2/15/2006 Vol. 3, No. 2

Professional Practice

The Rev. Stephen Harding on belief systems

From Copernicus to Newton…

One of the things that constantly surprises and delights me is the manifestation of belief by our patients and our families. To talk to people from many denominations—from ultra-orthodox Hasids and Eastern Orthodox Christians to Wiccans and Secular Humanists—is to marvel at the scope and breadth of humanity’s belief.

Recently, I gave my youngest nephew (he’s five) a glow-in-the-dark model of the solar system that came with planets, which, with his two brothers, we hung from their ceiling, and stars, which we scattered on every available surface of their room. Looking at the constellations that we had made, my mind jumped from the constellation of the stars to the ‘family constellations’that I see during the week as Chaplain.

Moving from the solar system through family constellations to the variety of religious experience (thank you, William James) that I encounter at the hospital, it is difficult for me to accept that my former interdisciplinary teams (IDT) had met the patient and families’spiritual or religious needs by asking, “What religion are you?”, “Are you religious?”, and, “Do you want to see the Chaplain?”

In an effort to go much deeper than these three questions, I ask the members of the IDT to tell me about the patient’s belief system, which is a different way of addressing the spiritual needs of the patient.

As Chaplain, I find that when I ask the question, “Tell me about your belief system…”, the door is open for the patient (and/or family) to share what they believe, why they believe it, why what they believe is important to them, how they live out their belief, and how what they believe is sustaining them or not in their medical treatment and plan.

Additionally, “What is your belief system?”provides the opportunity for organized religion, personal spiritual practices and rituals, non-traditional religion, and non-religious beliefs to be explored in a non-judgmental and accepting way.

Asking about a person’s belief system gives me a much better tool as Chaplain. I am now in the position of wanting to learn about them instead of being ‘the priest,’which sometimes comes with overtones of power and projection. In wanting to know about their belief system, I am in the position of fellow traveler and explorer with them, as opposed to being on the outside, doing to them.

Finally, I prefer this question because if I am to be their spiritual resource and guide while they are in the hospital, then I think I should understand what their own inner landscape looks like, so that I can better help them avoid spiritual pitfalls and remind them of the resources of what they believe.

Sitting with my nephews in the dark, we watched the glowing luminescence of the planets’bodies and the constellations of stars gradually reveal themselves. The solar system was beautiful, and it was a moment of shared discovery and joy. May your explorations of others’belief systems be as filled with a sense of wonder and beauty as I have had.

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

Advocacy

Chaplain Mark LaRocca-Pitts on "agape" care, part two

Agape Care: A Pastoral and Spiritual Care Continuum

Pastoral care and spiritual care are neither identical nor opposed, but are both expressions of a continuum of care defined as defined in my previous article as agape care. Chaplains and local faith leaders provide the full continuum of agape care, but with different emphases due to their different settings.

Pastoral care developed within the socially contracted context of a religious or faith community wherein the “pastor”or faith leader is the community’s designated leader who oversees the faith and welfare of the community and wherein the community submits to or acknowledges the leader’s overseeing. The “faith”they share is a mutually received and agreed upon system of beliefs, actions, and values. The faith leader’s care for his or her community is worked out within a relationship between the person’s unique needs, on the one hand, and the established norms of the faith community, as represented by the pastor, on the other.

If and when the individual’s needs and/or beliefs, actions, and values are at odds with the faith tradition, the faith leader’s response is either to lean in favor of the traditional norms at the expense of the person, to encourage the person to reconcile with the traditional norms, or to re-interpret those norms so as to include the person. Regardless of the specifics, “pastoral”care occurs within the dynamic of the aforementioned process.

Spirituality refers to an individual’s quest for meaning, purpose, and a sense of place and connectedness in the context of relationships with self, others, nature and possibly a Higher Other. Spiritual care supports the patient in this quest apart from the imposition or referencing of norms from the chaplain’s faith system, whereas pastoral care also supports the patient in this quest, but in the light of authoritative norms that the pastor and the patient hold in common.

The agape care continuum within the context of a faith community shifts from pastoral care toward spiritual care to the degree the faith leader allows the individual’s spiritual quest to take precedence over the norms of their shared faith tradition. An individual’s spiritual quest may never venture outside or contrary to the norms of his or faith tradition, but if it does and the pastor supports this venture, then the care shifts toward spiritual care. Thus, for the local pastor or faith leader the agape care continuum emphasizes pastoral care with spiritual care as a component or subset of that care.

Chaplains are not bound by the same social contract as local pastors or community faith leaders. Though the chaplain is accountable to a faith community within which the chaplain is a leader, the norms of the chaplain’s faith tradition do not automatically apply to patients. If patients invite the chaplain, whether explicitly or implicitly, to utilize his or her own faith norms in their care, then the chaplain becomes a faith leader or “pastor”for these patients and the agape care continuum shifts toward pastoral care. If the chaplain journeys with the patient as the patient negotiates and realizes their own journey without reference to or projection from the chaplain’s own norms, then the agape care shifts toward spiritual care. In the provision of agape care in the context of a secular institution, the chaplain first offers spiritual care to all and then pastoral care to those who invite it. Thus, for the chaplain the agape care continuum emphasizes spiritual care with pastoral care as a component or subset of that care.

Both the chaplain and the local faith leader are called to provide the full continuum of agape care to all for whom they care. Whether this agape care manifests as spiritual care or pastoral care, or a mixture of both, depends on the context and the needs of the patient or parishioner. For the chaplain, the patient primarily determines if the care is to be spiritual care or pastoral care, whereas for the local faith leader, the faith leader primarily determines if the care is to be pastoral care or spiritual care. However, as an agape care practitioner, when in doubt as to your context and which care you provide, simply love the one you are with.

[1] I want to thank the virtual community of chaplains at http://groups.yahoo.com/group/pastoralcare/ who provided valuable feedback when I raised this question on the list for discussion. If you are a chaplain and are interested in joining this list, send a request to pastoralcare-subscribe@yahoogroups.com.

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

Education & Research

Rabbi Sandra Katz on dressing for success

Do Clothes Make the Chaplain?

What we say before we speak comes from the impressions people form when they look at us. Can a chaplain’s appearance demonstrate a balance of compassion and authority?

Rev. Priscilla Denham informed me that she wore her clerical collar to serve as chaplain in the hospital. She said that it was important for women in clergy roles to establish and assert authority as full clergy. She told me I needed to wear a head covering consistent with my faith tradition, a skullcap. So I thought about wearing a yarmulke or kippah, as we call them in Yiddish and Hebrew. Rev. Denham told me that I needed something that would let everyone know that I am the rabbi. This became a jumping-off point for my thinking process about self-presentation.

First of all, the skullcap covering the head was originally intended for men. The skullcap for men is a case of tradition taking on the force of law. Jewish traditions for women’s appearance include a notion of modesty, tzniyut. Essentially, it means that modest, traditionally observant Jewish women will keep their elbows and knees covered, and will not wear revealingly low necklines. They also refrain from wearing pants due to the biblical admonition not to wear the garments of the other gender.

I reasoned that I would prefer to establish identity as a Jewish woman. I’m already in a male-dominated profession. I remember one of the first women in the rabbinate replying to the question, “Do you want to be a man?”I want my constituency to understand that I respect our traditions, and that I am quite pleased to be female.

I decided that when I had a committee of the people I serve, I would ask for their preference. Members indicated that they wanted me to wear the skullcap when I conducted worship services. When I read from the Torah, I put on the required prayer shawl, but I conduct the bulk of the service without it. What is a woman doing wearing a prayer shawl? When they see that I am preparing to read Torah, then it’s okay.

Whenever I am in my facility, I wear a name badge that says that I am a rabbi and director of spiritual care. That’s all the assertion I need. I know who I am. My constituency knows who I am. I can say it softly.

Modest dress has advantages and disadvantages. When traditional Jews see me in our pluralistic Jewish environment, it makes a lasting impression that I have not immediately offended them. Dressing modestly has the advantage of calming people in a sexually-saturated media environment. I serve a majority-female demographic group that is also older and perhaps a little conservative. I wonder if it jangles their nerves to see younger women in revealing outfits. At least one of my residents has made it a point to tell me that my skirts are too long, and we have made it a joke between us. Our clothing can be a point of contact to begin building trust and a metaphor to talk about inner and outer selves.

I find that when I serve Catholic individuals, many of them just figure I am a nun, consistent with their cultural context. It has been great to laugh with them when I tell them I am a rabbi.

I have wondered if I hide behind my long skirts. Would this practice, perhaps a spiritual practice, stand up to a different social setting? Would it be sensible to cover up in a warmer climate where it is less socially acceptable –and less practical? I continue to contemplate this issue, and hope that readers will “TalkBack”to PlainViews.

What does your faith tradition say about how you present yourself? How do you package yourself to convey authority and warmth simultaneously? If you wear a clerical collar, do you sense that some people are drawn and others repelled based on the collar alone? How mainstream do we want to look if we are practitioners of a non-Western tradition? How do we balance competing claims while maintaining identity and authenticity?

One year during a holiday celebration for Purim, when we sometimes dress as the characters in the story of Queen Esther, we had a group discussion. A resident mentioned that our external trappings are not always indicative of what is inside. She summed up her statement by saying, “In the end, Rabbi, everything we wear is a costume.”Let us choose our costumes with intention.

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 David Fries on praying while looking up

Ceiling Prayer

I wonder; how can prayer be made more natural and more often practiced and more enticing? Why? Anything delightful and immediately gratifying becomes more desirable and rewarding. Prayer could be like that. I often imagine seeing my prayer on the ceiling when I am on my back looking up. That is “Me the Artist,”I suspect. I began doing this as a child. Not so strange since curiosity and seeing are instinctual to both child and artist.

A patient recently told me that she prayed whenever she was looking up. As a little girl, her mother told her, “When you find yourself down, and you are looking up, pray.”Illness and being in a hospital bed fulfilled these two requirements for prayer. But normally, she said, she prayed infrequently. So we talked about prayer and need and frequency.

As we talked, I remembered a trick/tool from the television show Location Location. It is a BBC show about finding new apartments. The clutter in one apartment being viewed was too great to see the potential. Kristy, one of the hosts, suggested to the client that she lie down on the floor and look up at the ceiling. The ceiling duplicates the floor. So they both laid down on the floor, looked up, and the whole place opened up to ideas and possibilities. It was the same space seen afresh by looking up.

“I never heard of that before”this surprised patient said. She then did the same with the ceiling, over the bed, in the hospital room. I told her, “I am an artist as well as a chaplain. One is the ceiling. One is the floor. So I can, from experience say that just as painting never fails, prayer too never fails. Artists might not like the results. They might have to paint over what they have just painted. But they always, absolutely, get results when they paint. Something that needed to be voiced from inside came outside and was communicated. For me it is always the same with prayer. Prayer never fails. Prayer does what paint does. It speaks.”Then she looked up. “I understand.”She said that she was going to pass all this along to her mother.

The only draw back to seeing prayer on the ceiling is that it is a ceiling and that it will always return to that. Gladly though, when it returns to being a ceiling, I always experience an added delight. I see how the ambient light, both natural and artificial, washes over the ceiling like watercolor. It is, under certain conditions and at certain times, a sea of light washings. While lying on my bed I can walk on the sea-ling when I look up and pray. The ceiling becomes inspirational art when I desire/pray to see it that way.

Any ceiling anywhere is for me a sea for praying on. It makes me more attuned to the space where I am. Patients appre-sea-ate this use of the ceiling.

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.

Response to Anne Underwood's column

I am grateful for Anne Underwood's column. We have numerous conflicts both domestic and international, the creation story being only one. Our culture teaches us that to be faithful to your beliefs, you must not even listen to people with a different persuasion. We have even betrayed the unity of the church by allowing this attitude to shape conversations between people of different beliefs. To listen to another person of different persuasion does not mean that you have betrayed your own faith. We may even discover the face of God in the person who has a belief that is in conflict with ours.

Lorne Friesen
Chaplain
Eden Mental Health Centre
Winkler, Manitoba, Canada

Theology, Science, and The First Amendment
Intelligent Design, Darwin, And Religious Freedom
Part 2: Contextualizing the Conflict

Religious people disagree about many faith issues, beginning with the naming and worshiping of Divinity. Yet no doctrinal issue in contemporary American religion is as contentious as the Intelligent Design (ID) controversy.[1]

Spiritual care providers may work with patients and families who feel strongly about ID’s merits. Hence the importance of understanding the constitutional issues raised by affirming ID in public schools (last month’s column); the historical context of the contention (this month’s column); and the relatively peaceful coexistence in American society of other controversial religious doctrines (next month). Such understanding may facilitate open listening and respectful ministering to patients and colleagues.

The U.S. constitution constrains teaching religiously grounded doctrines as “fact”or, for that matter, denigrating them as “fiction”in public schools. Some hope to read Federal Judge John E. Jones’December 20 decision [2] in Kitzmiller as permitting ID discussions in elective philosophy or religion classes [3] even though his holding specifically forbids ID in science classes. [4] Cases winding their way through courts in Kansas and Georgia may determine whether ID discussions are ever permissible in public schools.

Within weeks of Jones’decision, a California school district cancelled an elective “Philosophy of Design”class to settle a law suit.[5] It promised “never again to offer a course that promotes or endorses creationism, creation science or intelligent design.”[6] Its decision reflects Kitzmiller’s finding that ID “cannot uncouple itself from its creationist, and thus religious, antecedents,”rooted in nineteenth century American Protestant Fundamentalism. [7] The activist history of the particular religious antecedents illuminate ID’s troubles.

Christian Fundamentalist’s efforts to block teaching evolution in public schools were far-reaching until the Scopes [8] “monkey trial.”After Scopes, creation proponents campaigned for “balanced treatment”laws giving equal time to biblical creation accounts. When those failed constitutional scrutiny, they adopted “scientific-sounding language”[9] and lobbied schools to teach “creation science”or “scientific creationism”as an evolution alternative. In 1987, the Supreme Court ruled this also unconstitutional. [10] Hence, the impact on ID of Kitzmiller’s holding that it is simply another form of creation science.

The cancelled “Philosophy of Design,”unlike Kitzmiller, was not mandatory or a science class. Complainants sued because the “course was motivated by primarily religious purpose as reflected in the course description,”the original Syllabi which listed 23 of 24 videos produced by religious organizations promoting ID [11] and the teacher’s statement “I believe this is the class that the Lord wanted me to teach.”[12] The course may have been constitutionally doomed by purpose rather than content.

This controversy’s passion is unique to the U.S. where European immigrants remembering religious tyranny created constitutional guarantees for freedom of religious belief and prohibited state endorsed religious teaching. [13] They offered no guidance for reconciling zealous belief with political neutrality. [14]

Spiritual care providers are well situated to mediate reflective peace. Disciplined to witness, without judging, patients’struggles to name and claim personal faith identities, spiritual care providers might bring the same non-anxious presence to discussions of species origins. The key is disengagement from cultural judgementalness. We all need to refrain from desire to reconfigure religion as science or sacramentalize science into religion.

I welcome any comments you might want to submit in response to these articles.

[1] Abortion distinguishes itself as an “act,”about which some people of faith feel strongly rather than a “doctrine”grounded in a religious tradition as is ID.
[2] Tammy Kitzmiller, et al. v. Dover Area School District, et al., U.S. District Court for the Middle District of Pennsylvania, Case No. 04cv2688, Judge John E. Jones III, December 20, 2005. Held the policy of Dover Area School District requiring ID be taught along with evolution in a public school science class unconstitutional pursuant to the Establishment Clause of the First Amendment.
[3] Jones wrote: “…we do not controvert that ID should continue to be studied, debated, and discussed. As stated, our conclusion today is that it is unconstitutional to teach ID as an alternative to evolution in a public school science classroom.”Id. at 137.
[4] The Judge ruled that ID is not a science noting that “Not a single expert witness over the course of the six week trial identified one major scientific association, society, organization that endorsed ID as science.”Id. at 70.
[5] Hurst v. Newman, United States District Court Eastern District of California, filed January 10, 2006 and settled out of court January 17, 2006. Information about this case is from plaintiff’s complaint available at www.au.org.
[6] Associated Press wire news reported in Portland Press Herald, Portland, Maine January 18, 2006.
[7] Kitzmiller, 136.
[8] Scopes v. State, 154 Tenn. 105 (1927) criminal prosecution of public school teacher for teaching evolution.
[9] Kitzmiller, 8.
[10] Edwards v. Arkansas, 482 U.S. 578 (1987)
[11] Hurst Complaint, p. 4.
[12] Associated Press quoted in note 6.
[13] Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; Amendment I, U.S. Constitution (1791).
[14] Historically, the nation’s ethos simultaneously embraces difference but demands conformity to specific understanding and expression of “acceptable”difference. Dualistic thinking, either/or dichotomies, black/white categorizations characterize both political conservatives and liberals (a limited two party system is illustrative) as well as those who call themselves religious or secular. Strong judgments about the “other”and fear of penetration of the often fragile and frequently rather artificial boundary separating them operate across the spectrum.

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 #5: (See below for responses)

A patient, who had small cell lung cancer and was in the hospital for chemotherapy, coded and was in the Intensive Care Unit. The family, divided on the extent of care that their loved one should receive, got into a fight in the ICU waiting room. The Chaplain, who had been with the patient and family prior to the code, was present when the argument started. The Chaplain was aware that the family had disagreed from the beginning on how aggressive the care should be for the patient.

What is the Chaplain’s role in this situation?

Given the chaplain's presence with the family what (if any) might be an appropriate intervention with this family?

Responses to Case #5:

It is my habit when there are multiple family members to try and figure out who seems to be (for lack of a better word) the power person in the family, along with the trait of calmness and reason. I try to gravitate towards that person in conflicting situations to encourage them to guide the family in proper ways. I would also, when reasonable, reduce the amount of persons involved in the conversations that are to follow...looking first for the legal next of kin.

Alan Faulkner, BCC,
Medical Oncology Associates of Augusta

No doubt, there were clues of a fight in the making before it actually erupted. This family is experiencing strong tension on at least two fronts, the 'code' event and the overall issue of care for the loved one, and they are ready to move toward some sort of resolution. As Chaplain, one of my first priorities would be to establish the primary emotional function of this fight. It might be a mutually agreed upon means to blow off steam. It could be an attempt to establish or reorder the family's emotional heirachy. It could indicate that family members are at very different places in their individual responses and are trying to 'come together,' or it could be a sign that everyone is just exhausted and desperately in need of a hiatus from the medical drama. Whatever the inspiration, they need to name and claim it if they are to heal the rift and move forward. Once we have a comfortable grasp of the conflicts underlying cause or causes, I would invite them to collectively consider a response, and depending on their needs and my relationship with them offer my observations.

Keith Goheen
Chaplain
Beebe Medical Center
Lewes, DE

Please check below for comments made about the last CaseConference.

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

Please check below for comments made about the last CaseConference.

2/15/2006 Vol. 3, No. 2 - Case #5
2/1/2006 Vol. 3, No. 1 - Case #4 Resolution
1/18/2006 Vol. 2, No. 24 - Case #4
1/4/2006 Vol. 2, No. 23 - Case #3 Resolution
12/21/2005 Vol. 2, No. 22 - Case #3
12/7/2005 Vol. 2, No. 21 - Case #2 resolution
11/16/2005 Vol. 2, No. 20 - Case #2
10/19/2005 Vol. 2, No. 18 - CaseConference #1

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

.

Reviews

Sarah Masters reviews the 2-CD Collection

Chant: Spirit in Sound

Chant: Spirit in Sound brings to life the remarkable world of traditional and contemporary chant and delves into the multicultural universe of old musical traditions. Chanting is an ancient and universal art that can be used by chaplains as a tool to bring the sacred into daily life.

Volume I, Ecstasy: the fire of devotion and Volume II, Stillness: the journey within include 25 tracks by chant artists. Chants from Christian, Jewish, Buddhist, Hindu, Islamic, African, Native American, Goddess and Shamanic traditions, among others, are included in the collection. Chantmaster Robert Gass discusses the science of sound and the musical and spiritual powers of chant found in mantras, entrainment, toning and harmonics.

From an Apache Honoring Song to the Islamic Call to Prayer to mantras from Sanskrit text, Chanting: Spirit in Sound provides a window into an ancient practice and this rich collection evokes spiritual feelings of community.

Completed: 1999
Producer: Robert Gass
Executive Producer: Bill Horwedel
Spring Hill Music, LLC

If you are interested in purchasing this film, you can do so at the Hartley Film Foundation’s Web site, www.hartleyfoundation.org. Just click on “Sacred Sounds”on the homepage for more information. The cost of the 2-CD set is $25.98.

Book Review

The Rev. Rob Ruff reviews

Anybody See My Shoes?: Poetic Reflections from a Chaplain

We healthcare chaplains are privileged to be a part of so many stories –the stories of our patients, their families, and the staff who care for them. Funny stories, sad stories, moving and touching stories. Hospitals, long-term care facilities, and hospices are settings filled with stories. Many times I’ve wanted to hold onto the stories in which as a chaplain I’ve played a part –to somehow paste them into a scrapbook in order to keep those stories for posterity and to honor those at the heart of the stories.

Dorothy Shelly’s book, Anybody See My Shoes?: Poetic Reflections from a Chaplain, is a just such a “scrapbook”of stories. Shelly, who has served as a chaplain in a long-term care facility since 1996, has lovingly shaped events from her ministry with the elderly into brief poems which effectively describe these funny, sad, and moving stories that occur each day in a nursing home. I felt as if I got to know Chaplain Shelly, her ministry, and the residents to whom she ministers through these lovely poems. I especially liked the poem about the woman who called out an unexpected “holy benediction”(“Anybody see my shoes?”) at the close of Morning Prayer. I was left smiling by the poem about the resident cat from the Alzheimer’s unit who was found curled up on the impromptu communion altar which the chaplain had formed out of an over-bed table draped with a draw sheet. And I was moved to tears by the poem about the resident suffering from dementia who tells his wife, “I don’t know your name, but I do know that I love you!”

The respect and honor that Chaplain Shelly accords the residents to whom she ministers are clearly evident in these poems. Sadly, such respect for the elderly is in short supply in our society, which worships youth and shuns the aged and the infirmed. I appreciated the fact that there is no sugary-sweet, everything-will-be-just-fine sentimentality in these stories. There is instead honesty –about illness, decline, and death –in these poems and there is the realization, born of the author’s Christian faith, that everything will finally be just fine only in God’s heavenly realm.

Poetry is a fine and fitting format for telling the stories of ministry, the stories we healthcare chaplains are privileged to live each day. Kudos to Dorothy Shelly for employing that format to such a successful end in Anybody See My Shoes?

Anybody See My Shoes? Poetic Reflections from a Chaplain. Shelly, Dorothy E. (Xlibris Corporation:August 22, 2005). 96 pp.

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