For family caregivers facing bereavement, a dose of philosophy can help

How can family caregivers be supported as they prepare for bereavement, while being given time and space to process their loss? Professor Jean-Marc Barreau of UdeM’s Institute of Religious Studies has thought about ways to provide caregivers with spiritual counselling during the “pre-mourning” stage.

In an article published in Laval théologique et philosophique, he proposes a theoretical framework based on two philosophical foundations established in France: Paul Ricœur’s concept of sollicitude (usually translated as “solicitude” or “care”) and Emmanuel Lévinas’ concept of visage (translated as “face” or “presence”).

In his seminal 1990 work Oneself as Another, Ricœur elaborated his conception of solicitude as an essential component of ethical behaviour. Barreau sums it up as “an attitude of spontaneous kindness linked to self-esteem which manifests in a delicate balance between giving and receiving, and an ability to ‘suffer-with’ that establishes a kind of reciprocity in the relationship.”

Lévinas’ theory of the face, developed in his 1961 book Totality and Infinity, is Barreau’s second theoretical cornerstone. For Lévinas, writes Barreau, the face is “an epiphany that resists all attempts at apprehension. It reveals an absolute exteriority that commands responsibility and bears the trace of the Infinite: the Levinasian face is neither seen nor touched but encountered, calling forth a desire for the Other that transcends narcissistic desire.”

Pre-mourning versus anticipatory grief

Barreau makes a distinction between “pre-mourning” and the more familiar concept of “anticipatory grief.”

“Pre-mourning involves a mental reorganization to deal simultaneously with two seemingly contradictory conditions, an impending separation and a present emotional investment, whereas anticipatory grief refers to the impossibility of reconciling these two states, which can lead to disinvestment from the relationship,” he said.

Pre-mourning is therefore distinguished by its capacity to harness the emotions for therapeutic ends. “Pre-mourning taps into the emotions to do what anticipatory grief does not: find support and ultimately live through the grief,” Barreau said. “This approach runs counter to the current tendency to pathologize grief and its emotions, including sadness. Instead, it creates a space where these emotions can exist and be channeled to support the grieving process, in contrast to the prevailing tendency to accelerate grieving.”

After death, “the relationship continues to evolve” for the bereaved person, Barreau said. “This will be facilitated if the caregiver is supported during what is called terminal lucidity—the final surge of vitality often observed in palliative care—which is the greatest gift the caregiver can receive.”

Clinical strategies for caregivers

In his article, Barreau outlines three clinical applications of solicitude for professionals and spiritual counsellors supporting caregivers during pre-mourning.

• Dealing with excess suffering: Solicitude addresses the unique suffering of family caregivers by establishing a connection to help keep them from being overwhelmed by responsibility. By “bearing the burden with,” solicitude alleviates suffering without denying it.
• Reinvesting desire: Solicitude creates a relationship that transcends the suffering. It reactivates the capacity to speak, act, tell and take responsibility. It also opens up a spiritual and transcendent dimension of desire, fostering a dialogue of spiritual desire between the caregiver and the dying person.
• Navigating the final passage: This involves reconciling the face-as-presence and the face-as-absence, and understanding the face of the deceased as a trace of the Infinite. This moment raises spiritual questions about the presence or absence of God and empty space.

The duality of spiritual support

According to Barreau, spiritual counselling has two dimensions: a horizontal journey with the person who is suffering, which involves authentic sharing of their pain, and a vertical dimension of openness to transcendence and questioning about the beyond. This duality uniquely couples the helping relationship and the search for meaning.

Solicitude strikes a balance between empathy and sympathy, providing an alternative to simple generosity, which can lead to exhaustion.

Barreau’s theoretical approach has practical implications for counsellors. It is also the subject of two research projects he is currently conducting on bereavement in children and the “Last Moment” service offered by Magnus Poirier funeral homes.