Pastoral and Practical Theology


97805674097751

I have recently seen at close hand the work a busy acute hospital having to deal with an older person suffering multiple challenges to well-being caused in the main by intense confusion as a result of the Alzheimer’s disease. The result was shocking and frustrating. Although,of course, a one-off situation which was intensified by my own sense of powerlessness and pain at the way this person was treated – I suspect that this experience may well be replicated across the UK. We keep on being told that the NHS is in crisis principally for financial reasons but the central organising question this book suggests that there challenges are also moral : it asks is how we care for vulnerable people in such a way as to deepen compassion and alleviate suffering.

Fo me, this book came at the right time and Andrew Sloane deserves gratitude and praise for a powerful narrative that asked this question: can the focus of modern medicine change? The implication is that if it does not its very soul is in jeopardy. In the light of my own experience the reader will understand why this plea resonated so deeply and profoundly in my soul.

To return to the anecdotal –  I remember during my time teaching at the Birmingham University medical school exploring with groups of students how far their ethical teaching and curriculum help them make decisions. Since those teaching days a great deal of attention has been given to public and academic debate about medical and bioethical issues. Those groups of students and young doctors taught me that they relied as much on intuition (I need to respond quickly and so do what I feel is right) as much as the body of knowledge oclassified as medical ethics.  Sloane takes one step back from the issue of the relationship between theory and practice and asks his reader to explore the nature of medicine and its role in human community.

The  nine chapters seek to put theology to work by offering a framework of Christian philosophical and theological thinking which might enable us to understand the nature and purposes of medicine and its role in a Christian understanding of human society.

So what does the book do?

First it presents a description of the contexts in which medicine is practiced in the early 21st century, identifying key problems and challenges that medicine must address. It then turns to issues in contemporary bioethics, demonstrating how the debate is rooted in conflicting visions of the nature of medicine (and so human existence). This leads to a discussion of some of the philosophical and theological resources currently available for those who would reflect ‘Christianly’ on medicine.

The core of the text attempts to articulate a Christian view of medicine as a moral practice which might be shaped by a Christian social vision and a number of key theological commitments.

The book concludes with some powerful pedagogical reflections (pp 178 ff ). First Sloane asks that if it is the case that medicine is an expression of a community solidarity with those whose vulnerability is exposed and if its goal is to express appropriate forms of care for the frail then we should rethink how we train doctors. In terms of medical epistemology, the internal goods of medicine and their relationship to other goals always threaten to distort or corrupt the practice of medicine. And in this we all need to take responsibility in relation to our wildly unrealistic expectations about what medicine can deliver.

A final theme, and possibly to be developed in his future writing lies, in the embodied nature of medicine. If we are ‘knowing bodies’ then doctors in partnership with their patients need to understand what is going on in the body: to listen carefully to the story of our bodies as to discern both what matters and how we might embrace frailty and nurture wholeness. The undue focus on investigations, the obsession with tasks and performance  both detract from the human element of the clinical encounter and (in Sloane’s view) wrongly understand the nature and goals of medical knowledge. This reflects an ongoing interest in a number of public bodies in the UK concerning the medical humanities and how these might be built into a more holistic approach of nurturing both medicine and the medical profession. Medical paternalism and powerful self protecting  professionalism needs to be challenged if the world of medicine is to be re-engaged and transformed. However this will require from us that we reconfigure what medicine can and cannot do for us.

This is a stimulating and enriching book. It is inevitably stronger on theory rather than practice but its call and argument is clear and convincing.It deserves to be picked up and developed by those of us who seek wholeness and all those professional groups that are tasked to care for those in need.

I hope to use some of this work in our future learning at Sarum College (www.sarum.ac.uk ) and particularly in the Sarum Centre for Human Flourishing.

 

James Woodward

Principal Sarum College

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9781849054973[1]

Jessica Kingsley Publishers 2015; 280 pages; £19.99 ISBN 9781849054973

I review this book (the second week of July 2016) when two particular conversations were at the forefront of my mind. The first was the smooth transition between Cameron and May into 10 Downing Street and the office of Prime Minister. What followed was much speculation about who would hold some of the key offices of state including the office of health secretary. This speculation triggered a great deal of social media interest in the health service and especially some of the frustrations on the part of healthcare professionals particularly about the culture of change, resource and the over politicisation   of care in the NHS.

The second was a conversation about church growth and how we face the reality of diminishing numbers (and perhaps even confidence) in religion today. Both of these areas of thought might take up many pages of a blog but they certainly shaped by appreciation and admiration of this book of 16 essays that explore issues of how we think about and deliver healthcare chaplaincy.

Let me give you an outline of book. Its editors are leading academics in the area of health, practical theology and chaplaincy studies. In particular Andrew Todd’s work in the Cardiff Centre the Chaplaincy Studies deserves particular respect and admiration for its quality and professionalism.

The book is divided into four parts. The first part (constructing spiritual care) explores models of spiritual care; discourses of spiritual health care; models of healthcare chaplaincy and how chaplains use the Bible as interpreters in their work. The second part (negotiating spiritual care in public) explores the value of spiritual care and the need for negotiation and persuasion for its value in the public domain; some legal and policy frameworks for spiritual care; the work of chaplaincy in a multi-faith and secular environment and the particular relationship between chaplaincy and nursing.

The third part (researching spiritual care) offers an overview of methodologies for research in spiritual care; deals with the particularities of research health context; looks at the significance of volunteers in the culture of the NHS and offers a particular process of observing, recording and analysing spiritual care in an acute setting. Finally part four discusses the practice of the spiritual care in the context of suffering; opens up the much vexed question of assisted suicide; digs deep into the care of those living with mild cognitive impairment and offers experience of spiritual care in a children’s hospice.

The editors provide a comprehensive subject and author index and throughout the work there is a careful structure and system of referencing. While it is almost impossible to provide consistency across a wide range of essays and chapters the editors have succeeded in providing a very useful and significant addition to the literature in this field.

So this leads to my to opening areas of discussion. The first is developed a little in this book that needs further work. How do we deal with our expectations around care and our experience of care in the NHS? With it’s ever developing technology and increased skill and professionalism is the health service nurturing a culture within which people feel valued, understood and responded to? Put more simply – is the health service looking after people as well as it might ? Are there  some indications that despite our increased investment in resources people feel dissatisfied with the quality of engagement, support and compassion. Perhaps it is inconceivable and impossible to deliver but should we always try to start with the patient and the patient voice when developing a narrative for care? This is of course where chaplaincy is at its absolute strongest – it engagement, understanding and transformative presence in and through the attentive and caring relationship. Chaplaincy needs to beware  of its tendency to detach itself from the patient experience in the ever understandable necessity for organisational security and affirmation. The power is  with the patient! Professionalism is always grounded in the narrative of the experience of illness.

The second and I admit a less obvious area of church growth is yet another area where chaplaincy may be critical in turning around the way in which individuals and groups access the spiritual (hence my organising title).Chaplains meet people where they are and on their terms within their life experience. This is an opportunity to illuminate, enlarge and connect with the spiritual – especially in times of crisis and difficulty. It may be that chaplains are altogether best placed to keep the rumour of Angels alive through their presence and engagement. Investment in agency and chaplaincy should be a key element to the churches strategy for recovering the pastoral as part of deepening spiritual connectivity and faith.

This is a very good book and I commend it as a stimulating, resourceful and informed collection of essays on care.

James Woodward

Principal Sarum College

 

 

 

9781785920363

Making the case for the relevance of pastoral care today, this book explores the role of pastoral care through the prism of music. Using musical analogies, the author provides a new way of understanding and practising pastoral care, grounded in practical theology. Challenging overemphasis on mission, he shows that pastoral care remains essential to the life of the church, especially when engaging with extreme situations such as dying, suffering or war, and considers the role of pastoral carers in the specific pastoral encounter and in the life of the church in general.

Here is my commendation

‘We live in interesting and complex times. Modernity has given us choice and freedom to shape our destiny in many, often competing, directions. The Church is only one place where the shape of human experience is opened up and attended to in our struggle to flourish. This context provides us an opportunity to reimagine how theology and its practice might contribute to well-being. Performing Pastoral Care is a serious and substantial contribution to our understanding of this practice as it calls us all to rediscover our pastoral heart with imagination and creativity. Interdisciplinary in its focus – music and theology both blend and dialogue to provide a stimulating, intelligent and well-organised narrative. The reader is asked to look outwards through a number of lenses and using a variety of methods to engage with the paradoxes and ambiguities of human experience. It succeeds in providing a significant contribution to the literature around music and pastoral theology and its carefully organised chapters offer practical tools for the resourcing of the shapes of pastoral activity and performance. I hope that it will be widely used as part of the ongoing conversation about what might need to be transformed in and through us as we seek to reach out and serve our world and its peoples. I shall be adding it to core reading lists for my students.’
– Dr James Woodward, Principal of Sarum College