Saturday, June 09, 2007

The Words We Use: From Pastoral to Spiritual

A few weeks ago, David Fleenor sent me an email. David Fleenor has himself been a blogger, although it’s been almost a year since his last post – but, then, he’s been busy: graduating from seminary, being ordained deacon and then priest, entering into a clinical pastoral education program with the intent to pursue certification as a Supervisor (a clinical educator – that’s certainly enough). The central point of his email was this:

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.


ReverendKathryn said...

Wow! You have both said a mouthful! I would agree with your colleague in his sentiment that our field is less "pastoral" (focused) and more secular (broadened). I am a member of CAPPE, the Canadian counterpart of ACPE, and have felt this movement as well. The field of healthcare/chaplaincy tends to be dominated by the Christian traditions, not surprising as it is founded on Christian principles, and yet our mandate is to minister to the world. To provide care for the souls, to care for all persons regardless of personal agreement in faith traditions, or any traditions. It is the care of the soul that is our business, but there are so many people out there who claim to hold the key or cure as well. People may not claim to be specialists in the field, but the fact that "anyone can do it" tends to diminish the position or role that the specialist few of us do have.

I also find that there is poor education or understanding from the public about the chaplain's role. While I hear the argument/comments about the distinction between "pastoral" versus "spiritual care", I have discovered through my CPE training and career that providing care for the many versus the few (all peoples versus one group) has increased my understanding of the term "Agape" love.

There are frustrations for all chaplains I'm sure, especially in this age of secularism. It is hard to define what we do without needing to define the definitions/terms used. It is not a language that is readily understood by all. But perhaps we need to educate more about our roles, the terms used and function. There will always be misunderstandings as experiences differ from client to client, but there can be a strengthened effort at education for and support within our disciplines. This is probably a cause of institutional apathy, and rise of secularism.

Marshall Scott said...

kathryn, welcome. I know well of CAPPE, which is also functionally the counterpart of APC (since in the US education and clinical practice are separate organizations), and a collegial organization in the Consultation.

I certainly think there is poor education about the chaplain's role. I think we have some hope of educating professionals (and reeducating them, what with turnover and all); but little of educating patients. Especially here in the US, those who are not part of a religious community have their images of religious professionals shaped all too often by religious broadcasters. Even those who are part of a religious community will commonly project their own experience on all religious professionals without distinction. Few know of the broad ministry of the chaplain, and then commonly through personal experience, either as a patient or through another institution - the military, or perhaps a school chaplain.

George Hankins Hull, Dip.Th., Th.M. said...

There has been an increasing trend in the pastoral care movement to
move away from chaplaincy and pastoral care in favor of promoting and providing "spiritual care." Many hospital departments have changed their names to reflect this shift in philosophy and practice.

Spirituality circumvents religion and promotes chaplaincy as a
generic practice. Religions are messy. They have rules, doctrines,
beliefs, ethics---some of which are flawed to be sure. But religions usually stand for something. Spirituality is an amorphous thing, an oblong blur, with implications of cosmic connection, but with no price tag---no demands no dogmas, and no ethics. Not even a dogma
demanding justice and mercy. The only perceptible doctrine promoted
by the spirituality movement is that people should feel good about

At its best the clinical pastoral movement teaches religious
professionals to be available to everyone. It also teaches them to
be critical of all religion---but dismissive of none. Religion has
caused considerable mischief throughout history. But religion at its best calls forth some of the noblest behavior of which human beings are capable.

The clinical pastoral movement has been correct to be critical of
each and every specific religious practice; within the limits of
mutual respect and decorum. At the same time, however, it must take
a permissive posture toward the various idiosyncratic manifestation
of religion, giving them the benefit of the doubt. That is the basis on which the clinical pastoral movement began in the early 20th century. The movement did not attempt to create a new religion, particularly one that by implication would be superior to all the other "flawed religions" of the world. The promotion of spirituality results in diminishing the role of the hospital chaplain as a religious professional in favor of that of a generic approach which in the end a social worker or nurse can provide.

thinking out loud
George Hankins Hull
College of Pastoral Supervision & Psychotherapy

Marshall Scott said...


Thanks for looking in and commenting. You and I hear from each other in other settings as well, so I appreciate you looking in here.

I see your points. Certainly, as I've said, there are many who speak of being "spiritual" precisely because they want to evade the commitments inherent in being part of a particular community. I would suggest, too, that joining any community, however vague and broad its commitments, because there are some commitments this moves the person from "spiritual" to "religious," even if the person would not use that language. I recall, for example, doing premarital work with a couple whose "faith community" was a 12-step recovery program. They were hesitant about claiming a denomination because they had been separated from, and had felt rejected by, churches they had experienced. I reminded them that their program was self-consciously a "spiritual program," and that in it they shared in a community of common understandings and values. We worked together from that starting point.

I'm more clear, I suppose, how that has undermined the understanding of clergy in the wider society than how it has undermined understandings of pastoral care. Granted, few people really know what we're about as chaplains; but that's not that new in my experience. I think our work has been undermined more by narrowing views in the larger society of what it means generally to be a religious professional. As people are less connected to religious professionals in their own lives, they base their expectations on those they see around them - and seeing much that concerns or frightens them (and concerns me, for that matter), they have more anxieties about us. Certainly, they see much they cannot claim; and so they choose to speak of being "spiritual."

As for me and mine, as it were: I've written at length about chaplains as ministers (if you like, you can check under in the labels under "Volunteers" or "Chaplaincy," and you'll see some of that). We are in agreement here, I think. But, inasmuch as we share a common liturgical heritage, that comes to me as no surprise.