James Morgante
I read with great interest Father Joe Driscoll’s article about the use of the terms “spiritual care” and “pastoral care” (Vision, April 2002). When I was doing a chaplain residency last year at St. Anne’s Hospital in Fall River, Massachusetts, the pastoral care department was in the process of adopting the term, spiritual care, and the arguments seemed reasonable. In time, however, I’ve developed reservations.
My main objection is that the term spiritual care suggests a primary focus on the spirit or the spiritual dimension of the human being. The problem with this point of view is that it tends to fragment a holistic understanding and approach to health care. The holistic paradigm, which speaks of body, soul (mind), and spirit (or physical, psychological, and spiritual dimensions) is much in vogue today. Most health care institutions profess a commitment to holistic care. But this usually means assigning different parts to different practitioners. The holistic vision, however, understands the close interconnections between all dimensions, and expects practitioners to think and treat holistically.
Assigning the various dimensions to individual practitioners makes sense in a health care system dominated by contemporary medicine. Contemporary medicine focuses primarily on the body and physical processes. Its philosophy is reductionistic or materialistic, only giving credence to physical causes and physical treatments. There are certainly historical reasons for this development, and the successes of contemporary medicine have benefited humanity tremendously. But its approach is not holistic, either in its understanding or in its treatment of disease.
Contemporary medicine is also intervention-oriented (in contrast to the preventive approach that is the hallmark of holistic medicine). Intervention and an exclusive focus on the body become problematic, however, in diagnosing and treating chronic illness (arthritis, many forms of cancer, type II diabetes, heart disease, etc.), because it is closely associated with diet and lifestyle. It makes a difference whether the treatment of chronic disease focuses primarily on the body or takes seriously habitual patterns that need to be changed (the realm of the soul and spirit). In addition to the potential harm caused by radical interventions, the holistic critique of a medical system geared towards technological solutions like open-heart surgery (a “very expensive Band-Aid”) is that they allow patients to continue unhealthy lifestyles without addressing the need for change.
As I outline in my chaplain residency project (“Towards a Theology of Wellness,” to be published in the fall in Health Progress, the journal of the Catholic Health Association), the Judeo-Christian tradition is decidedly holistic in its understanding of health and illness and blends both intervention and prevention. Jesus does not treat the body—or the soul or spirit—in isolation but all together. Disease is understood and treated holistically, by a divine physician who intervenes (without causing further harm), but who also clearly admonishes about what needs to change.
What this means for chaplains (and for all practitioners, particularly in religious institutions) is to be cautious about defining their role too narrowly. It is interesting that Joe Driscoll notes that “nurses and physicians are now claiming to do spiritual care” without considering the special competence of chaplains. While this may seem to be a cause for concern, such “holistic” thinking needs to be encouraged. Conversely, chaplains also need to think holistically, and to reclaim concern about treatment of the body too (in fact, the very first doctors were priests or holy persons). This means understanding the materialistic bias of contemporary medicine and its potentially adverse effects for the life of soul and spirit, and being informed about the alternatives.
Religious institutions, and chaplains in particular, are in a unique position to help bring about the integration of contemporary and holistic medicine, and especially holistic thinking, into the health care system. But by a “spiritual care” focus, chaplains may limit their vision. While there may be a better term than “pastoral care,” at least it allows them to claim a more inclusive vision, in imitation of Jesus.
Source: Vision, Vol. 12, No. 7 (July 2002), p. 3.
