Pastoral Theology for Public Ministry

PART ONE

PASTORAL

THEOLOGY

Resources for the Task

The next chapter will focus on hospitals, and specifically the wards of psychiatric hospitals where the origins of the therapeutic tradition of pastoral theology are to be found, but I would like to begin with a few words of perspective on the task of part one as a whole. Part one surveys three different, but related, traditions of pastoral theology. I call these traditions the therapeutic, the classical, and the liberation-ist, and the place to begin to think about them side by side is not quite the psychiatric ward, but the optometrist’s clinic.

Having one’s eyes tested by an optometrist is an experience of clarifying vision. During an eye test, one is asked to read a sequence of letters of ever-decreasing size, with the help of different lenses as needed. Spectacle frames may be perched upon the patient’s face, and lens after lens used to see how it enables sight. Sometimes specialized optometrist frames may hold several lenses at a time, so that one lens is placed in front of another, and another in front of that, all the time to bring vision into focus. As different lenses are tried out, with patience and skill, vision sharpens.

It may be helpful to hold on to this image of the optometrist’s clinic through what follows in part one. The three traditions about to be surveyed suggest different lenses to bring to perusal of pastoral care, different ways of seeing it. One particular lens or another may help to shape vision of a particular pastoral care setting and scenario. We will look through these three lenses, in order to suggest that there is always more than one way of looking at and considering a pastoral situation. Moreover, it is not just that the lenses may be viewed one at a time, but that for sharp vision of things, multiple lenses may need to be used in conjunction with one another. So the therapeutic tradition which is central to chapter 1 may need to be overlaid with what chapter 2 calls the classical tradition, which may further need to be seen from what chapter 3 calls a liberationist perspective. Looking through one lens may bring clarity to a pastoral situation, and enable pastoral action, but it might also be necessary to look through all three lenses, or the lenses in different combinations, to see a situation as clearly as possible. The optometrist’s multifocal spectacles need to be remembered as one stands in any particular place and their multifocal vision needs to be carried between such settings in one’s imagination.

On to the hospital.

CHAPTER 1

Reading the Living

Human Document:

A Therapeutic Tradition

With this chapter, we open up the first of three styles or traditions of pastoral care: the therapeutic, which comes first in as a broadly chronological sketch, with classical and liberationist traditions following. This chronology reflects the way in which each tradition emerged through the twentieth century. In what follows, then, the three traditions are presented in a construct that suggests their historical emergence as distinctive emphases through the last century, each of which remain viable in the twenty-first century, and all of which draw on long, even ancient, precedents in the practice of pastoral care and the durable sources of theology in scripture and tradition.

The therapeutic tradition is illumined by the image of reading the living human document. The phrase living human document is central to this tradition, and is one of its gifts and challenges to the practice of pastoral care. In order to understand its significance, we need to focus on the ministry of one particular Presbyterian minister in New England in the United States of America in the first decades of the twentieth century, Anton T. Boisen. Boisen lived to be nearly ninety years old, and by the time of his death in 1965 he had left a huge legacy to the church in the form of a program of pastoral training for ministers that came to be known as Clinical Pastoral Education.

Opportune Madness

Anton Boisen was born in 1876 in Bloomington, Indiana, the child of parents who had emigrated from Germany in the decade before his birth. Both of his parents were involved in the University of Indiana: His father taught modern languages (an area in which Anton would study) and his mother was among the first cohort of women to attend the university as students. Members of Boisen’s extended family were also involved in the work of the university: His grandfather was professor of math and a cousin of his grandfather was the university’s first president. Boisen’s father died when Anton was seven years old, and one particular other person also involved in the university, a Dr. William Bryan, came to be something of a surrogate father to him. This relationship was very important in Boisen’s youth, and remained so throughout his life. His autobiography, Out of the Depths, is dedicated to Bryan, as teacher and friend. Bryan was professor of philosophy and psychology and he encouraged Boisen to study psychology as an undergraduate, as well as supervising some of Boisen’s postgraduate work in that field. While unsurprisingly his father’s death during his childhood years left a profound and enduring mark on the son, the wider academic context of his upbringing is also important, as it underlines Boisen’s familiarity with a milieu in which he later sought and found influence himself.

As a young man, Boisen—a person with a preoccupied mind and a distant personality¹—was engaged in numerous lines of work, including things as diverse as modern languages (like his father), ordained ministry (like a number of others in his extended family), forestry, and ethnography, according to biographers. However, in all of these activities he had not found his vocation.² At age forty-four, Boisen experienced some kind of major mental disorientation that led to his hospitalization in a psychiatric institution. This important personal experience in Boisen’s life stands behind the pastoral theologian Robert Dykstra’s depiction of pastoral theology being born in madness.³

As he was to narrate in a substantial theological memoir of his experience published in 1936, The Exploration of the Inner World, Boisen came to understand the problem which led to his illness in terms of a sense of unfulfilled vocation—what he called his years of wandering. He also made clear that a more immediate presenting problem was a sometimes intense preoccupation with masturbation. Again in Exploration of the Inner World, he wrote, The realm of sex was for me at once fascinating and terrifying,⁴ and he was overwhelmed by it. In part, he was overwhelmed because his sexual interests could neither be controlled nor acknowledged for fear of condemnation⁵ in the religious environment in which he was raised. But at least on reflection, it seems that he understood this interest in sex-organ excitement—that apparently preoccupied him from the age of four—as a manifestation of the deeper distraction: his vocational wandering. It is clear from his reflections, too, that in his adulthood both his vocational and sexual frustration clustered around one particular woman. Out of the Depths indicates that he harbored a lifelong love of Alice Batchelder, which remained unrequited, and utterly consuming. Boisen himself suggested that his religious faith was interwoven with his love for Alice, just as it was with his memory of his father. For her part, Alice sensed that Boisen needed her, if not as a wife, then certainly as a point around which to center his life.⁶ In any case, when Boisen’s various wanderings led to an inability to function in his professional work and in the domestic sphere, his family arranged for him to be admitted against his will at Boston Psychopathic Hospital in Massachusetts. He was diagnosed with violent delirium and was considered to be a severe case from which recovery would be quite unlikely. A week later, he was transferred to Westboro State Hospital. Yet despite the initial diagnosis of severe delirium, and much to the surprise of his psychiatrists and the clinical team responsible for his care, Boisen was soon well enough to be discharged. As it happened Boisen was able to be given a choice to leave the institution within a matter of weeks. He chose to stay and remained a patient there for fifteen months.

Remarkably, Boisen chose, over time, to stay for extended periods over the next years, to live in the kind of therapeutic community in which he had initially been confined against his will. That is, although he was never forcibly admitted again, and so was always free to leave, Boisen chose to spend much of his life in institutions like the one in which he had been a patient. Sometimes he lived in such institutions in roles as chaplain, and at other times chose to live in hospitals as a patient. In 1924, four years after his breakdown, he was appointed as chaplain to a psychiatric institution, Worcester State Hospital, and chose to live in the hospital in his chaplaincy role. Later, when Boisen began to pioneer training programs for clergy working in hospitals, he again chose to remain living in hospitals.⁷ In other words, as Henri Nouwen—one of Boisen’s students and biographers—noted, Boisen made his own illness the focus of his life.⁸

However strange it may have seemed to others, for his own part, Boisen regarded his hospital experience positively. As he said, To be plunged as a patient into a hospital for the insane may be a tragedy or an opportunity. For me it was an opportunity.⁹ He saw it as the opportunity to understand the experience of mental illness.

As Boisen was later able to reflect on his initial hospitalization in relation to what he saw of others living closely with him in hospital situations, he came to think that mental illness was a matter of the patient’s inner world becoming disorganized. He stated what he came to see as a common problem for many persons in these terms:

Something ha[d] happened which ha[d] upset the foundations upon which his (sic) ordinary reasoning is based. Death or disappointment or sense of failure may have compelled a reconstruction of the patient’s worldview from the bottom up, and the mind becomes dominated by the one idea, which he has been trying to put in its proper place.¹⁰

For Boisen himself, his disappointment centered on his unrequited love for Alice; this had become the dominating idea which felled him.

Boisen’s Courage

Boisen was presumably at least partially aware of his own needs in choosing to make psychiatric hospitals his home, but his decision nevertheless took courage. This courage marked his later life as profoundly as his sexual preoccupations had marked his adolescence and young adulthood, and in one notable piece of testimony he likened his adventurous approach to a willingness to get lost: It is only the dubs who never go five miles from camp, who don’t get lost sometimes.¹¹ And

for me to stick right to camp and wash dishes all the rest of my life for fear of getting lost again would take out of life all that makes it worth living for me. I am not afraid. I have always managed to find my way through; and I do think that in a very real sense I have been exploring some little known territory, which I should like now to have a chance to map out.¹²

Over time, Boisen became convinced that problems commonly diagnosed as medical were in fact, or at least in part, religious¹³—as in his own troubles with sex—and he was concerned about what he perceived as the failure of psychiatrists to engage with the religious dimensions of the mentally distressed and the failure of Christian pastors to engage with the terrain in which psychiatrists worked. Boisen’s concerns about pastors were both that they had little or no opportunity to engage institutionally in ministry in psychiatric hospitals and that they had little or no training or skill to engage personally in journeying with others into their inner world of religiously related trauma. Religious language and religious practice were media through which disorder might be manifest. Hence, on the one hand, Boisen wrote, I feel that many forms of insanity are religious rather than medical problems and that they cannot be successfully treated until they are so recognized.¹⁴ He saw the key problem of many persons in psychiatric hospitals as that of not having resolved inner conflicts like that which Paul describes in the famous passage in the seventh chapter of Romans¹⁵—I do not do what I want, but I do the very thing I hate (Romans 7:15). So while the church may have believed and proclaimed that this Pauline conflict could be overcome, it is clear that some people struggle hard to resolve it, breaking down in the attempt. Psychiatric patients are those who have come to unhappy solutions which thus far the church has ignored.¹⁶ On the other hand, Boisen felt that the kindly but inept ministers who conducted services in the hospital might know something about religion, but they certainly knew nothing about our problems.¹⁷ As an example of what he meant, he related a story about one such minister preaching on the gospel text If your right eye causes you to sin, tear it out (Matthew 5:29) to a congregation of persons in mental distress. But Boisen also recognized that the fact that ministers might simply take services but not visit on the wards was not simply their fault: They probably received little encouragement to do so.¹⁸ Indeed, it was his own experience that when he looked for a ministry position in hospital chap-laincy, there were no available options. He decided therefore to take a job in the psychological department (and later the social services department) of a hospital. It was only after some time that he was able to move from that position into a chaplaincy role. Boisen’s life was marked not only by the courage to get lost, but also by the patience and persistence to find ways toward the opportunities he