Faith and Health in Secular Society – Viewed from the Theory and Practice of Pastoral Care

1. Faith and Health in Secular Society –Viewed from theTheory and Practiceof Pastoral Care Professor Tor Johan S. Grevbo Diakonova University College Oslo, Norway (Odense, Denmark, 19 May 2010) (The content is expanded in thefollowingversion!)

2. Main Intensions • To present pastoral care as the most widely spread art of dealing with troubled people from a specific Christian point of view (This will be done in great respect for other caring traditions with many similar traits!) • To paint a nuanced picture of our so called secular age • To let research and questions from the field of psychology of religion meet pastoral care constructively and critically, and vice versa. Content: a. Two Initial Inputs b. A Brief Introduction to Pastoral Care c. Ambiguous Traits in Our Secular Society d. Important and Problematic Elements in the International Health-Faith Research e. A Multi-factor Spirituality Model

3. A. Two Initial Inputs (a Secular “Hymn” and an Exposé of Pastoral Care)

4. A Secular “Hymn” Health is not bought with a chemist’s pills, nor saved by the surgeon’s knives. Health is not only the absence of ills, but a fight for the fullness of life. The Danish poet and scientist Piet Hein in his prologue to WHO’s 40th anniversary 1986

5. An Exposé: The Inherited Plurality of Pastoral Care The Christian ministry of the cure of souls, or pastoral care, has been exercised on innumerable occasions and in every conceivable human circumstance, as it has aimed to relieve a plethora of perplexities besetting persons of every class and condition and mentality. Pastors rude and barely plucked from paganism, pastors sophisticated in the theory and practice of their profession, and pastors at every stage of adeptness between these extremes, have sought and wrought to help troubled people overcome their troubles. To view pastoral care (...) is to survey a vast endeavour, to appreciate a noble profession, and to receive a grand tradition. Clebsh/Jaekle 1964/1994 (p. 1)

6. B. A Brief Introduction to Some Vital Aspects of Pastoral Care

7. Selected International Terminology • Hæ thæspsykjæsepiméleia(Plato) – Curaanimarum – Seel(en)sorge - Soul care/cure – Sjelesorg/själavård(Notice: the term is not originally biblical, and was in the church first fixed in plural in Greek, Latin and German – mostly due to Basil the Great ca. A.D. 360: epiméleia/therapeíatånpsykjån – and in order to avoid a narrow-minded individualism.) • Soul (in the church context normally used as term for the whole person as a living creature) • Pastoral care (standard English/American formulation, cf. the very influential book of Gregory the Great ca. A.D. 600 called LiberPastoralisCurae, published in English as Pastoral Care, leaving the cure-aspect aside, or better: included) • Pastoral care and counseling(the last word is used to describe a professional and authorized art of practicing pastoral care, normally with competence beyond just theological insight) • Pastoral (derived from the biblical image of shepherd, and usually not limited to certain office-bearers (pastors)) • Confident (the counselee, i.e. the person who in principle confide in the caregiver, used in Scandinavia at least from the 17th century)

8. Basic Assumptions • “Pastoral care” is basically a theological and Church-related discipline, dealing with all kinds of questions relevant to life and faith. (In contrast the “psychology of religion” is basically a psychological discipline, acting on the religious field in a wide meaning.) • Taking its foundation seriously, does not mean an inadequate limitation of pastoral care. Pastoral care can be offered – and has been offered – in a myriad of ways. This is particularly true for our own age. • An important distinction has to be made between - curaanimarumgeneralis(all ecclesial activities taking care of God’s people (in principle including all people created by God)) - curaanimarumspecialis(pastoral conversations and rituals, concerning one or few persons at a time) • Although one may be sceptical towards universal, trans-historical definitions of pastoral care, certain dimensions may gather what pastoral care basically – past and present – is all about.

9. Eight Dimensions of Pastoral Care • Healing (as restoration, and/or finding new depths and hopes in life, cf. Archbishop Rowan Williams, in Baxter 2007) • Sustaining (preservation, consolation, consolidation, redemption) • Guiding (eductive and inductive) • Reconciling (forgiveness and correction) • Nurturing (Main dish: acceptance, affirmation, grace and love, salted with honesty and confrontation – to promote a healthy growth) • Liberating (personal, structural, societal) • Empowering (looking for resources against “adapted helplessness”) • Resisting (concerns different kinds of violence and oppression, cf. next slide) Cf. Hiltner 1958 (1-3), Clebsh and Jaekle 1964/1994 (4), Clinebell 1984 (5), Miller-McLemore 2006, compiling several recent contributions, (6-8). To be pastoral in a Christian sense, all eight dimensions have to be seen and developed in the light of the triune God, not just understood according to social and medical sciences etc.

10. Angel with Boxing Gloves and Resisting PowerArtist: Elisabeth Helvin

11. Main Concepts of Pastoral Care and CounselingPracticed (more or less vigorously) To-day It is harmful to wipe out any of the dimensions mentioned, from the picture of PCC. It narrows the view and limits the possibilities in the numerous variations of pastoral care occasions. Not all representatives, however, are careful observers of this fact, and therefore become blind of several important aspects. One may divide the scene of PCC to-day in eight different parts, more or less interconnected in the actual practice of the caregivers. Some theorists are nevertheless – in spite of the practical demands – totally committed to a single one, or, at the most, to a couple of the following concepts.

12. From the right to the left wing, the eight different basic concepts may be indicated briefly by the following head words: • Kerygmatic Care (concentrating on transmitting the central Christian message of sin and grace to individuals) • Evangelical Care ( concentrating on a broad portion of fundamental biblical content and wisdom – including the exhortations – conveyed with personal commitment and dealing with psychology in very different ways) 3. Charismatic Care (concentrating on the god-given power of the caregiver, and his/her gifts to prophesy and to heal) • Spiritual Care (accompanying confidents to a deeper level of Christian and human insight, derived especially from the tradition of spiritual guidance with its contemplative legacy of prayer, pastoral diagnosis and discernment)

13. 5. Ecclesial Care (a broad parish-oriented and “deaconal” care embracing both life and faith, utilizing the specific means of pastoral care together with knowledge from other sources) • Analytic Care (concentrating on a conscious self- introspection through methods adopted from different schools of analytic psychotherapy) • Therapeutic Care (labelling the influential American movement from 1925, emerging through clinical pastoral education (CPE) as a professional and confident-centred help to self-help, drawing on the resources of various psychological trends submitted under the category of pastoral-psychology) • Socio-political Care (directed towards the society as trans- individual liberation from and change of life-restraining social conditions) Grevbo 2006 (pp. 302-408)

14. Competences for a Serious Pastoral Care-giver (independent of his/hers basic concepts) • Personological competence (concerning oneself and others) • Communicational competence • Hermeneutical competence • Spiritual competence • Historical competence • Theoretical competence (concerning pastoral care itself, and its theological, psychological, sociological, cultural, methodological components etc.) It is basically impossible to perform serious PCC on all levels without a learning process over several years, combining professional/theoretical skills, personal insight and a supervised practice. (On the other hand, I want to pay tribute to all representatives of Christian communities giving their own valuable contribution to the mutual dialog and consolation, fundamental to pastoral care.)

15. My Own Position: Honouring a Plurality of Perspectives The theory and practice of PCC reveals a plurality of perspectives and angels of incidence. This variety will naturally also have great impact on how the health-question is met, and how the faith-question is related to it. My starting point is that all the dimensions and schools which I now have summarized, have something useful to bring to the attention of the caregiver, in order to constantly challenge the biased mindset we easily carry around with us. It is always possible – and often fruitful – to think and act in another way, and to re-frame a certain situation from another point of view. (However, I am not sure all the Danes here agree, because one of the first times I revealed a similar position in a lecture in Denmark, I was met by a rather killing remark: “What you call multi-facetted and open-minded, we call impotence!” To day I have the nerve to counter by following fact: In the history of pastoral care my basic attitude is rather called humility. And not seldom that’s what pastoral care is all about.) Therefore it is vital to my own understanding of pastoral care to try to combine all the appropriate aspects and methods, in a way however, which is not careless, but critical. Through a rather compact phrase I call my own position: “a critical plurality of perspectives”.

16. Four Critical, Contextual Test-areas (in practice woven tight together) • The confident as context. This first area of critical observation deals with the given and unique pastoral case with one or more confidents in the centre – and leads to assessment of the appropriate attitudes, methods, steps etc. The warning not “to tar all with the same brush”, is a pastoral advise as old as the hills. 2. The caregiver as context. The critical examination concerns here my own ability and limitation to work adequately with a certain case to (and within) a certain time. 3.The social and ecclesial context. Here I critically take into consideration perspectives which are especially important to be represented and underlined in the society and church-life of to day, trying not to violate the specific needs of each individual confident while honouring over-individual aspects. • Theology as context. My practice is also continuously and critically accompanied by theological presuppositions: fx. the classical Christian understanding of God’s trinity (against any theological one-sidedness) and the accompanying awareness of God’s presence in all things; the built-in tensions (paradoxes) in Christology and other parts of Christian basics; the different aspects of biblical anthropology; some basic ethical values. Pastoral care is always – in a very broad sense – adapted theology in a biographical context. In doing this kind of caring theological work, I can’t just suspend the question of truth, and replace it by the question of effectiveness. (Faith, hope and love are the three outstanding words I soon will use in my definition – both in a general and a more specific meaning – to indicate the value of theological substance and richness in pastoral care. A theology abounding in perspectives, opens up not just a small and narrow room, but in fact the biggest space on earth, including the humble attitude of the inhabitants knowing they have not yet by far grasped the full truth, cf. Phil 3, 12-13.)

17. It is exactly because of my theologicalreflection that I operate with a double (or complementary) approach tolife and faith, both within the realm of pastoral care: • A general perspective – including all components of human beingness concerning body, mind and spirit within a family and social context, hereby all natural desires, longings, and hungers of the human heart, and the kind of faith evolving from that (i.e. an universal spirituality, theologically derived from man’s creation in the image of God). • A specific Christian perspective – where trust in the triune God, and a living through the Holy Spirit in the wide context of the Church community, builds the ultimate framework of faith and life.

18. This flexible and critical attitude I now briefly have presented, allows me to walk fearless along with the confident and learn from him and her in all aspects of life, and it gives me simultaneously the freedom of tentative exploration of the confident’s readiness for input during our journey together. (The last aspect is suppressed by most of the modern mainstream pastoral-care literature, being utterly afraid of acting in an authoritarian way or even causing some kind of mental assault.) The attitude and behaviour mentioned so far, is what I all together frame as “viatoric pastoral care”

19. Viatoric Pastoral Care The Latin word viatorhas two meanings: • A person walking along the road (a companion) • A person with something to convey (a messenger) A viatoric caregiver is consequently a person who – together with the co-walker – cares for a good journey (the process) and for what is passed on during the trip (the outcome). A possible definition of viatoric pastoral care sounds like this: Pastoral care is – in a social and ecclesial context – to walk a part of the way of God together with an undivided (not just a body, a mind or a spirit etc.) and unique fellow human being (or several of the same kind) in order to prepare for and convey faith, hope and love. (The “way of God” is here meant to include all aspects of life under his presence, and the last part of this definition is open both for “faith, hope and love” as vital elements in everyone’s life, and for the specific Christian fullness of the same three words.)

20. Some Consequences • Pastoral care and counseling (PCC) tries to meet the question of faith and health in all its perspectives, but not uncritical. • “There are things more important than being healthy, and worse than being ill” (Norwegian chaplain Peder Olsen) • Pastoral care-givers work in different contexts, and will occasionally have to adapt more or less painfully to the health-system, and always to the confident, but indeed without loosing their own souls. • For different research reasons a certain pastoral care approach has to be formulated much more precisely and distinctly than this overview allows.

21. C. Ambiguous Traits in Our Secular Society

22. Hallmarks of Our Secular Societies (cf. Charles Taylor 2007) • We live in societies where no parts of the political system are really connected to God, or some notion of ultimate reality. (The remains of state churches are e.g. rather a tool for political authorities to regulate Church-life, than opposite.) • We live in societies where the falling off of religious belief and practice is obvious. • We live in societies where belief in God is heavily disputed, remaining just one option among others, and frequently not the easiest one to embrace.

23. European Counterbalance • Believing without belonging (Example: even though a marked reduction concerning the more rigorous indicators of religiousness, such as participation in institutional Church-life and commitment to the credal statements of Christianity, is observed, certain dimensions of belief relating to the existence of soul and life after death, are rising markedly among younger generations, together with a variety of self-made beliefs and mixtures of it.) • Belonging (as a kind of relational belief) without believing (as a kind of full doctrinal belief) (Norw. situation as example: 90 % belong officially to the Church of Norway (80%) and other churches as a kind of religious “home” they do not want to leave, but only 31% confirm (2010) belief in the resurrection of Christ.) • Vicarious religion (Advocates the fact that Christian faith, seriously celebrated by an active minority, is performed on behalf of a much larger number, who (implicitly at least) not only understand, but, quite clearly, approve of what this minority is doing.) • From obligation to consumption(Church-attendance, once imposed, or at least inherited, have become instead a matter of personal choice for some periods or particular circumstances (e.g. rites de passage or life crises).)

24. Hidden religion (often disguised in compassion for art; personal perfection; various mystical experiences; veiled pilgrimages; fullness of human life etc., or in more destructive ways like: ecstatic behaviour through drugs, madness and excessive sport enthusiasm; self violation and eating disorders; worship of utopian revolutionary struggles; boundless sexual activity; experiences of inner emptiness etc. ) • Other signs of de-secularisation: - Influence of immigrants (Christians and Muslims etc.) - Growth of Charismatic and New-age movements - New religious interest among intellectual elite (e.g. philosophers like JürgenHabermas, SlavojZiztek, Alain Badiou, GeorgioAgamben, Simon Critchley (the last four taking great interest in St Paul, and among other things his biblical contribution in relation to our contemporary radical lack of active motivation and self-devotion)) - Abundance of “small holinesses” (fx. encountering death in the family; values worth fighting for; some cultural symbols;, experiences of intense relationship to nature, home(land) and people; free laughter; happiness of good meals and everyday life etc. – and, as also emerged in a Norw. survey on what people considered holy, even to clean the bathroom in a meditative, calm way)

25. Why Is This Broad Understanding of Religious and Sacred Signs Important? To be alert to meet all people – frankly and openly – in their, partly disclosed, existence as longing and aspiring creatures (hominesdesiderantes),and to challenge all pastoral care-givers to trace more or less distinct footprints of the confident’s personal apparition as an image of God. Because of the different cultural and ecclesial situation in Europe and US, and the built-in aloofness towards open faith expressions typical for Northern Europe, this kind of “detective work” (research) has to be dealt with very sensitively and contextually.

26. Possible Conceptual Consequences • If one emphasizes the obvious signs of secularisation in our age, it may be seen important to develop the therapeutic and social concepts of PCC (cf. types 6-8) as an act of conscious adaptation (or to offer resistance by contrasting concepts). • If one on the other hand emphasizes the obvious signs of sacralisation in old and new clothing, it may be seen important rather to promote the concepts of kerygmatic to ecclesial type (types 1-5), in order to thoroughly meet the spiritual needs of today (or to offer sobriety by contrasting concepts). • If one emphasizes the ambiguous signs of our time, as I do, it feels necessary to be able to play all the different tunes of the PCC-instrument, however in a contextual and critical way.

27. Three Ambiguous Traits Important to PCC • PCC has to relate to the strongly growing individualization – and at the same time to the accompanying need for commitment to a larger community (Koinonia). • PCC has to relate to the strongly growing differentiation and professionalism – and at the same time to the need of a uniting pattern of unpretentious mutual service (Diakonia). • PCC has to relate to the strongly growing secularization – and at the same time to the accompanying need for religious experience and personal faith (Martyria).

28. Pastoral Care in Our Secular Age • In our so-called secular age people need to meet a kind of pastoral care which is more than just a reflection of secular methods of caring. • In our secular age pastoral care-givers have to believe in every human being as a person longing for more (homo desiderans). • In our secular age pastoral care-givers have, at the same time, to present a realistic view of man’s possibilities and capabilities, even as persons of faith (more later). • In our secular age pastoral care-givers have to understand the many wounds, tiredness of words, and experiences of disrespect resulting from encounters with unwise representatives of faith communities. • In our secular age pastoral care-givers need to develop much patience, humility (doctaignorantia) and trust in God being present in all cases before us, together with us and after us.

29. D. Important and Problematic Elements in the International Health-Faith Research

30. a. Important for PCC Theory and Practice • It is important to notice that the core of relevant faith-health research is designed and carried out according to the highest scientific standards, or at least presented in a careful and critical way by leading compilers. • It is important to notice that a widespread alleged correlation between religious faith and anxiety, weakness, stress, neurotic behaviour, insanity and depression is nearly unequivocal rejected, and replaced by a significant positive association towards mental and physical health. • It is important to notice that the research opens a serious dialogue with educational and health institutions to grant spiritual and religious matters a genuine place in the screening and understanding of patients, and also when it comes to follow-up actions.

31. It is important to notice that the research in general confirms the spiritual needs (in a wide sense) of great many patients, and reveals that religious beliefs and practices may help cope with and reduce emotional distress caused by severe loss or change, and even (hereby) affect the physical condition positively. • It is even important to notice that severe ill persons commonly seem to become more religious after their diagnosis. • It is also important to notice that the research normally encourages a multidimensional and dynamic view of faith, flexible and large enough to encompass life as a whole. A valuable built-in critique of some unsound faith expressions is consequently also present (see also my critical comments later). * Seen from the perspective of PCC theory and practice all these aspects are of great value, and form an empirical foundation able to sustain and inspire different types of pastoral care.

32. b. Problematic Aspects by Adaption in Northern Europe I suspect an underlying, dare I say un-proportional (?), occurrence of a certain mentality and context (probably more linked to the American way of life and thought, than to the European). Head words: anthropological over-optimism; enthusiastic psychological climate; emphasizing of harmony, success and effectiveness; scientific and theological pragmatism; a more general, agreeable theology without strict confessional foundation; the unique social structure of American church-life and health-care system as the given background and recipient for most of the research. If my general observation is partly right, the faith-health research has to be developed further when adapted to a Northern European context – not only when it comes to data, but also in respect of ideology. This is especially true if one feels tempted to work in relation to the theory and practice of PCC. I therefore continue by singing a “broken hallelujah” in three verses, which at the same time gives a brief presentations of some basic considerations. “Broken” means here : cut into smaller pieces and without perfection.

33. Ring the bells that still can ring. Forget your perfect offering. There is a crack in everything. That’s how the light gets in. Leonard Cohen in “Anthem”

34. 1. A Broken Understanding of Scientific Research All kinds of scientific research have in a way to be controversial, and broken down from its often inhabited claim of superiority and perfection. It is wrong to ask whether a specific scientific approach has pitfalls or defects, the right question would be: which ones. No matter if you stick to a kind of methodoligicalscientific rationalism with its dualism of body and mind (Decartes, Hobbes, Spinoza, Leibniz); a kind of empiristic/positivistic research with its experiential/observational approach, accompanied by predilection for what can be counted, weighed and measured (Locke, Comte, Carnap); a kind of phenomenological method where experience is granted attention in the way it appears for the subject (Husserl, Løgstrup, Merleau-Pontey); a kind of hermeneutical approach, concentrating on understanding and interpretation of “texts”, and the conditions for such an enterprise, be it in a traditional, philosophical, or in-dept manner (Schleiermacher, Dilthey, Heidegger, Gadamer, Ricoeur) or the spin off in Habermas’ critical theory; postmodern “”deconstruction” and construction” (Foucauld, Lyotard, Derrida) – there are in all schools (and combinations of them) premises (axioms), limitations, and pitfalls to be carefully considered. The same concerns all kinds of quantitative and qualitative approaches, to use another well known differentiation. Most appalling is the haughty ambition of creating just one form of scientific method and language covering all areas of human life, most often voiced by some advocates of positivistic approaches. On the other hand, it can be wise to use exactly these kinds of methods to be heard in all dominant corners of the health-care and financial system!

35. From a pastoral care perspective I will at the same time most strongly oppose that only so called evidence-based research shall guide the practice and release financial support, as already suggested in many countries. In a competitive market where “scientific”, in a narrow sense, is an important trade mark, it’s reputation will easily be used to control all aspects of practice, even if comparable (!) research on practice seems to give meagre scientific evidence to support this strategy. It establishes a huge problem when a certain scientific method is given authority to construct and rule over the design of all clinical practice. The Norwegian philosopher and professor in Roskilde, Denmark, in the seventies, Hans Skjervheim, denounces such an attitude as a fundamental “instrumentalistic mistake” (1972). The mistake exists in superimposing instrumental reason as the only guiding principle for all institutions and relations. The result is a technification and increasing regulation of the whole clinical field . The Norw. psychologist and professor Tor-Johan Ekeland calls it a total “manualization of practice”, i.e. a rigid concept of direction according to certain standards, which limit the options and really make it difficult for the practitioner actively to use professional discernment and varied forms of expression (1999). * A broken understanding of over-ambitious and one-sighted scientific work, results hopefully in a kind of spiritual humility among scientifically orientated care-givers, promoting flexibility and appreciation of different scientific approaches, and even towards a non evidence-based creative caring.

36. 2. A Broken Understanding of Health The concept of health is not plain and undisputed, and has to be broken down from the utopian state of “total physical, mental, and social well-being” (WHO), and restored to something else than just “absence of ills” (cf. Piet Hein). The concept of health is transient and changeable. It varies from time to time, from profession to profession, and from person to person. It is from beginning to end a relative idea, and the famous WHO-formulation is by far convincing to all. May be health even includes experiencing the right to be “unhappy, ill and impotent”(O.S. Lian)? In a way health is also always a hidden factor(cf. H.-G. Gadamer: Über die VerborgenheitderGesundheit(1993)), un-accessible to the power of language . And John Steinbeck describes one of his protagonists as follows: “He was fifty-four, lean, handsome, and healthy in so far he knew. By that I mean his health was so good that he was not aware he had it” (The Short Reign of Pippin IV). * In a new study on howordinary Norwegians understand health (Helsepånorsk (2009)), two Norwegian professors(Per Fugelli (social medicine) and BenedicteIngstad (medical anthropology)) divide the findings into ten categories:

37. Ten Factors of Health (measured in Norway) • Health is well-being/satisfaction (trivsel) - a convincing No. 1. • Health is balance (likevekt) • Health is wholeness (helhet) – included belonging to a spiritual world • Health is adaption (tilpasning) • Health is ability to function (funksjon) • Health is moving towards a goal (bevegeseg mot et mål) – pursue interests with success and fulfil existential and moral aspirations • Health is power of life (livskraft) • Health is resilience (motstandskraft) • Health is absence of thoughts about health (fraværav tanker omhelse) • Health is absence of illness (fraværavsykdom ) – mentioned by 17 of 80 informants (low compared with international studies) * A broken understanding of over-ambitious or one-sighted concepts of health, results hopefully in a kind of spiritual humility , paying tribute to “moderate contentness” as a realistic and all right way of life, into which health in different aspects is reflected.

38. 3. A Broken Understanding of Human Being and Faith When it comes to a basic understanding of human possibilities and the nature of faith, it has to be broken in several ways: • The everlasting fragmented character of human nature has to be recognized, cf. the German practical theologian Henning Luther (1985): We have to say farewell to the myth of a banal wholeness, and recognize that we are “fragments of the past” and “fragments of the future” – and understand our un-extinguishable self-transcending aspiration on this background. • Existential anxiety and crises belongs inevitably to life itself, and can not be suspended by a successful personal growth etc., but often suppressed by it, cf. the Danish psychologist Bjarne Jacobsen and Søren Kierkegaard (2000). • The faith has to be broken in a struggle between what seems to be healthy (in a more narrow sense), but not necessarily true, and what seems to be true, but not necessarily healthy. To meet the Christian God seriously, is not just to find cheep grace, oblivion and peace, cf. the Danish bishop Kjeld Holm (1986). • A faith full of harmony, peace, and calmness is not a Christian faith – when not capable on all stages to include an amount of tribulation, anxiety, protest and despair, cf. the main stream spiritual history of the Church, and even most of the Lutheran tradition, fx. Grevbo 2006: Guds masker.

39. On this background I am not very puzzled by the fact that there is evidence of “unhealthy” struggle facing death among “hardcore-Christians” (fx. Pargament, Koenig, Tarakeshwar 2001). I am more puzzled by the fact that it seems to be so little of it, so little of observed struggle, fight, anxiety and shrilling cries when deep believing persons are facing the end of life. God is not just a nice and understanding social worker, and death is seldom just a friend, but even a real enemy. In some part of their existence, committed Christians will know that. To help people die in peace can therefore not be the only(!) goal for pastoral care. The main thing is to assist people in looking for some comforting divine hands to be within, in the very middle of struggles, protests, laments and a whole bunch of mixed feelings! To die blessed and saved, is, consequently, theologically more important than to die in peace after a fruitful and long lasting life. This insight also opens the importance of the eschatological perspective, which psychology and health-care as such, can not present. On the other hand is the psychological well being encountering death not irrelevant to pastoral care, cf. “the critical plurality of PCC-perspectives”. * A broken understanding of the capacities of human beings, and of what faith is psychologically able to accomplish during our lifetime without loosing its theological and spiritual roots, results hopefully in a kind of spiritual humility strengthening the courage to live and to die, in the middle of our recognized fragility and fragmentation in body, mind and spirit.

40. E. A Multi-factor Spirituality Model

41. The Main Dimensions of Spirituality Every human being is according to Christian anthropology a living and unique expression of body, mind and spirit in a family and social context. All these aspect are of course inter-related and can not be divided into pieces. We will now, however, concentrate on the spirit-aspect, and ask what are the characteristics of its expressions through everyday challenges, and especially in times of crises? I will defend three main dimensions, which again can be differentiated into cognitive, emotional and behavioural expressions (cf. Grevbo 2008, published even as official guidelines of spiritual care in palliation by Norwegian health-authorities): • Existential questions (Norw.: eksistens-utfordringer) • Questions of values (Norw.: verdi-utfordringer) • Questions concerning one’s belief system (openly religious or not) (Norw.: livssyns-utfordringer) These three areas are of course again interrelated, but profit on being separated for scientific and even clinical reasons. (See in contrast the compact definition of the Consensus Conference on Spirituality and Palliative Medicine (2009), honouring in it’s own way the same elements: “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”

42. 1. Existential Questions This area holds questions linked to the basic conditions of human life, deep and difficult questions which no one totally escapes. They cover challenges tied to - identity and meaning (fx: “Who am I now when my disease has completely changed my life situation?”) - suffering and death (fx: “How should I relate to death now when it is impossible to run away?”) - guilt and shame (fx: “What wrong have I done to deserve this terrible situation?”) - loneliness and isolation (fx: “How can I avoid loneliness, and at the same time avoid invasion by other people with various needs related to me?”) - freedom and responsibility (fx: “How can I endure in a situation where I am totally dependent on receiving help from others?”) - courage of life and ennui (fx: “Is there still something to hope for in my situation, a little spark with glowing potentials?”) (The examples of questions here, and in the following two sections, are directly derived from my own encounters with terminally ill patients.)

43. 2. Questions of Values Here is the place for concerns related to what is really valuable to us on the human level, and in the different phases of life.The focus is especially on all the various relations which fill a life of human beings, like the relation to: - ourselves - family - friends - work - material things - nature - art and culture - moral standards - life itself (past, present, future) Main question here: “What is most important to me in my actual situation?” Further expressions could be: “How can the life I have behind me, be a positive value in my last period?”; “Do I really still have a personal value in this phase of life?” etc.

44. 3. Questions Concerning One’s Belief System Questions of this ultimate character can be dealt with on an obvious religious basis (i.e. including a relation to a kind of deity), or reflect an immanent humanistic worldview. Not seldom will caring people meet a mixture of these positions, concerning - the ultimate meaning of life - life’s and death’s inhabited demands - human worth, and the fight for a worthy life - faith and doubts - hope for eternal life – and other ultimate hopes - forgiveness from and reconciliation with fellow human beings and God - God’s presence in suffering and loss - the role and practice of prayer - the possibility of divine healing - the content of (Christian) faith Central questions sound here like: “Do I have a sustainable philosophy of life, and does such a thing at all exist?”;“Is my wavering childish belief strong enough?”; “Why do God feel many times so distant, and why does he just not remove all evil things?”;“Does it help to pray?”;“Have I lived a good enough life?”; “How can I make up for all my wrong doings?” – Very often take these ultimate concerns however, not the shape of questions, but express themselves in a longing for a personal anchoring in some comforting words (in the Bible) and prayers, hymns and songs, blessings and other rituals.

45. The three extensive, interrelated and partly overlapping, dimensions of man’s inextinguishable spiritual quest, prevent us from ending up in a narrow corner when spiritual issues are at stake. Adequate spiritual care may on this background be summarized in the following statement: Spiritual care is • to notice the confident’s needs related to existential questions, questions of values, and questions concerning the belief system – and not just once and for all • to listen, within the framework of the confident’s own history of life and of the currant situation, in order to comprehend and collect the main points of interest • to assist the confident (and relatives) during the process, always concentrating on the confident’s own concerns – and at the same time being alert of the confident’s possible urge to change or develop the way of thinking, feeling, and/or acting in spiritual matters.

46. Some Expressions from Terminally Ill Patients “A serious illness effects us always – and not seldom to the better.” “Almighty God! If You let me live on, give me Your strength so I can make it; if You let me die, let me be embraced by Yourself and Your mercy”. “Every person has a story to tell, in serious crises perhaps with few or no words. I long intensely for someone to show me my value by listening carefully”.

47. Selected Literature Related to Grevbo’s Lecture (Odense 19.05.2010) • The well known publications of Koenig, Pargament, Wulff (and co-writers) are not listed. - Some of my own older simplistic works, still relevant to my basic understanding of pastoral care, spirituality and psychology of religion, are included. • Baumann K. (2009). ”ReligiöserGlaube, persönlicheSpiritualität und Gesundheit: Überlegungen und Frageni m interdiziplinärenFeld von Theologie und Religionswissenschaft, Medizin und Psychotherapie”. ZeitschriftfürmedizinischeEthik(Jg. 55 S. 131-144) • Baxter J. (ed.) (2007). Wounds that Heal: Theology, Imagination and Health. London: SPCK • Berg Eriksen T. (1995). Helse I hver dråpe: Innspil om etikk, kunnskap og omsorg. Oslo: Universitetsforlaget • Braut A. (2008). ”Spiritualitet og livsmestring. Teologiske og religionspsykologiske perspektiv på gudsrelasjon og trospraksis i møte med lidelseserfaringer”, Masteravhandling: Det teologiske Menighetsfakultet, Oslo • Brooks Holifield E. (1983). A History of Pastoral Care in America: From Salvation to Self-Realization. Nashville: Abingdon Press • Clebsh W.A., Jaekle, C.R. (1964/1994). Pastoral Care in Historical Perspective. Northvale, New Jersey, London: Jason Aranson Inc. • Doehring C. (2006). The Practice of Pastoral Care: A Postmodern Approach. Louisville, Ken.: Westminster John Knox Press • Ekeland, T.-J. (1999). ”Evidensbasert behandling: kvalitetssikring eller instrumentalistisk mistak”. Tidsskrift for Norsk Psykologforening , bind 36, s. 1036-1047 • “Forskning innen palliasjon”, temanr. Omsorg. Nordisk tidsskrift for palliativ medisin(4/2009) • Fugelli P., Ingstad B. (2009). Helse på norsk: God helse slik folk ser det.Oslo: GyldendalAkademisk • Furseth I., Leer-Salvesen P. (2007). Religion in Late Modernity: Essays in Honor of PålRepstad. Trondheim: Tapir Academic Press (cf. Davie G. “Religion in Europe in the 21st Century: The factors to take into account” pp. 37-53) • Gleason J.J. (Winter 2004). “Pastoral Research: Past, Present, and Future”. Journal of Pastoral Care & Counseling, Vol.58, No. 4, pp. 295-306 • Grevbo T.J.S. ((1999). ”Moden og sunn tro. Et mørklagt tema satt under teologisk og religionspsykologisk belysning”. Halvårsskrift for praktisk teologi (hefte 1, s. 3-12) • Grevbo T.J.S. (1982). ”Hva er nevrotisk religiøsitet?” Tidsskrift for Sjelesorg (hefte 2, s. 26-38) • Grevbo T.J.S. (1986). ”Adskillelse, sammenblanding eller hva? Et bidrag til debatten om forholdet mellom psykoterapi og sjelesorg”. Tidsskrift for Sjelesorg (hefte 1, s. 7-17)

48. Grevbo T.J.S. (1987). ”Norskdom og kristendom i dag. Kristendommens møte med norsk kultur og lynne i 1980-årene”. Halvårsskrift for praktisk teologi (hefte1,s. 3-21) • Grevbo T.J.S. (1987). ”Religionspsykologien i Norge: En oversikt fra 1915 til i dag”. Tidsskrift for teologi og kirke (hefte 4, s. 287-306) • Grevbo T.J.S. (1995). ”Sjelesorgen i dagens situasjon – med særlig henblikk på Danmark og Norge”, Tidsskrift for Sjelesorg (hefte 4, s. 190-205) •  Grevbo T.J.S. (1997). ”Sjelesorg – teologi i biografisk kontekst”. Præsteforeningens Blad (hefte 22, s. 870-879) •  Grevbo T.J.S. (1998). ”Livshistorie og religiøsitet”. Halvårsskrift for praktisk teologi (hefte 1, s. 24-32) •  Grevbo T.J.S. (1998). Det fir-foldige menneske. Et personlighetsspeil til sjelesørgerisk bruk. Oslo: Luther Forlag (4. oppl.) •  Grevbo T.J.S. (2006) Sjelesorgens vei: En veiviser i det sjelesørgeriske landskap – historisk og aktuelt. Oslo: Luther Forlag •  Grevbo T.J.S. (2006). Guds masker i sjelesorgen: Hvordan forholde seg til det guddommelige maskespill teoretisk og praktisk? (Skriftserien Koinonia nr. 5) Vikersund: Institutt for sjelesorg – Modum Bad (2. oppl.) • Grevbo T.J.S. (2008). ”’Viskningaroch rop’: Åndelige utfordringer innenfor palliasjon”. Omsorg. Nordisk tidsskrift for palliativ medisin (hefte 2, s. 31-38) • Grevbo T.J.S.(medforf.) (1975). Prest og menneske. (cf. ”Nevroseskapende trekk i menighetsliv og prestetjeneste. En innføring i debatten om ekklesiogene nevroser” s. 45-67). Oslo: Presteforeningens studiebibliotek nr. 2 (og senere opptrykk) • Holm K. (1986). Sorgens sprog – trækaf den principiellesjælesorg. Århus: Forlaget Aros • Jacobsen B. (2000). Den helbredende sygdom: Søren Kierkegaard – krise ved somatisk sygdom. København: Dansk psykologisk forlag • Luther H. (1985). ”Identität und Fragment. Praktisch-theologischeÜberlegungenzurUnabschliessbarkeit von Bildungsprozessen”.TheologiaPractica(20. Jg. Heft 4, S. 317-338) • Luther H. (1992). Religion undAlltag: Bausteinezu einer PraktischenTheologiedes Subjekts. Stuttgart: Radius-Verlag

49. Luther H. “AlltagssorgeundSeelsorge: ZurKritikamDefizitmodelldesHelfens”. WegezumMenschen (38. Jg. Heft 1, S. 2-17) • Martinsen K. (2006). Care and Vulnerability. Oslo: Akribe • Martinsen K., Eriksson K. (2009). Å se og å innse: Om ulike former for evidens. Oslo: Akribe • Neumann J.N. (2009). ”Religion undKrankenbehandlung: Eine medizinhistorisch-kulturanthropologischeVerhältnisbestimmung ”. ZeitschriftfürmedizinischeEthik (Jg. 55, S. 111-129) • Nome J. (1970). Kritisk forskerholdning I etikk og religionsfilosofi. Oslo, Bergen, Tromsø: Universitetsforlaget • Ramsay N.J. (ed.) (2004). Pastoral Care and Counseling: Redefining the Paradigms. Nashville: Abingdon Press (cf. Miller-McLemore B.J. “Pastoral Theology as Public Theology: Revolution in the ‘Fourth Area’” pp. 45-64) • Seitz M. (1988). ”Eingutes Ende finden! KlinischeErkenntnisund pastorale Aufgabe”. (VorlesungWürzburg 1988, priv. Kopie) • Skjervheim H. (1959/1974). Objectvism and the Study of Man, norskutg. Objektivismen og studiet av mennesket. Oslo: Gyldendals Fakkel-bøker • Skjervheim H. (1960). ”Deltakar og tilskodar” og ”Faktum og fridom”. Aarnes A. m.fl. Brytninger i tidens tankeliv. Oslo: Johan GrundtTanums Forlag (s. 63-91) • Skjervheim H. (1968). Det liberale dilemma og andre essays.Oslo: Johan GrundtTanum Forlag • Skjervheim H. (1971). ”Det filosofiske grunnlaget for psykoterapien”. Alnæs R., Johnsen,G. (red). Psykoterapi, bind III: Metoder ved forskjellige psykiske lidelser. Oslo: Fabritius & Sønners Forlag (s. 10-18) • Skjervheim H. (1972). ”Det instrumentalistiske mistaket”. Mediaas M. m.fl. Etablert pedagogikk – makt eller avmakt? Oslo: Gyldendal Norsk Forlag • Stollberg D. (1972). TherapeutischeSeelsorge: Die amerikanischeSeelsorgebewegung. Darstellung und Kritik. München: Chr. Kaiser Verlag • Swinton J., Mowat, H. (2006). Practical Theology and Qualitative Research. London: SCM Press • Taylor C. (2007). A Secular Age. Cambridge, Mass., London: The Belknap Press of Harvard University Press • TheologiaPractica (1992, 27. Jg. Heft 3): Gedenkschriftfür Henning Luther 1947-1991 (Red. Gert Otto, auchmitBibliographie)

50. Thomassen M. (2006). Vitenskap, kunnskap og praksis: Innføring i vitenskapsfilosofi for helse- og sosialfag. Oslo: Gyldendal Akademisk • Thornquist, E. (2003). Vitenskapsfilosofi og vitenskapsteori - for helsefag. Bergen: Fagbokforlaget Vigmostad & Bjørke • Unterrainer H.-F., Ladenhauf K.H. (2008). “Religiös-spirituellesBefindenimKontextseelischerGesundheitundKrankheitsverarbeitung: Ergebnisse eines interdiziplinärenForschungsprojekts”. Psychologie in Österreich (Heft 1 S. 54-61) • VandeCreek L., Bender H., Jordan M.R. (1994). Research in Pastoral Care and Counseling: Quantitative and Qualitative Approaches. Decatur, Ga.: Journal of Pastoral Care Publications • VandeCreek L., Lucas A.M. (eds.) (2001). The Discipline for Pastoral Care Giving: Foundations for Outcome Oriented Chaplaincy. New York, London, Oxford: The Haworth Press