bulletin 2/2013

Between Healing and Salvation

3 questions and answers for author Frank Mathwig, Senior Theology and Ethics Officer, on the discussions on palliative care.


By Frank Mathwig.

Theology and medicine do not always get along very well. The disparagement of medical anatomists at the hands of church fathers Tertullian and Augustine had serious consequenc-es for the history of medicine in Europe. By now, the cards have been reshuffled.

The biological-scientific worldview of modern medicine repeatedly has been putting theology and the churches on the spot. In cases of medical emergency, Christians will of course put themselves into the hands of the “demigods in white” – even at the risk of adverse effects – instead of putting all of their hopes in “Christus medicus” (c. Exodus 15:26) and the “Savior” (cf. Heidelberg Catechism, Question 1). Modern theology has come up with an adequate explanation: a categorical distinction must be made between medical healing and God-given salvation. It is true that this view does not quite gel with the miracle stories of the New Testament, in which physical-spiritual healing and salvation are very much connected. However, what speaks for this functional distribution of responsibilities is not only its practicability, but also that it keeps the realms of church and medicine from getting in each others’ way.

Lately, however, the distribution of labor between church and medicine seems to be compromised. This is because medicine, especially palliative medicine, increasingly advances into an area that heretofore had been exclusively the domain of churches and religious communities: human religiosity and spirituality, including spiritual and pastoral care. Since the end of the 1960s, a “spiritual turn” has been observed in the Anglo-Saxon countries. It was the World Health Organization (WHO) that brought about the medical breakthrough of spirituality in 1995 when it included “Spirituality/Religion/Personal beliefs” as a category in its questionnaires regarding health-related quality of life. What religious people knew all along has now been confirmed by medicine and psychology: spiritual resources (coping strategies) have a positive influence on coping with and overcoming illnesses, on preventing and avoiding certain risk factors, and on personal life satisfaction. Accordingly, spiritual care as a palliative care service is booming, and Switzerland is no exception.

The National Guidelines for Palliative Care (2010) emphasizes: “Spiritual support contributes towards improving a person’s subjective quality of life and the protection of their dignity in the face of disease, suffering and death. It assists people in their existential, spiritual and religious needs during their search for meaning, interpretation and assurance of life as well as their crisis management, always while considering the patient’s biography as well as his or her personal values and beliefs.” This concept of spirituality reflects some of the typical experiences of our time: the return of religion on the one hand, combined with the much-discussed shift towards more flexibility and individualization on the other. The dissolution of traditional religious milieus, the individualization and privatization of religious practices, the rise of non-institutionalized, consumer-oriented ‘religiosity’ corresponds to a concept of spirituality that emphasizes individual reflection, self-awareness or self-transcendence.

Mix-and-match spirituality – believing without belonging

The new spiritual quest for an explanation of the world, the meaning of life and life guidance affects hospital pastoral care offered by the churches in a special way. Reactions vary considerably. Satisfaction about the medical recognition of pastoral care at the sickbed is countered with the question of how and if these longings for spirituality can be reconciled with the objectives of Christian pastoral care. Opinions on this matter are enormously controversial. In addition, there are practical issues to consider, as well as aspects of church politics: in the face of its loss of meaning in society, shouldn’t pastoral care use this opportunity to jump on the spirituality bandwagon, discarding all theological concerns? Isn’t this a welcome opportunity for the church to regain lost societal terrain?

The problem goes deeper. Looking at theological literature in German, it is clear that spirituality had not been discussed at length before the last third of the 20th century. What does spirituality even mean from the perspective of the Christian church? A distinction between a “Roman” and an “Anglo-Saxon” line of tradition of spirituality has been established. While spiritualité can be traced back to Catholic monastic theology in France from the 17th to the early 20th century, the spirituality of the Anglo-Saxon world emerges in the late 19th century. The Catholic tradition translated spirituality as piety and related it to ideas of a life “emerging from the spirit,” “in Christ,” or “in the dawning Kingdom of God.” This spirituality was expressed in rigidly structured spiritual “exercises” and a decidedly ecclesiological communal practice. In contrast, the Anglo-Saxon line of tradition takes on a strictly individualistic perspective and focuses on the subjective and individual internalization of religion, usually far removed from any ‘official’ religious community. In a nutshell, the churches are guided by the Roman model while medicine has adopted the Anglo- Saxon model.

The two lines of tradition are far from unconnected. Protestant theology traditionally takes a relaxed view of plurality and personal individuality. Accordingly, there are significant efforts to mediate between individualistic spiritual care and Christian pastoral care. For practical theologian Traugott Roser, spirituality is “precisely – and exclusively – that which the patient thinks it is.” In fact, any patient in any specific situation has exactly the spiritual needs she feels she has and articulates towards the pastoral care giver. But does this patient’s perspective comprise everything the conversation partner can ‘spiritually’ contribute to the interaction? Roser seems to subscribe to this view when he considers the indeterminacy of spirituality the safeguard of the freedom of the individual against “appropriation by religions and religious communities.” Spirituality, he states, represents the “inviolability” of the person in the sense of religious freedom, even vis-à-vis that person’s own religious community.

The impulse of this new spirituality, critical of institutions, is obvious. It appears liberated from dogmatic belief systems, “Christian hang-ups” (Doris Nauer), and the problematic history of Christianity; it proclaims itself to be universal and peaceful, in contrast to churchly fundamentalism and militant missionary zeal, to be the product of personal desire instead of collective adaptation, to be authentic instead of merely socially learned. The church serves more or less explicitly as a negative foil for an emancipated understanding of spirituality. The latter meets with approval even among many church members. Individualistic spirituality appears as the long-awaited liberation from the dusty, authoritarian piety of the church communities.

Indisputably, the desire for new spirituality is also an expression of dissatisfaction with an antiquated churchliness whose rituals seem lifeless or woefully out of touch. The Reformers knew that only a reformatory church (semper reformanda) can be the church of Christ. The demand for a renewal of churchly community thus aims at something entirely different than propagating its abolishment. As much as spirituality springs from an individual need, as little can Christian piety be produced individually or even collectively. The mix-and-match philosophy of fashioning one’s world (and spirituality) according to one’s own whims does not translate well into real life. The church’s answer to human suffering therefore is precisely that people are not alone in times of need, that they can and should dependent on the expertise and social competence of others. The assertion that everyone is the architect of his or her own spirituality follows the same logic as Munchhausen’s emergency plan of pulling himself out of the mire by his own hair. The Baron of Lies is lacking Archimedes’ point of leverage, just as an individually constructed spirituality is lacking any point of reference in terms of relationships or meaning. After all, Christian piety does not come to people from within themselves, but from the outside, from Jesus Christ. Christian spirituality is fundamentally received and constituted by the relationship of giver and receiver. The space of this relationship is the Christian community that has been bestowed through this gift. In short: Christian spirituality is churchly spirituality, experienced in the inseparable unity of individual spiritual practice and spiritual community.

Braving the gap – pastoral care beyond camouflage and forced assimilation

That the medical spirituality debates are a challenge for theology and the church is acutely felt by every single provider of pastoral care in hospitals. Their competences are in demand more than ever while their church background is frequently and vehemently rejected. Palliative care physician Gian Domenico Borasio offers a provoking but astonishingly simple solution for the church’s dilemma. On the patient’s response to the offer of pastoral care: “Well, you know, I’m not very religious,” the doctor answers: “Neither are our pastoral care givers!” This anecdote may amuse a medical symposium, but for the church it has a bitter aftertaste of embarrassment, disillusionment and selling out. Because if this assertion is true, the church is already out the door; but if it is untrue, it at least raises the question of what caused the physician to say such a thing. Maybe the doctor didn’t listen all too closely, or he is rather tonedeaf or simply indifferent regarding religious matters. In any case, his opinion matches the experience of many pastoral care givers in hospitals: a patient’s interest in pastoral care is inversely proportional to the disclosure of the pastoral care giver’s spiritual home.

Such – often frustrating – experiences sometimes result in a defensive stance: better to be silent than to risk rejection. This strategy is not wrong in itself as long as it does not take on a life of its own and becomes a message. The patient’s need cannot become the normative regulation of pastoral care. This would reduce pastoral care to simple complicity of heterogeneous patient interests. Pastoral care provided by the church is not only confronted with religious plurality, but is a part of it and therefore makes the claim – also towards the patients – to be perceived and respected as one player in a pluralist concert. Precisely because it is not the conductor, but a member of the choir, it can and must offer its contribution in a self-confident and inviting manner. This is meant quite literally. The Biblical-Christian tradition possesses its own treasure of psalms, chorals, prayers and lines that speak to people and comfort them, even in situations that make our own words stick in our throats. Church pastoral care has nothing to learn from the concept of spirituality in medicine – but theology and the church would do well to take a leaf out of medicine’s book when it comes to self-confidence and aplomb.