As professional chaplains we need to be in dialogue with each other about what we do, how we do it, and why we do it a certain way and how these practices benefit our patients. The ultimate goal of MyPractice is to build a consensus about what constitutes “good practice” and eventually establish “Standards of Practice” for chaplains. As with quality improvements in our institutions, this is an ongoing process in order to improve our practice.

To have a description of a practice that you use in your setting considered for inclusion here, write it up and send it to PlainViews for consideration. The Association of Professional Chaplain's Quality Commission’s Best Practice Committee will work with the Managing Editor of PlainViews to review submissions and select articles for publication. Your submission does not necessarily need to be cutting edge (although that’s okay, too). We want to identify “good practices” that could be recognized as standard practice.

PlainViews will highlight one article in the second issue of each month. Readers are invited to respond to the featured practice. Responses will be posted as they are received. This is a great opportunity to start a process that will move us forward in professional chaplaincy.

If you’d like to respond to MyPractice, please send a comment of no more than 400 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editor in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “MyPractice” in your subject line.

We look forward to hearing from you.

Just Another Manic Monday

It’s just another manic Monday as I hustle to meet and greet those admitted over the week-end to the state psychiatric hospital where I serve as chaplain. By now I know to expect the unexpected – one must be deemed at imminent risk of harm to self or others to qualify for admission here, and week-end admissions are usually involuntary commitments.

By now I also know that, when a nurse greets me at the unit’s door with “yes, there is a God!” something’s up and this something isn’t, alas, my divine radiance, but rather a forewarning I’m about to be asked a big favor. I am not mistaken. I am asked to please, please, spend an hour or so with a “real handful,” as staff and other patients desperately need, well, a break. The patient in question has bi-polar disorder and is in the midst of an acute manic episode. “She did ask to see the chaplain,” adds the nurse, smiling – knowing this tidy tidbit will seal the deal.

I hear her before I see her, my challenging charge, her resonant voice graphically describing what will befall any and all who are complicit in her unlawful detainment. She speaks articulately, eloquently and, at times, colorfully, her intelligence and wit shining through the haze of her illness-mediated rage. As I round the corner to the area of the unit where she is being confined, I see her pacing restlessly, fists clenched and eyes darting.

She greets me with an irritable “What the hell took you so long to get here,” then comically quips: “If you will change this water into vodka, I’ll be your disciple.” I laugh. “Good,” she responds, “a chaplain with a sense of humor or who could use a stiff drink, too. Either way, I’ll talk to you.”

Her words come fast and furious, as if she has a lifetime to share in but a few minutes. She talks in superlatives and the stories she tells are larger than life. She has need for neither decorum nor discretion, swearing like a sailor and sharing intimate life details without compunction to a total stranger. I listen. I have learned that it is pointless to either reasonably respond to such grandiosity or attempt to contain the disclosures. I look for those nuggets of truth within the tall tales and seek subtle ways to guard her dignity. And I am watchful. I notice the rise and fall of her voice, the nuance of tenor. I pay careful attention to the pulsating emotion, aware that it can and will turn on a dime.

“You need to tell your Jesus to learn some boundaries,” she suddenly blurts out disjointedly. “He just barged into my room one night last week, unannounced and uninvited – so much for knocking on your heart’s door!” I laugh again, this time misreading the cues. “You think that’s funny?" she bellows. “Or is it you don’t believe me? Well, it’s true, whether you believe me or not, and it was scary and certainly not funny! You think I’m crazy, too, don’t you? Well I’m not! I’m not crazy!” She is wide-eyed, red-faced and breathing rapidly.

How I respond is critical, I know. I need to be a ballast of calm to her storm, despite my racing pulse and sweaty palms. I lean slightly forward, careful to keep a safe distance, and state, quietly but firmly: “I’m sorry. I misunderstood. I do believe that’s what you experienced with Jesus,” hoping she does not pick up on the careful phrasing. “And I do not believe you are crazy.”

She bursts into tears, sobbing uncontrollably. I find myself wondering what spiritual and/or other intrusions she may have experienced – psychotic symptoms often contain elements of reality. I consider the soul-searing pain of being deemed crazy by those who do not understand – or believe – that bipolar is a brain disorder. I think about the ways in which this illness has disrupted all aspects of not only her life but the lives of those who love her. I wonder who among her family and friends are still able and willing to be there for her, if anyone. I pray that somehow, someway she is able to find a refuge in God.

Like the torrential rain of a summer thunderstorm, her tears stop as quickly as they started. “I love to sing, do you? Come on, let’s sing!” And the manic dance begins again. I am already exhausted, and it’s been barely an hour since I became her dance partner. I wonder how much longer I can stay alert and focused, and, I have fresh appreciation for the work of our unit staff.

As I later leave the unit, I take a few minutes to reflect and center. I wonder if she will remember anything of our encounter – it is not likely, given her state of acute mania. I pray that God will nonetheless use our time together to further her journey of healing. I appreciate more deeply the miracle of biochemical balance and am grateful for the gift of wellness. And I pray that, somehow, someway, those whose challenge in life is living with an illness characterized by profound imbalance will find a way to do so gracefully, anchored by faith, hope and love. Then, well, it’s off to the next newly admitted person in crisis – acutely manic, floridly psychotic or suicidally depressed. After all, it’s just another manic Monday.

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