6/21/2006 Vol. 3, No. 10

Professional Practice

Rev. Sheryl Wurl on chaplains and mental health patients

Learning from the Mentally Ill

Yelling unintelligibly, the patient jumped off the gurney on which he’d been lying quietly and tore off his clothes. Instantly, patient and security officer were struggling on the floor, both shouting while the rest of us stood back yet as close as six feet away. There was a “pop!”then shrieking from both officer and patient, followed by an intense, burning sensation in our own eyes, noses and lungs: the officer’s mace had been discharged.

I was on-call chaplain that night and we already had three people in trauma bays, with another arriving via the helicopter. Wheezing, tearing-up and coughing, we tried to calm people while, at the same time, preparing for what was coming in from the helipad. Later, I approached the maced officer and then the sobbing patient and his stoic grandmother, asking how I might help. The officer said he was fine; the grandmother asked for prayer to help this grandson who’d been troubled since returning last year from active duty in Iraq; the patient pleaded for “a bullet in my head.”I held his hand instead, murmuring that he was not alone, until he was transported to a nearby inpatient facility.

Just another night at a level-one trauma center, trying to meet the needs of mentally ill people who have few resources and are served by health care professionals with little or no training in mental health care.

I’m lucky in this regard because the places I trained included psychiatrists and psychologists, as well as mentally ill patients and their families. However, I now supervise CPE students at an institution that has neither a behavior health unit nor the staff that such a unit requires. So, my students don’t have the same opportunity I had for engaging appropriately with, and learning from, people with mental illness.

Yet this population is making greater use than ever of our emergency department. Chaplains frequently are asked to intervene, and we respond to a wide variety of situations. Since CPE students have weekly on-calls and report numerous interactions with mentally ill patients, this topic is a vital part of our CPE curriculum at the University of Tennessee Medical Center.

Using the basic premise of clinical pastoral education—that patients are our teachers and that each person is a living human document of divine presence in the world—I used the Internet to ask chaplains for stories of experiences with people who have mental illness. In particular, I asked chaplains to share what interactions with mentally ill people have taught them about mental illness, about themselves, and about the injunction to “love one another.”

Respondents have sent reflections about such concepts as human frailty, goodness, patience, compassion, humility, and kindness. They generously acknowledged mistakes, hubris and fears, thereby inviting my CPE students to accept their own growing edges. I am still collecting responses and plan to post submissions on a web page for general viewing sometime in September 2006. Anyone wishing to be included may send reflections to me at swurl@mc.utmck.edu or call 865-544-9707 for further information.

Do you have thoughts about professional practice you’d like to share with your colleagues? Send an e-mail info@PlainViews.org.

Advocacy

Chaplain Rozann Allyn Shackleton on putting it down on paper

Advocacy and the Written Word

Often in discussions with colleagues, one hears the comment, “That’s a good idea. You should put it down on paper,”or “That’s a valuable program. You should share it with your colleagues.”

It’s my experience that while chaplains are active listeners and themselves highly verbal, they are, with few exceptions, reluctant writers. Thus, despite the fact that the written word is one of the best avenues of advocacy for the profession, we continue to see a proliferation of articles related to spiritual care written by physicians, nurses, social workers—everyone but those who are professionally trained—and called—to deliver it.

Just as those to whom we minister have stories to tell, so do we. Some of these “stories”are research/statistics based; some are how-to’s; some are rooted in the history of our profession; some are reflections on the days—and nights—spent in the ED, the ICU, the OR waiting room. Each of these illuminates a different facet of chaplaincy. Each advocates in a unique way for our profession.

With a subscription base of 7,200 worldwide, PlainViews is an ideal vehicle for “getting one’s feet wet,”though perhaps a better metaphor would be “getting one’s fingers moving across the keyboard.”The now famous refrain of PV Managing Editor Martha Jacobs—“It’s only five-hundred words”—can serve as a motivating factor. The specific categories, which focus on professional practice, advocacy, education and research, and spiritual development, help the neophyte writer to stay on track.

I encourage chaplains to consider other venues as well. Admittedly, as editor of Chaplaincy Today, the official journal of the Association of Professional Chaplains, I have a vested interest in making such a statement; however, I think it is fair to say that this and other publications focused on spiritual care not only provide us with ways to share our expertise with our colleagues, they add to our credibility as healthcare professionals.

The path to publication in CT is not a difficult one. Guidelines for authors are published on page two or each issue and also appear on the APC Web site (www.professionalchaplains.org) under Publications. Articles, essays, poetry/artwork are welcomed; submission via e-mail is preferred (cteditor@sbcglobal.net).

One of my editorial goals, indeed one aspect of my chaplaincy, is to provide assistance to prospective writers. I look forward to working with you as together we advocate for our profession via the printed word.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Education & Research

Ronald C. Hamdy, MD, on the importance of spirituality

Spirituality/Medicine Interface Program

The worlds of spirituality and medicine are often viewed as mutually exclusive. However, such a distinction overlooks the important role of spirituality in people’s lives, especially during times of illness or other crises. A growing body of research evidence suggests that spirituality and religion may influence the health of patients. The fact that most people consider themselves “spiritual”or “religious”testifies to the importance of this issue. Patients often value interactions with community-based clergy and hospital chaplains saying their visits bring hope and ease difficulties. Physicians receive little guidance in addressing this central but highly personal aspect of their patients’lives and rely on clergy to take over in this area.

To address the need, the Southern Medical Association (SMA) has been awarded a grant from the John Templeton Foundation to explore the creative interface between science and religion. The Spirituality/Medicine Interface Project has implemented a series of spirituality/medicine related educational activities including “Special Sections”in the Southern Medical Journal (SMJ), live conferences and a specially designed website focused on education and resources.

The scope and objectives of the project are to promote—among physicians, chaplains, counselors, students, ministerial staff affiliated with hospitals, social workers, nurses and other health care professionals—an appreciation of the importance that spirituality and religion may have in their patients’lives. Many people have migrated to this country and have adopted our way of life but adhere to some of their native customs as well. Understanding differences in beliefs can assist professionals in understanding how these factors may modulate their patients’responses to disease, treatments and other procedures. The goal is to encourage a “team”approach on this topic and for “the team”to recognize the important part that spirituality and religion may play in their patients’lives and then integrate spirituality into the day-to-day management of patients.

The Spirituality/Medicine Interface Conference will be held September 14–17, 2006, at the Emory Conference Center in Atlanta, GA, with a target audience of chaplains, social workers, nurses, physicians, medical students and residents. This format will allow a greater depth of discussion on various critical topics and bring the audiences together to discuss issues pertaining to “the team”in patient care. Topics will include how spirituality plays a roll in chronic illness, palliative care, substance abuse, cancer, depression, STD’s, domestic violence and catastrophes to name just a few. Some of the nationally recognized faculties included are Harold Koeing, MD, John Peteet, MD, Farr Curlin, MD, Conrad Daly, MTh, Robert DuRant, PhD, and James Hanvey, SJ, PhD. For more information, visit the website at www.sma.org/spirituality or call 1-800-423-4992.

Do you have thoughts about education & research you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Spiritual Development

Chaplain Marty Emery Hoffman on butterflies in unexpected seasons

The Butterfly Whisperer

Out of the blue,
a butterfly appeared;
I whispered a secret wish.
It seemed to sense my longing
as it brushed against my hair
and was gone.

I cried…again.

I recalled
what people say about butterflies
A connector with the spirit world.
A soul released from its body,
A sign of eternal life,
And I wondered,

Could it be……. you?

Fervently, now,
I silently shout
my secret wishes
to passing butterflies.
My yearning heart
whispers aloud
your name.

Your warmth,
your smile,
your love
flood
my
soul.

And I smile.

Do you have thoughts about spiritual development you’d like to share with your colleagues? Send an e-mail of any length to info@PlainViews.org.

EthicsWalk

EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

Anne Underwood is on a break for the summer. If there is a particular issue that you would like her to write about this coming fall, please send your ideas to: info@plainviews.org.

CaseConference

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

CaseConference #9 (See responses below)

A 27-week gestational age baby was emergently delivered and admitted to a Level 3 Nursery Intensive Care Unit in stable condition.

The unit chaplain, following the established protocol of the unit, met the parents and completed a spiritual assessment. On the third day of life, the baby exhibited changes in his condition. Tests revealed that an Intraventricular hemorrhage had occurred. However, as is typical in premature infants, the extent of the bleed was uncertain. The neonatologist updated the parents as to the changes, range of possible outcomes, and the plan to monitor the baby closely, including additional tests in two days to reassess the bleed.

The next morning the chaplain received an emergent page asking for her presence as "the parents have been informed that the baby is to be removed from life support."

Upon arrival to the mother's room, the chaplain found the parents in tears. They stated that mom's doctor had been in earlier in the morning and informed them that "something happened in the night" and that "they need to take the baby off life support." Additionally, the doctor had instructed the parents not to leave mom's room "because a neonatologist will be coming down to talk with you when it's not so busy in the NyICU." The distraught parents had been waiting for several hours. They asked if the chaplain would go to the unit and baptize the baby "in case he dies before we are allowed to go be with him."

What is the chaplain's role in this situation?

Should the chaplain check the facts in the NyICU before responding to the page to be with the parents?

Should the chaplain advocate that the parents be allowed to be with their baby no matter how busy the NyICU?

Responses to CaseConference #9

I would check with staff (MD/RNs) regarding change in condition before I enter the room and get a sense of parent information/presence in the area. In the level 3 nursery where I am chaplain we have a digital camera and staff ( often me) take pictures of important milestones in baby's story (NICU diary) including emergent baptisms but we try to have
parents present for such events. Parents are asked if they would like to be present for withdrawal and we take and develop pictures immediately of the event on a photo printer. Because this part of our NICQ collaborative focus; Family Matters work group, staff focus is really on whole family care. We use a wooden screen for privacy and a rooming out-room after withdrawal.

I think part of the role of chaplaincy is advocacy in an area where the staff may be very busy and we are an extra pair of hands and a voice when parents have often verbalized the desire to be close when things aren't going well.

Chaplain Michelle M Dragonuk, AC, BCC candidate (post interview), BSN, MACM,MDiv
Carle Foundation Hospital
Urbana, IL

I would think it important to go into NICU prior to approaching the parents. In fact, I would have assumed someone in the family was probably at the baby's side so would have gone there first. In the given situation, it would be vital for the chaplain to go to the NICU after speaking to the parents to gather information to take to the family and encourage the neonatologist or the nurse caring for their baby to go to their room or allow them to come in. They should never have been given that kind of information and then left to wait in the mother's room "for hours" without clear and accurate information about their baby's situation. In our NICU here, the parents are taken immediately to the infant's side after such information is given and the news is only given when there is time for a physician to sit with them and tell them everything they need to know. I think that the first ethical blunder here was someone telling the parents this news without being able to tell them everything and answer their questions.

Dan Dixson M.Div., CT
Coordinator of Pastoral Services
Community Medical Center
Missoula, MT

Please check the archives below for comments made about the last CaseConference.

Send your comments about CaseConference to info@PlainViews.org.

Reviews

Sarah Masters reviews the documentary

Sound of the Soul

Religious tolerance is in short supply in many critical areas of the globe but in Fez, Morocco, this month, the atmosphere of religious tolerance is palpable. The Fez Festival of World Sacred Music, known as "the Fez," annually brings together musicians from throughout the world who represent many spiritual paths.

Fez is a 1,200-year-old city long known to be a center of Sufi spirituality. The camera in this new documentary wanders through the narrow alleyways of Fez and focuses on singers, musicians and dancers ranging from Japanese drummers to the Irish vocal group Anuna to African berber women to a Harlem brass band. Whirling dervishes circle endlessly and a French early music group sings 12th century chorales in this cinematic journey through the ancient North African city.

Award-winning filmmaker Stephen Olsson shot the festival in 2002 and 2004 and this hour-long documentary captures the spirit of its founders, Dr. Faouzi Skali, a Sufi professor of cultural anthropology, and Mohamed Kabbai, a member of Morocco's Royal Cabinet, who came up with the idea of "the Fez" in response to the Persian Gulf War over a decade ago and to growing religious intolerance. Chaplains will find the spirit of religious pluralism so evident in the music and in the intercut discussions by scientists, spiritual leaders and philosophers attending the festival to be very reaffirming. As an Afghani sings: “Music is the sound of the soul.”

Completed: 2005
Running Time: 70 Minutes
Director: Stephen Olsson

If you are interested in purchasing this film, you can do so at www.hartleyfoundation.org. Just click on “Sacred Sounds”on the homepage for more information. The cost of the film series is $ 29.95 for a DVD.

Book Review

Rev. Dr. John Bauman reviews

The Psychospiritual Clinician’s Handbook: Alternative Methods for Understanding and Treating Mental Disorders

When I first read the title of this book, The Psychospiritual Clinician’s Handbook, I needed to do some translating between a language for spiritual counseling and the pastoral care language with which I’m more familiar. I had become somewhat familiar with transpersonal psychology that came into being in the Seventies. That was, as far as I could tell, a description of an attempt to integrate and understand new age spirituality and psychology. Ken Wilber is a driving force behind transpersonal psychology.

My training in pastoral counseling used the term pastoral psychotherapy while attempting to integrate the study of psychology and spirituality from the perspectives of a variety of religious and spiritual traditions that formed the basis for the American Association of Pastoral Counselors. The term psychospiritual clinician, while new to me, seems to be an attempt by the editors, who come from ancient Sufism and Kundalini yoga backgrounds, to cast a broad net in the spirituality and psychology world.

Thomas Moore, author of Care for the Soul and Soul Mates, offers a forward. Moore describes a transition occurring in our thinking about medicine and spirituality. That is, from an evidence-based approach to healing to a new approach in which spirituality is a major part; from spirituality as a matter of belief and morals to “discovering a translucent morality, a deep sense of community, and an awareness of fate and personal transcendence.”Moore suggested caution as psychospiritual clinicians go about developing a psychospiritual approach to healing, describing this book as a step in the direction of using imagination and intelligence to that end.

The Psychospiritual Clinician's Handbook is an edited compilation of 16 articles on a wide variety of topics to help the clinician understand and treat people who may suffer from one of a number of DSM IV diagnoses. I found most of the articles had something helpful to offer. For example, an article suggested that for patients diagnosed with Adjustment Disorders, treatment could be seen as an invitation to a journey of transformation to developing new life structures. The author of this article is Dwight Judy, a psychologist who is also a United Methodist teaching at Garrett Theological Seminary, a member of AAPC, and a past president of the Association for Transpersonal Psychology.

An article on “Spiritual and Transpersonal Approaches to Psychotic Disorders”quoted Ken Wilber and Joseph Campbell, among others, in a helpful discussion of the differences between psychotic disorders and spiritual experiences. The author, David Lukoff, quoted Campbell, saying that the mystic and psychotic are “plunged into the same deep inward sea. However, the mystic, endowed with native talents for this sort of thing and following stage by stage, the instruction of a master, enters the waters and finds he can swim: whereas the schizophrenic, unprepared, unguided, and ungifted, has fallen or has intentionally plunged, and is drowning.”

I found helpful perspectives in other chapters that contain insights on understanding and treating depression, bipolar disorder, eating disorders, spirituality and sexuality, obsessive-compulsive disorder, among others.

The Psychospiritual Clinician’s Handbook: Alternative Methods for Understanding and Treating Mental Disorders. Sharon G. Mijares, PhD, and Gurucharan Singh Khalsa, PhD, editors. The Haworth Reference Press. New York. 2005, pp 372.

Do you have thoughts about these reviews you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org