FIFTH NORMAN AUTTON MEMORIAL LECTURE

delivered by The Revd. Canon Ian Ainsworth-Smith, MBE
at Southwark Cathedral, London
on Tuesday 5 December 2006

“On re-discovering the integrity of Pastoral Care”

There is, as you may know, a Punch cartoon of the curate, somewhat naïve, who is giving his magic lantern lecture.  He looks his audience up and down and says “My dear friends, I shouldn’t call you friends since I know you so well…..”  It feels a little like that today.  Thank you very much indeed, Edward, for your invitation.  Indeed, what do we say about Norman?  Norman was an inspiration to so many of us.  I realise that I first met Norman over 40 years ago in his room at St George’s Hyde Park Corner.  I subsequently got to know that room rather well when it was the chaplaincy room at St George’s.  Norman was crucial for a group of us, now, I imagine, heading into retirement.  We were, I think, an especially “difficult” group of 1960s post ‘Honest to God’ ordinands.  Many of us believed that we were called to the ordained ministry but were pretty sure that the parish ministry was not for us.  I remember talking to Norman and having wise counsel from him.  I promise this is not a St George’s Hospital takeover today.  But I did enter a very rich inheritance at St George’s.  There was not a day in my time there that I did not bless the memory of Norman and indeed of Trevor Nash his successor and my predecessor for helping to make St George’s such a splendid place to minister in.  It is very good indeed to have Audrey Emerton, an old friend and colleague, here as well.  Not long before Norman died, the St George’s Nurses’ League ran a full study day on chaplaincy at St George’s, then and now.  It was a pleasure and privilege to be able to share that with Norman, to hear his wisdom and to hear how much he was respected and loved and to take part in that day, in the event, not long before his death.  The journey on which Norman started has been critical for many of us.  Something like six months into retirement I tried to think what is my “take-home message”, not having done any healthcare chaplaincy during that time!

In Research Ethics Committees you sometimes consider a drug that has to be eliminated from the system before you give a new drug and you then talk about a “wash-out period”.  So what is this message?  Very early on in my chaplaincy career a group of us found ourselves being supervised and consulting with Mary Welch.   Mary was a very distinguished Jungian Analyst who subsequently married a bishop!  In the 1970s she was superb mentor for a group of us clergy who were struggling with what a pastoral identity might be about.  Certainly in those days we had drunk heavily at, what I might call, the secular wells.  We had taken seriously the disciplines of depth psychology, and sociology and the rest.  I remember one particular meeting where Mary looked us up and down and said “Don’t forget to be priests and pastors at the same time.  You have something to offer which is crucial.  Don’t back away from it”.  And so I would like to borrow a title closely associated with Alastair Campbell’s 1982 book, ‘Rediscovering Pastoral Care’.  Pastoral care is sometimes less clear cut than its sister disciplines but worth the effort nonetheless.  There are many texts to which, as chaplains, we can turn.  We can think of Norman’s own books on the pastoral care of the sick, dying and the bereaved.   It was exciting to be able to develop and update some of Norman’s thinking when Peter Speck and I re-visited it in the ‘New Library of Pastoral Care’.

I think too of some of the people who now seem historic figures, but who affected us deeply at the time.  Do you remember Heije Farber, a Dutch Chaplain, who in 1971 wrote a book called ‘Pastoral Care in the Modern Hospital’?  He spoke of how chaplains and pastors could very easily feel isolated from each other and indeed de-skilled in the hospital by the apparent abundance of secular technology and expertise.  He was among the first to acknowledge that issue.  Interestingly he offered the idea of clowning, that you don’t, in fact, have to know everything and that there is sometimes a place for humour.  Heije also was the sort of figure you were drawn to and he gave many of us ideas.  I am all for the ideas of clowning.  However, I remember I once had a supervisor from Kentucky and on one occasion when I had attempted rather inappropriately to be a clown in a psychiatric setting and it had gone off rather badly he said to me, in his inimitable accent, “Ian, you can make a fool of yourself for Christ but you don’t have to make yourself a prize jackass”!   He was right to offer that warning.  The clowning theory is valuable except that it can sometimes, with some pastors, finish up making yourself into a victim who then becomes an object of ridicule and almost enjoys in some perverse way.  There is nothing particularly valuable in that although I endorse the need for the place of humour in pastoral care.

The other book which was certainly around when I first came into chaplaincy was Michael Wilson’s book “The Hospital: A Place of Truth”.  I still have that on my shelves in its original ring-binding!  Michael reminded us of several things.  Firstly how rapidly our hospital and healthcare systems were developing.   He wrote at the time too, when technologically-based healthcare certainly seemed to be on the up.  He looked very usefully, in a way in which we may now wish to look back on, and indeed revise, at some of the assumptions made in healthcare. I am sure that many of you here today will have considered Michael’s six assumptions made in healthcare?  He suggested that among some of the things that chaplains might want to look at was the assumption that staff assumed power over patients. 

Things may have changed now.  One of the things that I have noticed is how “patient power” can turn the balance of power in the other direction, especially in a world where a want and a need and a right can become confused and conflated.  Clearly there are some situations in which the patient is very disempowered and staff seem to hold power.  As a converse, I spent much of my time shortly before leaving St George’s supporting a consultant colleague who had, I believe, been the recipient of a vicious and untrue patient complaint.  As chaplains, we cannot appear to be the “stooges” for our fellow healthcare professionals but we should recognise that the principle of fairness must recognise that the power balance can run both ways!   Michael reminded us of the frequently made assumption that every problem has a solution. 

I remember very early on in my chaplaincy career arriving in an intensive care unit, greeting the nurse and saying to her,  “Jane, what a terrible smell!”  There was a consultant round going on and she said “Say that a bit louder!”.  Some very enthusiastic cardiac surgeons were working on “their” bit of the patient rather effectively but his legs were going gangrenous…  That is a good example of how carers can sometimes develop a tunnel vision.  We have some responsibility, I think, to raise questions about that.  We used to hear much, and at times we still do, about the role of prophecy in chaplaincy.  That I do fully appreciate and understand.  We need certainly to have the confidence to challenge a situation and thereby, hopefully, to help make sense of what is going on.  

One of the most backhanded compliments I ever received was from a doctor on an intensive care unit where the chaplains had developed a reputation for “trouble shooting” and sometimes calming a difficult situation.  His comment was, “I see your role at times is to operate the oil can.  But”, he said, “I hope you might feel free on occasions to have a well placed spanner ready to drop into the works!”  The sub-text might be: when do you operate the pastoral oil-can and when might be the time for some constructive spanner dropping?!  The latter function is traditionally what a prophet does.  We should, however, note two points.  The first is that an authentic prophet always speaks inside a situation and does not thunder at it from outside. 

At chaplaincy conferences over the years we have heard colleagues telling us how they were confronting their Trusts in a prophetic manner.  When you heard the story you could certainly see that the story had another side.  I have never been able to see any value in confrontation for its own sake.  I recall a particularly rich conference in St Andrew’s some years ago when a biblical theologian reminded us that prophecy is not the only strand in the Hebrew Bible.  Another “Wisdom” strand is quite definite that you may sometimes have to get inside the system, understand it and, if you like, play it long.  Norman taught us that our models need constant re-visiting.  For example, our practice of pastoral care has been largely undergirded by the exponential growth of the counselling movement, its skills and insights.  Most of us would now take counselling as a discipline very seriously.   We should have learnt our counselling skills properly.  But I would like to quote from a colleague, David Lyall, a very experienced hospital chaplain and pastoral educator from Scotland.  He says, “When a ministerial student learns counselling skills he (or she) most often does so in an extra-theological context.  The vocabulary and rhetoric he learns are those of another profession.  The student can very easily be left with a question, “How am I different from a non-ministerial counsellor”?  The common result of such an approach is that the student or pastor tries to adjust himself either as an inadequate theologian because he may well have been told that in training, or as a second-class counsellor. David points out both the strengths, but also the risks, inherent in therein, taking counselling skills as the only necessary component of chaplaincy.   We also know that counselling approaches whilst they have been invaluable sometimes may have sometimes been over-used and uncritically used.  For example, there is an increasing body of well-evaluated literature that seriously questions the value of much structured post-trauma counselling.  There is always a very thin line between help and persecution. 

My colleagues here today may recall a particularly tragic staff suicide in our hospital some years ago.  I was telephoned by the manager who told me what had happened and asked me to accompany him when we told her colleagues.  They were duly horrified and shocked, as one might imagine. After a while we stressed to them that they needed to be in charge of what was best for them on that day.  The Manager offered to provide any extra staffing, a good reminder what pastoral care and good management can go together! They asked me for three things,   “Would you come up this afternoon and put the kettle on as you have done now; would you bring a candle so that we can sit in a circle and remember her; and would you please make sure that we are not counselled”.  All these things seemed perfectly legitimate pastoral requests.  After other traumatic occasions there will always be some people, of course, for whom the loss had raised other losses which they did need to seek help for and which, paradoxically the way it had been handled left them free to look back. 

One function of pastoral care, I am quite sure, is to try, however tentatively, to put into actions, sometimes words, what other people can’t say.  We have that enormous privilege, particularly so in sector ministry, of being able to make that finger-tip contact with the unchurched.  I suspect that institutions with a new chaplain do, at some level which is probably quite unconscious, put the chaplain to the test.  If you can get through that test then you may be allowed into the next stage of trust.  This testing may be experienced as a persecution or confrontation but it can equally be an opportunity.  I remember that my test came very early when one of our distinguished physicians died.  He was a pleasant and friendly man and also a non-believer.  It was quite clear that some sort of memorial occasion was necessary to do justice to his memory.  His wife telephoned me and said, “What shall we do?” and I offered the chapel for a memorial concert.  The word got around that the chaplain had refused to do something for this particular consultant!  The misconception was rapidly rectified by family and colleagues and everyone was wholly supportive to me.  It was a breakthrough in relating to the hospital. 

A crisis may provide a learning opportunity as well. If we examine some of the historical development of pastoral care this may help.  You may remember Clebsch & Jaekle’s work “Pastoral Care in Historical Perspective”, written in 1964 and examining this development.  The authors took the experience of the Early Church where you not only had to heal the breaches and lapses in a church that had to survive under persecution, but also to sustain people struggling to survive.  Contrast their approach with Stephen Pattinson’s book, “A Critique of Pastoral Care”.  Affected by the liberation theologians he looked at the issue in a different and challenging way and  I am sure that colleagues here today can speak of the impact of his approach on mental health chaplaincy, against a climate of patient empowerment and advocacy.  Paul Halmos’s book “Faith of the Counsellors” (1964) pointed out the illusion of value-free counselling.  Counsellors always, he said, brought their own assumptions.  Problems are rarely individual. The pastoral role is one where we may have to live with, endure and sometimes enjoy, mixed messages.  

I remember that Tom Leary, a priest colleague in the Southwark diocese, once presented to the St George’s Hospital Psychotherapy Unit the findings of some excellent research that Tom and others had done on clergy marriages.  Tom and I, both became aware that some of our audience was switching off around us.  We stopped the meeting and asked what that was about.  One psychiatrist commented, “I am finding this very difficult because if the clergy cannot make a success of their marriages what hope is there for the rest of?“.  He was fully aware that, to use the jargon, he was using a powerful  and unconscious projection.  He recognised its illogicality.  Mary Phipps was quite right to remind us junior clergy all those years ago that sometimes we are the receptacle of other people’s longings.   Wesley Carr, is quite right to point out that the power of pastors may lie in the power of rituals that fascinating way of putting the unsayable into action which may have a significance way beyond the conscious.   One thing you don’t do with a ritual is to try to make sense of it or to explain it.  You may just have to go with it.  That activity becomes more complex as we increasingly lose our ability to connect with a common religious language.  Summoned to the bedside of somebody dying in South London, you could not assume in the middle of the night that the family round the bed would necessarily know the words of the Lord’s Prayer.  So liturgy and ritual should be used imaginatively and courageously.   Equally, I had a request from a doctor colleague at St George’s, a non-believer struggling, I believe, towards belief, who was dying and who said quite simply, “At my funeral will you simply use the Book of Common Prayer Service?”  I said, “Including the Calvinist bits?”  The doctrinal fine-tuning was my problem!  But it was important that something was done, and properly done, which did not need to be explained.   I was approached by a psychiatrist specialising in learning disability to meet a family of a young man with a severe learning disability whose mother had died some time previously and he had not been told.  His reaction, on subsequently hearing of his mother’s death, had been to mutilate himself, in fact tearing out an eye.  This is not to judge his family who genuinely believed they were doing the right thing for him at the time.  With everyone’s permission, the funeral service which I took, attended by the young man, his family and the caring team, was filmed.   You could see from his body language and demeanour that he was “connecting” with his mother’s death through the liturgy and through the occasion.   The words did not really matter.   

As I move towards a conclusion, I am also aware that we are moving into a different sort of world, one which many of us have to struggle to understand but there nonetheless.  So I would like to use the two words “multi-culturalism” and “post-modern”.  This is not the beginning of a long exposition, but a reminder of the fact that the assumptions which we made in chaplaincy over many years and which drove us on, are ones which may need, and will have to be re-visited.  I don’t, myself, believe that post-modernism is a concept of which we should be afraid.  But the notion of post-modernism reminds us that we may be able to assume absolutely nothing.  The hallowed “Four Principles” of medical ethics, beneficence, non-maleficence, autonomy and justice, are ones which will need something of a tweak if we look at them in a “post-modern” way.  They now seem rooted in a Judaeo-Christian and probably Islamic tradition which we could no longer take for granted.   However, as an aside, I have also noticed that on occasions, even in the most “secular” environment, a thoughtful theological input may indeed be heard with care and respect.  I chaired an NHS Research Ethics Committee for a while during the time when there was all the upset and publicity about the inappropriate post mortem use of children’s body parts.   Some of us were involved in the follow-up to those events.  There was in The Tablet an extremely good article, written by a college chaplain at Oxford who was herself a pathologist, asking in theological terms, “Why does this matter so much?” and she did a very good theological exposition which I put on the agenda of my Research Ethics Committee and said somewhat rather apologetically “l if you are chaired by a chaplain, you might get some theology on the agenda now and again” to which they all said “that’s fine!”.   I don’t actually believe that a thoughtful, theological exposition will necessarily remain unheard. Good pastoral care must be about taking the present experience absolutely seriously but giving space and the resources to look beyond it. 

But to return, for a moment, to the real world in which we are ministering at the moment and of which I can see something, even as a jobbing vicar in rural Somerset, is the letting go of images and assumptions on a scale that I don’t think we could have envisaged.  It seems to me that this fragmentation goes with consumerism.   The fact is that increasingly people may choose hospitals; they may choose their funeral ritual; and they certainly choose their wedding venue.  It is another world which we may not fully understand; which we may want to rail against or possibly go with at times.  I think it is to the world above all of pluralism where we know that many different views will operate inside one ward, one family, and thank God also inside a chaplaincy. I have made the mistake, which Peter Speck also admits to.  On one occasion, at a multi-faith conference where there were people from the Judaeo-Christian, Islamic tradition and also Buddhists, I said, “We only have one life”.  “Oh no we don’t”, the Buddhist pointed out.  So the message must be “assume absolutely nothing”.  Things that we have previously taken for granted we certainly cannot any more.  In my experience in a large teaching hospital there was not necessarily an assault on the Christian tradition from people from other faiths.  Sometimes the niggling came from what I would call the “secularist” position.  You can’t necessarily, if you like, go back to the grand script and claim it from there.  And certainly one of the things most modernism raises is whether we assume grand narratives which can no longer really be there.   We now live inside this very fast-moving consumer world and I can’t believe that this doesn’t and won’t affect our pastoral care.  The phrase which I note is  “modernity is built in steel and concrete” and reflects many of our hospitals, triumphantly put up in the 60s and 70s.  Post-modernity is more built in biodegradable plastic.  In other words what appears certain may constantly need to be re-visited.  That I don’t see or believe is necessarily a problem for us.  I do think it involves re-thinking much of our chaplaincy practice. 

One of the things which we hope we are good at is working with bereavement and loss.  So I think it is not too fanciful to suggest that in addition to working with individuals facing loss, we may well find ourselves ministering to ourselves facing the loss of certainty and sometimes the loss of position.  We may well find ourselves, and I believe we are increasingly so, working inside a health service which has to mourn its losses, to mourn a golden past that may be was, or may be wasn’t, and to mourn the loss of a vision.  Of course, churches and faith communities may equally need help and support and I believe that a contribution of we who are sector ministers is to re-write the narrative and to face uncomfortable truths and new opportunities.  I hope we have all learnt that grief for grief’s sake can become pathological.  There is no point either institutionally or individually carrying on with the grieving and the lamenting if it gets us nowhere.  Grief is about owning the past in order to look forward.  I use Michael Wilson’s rainbow image quite consciously, but I go back really to where I began wanting to thank the people like Norman, the people who gave us the vision, the people who above all made it clear that we didn’t have to do it their way.  We could go out with confidence, ask questions, make some mistakes, share the experience together, and have something to hand on to colleagues for reaction, comment and action.   

Thank you.

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