The Hospital Chaplaincy

It is interesting to notice that Jesus, when He read the les­son in the synagogue on that Sab­bath day recorded in Luke, read from Isaiah 61. It outlined His mission as preaching, healing, de­livering, restoring, and setting at liberty. In His first sermon Jesus dearly indicated that the relief of human suf­fering was the heart of His mission. It was a program that encompassed all in need. It is furthermore of interest to recall how much of this ministry and help was given to those who were sick.

Our Saviour recognized that behind some physical illness there could be discovered a spiritual cause. In healing the one sick of the palsy Jesus offered pardon for his sins (Matt 9:2-7). The man was sick of the palsy, but he needed the healing power of pardoned sin. This was not the same as some of the Jews taught; namely, that sickness was the direct punishment of God for sins committed. This Jesus denied, as in the case of the blind man (John 9:2, 3). Jesus saw in the man a spiritual need. One wonders how many there are in our hospitals and sanitariums today whose greatest need is the healing work of a skilled pastor—one who knows how to point the way to Him who gives a peace of soul the world cannot give. What a glorious opportunity confronts the hospital chaplain!

Need for Specialized Training

The strange thing is that, even with the ex­ample of the Lord Jesus spending so much of His time ministering to the sick, and even though we as a people have from the beginning realized the importance of the healing of the body in approaching the healing of the soul, we are in grave danger of being behind in the training of skilled hospital chaplains. For too long we have failed to realize the importance of specialized training for this work. Several of the major denominations are now beginning to set requirements of training for those appointed to such chaplaincies. Of course it would be ex­pected that such requirements would include ordination to the gospel ministry. It would seem obvious that pastoral experience would also be necessary. But the churches are beginning to require of their chaplains clinical pastoral training as well. We may disagree with much that we find in the realm of psychology, but I feel sure we would agree that many goodhearted and well-intentioned pastors have much to learn in understanding people with problems and how best to help them. A reference to a letter received from a chaplain of one of our large hospitals will indicate the problem. He says:

Several patients have told me that they did not want to have their pastors visit them again because of the unfortunate calls that had been made. In several instances I have had patients of other faiths call upon me to try to undo the damage done by their own pastors. The sad part of the picture is that these men probably were not aware of what they had done.¹

This letter is not citing an isolated case. Re­cently I have had other chaplains confide to me the same problem, and I feel sure that this could be multiplied many times.

What shall we do? Shall we blame men who are conscientiously doing the best they can? It seems that such a negative attitude would not solve any problems. Some churches, realizing the challenge of this problem, are constructing training programs besides establishing require­ment standards for their chaplains. The Council for Clinical Training' would seem to be a guiding light in this direction. Other church bodies appear to pattern their programs along similar lines. These programs are based on the assumption that the chaplaincy is a specialized calling within the ministry and needs specialized training. The Office of Institutional Chaplains of the Presbyterian Church in the United States of America has published a brochure entitled The Chaplain. It states, "The chaplaincy de­mands highly trained men, training which goes beyond that usually received in college and seminary."

As was mentioned at the beginning, Jesus felt the challenge of preaching the gospel to the poor, healing the brokenhearted, bringing de­liverance to the captives, recovering of sight to the blind, setting at liberty them that are bruised, and the preaching of the acceptable year of the Lord. This He said was His "anointed" mission. This was His Messianic work. In fulfillment of this mission it would appear from the divine record that the sick and bereaved presented a special challenge to Him. There were needs that seem to have been ac­centuated for them. Much of His work was comforting, assuring, and healing the sick and the distressed. There is scarcely any doubt that today the hospital work presents the chaplain with the same concentration of challenge. The church pastor often faces crises. The hospital chaplain is almost continually facing crises. The pastor often faces bereavement. The hospital chaplain faces it more frequently. The chap­lain faces all the problem areas confronting the church pastor, but many of these problems seem intensified. To very many, sickness is a crisis. They need specialized help to guide them through this ordeal. Note that—it is of great importance that the one who is chosen to care for the spiritual interests of patients and helpers be a man of sound judgment and undeviating principle, a man who will have moral influence, who knows how to deal with minds.⁴ (Italics supplied.)

Mental and Spiritual Crises

It is important to understand the reasons for these apparent crises if we are to try to help the patient. It would seem appropriate to list some of the things that disturb a patient in a hospital. To many, just being confined to a hospital calls for quite an adjustment. The patient is placed in a strange environment. The normal routine of life is interrupted. He must get used to unaccustomed routines. He is sur­rounded by strange people. A new uncertainty faces him, and he is surrounded by crises of varying degrees as other patients pass through surgery or therapy. There may be acute mental suffering that, in addition to the pain endured, may threaten the patient. Sedation may take care of the physical pain, but it is the chaplain who has to help wisely with the spiritual needs. The patient may be facing an operation or even death. There may be serious adjustments to make because of some new physical handicap imposed by surgery. Some have to adjust to the prospect of being permanent invalids. Any one or any combination of these situations can, and often does, produce a crisis in the life of the patient. He is challenged by the situation and feels at a loss, not knowing how to meet the demands of the hour. The patient needs skill­ful pastoral help at a time like this. We can act in such a way as to close a door that he may never open again. Note the statement of Ellen G. White:

The worker who manifests a lack of courtesy, who shows impatience at the ignorance or wayward­ness of others, who speaks hastily or acts thought­lessly, may close the door to hearts so that he can never reach them.⁵

There are questions that are not within the chaplain's province to answer, such as, Is my condition serious? Will I get well? These are questions that should be referred to the doctor; however, there is a ministry for patients that is peculiarly the chaplain's. Such a ministry may have a very important effect on healing. The patient may be beset by anxiety and fear. What a blessing it is to a patient to have the services of a skilled chaplain who knows how to help banish fear and inspire confidence by drawing upon spiritual resources and faith in God!

There is another problem often presenting itself to the hospitalized, and that is the time a patient has to lie and think. This frequently gives rise to doubts and a feeling of insecurity. Questions present themselves, and oftentimes the patient fails to find the needed answer. Thinking about the past may develop a sense of guilt. Thinking about the future sometimes pro­duces insecurity. The patient needs help and needs answers, but sometimes is afraid of the very answer he seeks. The patient is often sen­sitive and on guard, so to speak. Add to all this a sense of loneliness and restless boredom, and one can see that not infrequently the hospital patient is one who sorely needs help, and yet he is a difficult one to help. This is the kind of help the doctor may not be able to give. Mrs. White says, "The spiritual work of our sani­tariums is not to be under the control of physi­cians." ⁶ Even more important, it is the kind of help that he would not have the time to give even if he were able.

We must mention the chaplain's ministry to the dying and that of comforting the bereaved. Should the chaplain tell a patient he is dying, if asked, or if not asked? Should the chaplain ask a person about his relationship with God? What should a chaplain discuss if help is so­licited? How should a chaplain deal with rela­tives at a time like this? This article does not propose answers to these questions and prob­lems, but intends only to point out the need for specialized training in facing these critical pe­riods that come so frequently in his daily work.

In rounding out the picture of the training needs of a skilled chaplain, reference must be made to relationships. The chaplain needs the cooperation of doctors, nurses, and hospital staff if he is to work effectively for the spiritual care of the patients. He, in turn, must know how to cooperate with them. Good relation­ships are built up by mutual respect and under­standing. This kind of working together will save the chaplain from many pitfalls. If we do not know the patient's condition, it is easy to "cheer up" a person who needs rather to be kept quiet, or to encourage a person to talk when the patient should not use up the energy. The visit may be keeping a person awake when the greatest need of the moment is sleep. Then, on the other hand, there is the timing of a visit. How important it is to know that a patient has just been told he must undergo a serious opera­tion, or that the result of some test is disturb­ing! If the doctor has confidence that the chap­lain will know what to do and say, he will call on him. This may be just the moment when the patient will discover peace of soul and faith in God.

Example of a Training Program

We have discussed the challenges facing the chaplain. Now we turn to the question of what training is necessary to fit a man to meet these situations. The Protestant denominations that have already moved forward in establishing training standards require a man (1) to be an ordained minister of the gospel, (2) to have pastoral experience in some church (some church bodies expect three years of service as a minimum), (3) to possess personal fitness for institutional service, and (4) to have received adequate clinical training at a recognized train­ing center. By way of illustration we are setting forth here the Regulations for Institutional Chaplaincy adopted by the General Assembly of the Presbyterian Church in the United States of America, May 29, 1956, and established as the required standards by the Office of Institutional Chaplains of that body as of July 1, 1956. It is understood that these regulations are only cited as an example of what is being done by several other large denominations.

I. Minimum

To qualify for approval as an institutional chap­lain in any classification, the prospective chaplain must meet the following qualifications:

(a)   Graduation from an accredited college or university;

(b)   Graduation from an accredited theological seminary;

(c)   Ordination to the Gospel Ministry and mem­bership in good standing in a presbytery of the Pres­byterian Church in the U.S.A.;

(d)   Some service, preferably at least three years, as pastor of a local congregation or in the military chaplaincy; and

(e)   Personal fitness for institutional service.

II. For Resident Chaplain, Accredited

The office of Institutional Chaplains will grant accreditation to a man as Resident Chaplain, Ac­credited, who has:

(a)   Met the Minimum Standards noted in I above;

(b)  Served three years as the pastor of a local congregation or its equivalent, such as chaplaincy in the armed forces; and

(c)   Satisfactorily completed at least two quarters (24 weeks) of clinical pastoral training in an ap­proved center; or

(d)  In lieu of c above, presented evidence of experience sufficient to equal clinical training based on citations from other professional persons with whom the chaplain has worked;

(e)   Appropriate personal qualifications as ap­praised by those under whom he has studied and with whom he has served;

(1) Chaplains accredited in this classification by other recognized chaplaincy accrediting organiza­tions may be accredited by the Office of Institutional Chaplains.

III. For Resident Chaplain Supervisor

The Office of Institutional Chaplains will grant accreditation to a man as Resident Chaplain Super­visor who has:

(a)   Met the Minimum Standards noted in I above;

(b)   Satisfactorily completed at least one year of full time clinical pastoral training in an approved training center and at least three months of super­vised clinical teaching by an accredited instructor, Or

(c)   Satisfactorily completed graduate studies in appropriate fields which may be substituted for a portion of the clinical training required in III-b;

(d)   Appropriate personal qualifications as ap­praised by those under whom he has studied, those with whom he has worked, and by members of the Advisory Committee of the Office of Institutional Chaplains;

(e) Chaplains accredited in this classification by other recognized professional organizations may be accredited by the Office of Institutional Chaplains.

IV. Training Centers

(a)   The Office of Institutional Chaplains accepts as approved training centers those institutions now approved by the National Conference on Clinical Pastoral Training;

(b)   The Office may, in consultation with the Advisory Committee, grant approval to such other training programs as, in its judgment, meet pro­fessional and ecclesiastical requirements.

V. Certification

(a)   Candidates for approval as institutional chaplains shall supply to the presbytery from which they seek approval, evidence of their compliance with the Minimum Standards (I above);

(b)   Chaplains desiring accreditation under Standards II and III shall submit their evidence of compliance to the Office of Institutional Chaplains which, upon accreditation, shall notify the presby­tery in which the chaplain is serving;

(c)   Nothing in these Standards shall be con­strued as limiting the authority of a presbytery to approve the service of its members.

VI. Amendment

Amendments to these standards may be made by the Office of Institutional Chaplains with the ap­proval of the Advisory Committee and the Board of National Missions.

The question may be raised here as to whether these requirements are for the general hospital chaplain. The answer is given in the definition of institutional chaplains adopted by the General Assembly:

Presbyterian ministers serving full or part-time as ministers or chaplains in general and special hos­pitals (exclusive of Veterans Administration Hos­pitals), nursing homes, clinics, mental institutions, homes for children, homes for the aged, and correctional institutions shall be considered institu­tional chaplains and covered by these regulations.?

There are several other programs equally full and definite.

Seminary Approach to the Problem

At this point someone is asking, "What are we doing toward the training of chaplains?" As far as the writer is aware, we have not as a move­ment set up any requirement standards for training institutional chaplains; however, with a number of chaplains studying here at the Seminary, we have organized a training group. Through the group we are doing a limited work in this area. Courses are offered by Profes­sor Wittschiebe in general clinical training for pastors. To serve the purpose, we have need for more specialized courses. To give this more meaning, we should say a little about clinical courses of instruction.

Clinical courses are a combination of instruc­tion dealing with personality problems and ap­proaches toward their solution, sound counsel­ing techniques, and in-service training under the direction of a trained chaplain. The trainee both observes a skilled chaplain at work and deals with patients' problems himself, under the supervision of one with experience and un­derstanding

Clinical courses teach the trainee the invalu­able art of listening at the appropriate time. We shall never know how many golden oppor­tunities were missed while we were doing the talking instead of listening. Many a patient might have been burdened with a need that he would have expressed if we had given him the opportunity. The soul may have been searching to find the Lord Jesus while we were outlining some doctrinal truth that was not even in dis­pute.

Thus far we have dealt only with the chap­lain's training program that would bring us into line with other Protestant church bodies, yet it would seem fair to claim that our program of medical work is more closely integrated with our mission and message than that of other church organizations. Thus our program of training for chaplains should go still further. To meet the spiritual needs of those who come to our sanitariums and hospitals, we need train­ing in special theological problems. Why does God permit suffering? Is suffering a punishment for sin? Has God forsaken me? These are burn­ing questions to many a patient. How can I find pardon and forgiveness? How can I find peace of soul? These are often cries from a burdened heart. If you think that these questions are elementary, try to explain them satisfactorily to a hospital patient who is under great stress. You will soon find that you are dealing with the basic fundamentals of the Christian faith. You will also find that you need great wisdom and tact in order to win rather than repel the troubled one.

Naturally the big question that will be asked is, Does such a program yield results? It would appear impossible to give objective answers on a general level. The author is not aware of factual data that would enable us to make generalizations along this line. All that can be done is to offer some observations.

One of our chaplains, who had some training, connected with a local Adventist hospital. It was not long before he had a long list of Bible studies begun in the homes of those who had been patients. Soon there was quite a sizable baptismal group from the studies. This became the nucleus of a new church group.

Here is part of one student's monthly report, which deals with the follow-up work outside the hospital:

Lessons Given Out                                                 38

Another denomination that has adopted a chaplain's training program is showing great membership increase. This is not wholly due to such a program, but there is little doubt that people facing the critical experience of hospi­talization are receptive to the good offices of a skilled chaplain. This, in turn, often leads to a new Christian experience. At perhaps no other time is the opportunity greater for appealing to the hearts of men and women than while they are laid aside in sickness. To be successful, how­ever, one must make a careful approach.

The greatest wisdom and gentleness are needed to serve in this position [the chaplain's] acceptably, yet with unbending integrity; for prejudice, big­otry, and error of every form and description, must be met. . . . Care must be taken that the religion of Christ be not made repulsive by harshness or impatience.

This is a brief review of the problems, needs, and challenge of the spiritual opportunities of our hospitals and the development of training programs by other organizations. It is intended only to inform the field of the present trend in the training of chaplains and the awareness of your Theological Seminary to the possibilities opened by such training. At present we have a small program for the few chaplains training here in this area. We would give attention to a widening program of stUdy and clinical train­ing if there seemed to be a demand from the field for such a program. Inasmuch as the Semi­nary serves the whole world field, we would be glad to give study to a program that would meet our worldwide hospital needs. It would help the Applied Theology Department if those who are interested in the specialized training of chaplains would send to us their suggestions and observations.