Tuesday, November 8, 2011

Healing the Veteran: Mind, Body and Soul


Sts. Cosmas and Damian


The following is the text of a speech I gave to a very diverse group of pastors from the Boise area during a conference on Posttraumatic Stress Disorder.  Although I was treated with great kindness, consideration and deference by the audience, it was not as well received as I had hoped it would be.  I think that it challenged the closely held views of some of the participants; others had difficulty placing it into the context of their educations and/or frames of reverence.  Others were apparently bored by the autobiographical content; since my life is admittedly relatively boring, it would be disingenuous to take umbrage.  Nevertheless the lecture contains the philosophical elements of humanology and anthropiatry and the process by which I came to understand them.  Since the reader is not condemned to an hour of listening to a possible doofus in a lecture hall, and can extract from it what he or she desires, I have posted it in the form of a blog.

Keynote Speech:  Conference on Ministry to Veterans
November 9, 2011

It is indeed an honor to address this audience.  It’s an honor for a number of reasons, but one of them is that I have always felt drawn to the ministry.
See, when I was a lad age 7 we moved to a tiny village in coastal North Carolina.  I met this kid my age named Kevin Roughton and we became best friends.  Now even though North Carolina was then the least Catholic state in the US, Kevin just happened to be Catholic (his mom grew up in a Catholic orphanage in Pennsylvania).  “You should come to mass with me,” he declared, “you’re Catholic after all.”
“Am not,” I retorted. 
“Are, too,” he countered.
So I went home and asked my Dad.  “Are we Catholic?”
“I guess so,” said my Dad.  Crestfallen, I started going to mass with Kevin and his mother. 
 Being Catholic in North Carolina at that time was not easy.  I got invited to a lot of church picnics just to get harangued, but it was more than worth it for southern fried chicken and potato salad.  Kevin and I went to mass in Edenton NC 30 miles away but eventually we reopened a tiny mission church in our home town of Columbia.      
By the way Kevin and I are still friends.  He plays music professionally in the beach communities of the Northern North Carolina coast, around Nag’s Head.
In high school I was rather studious, a fact which all but eliminated any possibility of a youthful romance.  Superimposed on that problem was the fact that I had never been incarcerated, and to be popular in the rural south in those days you had to have “fought the law,” and I had not so girls were pretty much out of the picture.  To be fair, I had very little relationship with my mother, and I think a boy’s relationship with his mom contains certain elements that prepare him for the complex system of emotional barter between a young man and a young woman.  I was devoted to my church, and as I had been sitting on the bench in the game of romance, I began to think that perhaps I was meant for the clergy .  
I mentioned to Father Parker, our priest, that I was interested in the priesthood and he gave me information on several seminaries I could apply to, and he walked me through the initial phase of the applications process.  But Father Parker was nothing if not wise, and later he counseled me to wait until after I finished college to apply to the priesthood.  “I had had a bit of life experience before I became a priest,” he advised;  “I was in World War Two and I got to travel, and I think that’s what you should do.  Go to college, and if you still want to be a priest after that, apply again.”  So I went off to Georgetown University, discovered college girls and thought little about the priesthood for a long time thereafter.   After a while in college I reverted to my feral agnosticism. 
Years later I married a Southern Baptist girl from Rocky Mount, NC and we immediately ran into the problem of what church to attend.  We elected to become Anglicans, splitting the difference so to speak and so we went to All Souls’ Anglican Church in the evocatively named town of Ivy, just outside Charlottesville, Va.   The denomination was one of the schismatic branches off of the Episcopal Church and they were aggressively recruiting priests; I felt a resurgence in that old attraction to the clergy and thought that perhaps their choosiness line was on the other side of me.  Although I was still in residency I enrolled in training to become a deacon in that church.  Eventually our bishop, who had recruited me into the ministry and who was our instructor in the classes we were taking for the diaconate, left our parish under something of a cloud so I abandoned my trek toward the Anglican diaconate.  Besides, their standards seemed a little low.
When we moved to Roanoke, Va., we found an Anglican church that did not suit us because there were almost no couples our age there.  I called my wife’s cousin, an Anglican priest who had been our priest in Ivy and who had baptized our firstborn, and asked him what we should do; he suggested we try an Orthodox church.  He said he had gone to liturgy at an Orthodox Church, and quoting the emissaries of St. Vladimir, he said “I did not know if I was in heaven or on earth.”  Intrigued, we went to the only such church in Roanoke: Holy Trinity Greek Orthodox.  The priest, Fr. Bacalis, was one of those spiritually luminous people and despite the uniformly cool reception we got from the laos (the people in the pews), he inspired us to join their congregation.  Some years later in Charleston SC I became interested in being a perpetual deacon in the Greek Orthodox church, and with my wife’s somewhat reluctant blessing I formally applied to the Atlanta Metropolis to begin training.  For reasons I can only speculate about, my application was the beginning of a long period of non-communication from the Atlanta Metropolis.  I concluded that since the Chancellor of the Metropolis had been my parish priest and since he had heard my confessions, there may have been specific reasons why my application had been put “on terminal hold.” 
My point is that I’m the only person I have ever heard of, possibly the only person who ever lived, who has applied to the ministry in all three major branches of Christianity without it resulting in any kind of ordination.  Sometimes I suppose God sends us messages that are both quite clear but also somewhat embarrassing. 
But it is not that I have not been given a vocation and through this business I believe I have discerned the voice of God saying to me:  “Being a doctor is not enough for you?”  And the truth is, Medicine has brought great meaning and challenge to my life.  In retrospect, perhaps God saw that my desire to get involved in some aspect of the ministry was in some ways a lack of gratitude for the meaning he had given my life through Medicine.  It is also possible that he foresaw some untoward outcome of putting me in a pulpit somewhere.  There can be no doubt, however, that the calling to the ministry and the calling to medicine sound very similar, for they are both a calling to service to mankind. 
One of my many motivations for studying Medicine, in retrospect, must have been some psychological need I had to understand what a human being is.  I did a combined residency in Internal Medicine and Psychiatry so I could understand the diseases of the body and the mind and how they interact with each other.  The model of the human being I was using at that time was the same one used by René Descartes in his six essays called Meditationes.   In the model of Cartesian Dualism, a human has a body (“corpus”) and a mind (“mens”).  In the John Veitch English translation (1901), mind and soul are used interchangeably.  For example in one sentence where Descartes uses the word “mens,” Veitch translates “mind and soul.” This is evidence that as the East and the West grew apart, the model in the West became that a human being had two parts:  A physical part or corpus, and an intangible part or spiritus, into which mind and soul have been condensed.
I learned through my own experience and external observations, however, that humans are not quite that simple.  I’ll return to this issue a little later.
Now I mentioned that we became Orthodox Christians on the advice of my wife’s first cousin, an Anglican priest.  But as with any sort of metamorphosis one undergoes, it was not an instantaneous process.  Allison and I had to do a great deal of reading, and we had to attend liturgy frequently and at the end of about a year, we were quite literally anointed or chrismated into the Orthodox Church.  During the process of reading about Orthodoxy I learned a great deal about history and philosophy and one of the things I learned that surprised me the most was that Orthodoxy was in fact my ancestral house of worship.  The name “Albanese” means Albanian, and it was a name applied by Italians to Orthodox and Catholic Albanian (and also Greek) refugees from the Ottoman conquest of the Albanian homeland.  A number of my family members in New York have made this same journey back to their ancestral Christianity.
Of the most compelling things I learned during our journey to Orthodoxy was that there once existed a magnificent Christian empire in the eastern Mediterranean.  I knew very little about it, but learned that it lasted for a thousand years almost to the day.   They called themselves the Roméos, and they called their empire Romanía.  It is the historical spiritual homeland of all Eastern Orthodox Christians, much as Palestine was for so many centuries that of the Jews. 
How could it be that one of the most important empires in history is little more than empty space on the map of historical consciousness of Westerners, especially Americans?  One reason is that Edward Gibbon, the British historian whose magnum opus was The Decline and Fall of the Roman Empire, the traditional lens through which we perceive ancient Europe, felt that one of the worst events in world history was the Christianization of Rome.  I will quote E.J. Oliver [1958]:  “Although Gibbon judges events in the history of Rome with the serenity, detachment, and seeming objectivity of an English scholar, it is important to note that as the author of his History, he feels as a Roman, thinks as a Roman, and writes as a Roman. His Rome is neither Italian nor Christian, but simply Roman, or more precisely, Republican Roman. It is specifically for this reason that he expresses the strongest opposition to Christianity and the Byzantine Empire (I believe he called them a race of degenerate princes), since he considers the morals and manners of both institutions to be debilitating in nature, and therefore in exact opposition to those of Republican Rome.”  Julius Norwich is another historian who blames the Western lack of interest in Byzantium on the scorn directed at the empire by Gibbon. 
Another reason for the rather startling ignorance of the Eastern Roman Empire in the West is that Byzantium was Orthodox, and for the last five hundred years the religious consciousness of the West has been almost exclusively Protestant and Catholic.  Orthodoxy could only be perceived dimly behind the turbans and keffiyehs of the Muslims of Asia and North Africa, having been engulfed by an Islamic tide.  A hard example of this phenomenon is the book by one of our greatest contemporary historians, Paul Johnson, called “A History of Christianity.” He makes virtually no mention of the Orthodox East in this book. 
The Byzantine Empire’s first ruler was named Constantine the First and it’s last was Constantine the Second.  During most of its existence, it remained one of the most powerful economic, cultural and military forces in Europe.  It was the most stable power of the Medieval period and for much of its history the wealthiest place on earth.  Their culture was a blend of Roman, Greek and Arabic but their language was Greek.  It has also been said that the Byzantine Empire had a Roman body, a Greek mind and an Eastern, mystical soul. 
Come with me back there on the Orient Express to Istanbul, formerly called Constantinople (even by the Ottomans) and before that called Byzantium.  We will dial back the time gauge to approximately 1000 AD, the time of Basil the Second.  The extent of the Empire at that time was Asia Minor (Turkey), all of the Balkans and southern Italy and Sicily.  On this journey we will open the doors of the Hagia Sophia  and look upon Orthodox Christianity; we have a strong ethic in Orthodoxy against proselytism but we are always eager to share the riches of our faith and traditions with others.  We view ourselves as the keepers of an ancient version of Christianity, and although for a lot of reasons we do not encourage conversion from other Trinitarian communities, we believe all have something to gain from knowledge of our way.  Perhaps an analogy would be that in your seminaries, most of you study Greek to enhance your understanding of the Scriptures.  You may have seen the Idaho Statesman Sunday, where there was a front page article about an Orthodox iconographer here in Boise.  While he is devout, as are all iconographers, he sees no conflict with sharing his gift with the non-Orthodox, and he paints these sacred images for churches of all kinds. 
Now the Byzantines had universal literacy when in England, France and Germany it was only the monks who could read and write.  They had female physicians, and a tolerance for Catholics, Muslims and Jews that was unusual in the Medieval period.  While it would be unfair to say that the Jews fared as well under the Byzantines as they do in America today, their lot worsened terribly when the Crusaders and the Latin Kings invaded Byzantine territory.  Byzantine citizens practiced good hygiene when people in France and England smelled like barnyard animals. Much to the dismay of the Franks and Germans who visited there, they drizzled olive oil over their food.  Barbarity!
The West owes a tremendous debt to the Byzantine Empire.  First, for many centuries the Byzantines formed a strategic buffer between the West and the surge of Islam.  The continuity of Western European Civilization exists because of the valiant warfare of the Byzantine cataphract; had they not prevailed for so long this might well be a meeting of imams and mullahs as opposed to Christian ministers.  Second, Byzantine scholars brought the embers of classical thought with them to Italy as the hour approached of the final Turkish assault on Constantinople.  Lars Brownworth, contemporary historian and author of the book Lost to the West:  The Forgotten Byzantine Empire that Rescued Western Civilization,  has noted that of the some 50,000 original manuscripts we have from the Classical Age, 40,000 were brought to the West by these Byzantine scholars.  This was precisely the spark, argues Brownworth, that ignited the flame of the Renaissance. 
The Byzantines had a huge advantage over other civilizations that came before and those that came after.  They spoke and read and wrote in Greek, the language of Plato and Aristotle, but also the language of the Septuagint and the New Testament.  Therefore they understood the Scriptures with the discernment of classical wisdom, patterns of thought that have never been improved upon.  In the West, mind you, classical Greek thought had been largely discarded, for it was pagan and therefore unlikely to be of any value.  In Byzantium the writings of the Greek Fathers were on the bookshelf next to the Holy Bible. 
This is important because not only did the knowledge of the classics affect the way the Byzantines saw their faith, it also had an influence on the way they viewed the world around them.  Medicine, for example, was secular and essentially pagan (Hippocratic).  This fact had significant implications for the way mental illnesses were treated.  For Hippocrates wrote one of the most important essays in the history of Medicine, perhaps of civilization itself:  “On Spiritual Illness.” In this essay he says “I know you Greeks out there all think that when someone develops insanity, it was done to them by the Gods (here he articulates the concept portrayed in the story of Hercules).  But I tell you that insanity represents diseases of the brain.”  Hippocrates had skipped ahead many centuries of medical understanding.  Now in the West during the Middle Ages, as noted by Andrew White in his classic book “A History of the Warfare of Science with Theology in Christendom,” all too often were the mentally ill tortured to death because of the confusion between the mental and the spiritual.  In the Malleus Maleficarum, the infamous treatise on witchcraft, the authors say that one of the ways witches cause harm to mankind is to “deprive them of reason,” in other words, mental illness is evidence of demonic influence. 
The confusion between the mental and the spiritual is found in many places and it always has terrible consequences.  One example is this.  When I was in Charleston SC I was part of the chaplain’s corps of the Citadel (The Military College of South Carolina—you may be familiar with it from Pat Conroy’s The Lords of Discipline).  I was the leader of the Orthodox Christian Fellowship, and once a week I met with the cadets and we would study the Scriptures and the writings of the Holy Fathers of the Church.  When the Commandant of the Chaplain’s Corps, learned that I was a psychiatrist, he puffed out his chest and proclaimed “Doc, I believe that all psychiatric illnesses are basically spiritual.”   He was professing the belief, like the authors of the Malleus Maleficarum, that the signs of mental illness are evidence of a spiritual defect. The implication is that if someone with autism or schizophrenia were to make a heartfelt conversion to Christianity, his or her mental illness would resolve.  This error in thinking is what I call the spiritualization of mental illness.  As I said it was specifically refuted by Hippocrates 2400 years ago. 
This ran directly against my experience.  I said earlier that the body/sprit model of the human being started to run counter to what I was seeing in my professional life.  I knew many severely mentally ill people who were basically kind and while you can’t read hearts or minds, many of them appeared to have very deep faith.  They seemed to be taking in their faiths the only refuge they could find against a lifetime of isolation and torment. 
Let’s do a thought experiment.  We are going to go looking for a spiritual disease.  Could diabetes and sleep apnea be spiritual diseases?  Well, they are both the products of the two of the “seven deadly sins:” Gluttony and sloth.  If the symptoms of mental illness are due to a spiritual defect, why does God supposedly have such an easy time healing depression but a difficult time healing diabetes? 
In the ivory towers of academia, a similar problem exists.  Here, however, because atheism is so firmly rooted in the culture of academics, we see the reciprocal of the problem of people like the chaplain at the Citadel. The university professor perceives concepts like good and evil, spirituality and religion as fundamentally superstitious, and moral issues (for want of a better term) becomes subjugated to psychiatry.  Monstrous behavior is attributed to mental illness alone, and mental illness always predisposes to monstrous behavior.  This is what I call the psychologization of evil, and it is why many psychiatrists resent having to be custodians of pedophiles in psychiatric hospitals when in the opinion of many mental health professionals, they are not mentally ill.  In my experience, mentally ill individuals are rarely dangerous, and those who are usually have chemical addictions.  Many dangerous people who are not mentally ill also have chemical addictions. 
Scientology has very few adherents, but it has a disproportionate impact because it aggressively recruits from within the Brahman class of entertainers.  Its views, dimly perceived in much of the elements popular culture, that the symptoms of mental illness are caused by inhabitation from evil entities, is just as harmful to the mentally ill as the Malleus Malleficarum.
Is it any wonder, since the mentally ill have to contend with some ignorant people within Christianity, academics and Scientologists that we have closed the Mental Hospitals and turned the patients out into the streets?  This society, which perceives itself to be the most compassionate in history, has, I would argue, some very 17th Century ideas about how we should treat the mentally ill.  Patients with major mental illness have a reduction in life expectancy of approximately 10-25 years, most of the mortality coming from cardiovascular disease.  Available data also suggest that there is a significant reduction in life expectancy from PTSD as well; PTSD is not usually included in these data indexed above but in an article by Op Den Velde et al (2011) in Psychological Reports, PTSD among Dutch survivors of World War II led directly to decreased quality of life and a 42% increase in mortality. Were this another category of illness, the CDC would have declared a state of emergency I think. 
St. Paul, who although a Jew was schooled in Greek, writes in  I Thessalonians chapter 5:  “Now may the God of Peace himself sanctify you completely; and may your whole spirit (psyche), soul (pneuma) and (soma) body be preserved blameless at the coming of our Lord and Savior Jesus Christ.”  He makes unmistakable use of the classic Greek model of the human being. 
When I was a young man I had the unparalleled opportunity to study for a year in France.  I call it studying; it was mostly chasing girls.  The most durable part of that experience is the memories of all the people I met there:  French people, international students from almost every country, and a number of expatriate Americans of all descriptions.  One guy was quite a bit older than the rest of us students, he was a Presbyterian missionary.  He told me about his conversion.  Under the guidance of what we Orthodox would call his “spiritual father,” he accepted Christ as his savior.  “I don’t feel any different,” he protested to his mentor.  “It’s not in your feelings,” he replied, “it’s in your faith.” He was saying, the way I interpreted it, that faith is not a psychological experience. 
For Trinitarian Christians, the tripartite model of the human being has a certain significance.  Here are a couple of concepts from Oriented Leadership, a book written by Ben Williams and Mike McKibben as a kind of a guidebook based in Orthodox Theology for lay parish leaders.  “The understanding of God as Trinity was the direct result of experience, of revelation—that God is somehow Three-in-One and One-in-Three.  We human beings have this same image and likeness.”  Also:  “The Church Fathers affirm a Trinitarian nature in our mind, word and breath.”  Mind, word and breath correspond closely to mind, body and soul. 
So there is this view in Orthodoxy that in some sense Man is a kind of a Metaphor for God, and that we are made in God’s image in that we are trinities like Him.  It is important to recognize the limitations of any metaphor; if Christ is fully Human and fully Divine (Chalcedon 451), for example, is his Human Nature also Trinitarian like ours?  The concept of Man being made in the Image of God in this manner is a hypostasis (in mathematics, a hypostatic union is like honey has sweetness as opposed to honey is sweet) like the doctrine of the Trinity.  In other words, you believe it to a point but recognize that it is a concept limited by language and human cognition. 
The three systems of mind, body and soul are distinct from one another but they have hazy frontiers, and each can influence the other two.   Let us examine how the pneumopsychosomatic model of the human being might improve our understanding of various sorts of diseases and how to manage them.  We will do so by examining the relationships between the three systems. 
1.       Psychosomatics.  This is the study of the relationship between mind and body.  I am board certified in psychosomatic medicine, so it must exist.  The perfect example of psychosomatics is the cycle between depression and myocardial infarction, as demonstrated by Frasure-Smith.  We know that if someone has a heart attack, he is four times as likely to develop depression as he would if he had never had a heart attack.  And if a person who has had a heart attack develops depression, he is four times as likely to die of a heart attack during the next year as someone who has a heart attack and does not develop depression.  We already saw how major mental illness yields a reduction in life expectancy, in that case the imaginary arrow goes from the mind to the body.  In the reciprocal of that, a patient with liver failure develops confusion and disorientation, a case of the body affecting the mind. 
2.       Pneumosomatics.  This is the relationship between soul and body.  This relationship can be illustrated by the fact that those who go to church regularly live longer than those who do not.  Scientific articles in scholarly journals have demonstrated the health effects of various religious practices; one study demonstrated significant benefit from being an Adventist.  Of course that study was done at Loma Linda University, but it only proved what we already know.  Moreover Viktor Frankl, the Viennese psychiatrist who spent World War II in the concentration camps, concluded that it was those who had faith who were able to survive the horror, because it gave meaning to their suffering.  But how does the body affect spirituality?  Perhaps the most important way is the manner in which various biological imperatives, like the cravings for food and sex and sleep create distractions for us, and this is why so many traditions (especially perhaps the Orthodox) make use of asceticism as a way to open the nous, the eye of the soul, which we will again look at a bit further on.  Ascetic disciplines in the form of fasting and vigils make the body healthier as well.  As Chrysostom said, “The body tolerates hunger much better than it does gluttony.”  There is an ethic in Orthodoxy that one way to evaluate an ascetic practice is whether or not it is helpful or harmful.  The Orthodox Church disapproves of flagellation, for example, because although it serves the purpose of subjugating the body to the soul by conquering pain in a sense, ultimately it is harmful to the body. 
3.       Psychopneumatics.  This is the relationship between mind and soul.  This one is in some ways the hardest to characterize, because it is a relationship between two immaterial entities.  We know, however, that although faith does not prevent or treat mental illness, it can be an important part of recovery and it can have a mitigating effect.  There are data that show that religious experience decreases the effects of depression, anxiety and substance use on populations who participate (Wink et al., Research on Aging 2005).  In the other direction, when one is striving to improve the health of the soul, one turns one’s mind to the sacred, by reading Holy Books, meditating on holy things and so on.  The mind, when exposed to or turned toward the horrific, can have an impact on spiritual health.  Posttraumatic Stress Disorder is adumbrated by St. John Chrysostom thus:  “…there are those who are under an inner compulsion to sin:  their hearts and minds have become so twisted and distorted, possibly through bitter experiences in the past, so that they can barely prevent themselves from sinning.  This type of sin is really a spiritual disease; we must try to heal such sinners with the same combination of compassion and determination which we apply to bodily diseases.”  Of the six mature ego defense mechanisms described by George Vaillant, five are experienced by most people in a spiritual context including, get this, asceticism.  
Now let us examine the way in which all three systems work together.  We will look at two patients, patient A and patient B. 
Patient A has depression and diabetes.  She is taking an antidepressant and a medication to lower her blood sugar.  She feels like her health is slipping away.  She struggles to balance a 50 hour a week job and managing her relationships with her husband and her children.  She responds to stress by overeating and her blood sugar control is not satisfactory.  She feels she is too busy to go to Church. 
She struggles to fill an emptiness.  An Orthodox Christian, she talks to her priest, who recommends reading the Bible and the Philokalia, he recommends prayer and meditation, observance of the fasts, frequent attendance at liturgy and taking communion. 
Now we return to the concept of the nous, the eye of the soul.  In Orthodox tradition, the nous is normally closed because of the distracting cares and activities of this world.  By reading the holy books, meditating, fasting, consulting with a spiritual mentor, going to church and to communion the eye of the soul gradually opens and the divine light can enter, cleansing and healing mind, body and soul. 
While she had improved significantly on her antidepressant medication, her residual depression eventually subsided.  She gained control of her appetite and her blood sugars decreased.  She felt a calming and an inner peace she had not had in many years.  Patient A has experienced what is properly called noetic healing.  She also evidences what is called metanoia, a recognizable transformation in thought and behavior as caused by faith. 
Patient B is a Viet Nam combat veteran.  While in theater, he participated in the killings of numbers of civilians; he was acting under orders but was deeply conflicted about it, and he wondered for many years later if he could have prevented it.  This is the spiritual injury mentioned by Chaplain Holt a moment ago.  Gory images filled his mind without his consent, and he was plagued by nightmares of these events.  The spiritual conflict over killing affects his mind, such that he is debilitated by Posttraumatic Stress Disorder.  He cannot tolerate going to church because his hypervigilance makes it impossible for him to focus on the service.  He begins abusing drugs and alcohol, including intravenous heroin in an effort to find some kind of peaceful state.  He accidently inoculates himself with hepatitis C, goes on to develop cirrhosis and liver failure, and from there dementia and delirium.  So a spiritual conflict leads to a psychiatric disorder and from there to a substance use disorder and then disease of the body, affecting the function of the mind.  The challenge here may be to find a spiritual way to approach this patient, for the original lesion was a spiritual one, and it is difficult to imagine a durable recovery without spiritual intervention.  As St. John Chrysostom wrote:  “But only when we truly open our souls to the transforming grace of God will the symptoms of spiritual disease begin to disappear.”
To me, these cases are compelling evidence for the reality of the pneumopsychosomatic (anthropiatry or humanology) approach to disease.  One of the greatest problems with it is that not everyone perceives in him- or herself a spiritual dimension.   Once I had a chronic pain patient who was referred to me for psychotherapy, perhaps medication.  He spent the hour talking about how great was his suffering, and the only thing that would help would be escalating doses of opioid narcotics.  His provider, alas, was unwilling to increase the dose of the oxycodone, so the patient felt that life was not worth living.  I had just read Man’s Search for Meaning, so I shared with the patient that faith can give perspective to one’s suffering and perhaps he should explore the possibility of a spiritual answer to his dilemma.  Even though I took care not to recommend any specific spiritual pathway, I later learned that the patient had complained about me to the Patient Representative, noting that I had been “pushing religion” on him.  Physicians have to be very careful about the manner in which they make contact with their patients’ spirituality and in that case I must not have been careful enough.  I for one do not know how to address spiritual issues in such patients. 
Another problem if you want to look at it that way is that we live in a diverse and secular society.  When I was visiting Russia a few years ago, my hosts took me on a tour of a psychiatric hospital.  The hospital was full of Orthodox icons for the patients to venerate.  Presumably the patients were all Orthodox.  The benefits of living in a diverse, secular society are many but among the disadvantages is that you have to tread carefully on spiritual matters and it’s difficult to meet the needs of a large number of patients in one approach.  Nevertheless the Department of Veterans Affairs, even though we a part of a secular organization, recognizes the role of spirituality in the health of the veteran. 
Once some years ago I heard an anecdote about a woman who complained to her gynecologist about being depressed.  She had every reason to consult her gynecologist about depression because most gynecologists are pretty good with depression psychopharmacology.   He surprised her though, by telling her that if she were to accept Christ as her personal savior, she would no longer be depressed.  The gynecologist had violated a Hippocratic principle:  sacerdotalism.  Hippocrates warned that physicians should not get too deeply involved in the spiritual lives of their patients; there are professionals whose job that is and that is not what the patient is paying you for.  There are exceptions to this rule; when I was a student at Georgetown I met physicians who were Jesuits, but you knew right away they were trained priests by the way they dressed.  Most of us, however, know better than to do any more than facilitate interaction between our patients and their professional clergy. 
That’s why at the Boise VA the Chaplains are so important.  I know their value from personal experience.  Last January I was diagnosed with cancer, and the person who was the most important support to me through that terrible ordeal was Chaplain Bramhall.  There were important spiritual elements in my journey to feeling well again and Chaplain Bramhall, and I cannot forget my priest Father Nektarios, made it possible for me to get through that experience.  I had three great catastrophes going on in my life at the same time, and the only way I could rest was to believe that God was taking me apart, destroying me utterly so he could take my component parts and put them together into something more useful than me.  Father Nektarios asked me to read Job, which seemed too obvious.  But I read it with new eyes, closed my Bible and said, “Blessed be the name of the Lord.” 
As Chaplain Holt said in the video, there is a complex interaction between the biology, psychology and spirituality of the patient, and at our VA Hospital we recognize every element of the care of the Veteran.  The role of the minister or priest or rabbi is viewed with great importance on inpatient mental health, medical surgical wards, in Hospice and Palliative Care.  The challenge for me is to figure out how best to integrate the Chaplain’s Service into our activities in Medicine Service; our frontline providers are residents and they are focused on acquiring the knowledge and skills necessary to manage the biological needs of their patients.  But at the Boise VA, we recognize our patients not just as pancreases or dopamine receptors, but as human beings with biological, psychological and spiritual dimensions and we bring healing to them in all three systems.  In my opinion, that's how you care for a human being.   
Sources:
1.       The Byzantine Empire, by Julius Norwich. 
2.       Lost to the West, by Lars Brownworth. 
3.       Decline and Fall of the Roman Empire, by Edward Gibbon. 
4.       Man’s Search for Meaning, by Viktor Frankl. 
5.       The Orthodox Study Bible. 
6.       The Encyclopedia Albanica (theencyclopediaalbanica.blogspot.com).
7.       Greek Orthodox Archdiocese (goarch.org).
8.       On Living Simply, by St. John Chrysostom.
9.       On Wealth and Poverty, by St. John Chrysostom. 

(c) Copyright 2011 Robert Albanese





 

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