Faith and Health in Secular Society – Viewed from the Theory and Practice of Pastoral Care. Professor Tor Johan S. Grevbo Diakonova University College Oslo, Norway (Odense, Denmark , 19 May 2010) (The content is expanded in the following version !). Main Intensions .
Professor Tor Johan S. Grevbo
Diakonova University College
(Odense, Denmark, 19 May 2010)
(The content is expanded in thefollowingversion!)
a. Two Initial Inputs
b. A Brief Introduction to Pastoral Care
c. Ambiguous Traits in Our Secular Society
d. Important and Problematic Elements in the International Health-Faith Research
e. A Multi-factor Spirituality Model
Two Initial Inputs
(a Secular “Hymn” and an Exposé of Pastoral Care)
Health is not bought with a chemist’s pills,
nor saved by the surgeon’s knives.
Health is not only the absence of ills,
but a fight for the fullness of life.
The Danish poet and scientist Piet Hein
in his prologue to WHO’s 40th anniversary 1986
An Exposé: The Inherited Plurality of Pastoral Care
The Christian ministry of the cure of souls, or pastoral care, has been exercised on innumerable occasions and in every conceivable human circumstance, as it has aimed to relieve a plethora of perplexities besetting persons of every class and condition and mentality. Pastors rude and barely plucked from paganism, pastors sophisticated in the theory and practice of their profession, and pastors at every stage of adeptness between these extremes, have sought and wrought to help troubled people overcome their troubles. To view pastoral care (...) is to survey a vast endeavour, to appreciate a noble profession, and to receive a grand tradition.
Clebsh/Jaekle 1964/1994 (p. 1)
A Brief Introduction to
Some Vital Aspects
of Pastoral Care
- curaanimarumgeneralis(all ecclesial activities taking care of God’s people (in principle including all people created by God))
- curaanimarumspecialis(pastoral conversations and rituals, concerning one
or few persons at a time)
Cf. Hiltner 1958 (1-3), Clebsh and Jaekle 1964/1994 (4), Clinebell 1984 (5), Miller-McLemore 2006, compiling several recent contributions, (6-8).
To be pastoral in a Christian sense, all eight dimensions have to be seen and developed in the light of the triune God, not just understood according to social and medical sciences etc.
It is harmful to wipe out any of the dimensions mentioned, from the picture of PCC. It narrows the view and limits the possibilities in the numerous variations of pastoral care occasions. Not all representatives, however, are careful observers of this fact, and therefore become blind of several important aspects.
One may divide the scene of PCC to-day in eight different parts, more or less interconnected in the actual practice of the caregivers. Some theorists are nevertheless – in spite of the practical demands – totally committed to a single one, or, at the most, to a couple of the following concepts.
From the right to the left wing, the eight different basic concepts may be indicated briefly by the following head words:
fundamental biblical content and wisdom – including the exhortations – conveyed with personal commitment and dealing with psychology in very different ways)
3. Charismatic Care (concentrating on the god-given power of the caregiver, and his/her gifts to prophesy and to heal)
5. Ecclesial Care (a broad parish-oriented and “deaconal” care embracing both life and faith, utilizing the specific means of pastoral care together with knowledge from other sources)
Grevbo 2006 (pp. 302-408)
It is basically impossible to perform serious PCC on all levels without a learning process over several years, combining professional/theoretical skills, personal insight and a supervised practice.
(On the other hand, I want to pay tribute to all representatives of Christian communities giving their own valuable contribution to the mutual dialog and consolation, fundamental to pastoral care.)
The theory and practice of PCC reveals a plurality of perspectives and angels of incidence. This variety will naturally also have great impact on how the health-question is met, and how the faith-question is related to it.
My starting point is that all the dimensions and schools which I now have summarized, have something useful to bring to the attention of the caregiver, in order to constantly challenge the biased mindset we easily carry around with us. It is always possible – and often fruitful – to think and act in another way, and to re-frame a certain situation from another point of view. (However, I am not sure all the Danes here agree, because one of the first times I revealed a similar position in a lecture in Denmark, I was met by a rather killing remark: “What you call multi-facetted and open-minded, we call impotence!” To day I have the nerve to counter by following fact: In the history of pastoral care my basic attitude is rather called humility. And not seldom that’s what pastoral care is all about.)
Therefore it is vital to my own understanding of pastoral care to try to combine all the appropriate aspects and methods, in a way however, which is not careless, but critical. Through a rather compact phrase I call my own position: “a critical plurality of perspectives”.
2. The caregiver as context. The critical examination concerns here my own ability and limitation to work adequately with a certain case to (and within) a certain time.
3.The social and ecclesial context. Here I critically take into consideration perspectives which are especially important to be represented and underlined in the society and church-life of to day, trying not to violate the specific needs of each individual confident while honouring over-individual aspects.
(Faith, hope and love are the three outstanding words I soon will use in my definition – both in a general and a more specific meaning – to indicate the value of theological substance and richness in pastoral care. A theology abounding in perspectives, opens up not just a small and narrow room, but in fact the biggest space on earth, including the humble attitude of the inhabitants knowing they have not yet by far grasped the full truth, cf. Phil 3, 12-13.)
It is exactly because of my theologicalreflection that I operate with a double (or complementary) approach tolife and faith, both within the realm of pastoral care:
This flexible and critical attitude I now briefly have presented, allows me to walk fearless along with the confident and learn from him and her in all aspects of life, and it gives me simultaneously the freedom of tentative exploration of the confident’s readiness for input during our journey together.
(The last aspect is suppressed by most of the modern mainstream pastoral-care literature, being utterly afraid of acting in an authoritarian way or even causing some kind of mental assault.)
The attitude and behaviour mentioned so far, is what I all together frame as
“viatoric pastoral care”
The Latin word viatorhas two meanings:
A viatoric caregiver is consequently a person who – together
with the co-walker – cares for a good journey (the process)
and for what is passed on during the trip (the outcome).
A possible definition of viatoric pastoral care sounds like this:
Pastoral care is – in a social and ecclesial context – to walk a part of the way of God together with an undivided (not just a body, a mind or a spirit etc.) and unique fellow human being (or several of the same kind) in order to prepare for and convey faith, hope and love.
(The “way of God” is here meant to include all aspects of life under his presence, and the last part of this definition is open both for “faith, hope and love” as vital elements in everyone’s life, and for the specific Christian fullness of the same three words.)
C. presented, allows me to walk fearless along with the confident and learn from him and her in all aspects of life, and it gives me simultaneously the freedom of tentative exploration of the
Ambiguous Traits in Our Secular Society
- Influence of immigrants (Christians and Muslims etc.)
- Growth of Charismatic and New-age movements
- New religious interest among intellectual elite (e.g. philosophers like JürgenHabermas, SlavojZiztek, Alain Badiou, GeorgioAgamben, Simon Critchley (the last four taking great interest in St Paul, and among other things his biblical contribution in relation to our contemporary radical lack of active motivation and self-devotion))
- Abundance of “small holinesses” (fx. encountering death in the family; values worth fighting for; some cultural symbols;, experiences of intense relationship to nature, home(land) and people; free laughter; happiness of good meals and everyday life etc. – and, as also emerged in a Norw. survey on what people considered holy, even to clean the bathroom in a meditative, calm way)
To be alert to meet all people – frankly and openly – in their, partly disclosed, existence as longing and aspiring creatures (hominesdesiderantes),and to challenge all pastoral care-givers to trace more or less distinct footprints of the confident’s personal apparition as an image of God.
Because of the different cultural and ecclesial situation in Europe and US, and the built-in aloofness towards open faith expressions typical for Northern Europe, this kind of “detective work” (research) has to be dealt with very sensitively and contextually.
D. Signs Important?
Important and Problematic Elements in the International Health-Faith Research
Seen from the perspective of PCC theory and practice all these aspects are of great value, and form an empirical foundation able to sustain and inspire different types of pastoral care.
I suspect an underlying, dare I say un-proportional (?), occurrence of a certain mentality and context (probably more linked to the American way of life and thought, than to the European).
Head words: anthropological over-optimism; enthusiastic psychological climate; emphasizing of harmony, success and effectiveness; scientific and theological pragmatism; a more general, agreeable theology without strict confessional foundation; the unique social structure of American church-life and health-care system as the given background and recipient for most of the research.
If my general observation is partly right, the faith-health research has to be developed further when adapted to a Northern European context – not only when it comes to data, but also in respect of ideology. This is especially true if one feels tempted to work in relation to the theory and practice of PCC. I therefore continue by singing a “broken hallelujah” in three verses, which at the same time gives a brief presentations of some basic considerations.
“Broken” means here : cut into smaller pieces and without perfection.
Ring the bells that still can ring. confirms the spiritual needs (in a wide sense) of great many patients, and reveals that religious beliefs and practices may help cope with and reduce emotional distress caused by severe loss or change, and even (hereby) affect the physical condition positively.
Forget your perfect offering.
There is a crack in everything.
That’s how the light gets in.
Leonard Cohen in “Anthem”
All kinds of scientific research have in a way to be controversial, and broken down from its often inhabited claim of superiority and perfection. It is wrong to ask whether a specific scientific approach has pitfalls or defects, the right question would be: which ones.
No matter if you stick to a kind of methodoligicalscientific rationalism with its dualism of body and mind (Decartes, Hobbes, Spinoza, Leibniz); a kind of empiristic/positivistic research with its experiential/observational approach, accompanied by predilection for what can be counted, weighed and measured (Locke, Comte, Carnap); a kind of phenomenological method where experience is granted attention in the way it appears for the subject (Husserl, Løgstrup, Merleau-Pontey); a kind of hermeneutical approach, concentrating on understanding and interpretation of “texts”, and the conditions for such an enterprise, be it in a traditional, philosophical, or in-dept manner (Schleiermacher, Dilthey, Heidegger, Gadamer, Ricoeur) or the spin off in Habermas’ critical theory; postmodern “”deconstruction” and construction” (Foucauld, Lyotard, Derrida) – there are in all schools (and combinations of them) premises (axioms), limitations, and pitfalls to be carefully considered. The same concerns all kinds of quantitative and qualitative approaches, to use another well known differentiation.
Most appalling is the haughty ambition of creating just one form of scientific method and language covering all areas of human life, most often voiced by some advocates of positivistic approaches. On the other hand, it can be wise to use exactly these kinds of methods to be heard in all dominant corners of the health-care and financial system!
A broken understanding of over-ambitious and one-sighted scientific work, results hopefully in a kind of spiritual humility among scientifically orientated care-givers, promoting flexibility and appreciation of different scientific approaches, and even towards a non evidence-based creative caring.
The concept of health is not plain and undisputed, and has to be broken
down from the utopian state of “total physical, mental, and social well-being”
(WHO), and restored to something else than just “absence of ills” (cf. Piet Hein).
The concept of health is transient and changeable. It varies from time to time, from
profession to profession, and from person to person. It is from beginning to end
a relative idea, and the famous WHO-formulation is by far convincing to all. May
be health even includes experiencing the right to be “unhappy, ill and impotent”(O.S.
In a way health is also always a hidden factor(cf. H.-G. Gadamer: Über die
VerborgenheitderGesundheit(1993)), un-accessible to the power of language . And
John Steinbeck describes one of his protagonists as follows: “He was fifty-four, lean,
handsome, and healthy in so far he knew. By that I mean his health was so good that
he was not aware he had it” (The Short Reign of Pippin IV).
In a new study on howordinary Norwegians understand health (Helsepånorsk
(2009)), two Norwegian professors(Per Fugelli (social medicine) and
BenedicteIngstad (medical anthropology)) divide the findings into ten categories:
Ten Factors of Health (measured in Norway) most strongly oppose that
A broken understanding of over-ambitious or one-sighted concepts of health, results
hopefully in a kind of spiritual humility , paying tribute to “moderate contentness”
as a realistic and all right way of life, into which health in different aspects is reflected.
When it comes to a basic understanding of human possibilities and the nature of faith, it has to be broken in several ways:
On this background I am not very puzzled by the fact that there is evidence of “unhealthy” struggle facing death among “hardcore-Christians” (fx. Pargament, Koenig, Tarakeshwar 2001). I am more puzzled by the fact that it seems to be so little of it, so little of observed struggle, fight, anxiety and shrilling cries when deep believing persons are facing the end of life. God is not just a nice and understanding social worker, and death is seldom just a friend, but even a real enemy. In some part of their existence, committed Christians will know that. To help people die in peace can therefore not be the only(!) goal for pastoral care. The main thing is to assist people in looking for some comforting divine hands to be within, in the very middle of struggles, protests, laments and a whole bunch of mixed feelings!
To die blessed and saved, is, consequently, theologically more important than to die in peace after a fruitful and long lasting life. This insight also opens the importance of the eschatological perspective, which psychology and health-care as such, can not present. On the other hand is the psychological well being encountering death not irrelevant to pastoral care, cf. “the critical plurality of PCC-perspectives”.
A broken understanding of the capacities of human beings, and of what faith is psychologically able to accomplish during our lifetime without loosing its theological and spiritual roots, results hopefully in a kind of spiritual humility strengthening the courage to live and to die, in the middle of our recognized fragility and fragmentation in body, mind and spirit.
E. there is evidence of “unhealthy” struggle facing death among “hardcore-Christians” (
A Multi-factor Spirituality Model
Every human being is according to Christian anthropology a living and unique expression of body, mind and spirit in a family and social context. All these aspect are of course inter-related and can not be divided into pieces. We will now, however, concentrate on the spirit-aspect, and ask what are the characteristics of its expressions through everyday challenges, and especially in times of crises? I will defend three main dimensions, which again can be differentiated into cognitive, emotional and behavioural expressions (cf. Grevbo 2008, published even as official guidelines of spiritual care in palliation by Norwegian health-authorities):
These three areas are of course again interrelated, but profit on being separated for scientific and even clinical reasons. (See in contrast the compact definition of the Consensus Conference on Spirituality and Palliative Medicine (2009), honouring in it’s own way the same elements: “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”
This area holds questions linked to the basic conditions of human life, deep and difficult questions which no one totally escapes. They cover challenges tied to
- identity and meaning (fx: “Who am I now when my disease has completely changed my life situation?”)
- suffering and death (fx: “How should I relate to death now when it is impossible to run away?”)
- guilt and shame (fx: “What wrong have I done to deserve this terrible situation?”)
- loneliness and isolation (fx: “How can I avoid loneliness, and at the same time avoid invasion by other people with various needs related to me?”)
- freedom and responsibility (fx: “How can I endure in a situation where I am totally dependent on receiving help from others?”)
- courage of life and ennui (fx: “Is there still something to hope for in my situation, a little spark with glowing potentials?”)
(The examples of questions here, and in the following two sections, are directly derived from my own encounters with terminally ill patients.)
Here is the place for concerns related to what is really valuable to us on the human level, and in the different phases of life.The focus is especially on all the various relations which fill a life of human beings, like the relation to:
- material things
- art and culture
- moral standards
- life itself (past, present, future)
Main question here: “What is most important to me in my actual situation?” Further expressions could be: “How can the life I have behind me, be a positive value in my last period?”; “Do I really still have a personal value in this phase of life?” etc.
Questions of this ultimate character can be dealt with on an obvious religious basis (i.e. including a relation to a kind of deity), or reflect an immanent humanistic worldview. Not seldom will caring people meet a mixture of these positions, concerning
- the ultimate meaning of life
- life’s and death’s inhabited demands
- human worth, and the fight for a worthy life
- faith and doubts
- hope for eternal life – and other ultimate hopes
- forgiveness from and reconciliation with fellow human beings and God
- God’s presence in suffering and loss
- the role and practice of prayer
- the possibility of divine healing
- the content of (Christian) faith
Central questions sound here like: “Do I have a sustainable philosophy of life, and does such a thing at all exist?”;“Is my wavering childish belief strong enough?”; “Why do God feel many times so distant, and why does he just not remove all evil things?”;“Does it help to pray?”;“Have I lived a good enough life?”; “How can I make up for all my wrong doings?” – Very often take these ultimate concerns however, not the shape of questions, but express themselves in a longing for a personal anchoring in some comforting words (in the Bible) and prayers, hymns and songs, blessings and other rituals.
The three extensive, interrelated and partly overlapping, dimensions of man’s inextinguishable spiritual quest, prevent us from ending up in a narrow corner when spiritual issues are at stake. Adequate spiritual care may on this background be summarized in the following statement:
Spiritual care is
“A serious illness effects us always – and not seldom to the better.”
“Almighty God! If You let me live on, give me Your strength so I can make it; if You let me die, let me be embraced by Yourself and Your mercy”.
“Every person has a story to tell, in serious crises perhaps with few or no words. I long intensely for someone to show me my value by listening carefully”.
Selected Literature Related to dimensions of man’s inextinguishable spiritual quest, prevent us from ending up in a narrow corner when spiritual issues are at stake. Adequate spiritual care may on this background be summarized in the following statement:Grevbo’s Lecture (Odense 19.05.2010)