Journal of Religion and Health, Vol. 32, No. 1, Spring 1993
Easing Chronic Pain with Spiritual Resources PAUL A. MANDZIUK ABSTRACT: Chronic pain is noted as a growing problem among Americans, often misunderstood and untreated. Frequently, a spiritual crisis accompanies the condition. Pastoral caregivers have a unique role in bringing to bear the expertise of their profession as well as the traditions of prayer and meditation to contribute to the easing of the person's suffering. Pastoral attending can be a key component for relational support and coping with the pain. A brief case study highlights the effectiveness of using the skills of pastoral care for holistic care of the person.
With an ever-increasing number of Americans living with chronic pain, there is a need to respond with all the resources our society can muster. It is estimated that 80 million or more people of all ages in our country suffer chronic pain. 1 People trained in the profession of pastoral care have a bounty to offer to these persons. Chaplains and other people in the ministry of pastoral care can approach people in chronic pain by meeting them in their spiritual crisis, by validating and encouraging good medical and psychological care, and by offering the resources of spirituality in concert with their other treatments. "No one believes that I'm having this pain!" and "No one seems to understand me," are common refrains from inpatients in a pain management unit. Many have written about the subjectivity of pain, 2 as well as the powerlessness that m a n y people in pain feel in all relationships, including their relationship with God2
Spiritual crisis A spiritual crisis can be an opportunity for growth. People faced with chronic pain must confront the same kinds of losses as those who have any major Paul A. Mandziuk, M.Div., is a member of the Missionaries of LaSalette, currently serving as a chaplain at Saint Louis University Hospital in St. Louis, Missouri. 47
9 1993Institutes of Religionand Health
48
Journal of Religion and Health
debilitating illness. If there is an openness to faith, and to honestly examining some of the spiritual issues surrounding h u m a n mortality, the purpose of life, and so on, people in pain can experience new meaning and direction in dealing with the pain. Many who live with chronic pain turn their attention toward God. Of course, this can be both positive and negative. Some turn to prayer and rituals hoping for a miracle cure, and often this can be a sign of giving up on other reasonable treatment modalities. 4 Some will blame God for their condition, or believe that the pain is a punishment from God for sin or for neglect of religious duties. These few examples show how fertile the ground is for pastoral care to be able to respond meaningfully and skillfully to the concerns of those living with chronic pain. The challenge before the chaplain or pastoral minister is to use the moment of attention to God in a positive way, when invited to do so by the person in pain. Often the experience of turning to God in a time of pain results in a "stimulated relationship with God, ''5 or in a return to regular prayer and community worship. The opportunity to speak to a pastoral minister about these concerns, and the offering of new insights into the pain, its origins, and God's presence in the midst of it all, frequently seems to be a turning point. Beyond simply being attentive to God, in some cases the crisis leads to significant spiritual growth. Sometimes the negative views can be challenged by the minister, if the person in pain seems approachable, in order to offer alternative ways of viewing God and God's involvement in the situation; at times, simply sharing one's own faith about the meaning and origin of illness is a beginning. Frequently, more than one contact is needed to establish some rapport and to be able to enter into these issues with some depth. McPherson speaks of the patient as theologian, and notes that what persons think about God affects how they interpret pain and react to it2 He goes on to say that suffering can be creative, depending on how it is met and what is done with it. 7 One's encounter with God in the midst of pain can result in some learning and consolations that are beyond the scope of standard medical treatment and psychological therapies. A deepening in faith can lead a person to previously unknown strategies for dealing with pain. Growth in faith can also lead people to see the hand of God in the sensible treatments that are available, but that sometimes for "religious" reasons have not been tried. Sadly, there is a great resistance to this day among some faith traditions when it comes to drug therapies and psychological resources for pain. Hope is an ongoing concern for those living with chronic pain. Often they tend to want to give up. The pastoral minister can serve an important function in sorting out what "hope" means. Hopelessness is a great temptation for those in great pain. Yet it is essential for the pastoral caregiver to be realistic in talking about hope. 8 In taking a spiritual approach to the person's pain, any magical thinking or miracle-expectation should be avoided. Even with regard to the final object of hope, Pruyser encourages realism; he notes that
Paul A. Mandziuk
49
"hoping is a delicate process, not to be confused with wishing. ''9 Authentic hope refuses to dictate to God what must be done, but rather affirms God's presence now and trust that God will not abandon the person later. Authentic hope acknowledges that God walks with the person through the difficult times, and doesn't always act to remove or relieve the pain. Some Christian theologies speak to the sharing of the Savior's sufferings, the bearing of one's own cross, the redemptive meaning of suffering for the world, and even one's union with God who also suffered. To maintain hope is to draw upon the depth of faith and to refuse to allow the pain to force one to despair. Hope leads one to look for the presence of God in the small victories, instead of in the improbable miracle.
Managing the pain Great advances have been made in the treatment of chronic pain. Major medical centers have programs to assess the pain, and interdisciplinary approaches to bring relief. Often inpatients in these programs are wary of trying some of the treatments; yet many are ready to try anything, since previous methods have been unsuccessful for sustained pain relief. A discussion of all the medical and psychological dimensions of pain treatment is beyond the scope of this article. It is notable that there is a growing recognition by physicians and psychologists of the role of spiritual resources for dealing with the person in chronic pain. Chaplains and pastoral ministers are respected for their valid contribution to the wellness of patients. In some instances, the pastoral caregiver becomes a member of the treatment team. The major resources uniquely available to the pastoral minister are prayer and imagery. Prayer can include various forms and rituals, meditation, centering, simple recitation of favorite words, and so on. There is a vast richness of the variety of prayer in the many faith traditions. Imagery can also include many things: scriptural images, visual or recorded messages, imagination, dreams and interpretations, and so on. These resources can contribute in a positive way to the ongoing life and health of the person in pain. Involvement of the pastoral caregiver in the treatment of chronic pain is consistent with a holistic approach to care. Particularly where spirituality or religion is already important to a person, it should not be ignored in a total approach to pain relief. Nurses are becoming more aware of spiritual needs of their patients, and are often encouraged to consider these in assessment, i~ Frequently people in pain turn to others for assistance and guidance in prayer, 11and this provides an opportunity to introduce them to new and helpful resources. Use of prayer is a primary intervention to aid the person in pain. Acknowledgment of the power of God, placing one's concerns in the hands of the Almighty, crying out in anguish to the Divine: these are all ways of seeking
50
Journal of Religion and Health
refreshment and affirmation for one who has faith. Reading the Scriptures, celebrating Sacraments, praying a Psalm or other pr~yer can bring a boost to a chronic pain sufferer on an otherwise bad day. As Oates observes, there is also a value to prayer in its ability to refocus a person's attention, directing energy away from pain to invest it in an intentional communion with God. 12 A few moments given to prayer can have a great influence upon several hours of living and coping. Use of imagery is another helpful intervention for dealing with pain. Several writers have offered techniques of meditation with imagery, often very similar to relaxation techniques used by other disciplines. Many techniques for imagery involve deep breathing, repetition of pleasant images recorded on audio tape, or focused attention on scriptural images. Wuellner offers a meditation on "God the Healer" and on Christ as the "birth-giver" along these lines. 13 Spending time with Gospel stories, covenant stories, religious art, thoughts of heaven, and so on, can be a source of relief in pain. The imaginative forms of prayer on the patterns suggested by St. Ignatius are helpful, by placing the person at prayer in the midst of the gospel story, in effect becoming the one who is healed, or forgiven, or delivered from the crisis of the moment. Imagery can take the edge off the pain and allow one to focus on more pleasant concerns. The use of prayer and imagery has been compared to biofeedback and relaxation techniques. Often they have similar effects; more studies need to be done to clarify what is helpful and how these interventions work to relieve the pain.
Pastoral attending Persons with chronic pain take many different approaches to managing the pain. Of four approaches noted by Oates, only the realistic way is seen as positive and helpful. 14 Any forms of denial, magical thinking, and stoicism are rejected. Within the positive and realistic responses in pain management, a recent workshop in the St. Louis area discussed eight individuals' ways of dealing with chronic pain. These included: going with the flow; pain management and work adjustment; picking up the pieces; searching for answers; handling it quietly; working full time by applying biofeedback and relaxation techniques; sharing with others through mutual support; and gradually learning. 15The pastoral minister has a role in "attending" to these persons in their struggles and searching. Attending denotes "standing with" and "walking together" through the issues and conflicts and all the difficult days. Professionals trained in the skills of pastoral care have much to offer for meeting with a spiritual perspective the concerns of those in pain. The person in pain expects a different response from the pastoral minister than from a social worker, nurse, therapist, physician, or psychologist. An extremely significant act on the part of a chaplain or pastoral minister is simply to visit the person in chronic pain. Most feel a deep isolation, if not
Paul A. Mandziuk
51
abandonment, by friends and family, and often by church as well. And this can go on to include feelings of abandonment by God. The pastoral minister can be a positive symbol of God's care and presence reaching out to the person in need. The relationship and connection that can be established may become a positive source of healing. Along with visiting, the use of good listening skills is a great benefit to the person in pain. The pastoral caregiver can be a key person to listen to the many feelings expressed, including the anger at God that some hold within themselves. Chronic pain often turns people's lives upside down; the pastoral minister can be an effective listener to help the person maintain realism and yet offer hopeful alternatives. The several facets of the question, "Why is this happening to me?" are possible directions for the active listening of the minister. People in pain are not always the most pleasant people to visit; in fact, they are often avoided by others, perhaps because of the demands they make or the hopelessness they express. It takes patience to be with them, a patience that frequently results in beneficial encounters for both the minister and the person living with chronic pain. Standing with people in pain takes compassion. Every person who lives with chronic pain must deal with a number of losses. Honest concern and support on the part of the pastoral caregiver can go a long way in easing the pain of these losses. A spirituality of adapting to each day as it comes, looking at the possibilities and not only the negatives, can be a lifetime gift. The giving of encouragement is another part of a pastoral visit. When a person living with chronic pain is successful in new ways of coping, or masters new techniques, or attains a desired level of mobility, a celebration is in order. Wilke discusses the value of celebrating the gifts, abilities, and strengths of each person, never allowing the negatives to set the tone for life. TM The pastoral minister can approach the celebration with gratitude and thanksgiving to God, and support the notion that the pain can be "lived with," not just "suffered." Another kind of encouragement is the referral to appropriate medical and psychological resources. Pastoral caregivers sometimes encounter people in pain who have given up, and are unwilling to seek further treatment. Persons who were evaluated for various treatments several years ago and turned away may find other resources available today. Pastoral ministers can be sensitive to the financial burdens that come with chronic pain. Very often a person open to treatment is unable to afford medicine, a TNS unit, or follow-up care after a pain management program. The resources of area churches may be available to help in this regard.
A case study
The following description may illustrate the pastoral caregiver's potential for intervention with a person living with chronic pain. This example
52
Journal of Religion and Health
comes from an encounter with an inpatient on a pain management program. Susan, a woman in her early 40's, was admitted to the hospital to attempt a more complete assessment of her condition and to try some therapies and approaches to pain relief that were new to her. I visited her on an ordinary initial visit, which we attempt to make within 24 hours of admission throughout the medical center. She appeared quite depressed, her room was dark, and she was in bed. She was grateful for the visit; she didn't expect that anyone from pastoral care would visit her, since she wasn't Catholic and was admitted to a Catholic hospital. I assured her that chaplains were available to all patients, regardless of faith or church practice. This led her to speak briefly about the church to which she belonged. She didn't expect any contact with her pastor or any of the church members while hospitalized, because her home town and the town where her church was located were 130 miles away. She expressed some concern about having left her Bible at home; so I offered to bring her one and leave it in her doorway later in the day. When I asked if she would like to pray, she said yes; so I offered a brief spontaneous prayer commending her to God's care and asking that the team working with her would be guided by God to use their skills well. The next time I saw Susan she was looking brighter, was out of bed, and seemed to be making progress in the program. I just dropped by to say hello, and she asked if I had a moment to talk about a few things. In this visit, her concerns revolved around church beliefs and "why" questions. We spoke at length about illness and about God's desire to be present to those in pain, and how suffering isn't always relieved or taken away. She said that this is what she believes, but so many people at the church have a "stronger faith." They believe that God will heal all who have a strong enough faith, and couldn't understand why she has all this pain if she really is a believer. Without confronting her or speaking ill of the other members of her church, I supported her own belief (which was really close to my own). She went on to express her hesitation about using any drug therapies, again noting the pressure from her church that "all drugs are bad." She was also suspicious of psychology and its various approaches, about which her church was extremely skeptical. I invited her to consider the view that all these chemicals and approaches come from God; when used in a helpful and reasonable way, they are part of God's way of helping those in pain. The notion of the guiding hand of God being present in the advancement of medical and psychological treatments and therapies was acceptable and reasonable to her. She found many new insights about her pain, about her response to the program, and about her faith. She was aware that some of this would place her in opposition to the beliefs of other church members, but felt that the new insights and relief outweighed the potential conflicts.
Paul A. Mandziuk
53
Aware t h a t she was so far from home, I made some other brief visits in the th r ee weeks of her hospitalization. I proposed a couple of Scripture texts to use, and explained to her a little about imaginative meditation. For Christians, the Bible is a vast resource for such prayer, I assured her; she would find her own favorite texts as well. I suggested Matthew 11: 28-30, with a p r a y e r including placing herself in the image, with Jesus speaking to her; and Psalm 116, inviting her to see herself as precious in the eyes of God. Susan sent a message by one of her nurses t h a t she wanted to see me the morning she was to be discharged. I was touched by her t hanks and her transformation. She noted t h a t the meditations were helpful, and t h a t she was using imaginative pr a ye r with some of her favorite parts of the Bible, in addition to the ones I had indicated. She was a different person when she left h e r home, and I felt good about being a part of her total care.
Conclusion
Pastoral care has m a n y approaches to assist people living with chronic pain. In all phases of t r e a t m e n t and follow-up care, the spiritual dimension can play a significant role in pain relief. The pastoral minister is a key person to intervene when a spiritual crisis is present, as well as to call upon to offer unique resources for m a na gi ng the pain. Pastoral attending can be the beginning of a relationship t h a t in itself can be therapeutic in pain management. As noted in the case study, often it doesn't take a lot of time or effort to have a major impact on a person living with chronic pain. The expertise and resources of pastoral care have a clear place in the t r e a t m e n t of chronic pain.
References
1. Souhrada,L., "Pain Programs Offer Opportunities for Hospitals," Hospitals, December 5, 1989, 52. 2. Pruyser,P., "The Ambiguities of Religion and Pain Control," Theology Today, 1981, 38, 6. Also, Madden,M, "Let's Talk About Pain," pamphlet. Crystal Lake, Ill., Health and Wholeness Publications, 1985, p. 1. 3. Soeken,K.C., and Carson,V.J., "Responding to the Spiritual Needs of the Chronically Ill," Nursing Clinics of North America, 1987, 22, 609. 4. McPherson,R.,"The Chronic Pain Patient: The Role of the Pastor as Helper," The Christian Ministry, 1980, 11, 25. 5. Soeken, op. cit., 606. 6. McPherson,op. cit., 24. 7. Ibid., 26. 8. Oates,W.E., and Oates,C.E., People in Pain: Guidelines for Pastoral Care. Philadelphia, The Westminster Press, 1985, p.18. 9. Pruyser, op. cit., 15. 10. Soeken, op. cir., 603. 11. Pruyser, op. cir., 11.
54
12. 13. 14. 15. 16.
Journal of Religion and Health
Oates, op. cit., p. 125. Wuellner,F.S., "When Prayer Encounters Pain," Weavings, 1989, 4, 38-40. Oates, op. cit., pp. 14-19. Chronic Pain Outreach of Greater St. Louis, Inc., unpublished notes. Wilke,H., "Disability: Steps Toward Wholeness," Health-Values, 1989, 12, 46.
Easing Chronic Pain with Spiritual Resources PAUL A. MANDZIUK ABSTRACT: Chronic pain is noted as a growing problem among Americans, often misunderstood and untreated. Frequently, a spiritual crisis accompanies the condition. Pastoral caregivers have a unique role in bringing to bear the expertise of their profession as well as the traditions of prayer and meditation to contribute to the easing of the person's suffering. Pastoral attending can be a key component for relational support and coping with the pain. A brief case study highlights the effectiveness of using the skills of pastoral care for holistic care of the person.
With an ever-increasing number of Americans living with chronic pain, there is a need to respond with all the resources our society can muster. It is estimated that 80 million or more people of all ages in our country suffer chronic pain. 1 People trained in the profession of pastoral care have a bounty to offer to these persons. Chaplains and other people in the ministry of pastoral care can approach people in chronic pain by meeting them in their spiritual crisis, by validating and encouraging good medical and psychological care, and by offering the resources of spirituality in concert with their other treatments. "No one believes that I'm having this pain!" and "No one seems to understand me," are common refrains from inpatients in a pain management unit. Many have written about the subjectivity of pain, 2 as well as the powerlessness that m a n y people in pain feel in all relationships, including their relationship with God2
Spiritual crisis A spiritual crisis can be an opportunity for growth. People faced with chronic pain must confront the same kinds of losses as those who have any major Paul A. Mandziuk, M.Div., is a member of the Missionaries of LaSalette, currently serving as a chaplain at Saint Louis University Hospital in St. Louis, Missouri. 47
9 1993Institutes of Religionand Health
48
Journal of Religion and Health
debilitating illness. If there is an openness to faith, and to honestly examining some of the spiritual issues surrounding h u m a n mortality, the purpose of life, and so on, people in pain can experience new meaning and direction in dealing with the pain. Many who live with chronic pain turn their attention toward God. Of course, this can be both positive and negative. Some turn to prayer and rituals hoping for a miracle cure, and often this can be a sign of giving up on other reasonable treatment modalities. 4 Some will blame God for their condition, or believe that the pain is a punishment from God for sin or for neglect of religious duties. These few examples show how fertile the ground is for pastoral care to be able to respond meaningfully and skillfully to the concerns of those living with chronic pain. The challenge before the chaplain or pastoral minister is to use the moment of attention to God in a positive way, when invited to do so by the person in pain. Often the experience of turning to God in a time of pain results in a "stimulated relationship with God, ''5 or in a return to regular prayer and community worship. The opportunity to speak to a pastoral minister about these concerns, and the offering of new insights into the pain, its origins, and God's presence in the midst of it all, frequently seems to be a turning point. Beyond simply being attentive to God, in some cases the crisis leads to significant spiritual growth. Sometimes the negative views can be challenged by the minister, if the person in pain seems approachable, in order to offer alternative ways of viewing God and God's involvement in the situation; at times, simply sharing one's own faith about the meaning and origin of illness is a beginning. Frequently, more than one contact is needed to establish some rapport and to be able to enter into these issues with some depth. McPherson speaks of the patient as theologian, and notes that what persons think about God affects how they interpret pain and react to it2 He goes on to say that suffering can be creative, depending on how it is met and what is done with it. 7 One's encounter with God in the midst of pain can result in some learning and consolations that are beyond the scope of standard medical treatment and psychological therapies. A deepening in faith can lead a person to previously unknown strategies for dealing with pain. Growth in faith can also lead people to see the hand of God in the sensible treatments that are available, but that sometimes for "religious" reasons have not been tried. Sadly, there is a great resistance to this day among some faith traditions when it comes to drug therapies and psychological resources for pain. Hope is an ongoing concern for those living with chronic pain. Often they tend to want to give up. The pastoral minister can serve an important function in sorting out what "hope" means. Hopelessness is a great temptation for those in great pain. Yet it is essential for the pastoral caregiver to be realistic in talking about hope. 8 In taking a spiritual approach to the person's pain, any magical thinking or miracle-expectation should be avoided. Even with regard to the final object of hope, Pruyser encourages realism; he notes that
Paul A. Mandziuk
49
"hoping is a delicate process, not to be confused with wishing. ''9 Authentic hope refuses to dictate to God what must be done, but rather affirms God's presence now and trust that God will not abandon the person later. Authentic hope acknowledges that God walks with the person through the difficult times, and doesn't always act to remove or relieve the pain. Some Christian theologies speak to the sharing of the Savior's sufferings, the bearing of one's own cross, the redemptive meaning of suffering for the world, and even one's union with God who also suffered. To maintain hope is to draw upon the depth of faith and to refuse to allow the pain to force one to despair. Hope leads one to look for the presence of God in the small victories, instead of in the improbable miracle.
Managing the pain Great advances have been made in the treatment of chronic pain. Major medical centers have programs to assess the pain, and interdisciplinary approaches to bring relief. Often inpatients in these programs are wary of trying some of the treatments; yet many are ready to try anything, since previous methods have been unsuccessful for sustained pain relief. A discussion of all the medical and psychological dimensions of pain treatment is beyond the scope of this article. It is notable that there is a growing recognition by physicians and psychologists of the role of spiritual resources for dealing with the person in chronic pain. Chaplains and pastoral ministers are respected for their valid contribution to the wellness of patients. In some instances, the pastoral caregiver becomes a member of the treatment team. The major resources uniquely available to the pastoral minister are prayer and imagery. Prayer can include various forms and rituals, meditation, centering, simple recitation of favorite words, and so on. There is a vast richness of the variety of prayer in the many faith traditions. Imagery can also include many things: scriptural images, visual or recorded messages, imagination, dreams and interpretations, and so on. These resources can contribute in a positive way to the ongoing life and health of the person in pain. Involvement of the pastoral caregiver in the treatment of chronic pain is consistent with a holistic approach to care. Particularly where spirituality or religion is already important to a person, it should not be ignored in a total approach to pain relief. Nurses are becoming more aware of spiritual needs of their patients, and are often encouraged to consider these in assessment, i~ Frequently people in pain turn to others for assistance and guidance in prayer, 11and this provides an opportunity to introduce them to new and helpful resources. Use of prayer is a primary intervention to aid the person in pain. Acknowledgment of the power of God, placing one's concerns in the hands of the Almighty, crying out in anguish to the Divine: these are all ways of seeking
50
Journal of Religion and Health
refreshment and affirmation for one who has faith. Reading the Scriptures, celebrating Sacraments, praying a Psalm or other pr~yer can bring a boost to a chronic pain sufferer on an otherwise bad day. As Oates observes, there is also a value to prayer in its ability to refocus a person's attention, directing energy away from pain to invest it in an intentional communion with God. 12 A few moments given to prayer can have a great influence upon several hours of living and coping. Use of imagery is another helpful intervention for dealing with pain. Several writers have offered techniques of meditation with imagery, often very similar to relaxation techniques used by other disciplines. Many techniques for imagery involve deep breathing, repetition of pleasant images recorded on audio tape, or focused attention on scriptural images. Wuellner offers a meditation on "God the Healer" and on Christ as the "birth-giver" along these lines. 13 Spending time with Gospel stories, covenant stories, religious art, thoughts of heaven, and so on, can be a source of relief in pain. The imaginative forms of prayer on the patterns suggested by St. Ignatius are helpful, by placing the person at prayer in the midst of the gospel story, in effect becoming the one who is healed, or forgiven, or delivered from the crisis of the moment. Imagery can take the edge off the pain and allow one to focus on more pleasant concerns. The use of prayer and imagery has been compared to biofeedback and relaxation techniques. Often they have similar effects; more studies need to be done to clarify what is helpful and how these interventions work to relieve the pain.
Pastoral attending Persons with chronic pain take many different approaches to managing the pain. Of four approaches noted by Oates, only the realistic way is seen as positive and helpful. 14 Any forms of denial, magical thinking, and stoicism are rejected. Within the positive and realistic responses in pain management, a recent workshop in the St. Louis area discussed eight individuals' ways of dealing with chronic pain. These included: going with the flow; pain management and work adjustment; picking up the pieces; searching for answers; handling it quietly; working full time by applying biofeedback and relaxation techniques; sharing with others through mutual support; and gradually learning. 15The pastoral minister has a role in "attending" to these persons in their struggles and searching. Attending denotes "standing with" and "walking together" through the issues and conflicts and all the difficult days. Professionals trained in the skills of pastoral care have much to offer for meeting with a spiritual perspective the concerns of those in pain. The person in pain expects a different response from the pastoral minister than from a social worker, nurse, therapist, physician, or psychologist. An extremely significant act on the part of a chaplain or pastoral minister is simply to visit the person in chronic pain. Most feel a deep isolation, if not
Paul A. Mandziuk
51
abandonment, by friends and family, and often by church as well. And this can go on to include feelings of abandonment by God. The pastoral minister can be a positive symbol of God's care and presence reaching out to the person in need. The relationship and connection that can be established may become a positive source of healing. Along with visiting, the use of good listening skills is a great benefit to the person in pain. The pastoral caregiver can be a key person to listen to the many feelings expressed, including the anger at God that some hold within themselves. Chronic pain often turns people's lives upside down; the pastoral minister can be an effective listener to help the person maintain realism and yet offer hopeful alternatives. The several facets of the question, "Why is this happening to me?" are possible directions for the active listening of the minister. People in pain are not always the most pleasant people to visit; in fact, they are often avoided by others, perhaps because of the demands they make or the hopelessness they express. It takes patience to be with them, a patience that frequently results in beneficial encounters for both the minister and the person living with chronic pain. Standing with people in pain takes compassion. Every person who lives with chronic pain must deal with a number of losses. Honest concern and support on the part of the pastoral caregiver can go a long way in easing the pain of these losses. A spirituality of adapting to each day as it comes, looking at the possibilities and not only the negatives, can be a lifetime gift. The giving of encouragement is another part of a pastoral visit. When a person living with chronic pain is successful in new ways of coping, or masters new techniques, or attains a desired level of mobility, a celebration is in order. Wilke discusses the value of celebrating the gifts, abilities, and strengths of each person, never allowing the negatives to set the tone for life. TM The pastoral minister can approach the celebration with gratitude and thanksgiving to God, and support the notion that the pain can be "lived with," not just "suffered." Another kind of encouragement is the referral to appropriate medical and psychological resources. Pastoral caregivers sometimes encounter people in pain who have given up, and are unwilling to seek further treatment. Persons who were evaluated for various treatments several years ago and turned away may find other resources available today. Pastoral ministers can be sensitive to the financial burdens that come with chronic pain. Very often a person open to treatment is unable to afford medicine, a TNS unit, or follow-up care after a pain management program. The resources of area churches may be available to help in this regard.
A case study
The following description may illustrate the pastoral caregiver's potential for intervention with a person living with chronic pain. This example
52
Journal of Religion and Health
comes from an encounter with an inpatient on a pain management program. Susan, a woman in her early 40's, was admitted to the hospital to attempt a more complete assessment of her condition and to try some therapies and approaches to pain relief that were new to her. I visited her on an ordinary initial visit, which we attempt to make within 24 hours of admission throughout the medical center. She appeared quite depressed, her room was dark, and she was in bed. She was grateful for the visit; she didn't expect that anyone from pastoral care would visit her, since she wasn't Catholic and was admitted to a Catholic hospital. I assured her that chaplains were available to all patients, regardless of faith or church practice. This led her to speak briefly about the church to which she belonged. She didn't expect any contact with her pastor or any of the church members while hospitalized, because her home town and the town where her church was located were 130 miles away. She expressed some concern about having left her Bible at home; so I offered to bring her one and leave it in her doorway later in the day. When I asked if she would like to pray, she said yes; so I offered a brief spontaneous prayer commending her to God's care and asking that the team working with her would be guided by God to use their skills well. The next time I saw Susan she was looking brighter, was out of bed, and seemed to be making progress in the program. I just dropped by to say hello, and she asked if I had a moment to talk about a few things. In this visit, her concerns revolved around church beliefs and "why" questions. We spoke at length about illness and about God's desire to be present to those in pain, and how suffering isn't always relieved or taken away. She said that this is what she believes, but so many people at the church have a "stronger faith." They believe that God will heal all who have a strong enough faith, and couldn't understand why she has all this pain if she really is a believer. Without confronting her or speaking ill of the other members of her church, I supported her own belief (which was really close to my own). She went on to express her hesitation about using any drug therapies, again noting the pressure from her church that "all drugs are bad." She was also suspicious of psychology and its various approaches, about which her church was extremely skeptical. I invited her to consider the view that all these chemicals and approaches come from God; when used in a helpful and reasonable way, they are part of God's way of helping those in pain. The notion of the guiding hand of God being present in the advancement of medical and psychological treatments and therapies was acceptable and reasonable to her. She found many new insights about her pain, about her response to the program, and about her faith. She was aware that some of this would place her in opposition to the beliefs of other church members, but felt that the new insights and relief outweighed the potential conflicts.
Paul A. Mandziuk
53
Aware t h a t she was so far from home, I made some other brief visits in the th r ee weeks of her hospitalization. I proposed a couple of Scripture texts to use, and explained to her a little about imaginative meditation. For Christians, the Bible is a vast resource for such prayer, I assured her; she would find her own favorite texts as well. I suggested Matthew 11: 28-30, with a p r a y e r including placing herself in the image, with Jesus speaking to her; and Psalm 116, inviting her to see herself as precious in the eyes of God. Susan sent a message by one of her nurses t h a t she wanted to see me the morning she was to be discharged. I was touched by her t hanks and her transformation. She noted t h a t the meditations were helpful, and t h a t she was using imaginative pr a ye r with some of her favorite parts of the Bible, in addition to the ones I had indicated. She was a different person when she left h e r home, and I felt good about being a part of her total care.
Conclusion
Pastoral care has m a n y approaches to assist people living with chronic pain. In all phases of t r e a t m e n t and follow-up care, the spiritual dimension can play a significant role in pain relief. The pastoral minister is a key person to intervene when a spiritual crisis is present, as well as to call upon to offer unique resources for m a na gi ng the pain. Pastoral attending can be the beginning of a relationship t h a t in itself can be therapeutic in pain management. As noted in the case study, often it doesn't take a lot of time or effort to have a major impact on a person living with chronic pain. The expertise and resources of pastoral care have a clear place in the t r e a t m e n t of chronic pain.
References
1. Souhrada,L., "Pain Programs Offer Opportunities for Hospitals," Hospitals, December 5, 1989, 52. 2. Pruyser,P., "The Ambiguities of Religion and Pain Control," Theology Today, 1981, 38, 6. Also, Madden,M, "Let's Talk About Pain," pamphlet. Crystal Lake, Ill., Health and Wholeness Publications, 1985, p. 1. 3. Soeken,K.C., and Carson,V.J., "Responding to the Spiritual Needs of the Chronically Ill," Nursing Clinics of North America, 1987, 22, 609. 4. McPherson,R.,"The Chronic Pain Patient: The Role of the Pastor as Helper," The Christian Ministry, 1980, 11, 25. 5. Soeken, op. cit., 606. 6. McPherson,op. cit., 24. 7. Ibid., 26. 8. Oates,W.E., and Oates,C.E., People in Pain: Guidelines for Pastoral Care. Philadelphia, The Westminster Press, 1985, p.18. 9. Pruyser, op. cit., 15. 10. Soeken, op. cir., 603. 11. Pruyser, op. cir., 11.
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12. 13. 14. 15. 16.
Journal of Religion and Health
Oates, op. cit., p. 125. Wuellner,F.S., "When Prayer Encounters Pain," Weavings, 1989, 4, 38-40. Oates, op. cit., pp. 14-19. Chronic Pain Outreach of Greater St. Louis, Inc., unpublished notes. Wilke,H., "Disability: Steps Toward Wholeness," Health-Values, 1989, 12, 46.
