Clinicians, chaplains and spiritual care.

To the Editor: The June 2006 issue of the Southern Medical Journal featured a special section arising out of the SMJ Spirituality/Medicine Interface Project. Several articles in this section highlighted the contribution of pastoral care professionals to the process of health care and healing. Referring to chaplains as "hidden assets," the editorial introduction to this special section emphasized the specific training, knowledge and expertise of chaplains, with the preface that it was "not our intention to advocate that clinicians attend to the spiritual needs of patients under their care."

I applaud the recognition and exploration of the role of chaplaincy in health care. As the prime mover in the development of a department of pastoral care at the hospital affiliated with our family practice residency, I have been an advocate for clinical integration and professional recognition of chaplains in medical settings for many years.

As a family medicine educator and clinician practicing in a primary care setting, however, my particular passion focuses on the ways in which healthcare providers indeed do play a vital role in the spiritual care of patients.

First, I believe that all spiritual care is grounded in our own centeredness, intention and presence with other people. A spirit of compassion and healing may, or may not, be embodied in any of us as healthcare professionals.

There is always a "spirit in the room" as we work with people, for better or for worse. We may try to capture this spirit with a variety of words; calm, compassionate, time-urgent, businesslike, welcoming, honoring, analytical, detached, and so forth. Often, the spirit in our working with people is more to be experienced than to be described with language.

The spirit in the room matters. There is, for instance, substantial literature on "presence," "intention," and even "love" in health care. (1-4) For that matter, my chaplain colleagues often speak of the "incarnational" model of ministry. The thrust of this literature is that our spirits, or the ways in which spirit is visible or embodied in us as healthcare givers, has a bearing on the healing process. This is spiritual care and it pertains to all of us working in healthcare.

The second way in which healthcare providers play a vital role in the spiritual care of patients is in helping patients identify and give voice to their spiritual values and resources. To the extent that "attending to the spiritual needs of patients" pertains to spiritual issues or struggles, I do believe that the professional expertise of chaplains and other pastoral caregivers can be uniquely beneficial. Instances such as the dying man who needs to reconcile his homosexuality with his lifetime devotion to the Catholic church, the family who anguishes over why a loving God would visit their child with cancer, or the middle-aged woman who struggles with issues of bitterness and forgiveness with her sexually abusive father may be handled with compassion and expertise by our pastoral care colleagues.

I believe that the resources side of spirituality, however, is a matter for the attention of all of us who provide clinical care. Organizational consultant Margaret Wheatley observes that "real change begins with the simple act of people talking about what they care about." (5) There is power and empowerment, she argues, in people giving voice to the things that really matter to them.

There are countless ways of framing this conversation. In my clinical work, I begin with language of meaning, purpose and passion. What are the things that are really important to you? What do you take pride in? What do you hope for? Where do you find strength ... what sustains you ... what helps you to keep going? What helps you to be more peaceful and centered? What do you hope the legacy of your life will be? What are you really passionate about? When do you feel most "alive?"

My experience is that there is an affirming and energizing effect for patients in having the opportunity to speak even briefly about these personal and sacred things to somebody else. What you focus your mind and heart on becomes your reality.

I believe that these conversations a) matter clinically, and b) arise less out of specialized spiritual skills than they do out of genuine curiosity and an open heart. They are the kinds of conversations that doctors have been having with patients for generations, and they represent a significant piece of the overall picture of good spiritual care.

Frederic C. Craigie, Jr., PhD

Maine-Dartmouth Family Practice

Residency

Augusta, ME and Program in Integrative Medicine 

University of Arizona School of Medicine

Tucson, AZ

References

1. McDonough-Means S, Kreitzer M, Bell I. Fostering a healing presence and investigating its mediators. J Altern Complement Med 2004;10(Suppl 1):S25-S41.

2. Green J, Shellenberger R. The healing energy of love. Altern Ther Health Med 1996;2:46-56.

3. Jonas W, Crawford C. Science and spiritual healing: a critical review of spiritual healing, "energy" medicine, and intentionality. Altern Ther Health Med 2003;9:56-61.

4. Levin J. Jeff Levin, MPH, PhD. The power of love. Interview by Bonnie Horrigan. Altern Ther Health Med 1999;5:78-86.

5. Wheatley MJ. Turning to One Another: Simple Conversations to Restore Hope to the Future. San Francisco, Berrett-Koehler, 2002.