By Anne M. Windholz
During my chaplain residency at a large Midwestern hospital, I worked with adolescents in behavioral health, both one-on-one and as leader of a weekly, one-hour values discussion group.1 Some patients were grappling with eating or personality disorders; some were cutting themselves or fighting addiction. By far the greatest number suffered from severe depression, even attempting suicide. Few looked forward in hope.
Having been an English professor and teacher of children’s literature, I sought to create an intervention that would encourage patients to see themselves as the protagonist — the main character — of their life story and to identify a positive goal for themselves; to name the obstacles (antagonists or antagonistic forces) blocking their way; and to brainstorm about values that might help them overcome and succeed. Though their ages varied from 10 to 18 and they came from diverse racial and economic backgrounds, I found that all could connect with the power of story and begin thinking about shaping their own life narrative instead of allowing others — or their disease — to determine it for them.
Patient turnover from week to week was substantial. We started each session largely from scratch, identifying who we were and how we stood in relation to each other. My title was a puzzle to them: neither teacher nor counselor nor therapist. Those few for whom “chaplain” had any meaning at all ventured (with a question mark in their voice) that it had “to do with church.” This led to a discussion of beliefs, of spirituality as distinct from religion, and ultimately of what it means to value something or someone. Borrowing from Willard Ashley, I described a chaplain’s job as “to listen, learn, love, and liberate.” Often perceiving themselves as judged or dismissed, not heard, and not loveable, these kids were able to connect with those four L-words as values that could be measured by concrete actions.
Juveniles with mental illness, these patients could control little in their lives. How could I free them to tell their own story? Raised on movies and computer games if not books, they knew the plots of Harry Potter and the Hunger Games. They needed a storyline they could plug into: one less well known with less distinctive heroes, one less cluttered by the paraphernalia of Hollywood and current popular culture. One that could, as a relatively blank slate, free their imaginations.
They needed allegory.
Early in my teaching career I taught John Bunyan’s Pilgrim’s Progress. A 17th century best-seller and enduring classic, it relates the adventures of an allegorical everyman named Christian who leaves home (the City of Destruction) to seek salvation in the Celestial City. He faces monsters, troubles, and temptations along the way that threaten his survival. He also finds friends and tools that foster what we would call resilience. Filled with adventure and misadventure, horror, and hope, Bunyan’s plot offers touchstones upon which patients could loosely chart their own journeys.
I briefly summarized Pilgrim’s Progress, acknowledging its basis in a European, Christian world view while reassuring patients that neither need be part of their story. Seated around a large table, they each received a pencil and a time line with cartoon drawings inspired by Bunyan’s plot:
- The City of Destruction;
- The pilgrim’s Burden;
- The Slough of Despond;
- The friends Helpful and Goodwill;
- The distractions of Vanity Fair;
- The Valley of Humiliation, the Shadow of Death, and the Giant Despair who imprisons the pilgrim in Doubting Castle;
- The liberating Key of Promise and the Celestial City.
After explaining any parts that confused patients, I asked them to ponder what their own Celestial City, their own Slough of Despond, etc., might be. They were free to reconfigure the plot, to skip parts they found irrelevant or too disturbing. Working quietly, they took control of the story. Involved in the solemn work of naming fears and articulating hopes, they laid down boundaries between friend and foe, safety and danger, being sick and becoming well.
When we came back together, patients who felt comfortable were invited to share the allegorical names they gave themselves, how they labeled their best helper on the journey, and what they hoped to find in their celestial city.2 Their chosen names were poignant: Regretful. Thoughtful. Vocal. Compassionate. Selfish. Lonely. As Selfish named himself, he hung his head. Brash outwardly, he was in fact carrying — and hiding — a heavy burden of self-condemnation. Group members were uneasy about the negative label, but his willingness to be vulnerable gave everyone a chance to explore the power of self-naming, the danger of being named by others, and the liberation of re-naming. Selfish, who called his helper Beauty, quietly revealed that he was seeking Respect, Love, and Trust. Others in the group opened up: Lonely sought Optimism, Thoughtful was trying to find Motivation, and Regretful longed for Self-Compassion.
I did not ask patients to reveal their burdens or monsters. Group time was too limited, and exploring fears struck me as a task for one-on-one visits. Nor was I concerned with the “objective” truth of their stories; my role was not to treat their illnesses or fix their views of reality. My work was to help patients discover how deeply their stories matter because they, themselves, are valued.
The bedrock of chaplaincy is story. Belief in story’s sacredness is part of what makes our listening holy and allows us to honor the entirety of the persons we serve, not just focus on the illness that puts one in the hospital or the crime that gets one incarcerated.3 Dramatic enough to hold interest and general enough to support many personal stories, Pilgrim’s Progress provides one example of an allegorical scaffold upon which young patients can build meaning. To be sure, allegory’s tendency to label good and evil without nuance risks over-simplification. But it gave my patients the chance to name their monsters, to acknowledge their helpers, and to pin down their goals. It engaged their imaginations and offered them space in which to dream about what recovery might look like. And it reminded them that, like Christian, they need not walk their darkest nightmares alone. Being a pilgrim in supportive company can itself be salvation.
Anne M. Windholz, MDiv, Ph.D., BCC, is a chaplain at AMITA Health Alexian Brothers Medical Center in Elk Grove Village, IL.
2 No uniquely identifying patient information is disclosed in this essay.
3 Michele Guest Lowery notes the tendency of “people with mental disorders [to] over-identify with their illness and thus struggle to see themselves in a fuller context.” In “Behavioral Health,” Professional Spiritual and Pastoral Care: A Practical Clergy and Chaplain’s Handbook.” Ed. Stephen B. Roberts. Woodstock, VT: Skylight, 2012. p. 269.