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Grandiose Marketing of Spirituality

Spirituality can now be bottled, like medicine, labeled with “evidence-based quality indicators” and dispensed by “spiritual care specialists” (hospital chaplains) to patients, providing a unique contribution to positive health outcomes, thus guaranteeing chaplaincy organizations’ place in America’s health care industry.  So states, in more professional terminology, the Spiritual Care Association (SCA), a new chaplaincy certifying organization, birthed last year by the Association for Clinical Pastoral Education (ACPE)-affiliated Health Care Chaplaincy Network out of New York.

This is a critique of the Spiritual Care Association, which represents a rather grandiose movement in defining chaplaincy’s role in the health care of patients across America.  The aim is to create a much needed dialogue on this movement, including the extent to which the political, economic and legal determinants of health and illness are addressed in the spiritual care of patients.

In introducing itself last year, the Spiritual Care Association published a “White Paper” on “SPIRITUAL CARE: What It Means, Why It Matters in Health Care.” (By Rev. Eric J. Hall, Rev. Brian P. Hughes, and The Rev. George H. Handozo, HealthCare Chaplaincy NetWork, Oct. 2016)  The cover letter announcing this “New White Paper” states that it is “a milestone publication for the field,” because, “no other publication has presented with such clarity and with such comprehensive source documentation (93) footnotes on these topics: What is Spiritual Care, Spiritual Well-Being, Spiritual Care and Patient Satisfaction, Spiritual Care Generalists and Specialists, Role of Board Certified Chaplains, and Bottom-Line Impact of Spiritual Care.”  The “93 footnotes” of documentation support the assumption “that excellent patient experience encompasses the whole person, including spiritual care.”  The covering letter, written by HealthCare Chaplaincy Network & Spiritual Care Association President & CEO Rev. Eric J. Hall, also states that “professional chaplaincy is evolving to become an evidence-based profession with objective standards for quality care and scope of practice similar to other health care disciplines.” (“New White Paper: Spiritual Care: What It Means, Why It Matters in Health Care,” https://www.healthcarechaplaincy.org, Oct. 20, 2016)

“Excellent patient experience encompasses the whole person, including spiritual care.”  True.  But which “whole persons”?

I believe the Spiritual Care Association’s new document reflects a focus on white people.  In other words, the document is written by three white chaplains, for white patients.  It states that “spirituality and religion have always been central to the lives of the vast majority of Americans.”  An expert is then quoted to buttress this statement: “Researcher William Miller claims that ‘most people want to live with better health, less disease, greater inner peace, and a fuller sense of meaning, direction and satisfaction in their lives.’” (“SPIRITUAL CARE: What It Means, Why It Matters in Health Care,” Ibid)

It is assumed the document reveals the authors’ own unconscious, privileged, conditioning in America’s white-controlled hierarchy of access to political, economic, legal and religious power.  Of course, people of color, economically impoverished white persons, LGBTQ persons, immigrants, Jews, Muslim Americans and others “want to live with better health, less disease, greater inner peace, and a fuller sense of meaning, direction and satisfaction in their lives.”

But what would “better health, greater inner peace” and all the rest involve for “the whole person”?   For black people, most of whom are at the bottom of America’s white-favored hierarchy?  Who often don’t have the financial resources to maintain a healthy diet, never mind access to regular preventive health care.  Nor the racial identity that would guarantee “greater inner peace” in a “law and order” society where black lives often don’t matter.

What would “less disease” involve for economically limited white persons?  Who don’t have the means to invest in the pursuits of happiness that contribute to good health, fulfillment and longevity.

What would physical and emotional well-being involve for LGBTQ persons?  Who face continued political and religious discrimination that denies their inalienable rights and does violence to their humanity.

What would “meaning, direction and satisfaction” involve for immigrants?  For those designated as “undocumented”?  The “undocumented” especially forced to live in the shadows of health care in “the land of the free,” and threatened with deportation and the breakup of their families.

What would “greater inner peace” mean for Jews?  Branded as “Christ killers” in The New Testament (Matthew 27: 20-26).  Biblically-legitimized anti-Semitism that led to their persecution over the centuries by Catholic and Protestant-controlled countries.   Now, likely to face increased anti-Semitism in the current politically-empowered white movement to turn America into one nation under Christ.

What would “greater inner peace” and emotional health involve for Muslims?  Those who are Americans, increasing numbers victims of Islamophobic violence.  And those presently facing bans as they seek refuge in America, fleeing the bombing of their homelands, often-American bombs.

In 2016, the Spiritual Care Association designated May 10 as “Inaugural Spiritual Care Day.”  And “to mark Spiritual Care Day, SCA has sent ‘Thank You Chaplain’ cards with hand-printed artwork to about 10,000 chaplains and pastoral care departments in health care settings across the U.S. and abroad.”  The cards read: “Thank You Chaplain for honorably and compassionately providing hope, comfort and meaning to all those entrusted in your care on their spiritual journey.” (‘INAUGURAL SPIRITUAL CARE DAY TO RECOGNIZE CHAPLAINS’ VALUE TO PATIENTS AND THEIR FAMILIES, HEALTH CARE TEAMS,’ www.prweb.com/releases, May 3, 2016)

Again, what would “hope, comfort and meaning” look, feel and be like for “minority groups”?  Whose “spiritual journey” also includes struggles for safety, freedom, equality, and justice.

In their “White Paper “ on “Spiritual Care,” the authors refer generally to the centrality of “spirituality and religion . . . to the lives of the vast majority of Americans.”  They talk about the role of chaplains in “provid[ing] in-depth and specialized patient-centered spiritual care interventions that are sensitive to the unique spiritual, emotional, religious and cultural needs of the person being served; and the chaplains identify and contribute toward a specific positive outcome.” (“SPIRITUAL CARE; What It Means, Why It Matters in Health Care,” Ibid)

“In-depth and specialized patient-centered interventions that are sensitive to the unique . . . needs of the person being served”?  I counted two general references to “minority patients” in the authors’ “milestone” document  on “Spiritual Care”; and both references report the same general financial statistic about “cost savings” in the hospital care of “minority patients.” (See pages 8 and 13, Ibid)

“Patient-centered spiritual care interventions that are sensitive to the unique . . . cultural needs of the persons being served.”  Cultural competency is recognized as an important qualification of chaplains.  But what is missing from the Spiritual Care Association’s “White Paper” on the spiritual care of “the whole person” is “community competency.”

Urban specialist Dr. James Jennings puts flesh and blood on the spiritual care of “the whole person.”  In his essay on “Community Health Centers in U.S. Inner Cities:  From Cultural Competency to Community Competency,” Jennings writes, “The idea of . . . cultural diversity in the delivery of health services is limited and incomplete in responding to health challenges in US low income urban communities.  In these places,” he states, “where problems of poverty, unemployment, bad housing, toxic air, and dirty streets are found in greater levels than other places, community health centers must move beyond simply being culturally sensitive or reflective of local groups.”  Thus “public health officials interested in enhancing the well-being of residents in low-income and impoverished neighborhoods must be familiar with discourses and strategies which reduce wealth and power inequities.”  Even more: community health centers “must enhance their organizational role as community actors and become involved in working with other non-health organizations seeking to challenge the local and spatial manifestations of inequality.”  Thus Jennings sees “community health centers in low-income communities” as playing a key role in “linking better health for all people with a more just society.” (Ethnicity and Race in a Changing World: A Review Journal, Winter 2009)  Such “community competence” provides a critical context for performing bedside spiritual care.

“Community Competency” involves political competency.  A scary thought for many Clinical Pastoral Education (CPE) supervisors, who train chaplains, and for many chaplains themselves.  Whose comfort zone is one-on-one contact with patients inside the hospital.  That exclusive focus often becomes a supervisor and chaplain’s own refuge.  A hiding place from the risk involved in thinking outside the hospital’s walls and becoming knowledgeable of and addressing the systemic determinants of the illnesses of many patients.  If that is determined to be beyond chaplaincy organizations’ scope of practice, they should stop talking about treating “the whole person.”

What would “community competency” look like in the clinical pastoral education (CPE) of chaplains?  It requires chaplains becoming knowledgeable about the economic, political and legal inequities that contribute to the illnesses of many of their patients.  Thus CPE programs need to integrate such knowledge into the training of chaplains — and of other spiritual caregivers.  Such integrative training would expose CPE students to community leaders and organizations on the front lines of seeking to create “a more just society.”  The recruitment of more chaplains of color would also complement commitment to cultural competency and diversity of belief in spiritual care.

The recently formed Spiritual Care Association is committed to diversity in spiritual care.  It’s “White Paper” states that “an explicit ethic of professional chaplaincy is that the board certified chaplain seeks to connect the patient, family or staff person to their own spiritual frame of reference, not superimpose or proselytize any specific or spiritual tradition.” (“SPIRITUAL CARE; What It Means, Why It Matters in Health Care,” Ibid)  The mission of SCA’s parenting organization, HealthCare Chaplaincy Network, also emphasizes an admirable inclusive ethic: “to help people faced with illness and grief find comfort and meaning – whoever they are, whatever they believe, wherever they are.  (Ibid)

Again, what would “in-depth and specialized patient-centered care intervention” look like for discriminated against black persons, impoverished white persons, politically and religiously oppressed LGBTQ persons, and immigrants — and refugee seekers now being terrorized by a predatory Trump administration’s nativist bans and wall mentality?

The SCA’s “New White Paper” is blank on the political, economic and legal dimensions of “community competency.”  This omission directs one’s attention to the seminaries in which chaplains and their clinical training supervisors received their foundational theological training.  Missing in many seminaries is the modeling of a prophetic imperative that confronts political, economic and legal power with reality and moral truth on behalf of “the whole person.”

Fr. Henry Heffernan, S.J., former chaplain at the National Institutes of Health Clinical Center in Bethesda, MD, provides helpful commentary, broadening the meaning of “the whole person.”  He states that the presence of “chaplains in health service institutions” demonstrates “a basic respect for the humanity and religious convictions of patients and for the integral role of religion and spirituality in patients’ lives.”  But, he sees as “unwise . . . shifting the rationale for hospital chaplains to an empirically testable claim that the chaplain’s interventions with individual patients in the institution will improve the health outcomes of those patients in a way that is empirically measurable and that produces measurable cost  savings that exceed . . . chaplain salaries and overhead.” (“Religion and Health Research: Interpretation Sends Wrong Message Regarding Need for Hospital Chaplains in Health Care Institutions,” Journal of Pastoral Care & Counseling, Spring 2003, Vol. 57, (1), 79-81)

Chaplain Heffernan then widens the meaning of providing spiritual care for “the whole person.”  He refers to “another body of medical literature” that is focused on “the disparities in health status and outcomes between people in different socioeconomic strata,” which show that “affluent and well-educated on average have significantly better health and live longer than the poor with little education.”   In his view, “the empirical evidence on the affect of socioeconomic factors on health outcomes is much clearer . . . than the empirical assertion between religious practice and health outcome reported by Koenig, McCullough, Larson, Weaver and others.” (Ibid)

Chaplain Heffernan then makes this radical statement: “These socioeconomic disparity studies . . . would suggest that a government could do more in achieving significant improvements in the nation’s health by improving the socioeconomic status of the less fortunate in society, instead of promoting or subsidizing religious groups or chaplaincy practices.” (Ibid)

A reality check for correlating spiritual care with good health outcomes is provided by Drs. Richard Sloan and Emilia Bagiella.  Their research on “Claims about religious involvement and health outcomes” does not support the SCA’s “New White Paper’s” assertion that “professional chaplaincy is evolving to become an evidence-based profession with objective standards for quality care and scope of practice similar to other health care disciplines.” (Ibid)  Sloan and Bagiella examined many studies that claimed “health benefits associated with religious involvement,” and “conclude that there is little empirical basis for assertions that religious involvement or activity is associated with beneficial health outcomes.” (www.pubmed.gov, Vol. 24, Issue 1, pp. 14-21)

In 2006, Dr. Sloan authored BLIND FAITH; The Unholy Alliance of Religion and Medicine.  The Journal of the American Medical Association’s review of the book provides another reality check for spiritual care in stating, “A no-nonsense scientific assessment of the alleged benefits of religious practice on health outcomes, providing a welcome dose of skepticism and exposing over inflated and unsubstantiated claims.  Sloan has performed an invaluable service [with] Blind Faith . . . Highly recommended.” (“Blind Faith: The Unholy Alliance of Religion and Medicine”, First St. Martin’s Griffin Edition, April 2008, us.macmillan.com/blindfaith/richardpsloan)

“Over-inflated and unsubstantiated claims.”  The Spiritual Care Association’s “White Paper” on ‘SPIRITUAL CARE’ smacks of grandiose marketing.  This inflated self-assumed importance of chaplaincy is seen in the section on ‘SPIRITUAL CARE GENERALISTS AND SPECIALISTS.’  Like the “generalists and specialists” in medicine, the “special care specialists” are the ”board certified chaplains,” and the “spiritual care generalists” are the “physicians, nurses, social workers, etc.”  Here “the spiritual care generalist is responsible for screening for spiritual need and making referrals to the spiritual care specialist when more in-depth spiritual care is appropriate.”  Thus, “the nurse or social worker can perform a spiritual care screen,” and “a physician can take a spiritual history, and the chaplain can provide complex spiritual care in response to their referrals.” (“SPIRITUAL CARE; What It Means, Why It Matters in Health Care,” Ibid)  Chaplains with their own white coats.

My work as staff chaplain at Boston Medical Center included making the initial contact with patients affiliated with a religion and patients with no affiliation.  Many of those first contacts were often critical,  leading to timely spiritual care for patients at that very moment.  Spiritual assessment and care on the spot that a physician, nurse or social worker might well not do and should not be expected to do.

On the spot spiritual care.  A black woman in her 50s was waiting to be admitted when I entered Boston Medical Center’s Admitting Office.  She asked, “Are you a doctor?”  “No,” I replied, “I’m a hospital chaplain.”  She said, “Do you says prayers for people, and give the last rites?”  I responded, “I say prayers for people, if they want me to.”  She said, “I’m having surgery today, and I’m a little nervous.”  Thus began a timely pastoral/spiritual care intervention. (See ‘SPIRITUAL WELL-BEING,’ Pastoral Report, cpsp.org, Dec. 4, 2014)

In my experience, making rounds visiting patients, along with participating with staff in family conferences and other meetings, afforded the opportunity to establish relationships with nurses, physicians, social workers and other staff, which led to patients with spiritual concerns being referred to me.  It was about the regularity of my presence, and immediate availability when paged regarding patients’ needs.

“Physicians take a spiritual history of a patient?”  Dr. Richard Sloan points out that “physicians complain loudly and often about how little time they have to spend on direct patient care.”  And to introduce a discussion of religion would “forgo discussion of pressing medical matters.”  Sloan then refers to “another concern that for some may be most important of all: the impact that attempts to bring religion into the ‘laboratory’ of the scientist will have on religion itself.  Is there a danger,” he continues, “that in successfully demonstrating a relationship between religious involvement and better health, the advocates will win the battle and lose the war?”  The danger: “Will God and religion be reduced from a philosophy of how to live one’s life morally and ethically, one that answers questions about the mysteries of existence, to a treatment option that appears on a health insurance plan or an over-the-counter product available in the aisles of our local pharmacy?” (Blind Faith: The Unholy Alliance of Religion and Medicine, Ibid)  “How to live one’s life morally and ethically” is related to “community competency.”

There are other risks involved in a physician assuming a spiritual posture.  The physician’s authority in medicine may, in a patient’s mind, extend to religion.  Patients not religiously motivated could feel guilty about their lack of spirituality.  Others might associate religion with the physician and trust even more in a good health outcome.  And if a patient’s treatment doesn’t end well, he or she could feel abandoned and punished by God for not having enough faith.  There is also the danger of a physician using an ill person’s vulnerability to proselytize.  Also, a number of emotionally healthy patients have no need or desire for spiritual care, and a physician introducing a spiritual history is presumptuous.

This critique is about the grandiose marketing of spirituality, not about minimizing the importance of pastoral/spiritual care for hospitalized patients and their loved ones.  Pastoral/spiritual care is indispensable in the health care of patients.

As a chaplain at Boston Medical Center, my work led me to realize that pastoral/spiritual care is not merely about what a chaplain’s prayer may bring to a patient, but what a patient’s belief in his or her God may bring to a chaplain’s prayer.  Pastoral/spiritual care is about saying patients’ names – not just about praying for them in another’s name.  Pastoral/spiritual care is about enabling patients to tell their own stories, the sharing of which affirms and empowers the teller and often provides wisdom for the listener.  Pastoral/spiritual care is about giving grief the hearing it needs rather than remaining bottled up and beside itself.  Pastoral/spiritual care is about integrated self-awareness and inner emotional security that enable the chaplain to experience a patient’s reality, not interpret it, and to allow patients and their families to be who they are.

And, for a chaplain, “community competency,” as well as cultural competency, is required to understand spiritual distress in caring for “the whole person.”  Pastoral/spiritual care begins with knowledge of the lifelong institutionalized discrimination endured by a self-loathing, terminally ill black man, who believes that shortly he will be “shoveling coal” in hell.  Pastoral/spiritual care is about being sensitively present, on a midnight Christmas Eve, at the  bedside of a dying young white homeless woman, surrounded by her homeless male partner and her sister and brother-in-law, whose caring words and tears reveal: homeless, but not loveless. (See Alberts, A Hospital Chaplain at the Crossroads of Humanity, CreateSpace, 2012)  Pastoral/spiritual care is about performing the same-sex marriage of two longtime male partners, at the hospital bedside of the loved — and loving — partner who does not have long to live.

Hospital chaplains are in a unique position to witness daily the inequalities and injustices that adversely impact the health of many patients.  Thus chaplains and their organizations need to incorporate a critical dimension into their clinical pastoral training and spiritual care: knowledge of the political, economic and legal conditions that foster or undermine good health.   When chaplains adequately address these conditions, they will earn a broader and more vital place at the health care table — and fulfil their calling as prophets of the people and not simply pastoral/spiritual caregivers of the status quo.

More articles by:

Rev. William E. Alberts, Ph.D., a former hospital chaplain at Boston Medical Center, is both a Unitarian Universalist and United Methodist minister. His new book, The Counterpunching Minister (who couldn’t be “preyed” away) is now published and available on Amazon.com. The book’s Foreword, Drawing the Line, is written by Counterpunch editor, Jeffrey St. Clair. Alberts is also author of A Hospital Chaplain at the Crossroads of Humanity, which “demonstrates what top-notch pastoral care looks like, feels like, maybe even smells like,” states the review in the Journal of Pastoral Care & Counseling. His e-mail address is wm.alberts@gmail.com.

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