Back to the bedside?

Helen Orchard (Editorial, Modern Believing, Volume 41:2, April 2000)

Dr. Orchard is Senior Research Assistant at Lincoln Theological Institute.

During the course of my research into hospital chaplaincy in London last year, I was interested to hear a chaplain remark that ‘the bedside is not a good place to do theology – either your own or other people's'. 1 This prompted me to wonder where is a good place for a chaplain to do theology? Are those human tragedies encountered on the ward, ITU or in Accident and Emergency best processed theologically back in the office through personal reflection, during team meetings or perhaps in discussion with groups of chaplains from other hospitals? Having pursued the matter with a variety of London chaplains and scanned the profession's literature it seemed, however, that with a few exceptions, considered theological reflection was fairly thin on the ground. ‘I haven't got the energy to deal in that kind of currency', confirmed one chaplain, ‘it would be nice to do it, but a bit of psychology is good enough for me really; how human beings relate to each other'. Others reflected that chaplaincy get-togethers were generally used as opportunities to focus less on theology and more on ‘coping strategies' – strategies which organise time and tasks, helping to make the demanding and often draining job of the hospital chaplain rewarding, meaningful or even just bearable. Teaching, management, staff counselling, ethics, academic work and community liaison feature in this respect. They are all, of course, extremely legitimate tasks for the chaplain, but can also be used to provide coping or even, dare I say it, diversionary strategies. And faced with the challenge of providing spiritual care for, say the 70,000 patients who spin through your Trust's turnstiles each year, who wouldn't need a strategy? But of course it is a question of balance and, as another chaplain commented, ‘Just how do you know when you've done enough pastoral care?'

While the religious professionals have been devising their coping strategies, others have got down to the task of marking out the spiritual care terrain. There has been an underlying concern in chaplaincy circles over who is actually defining the spirituality agenda. Nurses in particular have become increasingly interested in the field as part of a two-pronged objective to improve holistic care to patients and, in these days of increasing specialisation, to buoy up their own professional role. The result has been, to a large degree, the secularisation of concepts of spirituality within health, with the legacy of Viktor Frankl's ‘meaning-centred' approach remaining remarkably influential. Definitions of spirituality are now commonly aligned far more closely with existential and psychological dimensions than with any notion of God or transcendence. Thus the religious component of care can easily be snapped off and handed to the religious professional to dispense. And the spiritual component? Why that, the argument goes, can be delivered by anyone.

All of this paints a rather bleak and possibly over-critical picture, but it does serve to highlight some of the problems caused by the general lack of theological thinking in the area of healthcare. Focusing on the root cause may be effective in helping to relieve some of the symptoms here. After all, surely applied theological consideration is the most fundamental of coping strategies? Theology is at the very heart of what chaplaincy is about – theologies of suffering and illness, health and wholeness, presence and incarnation – providing insight into what chaplains are doing in their work and why it is meaningful. The experiences of those working in secular, multifaith and multicultural organisations which cater principally for people in crisis make issues of orthopraxis, defined as ‘living out the struggle of faith',2 a daily imperative. It would be difficult to think of a location where the struggle of faith is more acute than at the bedside among the drips and tubes, the grasp of life and gasp of death. Similarly, a dose of practical theology could well provide refreshing input to wider deliberations on spirituality before we all drift off into the new age yonder.

It is in the context of the above concerns that it is a welcome task to be asked to introduce this edition of Modern Believing in which the contributors are either doing or exhorting us to do practical theology. The broad arena for the pieces is healthcare and there are a range of different foci, from the ethos of institutions to the voices of individuals. But the edition starts with a more general and theoretical piece from Michael Thompson, advocating renewed theological engagement with the wider development of the Church together with its schisms and sects. Are we going to sit back and let the sociologists describe the changes in our ‘ecclesiastical landscape' with no proper regard for the faith-dynamics involved? Now it is clear that the secularisation thesis is redundant and the postmodern mood is more conducive to interdisciplinary dialogue, it is time, suggests Thompson, for practical theologians to step up to the microphone. Indeed, without their voices the story of contemporary Christian communities becomes detached from its raison d'être and devoid of substance.

In a predictably stimulating paper, Stephen Pattison considers whether organisations have a spirituality. Using the NHS as a test case, he reflects on its character or ‘withinness', exploring a number of aspects of this inner dimension by looking at the organisation's myths, symbols and rituals. Those familiar with the workings of the NHS will find it hard to suppress a wry smile as ‘the bottom line' is exposed as a reality shaping myth and strategic planning activities are analysed in terms of ritual behaviour. The question of who is responsible for ministering to an organisation's spirituality is also posed: is it the remit of the Chief Executive, a local guru, or a corporate task? The name of perhaps the most obvious contender, the chaplain, is noticeably absent from this list.
A model for organising the work of a chaplaincy service is suggested by James Woodward, based on his own experience as a chaplain in Birmingham. He suggests a framework consisting of five concentric circles, each relating to a dimension of chaplaincy work and placing the patient at the centre. This in itself is worthy of comment as a number of chaplaincies now consciously situate work with other groups, particularly staff, at the centre of their practice. The assumption that a chaplain's priority is the patient is no longer a safe one to make. Woodward asks a number of pertinent questions of the profession, not the least of which is ‘where is God in all this?', reflecting the theme raised above for the need for a greater degree of theological questioning by the profession.

Paul Ballard and colleagues concur with the general view that, as far as the NHS is concerned spirituality is ‘in', with the growing body of literature testifying to this phenomenon. Nevertheless, there has been relatively little empirical work undertaken which explores the spiritual self-understanding of patients in the way Ballard's project has done. The result is refreshing. Rather than reading yet more definitions of spirituality and spiritual need, we hear instead the voices of patients themselves. The importance of context is stressed: what is true for a group of terminally ill patients in South Wales is not necessarily transferable elsewhere. But people's stories and experiences afford powerful insights and the fixedness of such studies is their strength as well as their weakness.

It is perhaps appropriate that in an issue devoted principally to healthcare, we finish with a piece on suffering. Michael Reiss approaches the subject from a novel angle, asking what the meaning of suffering is from a biological perspective. There is, he explains, an evolutionary function in both physical and mental pain which is primarily protective, preventing further damage to the body. The consequences of an absence of pain are shown in the tragic case depicted of a young girl with the rare medical condition of congenital painlessness. It is surely impossible to read her story without being curiously grateful for the ability to feel physical pain, appreciating the conundrum that the absence of pain can kill you. Now there's a good starting point for reflection.

Helen Orchard

1. Quotes are taken from interviews and fieldwork undertaken in a random sample of London hospitals between June and September 1999. The research was part of a project on models of healthcare chaplaincy which was funded by The King's Fund. [back]

2. P. Ballard and J. Pritchard, Practical Theology in Action, (London: SPCK, 1996), p. 4. [back]

Modern Believing, MCU, October Vol. 41, No. 2, April 2000