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! :)

Creating a loving community

13 Nissan, 5767

I went to a lecture on Friday that totally changed the way I understand something very dear to me. It helped me to see how something that I thought was just for other people to help me is also very much meant to help the helpers.

What I'm talking about is an amazing practice that is part of the Quaker tradition, and that has been popularized in workshops held by the inspiring educator Parker Palmer (best known for his book The Courage to Teach ). This practice is called a clearness committee. It is for people facing a difficult decision or issue. It is a way of asking a community of people you trust loving help you hear what your own inner voice is saying. It's not about getting advice -- and, in fact, the committee members are forbidden from offering you any advice.

This ban on offering advice may seem strange -- how can people help you with a problem if they can't offer you advice? Isn't advice what you need when you have a problem?

But, as a person who called a committee myself, I can tell you that the ban was one of the most amazing things about the committee. When people give me advice, I so often find it more hurtful than helpful. So often, I feel as though when a person starts giving me advice, what they are really doing is ceasing to listen to me. They've made a decision and judgment and are done trying to hear all the (often complex!!) factors that I am wrestling with.

What I'm really hoping for when I share a problem with another is help in finding exactly what the clearness committee is about -- clearness! That is, I'm hoping the other person will help me see the problem -- and all its aspects -- more clearly. I'm hoping for help clearing the fog that all the anxiety and uncertainty we feel when we have a difficult decision before us. With the fog clear, than I can choose what I know to be right for me, not what the other person thinks is right for me. This is what the clearness committee is all about.

But what the lecturer helped me see is how the clearness committee can benefit the entire community of people involved in it. Trust is key issue here. In a clearness committee, you sit and allow people to ask you any question they want. Although, you are not required to answer, I'm sure you can imagine this can be a very vulnerable and frightening place to be. I had thought, therefore, that community was a prerequisite for a committee to be called. That is, a committee should only be voluntarily called by a person who believes he or she already has a community of people they trust.

But, the Friday lecturer calls mandatory clearness committees! He uses them as part of a Clinical Pastoral Education (CPE) unit. Each member of (CPE) group -- typically a group of student chaplains spending some months together in very intense learning and work with hospital patients -- is required to call a clearness committee of the other group members as part of a mid-unit process of self-evaluation.

When I first heard this, I was totally shocked. The mandatory nature of it seemed to violate everything I believed about the clearness committee. But, as I listened to the lecturer explain his experience with it, I became more and more convinced that it is possible to use clearness committees in this way. He said one benefit of using the clearness committee in this way, is that it tends to more strongly build community among group members for the rest of the time they have together after this mid-term evaluation.

That is, the experience of being forced to trust the other group members -- and the experience of having them turn out to be worthy of that trust as they use your position of vulnerability to ask you questions lovingly, as opposed to using it as an opportunity to interrogate you as if this was a courtroom -- builds your trust in them going forward. That is, it helps build community.

Another thing it does, the lecturer said, is help the group members better learn the difference -- so important if chaplains are to help each other grow! -- between offering critique and criticism. Criticism makes people defensive and makes it hard for them to hear and consider what has been offered. Critique does not have this problem.

If you're interested in learning more about clearness committees, a great place to start is this short description of its rules from Palmer, himself. Here's an excerpt from that page:

The meeting begins with the clerk calling for a time of centering silence and inviting the focus person to break the silence, when ready, with a brief summary of the issue at hand. Then the committee members may speak—but everything they say is governed by one rule, a simple rule and yet one that most people find difficult and demanding: members are forbidden to speak to the focus person in any way except to ask honest, open questions . This means absolutely no advice and no amateur psychoanalysis. It means no "Why don’t you…?" It means no "That happened to me one time, and here’s what I did…" It means no "There’s a book/therapist/exercise/diet that would help you a lot." Nothing is allowed except real questions, honest and open questions, questions that will help the focus person remove the blocks to his or her inner truth without becoming burdened by the personal agendas of committee members. . . . . The only answer that counts is one that arises from your own inner truth. The discipline of the Clearness Committee is to give you greater access to that truth—and to keep the rest of us from defiling or trying to define it.

Another place to look is Palmer's newest book -- A Hidden Wholeness: The Journey Toward an Undivided Life. I haven't had a chance to look at this book myself, yet (it's on its way from Amazon!), but it is the one that the lecturer brought with him to the Friday lecture. He said that -- even though he has been using clearness committees for years -- this book contained lots of surprises for him about how Palmer uses them. The book also explains a more advanced practice called Circles of Trust. I don't know anything about that, so I am looking forward to learning more about them in Palmer's book.

One of the reasons I am so attracted to the idea of the clearness committee is that its central discipline -- that of asking honest, open questions -- also seems to be the central discipline of pastoral care. And, the closely related clearness committee discipline of the group members trying to remove their own agendas from the exchange to focus on the agenda of the person being helped, also seems to be a central discipline of pastoral care.

You, of course, can't remove your own agenda, unless you are aware of when you are imposing it. This is why chaplaincy education puts so much emphasis on getting to know one's self better, and to develop better self-awareness.

The Friday lecturer took this business of focus on self one step further. He said that "your most valuable resource in terms of ministry is your entire self."

That is, he was saying that the way you build yourself as a chaplain is not to focus on techniques -- not to focus on what you do. Rather you need to focus on what you are. That means you focus on developing yourself as a person; the development as a chaplain just naturally follows from that.

So, then, one way you know a CPE group is working well is when the group sees its work and its goals, primarily in terms of personal goals and not in terms of growing skills and techniques. For example, a doing-oriented goal would be, I'd like to be able to better offer prayers to families facing death. This goal is indeed laudable, but, a better, more personal goal might be, I'd like to better understand my own fears of death that arise when I am talking to people who are facing death. The idea is that if you are able to truly do the latter, that you will be able to be more present for families and patients and that everything you do with them -- including prayer -- will be more effective and more meaningful.

Said the lecturer:

The students often prefer to focus on the work, rather than on the self. [But] the clearness committee is less about problem solving than about drawing close to the true self. [That's] the thing that excites me about this . . . The questions that we ask . . . are about how goals are effecting their personhood.

I don't know if I myself would ever use the clearness committee in the kind of mandatory way the lecturer does, but I was so grateful to hear him speak and to be in the presence of someone else who had been inspired to try and use this incredible tool that the Quakers have passed on to us and to hear about his experiences and struggles with it. I learned so much!