Advancing Spiritual Care Through Research

Wendy Cadge. Spiritual Care: The Everyday Work of Chaplains. New York: Oxford University Press, 2023

Rev. Katie P. Rimer, Ed.D., BCC

Palliative Care Chaplain/CEC (pending)

Massachusetts General Hospital and Hebrew Senior Life

Boston, Massachusetts

Flipping through this much anticipated book when it arrived,  something shifted in me when I read the following anecdote in the appendix.  As a young sociology professor twenty years ago, Dr.  Wendy Cadge approached a senior physician at an academic medical center in Boston and told him she was thinking of studying hospital chaplains. The physician told her not to “waste her time,” because chaplains have too little status in the medical hierarchy and make little difference. Cadge writes,

In the next breath, he described being a medical student doing chest compressions on a patient. A chaplain was there, and this senior physician – then a medical student – asked the chaplain to pray for him in addition to the prayers offered for the patient. Hmmm, I remembered thinking as I heard these seemingly contradictory pieces of information. Don’t waste your time on chaplains yet ask them to pray for you in an emergency.  I had a hunch there was a story to tell here. (p. 165)

It is likely I was a CPE student at that very medical center twenty years ago, wrestling with those same contradictions as I considered making chaplaincy my life’s work. I met Dr. Wendy Cadge when I was a doctoral student and she was a young professor at Brandeis University. Cadge had spent a couple years teaching at my alma mater, and my college advisor connected us when she moved to Boston.  I introduced her to some of the chaplaincy leaders in the area hospitals. Looking back, I feel a debt of gratitude to Dr. Cadge for refusing to take that physician’s advice. Rather, she became deeply curious about the then untold story of what she calls in this book the sometimes invisible, in-between work of spiritual care.  For the past twenty years she has applied her academic acumen and native curiosity to the field of chaplaincy, organizing and advocating for the field along the way. This book is her latest gift.

You may have read Dr. Cadge’s 2012 book, Paging God, about hospital chaplaincy specifically. This book, Spiritual Care: The Everyday Work of Chaplains casts a much wider net and examines the work of chaplains in a variety of settings:  prisons, military, schools, hospitals, police and fire departments, hospice agencies, long term care facilities, air and seaports, and social change organizations. Cadge organizes her book around three central questions: who chaplains are, what we do across the United States, and how that work is connected to the settings where we do it  (p 4). Cadge is a sociologist of religion.  She shines light on this  work “at the edges” because she believes chaplaincy tells an important story about shifting cultural and religious values and priorities in the US. She also believes chaplains are uniquely poised to lead in an increasingly diverse and secular-but-still-seeking world.  With this book Cadge invites chaplains to consider ourselves part of a larger movement beyond our unique contexts.  Specifically, there are several reasons why you should read this book to more deeply consider this invitation.

Cadge colorfully illustrates chaplaincies in contexts that are very different.  I, as a hospital chaplain, did not realize chaplaincy is mandated in the military, in federal prisons, and in VA facilities, nor did I appreciate before reading this book the unique challenge of ministry within a context committed to the separation of church and state.  Military chaplains are mandated to “protect people’s first amendment rights to practice their faith,” (p. 141) and as such are keenly attuned to the importance of diverse religious expression.  This translates to a “perform or provide” commitment (p. 141) in military spiritual care: a chaplain is not required to perform a ritual outside their tradition, but they are required to do their best to find a chaplain who can. Also enlightening is the rich description of chaplaincy to seafarers – those who work on cargo ships and come to port from all over the world.  The New England Seafarers Mission provides hospitality and practical assistance to these seafarers (as well as to staff working on cruise ships) including ways to send packages home, Moneygram, and support or advocacy for personal concerns. Who knew about this most practical spiritual care that occurs literally at the boundary between land and sea, country and state?

in the chapter dedicated to describing what chaplains do, I saw my work reflected in the description of ministry “in between”: in between the religious denomination that endorses me and the secular organization that employs me, in between a patient’s life before hospitalization and the one after it, in between life and death. Cadge found that liminality and transition are hallmarks of chaplaincy, regardless of context. Based on her interviews with 66 Boston-area chaplains, she classifies the work of chaplains in four domains: rituals and ceremonies, individual supporting, mediating and bridging (between teams, between family members, between diverse peoples), and being present.  The more embedded a chaplain is in their particular context (what Cadge calls a “continuum of embeddedness”),  the more likely they are to perform some of the more complex responsibilities like mediating and bridging. This notion of embeddedness is something I thought about often as the director of a spiritual care department: at what point does the staff automatically think to call us in? Are we invited into leadership discussions? How much are we part of the fabric of the institution?  Do we help shape the culture? In my experience, it takes years to build the trust that enables this type of embeddedness. Dr. Cadge’s articulation of this concept was especially helpful.

Finally, I encourage you to read this book to wrestle with me about the question of certification and education for chaplaincy.  As a board certified hospital chaplain and former director (admittedly, in the very academically inclined Boston area), I was surprised to read that only 30% of the chaplains Dr. Cadge interviewed are certified to work as chaplains. Of these, 60% are certified by the bodies familiar in healthcare chaplaincy (APC, Nashema, NACC), 25% are certified by the military, and 15% are certified by a local certifying body that requires only a 47-hour week of training and no theological education. This means 65% of the people who participated in this study about chaplaincy define themselves as chaplains without formal certification. In terms of education, only 53% of the participants had at least one unit of CPE.  The project of this book stretched me beyond my academic bias and affinity for CPE to consider deeper questions about the essence of the work, what we call it, who should do it, and what type of training is necessary in different settings.  Perhaps because of the historically ‘low status’ of chaplains alluded to in the opening anecdote, I am among those who have fought hard for the field’s academic, ethical, and organizational credibility. At the same time, I cannot nor would not deny the value of the compassionate and courageous spiritual care delivered by some of the “uncertified” chaplains profiled in this book.  Furthermore, the cost of theological education (including extended time in CPE) is prohibitive for so many, and if we are committed to diversity in all its forms, we must pick up this question and figure out what to do. 

Cadge’s book helps point toward the key components of chaplaincy as practiced in different contexts. I had not considered the benefit of joining forces with those who work in very different non parochial settings under the umbrella term spiritual care, but I agree with her that ‘ministry on the margins’ may become more “ministry to the mainstream” as traditional religious attendance declines. Whether new financial models emerge to support this work remains to be seen (p. 155). In the meantime, please read this data-rich, provocative book and join me in this conversation.  Much of what happens in the future will depend on our claiming our seat at the table in diverse settings, our advocacy, and our ability to work across differences among ourselves and beyond. I am grateful to Dr. Wendy Cadge for helping us see ourselves better from the outside.

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