Spirit of Things

Who takes care of our spiritual needs as we grow older? Elizabeth MacKinlay, Director of the Centre for Ageing & Pastoral Studies in Canberra, reflects on spiritual care for the aged, and Koori psychologist Dennis McDermott reveals the challenges for indigenous Australians as they face old age with fragmented identities.

Transcript

This transcript was typed from a recording of the program. The ABC cannot guarantee its complete accuracy because of the possibility of mishearing and occasional difficulty in identifying speakers.

Rachael Kohn: There's one certainty about life, and that's death. Hello, I'm Rachael Kohn and if that's too morbid for you, cheer up, because it's also been said that 'If there wasn't death, I think you couldn't go on.'

This is The Spirit of Things on ABC Radio National, and this week we explore our September years.

Just because you're ageing or sick doesn't mean you're any better at facing mortality. In fact, losing your mental faculties can make it even harder. On today's program you'll hear from some experts on how to manage that last stretch into the dying light.

But there are ironies. Typically as people get older, they become more interested in their past. But trauma and fragmented identities can make that process more difficult. Koori psychologist, Dennis McDermott tells me about his own life and the plight of older Aboriginal Australians who go in search of their past. That's later in the show.

The Centre for Ageing and Pastoral Studies at St Mark's National Theological Centre in Canberra is at the forefront of researching and training people to help those who are living with terminal illnesses. The Reverend Dr Elizabeth MacKinlay is the director of CAPS and the first thing I asked her was how facing our death changes our search for meaning.

Elizabeth MacKinlay: I think it sharpens your focus. It really brings you to a point of beginning to think, 'What have I done in my life? What has my life been worth? What has been the purpose of my life? And maybe I've never thought about it before until this point.' It can happen also with the diagnosis of a terminal illness or various life crises can bring this about and really highlight the importance of the meaning of one's life.

Rachael Kohn: That can create a kind of secondary layer of crisis I imagine, because not only are you dealing with the actual physical mortality but also these big questions. Do you have answers for them?

Elizabeth MacKinlay: Well I guess we have some answers. We're exploring a lot and the life meaning; each person has defined their own meaning in life, and I guess I'm very much indebted to the work of Victor Frankl in beginning this whole journey of, well, when he wrote his famous book 'Man's Search for Meaning' after the Second World War, that was a jumping off spot for me in looking at what is the meaning of my life? What do I have to live for? What do I have to hope for? And that is a very individual thing. It's not something that we can give to somebody, a recipe for their life meaning. It's a process I think if we're going to be helping people find life meaning, it's a journeying with the person rather than laying out a road map and saying, 'This is your life'.

Rachael Kohn: Is there a difference though between sort of life meaning and final meaning?

Elizabeth MacKinlay: Yes, I believe there is. And again I go to Victor Frankl's work, because Victor Frankl said 'As we go through life, we attach provisional meaning to certain experiences in our lives'. It's as we experience them at the time, but as he said, it's only when we come to a realisation of our final days or hours, that we can actually put that whole story together. It's like shooting the movie for the first time, that you can see all the scenes and you suddenly have perhaps a higher experience, that you suddenly realise for the first time what that episode way back then really did mean. And it's not until you start to look at the whole that this is really possible.

Rachael Kohn: This means that narrative is quite important.

Elizabeth MacKinlay: Narrative is essentially important, and I think this goes into a faith perspective too. If you look at Judaism, if you look at Christianity, and you look at the scriptures and you see how important the story is God's story, and the human story that's intertwined, and in fact it's in narrative coming into later life, we're beginning to make sense of our life, it's a story that binds us together, it's a story actually that links back the previous generations with the succeeding generations. Some authors recently have even said We are story, rather than saying that We have a story. Because it connects deeply to our identity as human beings, as individual human beings.

Rachael Kohn: So I imagine then that this is a time of life where you're looking back on your life, but also trying to weave it into that other narrative of your own inherited tradition?

Elizabeth MacKinlay: Yes. Exactly. So it's both , and for people who have a faith tradition, this is a really important time in bringing those together, and in narrative gerontology, now it's a specialty of gerontology, people are looking at this outside of faith traditions, they're looking at it in the social context of the importance of narrative in ageing. But I think that in many respects the faith traditions can make that a stronger and deeper and richer perspective on binding the narrative. And it's also coming to a point of feeling that my life has been OK, that I can face the future with a sense of hope and wellbeing, regardless of the traumas and stresses and things that perhaps didn't go well in the past, that you can deal with those and leave them back there.

But there's a sense in which it's often important to deal with what was back there before you can come to a sense of the present and where you're going.

Rachael Kohn: I guess it's pretty hard though, to imagine doing it yourself. I mean how does one initiate this process in a constructive way, in a life-giving way?

Elizabeth MacKinlay: Some people do do a lot of this themselves. They're usually people who have a deep spirituality, and who are able to do this processing. But often it's very valuable to do it with somebody who might be a spiritual companion on the journey. We have been developing techniques of spiritual reminiscence and more recently we've actually been working with people who have dementia, and helping them tell their story and working with them in small groups. So with people within the group can affirm the story too. But it is something that we need to do a lot more to develop the skills, of how we tell our story, how we share our story, and there are two components to the story. There's the story-telling and there's the story-listening. And both are important. And the attitudes of the listener call forth the story in a sense, from the person whose story it is. And it's a sense of almost of awe and respect and being with and journeying with the person in that process.

Rachael Kohn: Is it important to twin the person who is facing their death, or a serious illness with a chaplain who shares the same tradition?

Elizabeth MacKinlay: I think it would be very valuable to do that, and where we possibly could, we should do that. I guess there are certain generic things within the journey which goes to being a human being, that we can journey together, but there are also things where it may be very important to have someone who knows their own tradition and can travel into the depths of that with them.

Rachael Kohn: Well you're an Anglican priest as well as the Director of the Centre for Aged Care and Pastoral Studies. So Christianity of course is central to the way you think about these issues. How does the story of Jesus help individuals who are facing their imminent death?

Elizabeth MacKinlay: It's really important first of all when you're working pastorally with someone, to know where they are on their journey. It's important for you to know what kind of an image of God they have, what they think about Jesus, before you can start to work with them in any meaningful way, because I think some people have not ever developed a personal relationship with Jesus, and if they haven't you can't make assumptions that they may already have a means of connecting with this. Whereas if somebody already has an intimate relationship with Jesus, then you're starting from a very different place. It's easy for you to be able to affirm that relationship, affirm the beliefs that they're carrying, to believe that there will be a presence with them as they journey, no matter what, that Jesus will not desert them on this journey, and that they will know that prayer is supporting them and giving them strength on the journey.

If however you've got somebody who perhaps has been a church attender, but has never developed a relationship with Jesus, and does not believe that this relationship is possible. Then you're starting a little further back because you need to work with them, actually where they are, not where you would like them to be, and I guess I call this the Jesus model anyway, because Jesus met people at the point they were at, and worked with them and challenged them. And I think for those people it's a very challenging thing to perhaps help them to see life in a different way. But we can't make anybody take a particular perspective. We can't make people have certain attitudes and we can't give them a belief that they don't have. It's something which has to happen internally, it's something that God's grace is present in the whole of that. So that's a very complex answer.

Rachael Kohn: Well it sounds like the Jesus model can be very important in informing the way the Chaplain or the pastoral carer is actually acting, and that in a sense, could be enough almost.

Elizabeth MacKinlay: Yes, I think so. Yes, I think that that's the essence of it, of being alongside people, of walking that journey in humility with them, and it's a very special place to be. It's a place that can become a sacred space as you share on the journey with another person.

Rachael Kohn: You talked this morning about being neighbours, and being friends. Can you unpack that?

Elizabeth MacKinlay: Initially you're looking at the whole concept of love, because I think that's the basis. But what does love look like in relationships and human relationships? I was taking the model of Jesus from John's gospel where Jesus tells his disciples, 'I call you friends, not servants', and then he's saying that no greater love has a man or a person, than to lay down his life for another. And this is showing this is the ultimate relationship, and while he was possibly talking about his own forthcoming crucifixion, there's also that message there I think for others, and that is this intimacy of relationship which is possible in Christianity and I was thinking about neighbours as being a slightly different nuance in this, but the neighbour is the person that you come across you meet, as in the story of the Good Samaritan that you don't necessarily have a relationship with them before, but they come across your path, or you're working with them.

It may be that the neighbour is somebody who is in an aged-car facility who seems to have behaviours that other people don't, and you might not like, and you think, 'I really don't want to care for that person. I really don't.' But yet there's something that draws you to that, and you know that that person needs help. You know that that person needs something that you have to give, and if you choose not to do that, you're not being a neighbour to them. And the relationship is one of - there's a duty in it, but I think love underlies that. If love is not there, then you actually can't do it, and I think that's what happens sometimes to people who burn out in aged care. Because they carry perhaps a lot of baggage, the love can't show through and the tensions build and it becomes a problem.

So the neighbour relationship I think is a really important part of this whole process where you can't always be a friend, but you could be a neighbour, and sometimes, if the neighbour can become a friend in the development of the process, and I think sometimes there are different kinds of friendships. You can have a friendship where people want something from each other rather than want to give to each other. And I think the therapeutic friendship is the one who wants to give, with no strings attached, and that developing boundaries and being aware of one's self and what one has to give, and what one's own inner needs that might get in the way of a pastoral relationship, is really important.

Rachael Kohn: Which means that people who work as chaplains or in pastoral care, certainly need to be cared for themselves?

Elizabeth MacKinlay: They certainly do. As a matter of fact, one of the staff at the Centre for Ageing has written a beautiful little book, which is called 'Tending the Flame' and it's beautifully illustrated, and it's really based on the experiences of people working in aged care, and the need to debrief, they need to draw aside and be reaffirmed, and it has the scenarios that can be really, really difficult things that they have to deal with, that is helping them come to a refreshment and renewal, and I think those kinds of resources are very important.

Rachael Kohn: Well a Christian Minister recently said to me, 'You don't have to like them, but you have to love them.' Which can sound from the outside as kind of hypocritical or false or not authentic, but certainly whatever it is, it's very demanding.

Elizabeth MacKinlay: It is. And it's interesting that you say that because in the AA movement, that's one of the things they say in their meetings, 'You may not like all of us but love us', you know, and that's reciprocal, because love and liking can be quite different, and it's the love which can overcome boundaries, and the liking is completely different.

Rachael Kohn: So, Elizabeth, what do you see in the future for this movement that you seem to be spearheading?

Elizabeth MacKinlay: I think we have a long way to go yet. Sometimes I think everybody knows about this stuff, and we can move on. But then I bump against reality, where someone will come to me and say, 'This went wrong', or 'That happened', and I realise that we still need to reach so many more people that there are many people who work in this field, who don't have the preparation, they don't have the knowledge of developing really helpful strategies that we can use to work with people. And of course in aged care, I mean spiritual care as a part of pastoral care, is not just the domain of pastoral carers and chaplains, it's also an important part of the role of all people who work with older people.

Because we relate to the person, which is a spiritual thing. It's not just feeding and clothing and so forth, it's the way we do it, it's our attitudes with which we do that, and of course, we pay these people less than the people in the supermarkets and I think that this comes back to as a society, how do we value our elderly, our weak, our vulnerable? There are enormous questions. When we're hit with someone who's near and dear to us, who needs care, we become very engaged in it, but as a wider society, and in government policy, we just are not doing nearly enough in this field.

Rachael Kohn: Elizabeth MacKinlay thanks so much for speaking to me. I know that the work you're doing is certainly assisting in getting government and everyone much more focused on this field, so thank you.

Elizabeth MacKinlay: Thank you, Rachael, it's a pleasure.

Rachael Kohn: Elizabeth MacKinlay is both a registered nurse and a priest in the Anglican Church of Australia, and she's the Director of the Centre for Ageing and Pastoral Studies at St Mark's Theological Centre in Canberra. She's also the editor of 'Ageing, Disability and Spirituality, Addressing the challenge of Disability in Later Life. (Jessica Kingsley Publishers London, Philadelphia, 2007)

We'll find out more about those spiritual reminiscence groups later on when we meet two chaplains who use it with residents in aged care.

ABORIGINAL SONG

Rachael Kohn: Most of the time when we think about the problems facing Aboriginal Australia, we think of young people, their education, their health, their social and economic prospects. Older members of indigenous communities fade into the background. At a recent conference on Ageing and Spirituality held by the Centre for Ageing and Pastoral Studies, Dennis McDermott spoke about himself, his mother, and the Aboriginal Australians he's been working with as a Koori psychologist. But Dennis is also a poet and an academic at the University of New South Wales.

Well Dennis, right at the beginning of your talk you said you were unsure about whether you should be there, because you were conscious of over-stepping or exceeding your authority to speak on Aboriginal spirituality. And that sense orf authority is pretty important in Aboriginal society isn't it?

Dennis McDermott: Yes, absolutely. You shouldn't step beyond the boundaries of what you are authorised or permitted to do.

Rachael Kohn: Which is so different from western society because we love to pontificate on absolutely everything, particularly things we don't know about because you can be more creative. But nonetheless, you did speak about Aboriginal spirituality. Where have you gained your knowledge, where have you gained your sense of authority about spirituality?

Dennis McDermott: I guess I learnt a lot from people like Uodgeroo, formerly Kath Walker of course, spending time with her on Stradbroke Island. I guess I mentioned that I had no distinct authority to speak on matters spiritual because I was raised outside a traditional culture. But that's not uncommon for an Aboriginal Australian, given the fragmentation of the last 200 years. So I have learnt from experience and from just picking up things around the place, but I have to stress it's in relation to my own spirituality and my own perspective. I don't pretend to speak from a particular clan or nation or tribal grouping.

Rachael Kohn: You read a poem, your poem, called 'Page 3 Story' which really tells a bit of the story about your own background. Can you read it?

Dennis McDermott: Yes. I used to read some of these poems to medical students I was teaching, and a few terms in the poem they wouldn't get, because the poem's set in the 1950s. So I finally I'd explain to them that Eisteddfods we had in the 1950s and '60s were like mini-Australian Idols of today, and also I guess talking about this concept of a Page 3 girl, which Rupert Murdoch gave to the world, starting in Australia, you know the bare-breasted beauty on Page 3. So those kinds of things. So this poem's called 'Page 3 Story'

Locks in the '50s went rusty,

Apart from mixed-up children, no-one ever took anything away.

Pure news, no Page 3 girl peeping from The Mirror,

Instead my sister's lubra lips were captured,

A prize grin above the tab, 'First Aborigine wins City of Sydney Eisteddfod'.

The only person apparently not pleased was my mother.

Didn't they know the Trinidad Connection?

Our honourable line of West Indian descent?

The line we'd heard for years, the lifeline that bound us mix-ups

To our parents.

My mother called it 'slur', called for apology, asked for and got

A printed retraction, Page 3.

That put them in their place.

Rachael Kohn: Well Dennis, that really indicates something of the fierce feelings around origins and particularly something about denial, coming from your mother.

Dennis McDermott: Yes. It took me years to realise where that denial came from. The denial was about survival. Survival for herself. My mother was a very dark-skinned woman with traditional Aboriginal features. I've got a lot more of my father's Irish side of the family features about me, much lighter in colouring. So she had it tough and in those days of course it wasn't just about the racism you'd incur, which was bad enough, but if you were Aboriginal, your lives were subject to a whole plethora of controls, virtually pass laws in some parts of Australia. Certainly restrictions on travel, marrying, jobs, education, a whole range of things and for many Aboriginal people, it was unbearable. You pretended you were Cherokee, or Indonesia, or Maori or something else, anything, so you'd get on with your lives. It sounds a churlish thing to do to your own identity, but I think many of us don't know how difficult it was back then, and above all, it meant you had a better chance of hanging on to your children, because if you were Aboriginal, due to the various Acts and regulations in the past over the decades, they could take your children away on a range of pretexts.

Rachael Kohn: Well your mother certainly poured a lot of her ideals in you, and made sure that you were well-educated.

Dennis McDermott: It was embarrassingly so actually as I said we were doing elocution lessons at the age of 4, and every opportunity for education, and I'm so grateful. I'm so grateful that she did. The difficulty was to find my way out of, if you like, that middle-class trap and back into a fuller aspect of my own way.

Rachael Kohn: How did you make that journey back? You mentioned Oodgeroo Noonuccal, was she the main connection back to your past, your Aboriginal past?

Dennis McDermott: That's a very good question. I mean she was certainly one of the first people who helped me get along that road. I used to go across from - I was at the University of Queensland in the early '70s, used to go across on the ferry to Stradbroke Island and stay with her, like many other people, as she was building an educational centre called Moongalba which has been going for decades I think. And she opened my eyes to a lot of things, but then there were other mentors and teachers along the way, right down to the recent times. I was doing some work with men who'd been removed, members of the stolen generations and put in a place called Kinchela Boys Home on the North Coast of New South Wales. Hearing their stories, stories that would break your heart, but also hearing about the survival and the connections to culture and reconnections to culture were fabulous. All these things have gone in the mix.

Rachael Kohn: Well those people, those fellows that you were working with are growing older, so how is their journey into the sunset years, is it helped by making those connections to the past, or can that be a very painful thing?

Dennis McDermott: It can be an incredibly painful process. Certainly that's what they all want, they all want to find those reconnections and restore something of their birthright, but along the way it's full of pitfalls. I used to do some work with Link Up in New South Wales, and of course there's one in every State. The organisation putting people back in touch with family and community. And they found a very tumultuous if you like thing, that they were investing a lot of time in tracking down someone's birth family, remember the Stolen Generation their birth family, their community, their place of origin, and slowly, slowly building a reconnection to take them home, as they call it, back to their place and those people. And sometimes when they did, things would terribly wrong. Terribly wrong. Because how do you replace sometimes 30, 40 or more years of fracture? How do you displace the difficulties and the feelings and emotion that are there and the resentments and things that are difficulty to actually work through.

Rachael Kohn: And yet so many Europeans, so many Westerns actually expect almost that Aboriginal indigenous Australians would go back and reconnect to this purer form of identity. I should say quote unquote, 'purer form of identity'.

Dennis McDermott: Yes, absolutely. In fact many of the men that we interviewed for this Kinchela boys home, planned to help them get on with their lives, said they wanted to reconnect in whatever way possible with their culture and their communities. But they weren't looking for something pure, there was no such thing as you rightly point out as something pure. Aboriginal culture is a living, breathing, evolving thing that's certainly back to culture in a way that meant something to them and to their community.

Rachael Kohn: What would your mother have said if you wanted to reconnect to some of her ancestors.

Dennis McDermott: For years, for decades, she would have denied it. She would have actually stonewalled me. Some people may have heard Sally Morgan's story, 'My Place' and there's a grandmother figure there who denies, who stonewalls the Sally Morgan character's queries as to where they come from. That was my mother. Stonewalling, stonewalling, stonewalling. It was too painful and too difficult to go there. She'd just say, 'Look, the West Indian thing, that's what my mother told me'. And I suspect there was shame there, shame growing up in the inner city, dirt poor, the time in the 1920s, who knows? There could have been two fathers involved. A lot of families, there's a lot of shame in going to those particular questions, so when I pushed her she'd break down in tears. But as I said in the poem though I read today, in the last few years of her life you could see she was accepting who she was and where she was from. So I think today she'd be very happy with that kind of search for the origins.

Rachael Kohn: Well tell me about her entry into old age. How did she go?

Dennis McDermott: Well almost like she was dragged kicking and screaming to an old person's home. Unfortunately her second husband died a few years before my mother, quite a few years before my mother in fact, and she was living on her own maintaining herself and my sister just a few blocks away, but looking after herself, she was so actively involved in things around her. When she could no longer look after herself, and was living in a Catholic-run home outside of Tamworth, as I mentioned today in my paper, she became part of a choir that went round to all the nursing homes in the area, and sang to what she called 'the old people'. And she had to sing sitting down because she couldn't stand for too long, but she was singing for the old people to make them happy. So it was something about that verve in fact I recall and if it's not too precious to share it, I suppose precious in the satirical sense to share it, the day before she died, I remember her sitting in the hospital bed singing all the old songs. She used to actually sing at clubs and various occasions professionally at one stage. And so she loved to sing. And her eyes sparkled, and she had such love of life at such times.

Rachael Kohn: I know that music is often the last thing to go if your faculties are slipping out. How was your mother in that case? Did she hold on to her mentality to the end?

Dennis McDermott: She did. She held on right to the end. She was sharp. No thanks to some of the medicos she dealt with, and I explained in the paper today, I've written about professionally, about how in fact when she had what I would call as a psychologist, a reactive depression, to looking after her second husband who was terribly ill for a number of years, the medicos without talking to the family, which is absolutely necessary in any context, specifically in the indigenous context, just put her on anti-depressants, then took her off them after we'd actually lobbied them, without telling her. So if you know anything about this kind of chemistry, there's a rollercoaster emotion going on in both instances. But no, despite that, and despite other that happened, she actually held on to her faculties.

Rachael Kohn: You're listening to Dennis McDermott on the Spirit of Things here on ABC Radio National, looking at the Ageing Spirit. Dennis is a koori psychologist and conjoint professor at the University of New South Wales.

You've established the Indigenous Psychological Association, is that right?

Dennis McDermott: I'm one of the small group of founders of the Australian Indigenous Psychologists' Association. So far we've held a couple of face-to-face meetings in a teleconference to get this thing off the ground. So there's probably a maximum that we know about of about 40 Aboriginal and Torres Strait Islands psychologists in Australia, and up till now there's been no network, no professional association. So now we've come together around a particular project and we've decided, with the very generous assistance of the Australian Psychological Society to set ourselves up in the next couple of years, and let's see how we go from there of numbering the auspices of the Australian Psychological Society, but we really want to get our own identity going to actually do some necessary work.

Rachael Kohn: What are the ingredients of indigenous psychology? I mean I immediately think are you drawing on Jung and the importance of myth and narrative, that sort of thing? Or are you coming at it from a totally unique new perspective?

Dennis McDermott: No, well I professionally I am drawing om Jung all the time, and certainly narrative therapy is a way that many people work now with indigenous clients and communities because the people who've used the narrative a lot, you know, you tell stories about what's going on, and make sense of the world through stories. I guess the major way I can answer your question is to say we're looking to go beyond the Western biomedical model, or the psycho-pharmacological model which are the terms one gives it. It's beyond, if you like, the intra psychic, what's going on inside the person's head, it's far beyond that, it's looking at the person in the context of their family, their community and what's happened to that family and community. So the indigenous preferred term is social, spiritual and emotional wellbeing. Everything's done in a holistic way, everything relates to everything else. So that's the tack that we're going to take as psychologists.

Rachael Kohn: There's so much attention now on youth issues and youth problems in indigenous society, but so little attention on to what Aboriginal elders face, that is the elderly in the Aboriginal communities. In fact they're often looked to for guidance to almost fix the problems. Who's looking after them, and what do you see as the kind of way forward?

Dennis McDermott: It's an incredible double bind, because obviously the elders are looked to for guidance and support. But they themselves are going through their own stuff. Quite often a whole series of age groups has been held together by an elderly granny or auntie. Who supports those people? People are looked to for perhaps the money they can provide as well as the emotional systems. It's a really difficult issue for many ageing Aboriginal people. Can I also say that there's been some reports coming out of South Australia in the last few years, actually pointing out how now as the baby boomers move through to old age, we, being all of Australia, are such a well-fed, well set up, well planned for, superannuated mob of retirees. Not strictly true for Aboriginal and Torres Strait Islander people. Because if you spent most of your life just scraping by, often actually being denied employment, or being denied rental accommodation, or being kicked out of school when some parent objected to your presence in the school, your earnings, your total life earnings at retirement age are often pretty meagre. Many Aboriginal older people are doing it tough financially and that often goes hand in glove with poor health. For many years Aboriginal Australians were denied access to the welfare system, as well as decades of consuming poor food etc., so there are many things going against them.

Going for them though, is their is real resilience in Aboriginal Australia.

Rachael Kohn: Is there cultural resilience? Because I think many people reading the papers day in and day out, would say, 'Hmm, maybe there isn't cultural resilience there, that it's kind of breaking down.'

Dennis McDermott: There's such dramatic presentations of what goes wrong in Aboriginal Australia and very little interest in what's actually going right. And there are tremendous programs and missions out there that aren't being reported at the same depth. I actually sincerely believe there's been quite a campaign to demonise Aboriginal men for example in the last few years, and there was this conference of Aboriginal men in Central Australia just a few weeks ago that said, 'We're sick of being demonised, we can't hold our head up. People look at us and think we're paedophiles, or wife-bashers.' All Aboriginal men are being tarred with the same brush in a way that no other population group in Australia is. It used to be called racism.

Rachael Kohn: One of the chief ways in which older Australians are cared for is in residential environments, and it could be called incarceration. You mentioned the word today. How do you think indigenous Australians would take to that kind of care, and what are the dilemmas for caring for them in the future, in ways that are not offensive?

Dennis McDermott: In fact there are a number of residential situations run for Aboriginal and Torres Strait Islander people. It's a fairly small percentage. Most Aboriginal people receive some kind of home care assistance to stay where they are. And yet there's a difficulty there because most of that move to assistance in the home is done on the premises that they've actually got a good housing situation, and what if in fact in poor housing, and sharing with many generations? It's not quite that easy to have that, again, that lovely twilight of retirement that Australians are supposed to be looking for. One reason why people actually choose to stay in their home and receive assistance package, because being close to country is important, particularly if you're about to die. Many people prefer to die in their own country or to live their last years in their own countries. That's one reason why if you have to move away to a residential situation, it's not so good. But there's nothing per se about residential care which is anathema to Aboriginal people, it's the kind of residential care. I talked today about moving beyond cultural awareness, as important as that is, to notions of cultural competence and cultural safety. So is that a place when an Aboriginal person feels safe to be themselves, where there's no disrespect or damage done to their self-esteem and identity, then that's a culturally safe place and they can inhabit it.

Rachael Kohn: Dennis McDermott thank you so much for talking to me today.

Dennis McDermott: Thank you, Rachael.

Rachael Kohn: That was Dennis McDermott who's a Koori psychologist, academic and poet, and his first poetry collection, 'Dorothy's Skin' was shortlisted for two literary awards. And Dorothy is his mother.

When Reverend Elizabeth MacKinlay mentioned 'spiritual reminiscence' earlier in the program, I was intrigued, and then made a beeline for two pastoral care workers who had been putting spiritual reminiscence groups into practice.

Adrienne Inch is the Pastoral Care Co-ordinator for Southern Cross Care in Perth, where Theresa Beuglehole is also a Pastoral Care worker. Theresa started off with a thumbnail sketch of what spiritual reminiscence groups do.

Theresa Beuglehole: We talk about hopes and dreams, spirituality, touching on religious background and rituals, and also family, friends, and backgrounds. It's sort of all one big package.

Adrienne Inch: And has an emphasis on what gives meaning to life. So all those things come together in your life, and as you reflect on it, how did it bring meaning at the time, and now as you reflect on it.

Rachael Kohn: And I guess in the aged context, pulling all of these things together is both important, but sometimes difficult. What are the obstacles to be able to pull this all together?

Theresa Beuglehole: I suppose the first obstacle would be memory loss, and a lot of aged care facilities are full of residents who suffer dementia and memory loss in some way, but we've managed to overcome that in many ways, by just remembering and reflecting back what we've shared already.

Adrienne Inch: Another obstacle is, because some of the people's memories are painful memories, particularly when you talk to them about World War II and some of them have been in situations in Europe and the UK as young people or young women or mothers, and they're in situations that have been bombed regularly, and this sort of thing. I had one lady in a spiritual reminiscence group who didn't talk about that much the first time we talked about it, and when she was in a second group and we had the same subject again, and the second time she was able to talk about the fact that she was bombed. Some of those memories are painful and it takes some trust and being able to take a risk to share that something will be accepted and be supported in the group.

Theresa Beuglehole: And there's obstacles physically. Hearing loss is quite often a really important factor, quite often they don't hear the question, and because they're so used to people ignoring them, would be the word, they only give very short answers, or they give the same answers. So to encourage them to go further is quite a step of trust for them, quite an experience as well.

Rachael Kohn: One of the terms that you both used this morning was a sense of self, and also a loss of sense of self. Now is the loss of self considered to be a loss of spirituality, or how are they connected?

Adrienne Inch: No, the loss of sense of self I guess has been highlighted through the writings of Christine Bryden who herself was diagnosed with early onset Alzheimer's, I think aged 46, and she talks about this loss of sense of self, and certainly our residents say to us 'I feel lost, I don't know who I am', so it's a similar thing. But in the context of that, Christine Bryden talks about the fact that her spiritual self can be ongoing and can actually flourish, even though all the other indicators and things that make up your sense of self, start to fall away and disappear, who she is in God and she has a very strong relationship with God, it remains constant, even though other ways in which she has defined herself, have been forgotten.

Theresa Beuglehole: I remember one particular church service that I was running at Christmastime, and we had actually sung 'Silent Night' as part of the service. One lady at the back of the room had severe dementia, she no longer walked, and she was in a large regent chair, or you could have a conversation with her, it just wasn't possible. And as we sung this song, 'Silent Night' from the front of the room I could see her eyes moving to the rhythm of the song. And when the song had finished, there was just a tiny teardrop coming down the side of her eye, and it was an awesome moment for me because it was a real revelation that spiritually we're still alive, and they might not be able to express it because of the dementia and their physical incapabilities but the spirit is always live.

Rachael Kohn: Wonderful story. And in those sharing sessions that you hold, called Spiritual Reminiscences, what are the effects on people of suddenly for example, admitting to each other that they have memory loss. What have you witnessed in those situations?

Theresa Beuglehole: Well first of all they were so amazed. It's something that they keep to themselves, so to know that this person next to them looks very, very normal, but has memory loss as well, is quite a surprise to them, and quite a relief too, when they find that there are others who share the same experience. And from there we're able to progress. And I've asked questions in the group 'What was your first job when you finished school?' and some sort of look at me very blankly, and say, 'I don't remember', but we go around further in the group and perhaps they remember a bit later on, but because the others know that they too have memory loss, they're very accommodating and very supportive. And sometimes they actually say, 'Don't worry, Lil, you'll remember later'.

Rachael Kohn: They understand. Adrienne, what are the ways in which you facilitate their reminiscences, is it just questions or are there other prompts?

Adrienne Inch: We've used a number of different prompts. The questions in the program are guidelines, so you can often start with a question, you know, 'Where were you born?' Most people can give you the answer to that. Sometimes you need to wait, just give them a minute to remember. And sometimes I have to say, I prompt them. So one of the question is, 'What has brought you joy in your life?' Well for anybody that's actually, you think, 'Well I've had lots of moments of joy, but to actually tell you one now, oh, I can't think of any', and I might prompt them and say, 'Well Mary, what was your wedding day like? Can you tell us about your wedding day?' So sometimes I'll prompt them.

The other things we've used are photographs. The week that is on relationships is one subject, Relationships, Isolation, Connecting. We went into the rooms when we went to collect them for the group and asked them to choose a photograph to bring with them. And one lady brought a wedding party photo, one lady had one of those frames that had about 12 different photos in it, and someone else brought a picture of her and it looked like her daughter, her grand-daughter and great-grand-daughter, and they brought them along, and then we asked them to tell us about the picture. And that was wonderful for one lady in particular. It didn't work well for all of them, but one lady in particular with the 12 photographs, 'Oh, this is my pet dog, and this is my Mum and Dad up here, and this is ...' and it was wonderful, a whole lot of stuff opened up. And the other thing we've used are pictures, pictures on the front of greeting cards like animals, birds, I ask them to choose one, we give them say three. So, they choose a landscape, or photographs or pictures of older people doing different things, from magazines or anything. And they again, they pick that up and then they'll tell you something they haven't told you before. 'Oh these birds, I used to go to my grandfather's farm for a holiday and they had birds like these.' That sort of thing. So we're using other things to stimulate their memories.

Rachael Kohn: I would imagine though that family photographs could be incredibly emotional and that people might just dissolve in tears. What do you do in a very emotional situation like that?

Theresa Beuglehole: What do we do? Sit with them. Sometimes cry with them, and just share the moment, because it's very important to them, and if they're emotional, then that's what they need to be.

Rachael Kohn: That's a very interesting comment because pastoral care often attracts people who want to do things, you know, help and heal and get over the problematic situation, and you've just pointed out that it's so much about sitting and allowing something to happen.

Theresa Beuglehole: My first experiences with pastoral care was actually just what you said, and I learnt very quickly that that's called burn-out and then I started to allow myself just to sit, reflect and not to take on board what they were sharing. And it's very important I know in my journey, it's very important to pastorally care for myself and to take time out. And some days I just can't do it, and on those days I just don't do it, it's easier.

Adrienne Inch: And I think the other thing that I've noticed in the facilities where we work, I've been in a situation where I've been sitting with someone, not in a group but just sitting with someone in one of the public areas, talking about something and the person starts to cry. And some of the other staff can go by and say, 'Oh cheer up, Mary, cheer up!' and I sort of cringe inside because the moment is there, if the lady needs to cry, let her cry. I'm happy to sit with her, hold her hand, let her cry, let her talk about the pain of losing her husband or whatever, her son, whatever the situation is. And probably we're the only person on staff really who - and that's our job of course, but often we're the only person there who's got the time and the inclination and the space to just say, 'Well, cry. If you want to cry I'm happy to sit here with you while you cry.'

Rachael Kohn: What role have rituals in the work you do and particularly in spiritual reminiscence?

Theresa Beuglehole: With aged care in particular, rituals are very important to this generation, and I've actually learnt that for myself because rituals aren't really important in my own spiritual journey. Then I discovered more and more just how important it is for them. Things like simple rosary beads, pictures on the wall, crucifixes and Mary, simple church services, lighting candles, singing hymns, all those things, the Eucharist in particular for some people, all those things are very, very important, and I think it's important as a pastoral care worker to understand that what's important for me might not necessarily be important for the people that I work with. So I need to let them and allow them to use the rituals that they need to use.

Rachael Kohn: And you work in a Catholic setting?

Theresa Beuglehole: The organisation is a Catholic-based organisation, but specifically most of the residents that we have, there'd be about 10% that would be Catholic, lots of denominations right the way across and we work right across the board. I have Jehovah Witnesses, I have Catholics, I have Baptists, Anglican, Presbyterian, Pentecostal, atheists.

Rachael Kohn: Gosh, now that is a very widely diverse population, and all of those groups would have very specific views of ritual. And indeed their take on Christianity.

Theresa Beuglehole: And they do. And you'll have people who - Anglican ladies who won't set foot in the church service if it's Catholic because that's what they didn't do in their day. But I've been fortunate in my own background to have actually experienced many different denominations and for me, I actually see the similarities in each denomination and the beauty of each, and I try to talk about that when I am confronted with those things. For me there's only one God, and there's just different ways of worshipping him and different ways of understanding, and that's OK. I understand quite differently to the way that you would, or the way every other person would, but that's OK.

Adrienne Inch: I had a moment in a spiritual reminiscence group which was interesting, where one lady - I think the question had been about what brings meaning to your life, or what spiritual practices are important to you, something around that. And one lady was quite a committed Catholic lady and she spoke a lot about her faith and trust in God and how important that was, and when we got to the next lady she said, 'Oh, I don't believe that at all.' And the moment she said that I could see this woman kind of rise up you know, the hackles went up you know. And so I said, 'Well look at that, we all have different opinions, don't we, about we all have a different approach top how we go. Now tell us, Louise, what's important to you in this? So then she went and talked about it, and I thought, I just needed to help the residents kind of smooth over this moment because I could see this lady about to 'How dare you challenge my faith that I've held dear for 80 years', you know, I could see this written all over so its well run, its managed.

Rachael Kohn: Well it is, and Adrienne, you've just hit on something that perhaps we haven't talked about much at all, which is that just within the Christian church itself, or the Christian faith itself, there are so many diverse traditions and views. So how does that - well I think you've already given a bit of an insight as to how it can make spiritual reminiscence groups a little bit tricky.

Adrienne Inch: Quite often though there's not really an opportunity for residents to actually get together and talk with the opportunity that we give them, and quite often they enjoy just actually meeting with one another, talking with one another, getting to know one another, and as long as we sort of keep the flow going and rise over the bumps and smooth them over, that seems to be more important, the connecting, rather than 'I'm right, and you're wrong.'

Theresa Beuglehole: And I think that the other part of that is we want the groups to be a place where people can express their diverse points of view. If I can help manage the process so that we don't have a stand up argument, I don't want to have stand up arguments, but I want them to realise that people just have different points of view and they don't need to be threatened, their own view is not going to change if someone is different to them, and we want the group to be a place where people can say, 'Oh, I don't agree with you', you know, that's a wonderful moment because they're interacting with each other, and having a discussion about what's going on, so sometimes you just need to facilitate, but I went to really encourage that in the discussion that happens in the group.

Rachael Kohn: Yes, you've just pointed out that although people are aged and they have certain challenges, physical and even mental, there is still an excitement about talking and connecting and having conversations.

Theresa Beuglehole: Very much so. They love to tell us about who they are, their children, their life, what it was like growing up in their times, and I suppose for their families, they've told that story so many times and their children and their grandchildren really don't want to hear it. And nursing staff and the carers don't have time to hear it. And they often don't have time to tell one another stories because they don't sit back and take that time because of their physical limitations and disabilities. But when we offer them that, they just bloom, and they really appreciate being heard.

Adrienne Inch: And they can actually be amazed that we want to listen, that we're actually interested in hearing the story.

Theresa Beuglehole: And that we remember, too. When I reflect back the next week what they shared with me, it's like, Wow, what I shared with you was important enough for you to remember, you must really care. Or you must really take an interest, and that's what takes us deeper into a spiritual journey.

Rachael Kohn: Well clearly Theresa and Adrienne you do care and you do take an interest, and a lot of people are grateful for that, especially those you work with. But thanks so much for talking to me and sharing with me.

Both: Thank you very much we enjoyed it.

Rachael Kohn: Adrienne Inch and Theresa Beuglehole both implementing spiritual reminiscence groups in Southern Cross Care in Perth, Western Australia. I can imagine that spiritual reminiscence can be beneficial for all of us not just the ageing.

Well, that's the program for this week, the Ageing Spirit can be an opportunity to actually pull together the strands of your life and make sense of it all.

A couple of weeks ago we spoke to Deborah Lovely a Christian weightlifter who was looking forward to competing in the Olympic Games. Well, she got into the top 10, so that's good, but ended in the 8th position.

Thanks again to CAPS, the Centre for Ageing and Pastoral Studies at St Mark's Theological Centre in Canberra. Details of our guests and also a link to download this program will be on our website.

Sound engineering this week was by Judy Rapley.

I look forward to your company again next week for another adventure into The Spirit of Things.

Guests

Assoc. Professor Elizabeth MacKinlay AM
is the Director of the Centre for Ageing & Pastoral Studies in Canberra, Australia.

Dennis McDermott
is conjoint lecturer at the Muru Marri Indigenous Health Unit in the School of Public Health and Community Medicine, the Faculty of Medicine, at the University of New South Wales. He is a Koori psychologist, academic and poet. Although he grew up on Gamilaroi land, Tamworth, NSW, his mother's mob is from inner Sydney, Gadigal country, and his father's from Donegal. As a registered psychologist of over twenty-five years experience, Dennis has worked in such diverse fields as alcohol and drug education and counselling, private therapeutic practice, community health and men's health research. He has trained Aboriginal foster carers, supervised counsellors to the "stolen generations" and worked with families dealing with a death in custody. His teaching and research interests encompass maternal and infant health, violence and injury prevention / safety promotion, men's and boys' health, chronic and complex disease management and prevention, Indigenous social, spiritual and emotional well-being, Indigenous health pedagogy, and the nexus of culture and context in service delivery. In 2005, he was made an Honorary Fellow - He Pûkenga Taiea of Te Mata o te Tau - the Academy for Maori Research and Scholarship.

Adrienne Inch
is the Pastoral Care Co-ordinator for Southern Cross Care in Perth, WA.

Theresa Beuglehole
is a Pastoral Care worker with Southern Cross Care in Perth.

Further Information

The Centre for Ageing and Pastoral Studies (CAPS)
CAPS is a centre where scholarship in ageing and pastoral studies can be pursued. The process of ageing is examined within the context of meaning in life and wellbeing for ageing. Quality of life issues for older people, including living with dementia, are subjects for research and education.

Muru Marri Indigenous Health Unit at UNSW

Southern Cross Care Australia
Southern Cross Care Australia (Inc) is one of the largest providers of aged care accommodation in the voluntary, not-for-profit sector in Australia, with in excess of 16,000 persons being recipients of care.

Ageing to Sage-ing
Reb Zalman Schachter-Shalomi teaches people how to be spiritual elders. And while dementia can spell the end of wisdom for many people, for Christine Bryden it was a journey to self understanding and spiritual growth. Broadcast on The Spirit of Things, 17 September 2006.

Music

CD title: Indian Summer
Track title: September Song
Artist: Dave Brubeck
Composer: Anderson/ Weill
CD details: Telarc CD 83670

CD title: All Time Favorites by Harry James
Track title: September Song
Artist: Harry James
Composer: Anderson/ Weill/ Arr. Conniff
CD details: CBS A 20715

CD title: Charcoal Lane
Track title: Summer of my Life
Artist: Archie Roach
Composer: Roach
CD details: Mushroom D 30 380

Presenter

Rachael Kohn

Producer

Geoff Wood and Rachael Kohn