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By Greg DuBow, Resident Chaplain ALGH firstname.lastname@example.org
In this article I aim to construct a non-violent mode of healthcare chaplaincy within the context of trauma. As a student intern at a Level I trauma center, I remember working with a family whose child was killed suddenly and in a particularly violent way. Pulling back the curtain to the trauma bay, I was not prepared for what I saw. The young boy’s eyes were glassy and his body was bent at angles for which I had no frame of reference in my mind. This child had been destroyed by an automobile and the driver had fled the scene leaving the boy, who had died instantly, the arms of his mother with whom he had been crossing the street. He had been cleaned as best he could and his family had yet to take the long walk from the family consult room to the bed where their child now lay. The family was surrounded by strangers, all of us cramped into a small sterile family waiting room. The boy’s father had just arrived at the hospital, oscillating between disbelief that his son was dead and blaming his wife for what had occurred. I was one of the strangers who was with them that dark morning as was a chaplain employed by the first responders present at the accident site,
garbed in all black with a white clerical collar. Choking on his tears, the child’s father screamed at him, “Go ahead and tell me that God is real now!” Everyone was quiet, waiting to see how he would respond, “He is.” The chaplain responded calmly, “You may not feel him right now, but he is.” His tone was even and measured, as if he were oblivious to the grieving father’s anger, like a parent explaining that one day when he was older he would understand. When I began my research I was narrowly defining trauma as a medical event during which a patient is threatened with potential loss of life or limb. While this remains apt, it does not reflect the alienation from self, others, and existential meaning that victims of trauma experience. I have begun to think of trauma as: violent uprooting which takes away all normal props, breaks up our world, snatches us forever from places that are saturated in memories crucial to our identity, plunges us permanently into an alien environment, and can make us feel that our very existence has been jeopardized. (Armstrong, 2000) Through my work I’ve learned that chaplaincy care in response to a traumatic event must primarily focus on and engage the patient’s interpreted sense of meaning. Victims of trauma and their families are a vulnerable population (Tedeschi, Calhoun, 1995) and because of this we need a heightened commitment to treating them ethically. Facilitating meaning-making in response to traumatic events with patients and their families is necessarily engaging the dialectical relationship between the patient’s embodied self and their engagement with non-being. To operate outside of this framework of knowledge without having accounted for it may result in harm being done to the patient and
their family. The family with whom I was working with was living out a nightmare. Amongst the flashes of guilt, sorrow, and rage it was clear that their situation had not yet become a part of the fabric of their world. Failure to cognitively integrate a traumatic death into one’s worldview is a common response to traumatic death by the bereaved. (Jacobs, 1993) Even if the family were to come to the theological conclusion that to them God feels absent but is nonetheless omnipresent, it is the responsibility of chaplaincy care providers to engage with the present moment as well as hope for the future. I knew viscerally that the way the other chaplain had responded to the child’s father was inappropriate in those first crucial hours. That chaplain offered words to them, out of a spirit of compassion, which were deus ex machina. In other circumstances the chaplain’s assertion may have been an appropriate challenge of faith or comforting words, but in the holy sanctuary of this family’s grief and pain it was a violent assertion which obstructed their flourishing. According to the Association of Professional Chaplains Code of Ethics, “the individual person possesses dignity and worth.” (APC, 2000) Honoring dignity and worth are qualities held as inherent within my own Unitarian Universalist tradition and putting belief into practice with my patients requires a dialectical mode of chaplaincy care which I have observed several experienced chaplains utilize – even if they would not name their methodology as such. A dialectical mode of chaplaincy relies upon walking with patients and their families as they engage the void and ‘violent uprooting’. Essentially, it is a dialogical exploration of
non-being between a chaplain and patient and/or family. The call is to walk in the liminal space between being and non-being. Presenting a patient or their family with interventions (prayer, companionship, advocacy, connection, etc.) that do not fit the internal logic of their experience in those first few fours of shock in response to a traumatic event is “like arguing with a fence post”. A chaplain may provide a hundred theologically sound reasons for why good things happen to bad people, but to use another Southern metaphor, if an exploration of theodicy does not cohere to an individual’s subjectivity, “then that dog won’t hunt”. A Dialectical Approach:
The other chaplain’s declaration angered me and I wanted to ask him to leave, but it wasn’t until much later that I realized that this feeling came out of my wanting to protect the vulnerable. A member of the extended family asked to talk with him out in the hallway and requested that he leave- teaching me a valuable lesson about creating safe spaces. Those who are not able to walk alongside those for whom they care are not let in to facilitate the work of bolstering resiliency. In that moment whatever God that bereaved father had previously believed in was dead. In the aftermath of that trauma, the attempt to fit his child’s death into a non-resonant ontological framework was counter-productive to both his constructive meaning-making and future growth as a person. Ultimately, fear of the void drives theological reasoning which attempts to violently quell questions about non-being. If psycho-pathology (a graceless, inefficient mode of coping with anxiety is the result of ineffective modes of death transcendence (Yalom, 1980) then it seems a logical corollary that inability to transcend traumatic events through constructive meaning-making results in pathological meaning-making. Anecdotally, I have often heard that people who have been through traumatic events are often more resilient than those who have not had similar experiences. This is a half-truth. People who have experienced trauma and have assimilated that experience into their worldview are likely to be resilient in response to traumatic events. However, those who experience a traumatic event and cope maladaptively are prone to sink further into the
seemingly inescapable abyss of their own heart. Trauma presents a chance for growth, but also intense human suffering. (Tedeschi, Calhoun, 1995) Paul Tillich wrote that, “the vitality that can stand the abyss of meaninglessness is aware of a hidden meaning within the destruction of meaning” (Tillich, 1952). I hypothesize that trauma heightens a person’s sense of their own alienation and that assessing for alienation in regard to trauma is a method which allows chaplains to journey intentionally with patients through the exile which trauma imposes on their lives. Ferrying the gulf between the worlds of the embodied self and the void with the traumatized is a hallowed task. To take up that oar, a chaplain must endeavor to put aside her or his denial of non-being and learn to navigate its shores. In being towards death in this way we are able to sing the vast mineral hymn of the earth, celebrating life. That child’s father’s existence was threatened with annihilation and in stepping outside of his journey by reassuring him, the first responder chaplain failed to honor his experience. Authentically journeying-with requires putting aside our own anxiety momentarily and entering the often nightmarish world of trauma. I began this project as an attempt to research how chaplains explore alienation with patients and their families. After initial inquiry it became clear to me that this subject lacks a shared vocabulary. Here I have begun to lay the groundwork for exploring a mode of chaplaincy which intentionally accounts for the existence negating qualities of traumatic events. Chaplains should enter into relationship with traumatized people focused on the meaning or lack thereof that those who are traumatized are able to construct as they engage with threats to and possible
annihilation of their existence. While many chaplains are able to enter this relationship with the traumatized without doing harm, chaplaincy as a vocation stands to benefit significantly from exploration of how to practice non-violently.
Narrative elements have been fictionalized to protect patient anonymity.
Works Cited: APC. (2000). APC: Code of Ethics. Retrieved 2010, http://www.professionalchaplains.org/uploadedFiles/pdf/code_of_ethics_20 03.pdf Armstrong, Karen. (2006). The Battle for God: The 4000-Year Quest of Judaism, Christianity, and Islam. Knopf. Brothers, Doris. (2007). Toward a Psychology of Uncertainty. The Analytic Press. Jacobs, Selby. (1993). Pathologic Grief. American Psychiatric Press, Inc. Tedeschi, Richard G., and Lawrence G. Calhoun. (1995). Trauma and Transformation. Sage Publications. Tillich, Paul. (1952). The Courage to Be. Yale University Press. Yalom, Irvin D. (1980). Existential Psychotherapy. Basic Books.
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