Pilgrimage at the end of life

Deborah Kelly, Integrative arts psychotherapist

Published in JHH15.2 – Healing Journeys

I originally trained and worked as a nurse and clinical teacher, and subsequently as a Shiatsu practitioner. I have worked in palliative care for 18 years exploring both Western and Eastern medicine. As an Integrative arts psychotherapist, group facilitator and teacher, my professional interests include working with nature, ritual, imagination and embodied exploration. Studying with Marie Angelo at Chichester University led me to explore transpersonal research methodology that could incorporate the sort of creative, imaginal and embodied explorations that were aligned to my therapeutic practice. Currently I work as a programme director, tutor, and examiner at the Institute of Arts in Therapy and Education in London. I also run a private practice and facilitate groups about death and dying, groups for elder women, and ecotherapy.

A pilgrim is a traveller – literally, one who has come from afar Click To Tweet


The group projects at the heart of this study were inspired by Dr Michael Kearney’s search for a new paradigm of palliative care, that would address suffering as well as pain (Kearney, 2009). Concerned that its growing medical specialisation might overshadow the original holistic focus of palliative care, he saw the potential of integrating Hippocratic medicine (from which our modern medical model developed) with the intuitive healing cultivated in temples dedicated to the god Asklepius.

Asklepian temples were built in places of natural beauty, where the air was clear and where water and springs were abundant. These sanctuaries are described as places set apart from normal collective life, and as such invited a journey towards healing. Activities there, which we might recognise as contemporary holistic therapies, included bathing, rest, exercise, engagement in music and drama, the ‘practice of beauty’ and attending to the psyche through ritual, meditation and prayer.

The preparation and waiting within the temples was intended to put the patients into the right frame of mind to undergo the final stage of healing, the incubation of a dream. This marked an initiation into another realm, where they would experience a ‘visitation by the gods’ (Patton, 2009:5). This inclusive, holistic approach involved a belief that the source of healing was within oneself and that healing can come through a dream, through a unity with the divine.

Inspired by Kearney’s vision, I set up two projects in palliative care, incorporating Asklepian principles, which are ongoing. Participants in the palliative stage of their illness travel to a venue in a beautiful natural setting where there is time for reflection, reverie and being in nature. There they receive body therapies and can take part in meditation, simple ritual (creating a wheel of the year) and experience embodied imagination through creative visualisation, art, story and myth. Reflecting on these group experiences, there emerged the concept of a pilgrimage within the therapeutic space: a sense of ‘leaving behind’ everyday life, and of ‘going towards’ a place of rest or healing, and the potential this created for transformation before the return. The discussion that follows is adapted from my main doctoral dissertation (Kelly, 2017).

Pilgrimage was not seen in any religious sense, but rather as naming a transformational journey of intention, that could incorporate literal and imaginal expression.


A pilgrim is a traveller – literally, one who has come from afar. Pilgrimages are often associated with a sacred destination whose significance can be religious, moral or spiritual. Schmidt, writing on pilgrimage and loss, identifies six types of pilgrimage: devotional, healing, ritual/life-cycle, obligatory, wandering and transformative. From the perspective of depth psychology, the encounter with the gods can signify the inner journey towards soul. Clift and Clift (1996:9) draw on Jungian concepts in describing pilgrimage as an archetype with the capacity to ‘rearrange psychic elements, thereby producing psychological, spiritual and social effects’, in Jung’s terms a heroic journey into the depths of the psyche in the quest for individuation.

To be a pilgrim is to experience life as an endless and eternal process of being

Satish Kumar (2009:16)

According to Joseph Campbell the journey of the pilgrim/ hero/heroine includes the departure, the initiation/ awakening and the return. The pilgrim’s return involves change: he or she cannot go back to what they were before. For people facing death, transformation is inevitable, not least by the physical disease and its treatment. The medical model aims to remove the impediment to health where possible, so that the patient can return to normal. But this is not an option for people facing death, whose journey may entail immense suffering and separation, alongside the potential for transformation. In Hall’s description of the pilgrim’s descent, before there can be revelation and rebirth/return, the separation must be followed by dismemberment. For Dante, the journey toward paradise takes him through hell. For those accompanying the pilgrim, the journey may be no less arduous for, rather than intervening as the Hippocratic doctor might, the palliative care (Asklepian) practitioner can do no more (and no less) than travel alongside. The task is to remain open to what unfolds, facilitating a personal experience of illness in an intuitive way, and so enabling a patient to ‘dive down into the experience of illness in a quest for healing’ (Kearney, 1992:46). Kearney challenges the palliative care practitioners to be committed to making a journey themselves, from the surface to the depths, ‘to know what it means to cross these inner boundaries’.

Pilgrimage at the end of life

At a conference on the Sacred Art of Pilgrimage in 2013 the poet Jay Ramsay, in distilling the process of pilgrimage, presented seven progressive perspectives. I have used this structure loosely to map out the stages of pilgrimage in relation to palliative care, and specifically in relation to our group-work projects.

The first stage: pilgrim not tourist

Satish Kumar, who describes himself as an Earth pilgrim, distinguishes the tourist from the pilgrim, who is seeking a deep inner purpose rather than a superficial experience of travel. As a consequence of being faced with a life-threatening illness, superficiality may drop away. Indeed, whether they welcomed it or not, our group participants were already moving into deeper waters, already beginning to leave behind what they had known and had expected from life. With this separation, everything had changed. In a sense they were already pilgrims. Yet unlike their illness, their journey towards our group meetings was one they had chosen.

They embarked on these journeys in the hope of finding rest, nourishment, and some level of healing experience. The facilitators also had to prepare for and hold an openness to depth and awakening. This trust and belief in a ‘journey towards healing’, a journey of intention, may contribute to the possibility of transformation, not in a passive way, but through an active openness to depth. As psychotherapist Jauregui (2007:174) writes: ‘Moments of surprise come, compelling us with their grace, even when the problems of life seem too daunting to bear, making room for our stories of epiphanies, we rivet our attention onto these moments, watch for the objections that conspire against them, and explore their power of healing. Look at this! we say, ‘Look with me’. And in the saying, we are changed, and so is the world.’

The second stage: reading the signs

Dawkins writes of pilgrimage: ‘Sensing or seeing the patterns in the landscape, and comparing them to the energies of your own body and psyche, can help you realise the subtle and intimate relationship between yourself and nature’ (Dawkins, 1998:142). For our group participants, the journey to the venue enhanced their awareness of the seasons and weather: people noticed how the landscape and natural world could reflect, or contradict or influence their inner world and their physical body. For example, ‘I heard the wind in the trees and my breath softened’, and ‘as the fields opened up, I could feel tension releasing’. The opening landscape brought a sense of peace and tranquility, a sense of something ‘dropping away’ as the journey proceeded, that seemed to encourage an awareness of other ‘signs’ on the way. I recall, for example, a woman who was astonished and inspired by seeing a fallen tree with new shoots; another who noticed a bird’s nest and saw new life; a young man who saw beauty inside a stone. The developing connection to nature also revealed death, and the cycle of the seasons, and the invitation to see life and death from a perspective beyond the individual.

The third stage: companions on the road: a shared journey

Along with intention and commitment to the journey, something shared had begun: a sense of fellowship and companionship, a sharing with others who understood about the cancer journey: the chemotherapy, the loss of hair, the loss of vitality and vigour, the fear in the dark nights, the deepening into life. The journey towards death, while immanent for some, was being shared by all.

According to Peter Dawkins the recurring path trodden by pilgrims, can heal not only ourselves but the land itself

The fourth stage: pilgrimage as story and remembering

As our journeys to the venue were repeated this prompted a remembering: a sense of others having travelled this way before. According to Peter Dawkins the recurring path trodden by pilgrims, can heal not only ourselves but the land itself. He writes:

‘[The land is] constantly energised by the flow of pilgrims and this stimulates healing and transformation in the land, the cosmos and the person… No-one can take part in this without being personally affected: the pilgrim’s own consciousness is raised, and he or she gains more understanding of life’

(Dawkins, 1998:142)

This view comes from a belief in Earth energy, and of transformative healing in a wider sense – ecological as well as personal. This connection between Earth, body, mind and spirit, though familiar in eastern and esoteric traditions, is less appreciated in western medicine, yet an intuitive sense of this connection soon emerged as we journeyed through the landscape. And the sense of stimulating healing through a flow of energy was present in other ways in our work, for example through bodywork, meditation, and tai chi.

As the seasons passed and the lanes renewed their spring flowers, or winter brought its stillness, people were remembered. And so a ‘flow of pilgrims’, a remembering of others ‘having gone before’ became an important aspect of our experience. This brings us to the second perspective, of a communal sense of remembrance, and of stories told of past group members, and the community of people coming together time and again. The repeated shared rituals and the stories told of others, and the ashes scattered in these places, or the images and poetry of past group members, all represented a similar record of those who had ‘gone before’. Perhaps like the offerings left at the Asklepian temples, that were adorned with inscribed accounts of healings, these elements offered new participants a sense of encouragement, and belief in our work. Somehow this past community affirmed the potential of the healing place we were creating, and legitimised it for others who might be wary of the group; for a significant aspect of any pilgrimage way to a healing shrine is the cultural legitimacy of the path. The knowledge that it has been powerful and affirming for others who have travelled it, is poignant when we think of the path we must all travel, and of those who have died before us, and who have left their marks along the wayside, or at the temples. They can be our teachers, guides, inspiration and hope.

The fifth stage: becoming part of the landscape

Jay Ramsay writes of a developing sense of inter-relatedness as the ‘pilgrimage’ proceeds; of a connection with the land and a growing sense of unity and belonging. Such a sense of interconnectedness – perhaps heightened for someone close to death – of being at one with the natural world, may enable a search for meaning, or prompt experiences of meaningfulness. The poet, mystic and philosopher John Moriaty speaks of experiencing such an interconnectedness – a sympathy deep down in all things, with all things, which places our life and dying in a different paradigm. From this perspective, unity with nature can offer a feeling for cyclical time, rather than the linear trajectory of time’s arrow. There is a rhythm, slower than we might be used to in everyday life: seasons come and go, death engenders new life, and nothing is lost. When there is a sense of time running out, as there can be for those living close to death, an experience of natural beauty can expand one moment into an eternity. At the other extreme, a glimpse of the incalculable distance of the stars, or of the vast age of the universe, may help put our lives into a far larger perspective.

Unity with nature can offer a feeling for cyclical time, rather than the linear trajectory of time’s arrow

The sixth stage leads into a visionary appreciation of the land as a place where ‘heaven and earth touch’ (Ramsay, 2013). Here, Jay Ramsay proposes we are seeing with the eyes of spirit. Henri Corbin coined the term ‘visionary geography’ in his writings on the world of imagination. He proposes that this imaginal world is real, with its own laws and purposes, ‘a world of visions, which guides, anticipates and molds sense perceptions’, through the imagination (Cheetham, 2003:71) enabling us to behold beings who can be interacted with, listened to, learnt from, and who may guide us (or terrify us), should we be willing or able to engage with this world. For our group participants this inner pilgrimage into other levels of awareness came through meditation, reverie, ritual, story and embodied imagination, engendering a movement into another world of potential wisdom and new landscapes. Crossing such thresholds has been seen by writers such as Stanislav Grof, as a preparation for the final crossing, of death.

Seventh stage. The Asklepian temple dream delivered a ‘visitation by the gods’, the final transformative, healing moment of the pilgrimage. In our work, it could come in the guise of an insight, a felt experience of meaning, a moment of deep connection or presence. The metaphor of pilgrimage can relate both to the physical journey and the inner journey, leading to transformation and the return. Yet when we consider the pilgrimage towards death, the idea of a linear trajectory, so central in western thought, can run us into trouble, implying as it does that we have run out of road; that there is no return. Continuing the linear metaphor, death might be the moment of transition from the earthly journey into something else, whether imagined as another shore, or a returning home or, through burial or fire – a physical return into the earth or the air. Eastern traditions instead embrace a circular movement towards the centre, or outward into waves of rarification – towards further incarnations or the final release of Nirvana. Whatever way we see death, it marks a transition of some sort, for as Hermann Hesse writes:

Maybe the moment of our death too Is just another gate to new dimensions The call of life to us will never end Well then, my heart, take leave and heal.

Hesse (2011:113)

Kreinheder reflects on this final stage of the healing journey in his moving and soul-full account of his own dying. He writes:

As death approaches and the ego weakens, the unconscious leaks through and before long we are almost immersed in the divine. God, as Master Eckhart envisioned him, is a great underground river, and as we are gently gradually borne upon the waters, we are supremely content and fully healed. Death is the final healing.

Kreinheder (1991:108–110)

For him, pilgrimage at the end of life was indeed a healing journey, returning him to wholeness. As companions on the way, we, who may not be so certain, can simply walk with compassion.


  • Cheetham T (2003) The world turned inside out. Henry Corbin and Islamic mysticism. New Orleans, LA: Spring Journal Books. Clift JD, Clift WB (1996) The archetype of pilgrimage. Mahwah, NJ: Paulist Press.
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  • Jauregui A (2007) Epiphanes. Where science and miracles meet. New York, NY: Atria
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  • Kearney M (1992) Palliative medicine – just another speciality? Palliative Medicine, 6, 39–46.
  • Kelly D (2017) An inquiry into the nature of therapeutic space, in palliative care groups working with nature and imagination. (Doctoral dissertation). Retrieved from: http://www.sacredsciencecircle. org/wp-content/uploads/2016/11/Deborah-Kelly-final-compressed-pdf (accessed 12 June 2018).
  • Kreinheder A (1991) Body and soul. The other side of illness. Toronto: Inner City Books.
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  • Patton K (2009) ‘Ancient Asklepieia: institutional incubation and the hope of healing’ in Aizenstat S and Bosnak R (eds) Imagination & medicine. the future of healing in an age of neuroscience. New Orleans, LA: Spring Journal Books.
  • Ramsey J (2013) ‘The heart’s journey’. Conference paper presented at The Sacred Art of Pilgrimage Conference 1 December, Wiltshire, Gate Keeper Trust

Related reading

  • Allan J (2006) ‘Introduction’ in Barnes R and Branfoot C (eds) Pilgrimage: the sacred journey. Oxford: Ashmolean.
  • Bosnak R (2009) ‘The physician inside’, in Aizenstat S and Bosnak R (eds) Imagination and medicine. the future of healing in an age of neuroscience. (pp xv–xxiv). New Orleans, LA: Spring Journal Books.
  • Campbell J (1993) The hero with a thousand faces. London: Fontana Press.
  • Corbin H (1989) Spiritual body and celestial earth. Princeton, NJ: Princeton University Press.
  • Grof S (undated) The experience of death and dying, psychological. philosophical and spiritual aspects [online]. Available at: www.maps. org/news-letters/v20n1/v20n1-9to13.pdf (accessed 28 June 2018).
  • Hall B (2016). Psychotherapy’s pilgrim-poet: the story within. Colorado Springs, UT: University Professors Press.
  • Kerenyi C (1959) Asklepios. Archetypal image of the physician’s existence. New York, NY: Pantheon.
  • O’Donoghue B (ed) (2013) A Moriaty reader. Dublin: The Lilliput Press Ltd.
  • Schmidt W (2013) ‘Transformative pilgrimage’, in Schmidt W and Jordan M (eds) The spiritual horizon of psychotherapy (pp 65–76). London: Routledge