Sunday, April 29, 2007

Spirituality for undergraduates

What's the single most healing thing you can offer to a suffering person? Giving them the opportunity to tell their story.

This single important fact has underpinned how we have trained hospital chaplains for many decades now. But, in recent years other professions -- including doctors -- have started to recognize this as well and have started to integrate this fact into their own training curriculums. And, as I learned at the Spirituality in Health Care Education conference last week, even pre-med (or maybe pre-med) undergraduates are getting a taste of this.

Professor Elizabeth R. Mackenzie spoke about a freshman writing tutorial class she teaches on healing narratives and humanistic medicine.

When I was an undergraduate at Grinnell College, I took such a freshman writing tutorial (mine was on Eastern European history) and I remember it as one of the most influential and inspiring classes of my entire college career. Dr. Mackenzie's class also sounds like it has the potential to be that exciting for her undergraduates thinking of entering medicine.

They have some eight essays over the course of the semester. The first two sound very exciting:
  • 1) Write a first-person illness narrative that ends with a life lesson that can be applied to others.
    • As Mackenzie points out, this can be heady stuff for a 18-year old who may have led a somewhat sheltered life and may never have been seriously ill. But she said, for example, an athlete could write about a time he or she got injured; there's a lot of excellent learning for a young person in thinking about how that experience might reflect something general about the human condition and not just their own individual experience.
  • 2) Collect an illness narrative by interviewing a peer using active listening techniques.
    • This helps introduce them to the whole idea of qualitative research, she said.

Here are some of the books she uses:

Here are some articles she uses as well:

One fascinating question that was only touched on briefly at the conference was the question of whether medical education should be involved in helping the doctor his or herself to be spiritually healthy. As David Hufford pointed out we would not, for example, make going to the gym part of a student's education on cardiology; we leave it up to the individual student to take care of whatever they might need to do to maintain their own physical health, and do not make it part of their formal learning.

I would agree about that example. But I think spiritual health is fundamentally different than physical health -- a physician in bad spiritual health (one who, for example, is so burned out from seeing death and suffering that they can hardly stand to talk to patients anymore) is one who is going to do damage to his or her patients. In short, I don't see how a physician who is not whole (spiritually), can possibly treat the whole patient (that is, treat the patient as a real person and not just a set of symptoms and diagnoses).

I think that's the point of Mackenzie and Charon and Barry Bub's work -- it's not just about benefit to the patient. It's about benefit to the doctor, and the assumption is that that benefit to the doctor ultimately accrues to the patients as well (who get better treatment, as a result). Bub, I think, would even say that the benefit the patient gets is not just spiritual, but is physical as well. That is, the physician who is whole enough to listen better is going to be able to miss less things and ultimately be able to diagnose and treat more effectively.

Hufford, however, seems very concerned that medical school teaching on spirituality not look soft in any way. For it to be taken seriously by students, he says it is essential that it be required, tested and graded. Just as it would be for a class on cardiology, he says the classroom curriculum needs to focus on real cases and needs to include real research based on real statistics. The content needs to have "clinical utility" he says. In that vein, it is important to point out that, no matter what you may think about the place of spiritual concerns in medicine, a very high percentage of patients make their most serious medical decisions based in part on religious/spiritual concerns; this alone makes it important to train physicians to have some sensitivity to spirituality, he says.


Another fascinating thing about Mackenzie's course is that she has had her students create and maintain some entries on Wikipedia. She said her students created the narrative medicine entry there, as well as the one on humanistic medicine.

This week in Boston!

This evening I will be heading off to Boston for the Rabbinical Assembly's annual convention.

It will be a great chance to reconnect with some old friends and colleagues, and an opportunity for some great learning. I am especially looking forward to hearing Jonathan Sarna, and hearing some of the sessions on Rabbinic Self-Care.

As I continue with my chaplaincy training, I am building skills and experience to help rabbis in this very important area of making sure to take care of yourself at the same time you are taking care of others (a very challenging thing to do as anybody in a caring profession well knows). I am looking forward to hearing more about what people are currently doing in this field.

Friday, April 27, 2007

God in five minutes or less

First of all, I wouldn't know what I'm doing, but mostly I don't have enough time!
A typical doctor's reasons for not addressing a patient's spiritual concerns.
Some 77% of patients want their physicians to address their spiritual concerns, but only a tiny fraction of doctors actually do, according to one study clinical psychologist Jean Kristeller cited at this week's Spirituality in Health Care Education conference.

To me, this kind of statistic is the most convincing kind of empirical evidence for integrating spiritual care into the health care system as well as making it a part of the way doctors and other medical personnel are trained. In contrast, trying to measure (in a scientific way) whether spiritual care (and/or prayer) actually improves people's health -- as critics of spirituality in medicine like Columbia University's Richard Sloan have pointed out -- has turned out to be extremely difficult.

But the patient's desire for this kind of treatment from their physicians should be enough of a reason to demand that doctors do do this (not to mention the fact that there are probably benefits that are not so easily measured with the tools of science). And, as Kristeller points out, the fact that some 10% of patients are uncomfortable with their doctors inquiring about this, is hardly reason enough to deprive the overwhelming majority who do. And since when do we say it is ok for doctors to avoid certain subjects with their patients because it makes the patient uncomfortable? Many people are uncomfortable being asked about their sexual history, but such questions are part of any standard medical history taking.

But that is not to say that the discomfort that some people may feel in being asked about their spirituality is not something that should be treated seriously. It also doesn't mean that physicians' concerns about their time shouldn't be taken seriously.

So, is it possible to train physicians to ask about spiritual concerns in a way that minimizes patient discomfort and that doesn't take a lot of time?

Kristeller says, yes. In an article she co-wrote with professor Leonard Hummel, she describes an interview script that she came up with for doctors to guide themselves through an effective spiritual interview that only takes five to six minutes (thus the title of this blog entry!). The script was used as part of their Oncologist Assisted Spirituality Intervention Study (OASIS). [The article can be found in the recent book Spiritual Transformation and Healing: Anthropological, Theological, Neuroscientific, and Clinical Perspectives]

Here is what the script looks like:
  • 1) Introducing the issue in a neutral manner
    • "When dealing with a serious illness, many people draw on spiritual or religious beliefs to help cope. It would be helpful for me to know how you feel about this." (emphasis, mine)
  • 2) Four paths to inquiring further, based on how the patient responds:
    • a) If the patient says they definitely have been helped to cope by their spirituality (a "postive-active" response) -- then the doctor responds, "What have you found most helpful about your beliefs since your illness." (emphasis, mine)
    • b) If the patient gives a more "neutral-receptive" response -- "How might you draw on your faith or spiritual beliefs to help you?"
    • c) A "spiritually distressed" response (such as anger or guilt) -- "Many people feel that way . . . what might help you come to terms with this?"
    • d) A "defensive/rejecting" response -- "It sounds like you're uncomfortable . . . What I'm really interested in is how you are coping. Can you tell me about that?"
      • This strikes me as an important part of the script for the doctor. It addresses the doctor's fear that he or she might offend the patient by bringing this up and gives them a graceful way out of that discomfort.
  • 3) Continue to explore further (based on the response in 2, above)
  • 4) Ask about the patient's ways of finding meaning and hope.
  • 5) Ask about the patient's resources/support system -- " do you have anyone you can talk to about these concerns?"
  • 6) Offer assistance where appropriate.
    • Refer to support group, and/or chaplain, etc. (Or even to a book to read.)
    • It seems to me this is another particularly important part of this script from the perspective of the doctor. It addresses the doctor's fear that they may get stuck talking with this patient for a long period of time (that is, it gives them an 'out').
  • 7) Conclude -- "Thanks for talking with me about this. May I ask you about it, again?"

Overall, I really like this script (and think it might even have application -- in a modified form -- for chaplaincy volunteers and students), but I have some criticisms and concerns:
  • It is both belief and coping centered
    • Belief -- This strikes me as a typically Christian assumption (that the essence of religion or spirituality is about belief; that is, that it is something that involves primarily thoughts). Yet, practices (including rituals) can be a much more important defining factor of many faith traditions and spiritualities. Ultimately, the defining factor in spirituality is about meaning, and meaning can come from many things other than a pattern of beliefs, including membership in a community and a set of rituals (see my blog entry on the definition of spirituality ).
    • Coping -- It is kind of maddening to a person (such as myself!) to see a thousands-year old system of faith (that one has devoted one's life to) reduced to a coping mechanism (as if it was the same thing as taking a pill!!). I don't worship God because God helps me cope -- I worship God because of my awe for God and my sense of submission to God's rule and commandments. It is something Holy to me, not a (mere) coping mechanism! And this, too, is what I seek to bring to patients -- something Holy, and not just a substitute for a pill!
  • It does not well address spiritual distress (2c)
    • A patient in spiritual distress is very often not at all ready to start talking about coping mechanisms (which is essentially what questions 4 and 5 are about). The pastoral care way to deal with a person in spiritual distress is -- ala Henri Nouwen's classic, The Wounded Healer -- to "deepen their pain." That is, to (before moving on to coping) help the patient explore the reasons for their pain/distress, and to heal by helping the patient feel less alone in their suffering.
    • Granted, deepening the pain is probably beyond the scope of the physician (who, unlike a trained chaplain, is not an expert at this kind of difficult spiritual exploration). It is also a task probably beyond the limits of the five-seven minute goal of the OASIS scripted interview. Thus, this is a good place to refer to a chaplain (or perhaps a social worker and/or therapist) and perhaps the OASIS script should be modified to reflect this.
  • The script does not directly address the key issue of hope.

Another concern is about properly training the doctors who do this. Kristeller says the doctors in the OASIS study were trained for two to three hours. She also points out that there is also an underlying assumption that the doctors involved are capable in basic (patient-centered) counseling techniques (although, it seems most medical school curriculums now have at least some basic counseling training in them).

But I have some concern that the script might actually be counterproductive in terms of good counseling techniques being used. As Fred Lee, a health care consultant (and author of fIf Disney Ran Your Hospital: 9 ½ Things You Would Do Differently) says, compassion means going beyond what you say. Focusing on what you say -- as a script does by its nature! -- means that you don't move beyond courtesy. But, certainly, in an encounter where a doctor is asking about a patient's spiritual concerns you, of course, want to move beyond courtesy to compassion. Lee -- whose work has become very influential at our hospital -- says that compassion is about what you feel. And the enemy of compassion is judging the patient. [It should be said, as well, that the OASIS script properly used is not meant to be stuck to word-for-word.]

All this also makes me curious about the focus on doctors. Could a script like this be used by nurses, or even admissions clerks. Or is there something about the doctor -- with all the authority that role bestows on him or her -- asking about these questions that is particularly healing?

Speaking of healing, Kristeller and Hummel note (pg. 276) that what they found to be healing about the OASIS approach for patients was not "prayer with patients, nor altering their treatment, nor even referral for spiritual counseling [but, rather] simply asking them a series of questions about their spiritual and religious resources." (emphasis, mine)

That is, it was the physician listening to the patient that helped! A book I would highly recommend for doctors (or chaplains and other educators of doctors) who are interested in improving their listening skills is Barry Bub's Communication Skills that Heal. Bub's book isn't packed with the statistics and careful research that Kristeller's work is. Rather, it is a a practical guide written by a doctor for doctors. But like Kristeller, he maintains that a mere five minutes or so is enough to help a patient feel profoundly listened to by the physician.

Bub also addresses a vital issue that I haven't seen from Kristeller -- how this might be healing for the physician as well. That is, it might help reawaken in the overstressed, burned out, jaded doctor the very idealism -- I want to help people! -- that might have been the very thing that brought him or her into medicine in the first place. [If you're interested in hearing more from Bub without buying his book he is featured in the "Healing Healthcare" podcast you can find on this page.]

This possibility of healing through listening is also very much touched on by what Kristeller and Hummel (derisively?) describe as the "theoretical musings of Rita Charon (2004) about the importance of narrative and empathy in the practice of medicine." (pg. 276)

There was another fascinating speaker at the conference -- professor Elizabeth R. Mackenzie -- who spoke in detail about her own use of narrative. I hope to write more about what she spoke about in the coming days.


A final question I want to touch on is how chaplains fit into all of this. There is some anxiety among chaplains about physicians (and psychologists, social workers, nurses, etc.) getting involved in spirituality in medicine. I think there are two foci for this anxiety:
  • 1) They're taking our jobs!
  • 2) They're doing it all wrong!

It's the second of these anxieties that I think is most worthy of reflection, and I think it comes to the heart of one of Columbia University professor Richard Sloan's objections to doctors being involved in spirituality (see, this article). Sloan is concerned that a doctor might not properly understand the coercive nature of the authority built into his or her role. That authority -- he says -- is proper when the doctor is recommending a medical treatment ("you must take this pill if you want to live!"), but not when matters of belief or religion are involved (as we, as a nation, believe in freedom of religion).

In clinical pastoral education, of course, we are very concerned with helping chaplains understand how they carry this kind of authority and how that impacts the spiritual care they do with patients. Anybody who has been involved in this part of the pastoral education process knows how very hard it is to come to well understand the authority one carries and how that might intimidate or coerce a patient; it is hard for me to believe that such an understanding can be met in the kind of short training session OASIS uses.

I am especially concerned because of the spiritual work I have seen some doctors and psychologists doing in health care settings. Sometimes there seems to be a very poor awareness of how the caregiver's own belief systems are being imposed on the patient. Either that, or the caregiver is just not giving enough value to the importance of the discipline of keeping one's own religious values under control in an interfaith and/or secular setting.

In clinical pastoral education we work very hard to train future chaplains and clergy to be aware of these issues. We know how much damage can be done to folks -- especially the kind of folks who have been wounded by their clergy (by sexual abuse or less onerous coercive and inappropriate behaviors) when they were children or otherwise vulnerable -- by imposing your belief structures on them. We know how important it is to allow people to voice anger at God or religion. It is painful to us to see people engaging in spiritual caregiving without the kind of training we have undergone in being sensitive to these issues.

Getting back to the first anxiety ("they're taking our jobs!"), the evidence seems to indicate that this fear is misplaced, at least with doctors. The OASIS study data said that 85% of the doctors in the study felt that a chaplain was the ideal person to be involved regarding a patient's spiritual concerns.

And, a study mentioned at the conference by the chief chaplain from the Hershey Medical center, Paul Derrickson, that one of the main effects of making medical students aware of the work of the chaplain was to dramatically increase the number of times they made referrals to chaplains when they working with patients.


I think, having now written and reflected on all this at some length that what I would ideally like to see done with something like the OASIS survey is to have chaplaincy integrated into it from the git-go. That is, it's perfectly fine to have a doctor use a tool/interview like this as a form of making a spiritual assessment (and, as chaplains well know and as the OASIS data supports, the spiritual interview/assessment in and of itself has a healing effect on most people). But at defined points in the interview script, there should be triggers to make the interviewer consider referring the patient to a chaplain. In particular, any patient in spiritual distress should be talking to a chaplain.

For many oncology practices, however, this may not be practical at the present time. Chaplaincy (and chaplains) tend to be hospital based. But most cancer care is outpatient these days. This opens up the question for the world of chaplains of how we might be able to become more involved -- and how we might be able to fund that involvement -- in the outpatient care of cancer patients.


[6/18/07 -- Another method for a physcian to take a "spiritual history" is Christina Puchalski's FICA. Here is an article, in which she cites FICA.]

Thursday, April 26, 2007

Who are the experts in spirituality in health care (revisited)

At the Spirituality in Health Care Education conference, yesterday, one of the speakers give a list of people one major health care center is considering inviting to be a scholar-in-residence on health care and spirituality:

  • Ira Byock, MD -- long time palliative care physician and advocate for improved end-of-life care. and author of Dying Well.
    • I heard Dr. Byock speak at our hospital some months back; it was very worthwhile!
  • Ed Pellegrino, MD -- Professor Emeritus of Medicine and Medical Ethics at the Center for Clinical Medical Ethics at Georgetown University Medical Center.
  • Stephen Post, PdD -- Professor of bioethics, of philosophy and of religion at Case Western University. He is also president of the Institute for Research on Unlimited Love, which focuses on the scientific study of phenomena such as altruism, compassion, and service and author of a series of books on ethics, aging and health.
  • Christina Puchalski, MD -- Professor, Departments of Medicine and Health Care Sciences at The George Washington University School of Medicine.
    • Her work, especially on helping doctors come up with ways to do spiritual assessment, was mentioned prominently at the conference.
    • Here is an article that mentions her work and contrasts it with her critics.
    • She is the author of A Time for Listening and Caring: Spirituality and the Care of the Chronically Ill and Dying
  • Richard Sloan, PhD, professor of behavioral medicine (in psychiatry) at Columbia University and a critic of spirituality in medical education. Author of Blind Faith: The Unholy Alliance of Religion and Medicine.
  • John Stone, MD -- Former professor at the Emory medical school. Now, a "poet, essayist, cardiologist and lecturer".
  • Rabbi Gerald Wolpe -- A rather famous Philadelphia-area rabbi who has become very involved in bioethics in his retirement.

Note that this list is long on people who are professors at medical schools and/or are physicians. Bioethics -- as opposed to spirituality per se -- also seems to be heavily weighted on this list. Some of these people have published books that are fairly well known among the general public.

I suppose the emphasis on medical school professor types -- as opposed to the kind of people better known among the general public as voices on spirituality and healing -- should not be surprising. After all, this list comes from someone speaking at a a conference superficially concerned with medical education, as opposed to interests of the general public.

I think that also gives a hint as to why the room was not packed at the conference. The organizer seemed surprised by this - after all, there is an explosion of interest out there in spirituality in medicine, so wouldn't you expect there to be a large number of people interested in hearing about it?

But, I think it is always important to keep in mind who our audience is. The conference, as it was put together, wasn't, for example, really oriented towards doctors (or medical students). There may indeed be a large number of doctors who are interested in learning how to integrate addressing patients spiritual needs into their practice. But this conference actually had little for them -- it, instead was oriented to people (perhaps me!!) who might give seminars or classes to teach doctors and medical students about these things.

Further, maybe you would have had a packed room if the conference had been oriented towards the general public (that is, to the average patient or family member). Perhaps a _sexier_ title might have been -- how to get your doctor to listen your spirit (and not just treat you like something that has a disease).

But, that would have been a different conference. And, I was glad to be at this one -- one oriented to people (like me!) interested in how doctors are educated. Doctors, obviously, will always be in a much more influential position to influence the shape of health care than (the very small number of) chaplains can ever be. If doctors can be acculturated and trained to expect spirituality to be a central part of health care, then it will.


By the way, here is the first post I made on this subject.

Bob, we hardly knew ya

One of the most inspiring voices I had found among Clinical Pastoral Education supervisors was Bob Cholke of the Cooper Heath Care System. His voice had the firm and fearless sound of a prophet. In it, you heard the passion and conviction of one who believed in the work of the chaplain and of the chaplain supervisor. I was looking forward to hearing more of it and learning more from him. I expected him to become one of my key role models as my career moves forward.

Now, it turns out I won't have that chance. Bob has just passed away suddenly and unexpectedly.

Among Bob's survivors is his wife, Joanne Martindale, who is the Director of Pastoral Care at Ancora State Psychiatric Hospital in New Jersey.

My heart goes out to her and all who cared for Bob.

May his memory be a blessing.

Information on Bob's funeral can be found here.

Wednesday, April 25, 2007

A battle won?

One of the most striking and encouraging things at the Spirituality in Health Care Education conference, today was to hear David Hufford, a decades-long veteran of educating medical students about the importance of spirituality in treating patients, say how much those students have changed over the years. Years ago, he had to start his classes with efforts to convince the students that it was worth their time to study this, he said. But students nowadays come to him already knowing it's important, and so he can move much sooner to teaching the 'how' of bringing spiritual concerns into patient treatment.

This gives me real hope that the job of integrating spiritual care into medical care will become easier in the future as the students of today become the medical care leaders of the future. And the beneficiaries will be the patients!

There was so much else that as interesting at the conference and I hope to find time soon to share some more of that here!


The miracle of spring

One of the things I love about living on the East Coast is the intensity of seasons here.

Just a few days ago it seemed like all the trees – with the exceptions of the early blooming ones full of flowers – still had the bare look of winter and the skies were gray. But then came some heavy rains and a couple of days with sunshine and all of a sudden the world has changed. Driving down to Philadelphia under sunny skies to the Spirituality in Health Care Education conference this morning, it seemed like all the trees had at least started to bud and the lower lying growth had already become the green of spring and summer.

Blessed are you, Lord our God, King of the Universe, who set the earth around the sun and tilted it in such a way to give us the miracle of the seasons!

Tuesday, April 24, 2007

The truth is always more heroic than the hype

Those words were spoken today on Capitol Hill by former Army private Jessica Lynch.

Sometimes it might seem too obvious to bother to state that lying is a bad thing. But, actually we need reminding all the time. The temptation to tell lies -- especially when we convince ourselves that it is actually in the best interest of the person we are lying to or about -- is sometimes overwhelming. We even have a phrase for doing this -- telling "white lies". Especially when people are sick, or in the hospital, we are tempted to lie to them -- to tell them they are sure to get better when we know they probably will not. We convince ourselves that we are serving them when we do that.

But the story told by Ms. Lynch and by the family of Army Ranger and former football star Pat Tillman should remind us of how painful lies can be.

It would be easy to convince ourselves that the military's lies about Lynch were in her best interest. After all, who wouldn't want to be hailed as a brave, gun-toting hero, as she was? Why would anyone want people to know that the truth is that you let your gun barrel get jammed with sand and that you endured sexual assault at the hands of your enemies?

Lynch bravely answered, today: "The truth is always more heroic than the hype," she said. "The American people are capable of determining their own ideals for heroes, and they don't need to be told elaborate lies," she also said. "I had the good fortune to come home and to tell the truth. Many soldiers, like Pat Tillman, did not have that opportunity."

Tillman, of course, was killed by "friendly fire" (that is, accidentally by his fellow soldiers) and not by the enemy as the military had long contended. HIs family testified as to how deeply wounded they were to realize that the military they had trusted and whom their loved one had served so bravely and faithfully had broken their faith with them by deceiving them about TIllman's death.

May it be the will of the Blessed Holy One that we find the strength to tell the truth even in the times when it is hardest and to keep our faith with those who trust us and count on us.

Letting nurses know that by them we are blessed

Sunday May 6 begins National Nurses Week. One thing that many hospitals -- including ours -- do to honor nurses is to send our chaplains out onto the floors to do a "Blessing of the Hands" ceremony. This can -- as it does for us -- just involve words (saying a prayer/blessing for the nurses). But some hospitals take it a step further and do a ceremony that includes anointing nurses' hands with oil.

Judaism, however, has had no tradition of anointing since the time of the Bible. Therefore, Jewish chaplains can find the demand that they participate in an anointing ceremony to be a troubling crossing of interfaith boundaries. This led, last year, to a very interesting discussion on the National Association of Jewish Chaplains mailing list.

Some Jewish chaplains shared that they would refuse to do any such a ritual as well. Others shared that they had come up with a more Jewish version of such a ritual -- a hand washing ceremony (based on the Levites washing the hands of the Cohanim/Priests, something for which there is substantial support in the Jewish tradition).

This led me to do some thinking about what the nature of blessing is in Judaism. Can we bless things? Can we bless people? Can we bless parts of people's bodies? What are we really saying when we do these things?

The Jewish way of answering such a question is to look to our ancient texts and traditions for guidance. The most prominent example of people blessing other people in our tradition comes from the 6th chapter of the book of B-Midbar (Numbers, verses 24-26). It is the priestly blessing (בירכת כוהנים/birkat kohanim) which God tells Moses to instruct Aharon and the other priests to use to bless the people Israel. It is a blessing that has been anything but buried in the Jewish tradition -- it is featured prominently in the regular prayer liturgy and is part of the traditional blessing parents say to their children:
כד יְבָרֶכְךָ ה', וְיִשְׁמְרֶךָ.
כה יָאֵר ה' פָּנָיו אֵלֶיךָ, וִיחֻנֶּךָּ.
כו יִשָּׂא ה' פָּנָיו אֵלֶיךָ, וְיָשֵׂם לְךָ שָׁלוֹם.
כז וְשָׂמוּ אֶת-שְׁמִי, עַל-בְּנֵי יִשְׂרָאֵל; וַאֲנִי, אֲבָרְכֵם.

May HaShem bless you, and may He keep you.
May HaShem shine His face upon you, and extend grace unto you.
May HaShem lift His face upon you, and may He give you peace.
[In this way, they will put My name upon the people Israel, and I will bless them.]
The last line (the one I put in brackets because it is not part of the blessing proper) makes one thing quite clear -- the actual source of the blessing is not the priests who offer it; the blessing itself comes only from God. The priests are merely requesting that God carry out this blessing for the people.

If we are to take birkat kohanim as our model, then, any blessing of a person should actually be a request to God to bless that person (and his or her works) -- something along the lines of, May God (or we could substitute a nice name for God like 'The True Source of all healing') please bless these hands, so that they may bring true comfort and healing to others. Keep their work in Your sight, Lord, and guide them on their proper path.

I think the original author of the prayer that is now most commonly used in the Blessing of the Hands nurses week ceremonies had a similar sentiment about the nature of blessings. Her name is Diann Neu, and she is a Catholic feminist liturgist and psychotherapist. When I wrote her last year, I shared with her a copy of her original prayer (which was not written with nurses specifically in mind) with her. She pointedly let me know that the text had been changed from her original in one important aspect:

(not specifically written for nurses)
The text I found
The author's actual original

Blessed be the work of my hands.
Blessed be these hands that have touched life.
Blessed be these hands that have nurtured creativity.
Blessed be these hands that have held pain.
Blessed be these hands that have embraced passion.
Blessed be these hands that have tended gardens.
Blessed be these hands that have closed in anger.
Blessed be these hands that have planted new seeds.
Blessed be these hands that have cleaned, washed, mopped, scrubbed.
Blessed be these hands that are wrinkled and scarred from doing justice.
Blessed be these hands that have reached out and have been received.
Blessed be these hands that hold the promise of the future.
Blessed be the work of my hands.

Blessed be the work of your hands, O Holy One.
Blessed be the work of your hands, O Holy One.

That is, there is a clear recognition by the author of the original of who the real owner (God) of those healing hands is.

My guess is that people changed the original in an attempt to make the prayer palatable to people who don't believe in God (or in one God). I must admit that, as a chaplain, I feel stuck trying to come up with prayers that are both consistent with my core beliefs and that would be palatable to someone who doesn't have a God belief. (This, by the way, is not a barrier to me ministering to such a patient -- I don't need to pray with or for someone to show them caring.)

But, it is neither of the above prayers that we use in nurses week. The blessing most commonly used is an adaptation of Neu's orginal that a CPE Resident made (in Chicago, I believe):

Nurses' Hands

Blessed be these hands that have touched life.

Blessed be these hands that have felt pain.

Blessed be these hands that have embraced with compassion.

Blessed be these hands that have been clinched with anger or withdrawn in fear.
Blessed be these hands that have drawn blood and administered medicine.
Blessed be these hands that have cleaned beds and disposed of wastes.

Blessed be these hands that have anointed the sick and offered blessings.

Blessed be these hands that grow stiff with age.

Blessed be these hands that have comforted the dying and held the dead.

Blessed be these hands, we hold the future in these hands.

Blessed be our hands for they are the work of Your hands, O Holy One.
Note that the last line of this version includes an acknowledgment of the ultimate source of the hands being blessed. I nonetheless am not entirely comfortable with this text as it does not make any reference to the Creator until the last line.

A modification that I think would bring it closer to the Jewish tradition would be something like this:

Blessed are Your, Lord/HaShem our God the creator of hands that touch life . . . ..
Last year, one Jewish chaplain shared with me prayers he created that he was more comfortable with. I like both of them more, as they answer my core concerns. (Both, by the way, were meant to be used with a handwashing ceremony, which is why the language of "lifting hands" (נטילת ידיים/nitilat yidayim) is used). The first is meant to be specifically Jewish:

Praised are You, Eternal G!d, Sovereign of the universe,
who hallows us through mitzvot, and commands us
to lift our hands.

The second is meant to be more suitable for all:

Praised are You the eternal source of all
who enables us to lift our hands
that we may continue
to do our work
day after day.

In the course of the discussion, one Jewish chaplain suggested the use of Psalm 90:17, another suggestion that I like and I think is firmly rooted in our tradition (especially as we recite it traditionally before performing some mitzvot).

יז וִיהִי, נֹעַם אֲדֹנָי אֱלֹהֵינוּ-- עָלֵינוּ:
וּמַעֲשֵׂה יָדֵינוּ, כּוֹנְנָה עָלֵינוּ; וּמַעֲשֵׂה יָדֵינוּ, כּוֹנְנֵהוּ

May the favor of the Lord our God be upon us,
And the labors of our hands, uphold them for us.
The labors of our hands, uphold them!
[A perhaps nicer translation might be, May the pleasantness of my Lord, our God, be upon us -- may He establish our handiwork for us; our handiwork may He establish.]

In conclusion, I would endeavor to avoid any kind of ceremony that looks anything like anointing; it's just not consistent with the Jewish tradition. Handwashing, to me, looks a lot like anointing, especially if it is a matter of one person washing _another_ person's hands. The only place I know of that in the tradition is the Levites washing the priests. Are we saying that nurses are like priests when we do this? I know there are some other places washing has come into the modern tradition (some people wash a female child's feet at a baby naming ceremony), but that strikes me as a place where a lack of a ritual (that is, an equivalent to the drama and power of circumcision for a boy) was especially glaring (which really is not the case with nurses hands!).

As far as prayers, I could imagine a number of options, including some use of Psalm 90 and/or an adaptation of the two prayers the other Jewish chaplain used.

But I also think I can live with the "Nurse's Hands" adaptation of Neu's prayers. I think the key for me would be to add an impromptu introduction I would give just myself (out loud to the group) before asking everyone to say the written text together. The introduction would make clear: a) that the prayer we are about to say together is addressed to God, and b) that we are saying it to ask for God's blessing to be upon us (and the work of our hands). Then we could recite the text of the Nurse's Hands prayer together.


By the way, when I wrote Neu last year, here is how she responded to my asking her if she was pleased about the adaptation of her original prayer:

I am pleased to see that my blessing is meeting the needs of the nurses. I see myself as a healer and feel strongly that healers need to be blessed for the work that we do.

And I was fascinated by what she shared about how she came up with the original prayer:

I was teaching a liturgy course and gave my students (Christian and Jewish) the assignment: take a symbol and write a blessing. I do the same assignments that I ask my students to do. So, about one hour before the class convened, I started to do the assigment. I searched for a symbol. Looked at my hands. Wrote the blessing.

Monday, April 23, 2007

Day of independence

Today is the 6th if Iyyar, Israel Independence Day (יום העצמאות; Yom HaAtma'ut).

Last year my former teacher, David Golinkin of the Schechter Institute of Jewish Studies in Jerusalem wrote an interesting history of prayers that Jews have said over the centuries for the countries in which they have lived.

He concludes his article with these words:
For thousands of years, Jews prayed or offered sacrifices for the king or the government primarily because they were afraid of them. In the nineteenth century, Jews in democracies such as the United States began to compose new prayers which expressed their true love and identification with their country. In 1948, the Jewish people for the first time since the days of King Alexander Yannai, entered a new phase of its history when it could pray to God to preserve and protect the State of Israel, “the beginning of our redemption”. As we celebrate Israel's 58th birthday, we hope and pray to God: “Bless the State of Israel…protect her under the wings of Your grace and spread over her a Sukkah of peace”.
May we not forget what a gift it is to live in a time where Jews are free to choose the government under which they live. And may we never forget our love for Jerusalem and its people.

A hope for peace

“How can you spend so much time around all the suffering you see in the hospital?” people ask me sometimes. But, what they don't know is how much my work is a source of inspiration and hope for me. And, I don't just mean my work with patients; I also very much mean my relationships with my non-Jewish colleagues.

I thought of this last week when I was at an interfaith conference in New York (the CCJU's "Colleagues in Dialogue" conference). The rabbis there with pulpit jobs were bemoaning how very difficult it is to get serious interfaith dialogue going back in their home communities. One young rabbi even recounted how he had been taken aside by some leaders in his community and scolded for talking with the “wrong people” in his efforts to reach out to some non-Jewish clergy. Others rabbis just complained about how hard it is to get their congregants interested in conversations of any great depth with other faith communities. They all asked the group (which included a variety of Catholics and Protestants) for their suggestions on how to improve their interfaith efforts when they go back home.

I sat there, silent, searching my mind for something useful to add to the discussion. I was surprised that nothing was coming to mind. And then suddenly I realized why – in my work I am privileged to experience very deep interfaith dialogue as almost a matter of course throughout my day.

And the interfaith dialogue I am privileged to experience is not just the kind of dialogue where people share information (“I’ll tell you about how we do prayer in my religion if you tell me how you do prayer in yours”), as useful as that kind of dialogue is. No, the dialogue I experience is also the kind that may be most hardest to get to – the kind where people of different faith traditions get to share spiritual experiences.

We recently had a patient at the hospital who had spent days amid winter weather alone, injured and unable to move trapped by a lonely set of railroad tracks. By the time he was found, his limbs were so damaged by frostbite that the surgeons were forced to remove most of his hands and feet, including all of his fingers.

To this point all you have is a tragic story. You have a story of such great loss that it would make almost anyone give up and just want to die. But the story of this man – call him “Jim” – does not end there. He did not crawl into a corner and die. He surprised everyone who had contact with him by refusing to give up. The physical therapists were amazed and inspired by how hard he worked every time they were with him to get back as much function as might be possible. They say that he never complained.

Another of our chaplains – a Catholic – formed a relationship with Jim and went to see him regularly during his long stay with us. One of the things that we do – as fellow chaplains in a Clinical Pastoral Education program – is hold case conferences where we present our encounter with a particular patient in great detail. And so this chaplan presented Jim’s case and what his interaction with Jim meant to him.

What happened in the room in the following minutes where the chaplain presented the case (and then we discussed it) was something powerful and Holy. I was deeply moved myself and spent a significant amount of time with tears in my eyes, as did some of the others in the room.

Why was I so moved? Because of what Jim _and_ Jim’s effect on this chaplain and others says about the human spirit. About the beauty and resiliency of that spirit, a spirit that I understand as a gift from The Blessed Holy One. A spirit that I understand as a sign that we are indeed made in the image of God (בצלם אלוהים).

The most miraculous thing about Jim’s case was to see what he awoke in others. Many people enter medical care fields out of a sense of an idealist hope to help people. But the hard reality of medicine in a cost-conscious world and the amount of suffering one is exposed to can make folks – even chaplains!! – hard and jaded over time.

I, however, had opportunity on my own to see what Jim awoke in the eyes of some of the people who had contact with him. His spirit awoke in them their own spirit of love and caring. He called forth in them the Bible’s command to care for the poor, the stranger, the widow and the orphan who are among you. He reminded them of what is Holy within them. He was a miracle to them.

What did Jim mean to my Catholic friend? I am not sure exactly. It is certainly possible that he saw something of Jesus in him, that he saw Jim’s suffering as somehow taking on the sins of others as Christians believe Jesus’ suffering took on their sins. It is possible that he saw Jim as somehow Holy because of his poverty, in line with a Christian belief – one not shared in Judaism – that there is some inherent religious value in poverty.

And so, I – as a Jewish person who most certainly cannot share a Christian’s belief in Jesus -- could not have the same religious experience as my Catholic friend did in reaction to Jim (as our theologies really are different). But, despite the differences in the nature of our religious experience around Jim, we were able to share that experience together. We were able to both have a powerful experience of the Holy together.

The rarity and preciousness of such profound sharing across religious boundaries is what I was reminded of at the CCJU conference. It gives me great hope to be reminded in my work of the possibility of such shared experience. To me it is a beacon of hope – it says to me that what we share as people of faith is more significant than what is different. And, perhaps more importantly, that it is possible to maintain our differences at the same time we share what can be common between us. This is the hope for the future, that people of all the world’s faiths will hear the call to live in peace – Shalom! – that sits at the center of every great faith tradition and will learn tolerance and love for one another across our differences and particularities.

May it come speedily and in our days.


At the CCJU conference, one of the speakers, a professor and Catholic nun by the name of Mary Boys, broke up interfaith dialogue into four types. I’m not quoting her here, but it went something like this:

  • Dialogue of life (talking with your neighbor of a different faith just over the back fence; that is, just talking with someone in the course of your regular everyday business).
  • Dialogue of action (working together with people of different faith in a soup kitchen . . . I am reminded of serving Christmas dinner to the homeless along with other members of my synagogue when I lived in New York)
  • Dialogue of spiritual experience (sharing a ritual together, like perhaps a interfaith Thanksgiving service).
  • Dialogue of theology (one of the people at the conference suggested that this might be a shared text study, but I wonder if that is not more like spiritual experience).

It’s worth keeping these categories in mind as you approach your own interfaith efforts. The last two of these four are the ones that people are sometimes most motivated to try, but they are also the very hardest to do (I am reminded of how hurt some Christians are when they find out Jews felt excluded by a prayer service they had tried so hard -- but naively -- to make 'interfaith' in advance). At the early stages of an interfaith dialogue effort just getting to know one another might be considered a victory. A dialogue of action effort has great potential for this and can very often be the easiest to enter into.


Another way I am privileged as a person working closely with non-Jewish clergy is to hear some perspectives that I might not have access to otherwise. One of my colleagues is from South Korea, the same country that the shooter at the Virginia Tech tragedy was.

When I asked my colleague if the fact that the killer was Korean had any significance to him, I learned a way of looking at what happened that I would probably never have seen otherwise. My colleague said that his greatest feeling in regards to the shooter was that his community was not able to help him (with his troubles). And he put the understanding of the young man’s afflictions through the prism of the lens of a native of Korea. That is, through the lens of being a male from a culture in which direct confrontation – including direct eye contact – is much discouraged, and then to find yourself in another culture (the shooter came to the US at age 8) where people are offended if you do not make eye contact with them and where direct confrontation – especially among males – is often expected and encouraged.

This new knowledge has the potential to help me as I work with patients going forward. If I should be ministering to a angry, young male from a place like Korea, it will give me the insight to be open to the possibility that the person before me is suffering in part from a difficulty adjusting to American culture. That understanding could help me to help that young person cope with their anger and the underlying casues.

Sunday, April 22, 2007

A light unto the nations

One of the most amazing things about working as a Rabbi/Chaplain to an overwhelming Christian population is to hear Christian patients testify about what Jews and Judaism have meant in their lives.

Just today -- at the end of a conversation of nearly an hour about her fears and troubles -- one such patient suddenly mentioned Liviu Librescu, the 76-year old Virginia Tech professor and Holocaust survivor who so bravely fought to save his young students' lives by blocking the door to the crazed gunman who stood on the other side. As she spoke, a tear came to the patient's eye, and, I'm not ashamed to say, to mine as well.

Professor Librescu, you are not just a hero for the lives that you saved -- at the cost of your own -- in that classroom on that day. You are a hero also for the message that you sent to people everywhere with your actions. Your name is surely a blessing to all of us.

Tuesday, April 17, 2007

New excitement at the CCJU

Today and tomorrow I'm at an interfaith conference in New York put on by the Center for Christian-Jewish Understanding (CCJU).

This is the third time I've been at one of the CCJU's events, but it was the first time I got to hear some of the Center's newer staff members (Ann Morrow Heekin, Ph.D., Director of Programs and Publications; and Rabbi Eugene Korn, Ph.D., Associate Executive Director) speak. I was very impressed by their energy and commitment and I feel very excited abut the future of the Center's work.

I look forward to telling you more about it soon!!! (While I was here, I also heard about some exciting new projects for Jewish text study that I hadn't heard about before that I will write about soon.)

Monday, April 16, 2007

The bed side is the classroom

That is how I heard a colleague on Friday describe what the "clinical" part of Clinical Pastoral Education is all about (specifically, he was referring to a student of his who didn't get it, and, instead, thought she should be taught everything about pastoral care in a classroom before ever working with patients).

Anyway, it's such a wonderful phrase that I can't imagine my colleague was the first to say it, but I just think it's such a wonderfully simple and direct way to describe what clinical learning is about that I wanted to take note of it. . . . He went on to describe classroom learning in CPE (specifically, the lectures we usually call them didactics) as necessary, but, nonetheless, essentially as "fluff."

I really couldn't agree more. When I think of the people who have taught me so much about pastoral care it is almost never from their lectures. It's from watching them work with patients (and other CPE students) or from receiving feedback from them about my own work (at the bed side!!).


Thursday, April 12, 2007

Who are the experts in spirituality in health care?

Some very wise person once said to me that if you ever want to become a leader in a particular field, look at the credentials that the leaders in that field hold, and then go out and get that credential/degree.

As a chaplain, I am, of course, very interested in the intersection between spirituality and health care. But do I have the right credentials to be a leader in this field? It has occurred to me that many of the voices most listened to in the field are those of doctors. Should a person like myself get a medical degree then? Or are there other credentials a leader in the field can hold?

In a couple of weeks I will be going to a half-day conference on Spirituality in Health Care Education at the Hospital at the University of Pennsylvania. The conference seems to be related to the U of P's Center for Spirituality and Mind,

So what kind of credentials do the people speaking at this conference hold?

Here are excerpts from the short bios of all the speakers (with the type of credential they hold in bold):

Phd in clinical psych:
Dr. Jean Kristeller received her doctorate in clinical and health psychology from Yale University in 1983. She is Professor of Psychology, and Director of the Center for the Study of Health, Religion, and Spirituality at Indiana State University. . . . Her work on the role of the physician in addressing difficult issues and on spirituality has been supported through NIH and private foundations, including the Metanexus Institute and the Fetzer Institute.

Ph.D. in folklore and folklife
David Hufford, Ph.D., has taught about religion, spirituality and health at the Penn State College of Medicine since 1974, and he won a Templeton Foundation Faith & Medicine Award in 1995. At Penn he has taught courses in spiritual belief and in alternative healing traditions since 1979. In 1992 Hufford won the Martin de la Cruz Award (for contributions to the study of traditional medicine), conferred by the Mexican Academy of Traditional Medicine at the Sixth International Congress of Traditional and Folk Medicine.

Ordained clergy and a certified clinical pastoral education supervisor
Paul Derrickson is an ordained Presbyterian minister who has served at the Hershey Medical Center [Pastoral Services dep't] since 1981 as the Associate and as Coordinator since 1995. . . . . Paul's primary focus has been developing and articulating the new role for chaplaincy in the changing health care environment ..

Physician (internist)
Gail Morrison, MD, is Vice Dean for Education and Director of the Office of Academic Programs at the University of Pennsylvania School of Medicine.

PhD (in what? sociology? folklore?)
Elizabeth R. Mackenzie, Ph.D. is a Senior Fellow in the Writing Center at the University of Pennsylvania, a Lecturer in the department of Science, Technology and Society and an Associate Fellow of the Institute on Aging, UPHS. She currently teaches courses on humanistic medicine, holistic healthcare and therapeutic writing. Dr. Mackenzie completed her doctoral dissertation on health belief systems at the University of Pennsylvania and soon after joined the Institute on Aging at the University of Pennsylvania Health System to conduct research on cultural dimensions of health and healthcare.

Physician (a radiologist with a big interest in the links between spirituality and biology)
Andrew Newberg, M.D. is an Associate Professor of Radiology at the University of Pennsylvania and is director of the Center for Spirituality and the Mind. He is currently an Associate Professor in the Departments of Radiology and Psychiatry at the Hospital of the University of Pennsylvania. He received his M.D. from the University of Pennsylvania School of Medicine in 1993 and is Board Certified in Internal Medicine and Nuclear Medicine. Dr. Newberg has been particularly involved in the study of mystical and religious experiences as well as the more general mind/body relationship in both the clinical and research aspects of his career. He has also co-authored three books entitled, Why We Believe What We Believe: Uncovering Our Biological Need for Meaning Spirituality and Truth, Why God Won't Go Away: Brain Science and the Biology of Belief and The Mystical Mind: Probing the Biology of Belief that explore the relationship between neuroscience and spiritual experience. The last book received the 2000 award for Outstanding Books in Theology and the Natural Sciences presented by the Center for Theology and the Natural Sciences. He currently teaches a course on Science and the Sacred in the Department of Religious Studies.

Here are the topics these folks will be speaking on:

Training Physicians to Engage Spiritual Concerns:
Jean Kristeller, Ph.D.,
Director, Center for the Study of
Health, Religion and Spirituality, Indiana State University

Spirituality in Medical School Education:
David Hufford, Ph.D., Penn State College of Medicine

Research in Pastoral Care Education:
Rev. Paul Derrickson, Penn State College of Medicine

Humanistic Medicine in Undergraduate Education:
Elizabeth Mackenzie, Ph.D., University of Pennsylvania

Integration of Spirituality into Medical School Curriculum,
Gail Morrison, M.D., Vice Dean for Education, University of Pennsylvania

So what have we learned from this?
  • For this center/conference, at least, doctors are the leaders in the field of spirituality in medicine (and medical education)
  • Chaplains (actually just one) are involved, but they are only being looked for expertise about their own profession!!!!!!!!!!! They are not being asked to speak about spirituality for doctors, patients for medical students!
  • Some people are able to enter this field from seemingly unrelated disciplines by doing research on the topic (that is, a folklorist who writes about the role of folk beliefs in religion and in health being seen as an expert on how to bring spirituality into medical school education).
    • This path is of particular interest to me, I think. I am certainly no folkloreist, but one research interest I have long entertained (based on my experience studying the tractate of the Talmud most devoted to the laws of mourning; the third chapter of Moed Kitan) is to do a study of the texts related to mourning . . . That is not new, but this gives me the idea of perhaps giving it this sort of twist/focus -- making a study in general of how ancient traditions have understood spiritual care (to the mourning, or also to how we minister to the ill? . . . or how a person can heal ones-self with spirituality?) AND how that understanding has changed over time. . . . And, then, with perhaps the main focus of the research being inside the Jewish tradition (with a special focus on the Talmud) . . . That would open up what kind of degrees/programs I could apply to. It could be history, for example, or religious studies. . . . What I like about this is that it keeps the focus of the studies/research inside religious (esp. Jewish texts), but it also gives that work (from the git go) a very real world kind of application (ie, a popularization of the work could be something like, The Talmud's Secrets on Healing). [or, perhaps, Healing in Judaism] .. . Cool!!!
  • A Doctorate in Clinical Psych is a potential path to earning respect inside the corridors of medical education
What this discussion really orbits around is something I've started to play around -- as much as becoming a CPE supervisor is something I want to do, I am not sure it is ultimately enough. I may need one more credential beyond that to become the kind of respected voice I want to be.

Anyway, it will be fascinating for me to look back what I have written here after I have actually heard these folks speak at the conference. . Maybe I will have a totally different view then! :)

More Vonnegut

Here are some quotes that are coming to mind, today:

From Mother Night (which I think is, ultimately, my favorite of his novels):

"We are what we pretend to be, so we must be careful about what we pretend to be."
I also like the quote the Times obit lifted from “God Bless You, Mr. Rosewater”:

“Hello, babies. Welcome to Earth. It’s hot in the summer and cold in the winter. It’s round and wet and crowded. At the outside, babies, you’ve got about a hundred years here. There’s only one rule that I know of, babies — ‘God damn it, you’ve got to be kind.’ ”

I think it must be hard for somebody who picks up Vonnegut's books for the first time, today, to really appreciate what they are about; much of their meaning came from contrasting what was within them with what was happening in the world around during the 1960s and early 70s. The Times article does a nice job of giving a sense of how the times in which Vonnegut wrote gave deep meaning (even political meaning) to a seemingly casual, throwaway phrase like "so it goes":

[“Slaughterhouse-Five,”] featured a signature Vonnegut phrase.

“Robert Kennedy, whose summer home is eight miles from the home I live in all year round,” Mr. Vonnegut wrote at the end of the book, “was shot two nights ago. He died last night. So it goes.

Martin Luther King was shot a month ago. He died, too. So it goes. And every day my Government gives me a count of corpses created by military science in Vietnam. So it goes.”

One of many Zenlike words and phrases that run through Mr. Vonnegut’s books, “so it goes” became a catchphrase for opponents of the Vietnam war.

Kurt Vonnegut dies

NEW YORK TIMES -- Kurt Vonnegut, whose dark comic talent and urgent moral vision in novels like “Slaughterhouse-Five,” “Cat’s Cradle” and “God Bless You, Mr. Rosewater” caught the temper of his times and the imagination of a generation, died last night in Manhattan. He was 84 and had homes in Manhattan and in Sagaponack on Long Island.

I just heard the news. I can't even begin to express the impact that Vonneget's works have had on my life. I think of him in the same way I think of Stanley Kubrick, another giant of post-World War II American artistic landscape: People call them dark. But I never saw them as dark. They may have used the tools of dark humor and satire to make their statements. But the point was the content of those statements. And I like how the Times characterizes that content -- as an urgent moral vision.

Kurt Vonnegut was a man of light, not dark -- a shining beacon of hope screaming that the world could be different and that we humans have been left with a choice of deciding whether the world should be a place of death and violence or a place of light and love. Kurt Vonnegut was asking us to choose life.

Choose life.

Sunday, April 08, 2007

A hidden wholeness

As promised, I spent some time over the last few days reading Parker Palmer’s latest book, A Hidden Wholeness: The Journey Toward an Undivided Life, in which he describes in detail how he uses things like the clearness committee to help people (and himself!) find their proper path in life.

This was the first time I have read anything of Palmer’s (his The Courage to Teach has been recommended to me, often, but I’ve never picked it up). On one hand, I was a bit disappointed by his writing. Unlike the book of the other creative educator I picked up recently (bell hooks’ Teaching to Transgress: Education as the practice of freedom), Palmer’s A Hidden Wholeness is not fueled by a compellingly written personal story. Some of his examples of how people were transformed by the clearness committee and other related practices were quite weak, as well.

But, on the other hand, I find some of his ideas quite compelling. To me, some of them sound like ‘Pastoral Care 101’. That is, they are statements of things that I think it is very important to make part of a pastoral care training program, and, as such, Palmer may become one of my theorists behind my own work going forward (as I work towards articulating my own personal theory of clinical pastoral education).

Here are some excerpts of parts of the book I found compelling:

If we want to create spaces that are safe for the soul [by soul Parker seems to be mean a relatively secular definition – something like true self or basic essence of a person; his work is centered around trying to create settings where people will feel safe enough to reveal their soul/true_self to other people (and thus to themselves!)], we need to understand why the soul so rarely shows up in everyday life.

[Parker goes on to explain a number of reasons why the soul/true_self is so afraid to be seen. He uses a nice image of the soul as being akin to a wild animal (powerful and beautiful, but also scared and shy). But he also succinctly expresses something that I often feel – that it is davka/precisely people’s insistence on helping (or fixing) that scares me away from sharing openly and honestly with them.]

. . . Convinced that people lack inner guidance and wishing to “help” them, we feel obliged to tell others what we think they need to know and how we think they ought to live. Countless disasters originate here . . . in presumptuous advice-giving that leaves the other feeling diminished and disrespected. (52)

[This sounds a lot like what I have heard as the definition of being patronizing – that we are patronizing when we assume (and communicate!) that we know better than the person themselves what he or she needs. . . . For Palmer, this would be a basic violation of the first rule of the kind of interactions he is describing. That is, Palmer assumes (in line with the Quaker tradition in which he is rooted) that each person has an inner voice or teacher that knows better than anyone else what it is that the person needs. The point of a discernment exercise like a clearness committee is to help a person hear their own inner teacher.]

Palmer also speaks compellingly of how when we are trying to minister to a dying person that this kind of relationship is the only one we have to offer:

When we sit with a dying person, we gain two critical insights into what it means to “be alone together.” [This phrase comes from Palmer’s discussion of how we need community to be able to be alone and we need to be able to be alone to be able to truly be with community.] First, we realize that we must abandon the arrogance that often distorts our relationships – the arrogance of believing that we have the answer to the other person’s problem. When we sit with a dying person, we understand what is before us is not a “problem to be solved” but a mystery to be honored. As we find a way to stand respectfully on the edge of that mystery, we start to see that all of our relationships would be deepened if we could play the fixer role less frequently.

Second, when we sit with a dying person, we realize that we must overcome the fear that often distorts our relationships . . . .

When people sit with a dying person, they know that they are doing more than taking up space in the room. But if you asked them to describe what this “more” is, they have a hard time finding the right words. And when the words come, they are almost always some variant on “I was simply being present.” (61)

[He goes on to describe his own experience of people trying to “help” him or “be present” with him during an episode of depression.]

. . . I took comfort and strength from those few people who neither fled from me nor tried to save me but were simply present to me. Their willingness to be present revealed their faith that I had the inner resources to make this treacherous trek – quietly bolstering my faltering faith that perhaps, in fact, I did. (62)

This, in fact, is how I have most been able to be helped by others in my own times of darkness – I have been helped most by the people who had the strength and courage to not try and help me. . . who were just willing to be present for me and walk alongside me in my despair. The one clearnes committee that I have called in my life functioned much in that way – the faith in me that these people showed by being willing to explore my pain and despair for an hour and a half (without offering me advice!) immeasurably bolstered my own confidence that I had the resources myself to cope with the issues before me.

The best image I know in Judaism to try and understand this is from Kabbalah (the Jewish mystical tradition). In Kabbalah, there is an understanding of the relationship between God and other things, and of how the nature of the relationship affected the way God created the world. The understanding is that God – in God’s true form – is so great that nothing else can exist separately before it. So, in order to make it possible for other things to exist, God had to practice withdrawal (צימצום/tzimtzum in Hebrew) or contract. In this way God lovingly created a space for God’s creation to form as independent entities capable of choice and acts of free will. For us to show love for others (and to help them grow and find their own true path), we also must be willing and able to withdraw at the proper times. Pastoral care is one such setting where this kind of withdrawal is needed.

I started reading Adin Steinsaltz’s The Thirteen Petalled Rose over the first part of Passover. Now that we are about to come to the last couple of days of this holiday of freedom, I intend to finish it. It is a succinct expression of Steinsaltz’s understanding of Kabbalah and the role it should play in a person’s life. Although I am hardly a Kabbalist myself (despite what I wrote in my last posting, I am a bit too much of a rationalist for that), I think that a careful reading of Steinsaltz’s work will help me refine my understanding of concepts like tzimtzum and help me to better integrate them into my own personal theories of Pastoral Care and Clinical Pastoral Education.

I think, for example, in Kabbalah’s understanding of how the soul and the body are interrelated to each other, there may be some good images for understanding and expressing the kind of concepts about wholeness that Palmer advocates for in his book. Palmer argues that it is a lack of wholeness – for example, contradictions between our soul and role – that lead us to do (spiritual) violence to ourselves and (eventually) to others. I think Kabbalah also should have some images to offer me towards expressing the importance of community to being alone and being alone to community.

One thing, by the way, that I do _not_ think I share with Palmer is his insistence (and this sounds to me like it must come out of some important Christian theological debate that I do not know about) that we consider people to be pure and without sin in their original state. It does not bother me that Palmer believes that, but it bothers me that he thinks such a belief is necessary in order to apply the techniques he advocates. In essence, he links this understanding of this original, pure state with the existence of the inner teacher; that is, seeking the inner teacher is the process of trying to return to some version of that pure state (before all the experiences of life corrupted it).

I guess Palmer needs all that because his argument for the existence of the inner teacher is essentially a theological one. . . . But, as a Jew, I don’t feel the same kind of need for theology that people steeped in (belief-centered) Christianity do. For me, it is just common sense that we best know our own way and that the best help is help that helps us find our own way. . . . I am sure there are sources in Judaism that support that, although searching for them will have to wait for another day.

Hag sameach!!!!!!!!!!!!!