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 7/21/2004
Vol. 1, No. 12
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Professional
Practice |
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Rabbi
Shira
Stern
on
G-d’s
“Larger
Presence”
I
Believe in Nature
Often when I speak with people, they tell me they aren’t religious, in
the strictest institutional definition, because they don’t believe in
G-d; they do, however, believe in Nature. So I push them a bit. "What
do you mean when you refer to Nature?" I ask. They reply that they
find spiritual solace, grandeur, awesomeness and peace in striking sunsets
and beautiful cloud formations. When they experience the violence of
a summer storm, they are reminded of a Larger Presence through the peals
and flashes that fill the air.
It is natural, therefore, that some of the most durable and evocative images
of G-d described in the biblical text are those described first in Exodus: "And
G-d went before the Israelites in a pillar of cloud by day, to guide them
along the way, and in a pillar of fire by night, to give them light that
they might travel day and night" (Exodus 13:21). However, “if the
cloud did not lift, they would not set out until such time as it did lift" (Exodus
40:37). They knew that G-d was always with them.
And then we are faced with the curious story of Miriam and Aaron speaking
against their brother Moses’ monopoly on leadership in Numbers 12. G-d
reacts forcefully to this gossiping, calling all three of them together
so that everyone is clear about the infraction. G-d reminds them that only
Moses is granted special prophetic status that guarantees straight communication: "With
him, I speak mouth to mouth, not in riddles." When the dust settles,
and the cloud lifts, Miriam is white with leprosy. Aaron panics, pleads
with Moses to pray on Miriam’s behalf, and G-d responds by insisting that
while the illness will be temporary, Miriam must be isolated outside the
camp for seven days. She was all alone, away from the others, surrounded
only by her illness.
What can we as chaplains do with this story? How do we find a way to model
compassionate care in a world that regularly isolates the sick, the infirm,
the otherwise different from its midst? And where is G-d for Miriam?
I think the answer lies embedded in the text. We know that the Israelites
never moved without the pillars of cloud or fire, without G-d’s presence
to accompany them, like children who stay close to their parents’ side
in strange surroundings. And we read that G-d is incensed against Miriam
and Aaron. Why, then, do we read that "the people did not march on
until Miriam was readmitted." (Exodus 12:15) Why not leave her behind
to experience her punishment alone? And why even mention the fact that
the community stayed put?
I see this as the first CPE paradigm presented and patterned by G-d: being
present with a patient in her suffering. If the Israelites didn’t move
on, then the cloud had not lifted, and if the cloud had not lifted, then
it meant that G-d was still there.
G-d did not leave Miriam while she was relegated, albeit for a short time,
outside the safety of her community. Miriam healed as G-d’s presence stood
firmly in place. And when she was able to return, the people moved on to
continue their journey.
As chaplains, we can’t always be there for everyone, at all times, whenever
we are needed; it would be a physical impossibility. But we can try to
provide a therapeutic, peaceful presence for our patients, our clients
and our residents. Sometimes knowing that our support system is nearby,
is comforting enough. And when it is not enough, G-d will be there, waiting
along with the patient, for the illness to take its course. "Surely,
though I walk through the valley of the shadow of death, I will fear no
evil: for You, G-d are with me." (Psalm 23:4)
So when I hear about G-d in Nature, in the clouds and in the thunder and
lightning, I agree with all my soul.
Rabbi
Shira
Stern,
B.C.C.,
a member
of
the
Advisory
Board
of
PlainViews,
is
director
of
the
Jewish
Institute
for
Pastoral
Care
of
The
HealthCare
Chaplaincy
in
New
York
City,
and
serves
on
the
National
Association
for
Jewish
Chaplains’
board
of
directors
and
executive
committee.
Rabbi
Stern
was
among
the
early
group
of
women
ordained
by
the
Hebrew
Union
College-Jewish
Institute
of
Religion
in
1983.
She
has
served
as
a pulpit
rabbi
of
the
Monroe
Township
Jewish
Center,
NJ
for
13
years;
as
East
Coast
director
of
MAZON:
A Jewish
Response
to
Hunger;
and
as
Middlesex
County’s
director
of
Jewish
chaplaincy
for
three
and
a half
years.
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Advocacy |
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Anne Underwood, M.S., J.D. introduces
EthicsWalk, a new PlainViews column
EthicsWalk:
An Introduction
Beginning in its next issue, PlainViews will feature a monthly column
called “EthicsWalk.” EthicsWalk will address spiritual care as an ethical enterprise.
It will explore why relationships between spiritual care providers and those
they serve need protection, and will examine what that protection entails.
Let me make it clear in this introduction that protection does not require
sterilization or a sealing off of our common humanity. It does, however, require
close attentiveness to the needs and perceptions of those who are served, which
is the crux of ethical behavior in the professions. PlainViews will
invite readers to share their responses to each EthicsWalk column, which will
be published in the following issue.
In the last issue of PlainViews,
Gerald Ash mentioned four of the
ten moral principles of medical ethics:
Autonomy, Beneficence, Nonmaleficence
and Justice. The other principles
that apply to professional ethics
are: respect, confidentiality, honesty,
fidelity, utility and burden/benefit.
They reflect the Theological Virtues:
faith, hope, love; and the Greek
Cardinal Virtues: prudence, justice,
temperance, and courage. These principles
and virtues inform, but don’t dictate,
ethical actions.
For professional care providers,
the first ethical question is always
“What should I do?” in relation to
another’s rights and/ or well-being.
What is the “moral,” or normatively
human, course of action? “Moral”
is not based on what Mother, the
Scouts, or a professional Code of
Ethics says, but on ethical principles
and one’s maturing ethical narrative.
Ethics is a process of making decisions
about what course of action is moral
in a given situation. Dilemmas arise
when there is more than one normatively
human response for the situation
and the responses conflict. For example:
“Should I have a sexual relationship
with the patient in 302?” is an ethical
question. It is NEVER an ethical
dilemma!
Whereas: “Should I inform the patient
in Room 302’s partner, who seeks
my spiritual counsel, that the patient
is HIV positive and does not intend
anyone to know?” is an ethical dilemma.
The decision implicates the justice
duty to warn versus patient autonomy
and confidentiality. [It may also
have legal consequences.]
EthicsWalk will invite you to enter
into a process of recognizing problematic
situations and making responses informed
by ethical values rather than fixed
rules; to honor professional codes
of ethics but not to memorize them!
Rather, I invite you to discern the
principles and virtues that underlie
those codes to inform your work.
Catholic moral theologian Richard
Gula notes: “’Shoulds’ and ‘have-tos’
belong to someone else. The ‘wants’
of conscience (what my truest self
would want to do) belong to us. Whereas
the ‘shoulds’ and ‘have-tos’ of the
superego look to authority, the ‘wants’
of conscience look to our personalized
and internalized values, or acquired
virtues.”[1]
Next month: The Genealogy of Sexual
Harassment Policies
[1] “Conscience,” Richard Gula,
in Hoose, Bernard. Christian Ethics:
An Introduction, The Liturgical Press,
1998. p.111.
Anne Underwood has an undergraduate
degree in religious studies, a master’s
degree in rural sociology and a mid-life
law degree obtained after working over
a decade as a college administrator.
She has mediated for the Maine family
courts since 1983. Currently she serves
as an advisor to the ethics commissions
of ACPE, APC, the CCAR (Central Conference
of American Rabbis), and NAJC, and
consults with a variety of Protestant
faith communities on issues of power,
fair process, and congregational conflict
management. Her articles on mediation
and restorative justice have appeared
in the ACPE News, The APC News and
on the ACPE web cite. Articles on clergy
accountability and judicatory processes
are published by the Alban Institute
and The Journal on Religion and Abuse.
A chapter, “Clergy Sexual Misconduct:
A Justice Issue,” appears in Body and
Soul: Rethinking Sexuality as Justice-Love,
Marvin Ellison and Sylvia Thorson-Smith,
editors, The Pilgrim Press, 2003.
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Education & Research |
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The Rev. Dr. Vance P.
Davis on Spiritual Care
for PTSD victims
SPIRITUAL
ASSESSMENT AND CARE
FOR VETERANS WITH
POST-TRAUMATIC STRESS DISORDER
I came to the Mountain
Home Veteran’s Affairs Medical
Center (later renamed
the James H. Quillen
VA Medical Center) in Johnson
City, TN
in 1993. I had worked
in a state psychiatric
hospital in Knoxville, TN for nearly 20 years before that.
In my work with veterans
and incest victims in Knoxville,
I became aware of the
deep spiritual injury
to those who had been
traumatized by combat
or sexual and physical
abuse. But it was my
work with the outpatient
Post-Traumatic Stress
Program at the Quillen
VA Medical Center that
taught me about the nature of
spiritual injury. I will
refer the readers to
the Diagnostic and
Statistical Manual for
Mental Disorders, Volume
IV (DMS IV) for the
official list of diagnostic
traits for post traumatic
stress disorder (PTSD).
PTSD is still regarded
as a type of panic disorder,
even though panic attacks
are only part of the
symptom picture.
In the late 1980's and
early 1990's VA chaplains
were working with a variety
of spiritual assessments
to help with spiritual
care of veterans. Gary
Berg, chaplain at White
Cloud VA Medical Center
in Minnesota, developed a comprehensive assessment
tool, which included
a section on "spiritual
injury." The spiritual
injury scale asked veterans
to report if they never,
sometimes, often, or
very often experienced
such spiritual injuries
as guilt, shame, rage,
grief, unfair treatment
by G-d or life, and other
injuries of the soul.
(See below assessment
form currently in use
at the Quillen VAMC.)
At Quillen we extracted
the spiritual injury
scale and expanded it
to use in the Substance
Abuse Treatment Program,
and with veterans with
PTSD in the psychiatric
inpatient unit and the
outpatient Post Traumatic
Stress Program. Assessment
is very important to
spiritual care in this
arena.
We discovered that veterans
with PTSD report that
they often or very often experience
rage, guilt, shame, grief,
and betrayal . Underlying
all of these experiences
is a pervasive lack of
trust. We deal with these
issues in educational
seminars for veterans
with PTSD: 12 two-hour
sessions over a six month
period. You might call
this psychoeducation
program “All you Ever
Wanted to Know about
PTSD, but were Afraid
to Ask.” We follow this
with coping skills workshops
to teach anger management
and assertiveness training. Spiritual
recovery is very much
a part of this training.
This is where the Spiritual
Injury Inventory comes
in. We help veterans
discern the difference
between shame and guilt,
we help them look at
how they have unresolved
grief from combat experiences
in which buddies were
killed, and we help them
deal with the sense of
betrayal by their superiors
and/or their political
leaders.
A distinction between
spirituality and religion
is drawn in these sessions,
and the focus is on spirituality:
defined as a group of
relationships (with self,
others, nature, and G-d
or Higher Power) which
help us make meaning
and find purpose in life.
A spiritual injury usually
indicates brokenness
in relationships in one
of the realms mentioned
above. Perceptions of
betrayal may lead to
rage, which may make
one feel guilty, all
of which is injurious
to one’s spirituality.
Trust is important, since
recovery depends upon
a person's willingness
to trust in a Higher
Power and/or other persons
who would guide them.
We also have a 12-step
program for PTSD, which
is two hours per week
for 12 consecutive weeks.
We deal with each of
the twelve steps, as
rewritten for PTSD, and
hope that this beginning
will lead to more effective
spiritual recovery for
those who participate.
It is helpful to use
the concept of spiritual
injury in ministering
to trauma victims, especially
those with combat-related
PTSD.
I am attaching the spiritual
assessment tool I currently
use as a "Readjustment
Counselor Therapist" in
the PTSD program. Since
I retired from chaplaincy
in 2002, I have been
serving part-time with
the PTSP in this capacity.
JAMES
H. QUILLEN VA MEDICAL
CENTER
POST TRAUMATIC STRESS PROGRAM
SPIRITUAL/RELIGIOUS ASSESSMENT
This
is an assessment of your
religious/spiritual practices
and the extent to which
you may have been spiritually
injured in your life.
This information is confidential
and will be used only
to help you deal with
your spirituality as
it relates to your PTSD.
A.
Do you have membership
in or participate in
any local church/ synagogue/mosque
or other organized expression
of religion?
____yes ____no (skip B)
B.
If A is yes, how often
do you participate?
Religious Holidays ___ Four or more/year___Monthly ___ Weekly ___
C.
Do you have a personal/private
spiritual practice?
____yes ____no (skip D)
D.
If C is yes, what do
you do?
Pray ___ Meditate___ Read ___Listen to Music ___ Walk ___ Run ___Talk
to Others ___
Other ___
Comments:________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
E.
If you are not religious
and do not have a spiritual
practice, how do you
cope with life’s cares,
and what gives you a
sense of purpose or meaning
in life?
Comments:________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
F.
Do you worry about your
doubts/disbeliefs in
G-d?
1. Never 2. Sometimes 3. Often 4. Very Often
G.
Do you feel G-d (or Life)
has treated you unfairly?
1. Never 2. Sometimes 3. Often 4. Very Often
H.
Do you feel that life
has no meaning or purpose?
1. Never 2. Sometimes 3. Often 4. Very Often
I.
Do you have feelings
of despair or hopelessness?
1. Never 2. Sometimes 3. Often 4. Very Often
J.
Do you worry about or
fear death?
1. Never 2. Sometimes 3. Often 4. Very Often
K.
Do you think about taking
your own life?
1. Never 2. Sometimes 3. Often 4. Very Often
L.
Do you feel sad or experience
grief?
1. Never 2. Sometimes 3. Often 4. Very Often
M.
Do you feel shame or
humiliation?
1. Never 2. Sometimes 3. Often 4. Very Often
N.
Do feel disappointed
or betrayed by others?
1. Never 2. Sometimes 3. Often 4. Very Often
O.
Do you feel anger/rage
or resentment?
1. Never 2. Sometimes 3. Often 4. Very Often
P.
Do you feel guilty over
past behavior (including
what you should have
done?)
1. Never 2. Sometimes 3. Often 4. Very Often
Q.
Would you like to discuss
any of these issues with
a member of the PTSP
staff?
____Yes ____No
If
yes, how can you be contacted?
_______________________________________________
_________________________________________________________________________
The Rev. Dr. Vance
Davis is currently retired,
working 12 hrs per week
with veterans with PTSD
at the James H. Quillen
VA Medical Center in Johnson
City, TN.
He was chaplain there for
10 years and coordinated
their CPE Program. Prior
to that he was a chaplain
at a state psychiatric
hospital for 20 years. |
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Spiritual
Development |
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Chaplain
Freda Brown encourages
us to be deliberate about
self-care
“100
Things I Genuinely
Like….”
On my way home from work a few days ago I was absolutely green with envy recalling
a conversation I’d had. Just prior to departing, a friend was sparing no
details about her recent vacation to Flagstaff, Arizona. She described morning
hikes and afternoon naps in a hammock strung outside in the breeze; and of
course, she talked of the smell of those ponderosa pines. I was so covetous.
But then, she did deserve it. She is manager of the Palliative Care department
at the hospital, and championing the cause of palliative care in the medical
center is an intense and exhausting feat. She is wise to take some time off
for rest and relaxation. My friend obviously knows the value of self-care.
As I complete my chaplain
residency in an acute-care
trauma center of a large
metropolitan city, I
too know intensity and
exhaustion. In fact,
those of us with vocations
in the caring ministries
know the grueling hours
that might extend well
beyond what is “normal”
by most people’s standards.
We know the emotional,
mental, and physical
toll that occurs with
long on-call shifts where
a truly caring presence
is the one thing that’s
needed. It is because
of my hospital ministry
that I have come to really
appreciate all aspects
of my own self-care system.
Without sufficient renewal
and restoration, my personal
resources become significantly
weakened and the effectiveness
of my ministry is minimized.
According to Stephen
Covey in his book, The
7 Habits of Highly Effective
People, “sharpening
the saw” is foundational
to personal effectiveness.
He defines this as a
way of renewing all aspects
of our personhood which
he perceives as dimensional
in nature — physical,
mental, social/emotional,
and spiritual.
What I’ve learned about myself is that an obvious obstacle to true self-care
is my tendency towards being overly responsible. I’m sure I’m not alone in
this propensity, because many of my colleagues in the helping professions are
inherently responsible people. There used to be a guilty feeling about the
laundry to be done, the errands to be run, or the crime-watch meeting to be
attended. For a long time, I told myself I just didn’t have time to
do anything for me. Finally, I learned to give myself permission to
take the time. I came to the realization that it was my own choice. No longer
do I have those guilty feelings, because to me it’s a matter of self-love.
I now give myself permission to love myself enough to care for myself
in a way that is unique to me!
Several weeks ago while
reading a book by Julia
Cameron, I was struck
by the suggestion to
list 100 things that
I genuinely liked — things
that reconnected me to
my emotional life. I
jumped at the chance.
There’s something about
writing down the kinds
of things that bring
you pleasure that seems
to validate them even
more. As happy as I am
to know that I’m caring
for myself in every area
of my life, I’m even
happier to have things
that I do for the sheer
joy of doing them. The
inner joy and peace in
the process of
doing is absolutely my
greatest reward.
When I posed the self-care
question to some of my
colleagues, I got an
array of answers as you
can well imagine. Indeed,
a Friday night margarita
or a novel of questionable
literary merit might
be just the thing for
some of us to let go
the intensity and exhaustion.
But, I know several who
practice other forms
of self-care. Changing
our eating habits, taking
up a foreign language,
going to the movies and
doing daily devotionals
are all considered aspects
of self-care. The ways
in which we do it aren’t
as important as the fact
that we consistently do something
to care for our own souls.
“You shall love the
LORD your G-d…and love
your neighbor as yourself.”
How can I love my neighbor
if I don’t first love
myself? How can I care
for the wounded souls
of my fellow travelers
if I can’t give care
to my own? My list of 100
Things That I Genuinely
Like contained many
of the ways I care for
my soul. I love to spend
time in the garden, make
gumbo, read a good book,
eat a delicious meal
with friends, take Spanish
classes, attend the Eucharist,
get a good night’s sleep,
my list goes on and on….
What about yours?
Freda S. Brown, MTS,
is completing her fifth
unit of CPE at Methodist
Hospital System in Dallas.
Pastoral ministry is her
second career. She spent
25 years in the clinical
laboratory as a clinical
chemist, of which two-thirds
of her time in the lab
was as a manager. Once
she completes her CPE she
is hoping to find a chaplain
position in the Dallas-Fort
Worth area. Freda is in
the process of ordination
to the diaconate of the
Episcopal Church.
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Reviews |
Macky
Alston reviews the film Bonhoeffer
Bonhoeffer
Bonhoeffer tells
the gripping story of
a pacifist theologian
turned assassin.
Engaging to young and
old audiences, ideal
for individuals as well
as groups, this new much-talked-about
documentary follows German
ethicist Dietrich Bonhoeffer
from his student days
in Weimar, Germany to
his work in the illegal
Confessing Church, to
his escape to America
in 1939, and to his return
into the eye of the storm:
the conspiracy to assassinate
Hitler.
One of the most renowned
theologians and ethicists
of the 20th century,
Bonhoeffer formulated
his beliefs in the crucible
of a long and ultimately
fatal struggle with the
Nazi regime.
He came to believe in
the church as community
during his tenure at
Union Theological Seminary
in New York. There, he
sat in the classroom
of Reinhold Niebuhr,
often called the “father
of social ethics.” Bonhoeffer
took from Niebuhr the
precept that the purpose
of theology and ethics
was to make the world
better, and he witnessed
for the first time the
political and social
engagement of the church
when he visited Abyssinian
Baptist Church in Harlem.
Other influences predetermined
his stand against the
Nazi regime. While at
Union, Bonhoeffer befriended
Jean Lasserree, a French
pacifist who believed
that war was contrary
to the ethics of the
Gospels. Bonhoeffer also
altered his theological
views during this period
of his life in regard
to the Sermon on the
Mount. The Sermon was
not, as he had come to
believe in Germany, designed
to make him feel sinful,
but rather served as
a guide on how to live
his life. “It is only
by living completely
in this world that one
learns to have faith,”
he said.
Gradually, Bonhoeffer
came to envision a multifaith
ecumenical community
as the way to preserve
peace. His views on pastoral
care were underscored
by an emerging belief
that the church’s primary
role was not ensuring
freedom to preach the
gospel, but rather ensuring
that freedom existed
to stand by victims and
care for an entire population
in need.
Bonhoeffer came to believe
towards the end of his
life that “the church
is the church only when
it exists for others.”
Macky Alston is the
director of Auburn Media,
a division of the Center
for Multifaith Education
at Auburn Theological Seminary
committed to supporting,
cultivating and promoting
powerful, engaging, balanced
and responsible media on
religion, spirituality
and ethics. He is a graduate
of Union Theological Seminary
and an award-winning documentary
filmmaker.
Completed: 2003
Running Time: 90 Minutes
Director: Martin Doblmeier
Associate Producers: Adele Schmidt and Janna Morishima
Editors: Matthew B. Kelly and Timothy Finkbiner
If you are interested in purchasing Bonhoeffer, you can do so at www.hartleyfoundation.org.
Just click on “Masterworks” on the homepage for more information. The VHS version
of the film is priced at $24.95 and the DVD version at $29.95. |
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