We Already Tried & Failed: Lessons from the Disenchantment of the Re-Enchantment
Boaz Goss, PhD., Graduate Student, Saint Louis University
Jeffrey P. Bishop, M.D., Ph.D., Director, Albert Gnaegi Center for Health Care Ethics, Saint Louis University
The chaplaincy movement is a historical attempt to re-enchant disenchanted medicine. There is strong evidence to conclude that chaplaincy failed this mission. Instead of re-chanting the medical enterprise so it could holistically care for the soul, disenchanted medicine consumed chaplaincy. Chaplaincy’s character was dissolved in this disenchantment. It was not longer a reform program, capable of revolutionizing the attitude and culture of medicine. It was reduced to a façade of spirituality, a veneer employed by disenchanted medicine to placate reformers without undergoing any of the actual, uncomfortable reforms. The resulting biopsychosocialspiritual medicine merely extends its disenchantment to the spiritual realm of the patient’s life. What was supposed to be the antidote became infected by the poison it was meant to treat.
Future efforts to re-enchant medicine must be historically aware and learn from chaplaincy’s failure. Tristram Engelhardt and Albert R. Jonsen have already detailed the failures of generic chaplaincy, which is disenchanted chaplaincy. Jeffrey Bishop has already explored the metaphysical battle that lies at the heart of the struggle towards enchantment. Bishop is correct to see the problem as ultimately a metaphysical one. Assuming that reality consists of only inert matter to be reorganized efficiently causes medicine to become a beachhead of disenchantment in the same way that modern philosophy became a beachhead for disenchantment centuries ago.
This paper seeks to expand Bishop’s project against the disenchantment of medicine by exploring the practical methods through which the disenchanted metaphysic behind modern medicine conquered and tamed the enchantment of chaplaincy. We argue that medicine’s disenchanted metaphysic is manifested by the insistence that spiritual care must meet quality metrics primarily through the use of spiritual assessment inventories. By accepting chaplaincy but forcing the enterprise to play by the rules of measurable efficiency through regulatory pressures to produce quantifiable results, chaplaincy was thereby forced to leave behind the enchanting elements it hoped to offer. Not even the most refined spiritual inventory is able to verify enchantment. As long as medicine is under the pressure of quantifiable efficiency measures, it will remain disenchanted, and will come to disenchant all elements within itself. By explaining the forces that caused the first re-enchantment of medicine to fail, this paper lays the groundwork and provides guidance for new enchanting movements inspired by this conference.
Jeffrey P. Bishop, M.D., Ph.D., Director, Albert Gnaegi Center for Health Care Ethics, Saint Louis University
The chaplaincy movement is a historical attempt to re-enchant disenchanted medicine. There is strong evidence to conclude that chaplaincy failed this mission. Instead of re-chanting the medical enterprise so it could holistically care for the soul, disenchanted medicine consumed chaplaincy. Chaplaincy’s character was dissolved in this disenchantment. It was not longer a reform program, capable of revolutionizing the attitude and culture of medicine. It was reduced to a façade of spirituality, a veneer employed by disenchanted medicine to placate reformers without undergoing any of the actual, uncomfortable reforms. The resulting biopsychosocialspiritual medicine merely extends its disenchantment to the spiritual realm of the patient’s life. What was supposed to be the antidote became infected by the poison it was meant to treat.
Future efforts to re-enchant medicine must be historically aware and learn from chaplaincy’s failure. Tristram Engelhardt and Albert R. Jonsen have already detailed the failures of generic chaplaincy, which is disenchanted chaplaincy. Jeffrey Bishop has already explored the metaphysical battle that lies at the heart of the struggle towards enchantment. Bishop is correct to see the problem as ultimately a metaphysical one. Assuming that reality consists of only inert matter to be reorganized efficiently causes medicine to become a beachhead of disenchantment in the same way that modern philosophy became a beachhead for disenchantment centuries ago.
This paper seeks to expand Bishop’s project against the disenchantment of medicine by exploring the practical methods through which the disenchanted metaphysic behind modern medicine conquered and tamed the enchantment of chaplaincy. We argue that medicine’s disenchanted metaphysic is manifested by the insistence that spiritual care must meet quality metrics primarily through the use of spiritual assessment inventories. By accepting chaplaincy but forcing the enterprise to play by the rules of measurable efficiency through regulatory pressures to produce quantifiable results, chaplaincy was thereby forced to leave behind the enchanting elements it hoped to offer. Not even the most refined spiritual inventory is able to verify enchantment. As long as medicine is under the pressure of quantifiable efficiency measures, it will remain disenchanted, and will come to disenchant all elements within itself. By explaining the forces that caused the first re-enchantment of medicine to fail, this paper lays the groundwork and provides guidance for new enchanting movements inspired by this conference.