Faux Chaplains

A colleague recently wrote about the perplexing issue of well-meaning family and friends pressuring the patient with theological platitudes such as “You should not question God” or with bromides such as “Be thankful it is not worse.” (For Chaplain Stacy Sergent’s post, see http://stacynsergent.com/2015/08/20/n-is-for-no/) She wrestles with how awkward it can be to jockey between shielding the patient from comments that isolate their feelings even more, and between honoring the family members’ own needs to quell their own anxiety. The following excerpt from my own book, Encountering the Edge is apropos:

“Even in the context of nearing the end of life, the patient and I have to sort out the nature of the relationship between us, no matter how transient it may turn out to be. Part of that relationship is the power imbalance between me as the professional and the patient… Upsetting the power imbalance works well when I am the one letting it happen. But there are less benign situations where someone else on hand other than the patient and family tries to take on the role of providing spiritual support in a dominating way. Not only do such persons usurp my role, they are, as faux chaplains, engaging in just the opposite of what clinically trained chaplains do. That is, despite best intentions, some people actually are preying on rather than praying for the patient and/or family, thus using the power imbalance for ill.

The problem of this misuse may be most clear in a context outside of hospice. A few weeks or so after the horrors of 9/11, victims’ families gathered in the renovated Central Railroad Terminal in Liberty State Park in Jersey City. A slew of social services were there to provide comfort to them in various ways, including a meal and the chance to pick up urns for their loved one’s ashes. Chaplain organizations, including the Association of Professional Chaplains (Protestant) and the National Association of Jewish Chaplains had summoned their members to help out with this event and circulate among the families to offer their nonjudgmental listening ears. I spent my time listening to families vent their anger and shock and feeling of senselessness. What I found most appalling was that some of the religious people on hand not trained to be chaplains were viewing the families as ripe for “being ready to know the Lord.” They handed out pamphlets galore and delivered their message but did not lend their ears. Yes, when people are in crisis they may find meaning and support by belief in a caring God. But people in crisis are vulnerable, and have less capacity to make decisions, including theological ones. A crisis can heighten ambivalence toward religion as well as resolve it…”

What follows in the book is an especially complex case of how I did my own hot-footed dance between handling a well-meaning friend who was overdosing on prayer with the patient, a spouse who wanted to buy the false hopes of her friend, and the dementia patient himself, who gave me subtle signals that he wanted peace and quiet. But you’ll have to read or listen to the book for yourself to find out what I did! (You didn’t expect me to give away the whole store, now did you? Encountering The Edge: What People Told Me Before They Died is available from Amazon and any other bookstore and on audible.com)

Chaplain Shoptalk: Payoffs of Pain

The “Prime Directive” of my seven years on the job at 3 different hospices from staff and supervisors has been, “Our number one priority is to reduce pain: physical, emotional and spiritual.” I imagine this is not shocking news to my readers who are familiar with hospice. Sounds like a no-brainer, doesn’t it? But not necessarily from the patient’s point-of-view. Whoa, huh?  

This subject came up among a few of my colleagues on Twitter these past handfuls of hours, in the context of well-meaning people like friends and family trying to make the suffering (of others, mind you, not themselves) meaningful with theological bromides like, “There’s a reason for everything.”

 “My Twitter colleagues practically gagged as they cried out to each other in mutual pain upon considering such platitudes. We all knew that for a chaplain to say anything like that would be a cardinal sin. We all lamented the destructive theological implications of such clichés. But what about when the patient says it? That’s when pain versus meaninglessness get pitted against each other, with pain often the winner. Or to put it another way, spiritual pain may distress a patient more than physical pain.

Patients often try to make sense out of their physical pain, or try to wring meaning out of the fact that the disease will only get worse. I have had patients refuse pain medication because they argued that their discomfort let them atone for some transgression. Some say it is God’s will to feel pain and therefore we must not question why we experience it. The alternative in the minds of those patients apparently is the more spiritually painful option of saying that God is powerless to prevent disease, or even worse, that God causes suffering at random or does not even exist.

To say that a disease “just happens” no matter the person’s merits, healthy lifestyle, or beliefs, can be more terrifying to the patient than some sort of explanation, no matter how unsavory or imbecilic the implications. To say that a disease is Divine punishment does not put God in an admirable light even for an adult, let alone a child. Yet when a patient says pain and disease are for a reason or are a test of faith and so on, this folk theology prevents them from having their cherished beliefs overturned.

What’s a chaplain to do? This reminds me of situations where I talk with patients who are racist or have other prejudices. (See my earlier post on that topic: https://offbeatcompassion.wordpress.com/2013/08/13/a-contest-between-prejudice-and-the-angel-of-death/ ) We cannot talk people out of their beliefs; we can only let them articulate them, creating a space for them to put those beliefs “out there” and reflect upon how they sound. Certainly once I write something, such as a post, I am almost always dissatisfied with the grammar, choice of words, and the inherent interest of the topic. Thus I revise and revise.

 So it is with speech. I know sometimes once I say something out loud to another person, I may realize it was not so smart or true after all, especially if they do not show agreement. But those people I said it to may be long gone by the time I have sorted that out for myself. So it is with our patients; we are there to enable them to go on to deeper insights that relieve suffering, but unlike published writing, we are rarely privy to the final draft of their silent revisions.