within you. You have to make your child, your spouse, your father, etc. live inside you and be a testament to these values. Don’t just cry or be sad, but also give thanks for the life this person has given you and try to find inspiration to live with your pain,” he adds.

“All cultures, in one way or another, try to answer certain universal questions. They all speak of a certain mystery, because no-one is quite sure what happens when we die. They all speak of a perception of time in the process of dying and after death: where are you, what time are you in?” reflects Morente, who points out that for some there is an afterlife, while in other cultures it is “a hereafter where those who have died walk among us, even though we can’t see them”, and for others, there is reincarnation. 

In addition to time and space, these shared concepts include identity: “The person who has died, who are they for you? And how did you imagine them in life or from other worldviews? Surrounded by loved ones who have already died? And are they all still the same age as when they died, or do you imagine them young?”. He adds one more element: “The bonding issue. If one of my relatives dies, what kind of bond do I want to have with the one who has gone?”. 

Although each culture answers these questions in a different way, the boundaries between them are not always clear. Morente, who is not only an anthropologist but also a specialist in grief intervention, explains that in this “global village” we all live in a cultural mix, and illustrates this with her own example: “I was born in Madrid, I come from a Judaeo-Christian culture in which, directly or indirectly, I’ve been taught about a heaven, an earth, and a reunion with loved ones… Whether or not I’m a believer or practice a faith, this is part of my cultural worldview of death. Now, after a year living in Bolivia and seven years in Mexico, very close to indigenous communities, my cocktail of understanding my death and that of my loved ones is seasoned by many cultural worldviews.” 

Pangrazzi points out that not all grief is the same: “It depends on the person, their resources, their openness to others, their spirituality. These are factors that influence the way we experience grief.” Marta Morente shares this diversity and points out that the “contemplative work” and “identity work” that the person has done also has a great influence.

Although there are no universal recipes for a good grieving process, for Morente the key is to go through it “well accompanied and listened to, and not just listened to with the ears”. And she elaborates on this with the following advice: “Nature has given us one mouth and two ears. So, in the grief process, listen twice as much as you speak, because people in grief need to be listened to and the people around them need to practice more of the verb to be than the verb to do: they need to know how to be and how to be present with your sadness, your anger, your fear, but also with your joys.”