Doctors and Spirituality: Nothing is Etched in Stone

On the premise one agrees spirituality is important to medicine, as I argued in yesterday's post, that's only where the story begins. There are even more questions to be raised about its management in the clinical setting. For example, who is best qualified to inquire about spirituality and, besides, isn't it an end-of-life issue? What if a patient asks their physician to pray with them and s/he is an atheist? These are real concerns and as a minister on the cusp of medical residency, I'd like to offer a perspective.  

Customarily, religious or spiritual preference is noted in the intake interview and becomes part of a patient's chart. Whoever does the intake should ask, at least generically, about the significance of religion, faith, or spirituality. During times of stress, changes of life, or when treatment decisions can be affected by religious beliefs, it's especially appropriate for the physician to broach the subject. When patients come to the clinic, they anticipate seeing a doctor they know and have come to rely on. The doctor-patient relationship provides an ideal basis for talking about what health or illness means to them, personally. As I define it, such conversations reflect "spirituality" in its most basic sense.  

Naturally, you'd assume spirituality to be an end-of-life concern but it surfaces at other times as well. For instance, couples who have been relatively uninterested in religion often express a desire to reconnect with family religious traditions when a newborn enters the picture. As a first-time pastor, I discovered young children in the home was associated with parents attending church regularly. Family atmosphere, the potential for children to learn moral principles, and social contact with other parents were important factors in the decision to become involved. Midlife is another time when spirituality may take on new significance. The point to remember is, spirituality and relating -- intrapersonally and interpersonally -- go hand in hand, and most of us are best at both while we're still breathing.

The question of qualifications is one that has far less importance for spirituality than the practice of medicine. Doctors are accustomed to referring patients when a specialist would be better qualified to be of help. Spirituality, however, doesn't require technical expertise to be addressed meaningfully. Patients don't expect their physician to be a theologian. What they expect is consideration, respect, and empathy. If we can't provide these qualities, we've got far bigger fish to fry than whether we can explain why bad things happen to good people. And for the record, even ministerial folk have a hard time with that one, if they're honest about it. As long as we stay in touch with our humanity, we've got all the qualifications we'll ever need.

Well, then, what about physicians counseling with integrity when their own convictions concerning spirituality are at odds with patients'? While statistics indicate physicians who are fairly comfortable bringing up spirituality tend to be persons of faith, there's absolutely no reason why this should be considered necessary or even advantageous. For one thing, it's not about what we as physicians believe or disbelieve, anyway. For another, there are a number of potential points of disagreement with patients, including music, politics, caffeine or decaf, none of which require us to alter our convictions to be medically effective. In any case, introducing spirituality into the conversation is never an occasion for us to persuade, convert, or pontificate.

Admittedly, possessing a spiritual orientation may seem helpful, but it can also create problems. The innocent presumption that you know what a patient is talking about since you're able to identify with their experience may result in failing to ask follow-up questions. Conversely, patients may withhold information believing a common experience tells you all you need to know. In situations like these, having no spiritual orientation or one that differs from your patient can be an advantage because it requires us to explain ourselves rather than err by relying on assumptions.

Finally, in the matter of praying with patients, I'm reminded of a wonderful line from the film, Oh, God (1975). John Denver's character asks God (George Burns) if they might just talk now and then, to which God says, "You talk, I'll listen." If a patient should ask their doctor to pray with them, whether or not they are persons of faith, offering to listen reverently while the patient prays is spot on. If they should ask you, as their doctor, to pray on their behalf, there is no harm in gently explaining your convictions should they differ from your patients'. By telling the truth you maintain your integrity and confirm your trustworthiness. Furthermore, your honesty tells your patient that you value them too much as persons to pretend to be someone other than who you are. The result could very well be a much stronger bond between you.

Admittedly, in this essay I haven't gone anywhere near the truly difficult and painful spiritual/ethical issues of blood transfusions and Jehovah's Witnesses, abortion, or faith-based objections to teenage birth control and HPV vaccination. My interest has been on what you might call "bread and butter" spiritual concerns, but demonstrating respect, empathy, and truthfulness is essential in any situation involving religion or spirituality. We struggle, do our best, make mistakes, fall down and get back up, mindful that where spirituality is concerned, nothing is etched in stone. 


(Creative Commons image by john-norris via Flickr)

Why is Spirituality Important to Medicine?

 
That's a good question. Why is it? Well, to try and formulate what I hope will be an equally good answer, we should begin by defining our terms, though I'll tell you right off, precise definitions are elusive. "Spirituality" can suggest devotion to a particular religious tradition, but often as not, it refers to something that has little or nothing to do with organized religion. It may signify a feeling of relatedness to something and/or someone greater than ourselves or express the way a person conceives of their life unfolding. It may describe a personal sense of meaning and purpose or the conviction there is no purpose, that life is a series of random events possessing no more significance or predictability than the numbers drawn in the lottery. "Spirituality" literally can mean almost anything; it all depends on how we use the word.

Sigmund Freud called religion and by extension, spirituality, a "universal obsessive neurosis," inferring it was associated with psychological ill-health. His most famous student, C.G. Jung, disagreed and considered spirituality essential to a patient's well-being. Individuation -- the process of achieving fully conscious self-realization -- could be nurtured by a spiritual orientation as well as psychotherapy. But instead of relying on the doctor and patient relationship, spirituality activates archetypal images residing in the unconscious that enable us to feel grounded and genuinely connected with the deepest aspects of ourselves, a process some call "soul work." Unlike Freud, it wasn't the practice of spirituality that troubled Jung; it was its neglect that created problems requiring psychiatric help.
 
Jung gave considerable attention to Christian images and theology in the development of Depth Psychology, but he also drew on other forms of spiritual expression, including Hinduism, Islam, and the study of alchemy. In the I Ching, for instance, Jung discovered a useful instrument for revealing his own unconscious motivations. He regarded the symbols that recur throughout the I Ching, religion and mysticism as comprehensible images of a mature and fully integrated self.

If we think of spirituality, therefore, as the expression of a powerful desire or need that, when adequately addressed, leads to a feeling of wholeness, we can begin to let go the notion that spirituality must be opposed to science and reason. True, spirituality is irrational in the sense that it's an intuitive process, but irrational doesn't equate with anti-rational. It simply means spirituality "knows" in a way that sidesteps reason or logic. We call this relying on "flashes of insight."

You could say, intuition operates like saltatory conduction in the brain and spinal cord. Some nerves, particularly the longest ones, are wound about with a substance called myelin, making them look like a string of hotdogs placed end to end. An electrical signal travels along a nerve by leaping between the spaces between one "bun" and the next until it reaches its target. This type of signaling is much faster than the stepwise transmission employed by nerves that don't require "rapid transit" for communication. Similar cognitive leaps characterize intuition, though we may have to retrace our steps in order to explain to others how we "arrived at the station," so to speak.

Quaker philosopher Elton Trueblood described post-WW II America as "the cut flower generation," and identified its critical existential problem as disconnection from its psycho-spiritual roots. Cut flowers look very nice in a vase, but they don't survive very long that way. Spirituality can be understood as an intuitive effort to find one's place in the universe, to put down roots and establish a sense of belonging.  

Although most people probably think about seeing a doctor or psychiatrist when they feel ill or they've got a problem, medicine is moving toward a model that promotes health and wellness. You take your car to the mechanic for regular maintenance, why wait until you're sick to see your physician about health maintenance? If your doctor is an osteopathic physician or psychiatrist, attending to the mind-body-spirit triad lies at the heart of their medical philosophy. "Spirit," like "spirituality," can mean many things, but as physicians, recognizing and cooperating with its presence means we wish to promote wholeness, a type of wellness that touches a patient through and through, that improves their quality of life and the lives of those around them. 

(Creative Commons image by NA dir via Flickr)

Letting the Chips Fall

I was getting some work done on my car and enjoying a visit with the mechanic when it happened, but I'll get to that in a minute. I like talking to mechanics and it's unusual for them to allow customers in the auto bays -- liability, you know. But this fellow's doubled as his waiting room, which, by the way, says a lot about the size of his operation. Anyway, since one of the two chairs was occupied by a morbidly obese collection of tools, greasy parts, and half-empty cans of WD-40, I sat down in the other.

I'd actually brought a book along to keep myself from distracting him with questions, but he wanted to talk and so talk we did, mostly about this and that. In which of the neighboring towns did I live, had I been there long enough to know his sister, when is the next snow coming. The kinds of things that make up life outside medical school and are common to small-town Maine. Probably small-town anywhere, for that matter.

Then he asked what I did for a living. If not the first question men ask one another, this is certainly the second or third. Men talk about work, what we do, how long we've done it, have we done it all our lives and where. It's how we size each other up, determine if we're responsible, reliable, if we can be taken seriously. I thought he handled my answer, that I was a medical student, rather well. It only took him about ten seconds to recover from the initial shock -- he did, however, turn around sharply and look at me like I'd just offered him a thousand dollars for a job he'd bill at ten -- before composing himself to ask what I'd done before. A guy my age must have done one or two somethings, maybe a few more, before sticking his neck out.

"I was a psychotherapist," I said in the most benign tone I could conjure. He picked up the theme like it was a favorite wrench he kept near at hand and related tales of family members who'd engaged the county mental health service, saying how he'd love to "get outta this garage" and do something with his life, while there was still time. Before standing on an uninsulated concrete floor in the dead of winter crippled him like it did his father. He reminded me of the bartender in Billy Joel's Piano Man.

He walked away from the window he was repairing in my passenger side door, shattered late one night by small-time crooks too stupid to realize a 2001 Honda was too old to have a navigation system they could pry free and fence for drug money. If they'd taken time to look in the window before throwing a brick through it, they'd have known. He stepped through the maze of tires and boxes, found a radio sitting on an oil drum, and switched from classic to alternative rock to country, listened a moment or two, and returned to my window. Watching him, I ducked my head and smiled; it was the same thing I would have done.

"Have you always been a therapist?"

Here it comes, I thought. No, I said, I'd also been a minister since about 19 aught 3, or so it seemed on weekends when I came home from rotations, dog tired, with two days to catch up on a week's sleep deprivation. Trying to salvage the situation, I added, but medicine had always been simmering on the back burner and just before my dad died, I finally gave myself permission to move it to the front. Too late, his demeanor had shifted as subtly as the tectonic plates and as noticeably as the Richter Scale identifying a tremor. Some things never change.

Up til then, we'd been two relatively ordinary guys talking about life and limb; a stranger would have sworn we'd known each other for years rather than 30 minutes. All that vanished so quickly it felt like it had never been there in the first place. I was a minister now and he was on his best behavior.

I didn't say it then, but I really haven't spent my adulthood with my head buried in the sand, fearful seeing the world as it was would sully my spiritual sensibilities. If I ever had them, and I feel sure I must have, they've been knocked down, brick and stone, by my own fallibility. A religion that's only good for Sunday morning rarely has much value the rest of the week. Some clerics like the interpersonal distance a collar or title provides; I like risking honesty. I like people who are sufficiently real to swear and not give a damn whether I notice.

In any case, I wasn't eager to put on my minister's hat quite yet and my friend couldn't see me wearing anything else. It's going to take some time. I'll go back to get my snow treads installed, and we'll talk again. Maybe eventually we can find a middle ground, one where he's him, I'm me, and we let the chips fall where they may.


(Creative Commons Sharealike image via Wikipedia)

Omega Thinking Revisited

A little over a year ago, I wrote a post entitled, Omega Thinking, describing my journey to medical school and the changes that have taken place in my life along the way. Since then, I've shared this concept with a number of people, some older, some younger, and all of them have found it a meaningful explanation of experiences they've had, and I've been encouraged to believe I may be on to something.

Let me give you a brief overview to get us all on the same page. In the photo you'll notice two Greek letters, alpha on the left, and omega on the right. While nobody's life proceeds in a straight line, for the sake of simplicity, let's say the left leg of the omega represents mine as a young man. At some point, I'm guessing about age 25, I took a left turn. I didn't realize what I was doing at the time nor did I make the turn intentionally. It just happened, like a lot of things.

For the next twenty or so years, I wandered, for lack of a better term, around the loop, attending graduate school, running a business, going through life trying to figure our where I fit in, if I did at all. Exactly when I took the second left, this time onto the right leg of the omega, is also uncertain. I think it was 1998, the year my mother died, my father was diagnosed with pre-leukemia, and I began premedical studies. In depth psychology, "left" symbolizes the unconscious and I've come to interpret the first left turn as a sidestep ultimately leading to self-discovery. The second left integrated the person I had been with the one I was becoming, and perhaps, ought to have been all along. This sounds easy; in reality, it was far from, though the details will only muddy the water, so we'll leave them out at the moment.

The complicating factor in all of this is the arrangement of the legs of the omega. Notice the point at which they are nearest one another. When someone undertakes a process like the one I'm describing, once they've come full circle, they're going to be more like the person they were when they started out. Yes, they're older, and hopefully, more mature, but that doesn't change the fact that they're closer to the starting line than the end of the race. It seems to me, for reasons only the unconscious knows and each of us has to fetter out, some of us need time in the loop in order to truly run our race to the best of our ability. Or to find out which one is our race to begin with.

In either case, once a person has exited the loop, they may find themselves out of step with members of their age-group generation in terms of interests and life tasks. While you were "in the loop," those who weren't, moved on ahead, and now, in a very real sense, your generation is not the one you were born into, but one you dropped into when you stepped out of the loop. Sounds like a time warp, doesn't it? But that's how people I've talked with describe it.

It can be genuinely confusing, when you find yourself in a position like this, and for most of the past year, I've wondered if there was a corollary to Omega Thinking that might verify I was on the right track. Something more than the validation I'd received from others who liked the idea. This week, I found what I was looking for. It surfaced while chatting with someone in recovery from alcohol dependence. The nature of recovery forces a person to confront issues that have been hidden for years, blunted by their drug of choice. Doing so can be difficult, painful, and yet, have the effect of creating the feeling that one is alive for the first time. Once you dare draw the curtains wide, there's no telling what you'll see. Although our histories were different, the pattern we followed was extraordinarily similar.

Was my initial left turn a mistake? Was it like this man's first drink as a teenager that made him feel like an adult and kept him drinking for thirty years? I'm inclined to say it wasn't because of the value I've come to place on the things I've learned and the relationships I've established along the way. The unconscious leads us where we need to go, even when we think we're in charge. I certainly thought I knew what I was doing at 25. If there was a mistake involved, it stemmed from trusting an omniscience I never possessed and relying on judgment that was untested and unproven.

I'm not about to say I'm older and wiser, now. Older, yes. Wiser is still ahead, somewhere down the road, or at least I hope so. But even the "older" piece of it is relative. It helps, having a grey hair or a wrinkle here and there, when trying to convince a patient to take better care of themselves. But I'm still a student -- 25 or 50 plus, it doesn't matter -- and I must come across as one because some of my patients treat me as though I've got a lot to learn. And they're absolutely right, I do. What I've learned already, by sidestepping into the omega loop, is how to pay closer attention to what life has to teach.(Creative Commons image by Leo Reynolds via Flickr)

Talk About Being Hard-Nosed

We were chatting about various issues, don't ask don't tell, the nature of relationships, and of course, politics, and how he imagined I might feel about them.

"I kind of expected, you being a man of the cloth and all, you'd think differently," he said.

"I'm sorry, but what does being a minister have to do with it?"

"Well, you know, the Bible says certain things just aren't right and I figured you being a minister, you knew the Bible better than most, and therefore you'd be pretty hard-nosed about those things."

He'd made a reasonable assumption, I just didn't happen to share it. To explain why, I told him the following story.

Once upon a time, there was a woman who had been caught, I assume by her husband, with another man. At this particular time in history, it was common practice to drag the woman out into the street, humiliate and then stone her to death. No one asked whether she had been abused or neglected and no one offered to represent her in court. As a matter of fact, there was no court except public opinion and in that one, she was guilty as charged.

Things were looking bad for the woman when Jesus happened by. The townspeople told him what was taking place and asked his opinion. He thought about it a minute or two and said, "Anybody who's never done anything they're ashamed of can throw the first stone." One by one, the people walked away. Then he said to the woman, "Looks like nobody's left to accuse you and neither do I. From now on, though, try not to get yourself into another situation like this."

"Yeah, but I'm talking about stuff that's unnatural," he said, "men and men, women and women. You got to be either for or against that."

"I don't have to be one way or the other on anything," I said, "because the One I work for wasn't. He dispensed with passing judgment except on those who thought they had a right to judge others. That didn't sit well with him. If he was here right now, you know what I think he'd tell us? Stop worrying about what other people do, whether it's right or wrong, natural or unnatural, and start being compassionate because some day you may need it as much as anyone else. And if you don't show it, you have no right to expect it."

Talk about being hard-nosed.


(Creative Commons image entitled "Hard-nosed" by Peter Giger via Flickr)

You Have Just Been Empowered

Putting my experiences in the PASS Program into words is becoming a work in progress. At first, I expected most of my posts would be diary entries, rather like those of my great, great, great maternal granduncle who was a circuit-riding Methodist preacher in the 1850s. Imagine the delight my ministerial self felt at discovering the daily grind to be more akin to revelation than mere reporting.

Of course, that's what makes it so difficult to verbalize, which explains why anytime you ask a question of a theologian, hoping for a multiple-choice type answer, you're likely to get the equivalent of an essay. The nature of the subject matter renders a yes-no response too simplistic to be meaningful. By the way, this is also a good reason to question any minister who presumes s/he can unveil the mysteries of the universe in three easy-to-follow steps.

Which brings me back to my original problem, namely, making sense of my experience here and why it is turning into a work in progress. If they were teaching a method, you ought to be able to order the CD and workbook for only $19.95 plus shipping and handling. But that's not what this place is about. We're learning how to think and that's a different animal altogether.

One of the things I'd hoped to do in my posts was discuss how it feels, being an older student, in an environment like this. Age, however, isn't a factor at all. While, as usual, I'm probably the oldest student here, as far as my driver's license is concerned, there are several others who've been around the block as well. Most are in their 20s and 30s, but our intention isn't to determine who's qualified to be a doctor by virtue of their age, gender, or social standing, but to gain whatever is necessary to pass board exams.

That said, we're all in a position of having to unlearn one way of dealing with the material and learning what I feel safe calling an entirely new one. In the process of delving into such organ systems as cardiology and neurology, students typically attempt to commit massive lists of diseases, signs, and symptoms to memory. The "time-honored tradition" of downloading information only to reproduce it for an exam -- called binge and purge learning -- becomes your default position until you've found a framework that fosters integration and the discernment of patterns.

For someone who has made his way through history and theology looking for connections, being shown how and then urged to apply that same inclination to medicine, is a radical departure from anything I might have expected. It's value, I think, lies not only in the way it promotes learning, but in the ways it builds upon strengths one already possesses. In other words, it's empowering, and that is something we all need no matter who, or how "young," (smile) we are.

(Public Domain image of Patterns in Ice via Wikipedia)

Bat Bleep Crazy

I used to think it was a liability associated with being a minister, but now I know it's simply a fact of life. People assume you're interested in morality and ethics because anyone who pursues a professional relationship with God is likely to be the kind of person who prefers to stay within the lines while coloring. You know what my problem was? I could never quite do that. My crayon books would have made Jackson Pollock proud (see photo). I wasn't being stubborn as a kid, or independent, or recalcitrant, I just couldn't keep my crayons between the lines to save my life.

I should have known this was a portent of things to come, but as a second grader, my vision of the future had a somewhat narrower focus, i.e. how many more weeks is it until Christmas? I'm still that way, as you may have guessed from the litter of holiday essays I manage to produce between Halloween and December 25. I mean, here we are, it's not even the end of June and I'm talking about it already. But this post isn't about Christmas. It is, however, about morality, ethics, and a disinclination to stay within the lines.

The reason I say this is partly due to the fact I have trouble seeing them. The lines aren't as distinct as they were in my coloring books depicting black ink on white newsprint outlines of Mickey Mouse and Donald Duck. It's not a matter of eyesight because mine has improved substantially over time to my doctor's amazement. It's really a matter of experience, and discovering that human nature needs grace most of all. Legislated morality is an open invitation to go bat bleep crazy.

A good friend of mine, now in his first week of residency, passed along a wonderful comment he overheard the other day: "Make sure you know the rules inside and out so you can discern when and how to break them." Some folks are very good at telling others what they should or shouldn't do and justifying it on the basis of any number of social considerations. What I've found, over the course of more years than I'd like to admit of doing pastoral counseling and psychotherapy, is that most people genuinely struggle over poor decisions or relationships gone sour.

It isn't that they want to screw up, but things happen that no one can anticipate. Life is far more complicated than a "do this and not that" orientation can manage. The gray areas are as common as frost heaves on a Maine country road after a hard winter, and believe me, frost heaves are really common. One can't always know with absolute or any other kind of certainty what is the best thing to do.

I'm bringing all of this up this morning because I'm thinking about all my friends who have begun residency this week. Technically speaking, they're involved in orientation meetings and the real work of doctoring starts next week. But eventually, they are going to be confronted with decisions that aren't crystal clear and situations they've never encountered before. They'll have the support of attending physicians, senior residents, and hospital staff, thankfully, but they'll still have to wrestle with the necessity of integrating training with conscience.

As they do, as we all do, I hope they find the grace of self-forgiveness in the process. No one is omniscient, everyone makes mistakes, rigidity breaks rather than strengthens the flailing heart. Granting oneself permission to ask for help, to be less than perfect, to be less than God-like, is the blessing of being human. We do far better seeking grace with every step we take, as my friend John Denver would say, and it's how we make ourselves better at the same time.


(Image of unknown license by Wallyg via Flickr; Rocky Mountain High, words and music by John Denver, copyright 1975)

Persons of the Cloth: Evening the Score

One of my favorite comments is, "Well, Beggar, you're not like any minister I've ever met before." It's important to emphasize the second contraction in that statement, not only out of respect for today being National Grammar Day, but because that's how they say it. A little incredulous, they mimic Mr. Spock arching an eyebrow, and look at me a little sidelong, as though they're not sure whether I'm lying about my credentials.

My first inclination is to ask what kind of ministers they have met previously since you'd like to know the competition. Usually, it's either been one who was dismissive of evolution, inclined toward fundamentalism, or didn't drink, smoke, chew, or go with girls who do (spoken in jest out West) and criticized anyone who did. From that company, I'm delighted to be distinguished. Not that there's anything wrong with holding those views -- it's a free country -- but they aren't mine and if I'm going to be blamed for something, I'd like it to be true of me and not someone else.

Somewhere along the line, the idea came about (propagated mostly by ministers themselves, I'm guessing) that being a Person of the Cloth meant one shouldn't be human. The irony of it is, the model, at least in my tradition, was so incredibly human it was possible to accuse him of drinking, partying, and hanging with prostitutes and tax collectors (the ultimate low-life in those days). So, why didn't he change his ways? Basically, it was because those people were the ones most aware of their imperfections.

If one becomes a minister because they're "holy" and therefore, predisposed to a life of self-denial, I'm in deep trouble. For me, it resulted from a sense of calling, not at all dissimilar to the one we talk about in medical school. It's the kind of thing you feel like you're supposed to do even though you can't really explain why. You may have to make sacrifices to do it well, but the fulfillment you gain makes it worthwhile. It can evolve, as well, as it has in my case, leading me to medical school (see 1/16/10).

As time has gone along, I've become more aware that being a minister means being a ministering person in the larger context of life rather than being employed in a church, but it still doesn't negate my humanity. The ministry isn't about me and it's sure not about trying to make people into my image. It's about being available to people and willing to help, if and where you can. I'm bringing this up today because it occurred to me, of all the times I've mentioned it, I've never explained why I became a minister and that just didn't seem fair. I guess you could say I'm trying to even the score -- hope I done good (chuckle).

What I'd Like to Have Back

I missed 2012 (2009) at the theater -- first one thing, then another came up and before I knew it, the film had gone to DVD. I saw it last night for the first time and while it was enjoyable, I was also glad I saved my brass for another day. The human story was a little weak and it reminded me too much of Independence Day (1996). It was kind of like, how many ways can director Roland Emmerich find to destroy the planet?

Aside from that, I woke up this morning thinking about the premise for the film and wondered what I would take if I had the opportunity to board one of the arks with basically what could fit into my backpack. What would I be unwilling to part with? Now, for the sake of argument, we're not including people or animals because that's an entirely different issue. I'm also assuming a day or two preparation time.

The first thing that came to mind was my laptop and back-up drive because they contain everything I've written as well as the accumulation of my medical education up to now. The next thing was photographs. I have several albums filled with photos of my family going back three generations, mostly inherited from my mother and aunt. Too many to take, I'd have to triage them, loading some into my computer and selecting others to keep as print copies. Why photos? Because if I was fortunate enough to have children in the New World, I'd want to be able to show them where they came from.

At this point, things start getting sticky. I've only got so much room and it's a matter of choosing between items of personal value and those that would render me more useful aboard ship as well as when we struck land. You have to consider that we're building a world from scratch and the question becomes, how can I maximize my contribution? From a medical standpoint, I'd want the contents of my doctor's bag, and as a minister, my minister's manual and Bible. We're going to need doctors and you can bet there will be a great deal of counseling and therapy to be done.

An electronic reader, storing the books I've come to love would save a lot of space, but it will be years before we publish real ones. I'd want a copy of my own, of course, but also a Greek New Testament my father covered in fine leather. Couldn't I have one fo those on my reader? Yes, but I'd like my children to see and handle the kind of work their grandfather performed.

So much would have to be left behind, but forcing oneself to think in terms of what is most essential puts it all in perspective. What seems to matter the most are those items that represent more than just themselves. A teddy bear from my childhood, a box containing ashes of beloved pets, my mother's engagement ring. I doubt there's room for a guitar, but I'd try to take one aboard anyway.

In the end, I have an idea there would be far less in my backpack than I initially imagined, partly due to the blessings of electronic storage. Much of what I've gathered or retained over the years isn't all that essential. Sure, they are things that meant something at one time and still do, but most I wouldn't miss in twenty years. In a situation like this, one has to think about what they'd like to have back, if there was a chance to obtain it. For me, that means the stuff of my past I would like to preserve in order to offer it to the future. Put in those terms, choices gain in importance, but perhaps become simpler as well.

Omega Thinking

In response to yesterday's post, one reader wrote she was glad I had decided the ministry would always be a part of my identity. I responded by saying, it's taken a while to grow into those shoes, and I'd like to expand on that idea this morning.

Unlike some who've made mid-life course corrections, for me, attending medical school hasn't been a matter of disconnecting from one career path to assume another. Lately, I've been thinking about it using the image of the Greek capital letter omega that you see on the right of the Chi-Rho symbol in the photo. The left leg represents my younger self taking a relatively direct route toward adulthood. At some point, I don't know where or when, I didn't necessarily get off track, but certainly took a left turn.

"Left," according to depth psychology, much like "downstairs" in dream imagery, represents a movement toward the unconscious. If you're left-handed, the right one would work similarly for you. By shifting attention away from dominance, i.e. reliance on our conscious strengths, we become more familiar with what is hidden or unexplored. This is not to say I saw the intersection approaching and switched on the turn signal. I didn't even know I'd changed direction at the time; it's something I've learned in retrospect.

For the past few years I've been moving around the loop, assuming I knew where I was going. It's safe to say I was completely unaware that, when I arrived, I'd be so close to where I started, but that's how omega thinking operates. It brings you back around to face yourself, albeit a somewhat older self, as represented by the space between the left and right legs of the omega.

Cosmologists theorize as we approach the speed of light, time slows down and finally begins to reverse itself. Coming to the end of the loop and setting off on the right leg seems like that in a sense. Some of the issues I face now are very much the same as my classmates. I think about residency, getting established as a professional, repaying student loans, and so forth. My perspective is somewhat different because I've been "around the loop," but that doesn't alter the fact. I don't mind; it actually feels appropriate. Turning right suggests a more conscious approach to life that encompasses and embraces what's gone before.

Integration is the term we use to describe the process of bringing conscious and unconscious together forming a functional whole. How peaceful and satisfied we are about who we are depends a lot on how well we do integration. This is not usually something we pay attention to at earlier life stages (though it can help a great deal if we do) but as we mature, it gains in importance.

I used to describe medicine and the ministry as wearing two hats instead of one. Now, I think of them as the same hat. The reason lies not in the nature of the hat but the person wearing it. If I was doing pastoral counseling I'd be a lot more clinical in my approach as a consequence of working in psychiatry. In medical settings, I tend to be more aware of issues related to meaning and purpose as a result of being a minister. One informs the other and I'm comfortable with that.

It comes down to being as opposed to doing. Both/and rather than either/or permits me to be myself. Instead of draining energy trying to maintain an artificial distinction between the two halves of my "coin," I can use that energy to be more attentive to patients, viewing them as persons in the process of becoming, even as I am. Even as we all are. It will make me a better doctor and it definitely makes me a happier person. And that's not a bad place to find yourself, no matter where you've come from.

Not From A Distance

I've never personally experienced anything that I can compare this to; I have no context for it. The scenes I've seen on television from Haiti. I'm not even sure I can put it into words. When asked how he determined where to begin each day's reporting, Anderson Cooper of CNN said, the story was all around him, he could begin anywhere. And yet, this is only one piece in a puzzle of suffering that is global.

At the same instant recovery teams are trying to dig survivors out of the devastation, a soldier from Maine is on duty in Afghanistan. In the company of her unit, she left husband and children, and shoulders a weapon in a place where winter would make the hardiest of Mainers shiver. She cannot help a Haitian child trapped in the rubble, nor can she help her own with their homework. She's busy, on the other side of the world.

Beggar, you're a minister, or you used to be, what do you make of all this? Well, although I don't fill the role actively in a church, I still am one and it will always be a part of what I do. For me, theology is incarnational and has been, ever since that night in Bethlehem. In a very real sense, this means I'm not looking for God high up and far away in some ethereal spirituality that has little or nothing to do with where I live. If I'm going to find him anywhere, it's right here.

I'm not even going to begin to try to explain what happened in Haiti because I have no idea. And, as I've said in other posts, even if I did know why, it wouldn't change anything. So, if someone wished to know where I see the presence of God in something like this, my response is, look at the people. I see it in the eyes of a correspondent who hasn't slept in two days. If any meaning is to come out of this, it will have to involve the stories of individuals and their community being told, and it's his job to try telling them. I see it in a doctor who has to decide which patients he can help, who has no morphine to ease the dying of those he can't. I see it in the faces of Haitians parading through the street at midnight, singing and chanting encouragement to anyone within earshot.

Not watching from a distance, but imminent, engaged, present in every sense of the word. That's where I see it. It's the only place I can.

)

It's Not About Explanations

For the portion of my career when I was a graduate student, I spent a lot of time writing about what other people thought. I guess that's to be expected, since graduate school is supposed to develop expertise in a particular subject and what better way to do that than become familiar with what other experts have said. In what often seemed like an ocean of term papers, I learned to amass references and synthesize arguments.
In retrospect, it was like being a minor character in Ayn Rand's novel, The Fountainhead. Without going into detail, Rand's hero, Howard Roark, is an architect who wished to design and build following his own ideas. The prevailing opinion, however, insists Greek and Roman architecture represents the pinnacle of architectural achievement and the best we can do is learn and imitate their principles.

My Howard Roark was a professor I met at Southern Methodist University who said of my first seminar paper, "This is fine, now what's your argument?" I was at a loss because, frankly, not only did I not have one, I had no idea how to begin making one. I was good at cataloging but as far as having an original idea and using the reading material to support it, in the immortal words of my father, I was up the creek without a paddle.

It took several years, in fact, for Dr. Roark's wisdom to sink in. It's very easy to feel inadequate and fall back to the safe position of being "just a student." But throwing ideas onto the table is how we transition from being a gatherer of information to a participant in the argumentative process.

And that brings us back to my topic of the past two days. When it comes to explaining and resolving the presence of evil in the world, I don't have a definitive solution. Or let's put it this way, I don't have one that covers every point in a logically consistent manner. But neither does anyone else, as far as I can see, so I'm in good company.

What I've learned in some thirty years of pastoral ministry, psychotherapy, and dealing with people in daily life is, most of the time such solutions don't really matter. When an avalanche sweeps a husband against the side of a mountain, burying him in literally tons of snow and ice (see post of 11/12/09), no one cares how you solve the problem of evil. They ask why does this happen, how could God let it happen, what have we done to deserve this. Even if you or I were God-like enough to know, that's not what they want to hear.

What they want -- what we all want -- is for suffering to be meaningful. Where meaning is not readily apparent, we have to find it for ourselves by wrestling with suffering and draining every ounce of significance from the experience. Whether individually or collectively, it's really not about explanations, especially in those situations where there are none to be found. Instead, we want to feel our suffering is worthwhile and something good will come of it. There's nothing theoretical about that.


Rodrigo Paoletti via Flickr)

No Moralizing Here

Since no one has asked me why, being a minister, I didn't write about issues like morality and family values, I thought I'd ask myself, why don't you? My answer surprised me: I do write about them, and fairly often. Just not in the way people might think. For one thing, I don't like to moralize.

When I graduated from seminary I suffered from a vision problem: I tended to see things in blacks and whites. The truth is, I had a head full of mush, as Professor Kingsfield from The Paper Chase was fond of saying, and had no more idea how to relate to the real life concerns of people than my dog has about driving a car. Seeing him sitting in the driver's seat when I come out of a store, I have to wonder what he's not telling me. Let's put it this way, I didn't know much.

As time has gone on, I've learned people are frequently harder on themselves and each other than I could ever be. Judgment and self-recrimination come at a price and you can measure it by the amount of ibuprofen and antacid they consume. It's like dragging a huge invisible bag around and stuffing it full of blame, guilt, fault-finding, and God-knows-what-all. It weighs you down until sooner or later you're sick, depressed, angry, or lashing out and picking a fight with some poor schmuck on the highway.

It really doesn't do anyone any good to moralize at times like these: most of us have already done enough of it for ourselves. We may not be fully aware we're dragging a bag behind us, but we know something's not working. We may not understand how it affects us, but we know we're sick at heart. We may not realize how badly we'd like to turn loose of the damn thing, but we know we have to do something.

There may be some who feel it's their duty to shout at a person who's drowning, "You should have learned to swim!" but my inclination is throw them a life preserver and if they can't grab it, dive in and help. It's not that I'm morally pure or anything of the sort. It's just that I know what it's like to be in over your head because, like most people, I've been there. Moralizing when I was a young "preacher boy," as we were called, was easier before I'd learned what it means to hurt.

So, family values? Sure. I've written about my father, a young boy and his mother, the delights of sunrise on my hayfield (photo), the warmth of new love, and the comfort found in the company of close friends. Those are what make for redemption, healing, and renewal. Since we're already good at filling the bag, I'd rather spend my time trying to figure out ways of making it bearable or better yet, letting it go.

(The Paper Chase by John J. Osborne, Jr.; photo by the author)

The Clock is Ticking

How many people do you know who, when choosing spouses, took a long, hard look at their parenting potential? I'm serious. Do you know anyone who did that? I'm pretty sure I don't. I'm not sure I ever have, as a matter of fact. I know plenty who've said (after the divorce), "S/he would have made a lousy parent." Why didn't they think about that before they said "I do"?

Maybe it's because we're in love and figure we'll work out kids later. Maybe we don't know what to look for -- we had poor role models and all we know is, we don't want to repeat our parents' mistakes. Maybe we're so enamored with what s/he is like with us we can't see through the forest to the trees. Maybe we're just too darned young.

Sorry, I don't mean to drag out age once again. No, wait a minute, yes I do. Not that age means "wiser" because I know more than a few who not only missed the train, they were never on the right platform to begin with. I'm referring to experience and that's neither a part of the gene pool nor does it come attached to any diploma I've ever seen.

Spouse-picking is less about native talent than hard work. And too many of us have relied on the former when we would have been better served by the latter. "I want a girl just like the girl that married dear old dad," might sound good but is it really? We tell ourselves because we turned out okay, someone like our parents will be just fine for our children. A little reflection on what mom or dad was really like can puncture that balloon. This is not to say we experienced bad parenting, it's just there are times we might wish we had different parenting.

I know, the biological clock is ticking -- for all of us. Because of that, it's even more important to figure out what we're doing sooner rather than later. Subtleties are important and I've learned to look for them. It's taken longer than I would have liked, but anything worth doing, as they say, takes time.

Looking for Harrison Ford

 
It seemed like a harmless question. "Have you noticed so and so?" Almost anytime a group of men or women get together, it's bound to come up in one form or another. Well, this time, a young guy I knew was asking it of me.

"Are you kidding?" I answered, "She's smart, attractive, great personality -- if I were single, I'd have wasted no time asking her out."

"Aren't you a little old for her?" he responded, wide-eyed and breathless.

"Things visible to the eyes, are immaterial where the heart is concerned," I replied, adopting a professorial tone for emphasis.

"Yeah, but you're going to die sooner than me, right?" He then added, suddenly aware of what he'd just said, "Statistically-speaking, that is."

I looked at him, wondering what madness had possessed me to call us "friends" in the first place, and said, "Not necessarily. Young men die as surely as older ones, sometimes much sooner. As the ancient Greeks used to say, no one knows the length of the thread of his own life. Which would you prefer, to marry someone because you thought they had a statistically greater chance of long life or someone you truly loved?"

"You like asking the hard questions, don't you? I suppose I'd want to marry someone I loved, but if I thought they might die soon, I'd probably choose differently."

This is a hard question? Seems obvious to me, I thought. "You still don't get it, do you? No one knows how long they have, not even you. The issue isn't the quantity of years anyway, but their quality. I've seen how she relates to guys, what attracts her and what doesn't. She likes maturity and character. She's not interested in Brad Pitt, she's looking for Harrison Ford."

I could tell he was still unconvinced, but our conversation had ended and he walked away. Some things, I thought, just take time. Love isn't always predictable and what appeals to one may not another. We make choices that reflect who we are as persons, that honor our sense of what is truly important. For some, age is far less critical than character -- something my young friend will hopefully learn.

After a few years.

(Creative Commons image of Harrison Ford by J. Michael Miley via Flickr)

Stepping Into the Fog

When I was a graduate student at Southern Methodist University I had the opportunity to study under Schubert M. Ogden. Although not exactly a household name, Ogden nevertheless was a brilliant and creative thinker who has since taken a very active retirement. In any case, I bring him up this morning because there's fog in the hayfield. When I woke up, it was only a tiny sliver along the treeline but in the past hour it's grown to the point that I almost feel like I'm living in a cloud bank.

Now what has fog got to do with Ogden? Well, it's like this. He once said that every human being lives on the premise of a basic faith that life is worth living. This is not religious faith as such, but simply the confidence that getting up in the morning is a worthwhile endeavor. He went on to suggest that this is, indeed, a faith decision because there really is no scientific or empirical evidence that living is preferable to the alternative.

This is very interesting. The newest buzzword in medicine is "evidence-based" and it refers to the idea that decisions should be based on the results of careful testing and the analysis of data. How could anyone determine that life was worth living based on empirical testing? Could we design a placebo-controlled double-blind clinical trial, such as is used in drug testing, to validate the premise? Forgive me if I sound ridiculous, but what would constitute a placebo? In drug testing, benign substances like a sugar pill are used as a comparison against the real medication. In a double-blind study neither the patient nor the tester knows who's gotten the medication and who's gotten the placebo. How can you fool someone into thinking life is worth living?

When it comes down to it, whether one likes the word "faith" or not, we go about our lives on the unspoken and, perhaps, unconscious notion that living is more meaningful than not. And that's one of the things that keeps us going. I can't see the hayfield for the fog bank, but that doesn't mean the hayfield is no longer there. It just means I can't trust my senses for valid evidence of its existence. If I want to walk out into the hayfield, I have to walk through the fog trusting my feet will find the ground.

Some would say I've simply made an assumption based on previous experience and faith has nothing to do with it. In point of fact, faith has everything to do with it. Faith has gotten a bad rap over the years and some would suggest it is both irrational and the activity of the uninformed. It is neither. Faith gathers and evaluates information and then acts on the basis of what is most persuasive. That is a rational process. We may not think about whether getting up in the morning is a good idea or not, but the fact that we do it means that at some point we decided it was better than the alternative. And that is a rational process, too.

Stepping out into the foggy hayfields of life may not always seem logical but that doesn't mean it's irrational. It just means a person has evaluated the information using criteria that is personally significant and decided on that basis. We may not always understand what drives a person and what motivates one might not motivate another. But however we live, sometime, somewhere, and in some way, we've decided that living is a pretty good idea. And that alone, is an act of faith.

(Creative Commons image by David Yu via Flickr)

The Little Things

Thanksgiving is here again and no doubt from one end of the country to the other, in all four directions, someone will say something about being "thankful" tomorrow. I'm thinking about a comment made to me a number of years ago by a minister I knew who said, "We ought to cultivate an attitude of gratitude." Ministers are known for a fondness for alliteration; they say it helps folks remember the main points of the sermon. That I recall this little tidbit after more years than I'm willing to admit is testimony to the effect of alliteration on my memory at least.

The whole idea of gratitude implies that I'm not the only, or even the ultimate, source of those things I appreciate in my life. Something or someone has entered my sphere of experience and bestowed upon me that which I did not have before. Furthermore, they've done this out of no desire or need to obtain something from me in return. There's been no transaction or exchange of goods for service or remuneration. It might not even be demonstrable that they are directly responsible for that which I enjoy.

I'm talking, of course, about grace. But not the grace of the magnanimous or spiritual. I mean the grace of presence: the grace that surrounds and penetrates us like the air we breathe, and is most frequently outside conscious awareness. You have to think about grace in order to notice it. Most of us are too busy to notice anything ordinary. We're busy looking for things that are extraordinary. Grace is everyday, plain, simple, interactive. Grace is waiting for us to see it and be grateful.