Vol. 2 No. 2 Specials

In September 2004, the Canadian Catholic Bioethics Association sponsored a conference examining the relationship between spirituality and mental health. As a new practitioner in the field of hospital chaplaincy, I found that my experiences with patients suffering from mental illness raised fears and questions that I wanted to explore. The conference was a rich opportunity to listen to clinicians, nurses, social workers, chaplains, and people who had suffered from mental illness. The comment that I found most memorable was that of a young woman who spoke first as a therapist, and then as a former patient who had struggled with multiple personality disorder after the birth of her first child. She recounted how a Christian community supported her through this difficult period and, years after her initial recovery, how she came to the amazing discovery that, “Among my 21 different personalities Jesus remembered the blueprint of who I am.” As this case suggests, both chaplaincy and mental illness raise the question of personhood and identity.

I work as a chaplaincy resident in an acute-care hospital setting. Formerly, I was a hospice chaplain in a geriatric healthcare center. Throughout this work, I have noticed a pattern among the patients who are referred to me. Typically, they are the ones who are described as “depressed,” “angry,” “anxious,” “afraid,” and “having difficulty coping.” Only a few of these emotional states can, in their extreme forms, be considered psychological disorders; nonetheless, there seems to be a common perception among medical professionals that chaplains should assist patients who exhibit what might be termed “psychologically-charged” emotional states.

One of the reasons that chaplains are employed in a health care setting is that chaplaincy shares the holistic ethos of contemporary health care providers. It is widely accepted today that a successful life entails physical, mental, emotional, and spiritual health, with chaplaincy enjoying a traditional relationship to spiritual health. For me, the more interesting question is whether and how chaplaincy can address mental health needs effectively.

My experience as a chaplain in a major urban hospital has shown me that hospitalization affects the mental health of every patient who is admitted. A pastoral counselor and psychotherapist once noted that, “Every sick person is depressed.” While hospitalization may have a positive effect on a person’s mental health if it is viewed as a constructive, life-extending step in treating a physical problem, more often than not, even this interpretation of being hospitalized yields to a deeper, more painful experience of the self as undermined. From the words that I have heard people use to describe their experiences, hospitalization often seems to be an assault on mental health. Patients lose a tremendous amount of freedom as soon as they are brought into a hospital. Individuals may be transported from one site to another without any opportunity to communicate with staff about where they are going, or why, or to convey their own wishes. One patient whispered to me that he felt as though he was “imprisoned…. Once I got in that ambulance, I lost my freedom.” Another patient in his thirties who was dying spoke with fear at the thought that he might die in the hospital: “I want my friends to remember me as I was, not like this. This is not me. This is not who I was.” Patients name their experiences as “terrifying,” “unexpected,” and “unbelievable.”