Proselytizing Positivism: Deconstructing the Shaming of Spirituality in Western Medicine and the Case for Medical School Chaplaincy
Elizabeth J. Berger, MS, Guest Faculty, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
In recent years, spirituality has become increasingly recognized as integral to holistic patient care, and some efforts have been made to integrate material pertaining to patients’ belief systems into medical, graduate and continuing medical education curricula. Still, the subjects of religion and spirituality remain positioned at an academic remove, with little to no attention to the spiritual well-being of providers themselves.
Mythic experiences, defined as “things that go beyond explanation,” happen all the time. Yet in the evidence-bound realm of Western medical culture, the accepted ideal is purged of mythic thinking, often with a stifling effect on the narratives of patients and providers alike. Positivism, the primacy of technology and the legacy of Cartesian dualism have rendered modern medicine—with its high rates of professional burnout and medical error—a kind of living paradigm of the Kabbalistic notion of the Shekhinah (the Divine feminine) in exile. The silencing of certain kinds of stories, particularly those related to mythic thinking or spiritual belief, is a barrier to communication, shared decision-making and effective self-care. Situated on the threshold separating life and death, medical culture has become a site for what Richard Pevear termed in his introduction of Fyodor Dostoevsky’s Notes from Underground, “profound human displacement; a spiritual void filled with foreign content.” This is due in part to persisting 20th-century associations of myth with falsehood and spirituality with anti-intellectualism.
Borrowing from the institutional leanings governing the separation of church and state, an essential underlying premise governing Western medicine is the misapprehension that secularism is necessarily a neutral and appropriate approach to the existential challenges of illness and disability. One example of secularism’s hold on medicine is the growing momentum of humanism in medical education. The conflation of the term “humanism” with the compassionate ideals of “humanitarianism” masks humanism’s roots as a philosophy of thought emphasizing positivism and non-theism. While the needs of individual humanists should certainly be accommodated in medical settings, humanism is not intrinsically inclusive and is therefore problematic as a blanket philosophy of medicine, medical education and patient-centered care.
Clinical pastoral care is unique among healthcare disciplines in that the chaplain is the only member of the interprofessional team responsible for serving both patients and staff. While an excellent built-in resource for providers, chaplains are frequently overlooked, in part, due to a lack of awareness about this aspect of their role and abounding misconceptions about what professional chaplains do. (Chaplains accompany diverse populations including non-theists. The advancement of any religious agenda is expressly contrary to professional standards.)
Beginning in the 1980s, precedents for medical school chaplaincy were established at Yale University and Tulane University, but the practice now appears to be limited to a handful of Jesuit institutions. Normalizing the availability of professionally trained chaplains to medical students early in their careers may engender a cultural shift towards self-assessment, self- care and tolerance in professional practice for the wholeness of all that inevitably lies in the shadow of our epistemological grasp.
In recent years, spirituality has become increasingly recognized as integral to holistic patient care, and some efforts have been made to integrate material pertaining to patients’ belief systems into medical, graduate and continuing medical education curricula. Still, the subjects of religion and spirituality remain positioned at an academic remove, with little to no attention to the spiritual well-being of providers themselves.
Mythic experiences, defined as “things that go beyond explanation,” happen all the time. Yet in the evidence-bound realm of Western medical culture, the accepted ideal is purged of mythic thinking, often with a stifling effect on the narratives of patients and providers alike. Positivism, the primacy of technology and the legacy of Cartesian dualism have rendered modern medicine—with its high rates of professional burnout and medical error—a kind of living paradigm of the Kabbalistic notion of the Shekhinah (the Divine feminine) in exile. The silencing of certain kinds of stories, particularly those related to mythic thinking or spiritual belief, is a barrier to communication, shared decision-making and effective self-care. Situated on the threshold separating life and death, medical culture has become a site for what Richard Pevear termed in his introduction of Fyodor Dostoevsky’s Notes from Underground, “profound human displacement; a spiritual void filled with foreign content.” This is due in part to persisting 20th-century associations of myth with falsehood and spirituality with anti-intellectualism.
Borrowing from the institutional leanings governing the separation of church and state, an essential underlying premise governing Western medicine is the misapprehension that secularism is necessarily a neutral and appropriate approach to the existential challenges of illness and disability. One example of secularism’s hold on medicine is the growing momentum of humanism in medical education. The conflation of the term “humanism” with the compassionate ideals of “humanitarianism” masks humanism’s roots as a philosophy of thought emphasizing positivism and non-theism. While the needs of individual humanists should certainly be accommodated in medical settings, humanism is not intrinsically inclusive and is therefore problematic as a blanket philosophy of medicine, medical education and patient-centered care.
Clinical pastoral care is unique among healthcare disciplines in that the chaplain is the only member of the interprofessional team responsible for serving both patients and staff. While an excellent built-in resource for providers, chaplains are frequently overlooked, in part, due to a lack of awareness about this aspect of their role and abounding misconceptions about what professional chaplains do. (Chaplains accompany diverse populations including non-theists. The advancement of any religious agenda is expressly contrary to professional standards.)
Beginning in the 1980s, precedents for medical school chaplaincy were established at Yale University and Tulane University, but the practice now appears to be limited to a handful of Jesuit institutions. Normalizing the availability of professionally trained chaplains to medical students early in their careers may engender a cultural shift towards self-assessment, self- care and tolerance in professional practice for the wholeness of all that inevitably lies in the shadow of our epistemological grasp.