To some degree both Father Paul Mason and National Secular Society president Terry Sanderson missed the point in their defensive discussion about health chaplaincies on BBC Radio 4 this morning (8 April 2009). The debate arose from the NSS’s call to end all state funding for NHS chaplains. A fairly simplistic ‘for’ and ‘against’ exchange followed. But we need to probe deeper.
First of all, the National Secular Society is not up-to-date with the facts. There is a direct correlation, demonstrated in abundant well-researched studies, between religious/spiritual practice and health. I’d be happy to send the NSS a list of these studies. On balance they show that someone with a religious/spiritual commitment is likely to be happier, healthier and longer lived than someone who is without.
Spirituality cannot be separated from well-being; it is part of it. The very foundations of hospitals, from the aesculapian temples to the monasteries, were grounded in the spiritual, recognising that what we feel about, find meaning in, and seek comfort through in the face of disease and suffering cannot be rooted in physical or psychological treatments alone.
Isolating chaplaincy from health care would be a further erosion in its effectiveness. Anyone long enough in the tooth in health care (and my nursing history goes back 40 years now), will tell you that when illness strikes whether major or minor even the most ardent atheists may find themselves turning to the divine for consolation and comfort.
Consolation is not just a soft option that we can do without, something that if we took away would not affect the disease process. A burgeoning body of research, for example in the field of psychoneuroimmunology (PNI) demonstrates that there is a direct impact upon our physical wellbeing from our spiritual and emotional wellbeing. In other words when illness strikes the associated fear and anxiety can compromise the immune response – just when we need all our strength to fight disease may also be the very point when we are less able to do so.
Help someone to feel better and “hey presto” the anxiety is reduced - the brakes come off the immune response leading to better tissue repair, ability to fight infections and so on. Chaplains and others who support patients spiritually may not be wandering around with scalpels and syringes, yet they also contribute to the healing process by helping people feel better and feeling better helps people get better, or die better.
Next, we are human beings not human doings. We do not exist simply through our physical bodies nor are we cured simply through practical scientific interventions. We also exist in a world where we seek meaning, connection, relationship – when illness strikes we not only want to know what and how something has happened (the blessings from our scientific understanding and advances) but also why it has happened in the sense of “what’s it all about, why is this happening to me, what will become of me?”
The search for meaning is not the realm, by and large, of the doctor and nurse. But it is the realm of the chaplain and others likewise trained in spiritual support. It cannot be separated off to be dealt with somewhere else when the crisis has passed. We do not enter hospital leaving our religious and spiritual coats on the hanger at home. These needs are a dimension of what it is to be human all the time.
Integration not separation is the key. And this is more than about patients. Chaplains form part of the health services providing support to health care practitioners. Health care work is emotional and spiritual labour too, and the carers need support if they are to do the caring without burning out. Chaplains often provide as much support to nurses and doctors as to patients. To suggest that “privatising” them to the religions would then free up resources for more doctors and nurses is a simplistic false economy.
First of all few doctors and nurses are skilled enough to fill the gap for patients that the chaplains would leave (and most chaplains work across religious boundaries, not just attending to their “own”). Secondly, the knock on effect among health care staff that would lose a major source of support with stress at work would be far worse than any compensation were chaplaincy monies to be used to buy more nurses. Chaplains do a huge amount of “invisible” work in supporting staff, preventing sickness and absence and helping to glue our otherwise dysfunctional hospital communities together. Hence it can seem easy to get rid of them.
But health care is not a reductionist industrial process as the NSS suggests. It does not function on rational input-output processes alone but on how people relate to one another, what sources of support they need, how they bring purpose to their work and meaning to the relentless tide of suffering that washes up on their doorsteps.
The “hell” that is our hospital environment – with its extremes of enormous joy in healing and mountains of human suffering and death is mitigated not just by effective treatments but also be effective relationships. The chaplain has a pivotal role to play in this for relationships are not just about how we work together, but how we find the energy to function each day in the face of some of the worst aspects of the human experience.
Most people (about four fifths of the population depending on whose surveys you accept) still believe in some form of deity, some caring presence that holds and helps them through illness and perhaps beyond. The NSS tendency to dismiss what they describe as “supernatural” eliminates something that is profoundly natural to most people, and we ignore that and the contribution of chaplains in the work of health and healing at our peril.
The NHS would not be better off without chaplains; it would not run more efficiently and cheaply and would not enhance health and healing. It would be the reverse of all of these. The sick person in need and the member of staff seeking support would be the first to suffer. The endless challenge that is illness would not be eased, it would be made worse.
If further evidence were needed, and with breathtaking irony, the same BBC Radio 4 Today programme followed the news item on chaplains with one about reports from the Royal Colleges of Nursing and Physicians suggesting that the price of booze needs to be increased to reduce the horrendous abuse levels now being experienced – the end product of which is filling our medical wards, our doctor’s surgeries and our emergency rooms at tremendous cost to the NHS.
Looking at the research, it is clear that four key things promote our sense of well-being:
* Faith – a sense of meaning, purpose and connection with life and participation in some sort of belief community
* Fellowship – of friends, family and community
* Fulfilling work – in which we can find meaning and reward
* Free Giving – participating in voluntary work of some sort that helps us feel we are giving as much if not more than we are getting.
If the research I have studied is right, it turns much of the current approach to health promotion policy on its head and to some degree subverts even the Royal Colleges’ report. Raising taxes may make booze more expensive and therefore consumed less by some. But they may seek alternatives and to some the increased costs will make no difference anyway. What drives our unhealthy lifestyle is more a crisis of meaning. So all the heath promotion policies in the world will have little impact unless backed up by tough legislation (as in the case of smoking) or, more importantly by looking at the root causes of the crisis.
These studies show that when we feel empty inside, disconnected from work and community or for that matter from the divine, however experienced, then we seek to fill the empty space with more shopping, sex, drugs, alcohol etc. Our health promotion policies need to be rooted much more in what we can do to help people fill the hole in the psyche that the loss of the 4 F’s brings.
It’s no accident that almost universal in treating various addictions we first have to tackle the emptiness within that the addiction seeks to fill, and that for most people seems to come only through the acknowledgement of some form of “Presence” that nurtures and fulfils. Of course, the chaplain in the hospital setting is available to address at least one aspect of the dilemma. The National Secular Society is arguing for getting rid of something when, paradoxically, it seems we need more not less.
© Stephen G. Wright FRCN MBE is Visiting Professor at the University of Cumbria, in the Faculty of Health, Medical Sciences and Social Care. He is the editor of the journal Spirituality and Health International.