Transcript Lysbilde 1

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
• To present pastoral care as the most widely spread art of
dealing with troubled people from a specific Christian point of
view (This will be done in great respect for other caring traditions with many
similar traits!)
• To paint a nuanced picture of our so called secular age
• To let research and questions from the field of psychology of
religion meet pastoral care constructively and critically, and vice
versa.
Content:
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
A.
Two Initial Inputs
(a Secular “Hymn” and
an Exposé of Pastoral Care)
A Secular “Hymn”
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)
B.
A Brief Introduction to
Some Vital Aspects
of Pastoral Care
Selected International Terminology
• Hæ thæs psykjæs epiméleia (Plato) – Cura animarum – Seel(en)sorge - Soul
care/cure – Sjelesorg/själavård (Notice: the term is not originally biblical, and was
in the church first fixed in plural in Greek, Latin and German – mostly due to
Basil the Great ca. A.D. 360: epiméleia/therapeía tån psykjån – and in order to
avoid a narrow-minded individualism.)
• Soul (in the church context normally used as term for the whole person as a living
creature)
• Pastoral care (standard English/American formulation, cf. the very influential book
of Gregory the Great ca. A.D. 600 called Liber Pastoralis Curae, published in
English as Pastoral Care, leaving the cure-aspect aside, or better: included)
• Pastoral care and counseling (the last word is used to describe a professional and
authorized art of practicing pastoral care, normally with competence beyond
just theological insight)
• Pastoral (derived from the biblical image of shepherd, and usually not limited to
certain office-bearers (pastors))
• Confident (the counselee, i.e. the person who in principle confide in the caregiver,
used in Scandinavia at least from the 17th century)
Basic Assumptions
• “Pastoral care” is basically a theological and Church-related
discipline, dealing with all kinds of questions relevant to life and
faith. (In contrast the “psychology of religion” is basically a
psychological discipline, acting on the religious field in a wide
meaning.)
• Taking its foundation seriously, does not mean an inadequate
limitation of pastoral care. Pastoral care can be offered – and has
been offered – in a myriad of ways. This is particularly true for
our own age.
• An important distinction has to be made between
- cura animarum generalis (all ecclesial activities taking care of God’s people
(in principle including all people created by God))
- cura animarum specialis (pastoral conversations and rituals, concerning one
or few persons at a time)
• Although one may be sceptical towards universal, trans-historical
definitions of pastoral care, certain dimensions may gather what
pastoral care basically – past and present – is all about.
Eight Dimensions of Pastoral Care
1. Healing (as restoration, and/or finding new depths and hopes in life, cf.
Archbishop Rowan Williams, in Baxter 2007)
2.
3.
4.
5.
Sustaining (preservation, consolation, consolidation, redemption)
Guiding (eductive and inductive)
Reconciling (forgiveness and correction)
Nurturing (Main dish: acceptance, affirmation, grace and love, salted with
honesty and confrontation – to promote a healthy growth)
6. Liberating (personal, structural, societal)
7. Empowering (looking for resources against “adapted helplessness”)
8. Resisting (concerns different kinds of violence and oppression, cf. next slide)
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.
Angel with Boxing Gloves and Resisting Power
Artist: Elisabeth Helvin
Main Concepts of Pastoral Care and Counseling
Practiced (more or less vigorously) To-day
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:
1. Kerygmatic Care (concentrating on transmitting the central
Christian message of sin and grace to individuals)
2. Evangelical Care ( concentrating on a broad portion of
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)
4. Spiritual Care (accompanying confidents to a deeper level of
Christian and human insight, derived especially from the
tradition of spiritual guidance with its contemplative legacy
of prayer, pastoral diagnosis and discernment)
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)
6. Analytic Care (concentrating on a conscious selfintrospection through methods adopted from different
schools of analytic psychotherapy)
7. Therapeutic Care (labelling the influential American
movement from 1925, emerging through clinical pastoral
education (CPE) as a professional and confident-centred
help to self-help, drawing on the resources of various
psychological trends submitted under the category of
pastoral-psychology)
8. Socio-political Care (directed towards the society as transindividual liberation from and change of life-restraining
social conditions)
Grevbo 2006 (pp. 302-408)
Competences for a Serious Pastoral Caregiver (independent of his/hers basic concepts)
•
•
•
•
•
•
Personological competence (concerning oneself and others)
Communicational competence
Hermeneutical competence
Spiritual competence
Historical competence
Theoretical competence (concerning pastoral care itself, and its theological, psychological,
sociological, cultural, methodological components etc.)
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.)
My Own Position:
Honouring a Plurality of Perspectives
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”.
Four Critical, Contextual Test-areas
(in practice woven tight together)
1.
2.
3.
4.
The confident as context. This first area of critical observation deals with the given
and unique pastoral case with one or more confidents in the centre – and leads to
assessment of the appropriate attitudes, methods, steps etc. The warning not “to tar
all with the same brush”, is a pastoral advise as old as the hills.
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.
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.
Theology as context. My practice is also continuously and critically accompanied by
theological presuppositions: fx. the classical Christian understanding of God’s trinity
(against any theological one-sidedness) and the accompanying awareness of God’s
presence in all things; the built-in tensions (paradoxes) in Christology and other parts
of Christian basics; the different aspects of biblical anthropology; some basic ethical
values. Pastoral care is always – in a very broad sense – adapted theology in a
biographical context. In doing this kind of caring theological work, I can’t just suspend
the question of truth, and replace it by the question of effectiveness.
(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 theological reflection that I
operate with a double (or complementary) approach to
life and faith, both within the realm of pastoral care:
a. A general perspective – including all components of human
beingness concerning body, mind and spirit within a family and
social context, hereby all natural desires, longings, and hungers
of the human heart, and the kind of faith evolving from that
(i.e. an universal spirituality, theologically derived from man’s
creation in the image of God).
a. A specific Christian perspective – where trust in the triune
God, and a living through the Holy Spirit in the wide context of
the Church community, builds the ultimate framework of faith
and life.
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”
Viatoric Pastoral Care
The Latin word viator has two meanings:
a. A person walking along the road (a companion)
b. A person with something to convey (a messenger)
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.)
Some Consequences
• Pastoral care and counseling (PCC) tries to meet the
question of faith and health in all its perspectives, but not
uncritical.
• “There are things more important than being healthy,
and worse than being ill” (Norwegian chaplain Peder Olsen)
• Pastoral care-givers work in different contexts, and will
occasionally have to adapt more or less painfully to the
health-system, and always to the confident, but indeed
without loosing their own souls.
• For different research reasons a certain pastoral care
approach has to be formulated much more precisely and
distinctly than this overview allows.
C.
Ambiguous Traits in Our
Secular Society
Hallmarks of Our Secular Societies
(cf. Charles Taylor 2007)
1. We live in societies where no parts of the political
system are really connected to God, or some notion
of ultimate reality. (The remains of state churches are e.g. rather
a tool for political authorities to regulate Church-life, than opposite.)
2. We live in societies where the falling off of religious
belief and practice is obvious.
3. We live in societies where belief in God is heavily
disputed, remaining just one option among others,
and frequently not the easiest one to embrace.
European Counterbalance
• Believing without belonging (Example: even though a marked
reduction concerning the more rigorous indicators of religiousness, such
as participation in institutional Church-life and commitment to the
credal statements of Christianity, is observed, certain dimensions of
belief relating to the existence of soul and life after death, are rising
markedly among younger generations, together with a variety of selfmade beliefs and mixtures of it.)
• Belonging (as a kind of relational belief) without believing (as a kind
of full doctrinal belief) (Norw. situation as example: 90 % belong officially
to the Church of Norway (80%) and other churches as a kind of religious
“home” they do not want to leave, but only 31% confirm (2010) belief in
the resurrection of Christ.)
• Vicarious religion (Advocates the fact that Christian faith, seriously
celebrated by an active minority, is performed on behalf of a much
larger number, who (implicitly at least) not only understand, but, quite
clearly, approve of what this minority is doing.)
• From obligation to consumption (Church-attendance, once
imposed, or at least inherited, have become instead a matter of personal
choice for some periods or particular circumstances (e.g. rites de
passage or life crises).)
• Hidden religion (often disguised in compassion for art; personal
perfection; various mystical experiences; veiled pilgrimages; fullness of
human life etc., or in more destructive ways like: ecstatic behaviour through
drugs, madness and excessive sport enthusiasm; self violation and eating
disorders; worship of utopian revolutionary struggles; boundless sexual
activity; experiences of inner emptiness etc. )
• Other signs of de-secularisation:
- Influence of immigrants (Christians and Muslims etc.)
- Growth of Charismatic and New-age movements
- New religious interest among intellectual elite (e.g. philosophers like Jürgen
Habermas, Slavoj Ziztek, Alain Badiou, Georgio Agamben, 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)
Why Is This Broad Understanding of
Religious and Sacred Signs Important?
To be alert to meet all people – frankly and openly –
in their, partly disclosed, existence as longing and
aspiring creatures (homines desiderantes), 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.
Possible Conceptual Consequences
• If one emphasizes the obvious signs of secularisation in
our age, it may be seen important to develop the
therapeutic and social concepts of PCC (cf. types 6-8) as
an act of conscious adaptation (or to offer resistance by contrasting
concepts).
• If one on the other hand emphasizes the obvious signs
of sacralisation in old and new clothing, it may be seen
important rather to promote the concepts of
kerygmatic to ecclesial type (types 1-5), in order to
thoroughly meet the spiritual needs of today (or to offer
sobriety by contrasting concepts).
• If one emphasizes the ambiguous signs of our time, as I
do, it feels necessary to be able to play all the different
tunes of the PCC-instrument, however in a contextual
and critical way.
Three Ambiguous Traits Important to PCC
1. PCC has to relate to the strongly growing
individualization – and at the same time to the
accompanying need for commitment to a
larger community (Koinonia).
2. PCC has to relate to the strongly growing
differentiation and professionalism – and at
the same time to the need of a uniting pattern
of unpretentious mutual service (Diakonia).
3. PCC has to relate to the strongly growing
secularization – and at the same time to the
accompanying need for religious experience
and personal faith (Martyria).
Pastoral Care in Our Secular Age
• In our so-called secular age people need to meet a kind of
pastoral care which is more than just a reflection of secular
methods of caring.
• In our secular age pastoral care-givers have to believe in every
human being as a person longing for more (homo desiderans).
• In our secular age pastoral care-givers have, at the same time,
to present a realistic view of man’s possibilities and
capabilities, even as persons of faith (more later).
• In our secular age pastoral care-givers have to understand the
many wounds, tiredness of words, and experiences of
disrespect resulting from encounters with unwise
representatives of faith communities.
• In our secular age pastoral care-givers need to develop much
patience, humility (docta ignorantia) and trust in God being
present in all cases before us, together with us and after us.
D.
Important and Problematic
Elements in the
International Health-Faith
Research
a. Important for PCC Theory and Practice
• It is important to notice that the core of relevant faith-health
research is designed and carried out according to the highest
scientific standards, or at least presented in a careful and
critical way by leading compilers.
• It is important to notice that a widespread alleged correlation
between religious faith and anxiety, weakness, stress,
neurotic behaviour, insanity and depression is nearly
unequivocal rejected, and replaced by a significant positive
association towards mental and physical health.
• It is important to notice that the research opens a serious
dialogue with educational and health institutions to grant
spiritual and religious matters a genuine place in the
screening and understanding of patients, and also when it
comes to follow-up actions.
• It is important to notice that the research in general 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.
• It is even important to notice that severe ill persons commonly
seem to become more religious after their diagnosis.
• It is also important to notice that the research normally
encourages a multidimensional and dynamic view of faith,
flexible and large enough to encompass life as a whole. A
valuable built-in critique of some unsound faith expressions is
consequently also present (see also my critical comments later).
*
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.
b. Problematic Aspects by Adaption in
Northern Europe
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.
Forget your perfect offering.
There is a crack in everything.
That’s how the light gets in.
Leonard Cohen in “Anthem”
1. A Broken Understanding of Scientific
Research
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 methodoligical scientific 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!
• From a pastoral care perspective I will at the same time most strongly
oppose that only so called evidence-based research shall guide the practice
and release financial support, as already suggested in many countries. In a
competitive market where “scientific”, in a narrow sense, is an important
trade mark, it’s reputation will easily be used to control all aspects of
practice, even if comparable (!) research on practice seems to give meagre
scientific evidence to support this strategy. It establishes a huge problem
when a certain scientific method is given authority to construct and rule over
the design of all clinical practice. The Norwegian philosopher and professor
in Roskilde, Denmark, in the seventies, Hans Skjervheim, denounces such an
attitude as a fundamental “instrumentalistic mistake” (1972). The mistake
exists in superimposing instrumental reason as the only guiding principle for
all institutions and relations. The result is a technification and increasing
regulation of the whole clinical field . The Norw. psychologist and professor
Tor-Johan Ekeland calls it a total “manualization of practice”, i.e. a rigid
concept of direction according to certain standards, which limit the options
and really make it difficult for the practitioner actively to use professional
discernment and varied forms of expression (1999).
*
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.
2. A Broken Understanding of Health
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.
Lian)?
In a way health is also always a hidden factor (cf. H.-G. Gadamer: Über die
Verborgenheit der Gesundheit (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 how ordinary Norwegians understand health (Helse på norsk
(2009)), two Norwegian professors (Per Fugelli (social medicine) and
Benedicte Ingstad (medical anthropology)) divide the findings into ten categories:
Ten Factors of Health (measured in Norway)
1.
2.
3.
4.
5.
6.
Health is well-being/satisfaction (trivsel) - a convincing No. 1.
Health is balance (likevekt)
Health is wholeness (helhet) – included belonging to a spiritual world
Health is adaption (tilpasning)
Health is ability to function (funksjon)
Health is moving towards a goal (bevege seg mot et mål) – pursue
interests with success and fulfil existential and moral aspirations
7. Health is power of life (livskraft)
8. Health is resilience (motstandskraft)
9. Health is absence of thoughts about health (fravær av tanker om
helse)
10. Health is absence of illness (fravær av sykdom ) – mentioned by 17 of 80
informants (low compared with international studies)
*
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.
3. A Broken Understanding of Human Being
and Faith
When it comes to a basic understanding of human possibilities and the
nature of faith, it has to be broken in several ways:
1. The everlasting fragmented character of human nature has to be
recognized, cf. the German practical theologian Henning Luther (1985): We have
to say farewell to the myth of a banal wholeness, and recognize that we are
“fragments of the past” and “fragments of the future” – and understand our unextinguishable self-transcending aspiration on this background.
2. Existential anxiety and crises belongs inevitably to life itself, and can
not be suspended by a successful personal growth etc., but often
suppressed by it, cf. the Danish psychologist Bjarne Jacobsen and Søren
Kierkegaard (2000).
3. The faith has to be broken in a struggle between what seems to be
healthy (in a more narrow sense), but not necessarily true, and what
seems to be true, but not necessarily healthy. To meet the Christian
God seriously, is not just to find cheep grace, oblivion and peace, cf.
the Danish bishop Kjeld Holm (1986).
4. A faith full of harmony, peace, and calmness is not a Christian faith –
when not capable on all stages to include an amount of tribulation,
anxiety, protest and despair, cf. the main stream spiritual history of the
Church, and even most of the Lutheran tradition, fx. Grevbo 2006: Guds
masker.
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.
A Multi-factor Spirituality
Model
The Main Dimensions of Spirituality
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 spiritaspect, 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):
1. Existential questions (Norw.: eksistens-utfordringer)
2. Questions of values (Norw.: verdi-utfordringer)
3. Questions concerning one’s belief system (openly religious or not) (Norw.:
livssyns-utfordringer)
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.”
1. Existential Questions
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.)
2. Questions of Values
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:
- ourselves
- family
- friends
- work
- material things
- nature
- 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.
3. Questions Concerning One’s Belief System
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
•to notice the confident’s needs related to existential questions,
questions of values, and questions concerning the belief system –
and not just once and for all
•to listen, within the framework of the confident’s own history of
life and of the currant situation, in order to comprehend and
collect the main points of interest
•to assist the confident (and relatives) during the process, always
concentrating on the confident’s own concerns – and at the same
time being alert of the confident’s possible urge to change or
develop the way of thinking, feeling, and/or acting in spiritual
matters.
Some Expressions from Terminally
Ill Patients
“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 Grevbo’s Lecture (Odense 19.05.2010)
•
The well known publications of Koenig, Pargament, Wulff (and co-writers) are not listed. - Some of my own
older simplistic works, still relevant to my basic understanding of pastoral care, spirituality and psychology of
religion, are included.
•
Baumann K. (2009). ”Religiöser Glaube, persönliche Spiritualität und Gesundheit: Überlegungen und Frageni m
interdiziplinären Feld von Theologie und Religionswissenschaft, Medizin und Psychotherapie”. Zeitschrift für
medizinische Ethik (Jg. 55 S. 131-144)
Baxter J. (ed.) (2007). Wounds that Heal: Theology, Imagination and Health. London: SPCK
Berg Eriksen T. (1995). Helse I hver dråpe: Innspil om etikk, kunnskap og omsorg. Oslo: Universitetsforlaget
Braut A. (2008). ”Spiritualitet og livsmestring. Teologiske og religionspsykologiske perspektiv på gudsrelasjon og
trospraksis i møte med lidelseserfaringer”, Masteravhandling: Det teologiske Menighetsfakultet, Oslo
Brooks Holifield E. (1983). A History of Pastoral Care in America: From Salvation to Self-Realization. Nashville:
Abingdon Press
Clebsh W.A., Jaekle, C.R. (1964/1994). Pastoral Care in Historical Perspective. Northvale, New Jersey, London:
Jason Aranson Inc.
Doehring C. (2006). The Practice of Pastoral Care: A Postmodern Approach. Louisville, Ken.: Westminster John
Knox Press
Ekeland, T.-J. (1999). ”Evidensbasert behandling: kvalitetssikring eller instrumentalistisk mistak”. Tidsskrift for
Norsk Psykologforening , bind 36, s. 1036-1047
“Forskning innen palliasjon”, temanr. Omsorg. Nordisk tidsskrift for palliativ medisin(4/2009)
Fugelli P., Ingstad B. (2009). Helse på norsk: God helse slik folk ser det. Oslo: Gyldendal Akademisk
Furseth I., Leer-Salvesen P. (2007). Religion in Late Modernity: Essays in Honor of Pål Repstad. Trondheim: Tapir
Academic Press (cf. Davie G. “Religion in Europe in the 21st Century: The factors to take into account” pp. 37-53)
Gleason J.J. (Winter 2004). “Pastoral Research: Past, Present, and Future”. Journal of Pastoral Care &
Counseling, Vol.58, No. 4, pp. 295-306
Grevbo T.J.S. ((1999). ”Moden og sunn tro. Et mørklagt tema satt under teologisk og religionspsykologisk
belysning”. Halvårsskrift for praktisk teologi (hefte 1, s. 3-12)
Grevbo T.J.S. (1982). ”Hva er nevrotisk religiøsitet?” Tidsskrift for Sjelesorg (hefte 2, s. 26-38)
Grevbo T.J.S. (1986). ”Adskillelse, sammenblanding eller hva? Et bidrag til debatten om forholdet mellom
psykoterapi og sjelesorg”. Tidsskrift for Sjelesorg (hefte 1, s. 7-17)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Grevbo T.J.S. (1987). ”Norskdom og kristendom i dag. Kristendommens møte med norsk kultur og lynne i 1980årene”. Halvårsskrift for praktisk teologi (hefte1,s. 3-21)
Grevbo T.J.S. (1987). ”Religionspsykologien i Norge: En oversikt fra 1915 til i dag”. Tidsskrift for teologi og kirke
(hefte 4, s. 287-306)
Grevbo T.J.S. (1995). ”Sjelesorgen i dagens situasjon – med særlig henblikk på Danmark og Norge”, Tidsskrift for
Sjelesorg (hefte 4, s. 190-205)
Grevbo T.J.S. (1997). ”Sjelesorg – teologi i biografisk kontekst”. Præsteforeningens Blad (hefte 22, s. 870-879)
Grevbo T.J.S. (1998). ”Livshistorie og religiøsitet”. Halvårsskrift for praktisk teologi (hefte 1, s. 24-32)
Grevbo T.J.S. (1998). Det fir-foldige menneske. Et personlighetsspeil til sjelesørgerisk bruk. Oslo: Luther Forlag
(4. oppl.)
Grevbo T.J.S. (2006) Sjelesorgens vei: En veiviser i det sjelesørgeriske landskap – historisk og aktuelt. Oslo:
Luther Forlag
Grevbo T.J.S. (2006). Guds masker i sjelesorgen: Hvordan forholde seg til det guddommelige maskespill
teoretisk og praktisk? (Skriftserien Koinonia nr. 5) Vikersund: Institutt for sjelesorg – Modum Bad (2. oppl.)
Grevbo T.J.S. (2008). ”’Viskningar och rop’: Åndelige utfordringer innenfor palliasjon”. Omsorg. Nordisk tidsskrift
for palliativ medisin (hefte 2, s. 31-38)
Grevbo T.J.S.(medforf.) (1975). Prest og menneske. (cf. ”Nevroseskapende trekk i menighetsliv og
prestetjeneste. En innføring i debatten om ekklesiogene nevroser” s. 45-67). Oslo: Presteforeningens
studiebibliotek nr. 2 (og senere opptrykk)
Holm K. (1986). Sorgens sprog – træk af den principielle sjælesorg. Århus: Forlaget Aros
Jacobsen B. (2000). Den helbredende sygdom: Søren Kierkegaard – krise ved somatisk sygdom. København:
Dansk psykologisk forlag
Luther H. (1985). ”Identität und Fragment. Praktisch-theologische Überlegungen zur Unabschliessbarkeit von
Bildungsprozessen”.Theologia Practica ( 20. Jg. Heft 4, S. 317-338)
Luther H. (1992). Religion und Alltag: Bausteine zu einer Praktischen Theologie des Subjekts. Stuttgart: RadiusVerlag
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Luther H. “Alltagssorge und Seelsorge: Zur Kritik am Defizitmodell des Helfens”. Wege zum Menschen (38. Jg. Heft 1, S.
2-17)
Martinsen K. (2006). Care and Vulnerability. Oslo: Akribe
Martinsen K., Eriksson K. (2009). Å se og å innse: Om ulike former for evidens. Oslo: Akribe
Neumann J.N. (2009). ”Religion und Krankenbehandlung: Eine medizinhistorisch-kulturanthropologische
Verhältnisbestimmung ”. Zeitschrift für medizinische Ethik (Jg. 55, S. 111-129)
Nome J. (1970). Kritisk forskerholdning I etikk og religionsfilosofi. Oslo, Bergen, Tromsø: Universitetsforlaget
Ramsay N.J. (ed.) (2004). Pastoral Care and Counseling: Redefining the Paradigms. Nashville: Abingdon Press (cf.
Miller-McLemore B.J. “Pastoral Theology as Public Theology: Revolution in the ‘Fourth Area’” pp. 45-64)
Seitz M. (1988). ”Ein gutes Ende finden! Klinische Erkenntnis und pastorale Aufgabe”. (Vorlesung Würzburg 1988, priv.
Kopie)
Skjervheim H. (1959/1974). Objectvism and the Study of Man, norsk utg. Objektivismen og studiet av mennesket. Oslo:
Gyldendals Fakkel-bøker
Skjervheim H. (1960). ”Deltakar og tilskodar” og ”Faktum og fridom”. Aarnes A. m.fl. Brytninger i tidens tankeliv. Oslo:
Johan Grundt Tanums Forlag (s. 63-91)
Skjervheim H. (1968). Det liberale dilemma og andre essays.Oslo: Johan Grundt Tanum Forlag
Skjervheim H. (1971). ”Det filosofiske grunnlaget for psykoterapien”. Alnæs R., Johnsen,G. (red). Psykoterapi, bind III:
Metoder ved forskjellige psykiske lidelser. Oslo: Fabritius & Sønners Forlag (s. 10-18)
Skjervheim H. (1972). ”Det instrumentalistiske mistaket”. Mediaas M. m.fl. Etablert pedagogikk – makt eller avmakt?
Oslo: Gyldendal Norsk Forlag
Stollberg D. (1972). Therapeutische Seelsorge: Die amerikanische Seelsorgebewegung. Darstellung und Kritik.
München: Chr. Kaiser Verlag
Swinton J., Mowat, H. (2006). Practical Theology and Qualitative Research. London: SCM Press
Taylor C. (2007). A Secular Age. Cambridge, Mass., London: The Belknap Press of Harvard University Press
Theologia Practica (1992, 27. Jg. Heft 3): Gedenkschrift für Henning Luther 1947-1991 (Red. Gert Otto, auch mit
Bibliographie)
•
•
•
•
•
Thomassen M. (2006). Vitenskap, kunnskap og praksis: Innføring i vitenskapsfilosofi for helse- og sosialfag.
Oslo: Gyldendal Akademisk
Thornquist, E. (2003). Vitenskapsfilosofi og vitenskapsteori - for helsefag. Bergen: Fagbokforlaget Vigmostad &
Bjørke
Unterrainer H.-F., Ladenhauf K.H. (2008). “Religiös-spirituelles Befinden im Kontext seelischer Gesundheit und
Krankheitsverarbeitung: Ergebnisse eines interdiziplinären Forschungsprojekts”. Psychologie in Österreich (Heft
1 S. 54-61)
VandeCreek L., Bender H., Jordan M.R. (1994). Research in Pastoral Care and Counseling: Quantitative and
Qualitative Approaches. Decatur, Ga.: Journal of Pastoral Care Publications
VandeCreek L., Lucas A.M. (eds.) (2001). The Discipline for Pastoral Care Giving: Foundations for Outcome
Oriented Chaplaincy. New York, London, Oxford: The Haworth Press