Stress in the chaplaincy
Code 99, emergency! Code 99, emergency!" The urgent call summoned the crisis team from all corners of the hospital. Skilled physicians and technicians rushed to the aid of an elderly gentleman in cardiac arrest. Frightened and concerned, the patient's wife waited outside the cubicle where her husband was lying critically ill. A member of the crisis team, the hospital chaplain greeted her and guided her to the seclusion of the patients' lounge. They visited quietly as the team worked on her husband.
This was to have been a day of celebration for the patient and his wife—the last day of work before retirement. She had packed his last lunch that morning. In a week they would move to Florida. As the chaplain visited with her it became apparent that the longer the team worked on her husband the grimmer the prospects became. Her tears flowed freely as the harsh reality of the situation developed.
"I'm so frightened," she said, "so frightened. What will I do if I lose him?" The crisis team coordinator motioned for the chaplain to join her. "He didn't make it, chaplain; they couldn't bring him around. He never responded. Perhaps you should break the news to her." The chaplain dreaded the task. His heart went out to her. As he turned to face the woman, his face revealed the truth.
"He's gone, isn't he?" There was a sense of reality in her voice, but the chaplain could see the pleading in her eyes. "Yes, I'm afraid he is. They couldn't save him. They did all they could, but he's gone." She and the chaplain cried together. They shared the pain of her loss and her memories of thirty-eight years of marriage.
After the bereaved wife said goodbyes at the bedside, she thanked the chaplain for being with her during the ordeal. They embraced, and she left. As the chaplain watched her leave, he knew he had shared the most intense moment of her life. He thought of Moses' experience, and saw new meaning in the words 'Put off thy shoes from off thy feet, for the place whereon thou standest is holy ground" (Ex. 3:5).
Hospital chaplains routinely respond to emergencies like this. Moved by the Lord's counsel to "love thy neighbor," they work in an environment of crisis and pain. One moment the summons is to the bedside of a frightened young woman facing breast surgery. The next to a grieving husband whose wife lies dying in the intensive care unit. What ever the crisis, the chaplain must meet the urgency and gravity of the moment. There is no time to plan strategy. Reacting appropriately demands an emotional commitment to share the anguish of a fellow human being. But this is not achieved without paying a price.
A retired U.S. Army hospital chap lain, with twenty-seven years' experience, comments on this cost: "There is a great amount of stress-related illness among those who serve as health-care chaplains. Even the 'giants' in the field are human. I believe their health problems were related to their vocation." Social psychiatry supports the Army chaplain's suspicion. Research has established a significant link between health problems and work stress. High levels of worry, role conflict, and a sense of unfulfilled role expectations are the main stressors contributing to tension-related physical and psychological illness.
Most chaplains have only a vague awareness of the link between physical problems and their vocation. James, a 44-year-old chaplain with thirteen years' experience, is typical. He is widely recognized in his hospital for the ability to nurture, to care, and to bring serenity and peace to suffering patients. But he suffers from serious high blood pressure, a condition that could lead to heart attack or stroke. The medication prescribed controls his blood pressure, but has made him sexually impotent. Though James was initially skeptical, he is beginning to accept the connection between his work and his blood pressure.
A recent study exploring work-related stress in the chaplaincy demonstrated considerably higher levels of impairment in that profession than in the general population. The study used physical symptoms to explore various organ systems and overall reactions such as fatigue, sleep problems, and mood disturbances. A cross section of the College of Chaplains, the certifying body for the profession, reported 57.7 percent impairment (based on three or more symptoms), as compared to 32.8 percent in the general population. More than 90 percent of the cross section reported one or more symptoms pointing to stress-related illness. Paradoxically hospital chaplains, in ministering to the stress-induced ailments of others, have largely ignored their own vulnerability to stress-related disease. They are professionals trained to recognize the warning signals, yet 76 percent of them reported excessive levels of fatigue—one of the major warning signals of stress.
One chaplain's response to the survey typifies the difficulty the profession has in accepting the idea that psychological stress in chaplains can be converted to physical impairment. Although he reported in the survey no physical or psychological symptoms, he stated orally to the researcher that twice within the previous five years he had undergone triple bypass surgery and saw no connection between it and his vocation.
Denial of the reality of psychosomatic illness can result in serious difficulty. Paul has been a hospital chaplain for thirty-five years. He is loved for his capacity to teach the gentle art of pastoral care. Literally hundreds of chaplains and pastors have received their pastoral vision from Paul. But he has had little time for himself or his family. Every year or so, however, Paul is hospitalized for extreme fatigue and symptoms of heart attack. Even in the hospital he makes himself available to his people. He won't admit the obvious relationship between the stress of his work and his hospitalizations. Paul's experience emphasizes the results of the study of stress in the chaplaincy.
The survey uncovered a number of startling findings concerning the overall health of hospital chaplains. Gastrointestinal complaints were the most prevalent (37 percent). A significant group reported cardiovascular symptoms (32 percent). Twenty-two percent experienced circulatory system difficulties.
Why do chaplains continue to deny the stress of their work? For one thing, stress-related diseases develop slowly after a crisis is encountered. Chaplains learn to adjust to symptoms of stress much like the victims of the Buffalo Creek flood, which nearly wiped out the town, had to adjust to the aftereffects. For more than two years after the dam burst, burying four thousand homes, survivors continued to suffer abnormally frequent major and minor physical ailments not directly caused by the accident. Chaplains also accept symptoms of stress as the necessary price that must be paid to carry out their pastoral role. The significance of the telltale symptoms are minimized or denied.
Unlike the treatment of infectious disease, which may require no more than a single shot of penicillin, the management of chronic stress-related illness demands a lifelong commitment to be responsible for maintaining one's own health. This requires hard work, serious commitment, and persistent practice of preventive techniques. Unfortunately, the busy life of the hospital chaplain often has no room for such a commitment in time and energy.
The summons "Love thy neighbor" takes priority over all else in the chaplain's daily schedule. Perhaps the chaplaincy needs to restudy that Biblical counsel in its entirety. The complete text reads "Love thy neighbour as thyself."
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Research for this article has come from the doctoral dissertation "The Effect of Work Role on the Mental Health of Hospital Chaplains," by Walter E. Kloss, Ph.D., 1983, on file at Newport University, Newport Beach, California.