By David Lewellen
Why do people take opioids in the first place?
It isn’t just about mental health or overprescription. One explanation gaining more attention is that the crisis results from a crisis in spiritual health. And spiritual health, rather than spiritual care, might be a promising direction for the future of chaplaincy.
“We’re good at care in a time of crisis,” said the Rev. Frank Mächt, director of chaplaincy at Dartmouth-Hitchcock Medical Center. “But the bigger question is, how do we impact spiritual health?” When he talks in those terms, he said, “people perk up. It fits in with population health and mental health. How do I train students to have an impact on spiritual health? I’m in my mid-50s, and this is a question I hope to engage for the rest of my career.”
It’s a big question, and answers so far are fuzzy. But there are obvious parallels with the medical professions, which excel at patching up sick people but are still laboring to be heard on healthy eating, exercise, safe water, and other preventative measures.
Similarly, Mächt said, recommending that patients meditate and do self-care “doesn’t get at the root of hope and despair.” Where are those roots? Mächt, who grew up in Europe, suspects that part of it is American isolation and self-reliance. “The communal aspect is counter-cultural in American culture,” he said. “Those are bigger philosophical questions that I hope we can engage.” And also, he cited the philosophical question of how we relate to pain and suffering – Americans tend to go for the quick fix, which in the case of pain medication might lead to addiction.
Mindfulness, although an after-the-fact solution, could help some people, but “how do we put these modalities in the community in a setting that could make a difference?”
Mächt is also thinking about how to extend the reach of CPE-trained chaplains. Historically, most police and fire chaplains, ministering to people on the very front lines of the epidemic, have not had that training. But at the moment, Mächt has two CPE students from an evangelical background who minister to fire departments as well as working at smaller hospitals.
Opioid addiction can strike any person from any background, but in Mächt’s hard-hit state of New Hampshire, he has observed that the burden is falling heavily on less educated, lower-income residents. And possibly as a corollary, he has seen that evangelical churches are doing a better job of ministry than either mainline Protestants or Catholics. Too many churches – particularly older, wealthier ones – see addiction as having a moral component rather than being a chronic disease. A church that “does not add insult to injury” has a better chance of restoring an addict’s self-image and helping them recover.
Mächt says that in New Hampshire, if an obituary of a person 50 or younger doesn’t list a cause of death, he assumes it was opioids. “But it doesn’t take your whole life away because you died in this way,” he said. Removing the stigma around addiction is one step to facing the problem.
Mike Barwell, media relations manager for Dartmouth-Hitchcock, said that the Centers for Disease Control and Prevention has done a study of social despair and emptiness, which seems to be rising. “What is it about this time and despair?” he asked. “And what is the spiritual response?”
But a default attitude in hospitals, Mächt said, has been “the medical team can’t do anything, so let’s get the chaplain to talk about the next life. But there are spiritual questions about a meaningful life in the here and now.” And chaplains are in a position to help with those questions – and maybe even to build social community. Mächt mentioned chaplains embedded in a healthcare staff who hear about everyday problems. “There’s a lot of untapped potential.”
“Chaplaincy is not about religion, it’s about the human spirit,” independent of theology, he said. And in a culture where doctrine is losing ground, recognizing the spirit might be the first step toward an idea of spiritual health that preempts resorting to drugs.