The nature of spiritual care is.... ???

So, in working as a weekend on-call person, I have found myself returning again and again to this question. The chief chaplain for the hospice organization for which I work is not Christian, has a medical background, and has 4 units of CPE. His notions of appropriate scope of practice differ strongly from mine. For one thing, he uses "energy work" such as Healing Touch and Reiki, as part of chaplaincy, and I'm not even completely sure how I feel about that. For another, he believes in "distance Reiki," and I completely do not, unless you consider it no more than another language for "prayer," and that's an equation that I suspect he would reject--he believes in distance work as an actual "healing" technique. And I think his understanding of healing, and of spiritual distress, is quite different from mine. Not to mention the fact that when we disagree he tends to say, "As we learned in CPE..." as a veiled power move, given that he has 4 units and I have 1.

On the other hand, among the chaplains employed by our "umbrella organization," I have found that some, Christians from different traditions, see spiritual matters explicitly through the lenses of their own denominational choices, and I don't agree with them either, and in fact I worry about the patients who encounter these folks. An example being the fellow who reported, in a group discussion, that patients often ask him what happens after death and/or what heaven is like. I asked him how he responded to these patients. His response was completely taken from a set of Bible citations, and his justification for the response was that "he knows" this is the truth. Not, he believes, or he chooses to believe, but he KNOWS.

So I have been grappling with the term "spiritual care," attempting to relate what "seems right" in patient situations to some sort of theological underpinning, looking for ways to understand why I think I am giving "spiritual care," what I think "spiritual distress" is, etc. And I have mentioned, in the large discussion group of chaplains, that we use the term as if we all understood it identically, and I don't believe that is the case. Some agree with me and want to talk about it and others become defensive. But it's a loaded question, the question of what we do, and at some point we will have to talk about it.

One difference I have with the Buddhist chaplain, and with a Unitarian Universalist chaplain who just resigned, is that I have experienced both of them feeling that "spiritual distress" is a bad thing that should be "treated" somehow, by energy work or by blessings or prayers for peace. For me, spiritual distress is both more complex in its nature and more ambiguous in its role in the lives of persons nearing death and their families. Perhaps it is true that the desired state for each person at death is peace, but I seem to encounter people who have needs along the way, needs for reconciliation, for community, for rage, for being heard, for doubt, for all sorts of things that don't immediately translate to peace. Even people who present as "fine" can encounter rough patches along the way to death, ways in which what they have believed or not believed suddenly ceases to be useful and leaves them unsupported. I tend to think that some amount of spiritual distress is pretty normal for persons who are facing a terminal diagnosis and that much can be gained by working through it in some way--finding an alternate way to think about illness and punishment, for instance, or telling a trusted person something that has been a deeply held secret, or expressing a regret, or re-examining some crucial life events from a different perspective. I've seen people do all these things, with and without the help of chaplains. I prefer the "working through" approach to the "energy work" approach, and I'll admit that is my bias. I also have a much "lower anthropology" than do many Buddhist, Unitarian, or metaphysical folks. I don't think the essence of human nature is perfect, alas, and nothing in my life experience suggests that it is.

I'll also admit my biases against "cheap grace" and against the facile use of Christian prayer and scripture when these are undertaken without first listening to the patient's own language and experience. For myself, Christianity is the faith tradition that is "in my bones," so to speak, but for many of the patients, Christianity, while it may have been a piece of their upbringing, is not meaningful in their current construction of spiritual understanding. There is an art, at which I need to get better, of asking questions that allow the patient's own imagery and language to emerge, and I think that is crucial. I also think it is crucial to be clearly aware that religion is not in any sense neutral and that religious teaching has done incalculable harm to incalculable numbers of people. Thus I have no feeling of automatic relief or optimism upon hearing that someone is a member of a church or denomination. That might be helpful for them, but might not be. It does not absolve the chaplain of the need to be aware of the potential for harm.

Anyhow, this is all getting too "heady." I'll close by saying that I pray with patients in less than 50% of chaplain contacts, which horrifies some, and my next post will discuss why I think helping the CNA prepare a body for the mortuary can be valid spiritual care.

If you've read this far, go look at Confessions of a CF Husband and offer the family some encouragement. I'm not in alignment with them politically and my spirituality is very different from theirs, but this young couple has a strong sense of call from God and are following that call despite tremendous personal hardship, and that is something to be respected.