Wednesday, February 9, 2022

The Psychological Autopsy and the Unvaccinated

Psychological Autopsy is the title of number 4 of a monogram series. Written by Avery Wieseman and Robert Kastenbaum and published in 1963, we are going back a few years. Both are remembered for their work in researching grief. I heard both years ago at grief seminars. 

I was nine years into my experience as a full-time chaplain and I had already begun to train lay people as story listeners in the hospital. We were to find that grief stories in some form provided the main category of stories heard by the Befrienders. We started a grief resource group in January 1975 to study grief in its many aspects. Then in 1976 we started a grief recovery group which went through many different phases before I retired in 1992. Genesis Hospital has since closed the grief recovery program. 

 

I came across this book in 1971 on a Clinical Pastoral Education sabbatical at the Alcohol Treatment Unit, the University of Iowa, Iowa City, Iowa. This was a very helpful learning experience providing deep insights into the issue of both addiction and idolatry in Scripture. Also how alcohol is used as a pain reliever in handling grief and losses of all kinds in the craving of being better, even perfect. 

 

The counselors at the Alcohol Treatment Unity talked about fractional suicide. Addictions take their toll on our life expectancy, lowering the years we live. And with Alcohol Addiction, the terminal face is either DT’s or Kidney failure. The terminal phase would be different for others. Smokers often have pulmonary obstructive lung disease and obese often have a diabetic condition with complications. The sources of the health problem are part of the psychological autopsy in answer to the question: when did they start to die.

 

Sometime after my reading of the Psychological Autopsy I had a situation in the hospital emergency room which was a classic example. A man working at the Rock Island Arsenal had a cardiac arrest. A young medical intern who was assigned to the Arsenal began procedures to resuscitate. He worked during the ambulance ride to the hospital and continued in the emergency room. The wife arrived and I spend some time hearing her side of the story. Her husband removed himself from relating to his family, even his wife, although they lived in the same house, eating and work was his only activity. 

 

I had a chance to visit with the young doctor after the wife left the hospital. I heard his lament about not being able to save this man’s life. I then shared with him the story I heard from the wife and the monogram on the psychological autopsy. The question was evident, when did this man begin to pull away from life and relationships. I do not have that story. What I have is the story of his dying process which began long before his cardiac arrest. Was his cardiac arrest part of a broken heart experience, loss of purpose and meaning, etc. We have questions without answers other than there is an in-depth way of studying our dying process: the psychological autopsy.

 

I know about this first hand. When the family farm was lost in 1938 under questionable legal circumstances followed by my father’s inability to get an automatic calf feeder on the market, he began to register a depression that became chronic and next, manifesting itself in a heart attack leading to an early death. There is a parallel in the broken heart syndrome. His unresolved grief did encourage me to facilitate a grief recovery group for 17 years to provide for others what he didn’t have himself. And this week the newspaper carried a large article on the broken heart syndrome listing various causative factors.

 

Moving fast forward to the pandemic and 2000-2002 with various mutations of the covid virus we have misinformation, excuses for resisting being vaccinate, anti science, no mandates, etc. all potential behaviors that can lead to death from the virus and can be registered under the psychological autopsy. 

 

An unvaccinated person may carry a hidden weapon, the virus, which can be he the cause of their death or others. And those who distort the best information we have at a given time as we continue learn more, this is a process, they may unintentionally or even intentionally contribute to a persons death. Example: my brother in law had a person he worked with buy into misinformation. He refused to be vaccinated He came down with the virus and went to the hospital where he died. I doubt if misinformation will be found on the death certificate. I doubt if the name of an unvaccinated person who spread the virus will be found on the death certificate. If you ask the question, when did this person start to die as posed by my understanding of the psychological autopsy, you have many contributing factors not identified. The reality of this dynamic requires a serious look in how you define freedom.

 

There is a forensic psychological autopsy professional for suicide. My niece is giving some consideration to studying for that profession.

 

Shalom,

Marlin Whitmer

  

Sunday, February 6, 2022

Correction: No light at the end of the tunnel

 Way back when the expression "light at the end of the tunnel" was actually read in more than one place to describe what was happening we were hopeful the worst was over. Now how long has it been. I have lost track of time in this timeless journey with the pandemic.

I have lost interest in tracking the metaphors. What has taken over as the virus has gone through various mutations is polarized society almost along political lines with other variations. Misinformation has been rampant. Anti-science has even evident. Court fights of mandates, masks, vaccinations, etc. have been evident. 

For myself at 91 years of age the last few years have been a self confinement. I haven't been out to California to see my family for three years and they haven't been here. Because my grandchildren here didn't want to be vaccinated we didn't meet.  Now they have had the virus so that is their excuse for no vaccination. They have all kinds of excuses.  I haven't seen them for some time. Texting and email and phone conversations have replaced face to face. The family did try Zoom a couple of times. I don't feel like much a grandparent when I look back on the relationship I had with my grandparents. 

The pandemic has made the grieving process different. The accumulation of loss and the various losses have generated the biblical laments for naming the pain. This is where metaphors come in now. They name the pain.

Saturday, February 5, 2022

The Emergence of Story Listening

My introduction to story listening came in the summer of 1953 in a Clinical Pastoral Training session at Bellevue Hospital, New York City. Fred Kuether was our supervisor. He gave us the experience of story listening by listening to  our stories and seeking to see how we were staying with the stories we were writing down in the verbatim of remembered conversations, one a week for 11 weeks.  

The dialogical approach was reinforced at the Virginia Theological Seminary where Ruel Howe introduced us to Martin Buber's I Thou approach. He lectured in a dialogical manner as the content of the class was a shared experience between professor and students. He later wrote a book on the Miracle of Dialogue.

After ordination I began practicing story listening in difference parishes. I finished my needed quarter of Clinical Pastoral Education in 1964 at Bellevue in order to be certified as a Hospital Chaplain. A couple summers before that I service as night chaplain at Bellevue to test my calling. 

In 1965 I became a full time chaplain at St. Luke's Hospital in Davenport, Iowa. Story listening was my focus as I made visits with hospital patients and staff.

I came across a book by Chad Sarah, The Samaritans, during those first years. The book is about his beginning a suicide prevention group in London. As they began to see people in emotional distress, the people would gather in the undercroth of the church waiting to visit a counselor. Lay people began serving tea and engaging in conversation. Then the professionals discovered they only needed to see half of those coming. As a result the lay people became a part of the program. Half the book was the story of their beginning and the second half was about the different emotions of the people who came. They were the same emotional dynamics of many of the hospital patients.

With the book as background a person came to my office with a request. Mavoreen said, "The Auxiliary rule is we are not to visit with patients when we take the notions cart around. I think patients want to visit, how can we change the rule." The change didn't happen over night. When I proposed to the Administrator training lay visitors I encounter resistance, "we're only concerned with what takes place within these four walls." Getting involved with folks not part of the medical community was overstepping.  At a later visit as I persisted he made a proposal. I would have to get permission from the Auxiliary, nursing service, and the medical staff. The Auxiliary said yes, nursing service said we will go with the doctors decision, and the medical staff of the doctors took over an hour to decide and then they made a decision not directly related to what we were about to do. The Sisters of Mercy visit patients and they aren't ordained. I know this since the secretary of the meeting told me some time later. After retiring he took the Befriender training.  He said later, "As a doctor I knew what I would say when I entered the room, as a Befriender I would find out."


To be continued.


 


 




Wednesday, October 13, 2021

I say he was "religious!"






IMG_1107.jpg


This is the picture of a horse and colt done by a pentalist artist. The drawing is done with a very sharp pencil making dots on the paper. The artist was invited to many horse shows to draw a memorable horse. There is more to the story of this picture than a horse show.


The artist was being treated for cancer and his daughter shared an observation with her father. You have never drawn a picture of a mother horse and her colt. He did not respond right away but he did begin. And the first drawing had the horse on one side of the drawing the and colt on the other. Then he drew another as his cancer progressed where the horse and the colt were closer together. His last drawing before his death was this madonna and child. 

He claimed to the end that he wasn’t religious. I say his drawing says otherwise. Religion from the Latin language is made up of two words re and ligio. We get our word ligament from the root word. And re is again and again. Re-runs, etc. Religion is how we connect with deeper meanings again and again. Maddona and child is definitely about a deeper meaning. 

The family had the funeral service at St. Peters Episcopal Church in Bettendorf. Iowa. I gave the homely and I had the picture propped up in a way so many could see it. His Faith journey is in the picture and his daughter’s invitation allowed him to make a powerful connection with compassion and love. The picture is an archetype transcending the mundane in a timeless way. 

The homely was longer but the distance of years keep me from reinventing all that I said. The gist of what I said is here.

More could be said, but for now let your imagination feast on this pencil drawing.

As one philosopher says, Susan Langer, our symbols are imbedded in us and they come out in music, art, and language.

Shalom,

Wednesday, September 22, 2021

An Advocate for Physical Therapy

Experience can be our teacher although you wonder sometimes how some people seem to learn so little from experience. The experience I want to commend comes from a number of sessions with a physical therapist. 

I asked my doctor for a referral to the location where Niki is the physical therapist. Annie, my wife, had been helped by the exercise to overcome some pain. My doctor made the referral and I was soon on Niki's schedule.

I wanted her to address the issues I have as I age. Balance was a major issue. The first time I had a series of 8 sessions also included help with back pain from a couple herniated discs in my back. I first experienced the pain in 2009. We are talking about 11 years with this ordeal. I have tried various approaches. Surgery was not on my list. I hear too many people have surgery without all of the best results. I don't know if it would make a difference. At my age in the 80's it was not an option and now I am 90.  Surgery is even less of an option.

Now at 91 I have been back to see Niki. I needed physical therapy after cateract surgery on my eyes. There were a number of limitations during that four week period with rules, no driving, no gardening, no lifting over 5 pounds, etc. I lost physical strength. To regain my strength Niki gave me some exercises and she returned to work on balance. Physical strength and balance are related. Now I am finished the physical therapy, I had to wait to drive for that. I have returned to the fitness center and I am getting my strength back. Best of all I am back in the garden where production is heavy with a number of plants. Green beans and tomatoes are especially productive as well and egg plant and several variety of peppers. 

We have a new fertilizer in our five raised beds, worm castings. A town over, LeClaire, has a worm factory in a garage. I buy by the pound now for my other plantings. More about gardening and worm casting later. Gardening is also physical therapy.  To be continued

Marlin Whitmer







A Wisdom Source

During my junior year in high school I came across an essay on wisdom. That did it. My interest and journey has continued to this day, now age 91.

The Celtic saying adds to the journey. "To journey with God, not knowing where you are going, but you will find out when you get there." The journey is intentional. 

Marlin

 Song of Pilgrimage 

Before I ventured forth,even while I was very young,

I sought wisdom openly in my prayer.

In the forcourts of the temple I asked for her, and I will see her to the end.

From first blossom to early fruit,
she has been the delight of my heart.
My foot has kept firmly to the path, diligently from my youth have I pursued her.

I inclined my ear a little and received her I found myself much wisdom

and became adept in her.
To the one who give me wisdom I will give glory, for I have resolved to live according to her way.

From the beginning I gained courage from her, Therefore I will not be forsaken.
In my inmost being I have been stirred to seek her, therefore have I gained a good possession.

As my reward the Almighty has given me the gift of language.

and with it I will offer praise to God.

Translated from the Latin (Ecclesiasticus 51:13-25) 


Monday, September 20, 2021

Chapter 2: Healing Power of Stories


The Healing Power of Stories


To Journey with Story Listening:

Medical, Biblical, and Pastoral


Abstract:

Stories and metaphors/metonymy are pervasive. Recovery of both has been going on for some time in our culture as story telling comes back into vogue. As for metaphors/metonymy, they can be found in any discipline. (Sacks, 1979) I will share my experience with several disciplines, concentrating mainly on the medical, Biblical, and pastoral. All provide us with important root and orientation metaphors.     

 


1. Medical 


Dr. James Knight of the Turo Infirmary in New Orleans at a Chaplain's Convention in 1967 spoke on "A Psychoanalyst Looks at the Role of the Chaplain." He helped shape my early days as a chaplain with a traditional word. He said "don't go native. You are a missionary in the exotic land of medical science. .... Engage in the Spiritual quest by having an “unresolved identity." I am still on the journey with an unresolved identity. 


I went to one of Dr. Hans Selye’s workshops on stress where he told stories and played down the scientific method saying “That is the way you write up your findings” (Selye, notes). The scientific method doesn't make discoveries. Discoveries are made by asking the question no one else is asking. Then he told the story of watching four patients come into the amphitheater when he was a student. The professor came up with four different diagnoses. Selye had a question no one else was asking, "What was going on in the body that made them all look sick?" His professor’s response, "Selye, do you want to get through medical school? Don't ask questions like that?" His peers echoed the same. The question haunted Selye and ten years later in an unrelated research project he got his first clue. Stress affects five glands of the body (Selye, workshop).


The Stress Response Syndrome is called "non-specificity" since more than one stressor can set off the same response. I wonder if the same be true about Story Listening/Story Telling. Could they be a "non-specificity" since different stories can have a similar effect on the body. Humorous stories would certainly qualify 


I haven’t researched a Story Response Syndrome in the same way as the Stress Response Syndrome. But I have some indication there is a StRS. As Selye named two types of stress, distress and eustress, I know story/metaphor can go either direction, and the terms nacebo and placebo are used by some to connote this very happening (Davidson, p. 48-50). 


I met Sir Roger Bannister (the first person to break the 4 minute mile) at a dual conference of the International Society of the Autonomic Nervous System and the Shy Drager National Support Group. I found myself in a one-to-one meeting with Sir Roger, a noted neurologist in England. I asked my $64,000 dollar question. “Befrienders, our lay hospital visitors, find on occasion that listening to the patient's story causes a change in color around the eye, from dark to light. What is going on in the autonomic nervous system to bring about that change?” Without losing stride he replied, “The placebo effect.” Others then came up and interrupted. I was left not understanding his short answer. 


I found what Sir Roger was alluding to in an article by Dr. Davidson on nacebo/placebo a year later (Davidson, pages 48-50). There was a reference to the Lancet Medical Magazine. "The placebo effect in general practice is the power of the doctor alone to make the patient feel better, irrespective of medication" (Thomas, p. 1067). That relationship in England is defined as placebo.


Sir Roger, knowingly or unknowingly, was saying we are all on the front lines of the health care delivery system. I contend other health care providers, professional and non professional, participate in the same phenomenon, especially through story listening. The Befrienders and I know it happens. We know we contribute to a patient’s quality of life, even extending life in some cases beyond what was predicted by the doctor. 


The placebo is redefined by Dr. Herbert Benson as "remembered wellness" (Benson, p. 20-1). When people tell their story they can move from sad times to good times and in so doing they are engaged in self care from a health standpoint. 


The placebo effect yields beneficial clinical results in 60-90% of diseases that include angina pectoris, bronchial asthma, herpes simplex, and duodenal ulcer. Three components bring forth the placebo effect:

(a) positive beliefs and expectations on the part of the patient; (b) positive beliefs and expectations on the part of the physician or health care professional; and (c) a good relationship between the two parties.


Because of the heavily negative connotations of the very words "placebo effect," the term should be replaced by "remembered wellness." Remembered wellness has been one of medicines most potential assets and it should not be belittled or ridiculed. Unlike most other treatments, it is safe and inexpensive and has withstood the test of time. (Benson and Friedman, p. 193) 


I would include the peace experience of patients part of the "remembered wellness" effect and the same components can be manifest in the relationship any person has with another. Lay people, then, become new clinicians on the front lines of the pastoral/spiritual/health care delivery system facilitating this phenomenon since health care is out in the communities in a variety of settings. 


One of my stories with "remembered wellness" came shortly after I bought Dr. Benson's book onTimeless Healing. We had stopped in Las Vegas to visit my Aunt residing in a nursing home. At one of the meals I sat next to an elderly lady who after preliminary remarks began to tell me about the death of her husband. Tears streamed down her cheeks. She continued with different parts of her story. Then she began to tell me about the birth of her younger sister in the family home. It was in the middle of the night when she was awakened. When she reached the hallway an older sister chased her back into her room. She began to laugh. Her sadness was gone the remainder of the meal. I was a witness to what I had been reading about, "remembered wellness." The telling of her experiences gave witness to the placebo effect. 


Journal writing is a way of moving these insights to a similar benefit. The effect of journal writing by asthmatic and arthritic patients has been investigated (Smyth, Stone, Hurewitz, and Kaell, 1999; Spiegel, 1999). Preliminary research for these studies comes from the work of Dr. Pennebaker (Pennebaker, p. 3-18). His work and the work of others have direct implications for the point of view in these presentations and the Healing Power of Stories. His studies began with students writing about their trauma experiences and the subsequent reduction in visiting the campus medical clinic as compared with students who wrote about more superficial events who in turn appeared more frequently at the clinic. Many others in various ways since have studied this. A long article by Pennebaker about their work and conclusions appeared in the spring 2000 issue of Literature and Medicine. The significant line for us is, "While hard and fast conclusions are rare in our line of work, the evidence of dozens of studies over a decade of research strongly suggests that there are significant, positive, consistent, and identifiable relationships between writing and speaking about difficult or emotional experiences and physical health" (Pennebaker, p. 3-18). Out of this research has come a computerized word study of significant words and the words used to identify the transition (Pennebaker and Francis). 


Here is another source for documenting story listening. Chaplain Larry VanderCreek wrote a short article on "Tragic Events and the Benefits of 'Cognitive Processing" and 'Finding Meaning." " They researched story listening with the effect on certain T-cells of Aides patients. The implications were sufficient to suggest relevance for chaplains (VanderCreek, p. 15). I am saying the research suggests relevance for all of us. 


I have a few stories to illustrate an interdisciplinary approach. At a Faith/Medical Forum on "the Role of Metaphor in Illness," doctors and clergy had different stories. What they had in common were important metaphors for understanding. We were on common ground. A neurologist had the story of a patient with back pain. After numerous tests he could find no physiological cause. He asked her what is going on in your life. When she told him he understood her back pain from the emotional load she was carrying. 


The bibliography giving metaphor resources from different disciplines of knowledge disappeared by the end of the evening. Almost every field of knowledge I know of identifies metaphor at some point in their material. Most medical terms have been moved from one field to another (Vaisrub, 1977).


2. Biblical


Every weekday morning chaplains and Befrienders gathered in the chapel for a shortened form of Morning Prayer with four Scripture readings followed by an open discussion after each reading. Prayers were offered following the readings and discussion. 


The greater awareness of metaphors in 1975 changed our discussion a great deal. We began to identify Biblical metaphors plus matching them  with our every day experiences. We began our own maieutic education as match makers. I had already been in the habit of bringing the Hebrew and Greek interlinear so word study had been established. Different translation were used to see various interpretations. 


Early on we came across forms of parakaleo (a called one alongside) and we moved the word to the ministry of presence. Having updated some of my study of William Temple I know he stressed the Body of Christ in public as “9/10’s.” We are out in the community “9/10’s” while “1/10th” in worship and learning. Parakaleo is where service and ministry in the world take place. 


Parakaleo informs my role as a Chaplain as well as the story listening role of Befrienders. This word has many different forms in Greek, one of which is "paraclyte" which is the word for Holy Spirit. Jesus says in John's Gospel, "when the Advocate (paraclyte) comes, ... the Spirit of truth" (NRSV, John 15:26). 


We miss the frequent places this Greek word appears since it gets translated out in English different ways depending on the translation: comfort, console, encourage, exhort, beseech, invite, advocate, helper, entreat, pray. 


You know the familiar translation of the Beatitude, "Blessed are those who mourn for they shall be comforted" (Matthew 5:7). John Knox translates this, "Blessed are those who mourn for they shall have a Befriender." I paraphrase this, "Blessed are those making major transitions in life for they shall have a 'called one alongside.'" St. Paul has to have loved this word. In his beatitude from 2 Corinthians 1:3-7 he uses a form of parakaleo 10 times in 5 verses.


Blessed be The God and Father of our Lord Jesus Christ, the Father of mercies and the God of all consolation, who consoles us in our affliction, so that we may be able to console those who are in any affliction with the consolation with which we ourselves are consoled by God. For just as the sufferings of Christ are abundant for us, so also our consolation is abundant through Christ. If we are being afflicted, it is for your consolation and salvation; if we are being consoled, it is for your consolation, which you experience when you patiently endure the same sufferings that we are also suffering. Our hope for you is unshaken; for we know that as you share in our sufferings, so also you share in our consolation. (2 Cor. 1:3-7, NRSV)


Now substitute "Befriender" for consolation. Next, substitute "called one alongside" for consolation. 


In the Letter to the Romans we have sumparakaleo meaning “mutually encouraged” (Romans 1:11, RSV) or “together we are alongside each other.” May these presentations and our e-mail discussion be the same for us as we continue to gather around our table in cyberspace. 


Our discoveries did not end with parakaleo. Then we found hineni. The word hineni is used five times in the call of Samuel. (1 Samuel 3:1-20) The word also appears frequently in the book of Genesis. 


Also, the discoveries do not stop. A web site reference helped give this concrete meaning (see http://www.csac-vt.org/news-naomi.html). Naomi Tannen gave a presentation to an all Counseling Service of Addison County staff meeting, "The Healing Potential of Responsiveness.” Her talk gives witness to the importance of hineni for her.


Since story listening was and is our mode these words in Hebrew and Greek are foundational. They provide a link with Scripture in our intentional direction.  


Scripture builds a case for listening as primary as “hear” begins the Jewish creed. I am also pursuing a study of the word akouo, listen/hear, which is used over 427 times in the New Testament. (page 111, Hedahl) I don’t know the number with shemei in the Old Testament for hear, listen, and obey but the number is considerable.


A Greek verb form of present active imperative provides the meaning of continuous in the present. This is the verb form used to describe the way Mary listens to Jesus in Luke 10: 39. She is "continuously listening." It was the better part. I say “listening continuously” is the better part in our pastoral role.


In Acts 10 we have Peter coming to a new realization that “God shows no partiality.” The new realization in Greek is a form of katalambano. I tracked the word lambano in the New Testament. The Gospel of John in chapter 1 has three forms sometimes translated apprehend, accept, and receive. (RSV) St. Paul in his letter to the Romans in chapter 1 has “we receive” related to the word “call” used three times. (RSV)  


The above were a few of our many word studies connecting with the stories we were hearing and our own lives.


4. Pastoral


a. Prayers.


My wife and I made a Celtic Spirituality Pilgrimage the summer of 1993. On Holy Island, Linisfarne, in the North Sea, I heard Deacon Kate give a definition to peregrantio which turns journey into a metaphor.


To journey with God, not knowing where you are going, but you will find out when you get there.


When I heard that I said, “I have been doing that all my life.” Peregranatio describes our gathering around the table in cyberspace. 


Celtic Prayers are basically poetry with repetition and rhythm, they were sung, and they use the metaphor to move from the earthy to the eternal. Prayers were said for all kinds of life experiences starting with rising in the morning, the various activities during the day, and retiring in the evening. They were the support for peregranatio. The practice is one we can easily employ from a metaphorical standpoint..


With the dawn of the new day may Christ ever dawn anew in my life.


A Celtic prayer with a metaphorical shift, “I kindle the flame in the hearth ... I kindle the flame of love in my heart. ... “ The secular disappears as all become one when the metaphor flips from earth to the transcendent. (de Waal, 1988)


b. research


My brother Ron found a web site with an article on metaphor entitled “Seeing with the eye of the heart” by Rachel Stanworth (Stanworth, 1997). I was able to get in touch with her, in fact, my wife and I had a most pleasant visit with her on Saturday morning, July 4, 2003, in London. She is much more into metaphor than I am and it was a pleasure to meet her and learn of her pastoral research at St. Christopher’s Hospice. This was before her book, Recognizing Spiritual Needs in People who are Dying, was published by Oxford University Press (Stanworth, 2004). 


Her research involves tape recorded interviews with 25 patients who are dying. The methodology is called “participant observer.” She describes in some detail her preparation to select and ready herself in the first half of the book. I say her preparation is as important as her findings. She makes the focus on listener concrete in comparison to the more abstract approach of Dr. Fiumara. Both come to the same perspective without knowing of each other as referenced. The internal preparation we make for listening become primary for both authors. 


Her findings are grounded in an understanding of symbol, metaphor, story, and the interior change within herself as she reflected on various aspects of language and various disciples of knowledge. She comes down decidedly on the side of pastoral care as being more open to the mysteries and that which points beyond words for ultimate meaning. A sacramental view of life is an essential for her (Stanworth, page 168-172).


A "divesting methodology" is at the heart of her listening model (Stanworth, p. 37-39). Slowly, I began to learn that to really hear another is akin to an "active divestment of self” (Stanworth, p. 39). ... real training for service asks for a hard and often painful process of self-emptying. The main problem of service is to be the way, without "being in the way” (Nouwen, 1998:79/Stanworth, p. 224).


Her approach to listen matches up with the kenotic insight of St. Paul in Philippians 2 plus Jesus instructions on dying to self. “Let the same mind be in you that was in Christ Jesus ... emptied himself ...” (Philippians 2:5-8, NRSV). 


She writes: “This is a conversational model of knowledge where wisdom does not equate with hitting some theoretical "bed rock’, but the ability to sustain dialogue in an ongoing process of discovery. The most successful outcome is shared understanding and mutual transformation. We feel that we have received something new and helpful for negotiating life and that some how have been enriched as a people.” (Stanworth, p. 7)


The last chapter on “Implications for pastoral care” completes the story journey of her preparation. Her basic orientation, “Attention is my chosen avenue for approaching the practicalities of welcoming, comforting, and learning from others” (Stanworth, p. 231). Instead of active listening we have attentive listening. And the discipline is one of intentionality. In the background is the Latin word tend for shepherd. 


For her metaphor and symbol are not simply about representing one thing in terms of another. They reveal something of the unknown and enable patients to explore and articulate the silent side of the boundaries in which they stand. Seeing the like in the unlike may even offer sanctuary in an apparently critical situation. 


Although the word poetry is not used as in Heidegger’s writing about listening, nor having a habitat as in Hadahl, she wants to explore this intangible from the standpoint of an artistic frame of reference, mystery, paradox, using story and narrative. And then taking the next step to say symbol and metaphors are the tools of story. Moving tools to name symbol and metaphor was a new leap in understanding for me (Stanworth, page 16-22). 


Her attentive review of the 25 interviews revealed nine metaphors that become the way spirituality is mediated in the here and now. “When one closely observes and listens to patients, these metaphors are clearly discernible” (Stanworth, p. 97). 


Her nine metaphors are temporality, marginality, liminality, control, letting go, archetypal hero, archetypal mother, archetypal stranger, and surplus of meaning (Stanworth, p 97-214).


Shortly after I purchased her book Bobbie became seriously ill with her third cancer, a lymphoma tumor. We had a chance to relate our own experience through these metaphors. In so doing we came to an unresearched conclusion. The metaphors to summarize the conversations wtih the 25 interviews can also be moved to any illness situation, any transition, including our own. 


We would add another metaphor from our experience. There are “gaps” in the health care system. “Gap” is the metonymy and an addition for the latin limen. “... doorway or threshold, liminality implies a borderline state. ...  " (Standworth, p. 117).We were often on the threshold of a new experience not being addressed. One gap now being addressed is cancer fatigue the side effects from treatment. 


Day by day we live on the frontier of the unknown, making new connections for meaning and living to fill in the “gaps.” We know first hand the question of time limits. How much time do we have? What do we need to do in the time we have? We know marginality, living on the edge, as a side effects require needs to be addressed at the time while lingering on into the remision stage. At present lymphadema in the arm needs attention. 


Beyond the mystery of the threshold (liminality) lies an opening for new understandings and connections. Rachel’s term “Surplus of meaning” for the ninth metaphor seems awkward to me. It is her catch all term and the place for the holy. At the same time I know what she is saying about going beyond our words to include the mystery in our encounters. 


We gave thanks in the midst of mystery on June of 2005 when the oncologist told us “complete remission” after reviewing the latest C.T. Scan. I said I want to write that down so I don’t forget. Thanks be to God! 


Rachel Stanworth’s nine metaphors, others from this presentation, still more to be identified, as well as the tools of story, all provide sensitivity in listening for clues and developing the ear of a poet. This reality becomes more important as health care moves out into the community for prevention and survivors of all kinds. Here is where we all are on the front lines of the health care delivery system. 


References:


Herbert Benson; Timeless Healing: The Power and Biology of Belief; Scribner, New York; 1996; 350 pages 


Herbert Benson, MD, and Eileen M. Stuart, RN, C, MS; The Wellness Book: The comprehensive Guide to Maintaining Health and Treating Stress-Related Illness; A Fireside Book, New York; 1992.


Herbert Benson, MD, and Richard Friedman, PhD; “Harnessing the Power of the Placebo Effect and Renaming It "Remembered Wellness’”; Annual Reviews of Medicine; vol. 47; pages 193-199;


Bible with the Apocrypha, New Revised Standard Version, Oxford University Press, 1991, 432 pages. 


Davidson, Stuart. (1996, November/December). Tomorrow's medicine: Placebos and nacebos,Healthcare Forum Journal, p. 48-50. 


Esther de Waal; Every Earthly Blessing: Celebrating a Spirituality of Creation; Servant Publications, Ann Arbor, Michigan; 1991; 148 pages. 


Esther de Waal; The Celtic Vision: from the CARMINA GADELICA --- Orally Collected in the Highlands and Islands of Scotland by Alexander Carmichael; St. Bede’s Publications, Petersham, Mass; 263 pages. 


Susan K. Hedahl, Listening Ministry, Fortress, 2001, 123 pages. 


George G. Hunter III, The Celtic Way of Evangelism, Abingdon, 2000 

Levine, Carol, and Murray, Thomas H., Ed.; The Cultures of Caregiving; Johns Hopkins University Press; 2004; 187 pages 


Pennebaker, James. (2000, Spring). Telling stories: The health benefits of narrative,Literature and Medicine, Vol 19, No 1, p. 3-18. 


Pennebaker, James, and Francis, Martha. (nd). Linguistic inquiry and word count, University of Texas at Austin; Published by Lawrence Erlbaum Associates, Software and Alternative Media, Inc. 


Pennebaker, James (web site search name: James W. Pennebaker) 

http://homepage.psy.utexas.edu/homepage/faculty/pennebaker/Home2000/JWPhome.htm 


Smyth J.M., Stone A.A., Hurewitz A., Kaell A. (1999, April 14). Effects of writing about stressful experiences on symptom reduction in patients with asthmatic or rheumatoid arthritis: a randomized trial, Journal of the American Medical Association, 281:1304-1309. 


Spiegel, David. (1999, April 14). Healing words: Emotional expression and disease outcome,Journal of the American Medical Association, 281:1328-9. 


Stanworth, Rachel; entitled originally 'Spirituality, language and depth of reality" ; is reprinted from the International Journal of Palliative Nursing, Vol 3 No. 1, Jan-Feb 1997 


Stanworth, Rachel; Recognizing spiritual needs in people who are dying; Oxford University Press, 2003, 255 pages 


K. B. Thomas; “The Placebo in General Practice’; Lancet; Vol 344; October 15, 1994; pages 1066-7 


VanderCreek, Larry; “Tragic Events and the Benefits of "Cognative Processing’ and "Finding "Meaning’.” The APC News, Nov/Dec 2002, page 15 


Vaisrub, Samuel, Medicine's metaphors: Messages and menaces.Oradell, NJ: Medical Economics Co., 1977, 124 pages. 


Copyright © 2008, Marlin Whitmer. All rights reserved.