Praying with those who might forget: pastoral considerations with memory impairment

This article gives an account of a person who had memory impairment and received pastoral care, with an emphasis on pastoral needs and prayer. The author provides a first-hand account addressing both sides of the pastoral care interaction. She experienced years of memory impairment comparable to mild to moderate Alzheimer's Disease. Now, however, she is a seminarian. She provides a detailed account of pastoral care received during the time of memory impairment and considers both the visiting pastor's intent and the author's recollection of the prayer and pastoral care received. Part of the uniqueness of this account is that persons with memory impairment do not usually regain their cognitive functioning and then also obtain pastoral education from which to provide the guidance gained as both patient and pastor.     

“Aunt Grace can't have babies”

One of the most necessarily sensitive areas of pastoral care is dealing with perinatal death. This case study grows from a need for care providers to understand better the feelings of a mother in the loss of her baby. This particular exploration evolved from a taped interview with the writer's aunt (now in her seventies) and her dealings with the multiple losses she experienced over fifty years ago. Her conversation in the interview gives credibility to many coping skills that we endeavor to teach today and that she developed for herself out of a need to survive....it was as if the birds would never sing again.-Aunt Grace     

It's Not a Story

This writing presents a firsthand account of living with the certain knowledge that you can't rely on your brain the way you used to. Epilepsy, multiple sclerosis, brain tumor—what do these words really mean day by day, moment by moment? The author blends poetry and prose in her account of forging a new relationship with her own brain. Activities that were once routine are now difficult and even dangerous. No longer is her brain a silent partner as she navigates the debilitating, embarrassing, and occasionally humiliating symptoms of her disease. Can I really get through this shower? How much help do we need today, Brain? Mindfulness practice helps the author become more aware of her moment-by-moment experience. Her therapist prods her to dig into her own story, but the author resists. She resists and yet she shares her story that may not be a story.     

Gray Matters: A Deployed Physician’s Perspective on Combat Medicine in Iraq

A female physician who was serving as a first-year medicine resident in Manhattan in September 2001 writes this paper. It details her experience of signing up for military service as a result of the September 11th attack on the United States. She lays out the surroundings, atmosphere, and reactions of those around her during the attack and details her own personal motivations for joining the military, her need to take control and help those in need heal while also trying to heal herself. Grateful, yet haunted by her experience, she provides an intimate glimpse into her time serving as a combat physician at a trauma hospital in Balad, Iraq during the 2007 military surge. A trained geriatrician and palliative care physician she recounts the stories of several patients that have forever shaped her life and explores the contradictions and ethical challenges she faced while caring for them ultimately struggling with the uncertainty of whether what she was truly doing was good for those she served or herself.     

Power, Medical Knowledge, and the Rhetorical Invention of “Typhoid Mary”

This essay examines the interrelationship between legal, medical, and public knowledge in the case of Mary Mallon. The author argues that although Mallon was never convicted of any crime, she was under the constant surveillance of medical authorities because of her characterization as a recalcitrant “typhoid carrier.” Mallon's physical body became a contested site of controversy as various medical and legal communities fought for the legitimization of their own bodies of knowledge. Modern health care theorists and practitioners still use a plethora of “Typhoid Mary” narratives in their discussions of the relationship between jurisprudence, ethics, and medicine.     

Seeing the Unseen: Pastoral Insights Drawn from James Turrell’s Artwork

According to Charles Sanders Peirce’s framework of semiotics, an individual’s life can be regarded as a work of art that as a sign continuously generates meaning by using various life experiences as its art materials. Here the individual plays a role both as an artist and as a viewer of his or her life. This semiotic implication of one’s life reshapes the general goal and function of pastoral care and counseling. In terms of art, the pastoral caregiver’s role is defined as that of a curator who facilitates the overall environment for aesthetic experience by helping an individual to see the unseen in his or her life as a work of art and does so in a didactic but unobtrusive way. As an example, a series of James Turrell’s art installations suggests how the role and function of the pastoral caretaker can be redefined. This aesthetic perspective also reflects the existential and psychospiritual dimensions of pastoral care and counseling.     

Why Be an Anti‐Individualist?

Anti-individualists claim that concepts are individuated with an eye to purely external facts about a subject's environment about which she may be ignorant or mistaken. This paper offers a novel reason for thinking that anti-individualistic concepts are an ineliminable part of commonsense psychology. Our commitment to anti-individualism, I argue, is ultimately grounded in a rational epistemic agent's commitment to refining her own representational practices in the light of new and surprising information about her environment. Since anti-individualism is an implicit part of responsible epistemic practices, we cannot abandon it without compromising our own epistemic agency. The story I tell about the regulation of one's own representational practices yields a new account of the identity conditions for anti-individualistic concepts.     

Inhibiting the mentalizing capacities

This paper describes a phobic patient who inhibited her capacity to mentalize defensively in situations when emotionally overwhelmed. When provoked by anxiety, she used the ‘silencing-method’, not reflecting on her internal world or her relationships. In order to avoid painful thinking, she stopped mentalizing and used practical or physical activities as a psychic retreat from an unpleasant reality. In psychoanalysis, she developed a growing tolerance to conceiving her own mental states However, even after several years of analysis, inhibiting her mentalizing capacities remained her defensive strategy. This paper suggests that phobia could be understood as an intolerance of conceiving mental states, preventing integration of psychic trauma. Improvement of the mentalizing capacities through psychoanalysis makes phobic symptoms fade.     

Toward professionalism or voluntarism in pastoral care

In its modern evolution as a subprofession, pastoral counseling has increasingly developed professional criteria to determine who can and who cannot legitimately do pastoral counseling. This trend moves pastoral counseling toward the medical profession and away from the life and mission of the institutional church. As pastoral counseling seeks a legitimacy in close association with the medical profession it runs the risk of losing touch with the institutional church—the voluntary associations of Christians that have always been the ultimate source of legitimacy for the ministry in America. The present challenge facing the field of pastoral care is to shift attention from professional specialization outside the church to an effort within the church to train the laity to be effective agents of pastoral care.This article was first presented in the Seminary Series Lectures, The Graduate Seminary of Phillips University, Enid, Oklahoma, during the spring of 1975.     

Thinking about and working with depressed mothers in the early months of their infant's life

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the     

On mirroring in group psychotherapy

“A woman has two images. There is a magical person seen or remembered by those who love her, her finest qualities are flesh and spirit illuminated. She herself knows this ideal self; she projects it, if she is confident; or she daydreams her ideal self; or she recognizes it with gratitude in the admiring eye of others. There is at the same time a second image; the woman as seen by those who dislike or fear her. This cruel picture has an all too powerful mirror in her own negative idea of herself. She sees with fear her own ravaging impulses and most painful of all, a graceless, freakish, and unlovable physical self, this was the mirror her parents held before Edith. Her brothers saw her with love. She herself knew both images. Her life, and her poetry, constituted a flight from the second one.”     

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother

I describe the therapy of a 20-year-old woman who believed that her difficulties in concentrating and remembering were caused by her 'ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.     

The development of a dream from concrete realization to symbolic story

This paper is based on material from an analysis with a girl who was four years old at the time she started analysis. I relate how we worked with her feeling of vacillating, between invading and being invaded by the object, and how she was finally able to let go of her omnipotent control to a higher degree than before. Inspired by Hanna Segal and Donald Winnicott, I trace our progress from; (1) a denial of separation; (2) the analysand establishes a certain sense of separation by creating her own “space”. Through splitting and projective identification, she rids herself of feeling dependent and helpless, feelings that she cannot bear to acknowledge. The analyst receives, contains and names these feelings; to a stage where (3) the relationship established through the agency of projective identification is dissolved, and makes way for an ability to experience dependence as well as a recognition of the analyst as a separate person whom the analysand needs and can use.     

“For-giving” and Forgiving: Process and Practice in Pastoral Care

This article examines some of the basic psychodynamic understandings of forgiveness including forgiveness as aesthetic, ahistorical, tact, or the ability to for-give that Julia Kristeva (1995, 1989, 1987a, b) presents in her writings on depression and melancholia, analytic process and technique, and love and faith. These are supplemented by more recent examinations of forgiveness in the therapeutic community (Worthington 1998; Watts and Gulliford 2004; McCullough et al. 2000) as they relate to Christian belief, Christian practice and pastoral care. I argue that it is in the context of a caring relationship where and when individuals experience “for-giving” that they develop the ability to accept forgiveness (especially of the self) and thus become individuals who can extend forgiveness to others. Even those entering pastoral ministry who have no desire or little ability to engage in pastoral counseling will be served well if their own abilities to be “for-giving” are cultivated during their theological education. Thus, the application of “for-giving” extends far beyond the analytic process or technique that Kristeva envisions to include pastoral identity formation and pastoral ministry.     

Long-Term Psychoanalytic Therapy as a Life-Saving Procedure

A dramatic long-term psychoanalytic treatment of a psychotic character disorder is presented in detail. This patient began therapy with a long standing history of an eating disorder for which she had received many hospitalizations and forms of treatment without any success. She was in a deep despair and as a last resort agreed to a psychoanalytic therapy. During the many years of treatment the eating disorder completely resolved but was replaced by a series of very dangerous accidents that occurred each time she was betrayed and disappointed by a boy friend. This went on pari passu with a deepening understanding of her childhood and her psychodynamics but the middle of the therapy was very stormy and required tenacious efforts to maintain the treatment. The self-destructive behavior was traced to early and profound childhood disappointments and a sense that these were her fault because she was so unlovable and therefore deserved punishment. A dangerous stalemate developed in the treatment after a number of years. The analyst presented the case to colleagues several times and wrote it up in detail, which enabled him to understand his own countertransference and resolve it. This resulted in a dramatic change in the patient and a very favorable and happy ending to this very difficult treatment after 15 years. Although the author believes all patients in psychoanalysis should be approached with as neutral and objective a stance as possible, emphasizing free association and dream material in order to interpret the crucial childhood determinants of the patient's psychopathology, in cases such as psychotic character disorders the outcome clearly also depends on interpersonal factors. The case illustrates the deep partly conscious and partly unconscious interaction between a patient and her analyst over many years of treatment and the profound effect this has on the outcome. It underscores the importance of patients being allowed to heal in their own way and in their own time without intrusion or interference from the analyst. It also demonstrates the crucial importance of long-term psychoanalytic therapy as a life-saving procedure in cases where it is appropriate in spite of the great amount of time and expense involved.     

Providing Pastoral Care Services in a Clinical Setting to Veterans At-Risk of Suicide

The value of enhanced spiritual wellbeing has largely been overlooked as part of suicide prevention efforts in Veterans. The aim of this qualitative study is to examine the clinical pastoral care services provided by VA Chaplains to Veterans at-risk of suicide. This study was conducted using in-depth interviews with five Chaplains affiliated with a medical center located in upstate New York. This study was able to show that some at-risk individuals do actively seek out pastoral care, demonstrating a demand for such services. In conclusion, a pastoral care framework may already exist in some clinical settings, giving at-risk Veterans the opportunity to access spiritual care.     

Pastoral care and the people of god

Various attempts in the last twenty years have sought to understand pastoral care as a function of the congregation, yet even ardent supporters have lost sight of their own vision. This article proposes that we define pastoral care as the work of the church, tie it more closely to the suffering associated with carrying out the church's mission, and develop a model of pastoral care that will differentiate everyday untrained lay pastoral care, care by clergy and trained laypersons, and pastoral psychotherapy. It offers theological rationales and draws implications for pastoral theory.Reverend Burck is Chaplain-Supervisor and Assistant Professor of Religion and Health, Rush-Presbyterian-St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, Illinois 60612     

How Françoise Dolto links Lacanian psychoanalysis with the Christian Gospels

This article introduces to an English-speaking audience of pastoral therapists, the writings of the French Lacanian psychoanalyst, Fran?oise Dolto (1908-1988) on the links she discovered between the most profound question raised by Lacanian psychoanalysis in its dynamics effects and the questions raised by the Christian Gospels. The author summarizes the main points of Dolto's Lacanian thought and where she departed from Lacan in her interpretation of the unconscious ethic of desire. Using Dolto's three writings on Lacanian psychoanalysis and the Bible, as well as material from her published clinical studies, the author illustrates Dolto's approach to the Bible, the parable of the Good Samaritan, and her application of the dialectical principles of desire in three case studies.