Peggy Treadwell, a colleague at Episcopal Café, recently wrote of her experience in recognizing and adjusting to her mother’s aging and increasing frailty. It is a moving piece, and I commend it to your attention.
Part of what caught my attention was her first sentence: “My mother regularly tells me she is ready to die.” That sentiment used to get me regular referrals from the Consultation/Liaison Psychiatry Department in a hospital I used to serve.
The referrals would come to me from one of the staff clinicians – one of the psychiatrists or the clinical psychologist. The referral was always for the same concern: a medical resident would refer to the Psych staff a patient who the resident thought might have suicidal ideations – thoughts about committing suicide. Now, that’s not an unknown referral for a chaplain, but it’s not that common, and it’s not common at all for the referral to come from Psych staff.
So, I would go to see the patient; and inevitably the circumstances were largely the same. I met an elderly, faithful evangelical Christian. The patient would be happy to speak with me, and especially happy to speak about his or her faith. And, as I knew it would, somewhere in the conversation about the patient’s illness and condition, the patient would say something like, “I know the Lord, and I’m not afraid to die. I know Jesus, and I know I’ll be with him, and if he’s ready to call me home, I’m ready to go.”
Now, perhaps to most of my readers that might seem banal, and certainly not suicidal. But in fact the referrals came to me this way: first, a resident, commonly a foreign national and graduate of a foreign medical school, and commonly not a Christian, would meet the patient to take a history and physical. In the course of discussing the patient’s understanding of his or her disease, the patient would make the statement above. The resident, entirely unfamiliar with a sentiment so common among elderly and ill evangelical Christians in the United States, would perhaps probe a bit further. The patient, of course, would affirm the statement that he or she was not afraid and was ready. To the resident, this seemed not only potentially suicidal but also persistent and determined. So, the resident would chart his or her concern, and make the referral.
The Psych staff would then discuss this with the resident. It helped a great deal in their assessment that the three staff clinicians, and most of the clinical psychiatric nurses who worked with them, were raised and educated in North American culture. It was even more helpful that they were most of them faithful believers. One psychiatrist was an active Roman Catholic, while the other was an observant Jew; while the psychologist was an active Presbyterian. The psych nurses represented a variety of traditions. And so they understood quite well what the medical resident was describing; and they understood it was quite unlikely to be true suicidal ideation.
And so the referral would come to me. I would then see the patient and have the conversation I described above. I could then make my own record in the chart, noting the resident’s note and concern, and expressing my own assessment. At the time to make it sound a bit more clinical I would write that such language was “within normal limits” for the thinking of elderly evangelical Christians.
And often that was not the end of the story. Another chaplain and I frequently attended the Consultation/Liaison Psych weekly Case Conference. There we had the opportunities to give our own perspectives on these and other cases, and to participate in the education of psych and medical residents. (They were also quite indulgent: they put up with the project I had then of identifying a country song for every major psychiatric diagnosis.) It was a valuable, and an unusual opportunity to bring the importance of a faith perspective in a clinical psychiatric setting.
I know how unique that experience must seem; and I’ll admit I haven’t had one quite like it since I left that hospital. At the same time, my experience has been that in fact psychiatry and psychology professionals have been respectful of how important faith can be for a patient, and respectful of those of us who respond professionally to that faith. In part it’s from simple sensitivity to and respect for the patient, regardless of the professional’s own opinions in matters spiritual. But it’s also been my experience that those professionals, whether psychiatrists or psychologists, and particularly clinical social workers, do indeed respect professional chaplains as “advanced practice” and specialized ministers. That’s not to say that there aren’t still out there those classical and neoclassical analytical types – successors to Freud and Adler and their disciples, more likely to see pathology, sort of like Communists, under ever bed. And there are certainly those who feel unprepared to address these issues in the patient’s own terms, however spiritual they may feel in their own lives. But most I’ve found, as I’ve said, to be respectful of the patients in their faith, and respectful of those of us who address issues of faith in the clinical environment, sharing in the same commitment to approaching the care of patients with respect for their integrity and personhood. Indeed, by and large they have professional respect for most clergy, and for the patients’ relationships with their clergy.
That’s not to say that they respect all clergy; but in fact the problems they have with clergy and clergy-parishioner relationships are also shared by chaplains. Clergy who deal solely in fear, or who manipulate their patients to maintain control, are concerns for behavioral health professionals and chaplains alike. I have said that my response to the old joke about the cleric who commented that God was in charge and he was only in sales, is to say that I am in maintenance. I have found many opportunities over the years to work to repair damaged relationships with God and with other people that were structured and damaged specifically and particularly by clergy.
There are also those clergy (and this sometimes includes chaplains) who think they understand behavioral health issues and diagnoses much better than they actually do. I’m not a psychologist, even though I’ve had more exposure to and training in behavioral health care than many clergy. And there are those clergy, including colleagues in chaplaincy, who have sought out academic and clinical education in psychology and counseling. On the other hand, we have all, I think, encountered clergy who have thrown around psychological terms in ways that simply demonstrated that they didn’t know what they were talking about. The results were often parishioners who ended up labeled rather than helped.
But in fact most of us know our limitations. Folks in behavioral health know their limitations in addressing issues of faith, and we in ministry know our limitations in addressing psychiatric issues. And in that knowledge we have found ways to work together to benefit those we serve. My situation in that previous hospital was unusual in its structure; but I have found the intent to serve together and the respect to make that possible is quite common. It is a recognition that human beings are creatures with bodies and minds and spirits; and that to care for the whole person is to care for body and mind, and for the spirit as well.