By Gerald M. Gundersen, MA, MTS, BCC
Palliative care is a comprehensive approach to preventing or relieving all types of human suffering, physical, social, psychological and spiritual. Pastoral care shares this same goal with special emphasis on spiritual intervention. Just as God, the creator and source of all goodness, is in a unique position to forgive sins and take into account human failings, the chaplain is in a unique position to talk with patients about God and forgiveness, and does so by combining pastoral with palliative care. This brief reflection touches on forgiveness in relation to patients who struggle with mental illness, addictive behaviors and post-traumatic stress disorder. Participant observation, pastoral counseling and shared learning with patients in a psychiatric hospital over a period of five years form the foundation of the case study methodology.
By definition, forgiveness includes the concept of “letting go,” of pardoning oneself or others for an offense. One of the intended consequences of “letting go” is reconciliation with the source of one’s pain in such a way as to be able to release oneself from the bondage of negative thoughts and feelings. In this context, reconciliation becomes analogous to liberation from the hurt and pain associated with particular persons or events. The chaplain often serves as a sounding board for patients as they start to think about forgiveness, assess its importance, and decide whether they are ready to make a commitment. Many patients who understand and verbalize the importance of forgiveness to move on, prefer to “sit on the sidelines.” Others have tried and failed or have had mixed results. Many fear making a commitment. All too often, their human frailty, marred by mental illness, addictive behaviors, and traumatic events, impacts recovery and can overwhelm their best of intentions. For many of these patients who may lack hope and are not ready to take forgiveness seriously, pastoral care may consist simply of words of encouragement to remain open to forgiveness as an option, to keep God close and not to abandon God as co-participant and healer. The effects of such exhortations usually are short-term, superficial and fail to give patients the tools by which to strengthen their resolve over time. They are similar to giving a person a fish to forestall hunger for a day when teaching a person how to fish can forestall hunger for a lifetime.
One of the premises of this paper is that moving beyond an understanding of forgiveness requires a strategy and game plan that can strengthen individual recovery and improve one’s personal relationship with God. This dual challenge is met in part by looking for useful tools to help guide the process. Sacred Scripture is a rich resource for this purpose, and, in particular, the example set by Jesus. A brief synopsis follows highlighting the applicability of his approach to forgiveness of others.
Forgiveness of Others: At the time of his crucifixion when he experienced his most intense human suffering, Jesus cried out, “Forgive them Father for they know not what they do.” His expression came spontaneously in response to callous and brutal treatment from others. He could have said, “I forgive them Father for what they have done.” But, he asked the Father to do something that he was not ready to do for himself because of his pain and suffering, deal with forgiveness and impart forgiveness in God’s own way and in God’s own time. Patients are asked to consider doing the same thing, relying solely on God until they are ready to forgive on their own. This approach separates patients from direct confrontation with the source of their pain and entrusts to God the responsibility for doing the “heavy lifting” in support of those unable to help themselves. “Come to me all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart and you will find rest for your souls” (Matthew 11:28).
Part of the process of working with patients on forgiveness of others entails having them identify their expectations from God and their expectations of themselves. What would patients want God to do as an intermediary? Patients can be quite expressive on this subject, and there is always a wide range of possibilities in response to this question: God can help their offenders become more aware of the harm they have done and the pain they have caused because of their actions; God can help them to repent of their actions and atone for their sins; God ought not let them forget their offenses or rejoice in their evil deeds, and so on.
In focusing on their expectations of themselves, patients can speak of their need to change, “to get off the merry-go-round that is killing me,” and of renewing their efforts to improve their relationships with God. They can identify the need for personal repentance for their own sins and failings. Some can relate their own difficulties and lapses to their attitudes toward themselves, others, and toward challenges in their lives, such as coming to grips with forgiveness. Many look to God for help to provide structure and meaning in their lives. They cite a need for paying closer attention to a daily routine with positive supports to aid recovery. Frequently mentioned activities include: prayer, Scripture reading, spirituality groups, avoidance of negative influences, gainful employment and service to others.
Forgiveness of Self: One patient helped to clarify why forgiveness of self is so difficult and demanding. She noted that she had to live with herself 24 hours a day, and could not take leave of her feelings or of the memories triggering her depression. Therapy helped her to identify specific areas that she could work on while in the hospital, but she could not escape from her feelings of having done something wrong. She could not avoid self-chastisement, denigration, and the belief that somehow she was responsible for the abuse she experienced at the hands of others.
This example highlights the challenge for chaplains in working with patients to promote healing through self-forgiveness. Many victims of abuse can be harder on themselves than on their abusers, and struggle to release themselves from the bondage of shame and guilt. This seeming paradox can present special challenges for chaplains in response to the complex and at times overwhelming problems presented by patients. Another example that is less extreme, but equally daunting, is self-forgiveness in ministering to patients who have addictive problems, many of whom have experienced repeated disappointments and failures because of their use of drugs or alcohol, and in spite of having turned to God for support.
The chaplain’s role and effectiveness as a pastoral care provider in matters of forgiveness continues to center on bringing God into discussions as a divine reality, a loving presence, an intermediary and source of strength and security for people who are hurting. Even though forgiveness plays out differently in each person, patients generally appreciate options or strategies that offer them a glimpse of hope. Occasionally, patients need to be reminded that their persistence in asking God for help, their courage in facing hardship, their sense of compassion for themselves and others, and the insights they share along the way with all of us are those easy-to-miss signs of God’s presence continually at work in their daily lives.
Gerald M. Gundersen, firstname.lastname@example.org, currently chaplain at the Psychiatric Institute of Washington, is former resident chaplain at St. Elizabeths Hospital in Washington, DC.