Religion has left the hospital: the uneasy silence of professionalization

By Peter Versteeg –

Have you ever wondered why something happened to you? I hope you haven’t because this question often arises when people are faced with something really serious, such as a severe illness or a traumatic event. But what is the nature of this “why” question? Does it seek a philosophical answer or is it an emotional outburst that cannot be answered? As a Master’s student Spiritual Care, I investigated these questions, inquiring into the ways in which spiritual care practitioners hear the “why” question in situations of spiritual counselling. An anthropological viewpoint helps us to not reduce these meaning-making processes to a strictly personal psychology but to understand them as social and contextual.

Spiritual care is support and consultation in relation to ‘meaning orientation’. This can include existential and moral problems. Spiritual care practitioners or chaplains work in fields such as healthcare, the military, and law enforcement. Originally, chaplains were sent by a particular denomination, according to the pillarized organization of religion in the Netherlands. As such there are Catholic, Protestant, humanist, Jewish and Islamic, Buddhist, Hindu, and Eastern Orthodox spiritual care professionals.

While the field of spiritual care is still rather pillarized, this is gradually changing under the influence of the professionalization of the discipline. Although all chaplains are required to develop a particular ‘spiritual competence’, they are foremost trained to develop professional competence in the sense of being knowledgeable about religion and ethics, as well as counselling skills. This professionalization gave rise to a whole new profile of chaplains: the so-called ‘general spiritual care professional’. This new professional chaplain caters to a population of clients who have no articulated (institutional) worldview. However, professionalization does create another problem of meaning. The “why” question testifies to that.

During my internship at a hospital, I observed that many patients ask this “why” question. My colleagues, however, were often not impressed by it. Wasn’t the “why” question a cry for help, an expression of distress? This meant that it made little sense to get into the content of it. The content, after all, lay behind this question, in the realm of emotions. The counselling intervention that was needed was to give room to emotions. Instead of discussing the “why,” the patient should be given the freedom to express their feelings. The problem is, after all, the despair, the bewilderment, about the crisis the patient is facing. From a cognitive anthropological viewpoint the “why” question can be called a template: a more or less standardized way of speaking and acting that is invoked by a particular situation. The concept of a template is related to the term ‘script’; and we can consider the template as a component of a script. In the case of patients, the “why” question is part of the script ‘seriously ill’ or ‘traumatic event.’ Within the spiritual care methodology,  emotions seemed to form the centre of this script, and therefore had to be addressed.

In the experiences I had with patients, it became clear to me, however, that the “why” question could be a genuine inquiry—a question through which people sought an explanation for their suffering. Mr. Wiegers, an elderly man with terminal cancer and a self-proclaimed atheist, wondered if he was being punished. “Have I done something wrong? I don’t believe in anyone up there, but it feels like someone is after me.” Jeroen, a man in his early fifties who had experienced a serious traffic accident, asked how this could have happened. “Is there something I need to learn? Because otherwise, I don’t understand it. Is it like karma?” He tried to fill in the blanks and suggested explanatory models for his trauma. Could it be something like that?

In both cases, the patients turned to me as a ‘meaning expert’. That was my role. However, I could not deliver what they asked for because I did not feel that these questions should be addressed directly. Just like my colleagues, I chose the indirect approach of the emotions: Why is it important for you to get an answer to this? How do you feel about it? From the perspective of emotions, the chaplain provides meaning by enabling exploration of the patient’s feelings. At the same time, it falls short because the substantive inquiry remains unanswered. The specific meaning the patient is looking for is basically ignored.

The problem here is that the professionalization of spiritual care, which is able to address the life questions of individuals ‘without religion’, paradoxically, also produces a particular secular spirituality. Within the field of spiritual care, a common denominator has emerged, i.e. a general psychology of emotional support coupled with a spirituality of acceptance. This widely shared goal orientation of spiritual care brings with it an uneasiness to directly address religious or philosophical questions. I recognize this discomfort in myself as a general chaplain. In the conversations with patients, I discovered that I could not provide a direct answer to their “why” questions. Instead, I sought ways to help patients understand that this question has no answer. From there, I wanted to explore with the patients what the emotional significance was for them. However, this approach was based on my individual agnostic orientation, a worldview that clearly did not align with all my patients’ perspectives.

The professionalization of spiritual care contributes, among other things, to more effectively supporting patients who do not have a clear worldview orientation. The substantive competencies of the chaplain depict them as someone capable of delving into and exploring meaning based on the academic knowledge of religion, meaning, and ethics. This professional content offers ample opportunities to engage in conversations with patients and support them. Often the chaplain then resorts to techniques, such as empathic listening, allowing space for emotions, and providing emotional support. These techniques essentially replace a more worldview oriented intervention. As mentioned, this approach of emotional support with a focus on acceptance is suitable for dealing with very diverse groups of patients, including those who have little or no articulated life orientation. However, it is much less suitable when the latter group has specific existential issues, such as the “why” question. It seems that professional spiritual support sometimes needs a pinch of religion after all.

An earlier version of this blog was presented at the Alumni Day Anthropology, 19 November 2023, VU Amsterdam.

Peter Versteeg teaches anthropology. He recently earned his MA Spiritual Care from Radboud University Nijmegen.