Last week I gave a talk on chaplaincy at The Buddhist Soociety in London. Here is a paper which I wrote up based on the themes in the talk. This talk is copyright and may be published in future so please do not copy without permission.
Walking in Others’ Shoes: chaplaincy as accompaniment
by Caroline Brazier ([email protected])
I am here today to talk about the role of the chaplain in healthcare settings. In particular I would like to reflect on the role of the chaplain as somebody who accompanies.
Accompaniment and Aloneness
What does it mean to accompany? In Buddhism the idea of spiritual friendship is one which goes back to the time of the Buddha. In fact we can think of the Buddhist path as one which has both aspects of solitariness and of walking alongside one’s fellow travellers. The Buddha himself began his journey alone, and the ability to be alone was something which he valued. Aloneness was both an aspect of his behaviour - in going out from the palace, the village, the home life and the world - and a mental state; leaving behind the psychological ‘others’ who tend to crowd our minds with attachments and limitations.
At the same time, companionship was important both in the Buddha’s original search, as we see in his relationship with the four ascetics before his enlightenment, and in his development of the four-fold sangha in his later ministry. The qualities of the spiritual friend were something which he addressed in his teachings, (and something which we draw on in the chaplaincy training). Friendship is, as he famously said to Ananda, central to the spiritual life. Sangha became one of the three pillars of the Buddhist life.
The paradox between accompaniment and being alone is deeply relevant to the life of the hospital chaplain. We can and do walk together with those whom we support, whether patients or staff, and yet, in a way, it is our separateness which allows us to offer the special kind of relationship which comes from our role.
On the one hand, the role involves being with the patient at different stages of their journey through the facility. Both at times of stress and transition, and in the long periods of waiting when nothing much is happening and the patient endures boredom and discomfort with little prospect of returning to ordinary life, the chaplain can be a supportive presence at the bedside, able to accompany the patient in a way that other staff may not. The chaplain comes into the world of the patient as an ally, unencumbered by the need to fulfil medical functions or family agendas, and has time and emotional clarity to be able to be with the person at this time of need.
On the other hand, the role of the chaplain is defined by its separateness. Sometimes described as occupying liminal space, separated from and bridging the other spheres of hospital life, the chaplain moves between the other professionals and the patients, not tied to their protocols or agendas and able to hear all points of view without having to assert her own position. This latter position has something of the quality of ekegata or singularity. It is the practice of nonattachment embodied.
In Others Shoes
When we talk about putting ourselves into the shoes of others, we are describing in relationship of empathy. Empathy was described by Carl Rogers as an ‘as if’ quality. In other words, when we have empathy for another, it is as if we walk alongside them and learn to see the world through their eyes.
When we practice empathy, we step out of our habitual ways of seeing things. We try to find a special kind of accompaniment in which we not only walk alongside them, but also attune to their emotional and psychological state. We understand why certain things are significant and why others are not.
Empathy allows us to establish psychological contact, a basic condition for growth and change. It allows us to accompany at many levels, and to hear how it is for the other, letting go our own preconceptions about the situation. We step out of our habitual constellation of reactions and feel our way into theirs. This is the essence not only of good practice, but also of spiritual practice.
Empathic connection is a gift and an opportunity for spiritual and psychological growth. Through empathy we discover worlds which ordinary life does not present to us, extending our range of experience and broadening our knowledge. At the same time in order to create an empathic connection we have to draw on our personal stories and reactions, finding enough common ground to be able to imaginatively feel the experiences of the other. Some of these experiences may be uncomfortable – things which we would rather not be reminded of. Others are things which we have known only in imagination, but which yet fill us with fear.
So, on the one hand we are drawn out of habitual responses and surprised by new perspectives, whilst on the other being thrown up against habits of mind which we may have been trying to avoid.
Searching for the Mustard Seed
Working in hospitals, we are frequently faced with experiences which are difficult and unpleasant. We may never have faced serious illness ourselves, but through accompanying others in our work as chaplains, we come up against the reality of losing faculties and experiencing pain and the prospect of death. These encounters remind us of our own mortality. Each time we are with the patient who is in this position, we are faced with universal suffering which is intrinsic in the human situation.
None of us have lived without encountering death. Just as Kisagotami discovered, there is no house able to offer the mustard seed of life untainted by mortality. In this work our own experiences of sickness, death and loss are brought to mind. We cannot avoid the truth.
Often when I sit by the bed of an elderly patient in the hospital, looking at his wasted body, I find myself thinking of my parents and grandparents. Last year my father was in hospital himself, and as I meet the old men on the ward, I think of him, weak and frail. The memory of how his lifetime of work for others was reduced to a sick old man in his pyjamas lying, gazing out of the window and wondering if he would ever go home, reminds me that although these patients are sometimes barely able to communicate, each has a lifetime of experience and has or had a circle of friends and relatives.
Often too, I find myself noticing the date of birth on a patient’s record and realising that we are of the same age. It can come as a shock to realise that the hollow face of the person in front of me could be my own. Looking in this mirror is a reminder of the transience of life and the chance by which each of us remains healthy.
Recognising that sickness and death are not phenomena separate from ourselves is part of the Buddhist concern. Dukkha is omnipresent and opening to that reality is the spiritual task.
Fear and Dread
Before his enlightenment, the Buddha faced his demons. Walking, sitting and sleeping in the dark spaces of forest he sought out the experiences which terrified him and stood firm until his fear departed. We can read about this experience in the Sutta on Fear and Dread in the Majjhima Nikaya (MN4). It immediately preceded his spiritual breakthrough. Entering the dark places was a route to enlightenment.
Some hospital situations are dark spaces. For the most part chaplaincy is about quiet conversations on ordinary wards with people were waiting for or recovering from mundane operations, but sometimes we find ourselves brought into the centre of a tragedy. A young woman whose suicide attempt has left her brain-damaged; a man whose minor operation went wrong, leaving him with multiple health problems; an elderly gentleman who is feet are blackened with gangrene, who dreads the operation to remove them; an woman, confused and incontinent, her swollen belly holding a tumour which is beyond operation. As we enter into these relationships we cannot go untouched. Feelings of fear or disgust inevitably arise from time to time, and yet our role demands that we stay. Indeed, not only that we stay, but also that we remain grounded and mindful as a support for those who we are accompanying.
The role of the chaplain is therefore an opportunity not only to help others, but to deepen our own practice. We are expected to transcend the urge to run away physically, spiritually and psychologically. It holds us in the forest. Faced with the reality of human situations, we are surrounded by the reality of affliction, the first Noble Truth.
Different Responses to Suffering
In the hospital situation, we meet ordinary people who are trying to cope with extraordinary events. Illness can strike suddenly or slowly. In either case, adjusting to the reality of a changed life isn’t easy. People respond in different ways. For the chaplain, part of the role is to listen and accompany, but also to help the person to find within the situation a source of spiritual strength. For different people this may be different. The secular setting of the hospital itself imposes a frame in which nothing can be assumed. At the same time, it is often at times of crisis that people discover the importance of the spiritual dimension of their lives.
As a chaplain, I am involved in listening to people of all faiths and none. Some of the people whom I visit are declared Buddhists, but many are not. Some are of other faiths – Christian, Muslim, Hindu, Sikh or Jewish; some are of no faith and declare that they do not believe in anything. I am there to talk to anyone who wants to talk. Chaplaincy goes beyond the label, and whatever the identity the person has chosen to sign up to, their beliefs and practices are particular to them and the present circumstances.
For some people the encounter with illness can be an important opening in their religious life. For others it is the confirmation of an existing faith-practice. I have met many people for whom the presence of a congregation of spiritual friends is a vital lifeline during the hospital experience. The Christian couple supported by their church members who bring the wife to visit her husband and make sure that she is not left to cope at home alone; the SGI member whose friend phones daily at 10.00am to share chanting practice; the young man from an evangelical house-group which sends cards and good wishes and remember him in their prayers: for all of these the supportive spiritual community offers a safety net at a time of crisis. Buddhist communities vary in the quality of support that they offer. Whilst some are excellent, visiting, dedicating merit to the sick and giving practical help, others may be more places where people to come together for solitary practice. With ageing Buddhist populations, concern about mutual support and welfare is something that we could well address.
These times are also times when faith is tested, and I meet people who either seem to cling too strongly to their lifelong beliefs with the kind of desperation that seems fuelled by incipient doubt. Putting on a brave face can overlay fear and despair, and sometimes it may be helpful to give space to the doubts which are unspoken. At the same time, sometimes the brave face is an act of courage. Respecting its function and supporting the person in building their strength and ability to resist the urge to give up may be what is needed. To some extent such different responses are cultural, and as we get windows into the different lives and values of different patients, we may come to respect that there are different ways to live out one’s spiritual strength, as well as understanding the relativity of our own views on what is the right way to handle life events.
Some people lose faith completely in the face of illness, becoming angry or despairing. Some people never thought much about spiritual matters and have no interest in doing so while in hospital. I sometimes feel a little uncomfortable as I move from bed to bed, sensing that the patients I meet are ‘sitting ducks’ who have little choice but to be visited by the chaplaincy. What have they done to deserve this religious intrusion in their day? I ask myself. This thought is probably helpful as it makes me more sensitive and wary of being an imposition. I approach cautiously, introducing myself and offering my availability, but I always ready to move on if I sense that my presence will be an intrusion.
Sometimes, though, the person is ready to express their doubts and tell me why they think my religion (whatever they assume it to be) has it wrong. Giving space for anger as well as piety is important to the chaplain’s role. Often the anger comes from deeper questions, and once released gives way to struggles with fear or important enquiry into the real nature of life and experience. It is not uncommon for people not to have discussed religious matters since childhood, and sometimes the reaction still carries the fury of the child forced into church against his will. Giving space for such conversations feels deeply important, and can lead to real changes and breakthroughs for the person, which go far beyond their immediate hospital situation.
Sometimes beyond the anger and doubt is remorse. Some of the most touching encounters which I have had have been with people who, in suffering from a final illness, have come face-to-face with their actions in the past. Among these, I remember several soldiers who, in old age, struggled with things that they had seen and done during their careers. Even though they were not willing to voice to me scenes that haunted them, talking about their feelings of guilt and regret, and their sense of the inevitability of what they have done, seem to bring them into a deeper connection with the spiritual life.
Finding meaning when life is at its toughest is the spiritual challenge. As we know, the Buddhist teaching suggests that, faced with difficult experiences, the common reaction is avoidance, particularly in the form of clinging and craving. Attachment may manifest in various ways, but its opposite is to live in the uncertainty with courage and honesty. The spiritual accompaniment which the chaplain offers may help to facilitate this. To offer this, however, the chaplain herself needs a capacity to engage in the midst of the situation.
A Practice of Singularity and Non-Attachment
Chaplaincy demands of us that we practice and non-attachment. This is the singularity which we spoke of earlier.
It means not being attached to a particular approach or practice. The Buddhist chaplain is by nature cross tradition, and, whatever our allegiances and preferences, we are required to offer support to all. This means that the chaplain needs some knowledge of different Buddhist traditions, and at least a cursory experience of their practice. I may on the same day be sitting with a Sri Lankan Buddhist, discussing meditation and sharing memories of their temple which we both know, and then visit an elderly Chinese gentleman who speaks no English, but recognises my chanting of nembutsu. I may sit in silence with a Western Buddhist who want support for his meditation practice, and then discuss the nature of enlightenment with another who lost contact with his group 20 years ago but still reads Buddhist books and regards himself as living by the philosophy that they teach.
On the same day I will no doubt meet many of other faiths and none, supporting them through a serious conversation or passing the time of day, listening to grumbles about hospital food, and having a laugh about some event of the night before that they have recounted to me.
It means not being attached to a role, a routine or a style of operating. Each ward has its own protocols, each patient their own style of interacting. We do not know what we will meet when we enter a room. We have to be willing to respond to the situation and do our best. We also have to know that we will get it wrong repeatedly, but yet we will continue. We have to be willing to be bored and listen to the same story over again. We have to be willing not to understand, and not to ask why. We have to be willing to be with people who are in extreme circumstances, injured, unwashed, dishevelled and smelly. We have to move between the cultures of chaplaincy teams, ward staff, patients. We have to be in a minority in all these situations, often operating out of a set of ideas which the other groups to not understand.
A Practice of Caring
The Buddha cared for the sick. He taught his disciples to care for one another. When they neglected their fellow sangha members in favour of their meditation practice, he remonstrated with them.
The bodhisattva ideal of Mahayana Buddhism is not simply concerned with spiritual salvation, but is broadly taken to incorporate caring at all levels. Likewise the chaplain by going into the situations of the world brings the possibility of spiritual conversation into practical helping environments.
This sort of accompaniment is one in which the chaplain steps out of the confines of the practice centre and enters into a less certain space where dukkha is evident.
