"The intangible is often more real than the tangible to a person who is mentally ill."
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Ministry of presence also involves acknowledging the “human” needs of a patient for companionship, beauty, and knowledge. A patient once exclaimed, “Finally! Someone to talk to. I haven’t spoken to a single person in six hours.” This patient, a twenty year old woman, had been lying alone on a cot in the emergency room from morning until early evening until I stopped by. Despite the bustle of hospital environments, a patient’s world is often eerily silent and uneventful. The social encounters that people normally experience in the course of a day are severely reduced in a patient’s experience. If people establish who they are largely through their relationships with others, then isolation from human contact in a hospital setting cannot be helpful for people suffering from mental illness. For this reason, programs to increase contact, such as hospital chaplaincy, may contribute to recovery.
Of course, psychiatrists are the primary professionals responsible for treating mentally ill patients. Interestingly, when I have had the opportunity to observe firsthand how psychiatrists operate, I have found that there is a surprising degree of overlap between the kinds of questions that a psychiatrist asks and those asked by a chaplain. The difference, however, is that a chaplain’s holistic approach uses emotional and psychological data to subsequently address issues of spirituality.
It is often the case that those who have acute forms of mental illness such as schizophrenia find it difficult, if not impossible, to communicate at the rational level. They may find it easier to communicate at a “supernatural” level to express what they are feeling. Language which speaks to, and speaks of, the intangible is often clearer and more real than the tangible to a person who is mentally ill. Such patients create mechanisms to displace or translate their experience in a way that makes the pain manageable. Often this takes the shape of having multiple personalities. Prayer and spiritual language may sometimes be the only way to meet these patients in their dis-integrated states. Some psychiatrists have begun to incorporate prayer into their practice, and they have reported that the integration of personal faith into their professional work has in fact enhanced the efficacy of their therapy.
I remember praying with a schizophrenic patient who was so fragmented that she could not recognize that I was praying for her. When I uttered her name in the prayer, she repeated it, as if speaking of a third person in the room. In the middle of the prayer, this person, who sported a shaved head and was barefoot, leapt off her chair and began to rummage in her dresser. When I finished the prayer and opened my eyes, I saw the tiny bald woman, kneeling down before me, holding a shiny gift in a gesture of offering. The image of this woman reminds me that chaplaincy is not only concerned with eliciting the personhood that is latent in a sick patient, but also with receiving and recognizing the gift of personhood that each human being offers, beneath all the anger, the weakness, and the pain. I still find it a unique challenge to minister to those who are mentally ill, and I feel that these patients in fact offer chaplains the greatest opportunity to do our work: the work of recovering personhood.
Carolyn Chau, a 2003 graduate of Yale Divinity School, is a chaplaincy resident at the University Health Network (UHN) in Toronto, Canada. She is responsible for meeting the spiritual needs of patients on the Cardiology unit, as well as on the Ear, Nose, and Throat Oncology and Head and Neck Plastics units.