Monday, January 29, 2007

Wag the dog

Wag the dog

It was a movie about how a (fictional and) cynical US presidential administration decided to pursue a (fake) war just to distract the public from troubles at home.

Now it appears that anti-Israeli terrorists are doing it for real. According to an Associated Press article about a suicide bombing that killed three Israelis Monday in the resort town of Eilat, "[a] An Islamic Jihad Web site said the attack was meant to help bring an end to weeks of Palestinian infighting that has 60 people in the Gaza Strip since December."

Wow. Now they're not even claiming to be fighting Israel when they murder innocent Israelis. They're killing them to distract themselves from killing each other. .. . . . And Jimmy Carter thinks that all the troubles are Israel's fault. Thanks, Jimmy. You're a pal.


Sunday, January 28, 2007

Prayer through an interpreter

If you're a hospital chaplain this is a heartbreaking situation you know -- you're with a patient who is clearly in deep spiritual pain and everything in you wants to reach out to him or her. But you don't share a common language and can't understand each other's words. For a non-Spanish speaker (as are most chaplains) like myself, this situation is becoming more and more common. And it's especially tough if you are the kind of chaplain -- like myself -- whose primary way of ministering to people is through (the pastoral) conversation.

Just, today, I was with one family where I faced this situation. It was one of the most challenging situations you can find in the hospital -- the failed pregnancy. The fetal death. The broken hopes and dreams. The unfathomable question of why would God create a world in which people face such suffering and heartbreak. What purpose could it have? Why would God let this happen?

My heart always plunges when I'm on-call and I see that it's the maternity ward that needs me. I deeply fear this situation. I have no answers to offer to either myself or others. All I have is my faith in God and in God's goodness and greatness. And of what value could that possibly be to someone who does not necessarily share my kind of faith.

But this time, my heart plunged even further when the nurse told me that the woman -- her baby had been only 16 weeks old when she lost it -- was a Spanish-only speaker. The nurse even told me that the woman had told her -- through an interpreter -- that she was not religious. What could I possibly offer? I didn't even have any reason to think that this woman would want to see me (chaplains are always called to deaths at our hospital, so the nurse had called me even though there had not been a request from the family).

I even delayed going for a little bit. Then I got called to another death and went to that one first. I offered comfort to a woman who had just lost her husband of 48 years. When I was done with her, I took a deep breath and -- strengthened in my confidence in my sense of my pastoral role by my success in that situation -- started straight for maternity.

When I got there, I learned from the nurse that this was the third time or so that this woman had had a failed pregnancy since her last successful one (she had two children, I believe). The nurse told me that the husband had arrived and that he spoke English well. I decided to go in without calling for an interpreter. But when I got in the nurse asked the woman if she wanted the interpreter and the woman said, yes.

While waiting for the interpreter, I did just say I was sorry for their loss, but then -- for what seemed like a huge passage of time -- I just waited and stood there silently, looking at this woman who was looking not at me, but at the television screen. I tried to focus my attention on the gravity of their loss.

When the interpreter came I again expressed my condolences. I said I had heard that she had had other losses like this and said I imagined this would be a heavy burden upon her. I wanted to ask more questions. It is my practice to try and learn as much as I can about a patient and their current situation before offering a prayer. I believe that (the pastoral) conversation is healing in and of itself, and it helps me to formulate my prayer. I think of my prayer as offering the chaplain's (that is my) hopes for the patient and those hopes are based on what I have been able to learn about the patient's own hopes during our conversation.

But, for reasons of which I am not sure, I felt that that would not be possible here, and that I would do what I have criticized many other chaplains for -- I went almost straight to offering prayer. I was surprised that she said, yes. I asked her what she would like me to prayer for. She seemed confused by the question, but she answered it. She wanted me to bless her child, so that it might go to heaven.

I closed my eyes and took a deep breath. It can be a frightening thing to close your eyes when offering prayer. It feels to me like stepping off the edge of a cliff. The only way to know how your prayer is affecting people is to look upon their faces. But, I took a leap of faith. I trusted that my faith would guide me. I closed my eyes.

It was the second time in only a few days that I had been called upon to prayer through an interpreter (and I had never been asked to do so before!). I kept my statements short and paused to allow the interpreter to repeat them in Spanish. I heard her struggle with some of my words. My prayer went something like this:

Dear Lord.
Father above.
Source of life. [I heard the interpreter struggle with this]
You are the God of compassion.
Please, Lord. Please, let Your arms be open.
Let Your arms be open.
Accept this child, Lord [I heard the interpreter struggle again]
Let her know your comfort.
Let her know your peace.
Let her know your glory.
Hold her in your arms.
And, Lord, too,
Please watch over this mother and this father.
Bring them peace and comfort.
Bring them strength.
Remember them, Lord.
Let Your heart be open.
Listen to their hopes, Lord.
Lord, please. Please Lord.
Hear their prayers.
Let their hopes be Your hopes.
Lord, we thank Your for everything You have given.
Please, Lord, give us strength.
We pray in your name.
When it was over, I said a few more words about hoping they would find peace and healing. The mother said, gracias, and I left.

As I left, I was wondering -- as I think we chaplains so often do -- whether my work had done any good at all, whether it had touched anyone. Whether it was even welcome at all, or if I had been imposing myself and my beliefs on the patient. I was especially curious because I had prayed through an interpreter and because I had offered a spontaneous prayer to people who did not seem used to someone composing a prayer off the top of his or her head. And, so, when I saw the interpreter had followed me out of the room I was about to ask her -- in a dispassionate way as one professional to another -- "did you think that worked? Did I do ok?"

But before I could say anything like that I realized that she was crying and had turned her face towards the wall. I realized that I was now being called to do ministry to staff. And so I approached her and asked if she was alright. [As I did, I heard the parents break out weeping loudly in the room and I closed the door.] She talked about how hard it was and how we don't know the answers to why something like this happens. She told me she had never heard someone offer such a beautiful prayer around something like this.

I think I ministered to her fairly well and she hugged me at one point. But I also think I made some errors that distanced myself from her. I, for example, said several times "these are hard, these are hard."

In retrospect, I think I was talking really about myself in that moment. I've been through quite a few of these now (although in total probably not much more than 10). I've also seen quite a few infant deaths in our emergency department. But the interpreter hadn't. She said that after working nearly two years (I believe) at the hospital and seeing many tough things like deaths coming into our emergency department, she still had never been around this before.

Oddly enough this would have been the first time in my some 15 months at our hospital that I had prayed through an interpreter if the actual first time had not been only days before (Monday, I believe). That was also for a tragic death of a life barely started. Although in that case it was for a baby that had been born and had lived for six months only to die suddenly and be brought into our emergency department.

One of the unfortunate tragedies on top of tragedies that happens sometimes for a family that loses an infant to Sudden Infant Death Syndrome or something similar is that initially they may be suspected of some wrongdoing in their child's death. Because of that, this poor family had been denied holding their infant daughter after her death as the coroner needed to investigate by doing an autopsy and didn't want any evidence destroyed by someone touching the body.

And, so, the next day their pediatrician was with them when they came back into the emergency department and the coroner who told them they were cleared. The pediatrician asked for a chaplain to be called and I was the one available. And I offered a similar prayer through the interpreter.

I remember thinking as I was walking back to the office -- "how did I know how to do that?" That is, how did I know how to pray through an interpreter? I had never done it before. How had I known to go slower, to use simpler words and to keep my sentences short and to the point? It felt like I had done it before and was an old hand at it. But the fact was I had never done it before.

What I'm getting at here is that when you work through an interpreter it changes what you do and say. It's not as if you say exactly the same things you would have said if the family had spoken English and the interpreter was just some kind of passive machine translating your words.

Anyway, so it's an interesting question to think about -- how working through interpreters does (or should) change the way we work. What are the limits of working through interpreters? Is it still possible to have your main pastoral tool be (the pastoral) conversation or do you need to use more ritual and prayer (as I did with the first family I wrote about here)? All interesting questions. I wonder if anybody has written about this.

Let me know if you've heard about anything!!! :)

Opening up an oral tradition

יום ראשון ט' בשבט תשס"ז

One of the things that shocked me the most when I started to get to know people training to be CPE supervisors was how many of them -- even people who had been training for years! -- had serious concerns about whether they would ever be able to finish the process. In all my encounters with various professional educational processes, I had never seen anything like this. In rabbinical school, for example, there was some attrition. But that was mostly in the early years (of what is typically a five to six year process); by the time people had invested a lot of time, they were almost sure to be able to finish.

The stress and grief that these supervisors-in-training (SITs) I was meeting were experiencing was so high. It's hard for me to imagine what it would be like to invest years of your life in a demanding and consuming processes and have it all come to naught. [A CPE supervisor, by the way, is essentially a person who trains other people to be chaplains or who provides chaplaincy training to seminary students.]

It turns out that the "powers that be" in the CPE have recognized that there is a problem. They issued a report that summarizes the problems and recommends solutions. Basically, the report identifies a great deal of inconsistency in the education of SITs. There is no real standard path or curriculum. But, perhaps worse, there is a great deal of inconsistency between how supervisors are trained and how they are certified. That is, the people who serve on the certification boards that decide whether someone will be approved (certified) to be a supervisor are not the same people who are actually involved in training SITs. So, the SIT hears one thing from the person who is training him or her, and then goes before a committee and is shocked to be told that they have it all wrong and maybe should give up trying to become a supervisor at all.

Here is the way the report puts it (emphasis mine):
. . . there are often differing expectations between those who provide supervisory education and those who certify. We note that the language, concepts and methodologies valued by the volunteers who work in certification is often different from the expectations (and understanding of the standards) of both supervisory educators and candidates. This has unfortunately led to too many painful and conflicted experiences. One systemic result may be that our methods of evaluation of supervisory candidates and associate supervisors tend to focus more on subjective assessments of personal integration than on professional competency. Both are essential, but the feedback from those who have experienced the certification process as students and as educating supervisors suggests we have erred on the side of subjectivity, with an “oral tradition” that is difficult to comprehend.
I was really interested here by the use of the term "oral tradition". This expresses some of how I have felt about the process of entering supervisory education. I felt like I was approaching a very closed world where it was impossible to get information except by meeting an insider who was willing to talk with you. That is -- unlike let's say law or medical school -- I could not just get on the Internet or go to a bookstore and find things to read that would help me understand what was involved. Finding out about rabbinical school, also, I must say was something of an "oral tradition", but there were more people to talk to and more ways of getting at that information.

There was another thing that shocked me when I started to meet SITs -- learning that, for many of them, the obstacle is completing some theory paper. I found this very surprising. Although these theory papers are major projects, the assignment didn't seem to me to be much more demanding than for a term paper in a graduate school class (ie, we're not talking about a PhD dissertation here!!). I would have thought that a person with so much at stake in terms of his or her career would just, at some point, force themselves to sit down and write the thing.

But, it turns out that it is not just the people I met who are having trouble with the theory papers. The problem is endemic according to the report:
. . there is broad acknowledgement of the value of theory paper requirement and there is clear evidence that theory papers required of supervisory candidates are a significant stumbling block for a large percentage of students in supervisory education

Here is the introductory paragraph for the report's recommendations to fix the problems (emphasis, mine):
Recommendations: It is evident from the above analysis that the goals of streamlining the supervisory education process and ensuring attainable and measurable outcomes will only be met with significant structural process improvement efforts. We believe a cultural shift in the supervisory education and certification components of our organization is necessary, toward objective and quantifiable competency assessments and definable measurements of personal and professional integration. We believe that the education and development of our future supervisors needs to be organized around a universal core curriculum, definable best practice standards for supervisors who provide supervisory education, and clear competency standards for candidates. We believe that the ACPE needs to assure consistency, standardization and expertise in its certification processes or move toward professional certification processes used in other parallel professions. And we believe the supervisory education experience itself needs to move toward a collaborative, mentoring model that supports both personal integration and professional competency development. At the same time, we recognize that the subjectivity that is inherent in our education and certification processes is of high value and contributes both richness and depth to our unique organizational culture. Indeed, we find ourselves wanting to protect the subjectivity of our individual educators and certifiers while still promoting consistency in our interactions, assessments and evaluations.
The report has a series of recommendations about the theory paper requirement. They include:
require that all written material, including the two theory papers, be submitted five months prior to the scheduled Certification Commission appearance date; that one month be given to the committee to assess the materials according to a scoring grid (adapted from CAPPE); that the results of the scoring grid be provided to the candidate, including specific recommendations for satisfying the standards; that, if necessary, the candidate be given sixty days for a re-write and re-submission of papers; that the committee again have one month to assess the materials, and that, if the papers do not meet standards upon second submission, the appearance before the Certification Commission be canceled
Probably one of the most important recommendations of the report was that the "associate" level of CPE be eliminated.

I also, by the way liked the way the report phrased some of the problem that chaplains and CPE face today:
We are also aware of two significant challenges to the future of our organization. The first significant challenge is the changing landscape of American religion and its evolving role in culture and society. We note that religious expression has become more diverse and that health care institutions, in particular, have given rise to new – and some would say competing - forms of spiritual care, leading to experiences of marginalization and decline in authority.

Tuesday, January 23, 2007

Where is God?

יום שלישי ד' בשבט תשס"ז

This question, of course, is a common anguished cry for a suffering person. But, it's not that question I'm referring to here. I'm thinking about how close we think God is to us, or how directly God can get involved in our lives. And, more specifically, I'm thinking about how the answers to these questions might be different for a Jewish or Christian chaplain.

A couple of things recently sparked my interest in this question. One was when I heard one of my Christian colleagues talking about how he understood how God relates to the pastoral care work he does and how he is endeavoring to improve in his work. He said he is trying to cleanse or purify himself so that he can be a more accurate and clear channel for God, and for God's love, mercy and message. This person left no role for his own participation, except for being a channel.

My immediate gut reaction was one of horror. I'm not sure exactly why I had such a visceral reaction, but I was nothing short of disgusted. This sense of just being a vessel for God's will is so very far from my theology. . . The image did not come to mind at the time, but now his statement makes me think of Star Trek's the Borg with their complete subservience to some central mind. It's a horrifyingly dehumanizing image. . . . And, I guess that ultimately, finding a holiness in humans -- especially in their individual uniqueness and in their interactions with one another -- is a core belief for me. And I think this means that I assign a certain kind of distance to God. Not that I don't think that God's presence can be immediate and close to us, but that much has been delegated to us. [This kind of distance conception may find expression in the Kabbalistic concept of Tzimtzum.]

I had some related thoughts this past Friday when I heard a presentation on "What do we mean by Spiritual Reflection?". It was given by a Rabbi to a group of mostly Christian chaplains. It's a good question because much of what has been written about spiritual reflection (usually called theological reflection) is written by Christians for Christians and it's not so clear what about it can be applied to other faith traditions.

She talked about an exercise she does where she asks her students to write a paper on where they see God -- or some other ultimate -- in the work they do in the hospital (or maybe she asked what _meaning_ God had in that context). . . . I reflected on this for a while and realize that when I had been a beginning chaplaincy student that I probably would have found such an assignment offensive (and maybe even fundamentally Christian).

I asked her how she would have reacted if a student had asked to answer the question in regards to "Torah" (as opposed to God or "The Ultimate") and she said she would probably not accept that because it was "a different assignment".

She then challenged me to talk about what about my background would have made me want to write about Torah. I thought back to my youth and realized that God had been so little talked about in my home and in our religious life. Torah, on the other hand, was a topic of great importance (and reverence).

Now we Jews have changed some in recent years (and are more likely to talk explicitly about God and our relationship with God). But there is still something basic about Judaism that I think is being expressed by all this -- for us, Torah itself is an ultimate value. Sure, we connect Torah with God -- and might even believe that the words of the Five Books of Moses were dictated by God to Moses -- but most of our discussion about how to follow God's will is at least one step removed from any kind of direct contact with the Deity. That intermediary -- if we can even call it that -- is not a person or a priest. It is Torah -- the collective wisdom of our faith and our tradition.

I remember the first course I took at the Jewish Theological Seminary. It was a summer course in modern Jewish philosophy taught by Neil Gillman. He called it God, Torah and Israel.

God and Torah may be ultimate values in Judaism, but so, very much, is Israel. I think the Judaism that I grew up with in the 1960s and 70s was very much a post-Holocaust Judaism where we focused very much on the last two of these three. Maybe by deemphasizing talk about God we were avoiding dealing with the unanswerable question of "where was God?" in the Holocaust.

But, we were also following in the long tradition of our faith, which has since the time of the ancient Rabbis at least emphasized study (of Torah) as a key -- if not the key -- way of worshipping God.

Sunday, January 07, 2007

The intersection of religion and psychology

יום ראשון י"ז בטבת תשס"ז

I’ve been reading Jack H Bloom’s The Rabbi as a Symbolic Exemplar (one of the most influential books in recent decades on the training of rabbis in professional skills), and have been wrestling with how much I both agree and disagree with much of what he says.

One of the main aspects of Bloom’s work (not surprisingly as he is both a rabbi and a psychotherapist) is his view that religion and psychology are complimentary to one another (see, Neil Gillman’s foreword, pg. x).

I, on the other hand, have long viewed them as being almost complete opposites -- ones that are often in conflict with one another. But this view has been deeply challenged ever since I started to get serious about chaplaincy and, especially Clinical Pastoral Education (CPE), which is, at its core, profoundly committed to the complimentary use of the insights that both religion and psychology give us.

So, here is my current attempt to resolve/understand the conflict – it all centers on a fundamental cornerstone of my theology: on the Bible’s declaration that mankind was created in the image of God (בצלם אלוהים/btzelem elohim).

I can only begin to explain the very profound and complex meaning בצלם has for me. But, one part of it is the belief that every human is unique and is inherently beautiful in that uniqueness.

So, I think I now see psychology as doing two things that are in tension with one another -- 1) doing violence to בצלם, and 2) aiding in our understanding of it:

  • Violence – that is, when psychology takes us away from understanding the individual as unique (and thus beautiful). Psychology does this by its very nature because it routinely has us categorizing and labeling people.
    • One very common case of this that I have seen many times is when a psychotherapist diagnoses a person as a borderline. Usually, that is the end of the psychotherapist having any desire to further work with the person – the diagnosis essentially means the person is untreatable. . . . As a chaplain – someone motivated out of a religious tradition (with בצלם deeply within it) -- I am not so quick to give up on people in this way.
  • Aiding – that is, aiding in our understanding of the uniqueness and beauty of each individual. Or put another way, psychology is useful to me when it (as does religion for me) fits in with the search for truth. . . . that is, the truth of what life, humanity and existence are all about. . . . The tools and theories of psychology help open my eyes to things about the (holy!) individual before me that I could not have seen without it.