With God in the Storm: Hospice Chaplaincy for Patients With Mental Health Challenges
Aaron Klink, MAR, MDiv, ThM, Pruitt Hospice, Durham, NC
In the United States, Medicare regulations require all hospice patients to receive spiritual assessments and if they desire, spiritual care from hospice staff. Ideally, spiritual care would a patient’s religious community with whom they have an enduring relationship, and shared spiritual beliefs would provide support. Hospice patients have often had extended absences from religious communities for some time due to medical conditions, leaving them without connections to current congregational leadership. In this case, a chaplain can provide spiritual support to a patient. As Wendy Cadge notes in her book on Chaplaincy, chaplains are often the new spiritual care workers in the United States.
As a hospice chaplain, I find patients with severe, persistent mental health challenges often lack religious community support because their religious communities did not know how to support them during their illness. Some got labeled “possessed” or told them to “pray their way through” a mental health challenge (evangelical and Pentecostal Christians) or advised them to seek medications without attention to the spiritual ramifications of mental health challenges. (Liberal and mainline Protestants and some Roman Catholics). Patients with mental health challenges often have frayed family relationships or have been abandoned after years of frustration, leaving the patient without strong care advocates. In such cases the hospice team becomes the primary unit of support and advocacy. The patients often search for God amid what theologian John Swinton calls “a storm”.
Contemporary Clinical Pastoral Education rarely gives chaplaincy trainees extensive exposure to patients with mental health challenges. That is a departure from the early days of Clinical Pastoral Training, which primarily occurred in psychiatric hospitals, in the theory that work with psychiatric patients caused students to learn to listen carefully to accounts of suffering in relation to spirituality. One of the prominent early voices in the Clinical Training movement Anton Boisen, argued that training students on patients with psychiatric problems allowed them to encounter ”individuals whose behavior is guided and controlled by certain value judgements. We see these individuals breaking down or broken down under the stresses and strains of love and hate and fear and anger. See them grappling with spiritual issues of life and death, of survival and destruction; and we can observe the end results and diverse ways in which individuals deal with failure to measure up to the moral standards which they have accepted as their own”.[1]
Boisen’s argument is based on a Freudian model of mental illness that has fallen by the wayside with the rise of biological psychiatry. However, without proper theological frameworks and basic medical knowledge, hospice chaplains struggle to provide appropriate spiritual care to patients with mental health challenges. I argue that understanding a patient's mental health condition helps chaplains understand the relationship between that diagnosis and the patient's spiritual perceptions and journey. This paper argues that chaplains who know the signs and symptoms of mental health challenges can provide presence that helps a patient understand why for instance, depression rather than a lack of faith makes God feel absent. AT the same time, from a theological point of view, Chaplains can help the medical team understand that patients might be having real and powerful experiences of the divine that cannot be reduced to a medical diagnosis. Awareness of a mental health challenges can help chaplains be more present to patients in non-anxious ways while affirming the possibility of God's presence amid illness. Using a case study from my own hospice work to explore how mental health challenges make using some popular models of end-of-life care difficult. I also argue that chaplains can advocate for patients with mental health challenges by refusing to deny the possibility and experience of God's continuing presence in the lives of patients amid the challenge, while also letting diagnostic knowledge inform their care. This approach allows chaplains to be powerful advocates for care of a marginalized population that is often not respected or labeled “difficult” by the medical team.
As a hospice chaplain, I find patients with severe, persistent mental health challenges often lack religious community support because their religious communities did not know how to support them during their illness. Some got labeled “possessed” or told them to “pray their way through” a mental health challenge (evangelical and Pentecostal Christians) or advised them to seek medications without attention to the spiritual ramifications of mental health challenges. (Liberal and mainline Protestants and some Roman Catholics). Patients with mental health challenges often have frayed family relationships or have been abandoned after years of frustration, leaving the patient without strong care advocates. In such cases the hospice team becomes the primary unit of support and advocacy. The patients often search for God amid what theologian John Swinton calls “a storm”.
Contemporary Clinical Pastoral Education rarely gives chaplaincy trainees extensive exposure to patients with mental health challenges. That is a departure from the early days of Clinical Pastoral Training, which primarily occurred in psychiatric hospitals, in the theory that work with psychiatric patients caused students to learn to listen carefully to accounts of suffering in relation to spirituality. One of the prominent early voices in the Clinical Training movement Anton Boisen, argued that training students on patients with psychiatric problems allowed them to encounter ”individuals whose behavior is guided and controlled by certain value judgements. We see these individuals breaking down or broken down under the stresses and strains of love and hate and fear and anger. See them grappling with spiritual issues of life and death, of survival and destruction; and we can observe the end results and diverse ways in which individuals deal with failure to measure up to the moral standards which they have accepted as their own”.[1]
Boisen’s argument is based on a Freudian model of mental illness that has fallen by the wayside with the rise of biological psychiatry. However, without proper theological frameworks and basic medical knowledge, hospice chaplains struggle to provide appropriate spiritual care to patients with mental health challenges. I argue that understanding a patient's mental health condition helps chaplains understand the relationship between that diagnosis and the patient's spiritual perceptions and journey. This paper argues that chaplains who know the signs and symptoms of mental health challenges can provide presence that helps a patient understand why for instance, depression rather than a lack of faith makes God feel absent. AT the same time, from a theological point of view, Chaplains can help the medical team understand that patients might be having real and powerful experiences of the divine that cannot be reduced to a medical diagnosis. Awareness of a mental health challenges can help chaplains be more present to patients in non-anxious ways while affirming the possibility of God's presence amid illness. Using a case study from my own hospice work to explore how mental health challenges make using some popular models of end-of-life care difficult. I also argue that chaplains can advocate for patients with mental health challenges by refusing to deny the possibility and experience of God's continuing presence in the lives of patients amid the challenge, while also letting diagnostic knowledge inform their care. This approach allows chaplains to be powerful advocates for care of a marginalized population that is often not respected or labeled “difficult” by the medical team.