By Gerald M. Gundersen, BCC
One of the inspirational leaders in my Clinical Pastoral Education (CPE) training at St. Elizabeths Hospital in Washington, DC, was Anton Boisen, a man suffering from mental illness who over the course of his long life contributed so much to CPE training and the grounding of chaplain candidates in “real world” spirituality. His ability to merge behavioral science with pastoral care is imbedded in CPE training and reflected in the basic elements contributing to his case study method: intergroup relations, verbatims, spiritual need assessments, a practical, “hands on” experience, and shared learning. Pastoral care was not to be isolated from other disciplines but linked in ways that would provide mutual respect and mutual support. His approach to CPE provided an enduring example of best practices.
My experience as a chaplain has been mainly with individuals suffering from mental illness, addictive behaviors and acute depression. The use of mantras as an aid to recovery is an effort to put into practice some of the values expressed by Boisen in promoting the use of faith-based and secular disciplines to support pastoral care. Among PTSD patients are some who barely have strength enough to connect to a “higher power” because of their mental anguish and pain. Others question whether anyone can help them, even God, because of their heightened state of vulnerability, horrific life experiences, and total devaluation of self-worth. Some have attempted suicide. Many experience what might be called a “spiritual dryness” that resembles what St. John of the Cross refers to as the “dark night of the soul.” PTSD patients experience flashbacks, nightmares, recurrent dreams, disturbances from noises and other events, any one of which can trigger fear and depression.
In an earlier paper made available through NACC and ACPE, I introduced mantras for consideration as an example of a type of strategy that seemed to show promise of helping some PTSD patients address issues of debilitating thoughts. I drew from the practices of monks in the early Orthodox Christian church. They used what has become known through the ages as the Jesus Prayer, a mantra said over and over to promote closeness to God: “Jesus, Son of God, have mercy on me, a sinner.” For PTSD patients, the words were changed to meet individual needs and preferences. Prior to presenting a mantra as an option for a patient, I would make a spiritual assessment based on discussions with the patient to determine whether a patient could benefit from such a strategy. Once a determination was made, I would give the patient a handout, explain its purpose and ask the patient to read and react to its content. The mantra used was: “Oh God, please save me from negative thoughts, I beg of thee, I beg of thee.” The strategy proposed was flexible and could be used at any time. It was not a short-term cure, but presented to patients as a life-long option to help them overcome invasive, debilitating thoughts, and to bring a transcendent power into their lives on a regular basis.
Generally, patients found value in having recourse to a spiritual option that could help them gain control over their afflictions while at the same time nurture a habit of turning to God for support. The same mantra did not appeal to all patients. Some preferred using “bad thoughts” or “harmful thoughts” rather than “negative thoughts.” Some suggested changing the content to fit their particular concerns and needs such as: “Oh God, forgive me my sins and help me to heal.” or, “Dear God, bring your love, peace and goodness into my life.”
One of the unanticipated outcome measures in working with patients who expressed lack of faith and skepticism about God’s presence was their recognition and appreciation for a visible sign of support, a handout with specific instructions to follow. Many patients might express doubt that God could or would help them, but most seemed to respond positively to pastoral care that included, as part of the action, receiving something tangible. Such a gesture often appeared to open doors for discussions that otherwise might have remained closed. Another common residual effect was the positive response of patients to what they saw as pro-active pastoral care on their behalf, the effort to invite God into their lives in ways which they could understand even though they might not be ready to take advantage of such an opportunity.
From a research perspective, results were tied to a one-on-one, case study methodology and personal, idiosyncratic experience. Time constraints affecting number and duration of visits as well as lack of follow-up of patients greatly limited assessment of results. Although both the ACPE and NACC made the paper available to members for comment through their respective websites, the response rate from both sites was much lower than anticipated. I thought there would be at least 30 responses. Instead, there were fewer than ten. None of the respondents offered critiques of the proposed strategy. But, two readers provided substantive leads and insights in support of mantras as valid strategies for patient recovery and spiritual healing. One respondent cited a publication focused specifically on PTSD and traumatic brain injury (TBI) patients titled “Spiritual Care Handbook on PTSD/TBI” by Rev. Brian Hughes, BCC, and Rev. George Handzo, BCC.
A section of the handbook highlights Spiritual Mantram Repetition and some of the beneficial medical effects associated with the use of a mantra. The core training to develop meditation techniques could last up to six weeks. Some hospital sites were able to follow up on patients to assess longer-range outcomes. The inclusion of Spiritual Mantram Repetition in the handbook for the treatment of PTSD helped to confirm the connection between the use of mantras and spiritual healing.
A second respondent sought to strengthen the evidence-based value of mantra intervention by noting the collaborative works of a neuroscientist, Andrew Newberg, M.D., and a therapist specializing in spirituality, Mark R. Waldman. Their books, titled “How God Changes Your Brain” and “Words Can Change Your Brain,” provide scientific evidence of the benefits gained from active and positive prayer and meditation, including mantra repetition.
Both of the above examples in support of mantras require extensive time and cost commitments on the part of patients to acquire meditation skills necessary to achieve physical and spiritual benefits. The procedure I follow is a band-aid approach in contrast to such comprehensive and intensive strategies. A handout can be offered to any patient regardless of means or time constraints. With a little practice, patients can develop the necessary techniques to diminish the number and effects of intrusive thoughts by bringing God more readily into the healing process.
Since writing about mantras, I have started to make Handout No. 1 available to other patients at the hospital on a selective basis, particularly patients with substance addictions. I have broadened the suggested use of mantras to include any and all negative thoughts or temptations, no matter how minor, in order to help patients develop the habit of using a mantra on a regular basis. Once a mantra response becomes automatic, patients can adjust its use as needed. One of the lessons I have learned in working with mantras over the past three years that Anton Boisen would applaud is that best practices are only “best” for a while, and never remain static. They can always be improved upon as situations change and new information becomes available.
Gerald M. Gundersen is currently chaplain at the Psychiatric Institute of Washington and former resident chaplain at St. Elizabeths Hospital in Washington, DC. He serves on the NACC’s Research Task Force.
