Article
Care
Change
6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient
Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care.   Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions? 

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.  

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers. 

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.  

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired  infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’. 

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care. 

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?” 

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. 

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.” 

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.  

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.  

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”    

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.  

Article
AI
Belief
Culture
Mental Health
Pride
4 min read

Are AI chatbots actually demons in disguise?

Early Christian thinkers explain chatbots better than Silicon Valley does

Gabrielle Thomas is Assistant Professor of Early Christianity and Anglican Studies at Emory University

An AI image of a person stood holding a phone with a bubble above their head, below them is a chatbot-like demon with a tail
Nick Jones/Midjourney.ai.

AI Chatbots. They’re here to save us, aren’t they? Their designers argue so, fervently. There’s no doubt they are useful. Some, like EpiscoBOT (formerly known as ‘Cathy’), are designed for those asking ‘life’s biggest questions. 'Our girlfriend Scarlett’, is an AI companion who “is always eager to please you in any way imaginable.”  So why not defend them?  

 They offer companionship for the lonely, spark creativity when we run on empty, and make us more productive. They also provide answers for any and every kind of question without hesitation. They are, in short, a refuge. Many chatbots come with names, amplifying our sense of safety. Names define and label things, but they do far more than that. Names foster connection. They can evoke and describe a relationship, allowing us to make intimate connections with the things named. When the “things” in question are AI chatbots, however, we can run into trouble.  

According to a study conducted by researchers at Stanford University, chatbots can contribute to “harmful stigma and dangerous responses.” More than this, they can even magnify psychotic symptoms. The more we learn, the more we are beginning to grasp that the much of the world offered by AI chatbots is an illusory one.  

Early Christian thinkers had a distinct category for precisely this kind of illusion: the demonic. They understood demons not as red, horned bodies or fiery realms, but as entities with power to fabricate illusions—visions, appearances, and deceptive signs that distorted human perception of reality. Demons also personified pride. As fallen angels, they turned away from truth toward themselves. Their illusions lured humans into sharing that pride—believing false greatness, clinging to false refuge. 

 Looking back to early Christian approaches to demonology may help us see more clearly what is at stake in adopting without question AI chatbots. 

  

According to early Christian thinkers, demons rarely operated through brute force. Instead, they worked through deception. Athanasius of Alexandria (c. 296–373) was a bishop and theologian who wrote Life of Antony. In this, he recounted how the great desert father was plagued by demonic visions—phantoms of wild beasts, apparitions of gold, even false angels of light. The crucial danger was not physical attack but illusion. Demons were understood as beings that manufactured appearances to confuse and mislead. A monk in his cell might see radiant light and hear beautiful voices, but he was to test it carefully, for demons disguise themselves as angels. 

Evagrius Ponticus (c. 345–399), a Christian monk, ascetic, and theologian influential in early monastic spirituality, warned that demons insinuated themselves into thought, planting ideas that felt self-generated but in fact led one astray. This notion—that the demonic is most effective when it works through appearances—shaped the entire ascetic project. To resist demons meant to resist their illusions. 

 Augustine of Hippo (354–430) was a North African bishop and theologian whose writings shaped Western Christianity. In his book The City of God, he argued that pagan religion was largely a vast system of demonic deception. Demons, he argued, produced false miracles, manipulated dreams, and inspired performances in the theatre to ensnare the masses. They trafficked in spectacle, seducing imagination and desire rather than presenting truth. 

 AI chatbots function in a strikingly similar register. They do not exert power by physical coercion. Instead, they craft illusion. They can produce an authoritative-sounding essay full of falsehoods. They can create images of people doing something that never happened. They can provide companionship that leads to self-harm or even suicide. Like the demonic, the chatbot operates in the register of vision, sound, and thought. It produces appearances that persuade the senses while severing them from reality. The risk is not that the chatbot forces us, but that it deceives us—just like demonic powers. 

Using AI chatbots, too, tempts us with illusions of pride. A writer may pass off AI-generated work as their own, for example. The danger here is not simply being deceived but becoming complicit in deception, using illusion to magnify ourselves. Early Christian theologians like Athansius, Evagrius and Augustine, warned that pride was the surest sign of demonic influence. To the extent that AI tempts us toward inflated images of ourselves, it participates in the same pattern. 

When it comes to AI chatbots, we need a discipline of discernment—testing whether the images and texts bear the marks of truth or deception. Just as monks could not trust every appearance of light, we cannot trust every image or every confident paragraph produced by the chatbots. We need criteria of verification and communities of discernment to avoid mistaking illusion for reality. 

Help is at hand.  

Through the ages, Christians have responded to demonic illusions, not with naïve credulity nor blanket rejection of the sensory world, but through the hard work of discernment: testing appearances, cultivating disciplines of resistance, and orienting desire toward truth.  

 The Life of Antony describes how the monk confronted demonic illusions with ascetic discipline. When confronted by visions of treasure, Antony refused to be moved by desire. When assailed by apparitions, he remained in prayer. He tested visions by their effects: truthful visions produced humility, peace, and clarity, while demonic illusions provoked pride, disturbance, and confusion. We can cultivate a way of life that does the same. Resisting the illusions may require forms of asceticism: fasting from chatbots and cultivating patience in verification.  

Chatbot illusions are not necessarily demonic in themselves. The key is whether the illusion points beyond itself toward truth and reality, or whether it traps us in deception.  

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?
 
Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
Editor-in-Chief