Theology of Pastoral Care

The following reflection was presented at the end of a unit of CPE, as a chaplain intern at NYU Langone Medical Center. It reflects my personal theology as it relates to pastoral caregiving.

Clinical pastoral education has greatly deepened my theology. Ultimately, my pastoral theology is an assertion that redemption comes from within. I will explore and develop this assertion in the following pages.

Like many of the other listening professions, chaplaincy is predicated on the assumption that talking helps. Anger, sadness, fear, guilt, hopelessness, loneliness, and a whole host of other difficult emotions can be alleviated by talking through them. Speech, therefore, holds a certain transformative power.

Judaism, too, affirms the power of speech. Looking at Genesis 1, the Tannaim (1^st and 2^nd centuries, Palestine) declare: “Ba-‘asarah ma-amarot nivra ha-olam / By ten acts of speech was the world made” (Pirkei Avot 5:1). Jewish liturgy praises the One “she-amar v’hayah ha-olam … omeir v’oseh … gozeir u’mkayeim / [the One] Who spoke and the world came into being … Who speaks and acts … Who decrees and fulfills” (P’sukei D’zimra). Since human beings were created “betzelem elohim / in the image of God” (Gen. 1:27), we too can create with our speech. The late-medieval Jewish philosopher Joseph Albo (15^th century, Spain) in his work Sefer Ha-Ikkarim argues that it is the power of speech that separates human life (which he terms “m’dabeir / speaking”) from animal and plant life (“chai / living” and “sameach / happy,” respectively). Indeed, it is through the human being that God “hitkin … binyan adei ad / eternally perpetuates the world” (Sheva Brachot, blessing #4). Talking—and for the chaplain, listening—perpetuates the work of creation by allowing experiences and emotions to be processed and transformed.

Judaism insists that processing one’s experiences and emotions is critical for finding comfort. The holiday of Tisha B’Av is an exemplar of this principle. Tisha B’Av is a day of remembering our national and personal tragedies. We lament. We fast. And yet despite our sadness (or perhaps because of it), Midrash Eichah Rabbah declares (1:51) that the Messiah will be born on Tisha B’Av. Redemption, it seems, can only come by acknowledging our losses. Similarly, Moses’s timely retelling (Deut. 1:22 ff.) of the story of the scouts (Num. 13) seems to suggest that the Israelites can only enter the Promised Land if they first remember their past failures. Another illustration of this point: On the restless night before Jacob is to be reunited with Esau, Jacob wrestles with a man/God. After the man/God sees that he/it cannot beat Jacob, Jacob says “lo ashaleikhacha ki im beirachtani / I will not let you go until you bless me” (Gen. 32:27). Like Jacob, our lives are full of struggles. And the only way to find the blessing in the struggle is to wrestle with it and not to let it go until it blesses us.

Unlike Jacob, Moses leaves his grief over Miriam unattended to, a negligence that may have contributed to his banishment from the Promised Land. The Torah makes no mention of anyone mourning for Miriam after her death. It simply reports that the Israelites were without water. Indeed, Miriam is a symbol for water. Her name contains the word yam / sea, and contains the letters of the word mayim / water. Additionally, it is Miriam who placed Moses in the waters of the Nile and danced by the waters of Red Sea. As such, before Moses strikes the rock to bring forth water, he calls the Israelites “morim / rebels” (Num. 20:10). The word morim is spelled exactly the same as the name Miryam, only with different vocalization. Moses was silently grieving for Miriam, and his striking of the rock represents his displaced grief. Moses’s unprocessed baggage ultimately prevents him from entering the Promised Land.

If emotional processing is the gateway to alleviating suffering, Judaism further seeks to understand the source of suffering. The Book of Job suggests that suffering is not a result of divine reward and punishment—as other parts of Tanakh might suggest (see, for example, the second paragraph of the Shema [Deut. 11:13-21])—but rather that the origin of suffering is beyond human comprehension. “Eifo hayta b’yasdi aretz / Where were you when I founded the earth?” (Job 38:4) God asks Job. (It is worth noting that Job’s so-called friends unsuccessfully try to comfort him with an explanatory, problem-solving approach, rather than with an empathetic, experience-affirming approach.) Job’s comfort (and the end of his suffering) comes only after he understands that suffering cannot be explained using human logic.

The first chapter of Genesis depicts a God whose creation is wholly good. Deutero-Isaiah, on the other hand, describes a God who creates both good and evil. The prophet—writing in the context of exile and against the influence of Persian Zoroastrianism (that is, dualism)—declares “yotzeir or uvorei choshech, oseh shalom uvorei ra’ / [God] creates light and creates darkness, makes peace and creates evil” (Is. 45:7). God creates the entire world—both what we perceive to be good and what we perceive to be evil. I would characterize this aspect of God as “Source and Substance of all Creation.”

Perhaps one of the most eloquent expressions of good and evil comes from the piyyut (liturgical poem) Unetaneh Tokef, a centerpiece of the High Holiday liturgy. The piyyut declares that on Rosh Hoshanah, God decides “mi yichyeh u-mi yamut / who shall live and who shall die.” This statement reflects a theme from the Book of Job—that no matter how much we try to control our fate, many things are beyond our control and our understanding. It is a very sobering realization (like the one I’ve had in the hospital) about the fragility of life.

The piyyut goes on to say “u-t’shuvah u-t’filah u-tz’dakah ma’avirin et ra’ ha-g’zarah / repentance, prayer, and righteousness can transform the severity of the decree.” Herein lies both the challenge and the wisdom of the piyyut. A careless reading of this last line would suggest that righteousness will be rewarded with prolonged life. This is counter to human experience. However, a more careful reading of the piyyut yields a different conclusion. This last line of the piyyut is an adaptation of language that appears in Midrash Genesis Rabbah: “Sh’loshah d’varim m’vatlim g’zeirot ra’ot: t’filah, u-tz’dakah, u-t’shuvah / three things annul a bad decree: prayer, and righteousness, and repentance” (44:12). Where Genesis Rabbah says “m’vateil / annul,” Unetaneh Tokef says “maavir / transform.” The difference is subtle, but important. Genesis Rabbah suggests that righteousness and reflection will be rewarded; Unetaneh Tokef suggests that righteousness and reflection will provide comfort. Righteousness will not cause suffering to be annulled, but rather will cause our experience of suffering to be transformed.

A central tenet of Judaism is of God as redeemer. Rashi (11^th century, France) notes that at the moment of Revelation, God introduces God’s self not as Creator, but as Redeemer: “I am the Eternal, your God, who brought you out of the land of Egypt” (Ex. 20:2). The exodus from Egypt is the paramount expression that God is with us in our times of trouble. However, redemption should be understood not as the termination of suffering, but rather as a comfort through suffering. Even after their redemption, the Israelites suffered in the desert, and also in the Promised Land. Nevertheless, God’s comfort was with them in the desert (eg. the pillar of cloud, the well of water, and the manna [Ex. 13:21, 17:6, 16:4]). The prophet Hosea declares that God loves and comforts the people Israel not only in their suffering, but even in their transgression. Even when God seems to cast us out, “v’eirastich li l’olam / I [God] betroth you unto Me forever” (Hosea 2:19). Heschel (20^th century, Polish-born American) calls this prophetic trope “divine pathos.” I would characterize this aspect of God as “consciousness,” or “the God within.”

The chaplain’s job is to help create a space in which a person can access his or her own God within, his or her own redeemer, his or her own comfort. The chaplain creates this space by acting as a wounded healer. The wounded healer is a living expression of the phrase “chazak, chazak, v’nitchazeik / be strong, be strong, and we will all strengthen one another,” which Jews recite upon completing a book of Torah. The wounded healer’s purpose, however, is expressed in the converse: “I am wounded, and I see that you are wounded; so together, we can acknowledge that to be wounded is to be human, which ultimately, is life-affirming.” As Naftali Herz Weisel (18^th century, Germany) reflects, you are to love your neighbor kamocha—not “as you love yourself,” but rather because your neighbor “is like yourself,” which is to say, he or she is also human. He or she also contains God within.

The following, therefore, is my theology of pastoral care: by creating a space in which patients can engage in the divine work of talking, the chaplain enables his patients to wrestle with their suffering; suffering exists alongside good, in the universe that was created by the Source and Substance of all Creation, for reasons beyond human control or understanding; and when patients wrestle with their suffering, they may discover that to suffer is to be human, to be human is to contain God within, and to contain God within is to have the capacity for comfort and redemption.