Chapter Twenty: Engaging as a Chaplain with the anger and suffering of someone coping with trauma and disability.
Introduction
1. Case Study: The experience
2. The Analysis
3. Theological Reflection
4. Response
Conclusion
Introduction
“Since becoming disabled some friends have vanished and most just don’t get it. ….perhaps I just don’t have much in common with people anymore. I don’t know why I posted this, there isn’t an answer, I’ve tried all the usual joining stuff but to no avail.” Lucy’s message posted on the Apparalyzed web site 13/12/2006
This cry of desperation of a young person, recently injured, expresses the depths of despair that people coping with trauma and disability often feel. It is into this situation that a hospital chaplain may arrive. The irony of a ‘disabled’ chaplain visiting on the hospital wards of one of the UK’s National Spinal Units is self-explanatory. The surprise in this story is that this chaplain did not expect such diversity in people’s response to trauma through injury.
As Chaplains we always bring our stories into dialogue with the stories of the patient and hopefully create a safe space whereby the patient and chaplain can encounter the story of a God who is near to the broken hearted, a God who, in Christ and through us knows and embraces suffering.
This paper will outline one particular case study of someone coping with trauma and permanent disability. Using the Weaver pastoral cycle as a model for theological reflection we present the case study as the ‘experience’ and subject it’s key themes to analysis, to explore what is going on. This will be followed by a stage of theological reflection, asking how the scriptures inform the discussion. To avoid the exercise being a passive model, this in turn will lead to an action response. Weaver’s spiral model (Weaver, 2006, p.5), is clearer than the Fraser praxis model (Ballard & Pritchard, 2006, p.84), showing that the process itself will move the relevant parties on to a new
situation, changed as a result of the experience, analysis, reflection and response. Such a model, although it is only a tool, can be an important discipline, offering the theologian a checklist, encouraging the theologian to avoid taking shortcuts in learning from real life experiences. (Ballard & Pritchard, 2006, p.87)
1. Case Study: The Experience
One patient’s response to pain and loss in the context of accident induced disability.
The experience
Rick watched me intensely as I moved from bed to bed in the spinal unit. I talked and prayed with a variety of patients, all trying to come to terms with an able bodied past that had been hijacked by an accident or an illness which had transformed them into the ranks of the ‘disabled.’
Twenty-five years earlier, I had spent 10 months on that same hospital spinal unit as a result of a road traffic accident. I had once received comfort, support and encouragement from the chaplain of that day. Now the roles are reversed and, as chaplain I had the privilege of ministering on the same spinal unit.
Towards the end of the ward visit, I introduced myself to Rick, greeted him and said ‘How are you coping?’
‘Are you a vicar then?’ he replied
‘I’m one of the chaplains.’
‘Do you believe in all that God stuff then?’
Yes….
‘You disgust me.’
‘I’m sorry, if I disgust you, would you like me to leave.’
’I’m asking you questions, you can leave when I tell you to.’
‘I’m clearly not helping you and I think it would be better if I left you in peace.’
‘So that’s it, you walk off and leave me lying here when I’m still talking to you.’
‘I’m happy to stay, If you’d like me to.’
‘I don’t like you at all, you disgust me, but I’m asking you questions.’
‘What would you like to ask me?’
‘Does God really want people like you walking around in dog collars, it disgusts me!’
The conversation with Rick continued, I realised he was well versed in Christian jargon and I asked him If he had a religious background. He refused to answer.
I left that visit feeling I had been spiritually attacked, not so much by Rick but by whatever dark spiritual powers Ephesians 6v12 is referring to. It felt like I was in a spiritual battle, I also thought that I was, in some way, an outlet for Rick’s anger and frustration at his trauma and his disability.
Rick had broken his back falling from a height while escaping from committing a burglary. I therefore, sensed that there was an issue that Rick thought his injury may be divine retribution for past crimes committed.
I made a point of speaking to him each week when I visited the ward. In the end, we did become quite close. Later, he told me he had a Christian conversion many years earlier and had attended a Free Church, evangelical fellowship but since then had fallen into a life of drugs and crime.
Before he was discharged, he asked me for a bible, saying he wanted to start reading ‘the good book again.’ When I asked if he would like me to pray with him about the future and his discharge from hospital, he declined saying “I’m not ready for that yet.”.
Rick was discharged in a wheelchair – a paraplegic for the rest of his life. He now lives alone in a ground-floor flat on a council estate in Wakefield.
2. Analysis
This case study, the story of Rick and the Chaplain, enables us to apply the principles of Practical Theology. The key themes we shall attempt to analyse in the story will include the role of the chaplain in journeying with the patient. We will touch on the psychological aspect of Rick’s response to his disability, the psychological aspects of guilt arising from crimes committed.
Our theological discussion will look at the meaning of the ‘spiritual battle’ and develop into a discussion on how divine retribution is satisfied by grace through our Lord Jesus Christ.
There is a further reflection on valuing patient’s prayer requests, which will lead to a discussion on the meaning of healing and cure.
Ballard and Pritchard (2006, p.4) emphasise the importance of ‘contextualisation of theology’ – the need to take the living context seriously as a base for theological reflection. In the case of the Chaplain and Rick we must acknowledge the difference in social backgrounds of the two in dialogue. The Chaplain, a paraplegic from an evangelical church background, the patient, a paraplegic, with a social life of crime to feed addictions. Where the chaplain has come from will affect the way he perceives the case. Both global and local contexts ‘provide settings for the stories and their interpretations.’ (West Noble and Todd, 1999: p. 7)
By acknowledging the context and difference from the outset we will be better equipped to reflect on the case later. We must also note that scripture shapes the chaplain’s understanding of this story adding a gospel metanarrative to the context.(Lyall 2001, p. 46)
One of the main themes of the case study is that of two people, Chaplain and patient journeying together. The patient has recently suffered a major life trauma and the Chaplain is trying to ‘listen’ to the patient. ‘Listening to more than the words, gestures, body language, reading the silences…learning what people are saying. The non-verbal as well as the verbal…you must go deeper .in order to understand people both in their pain and in their grief.’ Vanier (The Broken Body, quoted in Stoter, 1995 p.27)
Stoter (1995) goes on to define spiritual care as ‘responding to the uniqueness of the individual.’ (p. 8) Later, Stoter refers to the ‘unpredictability of the relationship.’ In the chaplains journey with Rick that was clearly true from the outset! It could be said that the Chaplain and Rick, got off on a bad footing but by using the language of ‘journey’ rather than ‘encounter’ we observe there was a real sense of growing together in relationship, accepting each other’s individuality and rights to difference which includes difference in emotional response.
From the outset it was important to establish some professional boundaries, the patient was aggressive and rude and there was a clear ‘tussle’ over control. The patient seemed eager to control the visiting terms by dictating when the chaplain left. This, of course, raises issues of when should the chaplain express a ministerial authority? Godly wisdom is needed in dealing with such situations and each must be dealt with on a case by case basis. In this case the chaplain felt it was important for the patient to know he was not a captive audience thus ignored the ‘rudeness.’ Later, on subsequent visits, the chaplain emphasised boundaries of confidentiality, time and the degree of involvement to ensure there could be a natural end to the journey.
Speck (1988) states that an important part of respecting oneself is recognising the necessity of setting boundaries within pastoral relationships. There are a wide variety of boundaries relating to such things as confidentiality, time, degree of involvement, frequency of meeting, personal beliefs, and the amount of our own life experience that we may share with the other person’ (p. 19).
Initially control, was important to the patient which could be a response to the lack of control he was experiencing as his able bodied world was crumbling around him. Was there a possible case of the chaplain emotionally abusing the patient by threatening to walk away from the situation, regaining the upper hand in the tussle for control whilst exploiting the patient’s lack of mobility? The Hospital Chaplains Handbook [2005] states that abuse can ‘result from a misuse of power or a betrayal of trust, respect or intimacy which causes harm or exploitation’ (p. 158). The encounter in this case study needed to be handled sensitively to avoid such an accusation.
By the end of this five-month journey the Chaplain was able to say he and Rick had become close friends. As the weeks went on Rick revealed he had a Christian conversion some years ago and had regularly attended a church but had fallen into ‘bad company’ and ‘slidden’ into a life of drugs and crime. Through the mutual journey, Rick was able to revisit his Christian roots and asked for a bible to read while he was in hospital.
Turning now to some of the psychological aspects of personal bereavement regarding his loss of mobility. Many studies in Pastoral care emphasise that the Chaplain should try and be understanding towards the emotional response of ‘being a patient.’
Cobb and Robshaw (1998, p.1) say that when people experience suffering it is ‘seldom a purely physical affair.’ There is the response of the patient to the ‘life trauma of adversity and tragedy. Physical pathology is one aspect of suffering which is characteristic of a biomedical model of illness. Other models take into account different perspectives of illness such as the psychology of illness or sociology of illness.’ In our case study the Chaplain needed to accept that the bedside visit could be a valid outlet for the patients anger and frustration. Each patient’s response to pain and suffering and loss is different and Rick was expressing pain as well as anger.
Looking wider at the macro-narrative, it is, today, a societal norm that rage and anger are expressed rather than suppressed. In the July 16th 2006 Sunday Times magazine, Tim Rayment’s article ‘The Age of Rage’ quotes a Royal College of Nursing survey in which 27% of nurses say they have been attacked at work. In the same article Mike Fisher founder of the British Association of Anger Management says ‘all inappropriate anger is a defence mechanism against some sort of pain.’ He goes on to say ‘anger is our way of telling the world: “I am here. I exist. Take me seriously.” ’
Stoter (1995, p.61) says ‘there is a considerable element of loss …..involved with…..injury..’ he continues, ‘being a patient in hospital can bring a threatening loss of liberty and freedom. There is the disorientating effect of separation from family and work….and relationship limitations. This anxiety often presents in a panic reaction….’ Furthermore, Stoter says ‘the threat of potential loss is also present in many cases of disability… patients so present defence or distancing mechanisms…’ [p. 63]
Could it be, within this bigger picture of the ‘age of rage’ that Rick’s onslaught was a panic reaction or release of unexpressed, pent up frustration of being thrust into the previously unknown world of ‘paraplegia.’ That release, triggered by the chaplain asks something as simple as ‘how are you coping?’
During the weekly visits the chaplain became more aware that Rick perceived his injury as a kind of ‘just desserts.’ He had broken his back partaking in a crime. The chaplain began to gently enquire about Rick’s view of divine retribution. Speck (1988, p. 34) says ‘there are many people who feel…. it [injury] is a result of some wrong doing in the past…it is [therefore] not surprising that some anger should be felt towards those who represent that power.’ It is possible that Rick’s reaction to the chaplain and his focus on the ‘dog collar’ indicated hostility at the ‘divine’ paying him back for his life of crime. Throughout the journey the chaplain hoped to explain the truth of grace and of God’s unconditional love. We shall refer to this later in our theological reflections.
May Ann Coate (1994, p. 84) said ‘In any forgiveness needing situation there are often at least three unpleasant sets of feelings causing or contributing to the stress and estrangement: anger, guilt and isolation.’ These three ‘unplesants’ were active in our patient Rick. The Chaplain sought to discuss a pathway to forgiveness, aware that (p.84) ‘people who are unable to countenance the possibility of forgiveness may be seriously impeded in their search for some peace of mind.’ Cote (p. 120) refers to the ‘depressive position’ of our human development as being that ‘stage at which we first come to know that our ‘bad’ is containable in our ‘good’ and that reparation and creativity as well as mere survival are possible’. As the Chaplain’s relationship with Rick blossomed that spark of creativity and reparation seemed to reignite.
3. Theological Reflection
Our theological reflections will examine the prominent themes of spiritual conflict, the possibility of divine retribution and divine wrath in the context of a loving God. There is a further issue of prayer for healing or cure in the face of permanent disability to be considered.
From his evangelical/Pentecostal background the Chaplain’s immediate response was a feeling of being ‘under attack.’ Paul writing from prison in Ephesians 6 v 12 (NIV) says ‘our struggle is not against flesh and blood ……. but against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.’ Earlier as a free man we read how Paul addressed these spiritual forces of evil when they revealed themselves in the person of a slave girl in Acts 16 v 17-18. ‘Finally, Paul became so troubled that he turned round and said to the spirit “in the name of Jesus Christ I command you to come out of her!” At that moment the spirit left her.’
There is clearly biblical precedent for the chaplain’s initial response to the encounter with the patient. In addition, his faith background informed his current response, an aspect of the ‘contextualisation’ mentioned earlier, hence his description of being ‘under attack’ through the encounter. Exorcism or deliverance ministry is exercised by most branches of he Christian church and other faiths. Usually there are clear guidelines so that the ‘pastor’ does not respond to the spirit in a knee jerk reaction. Indeed, Paul, in Acts 16 responded as he did after ‘many days’ (v17).
Some Modern day theologians would argue that such biblical narrative is not meant to be ‘scientific accounts of history, it is literalistic absurdity.’ Although Tillich (1951, p. 50) would be advocating that we should not take Paul’s language literally, it can be perceived that there is an active power of evil in the world. To St. Paul the whole universe was a battleground and we not only have to negotiate the attacks of humans, he says, but we also contend with the attacks of spiritual forces which are in opposition to God.
The Chaplains Handbook advises ‘the Healthcare organisation will expect the chaplain’s department to function effectively as a professional and organisational unit and in addition chaplains will expect their departments to be a place of support and sharing.’ (p. 93) What followed immediately after the chaplains first visit with Rick shows the importance of reflecting as a chaplaincy team as well as individuals.
Back in the Chaplains office for lunch there was John, the head of Chaplaincy services, Bill, a volunteer visitor and Rob a Christian radiologist having a lunch break. The Chaplain relates the story to the ‘team’ and admits to feeling ‘under attack.’
“You don’t want to see a demon every time someone looses their temper,” says Bill.
“Many staff members have experiences of patients verbally abusing them, don’t take it to heart,” added Rob.
“You often find patients react to trauma in unusual ways” said John, “the person in the dog collar represents of God and the patient is not happy with God at the minute!”
As the four reflected on the encounter, the chaplain reflected on his response and sought other explanations which may be less about deliverance ministry and more about understanding the complexity of the human nature.
As their journey unfolded the chaplain became more and more aware that Rick thought he ‘had it coming to him,’ that God had dealt him this blow because of his waywardness. They were able to chat about the inconsistency of this for example, why some greater sins could go un-punished while lesser demeanours were dealt with harshly. The Psalmist also struggles with such inequality in Psalm 73 ‘for I envied the arrogant when I saw the prosperity of the wicked. They have no struggles; their bodies are healthy and strong… they are not plagued by human ills.’
Further, Pattison (2000, p. 33) speaks about the Christian God who is:
‘paradoxical in character. He is thought of being loving , accepting and compassionate, full of mercy and loving kindness to all. But he is also perceived as being just and moral, a judge who demands righteousness and obedience to his commands.’
Divine punishment is an emotive subject. There is an absence of modern day sermons on the wrath of God, it may not be politically correct to speak of divine retribution but our patient in this case study appeared to be applying it to his predicament.
There is biblical precedent for such theology. Picture the nation of Israel, in their days of Theocracy doing ‘evil in the sight of the [Sovereign] Lord…. therefore the anger of the Lord was kindled against Israel ……’ (Judges 3 v 7,8 NRSV). (See also Lord’s response to ‘wickedness’ in the ‘flood narrative’ in Genesis 6 v 5.)
In the New Testament the disciples picked up on another Jewish theme of suffering always being connected with sin, either that of the individual or earlier generations (see Exodus 20v5). John 9 records, ‘As He [Jesus] went along, he saw a man blind from birth. His disciples asked him “Rabbai who sinned , this man or his parents, that he was born blind?” “Neither this man or his parents sinned” said Jesus’ (v 1-3). He goes on to say that by this, God, in Jesus would be glorified. Clearly Jesus’ teaching contradicted the traditional Jewish belief.
Coate MA (1999) would argue from a psychological perspective saying some would perceive their injuries ..’serve the purpose of condemning and punishing us for the things we have done. The terrifying gods inside of fear and punishment preventing the God of love and compassion making an impact on them.’ (p. 53)
The gods within Rick seemed to be squashing the message of an all loving God, inviting all who are weary and heavy burdened to come for rest. (Matt 11v28, NIV)
So how can the paradox of the merciful compassionate God be equated with the wrath of a just and righteous judge? True enough, our patient was guilty of many a sin (as we all are) and before a just judge he would be deserving of whatever sentence the Almighty would hand down.
This paper cannot fully examine the doctrine of penal substitution but JB Phillips translation of Romans 5 v 6 – 8 explains, ‘while we were powerless to help ourselves, Christ died for us.. the proof of God’s amazing love is this: that it was while we were sinners that Christ died for us.. now that we are justified by the shedding of his blood, what reason have we to fear the wrath of God?’
Theologians debate whether or not ‘Christ died for us’ means ‘in our place’ i.e. as a substitute for us. Grudem (1994) gives the evangelical perspective: ‘Christ was a substitute for us when he died… this understanding is in contrast to other views which attempt to explain atonement apart from the idea of the wrath of God’ (p. 579).
Thus, the guilt our patient, Rick, bore was, according to Romans 5 borne/taken by Christ on the cross. The idea that his injury was divine retribution was a false premise. The wrath of God was negated by Christ bearing our sin and shame on the cross. Whether, the Christian Chaplain was able to convey this Christian truth remains to be seen!
Finally, in our theological reflections, there is an issue of healing to be considered. In this case the patient consistently declined the offer of prayer at the bedside preferring the chaplain to enter a prayer request in the Chapel daily prayer book. What prayer does the Chaplain enter in the book? The patient offered no words of prayer to quote. What is appropriate prayer for a permanent disability? There are no medical grounds for total recovery. The chaplain must be careful not to give false hope or rash pronouncements of faith that could disturb or emotionally abuse the patient. On the other hand Jesus performed more miracles of healing than any other kind. John 20 v 31 says the miracles were recorded so that ‘you may believe that Jesus is the Christ, the Son of God, and that by believing you may have life in his name.’ Ultimately, it seems, the miracles of healing were not to eradicate the world of illness and disability, despite the fact that there were times when scriptures tell us the sick came to Jesus and ‘he healed them all’ (Matt 12 v 15 NIV (cf Luke 6 v19)). Rather, the miracles would point to Jesus as the Christ.
By not requesting a prayer for the reversal of the effects of paralysis, in the prayer book, the chaplain was subconsciously distinguishing between healing and cure. Stoter (1995) says ‘there is often a common assumption that the cure is the only acceptable outcome. Cure is concerned with the eradication of disease….Healing has a wider connotation …. being concerned with whatever is happening within the person….… Healing is about journeying towards wholeness of mind, body and spirit as an entirety.’ (p. 154)
The Christian perspective is that the patient would find ‘life’ by believing in Christ according to John 20 and that in itself would be wholeness i.e. that fullness of life that we were created to become (John 10v10). Atkinson (1993) puts it this way. ‘If He [Jesus] is the Human Being, we are all human becomings, on the way to our true humanity, as that is found in our relation to Jesus Christ.’(p. 20)
4. Response
Practical Theology is more than an academic exercise, the object of the process is not to reflect only. How do we respond to our case study?
From the chaplain’s experience with Rick and the subsequent chaplaincy team’s reflections we must ask the question would it have been appropriate to offer post discharge spiritual after care? Rick had expressed a determination to return to his faith and to renounce his association with those who had drawn him into the under world of drugs and crime. This is indeed a bold repentance but his concerns about the solitary life he faced on the ‘outside’ could have been appeased by an offer of spiritual after care and a possible introduction (with permission) to an active local church community. There is a model in place for the ‘patient liaison officer’ to ensure an ex-patient is re-integrated into a community. There may be a role for the chaplain to meet with the liaison officer to offer spiritual support as part of the NHS after care.
The importance of ‘prayer in the chapel’ after the visit should not be overlooked. This is a real glimpse of the patients attempt to reach out to God without the pressure of ‘bowing heads’ together with the clergy on the ward. The request should not be seen by the chaplain as ‘prayer declined.’ The entry on the prayer book or prayer board should thus be dealt with respectfully, with conviction and should actually be verbalised in some formal intercessory setting, eg morning prayers or a weekly communion service.
Conclusion
In conclusion the chaplains journey with Rick was truly a unique one. It has helped to reflect on this situation theologically. There were personal lessons to be learnt about not being hasty in drawing conclusions, about the importance of group reflection and about seeing the evolving relationship with the patient as a mutual journey.
There were a plethora of central pastoral issues such as learning to listen, enquiring about divine retribution and perhaps the most obvious issue of allowing the patient to vent his anger as part of his journey to wholeness. Additional issues such as chaplaincy teamwork and spiritual warfare may have been less central but the jousting for control would have been fascinating to watch but less so to participate in!
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