Bridging Neuroscience, Chaplaincy and Theology

September 23, 2015
Ramakrishnan Parameshwaran, HDS MDiv candidate

Krish, alias Ramakrishnan Parameshwaran, presented excerpts from his recently published position paper on the meeting points of Medicine, Chaplaincy and Theology.  The abstract of the publication, titled ‘You are Here’: Locating ‘Spirituality’ on the Map of Current Medical World can be found at PubMed and the complete, peer-reviewed but pre-published author’s proof-read copy can be found here.

The question-and-answer session that followed the presentation demonstrates the CSWR resident community’s weekly brain-storming activity on issues of importance to HDS and theological-community at large.

Grossly, what does your paper present?

I had reviewed the most recent medical literature on ways in which medical researchers and clinicians are trying to incorporate spirituality and religion into their patient-care practices. This paper tries to educate clinical professionals and theological scholars on various aspects of spirituality-related research work that is happening around the world. The idea is to converge all those like-minded people and their works into a unified structured program through clinical chaplaincy education and training.

Of late, because of prolific medical research publications on spirituality, health care professionals have been wondering if ‘Medicine is returning to the fold of Religion’. This is an anxiety provoking idea – anxiety, because of the dogmatic and doctrine-based counseling by religious professionals in the past. I am highlighting how the current world could return to an evidence-based model of spiritual care chaplaincy rather than tracing its steps back to a dogmatic world of ‘religion’.

What is your contribution to this growing field of spirituality in medicine?

Recently I had published a paper on my understanding of neuropsychological mechanisms underlying chaplain’s spiritual care process. The idea behind that is to educate or at least to encourage the medical professionals as well as the chaplains to become curious about the possibility of developing spiritual care process as an evidence-based model of therapy.

Do you think the religious community is gearing up to this opportunity of meeting the medical community who are willing to incorporate spiritual skills into their clinical practice?

Yes. My article in the journal of Current Opinion in Psychiatry is the first of my attempts to highlight the parallels between the purely academic methodology of Comparative Theology (CT) propounded by Professor Francis X. Clooney at HDS and clinical chaplains’ model of spiritual care. With this I am trying to advance the theoretical, methodological framework of CT into the clinical chaplaincy model. What we can achieve with that? Building parallels between theological and neurological frameworks through which a clinical chaplain would work to produce a desirable clinical outcome in his/her patients will validate the CT methodology.

In addition, by incorporating CT methodology into chaplaincy, I am also proposing to expand the hitherto understood chaplain’s reading of patient as a ‘Living Human document/scripture’ into a bidirectional model in which the chaplain would also look at him/herself as yet another ‘Living Human Text’. Thus the chaplain’s ‘Listening presence’ is not only for the patient but to him/herself – he/she would go back and forth between reading the patient as well as the self as two different Living Human documents/scriptures.

What are the gains in advancing this theory?

By proposing the chaplain’s spiritual care as a model of Comparative Theology, we will start to build a robust theological framework on which chaplaincy training can be built. It will be robust in the sense that the advantages of an empathetic reading of alien tradition as practiced in the CT process can be made available to the chaplaincy process. And, in turn the CT model will be validated by the positive and desirable clinical outcome that may be evident from its clinical application.

What are the difficulties you face in this bridging process?

Bridging theology with neuroscience involves two bridges and three different departments: (1) Neuroscience or Medicine at large (2) Clinical chaplaincy or Spiritual Care departments and (3) Theology/Seminary or Divinity schools. All these departments/specialties are in place, and functioning robustly but independently. There is a lack of understanding of how to build a unified theoretical framework using empathy-healing related concepts from all these three specialties.  Unifying these theoretical frameworks may help in validating and strengthening the healing concepts within each of these specialties and would help them grow individually as well.

Why do we need theology for this kind of work, and not just training in empathy-skills?

As a psychiatrist I worked with acutely and chronically ill patients with severe levels of psychopathologies and also of various kinds of psychopathologies. I always wanted to work with the “normal” of our society. But I was aware that the “normal” population of our society will have gradations of personalities from disorder to divine. While the patient population’s aim is to become normal the ‘normal’ in our society aim for super-normal skills and attitudes so as to avoid all kinds of tribulations that a ‘normal’ life has. To understand what that super-normal skill or attitude could be, we need to invest ourselves in studying the nature and/or behavior of the divine or god-incarnates or prophets (theology in its true sense) as described in various religious scriptures. Hence the need for expertise in theology (study of gods).

The model of clinical chaplaincy has to be driven by CT that draws upon the wisdom or lessons from different religious traditions and from the divine personalities represented or understood in each of them. Not focusing on one religious tradition but developing vocabulary from different religious traditions in order to be able to respond to a broader range of human emotions across different religious-cultural situations will prepare a chaplain to be effective in serving patients in a pluralistic hospital setting.

What if the patient is atheist? What would prepare a chaplain to provide spiritual care to an atheist?

The model of clinical chaplaincy is not based on any particular tradition. The chaplain may be grounded in any particular faith tradition but, when in a clinical situation, his/her primary allegiance is towards the patient and not to his/her own religious tradition. Remember, the model of chaplaincy is that of CT – education and training in CT methodology will help a chaplain move back and forth while reading the patient as an ‘alien religious scripture’ and return and re-return to read him/herself as another ‘living human scripture’. The reading that a chaplain does is that of the thoughts and emotions, expressed or unexpressed by the patient.

And, those thoughts and emotions of the patient may be informed by one or multiple religious traditions or by none or by the patient’s own self-created idiosyncratic beliefs. What a chaplain does is to inform him/herself of the pain and suffering that the patient may be undergoing, created by the discrepancy between the ideal-tranquility that his/her personal divine-spot would have provided versus the current life-situation that has removed him/her from that tranquil spot.

A chaplain’s work is to be a reflective presence to his/her patient. He/she is not there to give any type of advice, or try to heal the patient for that matter. But only to present an empathetic, mindful and tranquil self even though experiencing, in a healthily-detached way, his/her emotional disturbances that may be triggered by patient’s stories. In that healthy-detachment the chaplain empathizes with his/herself that may be experiencing the pain and suffering. Through that self-empathy chaplain heals him/herself from the pain he/she suffers from the clinical encounter.

At the same time, observing the chaplain’s thoughts, feelings, intentions, as well as mindful and empathetic presence, the patient starts to become mindful of his/her own thoughts and emotions and develops empathy towards the self. It is a kind of acceptance or self-forgiveness in which lies the healing power.

If it is not based on any particular tradition, how does expertise in theology become necessary, at least for the chaplain? In other words, do we need a scholarly theology education for this kind of job?

What I am envisioning is a new super-specialized department of psychiatry called as ‘Spiritual-Psychiatry’. It can be built as a fellowship program similar to Child, Addiction or Geriatric Psychiatry. And, for this, an MDiv and one-year chaplaincy residency training is enough. Such training would equip a psychiatrist or a medical professional to provide spiritual care to his patients. I can also think of wide range of futuristic roles for those leaders, such as building a hospital-church chaplaincy program, school and higher education chaplaincy, or policy developers in biomedical ethics, social psychiatry or positive mental health programs.

But, an MD-PhD program or PhD program in clinical chaplaincy with scholarly education and training in neuropsychiatry, supervisory chaplaincy and CT would provide an individual with necessary credentials to become an academician who can run such a fellowship or doctoral program to groom future generations of spiritual care leaders