What is a Chaplain, Anyway?

I'm standing outside the trauma bay as I hear that the patient has arrived and is being wheeled in. I see him come around the corner with EMS. The man is lying there, lifeless, with his large stomach showing for all the people in the Emergency Department to see. EMS is doing chest compressions - he has no heartbeat, and they are trying to regain it. I'm new and just started my clinical training... I stand there and watch as EMS tells the story of what happened to this man. It didn't make sense. He was cooking after having an outpatient procedure earlier in the day, and he collapsed. Not long after this, he was pronounced as deceased.

I remember wondering about this man. Who is he? Did he deserve this? What was happening with his soul or spirit through all of this? Then, he was dead - to which the only question on my mind was, "What the fuck am I doing here?"

Now, this was during my clinical training and I know why I would be in a situation like this in my current role. But perhaps you can relate. A chaplain enters the room when you are at the hospital, or you see one in the military, or something else. Perhaps you thought, "What the fuck is a chaplain and/or what are they doing here?" My hope is that this article will be of some use to you in that regard. Chaplaincy is changing as our culture changes, and it is helpful to know what the fuck they are doing here.

Some Context

One of those weird things about the United States is the number of chaplains we have. If you go to another country, it will likely be difficult to find a chaplain. Yet, here, they are in our hospitals, government, police departments, IndyCar, the NFL, and much more. Maybe it will come as a surprise to read that the Chaplain Corps of the US Army is the second oldest corps, with infantry being the oldest, of course. The Chaplain Corps is older than the US itself, and it sure has a long and complicated history.

I don't claim to be a historical expert on chaplaincy, but what I can tell you is that it started out as a largely religious role. Chaplains have long held the tradition of holding worship services near the battlefield, running chapels in hospitals and the military, and the like. So, many chaplains were clergypersons early on. However, the role has shifted over the past 250 years of chaplain history in the US. Chaplains are still credentialed in ministry, yet the role is different. In my opinion, the role is better equipped to address the needs and wants of an American society that is becoming less religious.

Simply put, the role of the chaplain of today is spiritual care. This is complicated across settings due to differences in function and lack of standardization. For example, hospitals often refer to chaplains as providing "spiritual care" whereas the military may call it "religious support." Other settings have other definitions and if you try to read all of the nuances you will likely end up falling asleep. This is further complicated by the differences in required training and education across settings - that topic is one that will cause a lot of hurt feelings in a debate.

So, let's go with the premise that chaplains do spiritual care. What does that even mean... Perhaps you are thinking we have a crystal ball or something. Maybe some chaplains do, but I don't and I that is probably for the best. Spiritual care likely looks ordinary from the outside. It may look like a conversation, ritual, a counseling session, crisis intervention, or many other things. Perhaps it is understood better after defining what spirituality is.

Spirituality

Currently, one of the most widely used definitions of spirituality was developed by physician Christina Puchalski, MD and other researchers in a recent project. They write, “Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions and practices.” (International Conference on Improving the Spiritual Dimension of Whole Person Care, Puchalski et al. 2014).

Secondly, one of my favorite definitions of spirituality comes from astronomer Carl Sagan: "'Spirit' comes from the Latin word 'to breathe'. What we breathe is air, which is certainly matter, however thin. Despite usage to the contrary, there is no necessary implication in the word 'spiritual' that we are talking of anything other than matter (including the matter of which the brain is made), or anything outside the realm of science. On occasion, I will feel free to use the word. Science is not only compatible with spirituality; it is a profound source of spirituality. When we recognize our place in an immensity of light-years and in the passage of ages, when we grasp the intricacy, beauty, and subtlety of life, then that soaring feeling, that sense of elation and humility combined, is surely spiritual." (Sagan, Carl; Druyan, Ann (1997). The Demon-Haunted World: Science as a Candle in the Dark. Ballantine Books ISBN 0345409469)

"Science is not only compatible with spirituality; it is a profound source of spirituality." - Carl Sagan

Hopefully those definitions are helpful for some context. Perhaps they invoke some interesting feelings in you - excitement, frustration, curiosity, something else? There was a time of my life where I would not accept either of these definitions. This is largely due to feeling like I knew the "correct" answer as it fit within my theology. Yet, I have since changed my mind and find these definitions incredible useful and relevant in my professional practice.

Given these definitions, it is likely also helpful to note some themes of what spirituality may look like in a spiritual care encounter with a chaplain. There has been some recent work in this area, and one of the most widely recognized themes that chaplains delve into during an encounter is meaning and purpose. This can certainly lead to the thought of "what is the meaning of life" or something like that. But it can also be many, many other things. For example, as humans, our society functions off meaning. Lunch time has a purpose. Families have meaning. The sun going down has meaning, and our sleep has a purpose. Within healthcare, meaning can look like trying to identify the existential meaning of losing a limb, being diagnosed with cancer, losing a loved one, and so much more. I imagine chaplains in professional sports are faced with athletes pondering questions about why they did not make the playoffs after working so hard all season - what was the purpose of the season? Soldier, Sailors, Marines, and Airmen are faced with questions related to the meaning of war, the purpose of a conflict, the meaning of their service, and so on.

The list can really be endless when it comes to meaning and purpose. These things drive our lives. They dictate our day and our actions. We often don't think about it this way. A chaplain's role in these interactions varies. Generally, I will say that I feel it is unethical to try to "fix" a person's questioning or find the answers for them. Some chaplains may disagree, but this is the way I was taught and function within my role. Simply put, we live in a post-modern world where truth is relative - my role is to help others explore what truth may be in their life. If it is the same truth that I live by, then that's cool. If not, then that's cool too. If a chaplain tries to convert you to their point of view, religion, etc., it is a good time to walk away (unless you're into that kind of thing).

A second common care theme that chaplains work with is relationships. This can be any relationship. There was a time in my profession where I emphasized that relationships include relationship with self, others, and the divine. I still believe this but I try not to be too academic about it. I remember a time where I met with a patient who had been in a car wreck. Approaching her, I thought we would end up discussing the accident. Yet, we spent most of the time talking about her recent divorce (which led to overuse of alcohol, which led to the accident, and so on).

After these two themes, some of the themes seem more "minor" to me. They are not minor in manner, but are less frequent themes compared to relationships and meaning/purpose and relationships. These themes include transcendence, identity, peace, worth, and more.

"Doing" Spiritual Care

In general, these themes likely give you a better idea of what spiritual care is and the things that chaplains specialize in. This may lead you to questions of how spiritual care is provided aside from the content of what is discussed. This often comes down to what healthcare views as "interventions" or skillsets or something else. So, for clarity's sake, here are some things that chaplains do.

• Active Listening (probably the #1 thing)

• Life Review (hearing stories of one's life for grief support, forgiveness, etc.)

• Religious ordinances, sacraments, rites, or the like

• Advising staff on moral/ethical issues

• De-Escalation

• Prayer

• Assist in religious accommodation

• Refer to clergy to provide a specific care (last rites, Sadr meal, etc.)

This is a very basic list... You may read this list and not be terribly impressed. And I get it. So let me share a bit about the "how" behind the "what" it is that chaplains do.

Chaplains are trained in a number of different settings with different expectations. These are muddy waters... and that will be a blog post for another day. So, I will share about my own training and how it fits into the things that I do for the people I am with.

Although I have a Master's degree from seminary, much of what I learned about being a chaplain has been through my clinical training. This training is called Clinical Pastoral Education (CPE), and there are different groups that have their own CPE programs. There are certain things that chaplains are taught during CPE, which seem to be some of the foundation of clinical chaplaincy. These things include (but are definitely not limited to) being non-anxious & non-judgmental, listening (and really fucking listening), addressing the other person's needs during an encounter and not my own, and more. Basically, CPE is a program where chaplains work on their own problems in both group and individual settings. The idea is that you cannot give what you don't have, so you better work on your own shit-sandwich before you hand it to other people. After all, hurt people really do hurt people. Yeah, that's cliché, but there is nothing like analyzing your own visits (and your peers') to point out all the ways your own trauma influenced the visit. Essentially, the aim of the training is for personal transformation so that chaplains are better able to care for the needs of others.

I once visited with a patient who had been diagnosed with a chronic but not terminal disease. At first, we started talking about where he was from, where I am from, and so on. Then, the visit shifted and he began to talk about this newly diagnosed illness. The theme of the conversation quickly became related to the meaning of his life now that he is living with this disease. Truthfully, much of what I did was listen. In Western culture, we have adopted this bad practice of trying to fix other's people's problems. Someone shares a problem, we offer a solution. Perhaps I don't need to make a big point to say that sometimes you and I just need to complain and we don't want any feedback other than to be understood. Its like when a smoker is diagnosed with COPD, they are angry about it, and someone says, "you wouldn't have this if you had not smoked all your life." Yes, scenario that really happens. Do you really think they don't know that?

So, this patient is sharing with me about the direction of his life now. He shares about the song "Seasons in the Son" by Terry Jacks, who wrote the song after learning that he had terminal cancer. And as I listened, the patient came to his own conclusion, which was that he had possibly another 20-30 years of life left. This illness would be chronic, but it won't kill him. He has grandchildren now. Things are different, but he said, "I'm going to be the best grandfather that I know how to be." And that was basically that. The visit concluded shortly after this revelation. We prayed before I left (he asked), and we went on our separate ways.

What happened in this visit was active listening, which I did by using the material he provided during the visit - disease, Terry Jacks, grandchildren, etc. I did not try to fix him. In chaplaincy, some call this "creating sacred space" for a person to share some of the deepest pieces of themselves. In the end, this man may have returned home with a new sense of meaning to his life.

Another common thing that chaplains do is something I find myself wanting to avoid writing about, which is grief support during death notifications. Sometimes I feel that I am viewed as the grim reaper or death itself when going into a situation. I show up out of the blue, and the family reads my badge. They know why I am there and so do I. The reason I don't want to write about this is because it can be a stereotypical chaplain thing, and there are times when I am there to support a family member and the patient is doing just fine. But, we are there when someone is told that their loved one unexpectedly died. And during those times, I view my role as advocating for visitation, advocating for questions being answered from loved ones, providing a private space that loved ones can grieve at any volume they need, and making sure people are physically safe. This may lead to prayer and life review and the like, but the chaplain is generally there to be as hospitable as possible in giving people space to feel what they need to feel.

Chaplains are not only around when bad news is delivered. Sometimes they will go room to room in the hospital to see if there is any way they can help patients. Sometimes I call these "cold calls." I show up, I introduce myself, I ask how things are going, and go from there. These visits range from 15 seconds to 1-2 hours. The ball is in their court. So, you may have a chaplain stop by sometime just to see how things are going - you don't have to share anything with them, but they are there for you if you want it.

There are many other examples I and my colleagues could provide, but I fear that I will go on too long and create a novel with this article. Perhaps to sum it up, spiritual care is abstract. There are some themes, principles, things to "do" with others, and so on, but there is no playbook. Also, spiritual care & chaplaincy look different in different settings. Much of what I have written about is within the healthcare setting. In my opinion, spiritual care is patient-centered care - each situation, person, issue is different. The least I can do it try to help you feel understood. It is only through understanding that there is enough trust to be open to change.

Chaplain Training & Education

If you are curious, here is a list of the requirements for chaplains within most settings. However, some employers provide much less and much more than this.

• Bachelor's Degree in any subject.

  • 120 credit hours is often the standard.

• Master's Degree in the academic discipline(s) of Theology, Philosophy, or Psychology.

  • 72 credit hours if often the standard.

  • Many chaplains have a Master of Divinity from a seminary.

• Endorsement from a faith group.

  • This is the "big" credential chaplains need. It is required for military chaplains, board certified chaplains, and more.

  • Endorsement is essentially a faith group "signing off" on a chaplain and noting that the chaplain has met their requirements to be a chaplain.

  • Endorsement can come from church denominations, humanist groups, universalist groups, Jewish groups, Muslim groups, etc.

  • I often like to say it like this - nurses get their RN from the state. Chaplains get their credential from faith groups. I think this has to do with separation of church and state, but I don't want to be confidently incorrect about that one.

• 4 units of Clinical Pastoral Education

  • This often is done via an internship and residency, which is a minimum of 15 months of training in total.

• Board Certification

  • This is done with different professional groups. This is also muddy territory - just know these groups exist and have standards chaplains must meet to be certified.

  • A Board Certified Chaplain (BCC) is sort of the "gold standard" within chaplaincy.

So, I hope this gives you some insight related to what we are doing here... I imagine this leads to other questions or thoughts. Hopefully I can address them in other posts. If not, feel free to click on the "contact" tab and email me.

Thanks for reading.

TSS