SHANTI—A WORLD MODEL FOR COMMUNITY SERVICE Dr. Charles A. Garfield

Below, Charles Garfield, Ph.D., founder of Shanti and Clinical Professor of Psychology in the Department of Psychiatry at the University of California School of Medicine in San Francisco, answers some frequently asked questions about Shanti and its programs from his own personal perspective.
This interview with Dr. Garfield was conducted in 2001.


1. What is the Shanti model of peer support and its legacy?

Shanti, at its best, is an ongoing experiment in caring and compassion.

Writer Barry Lopez once said, "Sometimes people need a good story more than food." A story that nourishes us by showing what matters most in life. Today, Shanti is teaching anyone who wants to listen a story of the loving spirit of service. Watching our volunteers and other caregivers closely is like watching a shared awakening, a shared opening of hearts.

Every day in San Francisco (and in many other cities where Shanti-inspired services exist) we see volunteers sitting with their clients, and we see the healing and support being sent from one to the other. It would be an understatement to say that the skills and compassion Shanti volunteers possess are needed in a world where suffering abounds: the AIDS pandemic, cancer and other life-threatening illnesses, homelessness, poverty, starvation, racism, classism, homophobia, environmental degradation, destructive addictions of all kinds, violence in all its extreme forms—and on and on. Shanti volunteers are antidotes to the rampant suffering we see all around us. They show us that people will sacrifice for people. That we can identify deeply with other human beings.

Shanti is a lasting legacy to the thousands of volunteers in San Francisco who taught us so much throughout the organization's twenty seven-year history—especially those caregivers we've loved and learned from in this time of HIV/AIDS. Men and women who have been much more than buddies to their clients—but rather trained caregivers with real skills who help enhance the quality of their clients' lives. They've also been a community of memory as well as a community of caregivers. Their legacy is an expression of the Shanti model of peer support, which I was fortunate enough to develop in the early 1970s in my work at the Cancer Research Institute at the University of California Medical Center in San Francisco.
• First and foremost, the Shanti model is a model of caregiving where the volunteer learns to listen, speak, and act from the heart in service to our clients.
• Second, it is a model of caregiving where the volunteer is an advocate who helps communicate the needs of people with chronic and life-threatening illnesses to healthcare, social service, nonprofit, and government agencies.
• Third, the Shanti model is a model of caregiving where the volunteer assists with the tasks of daily living.
I'm proud of the many hundreds of organizations locally and worldwide who have contacted us about learning and using the Shanti model of peer support. I'm also gratified that a few share our name, Shanti, Sanskrit for inner peace…the peace that sometimes comes when two people connect in the spirit of service. The source of this spirit is two simple truths. First, in the words of the poet Kahlil Gibran, the work of Shanti volunteers is "love made visible." Second, and most important, is our understanding that indifference harms and love heals.

2. Why do you believe the Shanti model of peer support has inspired so many community organizations in the U.S. and abroad?

Two things: because it is an approach to serving people that works and because it is based on genuine caring. The word "care" derives from the Gothic word "kara" which means "to lament, to grieve, to experience sorrow, to cry out with." Henri Nouwen, a Catholic theologian whose work I admire a great deal, said: "We tend to look at caring as an attitude of the strong toward the weak, of the powerful toward the powerless, the haves toward the have-nots. We often experience great discomfort when we are invited to enter into someone's pain before we have done something about it."

At Shanti, we know that concern at a distance is diametrically opposed to the basic component of caring, namely empathy—the more expressive German translation of which is "einfuehlung" meaning "to feel oneself into". Nouwen also tells us that, "when we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving much advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a gentle and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not healing, not caring, and face with us the reality of our powerlessness, that is a friend who cares."

Such insights, which I learned at the bedsides of seriously ill and dying people at the Cancer Research Institute, led directly to the values that underlie Shanti's approach to caregiving. It is Shanti's model of peer support and its values that best capture the essence of our work and its attractiveness to other communities.

Sometimes I ask myself: How do we do it? From what do we draw our strength? How did a small everyday group of people transform itself into a community of skilled caregivers committed to serving those who need us most in a time of AIDS?

Eventually, more complete answers to these questions may be available to us. For now, the best I can do is repeat the words of one of Shanti's finest caregivers: "We show up. We pay attention. And we care."

3. What do you envision Shanti's peer support volunteers doing?

Our volunteers help fill the gap between services that health and social service professionals provide and the support traditionally offered by a person's family and friends. For over twenty-seven years, Shanti volunteers have been trained to listen, speak, and act from the heart while assisting our clients to meet the psychosocial and spiritual challenges that accompany AIDS and other life-threatening illnesses.

4. What do you think volunteers receive in return?

An effective peer support relationship is a partnership of equals unlike a medical model relationship of expert and patient. Hundreds of Shanti volunteers have told us, "I receive much more than I give." What they have discovered are the rewards available to all skilled caregivers who open their hearts to people in need. Like other potentially life-transforming experiences, Shanti work can offer you an opportunity to put yourself in the way of grace. Volunteers can learn life's deepest lessons, heal wounds of long duration, and build skills that enhance careers and employability. Most importantly, whether a volunteer deals with the more mundane aspects of life or the more sublime ones, he or she can discover how rewarding it is to make a difference in the life of another person.

5. What kind of training do people need to be Shanti volunteers?

The Shanti training emerges from a question: What skills and attitudes characterize our best caregivers and how do we acquire them? Volunteers are trained in peer support and communication skills. Also, they learn about multicultural awareness, grief and loss, and some of the medical and nursing challenges facing their clients. Needless to say, "on the job" learning continues as long as the volunteer supports his or her clients. Our basic premise has always been that Shanti volunteers are trained to be more than "buddies" to their clients. They are skilled members of their client's support team and can help with a wide variety of tasks and issues that often slip through the cracks in difficult times.

6. How would you respond to people who say they want to volunteer, but their life is too full or that they are not confident they are emotionally equipped to do the work?

The best way to find out how well you can do the work is to try it. Volunteers often describe the time with their clients as rich and energizing rather than draining. Certainly there are times when the work brings sadness and frustration, but there are also times of joy, laughter, and the deepest mutuality and respect. Shanti will help any potential volunteer to determine the caregiving work that best suits his or her skills and interests, and time schedule.

7. Are you optimistic or pessimistic about the future of the AIDS pandemic?

Since we can't predict the course or outcome of our current AIDS predicament, or the global response to this tragedy, it seems to me that optimism is as reasonable an attitude as pessimism. Each one of us has the option of "voting" with our faith and actions by choosing an optimistic or pessimistic stance, and proceeding accordingly. Since I don't know the outcome, I shall vote "YES" and proceed as if I and we can make a difference. Personally, I will continue to study the inspiring lives of Gandhi, Mandela, Aung Sann Suu Kyi, that wonderfully brave woman from Burma, the Dalai Lama and others. Most of all, I'll keep learning from our own clients and caregivers, and the Shanti experience itself.

8. What is your hope for the Shanti L.I.F.E. Program?

My current work with Shanti's L.I.F.E. Project has rekindled my long-term interest in mind/body approaches to medicine and specifically in AIDS and cancer survivors. Based on the burgeoning field of psychoneuroimmunology, the L.I.F.E. Program can help us:

A. "To understand the capacity of men and women to live beneath the pressure of protracted crisis, to sustain terrible damage in mind and body, and yet be there, sane, alive, still human." (from Terrence Des Pres whose book The Survivor is a brilliant analysis of the Holocaust survivor.)
B. To offer insights into the ways that the specific LIFE psychosocial cofactors can be instrumental in promoting quality of life, longevity, and survival.
C. To examine closely the optimal ways of providing more integrated, holistic care to men and women with HIV/AIDS and other life-threatening illnesses—and to develop prevention counseling approaches based on the L.I.F.E. Program.

As we continue to confront the AIDS pandemic, it has become obvious that some events that befall us are outrageously painful and unfair. However, it may be precisely these events that trigger quantum leaps in insight and deeper understanding. Clearly such events are unwelcome, but the difficult task of coping with them may lead us to greater emotional and spiritual strength. The L.I.F.E. Program can help people harness that strength.

I believe that the L.I.F.E. Institute's strong commitment to educating people with HIV/AIDS to live well and even survive the illness altogether, is not only practical but visionary. Each of us is rooting for the day when surviving AIDS is a commonplace reality. Psychoneuroimmunology is helping us understand how a mind/body link may be basic to such survival. In related research, Lisa Berkman, an epidemiologist and public health specialist at Yale Medical School, found that friendless patients die at three times the rate after a heart attack than others who have family or friends to help them recover. L.I.F.E. is helping us learn how survival is effected by psychosocial factors and how these factors interact with the immune system. In this light, we are also seeing that the life-affirming attitudes and actions of Shanti caregivers are even more valuable to our clients' welfare than we have thought all along.

9. What is your vision for the Shanti National Training Institute*? 

The year was 1979 and Shanti had been serving Bay Area clients facing life-threatening illnesses for five years. We were one of the first volunteer-based organizations of its kind in the nation and over 300 agencies and communities in the U.S. and abroad had contacted us for help in setting up similar services.

I remember the early days of this effort well—sitting in a church basement in Columbus, Ohio listening to the directors of eighteen different volunteer projects modeled after Shanti. I remember speaking about Shanti's newly launched training institute that same year during a keynote speech in Milan, Italy at an international cancer symposium. The positive responses to these presentations and others spoke volumes about the wide interest in Shanti's approach to training and using volunteers.

Then, as fate would have it, the world threw us an immense curve ball. The AIDS pandemic forced Shanti to put its new national institute on the back burner and reaffirm its commitment to direct service. All of us can be proud of this decision to serve our brothers and sisters with HIV/AIDS and the everyday heroism of Shanti volunteers past and present. We can also acknowledge that Shanti continued to share its growing expertise with other organizations and communities throughout the pandemic's onslaught. An important part of my own AIDS work in the decade from 1981 to 1991 was directed at sharing the Shanti model and our approach to training volunteers with many communities outside the Bay Area.

Now it is 2001, and we have successfully launched the Shanti National Training Institute. Nowadays, we are far more knowledgeable and competent in caregiving and training volunteers and volunteer managers than we were in 1979 when I first outlined our plans and approach for a national training institute. We know that the Shanti National Training Institute (SNTI) is a legacy to the thousands of volunteers and clients who taught us so much during our twenty-seven year history, particularly in this time of AIDS. SNTI is currently training volunteer managers from agencies who serve people with HIV/AIDS, cancer, Alzheimer's disease, the frail elderly, the abused, the homeless, hospice, interfaith groups, and many others. Finally, SNTI is offering the Shanti model of peer support and the Shanti model of volunteer management in a way that speaks to the best in human beings and to the farther reaches of compassionate community.

There are many millions of Americans who volunteer their time and services to organizations across the country. From the Red Cross, Sierra Club, and the American Cancer Society to schools, nursing homes, hospitals, churches and community organizations of many kinds, there are thousands of valuable programs that could not exist without the hard work of dedicated volunteers who are America's invisible workforce. Yet it is not uncommon for volunteers and volunteer managers to receive little or no formal training to prepare them to serve their clients and communities.

The Shanti model of volunteer management shows managers how the Shanti model lies at the heart of our effectiveness—and how the Shanti model is the key element in the effective screening, training, support, supervision, and retention of volunteers. SNTI has long been one of the next logical steps in Shanti's development as an organization.

Currently there is a sea change in volunteerism and volunteer management. My hope is that SNTI will continue to show volunteer managers the necessity of a radically new notion of "how things work", rethinking the very concept of the volunteer organization—its purpose, its structure, its operation, and its internal and external relationships. Collectively, volunteer organizations can exert great influence and where that influence is further humanized, lasting and significant improvements can occur to the very fabric of society.

10. What is the ultimate importance of Shanti's contribution in the world?

When all is said and done, we may better understand how Shanti's work exerts a positive influence on humanity's spiritual and social development. For now, we know that our collective efforts help to answer two of humanity's most vexing questions: What is the good person and what is the good society?


*Since this interview took place in 2001, the Shanti National Training Institute ceases to exist.

© Charles Garfield Group, 2001