I have been giving some thought lately to the trend our profession of moving away from the terms "pastoral care" toward the term "spiritual care." I wonder what your thoughts are on the topic.
My own thinking at present is that the movement away from pastoral care to spiritual care may be a secularization of the former. At it's best I think it is an attempt to be inclusive of people of all faiths and no faith. At it's worst, however, I am afraid that it denies the chaplain's primary role as minister and seeks to conceive of us as areligious meaning-making practitioners, which is only one aspect of the work a chaplain may do. I have more thoughts on the topic but I will leave it at that and look forward to hearing from you on the matter.
I certainly think he’s accurate in identifying the trend, and not just in health care chaplaincy. Over the past generation or so the traditional words for talking about one’s spiritual life have changed. The most visible evidence is the common statement, “I’m not religious, but I’m spiritual.” Now, that may mean many things – “I think a lot about the meaning of life, but no one religious community seems to fit;” or, “I like to think I’m a seeker, but I’m afraid any specific religious commitments will be too restrictive;” or, “I don’t want to seem shallow or unconcerned about life, the universe, and everything, and as long as I can claim something that somehow sounds appropriate I can pretend I’m not shallow, and I don’t have to feel guilty about it, and you can’t make me!” - but one way or another it represents a departure from the tradition language of established traditions, and especially of the predominant Christian traditions.
That said, my experience of my own professional community is in part in line with David’s understanding of the trend “at its best.” It does certainly represent an effort to be inclusive. After all, we serve all those patients who come to us, and not simply those of our own tradition. The Code of Professional Ethics of the Association of Professional Chaplains (APC) includes these statements:
Members shall serve all persons without discrimination regardless of religion, faith group, race, ethnicity, sexual orientation, gender, age, or disability.
Members shall affirm the religious and spiritual freedom of all persons and refrain from imposing doctrinal positions or spiritual practices on persons whom they encounter in their professional role as chaplain.
Those categories end up including many folks for whom the traditional Christian language of ministry is inappropriate; and many more, those inactive Christians, for whom they describe a professional relationship they don’t have
And as important as it is to be inclusive in our respect for those we serve, it is also important to be respectful of those with whom we serve. Certainly, most Chaplains in North America are Christian, as are most religious believers, simply by the numbers. At the same time, the community of professionals providing spiritual care in health care settings is not simply Christian; and the numbers of chaplains coming from Judaism, Islam, Buddhism, and Hinduism are growing. Within their own traditions they would not be called “pastor;’ nor would most of their traditions identify spiritual and emotional support for the sick and suffering as “pastoral.”
In a broader sense, that is a dynamic of the term “pastoral” in pastoral care that we can’t ignore: the term is so distinctly, almost exclusively Christian. While we could, I suppose, in theory say that it hearkens predominantly to the solicitous care of a shepherd for livestock out to pasture, it would be a bit of an academic stretch. In this culture so permeated with Christian influence we could hardly speak of the solicitous shepherd and not recall the Good Shepherd. In my roots in religious studies, I recall some few references to God as Shepherd in the Jewish Scriptures, but with little of the connotation of individual care and support (Psalm 23 [or 22] notwithstanding). I am certainly open to correction, but I don’t recall the image at all in my reading of translations of the Q'uran or of Buddhist or Hindu texts. While my colleagues in other traditions may well appreciate a “pastoral” metaphor, they could reasonably prefer imagery from their own scriptures that speaks to the “cure [as in care, responsibility] of souls.” There’s just no separating the label of “pastoral” from the title of “Pastor,” much less from the ultimate Christian Pastor, the Good Shepherd.
That dynamic is also relevant in communicating what we do to the health care team. That context is ever more pluralistic, reflecting and to some extent concentrating our ever more pluralistic society. For our colleagues in other professions the word “pastoral” is not necessarily meaningful. All of the professions in health care are oriented toward providing care; but each has to clarify what type and how. It may well communicate more clearly to speak of spiritual care – of care for spirits, to complement the care of bodies by physicians, nurses, and others; and the care of minds psychologists, social workers, patient advocates and others (and yes, I know I’m oversimplifying those categories) – than to speak of pastoral care to folks who have limited and often ambivalent impressions of pastors, and no impressions of pastures at all.
I think that is also an issue we need to acknowledge: that those we serve and serve with may well have ambivalent, and even suspicious feelings from their images of “pastors,” and Christian clergy in general. Even those of us who are Christian chaplains feel some need to distinguish ourselves from the more judgmental and negative images of congregational clergy. Certainly, we’re not in the business of proselytizing; but neither are we simply in the business of providing Christian support for Christian patients. There is an old joke about the Christian minister who is asked about the weather, and responds, “You’ll have to take that to the Boss; I’m just in Sales.” My corollary is that I’m in Maintenance. I’m in the business of supporting spirits that feel broken, and helping them find the resources within themselves and their own backgrounds to re-knit and renew and restore. I’ve seen enough of that brokenness caused or exacerbated by Christian clergy to be wary of too much association, even if I don’t myself shy away from the title “Pastor.” My own perspective is that this is how God in Christ has called me to be a Pastor.
Now, I am an Episcopal priest in this practice of spiritual care, and not simply some “areligious meaning-making practitioner.” While I don’t trumpet it, neither to do I hide it. I choose to work in clericals every day, preferring to embrace a known image of a spiritual practitioner and deal with the ambivalence and hostility as I encounter them. At the same time, I certainly think we need to recognize “the chaplain’s primary role as minister” within a much wider context of ministry. I have said elsewhere that we are advanced practice ministers specializing in health care settings, even as we are adjunct health professionals specializing in spiritual care. In our pluralistic environment, there may be many models of ministry, some of which might fit well with “pastoral,” and some which might not. On the other hand, all are in some sense in pursuit of “the cure of souls” – support and care for human spirits in crisis and stress. In that context, “spiritual care” may be more recognizable, more translatable, than “pastoral care:” and so may communicate more clearly to those we serve, and those we serve with, the service we are called to provide. After all, many of them, perhaps most, don’t have a pastor; but each of them has a spirit, worthy of our respect and our care.