Thursday, August 17, 2006

Pastoral Care for the Suffering

A pastor cares for sheep. He leads them to warm, green pastures and to refreshing waters. He leads them and they follow him. As a pastor, I care for people. I lead them to Jesus. Most of the time, people are rather satisfied with their lives. They feel well cared for, their needs are met, and they understand their lives. Other times, they feel completely out-of-control, wildly hurdling through unknown space, not knowing what the next day will bring. These sheep need special attention and care. I wish to speak about this sort of pastoral care in this paper.

What would (will) you do if (when) you learned you had cancer and only a few months to live? Your understanding of your life and all your relationships and activities would change drastically. It would be a painful experience filled with great suffering. How could a pastor help?

Pain and Suffering
“Pain can be defined as a greater or lesser degree of physical discomfort.”[1] Pain can be inflicted by a gunshot, a lack of food, or the prick of a needle. Pain is usually managed by the person himself or herself, and by healthcare professionals in more severe cases. “Suffering, on the other hand, can be defined as the existential anxiety, fear, worry, or hopelessness that may or may not accompany pain.”[2] Suffering may or may not have a particular pain associated with it. Suffering is usually managed by the person himself or herself, and by pastors and psychiatric professionals in more severe cases. To understand the role of the pastor, we must first understand patterns of behavior common among those who suffer greatly.

Those who suffer learn to cope with their suffering in different ways. When pain causes fear, worry, anxiety, or a feeling of hopelessness, this suffering is quite unpleasant. How people learn to react to this “unpleasant-ness” is called “coping.”[3] Coping is a learned behavior – a reaction to suffering. Think about a boxer who has been hit with the same right jab three times in a row. He will soon learn to deal with this suffering (resulting from the pain in the nose) by dodging or ducking or striking first or perhaps by throwing in the towel. These are examples of coping.[4] Some boxers are better than others at finding a coping mechanism that works well. Though I am not a boxer, I would think that striking first would work better than dodging. The same is true for other sufferers.[5] Now, we will look at some patterns of typical coping behaviors.[6]

Coping Strategies
1. Seek or deny information. Some people, when confronted with a crisis seek information. This can be quite helpful if a decision needs to be made. Sometimes, however, the information-seeking behavior is a distraction. It can be a way to deal with the crisis academically and cognitively so as to not deal with the crisis emotionally – thereby reducing the level of suffering. In medical crises, many have turned to the Internet for information – they can find more information than they could possibly use. Others refuse to learn about the crisis, preferring to be content and oblivious to the facts. These people often are quite resigned to follow the will of others and do not wish to be bothered by information. They reduce the level of suffering by reasoning that “I cannot do anything anyway, so why worry [or get involved, or be anxious]?”

2. Community or isolation. Some seek solace in community. During times of suffering, some exhibit behaviors that draw others in to commune with them – to identify with their sufferings. Many people find relief from their suffering by sharing their burden with others who can lighten the load. Others, however, feel that community only causes more suffering. The presence of community adds to the already unbearable stress, so they repel people (politely or otherwise) in order to avoid further suffering.

3. Busyness or Idleness. All of us have seen a child in pain from a clumsy fall who is quickly distracted from the pain by a piece of candy or a favorite toy. As adults we may do this with movies, music, sports, or TV. Those in crisis may distract themselves with business – that is, keeping busy. Perhaps they continue as if the crisis had not occurred (some might even say it this way), others may find new tasks or tasks that have been put off for many months or years. People learn that if they are busy, they are less likely to think and reflect on the crisis, the pain, and the suffering. A few others learn that idleness can have a similar effect. Inactivity comes in the form of fantasies, commonly.

4. Compliance or Noncompliance. In a crisis situation, many people become highly compliant with almost any directive. Many will ask strangers who care to listen, “What should I do?” And they might just take whatever advice is given. In the hospital, doctors, nurses, and other healthcare professionals like these people because they are so easy to work with. These sufferers learn that passivity makes them feel less responsible for their actions. Less responsibility results in less suffering (though not always less pain) because one feels less guilt. Other people become noncompliant in a crisis and are at least suspicious of every direction given to them. They think that no one is benevolent and if they comply, their suffering will be heightened, therefore, they reduce suffering by refusing to comply with any directive.

There are many other sorts of coping mechanisms and ways to classify them. This is just a survey of some of the more popularly used strategies.[7]

Pastoral Care
The pastor has much to gain from a good understanding of coping mechanisms. People naturally seek to find meaning in life – a connection with the spiritual world – with God. They long to know and feel that they matter to God and to others. When that knowledge or feeling is disrupted by pain,[8] people suffer and they respond with coping mechanisms. What is the pastor’s role?

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Theology of the Cross
Martin Luther speaks about a “theology of cross” vs. a “theology of glory.” Richard Eyer explains

…the theology of the cross says that God comes to us through weakness and suffering, on the cross and in our own sufferings. The theology of the cross says, “My grace is sufficient for you, for my power is made perfect in weakness.” The theology of glory on the other hand says that God is to be found, not in weakness but in power and strength , and therefore we should look for him in signs of health, success, and outward victory over life’s ills.[9]

Suffering of Christ
As pastors, we must help people to embrace their sufferings – not masochistically[10] – but in a way that acknowledges that Christ meets with us through suffering. He speaks to us through suffering. He suffers with us, and for us. He is the Suffering Servant of Isaiah before he becomes the One enthroned on High. Far from indicating the displeasure of God, pain and suffering helps us to identify with him in his sufferings. The Apostle Paul speaks to us this way,

I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death, and so, somehow, to attain to the resurrection from the dead.[11]

Pastor's Role
The pastor’s role is to point each sheep to Christ in the midst of pain and suffering – to know, understand and feel the grace of God in the midst of (not necessarily relieving them from) suffering. The pastor must resist the temptation always to enter in to the coping mechanisms of the patients and help her or him continue to avoid suffering as much as possible. How can the pastor do this?

For some, the most effective way to help the sufferer to know, understand and feel the grace of God is to remind them of the truths they hold so dear. For example, the first question of the Heidelberg Catechism asks, “What is your only comfort in life and in death?” and answers, “That I am not my own, but belong to my faithful Savior Jesus Christ…” Perhaps reading a passage of scripture (such as Romans 8 or John 10, etc.), perhaps praying with and for them. In John 11, when Martha’s brother Lazarus died, Jesus came to see her. Martha said, “Lord, if you had been here, my brother would not have died.” Jesus then goes on to explain, “I am the resurrection and the life. He who believes in me will yet live.” These are words that Martha acknowledges that she knows and believes, but she needed to be reminded in this time of crisis.

Mary comes to Jesus a few verses later and says the exact same thing (word-for-word) as her sister Martha. Jesus responds completely differently. He weeps. Why the difference? These two dear friends of Jesus were processing their suffering in completely different ways. They were, no doubt, using different coping mechanisms in response to their sufferings – they were asking completely different questions even though they were using the same exact words.
As ambassadors and representatives of Christ, pastors must learn to use good judgment in pointing sufferers to Christ. This skill will be honed through experience, wisdom and training. When a sufferer is using coping mechanisms to avoid his suffering out of a theology of glory (this applies to all of us at one time or another), the pastor must use great wisdom to know when and how to challenge that coping mechanism and invite the sufferer to see Christ in the middle of the suffering.[12] This kind of difficult work should drive us to our knees in prayer and humble dependence upon God’s Holy Spirit for heavenly wisdom.

[1] Richard C. Eyer, Pastoral Care Under the Cross: God in the Midst of Suffering (Concordia Publishing House, 1994), p.44

[2] Ibid., 44

[3] This is an over-simplification, but for the purposes of this paper, it is adequate.

[4] Some boxers might cope by taking medication that will dull the pain (and thereby reduce the suffering). This kind of coping is important, but best left to the medical professionals, and so will not be discussed in this paper.

[5] It is not the purpose of this paper to discuss which coping mechanisms are better than others – or even how to determine the difference between bad and good. These questions would be a good place to start further studies.

[6] We will look at several different kinds of coping strategies for the purpose of providing examples to show how coping works and what it looks like in real life – not for any sort of diagnostic resource.

[7] These strategies are taken largely from Avery D. Weisman, The Coping Capacity: On the Nature of Being Mortal (Human Sciences Press, 1984), p. 31-60

[8] Most people (at least in American culture) naturally think and feel that the presence of pain means that God is displeased with them, thereby disrupting their feeling of love and acceptance.

[9] Eyer, p. 27

[10] This stance of helping people to suffer is not masochistic, because they (we) suffer for a greater joy. This is not unlike helping a teenager endure the pain and suffering of a new and difficult job at McDonald’s in order to gain the joy of the paycheck.

[11] Philippians 3:10-11, NIV

[12] The methods employed by the pastor to point to Christ in the midst of another’s suffering could be the topic of a future study.


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