One of the things about Chaplaincy that I've come to appreciate and feel incredibly ambivalent about is the amount of access I have to the life-stories of my patients. Patients tell me things that they confess having kept secret all their lives. It is a privilege, perhaps an unearned one, to sit in a place of sacred receptivity, to be a site of intimate telling and unburdening for people. What I'm struggling to understand is how I should respond to the information I am given. I have a responsibility to keep the confidentiality of my visits except when treatment teams need to be given information for health care reasons. Most of the time the details of my pastoral visits are kept quiet; they linger in the recesses of my mind and I take them in prayer to a Source much greater than myself. But lately my conscience is being kicked by patterns I'm detecting--patterns I'm particularly able to observe because of the access I have.
Doctors diagnose physical ailments. Psycho-social teams tend to the psychological and social support systems in place (or lacking) in the lives of patients. But Chaplains get to hear about everything, particularly about the things that are causing guilt. G-d knows religion has been about propagating guilt in a major way, especially in certain theological circles, so it's no surprise that patients would project this "guilt seeking" sentiment onto Chaplains and engage the relationship from there. I hear confessions everyday. I hear people's meaning-making methods multiple times a day. I get to hear how people make sense of their illnesses, how people interpret the traumas that have happened to them. More often than not, people see their sickness, psychosis or trauma as punishment or karma, or they take full responsibility for what's happening to them without consideration of the larger systems that might have contributed to their current struggle. In this work, as a result of being a Chaplain in the VA, I have begun to a) detest strongly the role of secrecy and guilt-provoking in conservative religion & 2) think about what role I can play in unlocking those shame-based halls of psychological and spiritual abuse in my lifetime as a Chaplain/Minister.
Let me be specific...
There's a particular clinic that I work on 3x a week. I have been listening to the life stories of these guys for 7 months. They all have a disease of the blood. More than any other unit or clinic I rotate on, these patients have family problems. In fact, all of them, with one exception, are estranged from their children. The one exception is estranged from his mother. Now tell me that problems within the blood line aren't at all related to problems of blood flow. Is that mere coincidence? Or how about the fact that over 75% of the patients I see in the "Psych Ward" confess to having "homosexual experiences" during their time in the Military. Are these just "bad apples" or is psychosis something that results when we tell people their biological proclivities and pleasure-seeking capacities are sinful and unnatural in the eyes of God?
It's not always ethical to make these connections. These insights/observations are often unwelcome in the health care world because they aren't "empirically proven." Further, drawing conclusions like this can often place the locus of responsibility for health impairment on the patient. That is the last thing I'm trying to do. What I'm trying to do is open conversations about "sickness" up so that the locus of responsibility for health widens. I'm also offering this reflection up to document my struggle with what needs to be kept quiet (for confidentiality and integrity's sake) and what needs to be exposed for the sake of life/justice itself. How can I look upon these conditions/realities and the suffering they cause, knowing they will continue if silence remains so pervasive, and keep my mouth shut? It's not an easy line to tow and I always learn so much when I pose questions to those who have gone before or who are struggling to tow the same lines. Having said that, I'd like to hear what my other Chaplain sisters and brothers have to say--Wade, Laura, LeAnn, Anna? What is our responsibility with the information we receive, as chaplains, prophets and pastors, to our patients and to the world?
7 comments:
Hey Emily...you brought up some really deep struggles. How would you feel about my passing along your blog to my former mentor (and current book club leader) Rev. Carolyn Talmadge? She's the minister at the Edge Campus Ministry at SF State, and a staff chaplain at the VA in San Francisco. I think she could be helpful.
That would be great. Thanks! Hope you're well.
Well, I have to admit, your blog has caused me to think long and hard. To be honest, coming from a conservative background and specifically having been told that EVERYTHING that happened to people was in correlation to their obedience or disobedience to God. I just couldn't go there. Perhaps my resistance to hold these tensions are called into accountability now through your blog. mmm, maybe I should talk more about this ;)
On the other hand, I have had the experience of seeing how healing integrated care can be for individuals. For me, it's a really tender responsibility and not one that I take lightly. There are times when I bring things up and other times when I let them bring them up. This feels really connected to our conversation the other day about making sure we, as pastors and chaplains are spiritually prepared/centered for the work we face. It's a holy journey. I'd love to hear other thoughts on this as well though.
Thanks for sharing, my friend. My first thought is a question... can you say more about what you mean by "it's not always ethical to make these connections?"
In wanting to hear you unpack that a bit more, I also offer that it is always "ethical" -- the question is what ethics are at play? What are the various frameworks that ground and guide our decision making in a particular situation?
And one more thought... re-reading your first paragraph made me think of the value of "both/and" vs. "either/or" thinking. What ways might you/we both honor confidentiality and name the connections between the stories people share - particularly in addressing injustice?
I think of the relational faith based justice movements (e.g., PICO -- and our Santa Cruz County's COPA). Their process begins with storytelling, so recently they've been holding house meetings for folks to talk about how the economic downturn is impacting their lives. As those stories are shared in small groups and then brought to the larger community - themes are discerned and action items created (e.g., meet with County Supervisors). People find they are not alone and become empowered to speak collectively in the pursuit of justice.
So in our roles as chaplains, how might we do both/and? Both offer sacred space to individuals to unburden themselves/see new possibilities and help facilitate collective change?
One idea to throw out there is a "round table discussion" with varied colleagues at the VA re: a particular connection. Perhaps you could offer a springboard for conversation with a relevant article and/or a paper summarizing some of your thoughts findings (e.g., 75% of the men on the unit...). Maybe you can contribute to collective change by connecting with an organization working with military folks and their families on a particular issue(s)- with your involvement and action informed by the stories you have heard.
Other thoughts... ideas?
Reading your post, I suddenly realize why confession must be before "God and humanity." You are the humanity part. As a pastor (however you define the Church you serve), part of your gift is to see those connections held in the "secrets. Then, as a pastor, you can honor the secrets in a way that is respectful of individual pain and lifestories while also addressing those truths and connections you see. Your insights about blood reminds me again how illnesses are metaphorical - because we are metaphorical beings. Though we certainly don't "cause" illnesses by rejecting our bloodlines, (any more than we cause cancer by repressing our emotions) they are nevertheless connected - by our perspectives on illnesses. At the same time, we create illness and abnormality on a systemic level - beyond empirical causality (and sometimes by design). Treading on very shaky ground, I would suggest that HIV and crack cocaine addictions are just two examples of social illnesses manifested physically. Not causally, but metaphorically - nurtured by systemic organization, which includes guilt and sin. I do not think gay men and poor inner-city folks (disproportionately of color) and people on the continent of Africa are responsible for this, but rather that socially these populations bear the cost of our unhealthy systems. Perhaps this was the original insight that got twisted into notions of individual guilt for senseless suffering. Perhaps those early Christians discerned that we do have a hand in our own (and our communities' and globe's) well-being. But they barked down the wrong hole by tying it to "sinful nature." My question is the same question you ask: what do we do with that?
You're right to identify guilt as the culprit, and secrecy and God's omniscience/omnipotence wrapped up in it. As pastors who know this, we can only try to encourage seeds of different understanding of reality. This is what I see Laura suggesting: honoring the trust that has been placed in you by the stories - trust to use the information wisely for caring instead of destruction. And in doing so - as your instincts tell you - you are not alone.
Reading back over this, I question a lot of my conclusions. But I think you have identified a glimmer of something, and it's all part of figuring out what to do.
i read something today that brought me back to your questions. In Griffith & Griffith, Encountering the Sacred in Psychotheraphy: "People not only use tropes . . they also perform tropes. . . Through the performance of tropes meaning becomes incarnate." I would add that tropes write themselves on our bodies, too.
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