The Soul of Medicine: Spiritual Perspectives and Clinical Practice

13. Spiritual Care and Chaplaincy

CHAPTER THIRTEEN Spiritual Care and Chaplaincy Terry R. Bard, D.D., and Walter Moczynski, D.Min., M.T.S., M.Div. The earliest human records document provisions for spiritual and religious care. Health and well-being have been intimately intertwined throughout history, often in communal life and frequently in religious belief and practices. Religious leaders were originally the arbiters of practices directed to address both physical and spiritual well-being, and religious beliefs and forms provided the contexts for undergirding this relationship. Whereas most early cultures shared the perspective that body, mind, and spirit were integrated functions, and believed that problems occurring in any one of these three dimensions affected the other two, Greek culture offered a different conception of the relationship, suggesting that body, mind, and spirit each had its own independent integrity and reality. Greek notions took hold in the Middle East and influenced early Christianity. In ancient cultures the concept of soma sema, the body as the prison of the spirit (or “soul”), became embedded in both theory and practice as formal disciplines relating to these dimensions emerged. The priest or shaman, formerly arbiter of all three, emerged as the communal overseer of the spirit, while the physician became the caretaker of the body, and the philosopher addressed the concerns of the mind. 226 Implications and Applications Over the centuries, societies and individuals have struggled to relate these three aspects of human experience. A number of debates during the early 20th century left most Western professional practitioners with the belief that these realms, though sharing some overlapping concerns, were independent of each other. Physicians were to concern themselves with bodily things; the newly emerging practitioners of psychology, neurology, and psychiatry were to address the mind; and religious leaders were to devote their efforts to the spirit. Exceptions such as Christian Science notwithstanding, the dominant model for Western society was a separatist one. Challenges to this separatist model persisted, however. Alternative practices emerged in the 1960s and early 1970s, as Anglican bishop John Robinson and others declared God dead, as experimental psychology evolved into clinical psychology, and as medicine began to learn of relationships among body, stress, and belief. The early 21st-century reconsideration of the relationship of body, mind, and spirit may sort out differently than it did a century ago. Pastoral care occurred informally and haphazardly in hospital settings before the 20th century. Most frequently it occurred through the administration of religious rites and sacraments by clergy. A number of cultures and religious traditions regarded visiting the sick as a special obligation of their membership or their clerical representatives. More focused education in clinical pastoral care began during the early 20th century coincident with ongoing formal debates over the relationship between religion and medicine. Richard Clark Cabot, M.D. (1869–1939), frequently credited as one of the founders of the pastoral education movement, began working with ministerial students at Worcester State Hospital. One of his students, Anton T. Boisen, later became a patient at the same institution. During his hospitalization and eventual recovery , Boisen began to appreciate the analytical approach to care that he had experienced. He concluded that such an approach, which used objective assessment and knowledge of human predicaments as a template, would benefit ministers in their pastoral function. Boisen posited that all individuals were “living human documents” who need to be understood and ministered to in this context. The suggestion of such early pioneers that the pastor, too, should engage in self-reflection as a living human document marked the beginning of what has come to be known as clinical pastoral education (CPE). This movement evolved over time to become a model for training. Initially, Protestant “pastors” were Spiritual Care and Chaplaincy 227 trained; by the 1990s ordained clergy of many denominations sought proficiency in clinical skills, team work, and self-reflection. More recently, such training has also become available for many nonclergy who express interest in providing pastoral and spiritual care. All professional pastoral care organizations today require candidates seeking board certification to have successfully completed a minimum of four CPE “units” comprising 400 hours each of a mixture of didactic, interactive, and supervisory experiences. Clinical pastoral training that originally took place in hospitals expanded to a broad range of institutional and organizational training sites, and collaboration with Protestant seminaries helped to provide an academic structure. Eventually offering a variety of training levels along with a coterie of advanced, experienced...