public hospital in America was established in 1736 before the Revolutionary War. The first chaplain, John Stanford, a priest of the Church of England arrived on the scene in 1816. The Episcopal Church supported the Bellevue Chaplains till five years ago when the Rev. Glendon Jantzi, CPE Supervisor, retired. The Carmelite Fathers came from Ireland at the turn of the last century to fulfill their apostolate as hospital chaplains to Bellevue. They continue as the Roman Catholic chaplains to this day.

Clinical Pastoral Education began at Bellevue in 1940 with the Rev. Ralph Bonacker as the first supervisor. He was followed by many leading lights in the CPE movement: The Rev. Thomas Morris, The Rev. Arthur Elcombe, The Rev. Armen Jorjorian, The Rev. Fredrick Keuther, The Rev. A.P.L. Prest, The Rev. Alvin Hart, and from 1967 – 1999, the Rev. Glendon Jantzi.

The Bellevue Chaplains Clinical Pastoral Education program was renewed January 1, 2005 as a satellite of Robert Wood Johnson University Hospital, New Brunswick, New Jersey. The Rev. Paul Steinke is the ninth CPE supervisor in Bellevue’s 60-year history of offering clinical pastoral education.

Bellevue is a microcosm of the Third World – a hospital for the undocumented, impoverished and disenfranchised. No one is turned away. Bellevue’s emergency room is the largest in the USA. Lewis Thomas, M.D., the distinguished physician and essayist once remarked, “If I were to be taken in a taxicab with something serious or struck down in a New York street, I would want to be taken to Bellevue.”

 Bellevue with its 750 beds and many clinics for addictions and victims of torture could not be adequately served without a clinical pastoral education program. Chaplain interns provide the bulk of bedside pastoral caregiving. The sixty-year tradition of clinical pastoral education at Bellevue continues to keep the circle unbroken.

The Rev. Paul D. Steinke, 01-06-05

Minneapolis: Fortress Press, 2010. Soft cover. 200 pp. $22.00

                                                                              Reviewed by Paul D. Steinke

                                                                            Bellevue Hospital Center

Get this book! Rosemary Radford Ruether provides us actually with several books. Many Forms of Madness is a mother’s harrowing narrative about her son, David’s lifelong struggle with mental illness.  It is a story of love, suffering, disappointment, and rage with scraps of hope shoved between the lines. The historian, Ruether provides an upsetting, and shameful record of society’s care of the mentally ill. Her chapter on the causes of schizophrenia bristles with the arrogance and ignorance of the mental health professions down through the decades. Another book within this book is Ruether’s expose of the international pharmaceutical cartel that controls the education of psychiatrists and the direction of the therapeutic treatment of the mentally ill. She is enraged by the pharmaceutical companies pushing their life destroying psychotropic drugs on the most vulnerable people in our communities.

One of the most powerful elements of Ruether’s book, she may not have intended. It lies between the lines – she cannot not communicate her rage. Her attempt to reframe David’s life is a mother’s attempt to redeem a life shriveled almost dry by forces beyond her control. You won’t be able to read this book straight through, but you will not be able to put this book down.

It is no comfort to the mentally ill or their families to say schizophrenia remains a mystery. It remains an under investigated illness.  Our vaunted sciences and technology know nothing more about this illness today then they did forty years ago. I do not see much difference between patient care at Norwich State Hospital in Connecticut in 1971 and Bellevue’s eight psychiatric units and numerous outpatient clinics in 2010. In forty years science and humane treatment have given hope to depressed people and folks with Bi-polar illness. In those same forty years the treatment of schizophrenic patients has changed little. The light of hope provided by the community mental health movement in the 70s was quickly extinguished. We have no better idea today about Schizophrenia than we did forty years ago. The cycle of hospitalization and/or imprisonment, homelessness, group homes, board and care homes (usually old rundown motels), and hopelessness remains the daily bread of all these people. And these fellow human beings, created in the image of God, continue to be misunderstood, mistreated and marginalized. Their lot is the cry of dereliction from the cross!

A young woman recently appeared in the doorway of my office and asked if she could talk to me. I was reading Many Forms of Madness at the time and she was not unlike how I envisioned Rosemary Ruether’s son, David to be. After we shook hands and she sat down she said, “I’m schizophrenic and get depressed. I just got past a bad relapse and my social worker thinks I should get some training and you teach people to visit patients.” She then opened her briefcase and showed me several certificates of education programs she had completed. We talked about her accomplishments and her sister, “a successful business woman.” She was matter of fact in relating her occasional homelessness.

 My colleagues know that I seldom refuse anyone a single unit of CPE, whether undocumented or homeless. My afternoon guest was straightforward with me. I needed to be straightforward with her. “Our clinical training program is so emotionally intense. I, I… do not think that someone with your recent medical history would, er…er…  gain much from it.” The afternoon guest experienced my awkwardness in turning her down. Her reply graciously saved me: “I really can’t manage something so intense.” I wish my therapist could read me as well.

Years ago Jay Haley, the pioneering family therapist, in a lecture at Philadelphia State Hospital posed the question: What are schizophrenics for? Anton Boisen discovered the answer years before as a patient and then a chaplain on the dark, forbidding floors of Worcester State Hospital. The answer is they are our teachers. These living human documents, are not broken pieces of machinery, they are sons and daughters – created in the image of God.

Rosemary Radford Ruether’s Many Forms of Madness: A Family’s Struggle with Mental Illness and the Mental Health System provides us with an urgent call to again become advocates for the mentally ill. The State Mental Hospitals from Milledgeville to Central Islip in which many CPE supervisors and professional chaplains trained are mostly gone now. The legions of mentally ill remain in prisons, on the streets, and in board and care homes. They need again our louder voices and deeper deeds to survive and thrive. Society fails them. Mentally challenged people and their families seldom hear from the church, the synagogue or the masjid. We haven’t learned all we need to learn from these chronically ill people. Without embarrassment they openly display their neediness before us. “They are not self-sufficient,” as Stanley Hauerwas has often reminded us (Hauerwas, 1986, p.176). They can teach us to be less embarrassed and more open about our own neediness and the poverty of our own lives. Rosemary Ruether’s Many Forms of Madness provides fresh sight, stirring motivation, and a call to renew our commitment to those who taught us how to do pastoral care.        Created She them in Her own image.

References

Hauerwas, S. (1986), Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church. Notre Dame, Indiana, University of Notre Dame Press.

The Rev. Paul D. Steinke, CPE Supervisor, Bellevue Hospital Center, New York City

Any talk about clinical pastoral education needs to begin with Anton Boisen, the founder of CPE. He is the one who first called the patients “The Living Human Documents.” And because he did we do not look at patients as broken pieces of machinery – we look at them as our teachers with dignity and respect. CPE was born in the dark, shadowy halls of Worcester State Hospital where Boisen decided his illness was a spiritual journey – an exploration of the inner world.

Boisen left Worcester State Hospital for Elgin State Hospital in IllinoisHospitalwhere Anton Boisen decided that his mental illness was

. There he trained Clarence Bruninga (first generation) who went directly from Seminary to clinical training. Clarence Bruninga, who died this year, went from Elgin to Norwich State Hospital in Connecticut where he trained me and Ralph Ciampa (second generation). Many of you know Ralph as the CPE Supervisor at the hospital of the University of Pennsylvania and also as the person who trained your supervisor Steve Dutton (third generation). And Steve Dutton trained all of you (fourth generation). So none of us are far removed from Anton Boisen.

Today we celebrate the CPE journey. What remains memorable is the journey itself- these weeks and months and years of ministering to suffering people at Christiana and learning from your experience with the guidance of Steve and Tammy and Timothy.

Eudora Welty wrote a short story about an old Negro woman, named Phoenix  Jackson–not too subtle a name. Phoenix lived way out in a deep rural area of Mississippi near the Natchez Trace with her grandson. The grandson had swallowed some lye and his throat and esophagus were scarred with pain. Every month or so Phoenix would have to travel miles and miles to town to the doctor to get pain medication for her grandson. It was an arduous journey for an old lady in her 80s, wrought with physical dangers – battling undergrowth and thorns, wild animals everywhere, climbing barbed wire fences, struggling up steep hills. She battled onward. Occasionally she would meet a hunter. Finally, she arrives at the clinic to get the meds. The clinic personnel have obviously not taken CPE. They treat Phoenix like a dememented old lady and worse they relate to her like she’s a welfare case. No one in the clinic recognizes her long walk, no one validates her struggles, and no one listens to her.  Phoenix picks up the medication for her suffering grandson and returns to the dangerous and difficult way back to her grandson. The title of this short story is “the worn path.”

To call the CPE experience “a journey” is kind of a cliché. Lets call CPE The Worn Path. It is my hope and the hope of your supervisors that CPE has become for you a Worn Path – indeed a Habit of Being. It is a worn path fraught with danger yet ultimately worth any danger in order to minister to suffering people. And Like Phoenix, we who trod this path over and over again, are renewed in ways that we do not anticipate. We can feel crushed by the burden one day and so competent in our skin the next.  The irony and truth of Eudora Welty’s story is that the myth of the Phoenix, of life rising out of ashes, is no big deal – it’s not a big show, it’s not up in lights on Broadway – it is captured in the words from St. Matthew that precede the story’s telling: “Blessed are the meek for they shall inherit the earth.” CPE is just a path, not a super highway. We are just folks struggling with our own wounds trying to address the wounds of suffering people. The pastoral relationship occurs when your vulnerability meets the vulnerability of your patients, peers and supervisors.

I want to remind you of three things you have done as you trod the worn path of clinical pastoral education this year and this summer:

1. First of all you have defied the  entropic vortex of the autonomous self.

Any writer will tell you that when you are too in love with a sentence you write, it probably should be discarded.. I must say I am in love with this sentence “Defying the entropic vortex of the autonomous self.”  The word “defy” just appeals to my authority issues so much – it means “to challenge the power, to resist the status quo .”  “Entropic” – that wonderful idea from Thermal Dynamics that things are sliding down and away. And “vortex,” which is the center of the whirlpool. And “autonomous self” which is the state of being an independent being.

I’m not condemning autonomy here. Achieving autonomy has probably been a goal of many of you in CPE. I’m not talking about all the discoveries you made about yourself, all the soul searching you did. What I am saying is that by delivering pastoral care to suffering people you have defied the dominant culture of the self in which we live, a culture that designates the weak and the infirm, the sick and dying as second-class citizens.

We live in a culture formed by the Enlightenment of the 18^th and 19^th centuries in which the highest values are progress and positive thinking, youth and vigor, health and self-reliance. The self-sufficient are valued, not those who are suffering..  The rampant individualism of American culture  leaves people in hospitals bereft of any community and little support.  In a culture that avoids weakness and celebrates the strong. people in hospital beds who are not the strong- loose out.

You defied our lone ranger culture to provide suffering people with a fellowship unlike any other. You did this by providing community and companionship to the very people our culture isolates – suffering people.

The Duke theologian Stanley Hauerwas writes: “By its very nature suffering alienates us not only from one another, but also from ourselves.” You have attended to suffering people. connecting to them with a transfusion of care, of spirit, of life itself.

Gregory Orr, the Virginia poet, went hunting one Fall morning when he was 11 years old with his father and brothers. He accidentally shot and killed one of his brothers. Years later he wrote the poem, After a Death:

I heard the front door close

And from my window saw

My father cross the moonlit lawn

And start up the orchard road.

Then I was with him,

My mittened hand in his,

And Peter, my brother, his dead son,

Holding his other hand.

The way the three of us walked

Was a kind of steady weeping.

And so may we characterize the way we walk the worn path of CPE, the way we bring community to suffering people as “a kind of steady weeping.” 

1. 2.     Your second accomplishment in CPE is that you have been emotionally gripped by your failures.

 David Brooks in the NY Times in his June 6th column about Abraham Lincoln writes:

It would be nice to have a president who had gone to school on his own failings. It would be comforting to see a president who’d looked into the abyss, or suffered some sort of ordeal that put him on a first name basis with his own gravest weaknesses, and who had found ways to combat them.

You are now fluent in the CPE language of strengths and weaknesses. You discovered you are stubborn or that you couldn’t walk two steps without pleasing someone. Or you discovered you are a doormat for authority figures or that you hide under the table when conflict is brewing. You explored the intense fear you didn’t know you had or your defensiveness when your work was critiqued. You can see now that looking good was your first priority. Some of you may have found out you are like Father James in Graham Green’s play, The Living Room. Father James is speaking to a parishioner in dire crisis:

I want to help. I want to be of use.

I would want it if it were the last

Thing in life I could have. But when I

Talk my tongue is heavy with the…the,

The catechism.

Others may have discovered that your “voice is chained in your throat.:”

And writ large for all of us in CPE is our anger….unruly on the one hand and the bridge to reconciliation on the other hand.

I am sure you have discarded the grandiose Rescuer you and put on the garments of a more modest, realistic you. You came to Christianna Hospital to help people and all you ended up doing is listening to the cry of anguish of suffering people. You have toned down the noise of your own voice to hear the suffering of “maimed, the halt and the blind.”

You may also have been gripped in CPE with the failure of God. Robert Olmstead in his Civil War novel, Coal Black Horse, tells the story of a young man sent by his Mother to retrieve his Father from the battlefields.

He comes across a field where the battle has just ended:

It was a horrible scene to witness, replete with  sorrowful pleadings for water and assistance, while the silent dead resided in strange repose, their stiffen arms reaching to embrace heaven. He decided that from that day forever after that there must live a heartless God to let such despair be visited on earth, or as his father said, a God too tired and no longer capable of doing the work required of him.

You have been gripped by your failures. And those failures, those weakness, your screwed up history, you,warts and all, are the best resource you have for pastoral caregiving. You minister out of your own suffering, your own failures. As a man mourning the death of his son said: “The tears of God are the meaning of history.”

1. 3.     And in CPE you have acknowledged the “restiveness of what it means to be human.”

The poet, Carl Phillips in his essay on the Psalms writes:

The trajectory-psychological, emotional- of the Psalms is that of restiveness itself…If we read the entire book, we cannot help but understand that the only constant (in the Psalms) is fluctuation – astonishment gives way to joy, joy to fear, fear to despair – and despair again – and temporarily to joy. This is the restiveness of what it means to be human and perishable. To be flawed, to be alive.

The word restive is defined as 1. refusing to go forward, balky like a horse. 2. hard to control, unruly. 3. impatient under pressure, restless, unsettled.

The human condition is not defined here as utter Calvinist depravity or the Lutheran original sin or the Anglican bad manners, like wearing white after Labor Day (that’s a low blow to get a cheap laugh) nor is the human condition equated with drinking and dancing and lusting as in the Pietist and Holiness traditions.

The human condition is called restiveness. This restiveness, this balkiness, this unruliness, and this unsettledness-  you have discovered in yourself and in your patients and in your peers and supervisors. On the worn path of CPE you have seen what it means to be a human being.

• How ordinary people like us can connect  to one another occasionally,
• How stubborn folks like us can change our minds,
• How religious people like us can set our souls in a different direction,
• How restive people like us can walk the worn path.

The poet says this is the restiveness of what it means to be human, to be perishable. And in CPE we discovered the perishable nature of the human in ourselves and in our patients. Elizabeth Spires, the Baltimore poet in her poem Now the Green Blade Rises remembers the recent death of her mother:

Sometimes, when the phone

Rings, I think it is you.

Three months, and I still believe

I’ll hear your voice at the other end

Of the line. But you’re dead,

And the world is ash. Your body

Words that used to live.

I had a dream, black and pictureless.

You were calling my name

Over a great distance. It hung

Suspended in the dark air,

But I could not move,

Had no voice to answer.

Mother, forgive me if I can.

Now, if I could, I would sit

With you in a simple pew

Somewhere quiet and dim.

To be there would e enough.

There’d be nothing  we’d have to say.

The moment held like a book

Between us, a silent offering.

It would be midwinter.

We’d watch the slant light

Of late afternoon stream

Through high windows

To warm cool stones, warm us,

And fall on an open hymnal

To lines we’d read by touch

Now the green blade rises from the buried grain,

Wheat that in the dark earth many days has lain;

Love lives again that with the dead has been;

Love is come again like wheat arising green.

There soul to soul,

We would have forever

To finally speak again.

To be alive in the poet’s view is to embrace are humanity, our perishableness and in so doing we recognize our restiveness. And it is there where we all meet soul to soul – the green blade rising over and over again.

By now you’re saying – wow – CPE was a lot more fun than this graduation  speaker has pictured it.  We’re headed home or for the beach and a well-deserved vacation and this guy is plying us with all these accomplishments, which sound so serious, even bleak. And so I leave you with a song as the blessing this afternoon.   I heard Sam Bush, the great mandolinist sing these words at a Bluegrass Music Festival earlier this summer:

• Take time for sunshine,
• Take a whole lot of time for love.
• Take time to thank and praise heaven up above,
• And take a little time for howling at the moon.

Ambulances arrive, staff move among the gurneys – the choreography for all its energy seems softer and less brittle than the ER TV show.  

As Bellevue’s pastoral educator I trip through the ER with each chaplain intern in the second week of their 10 weeks, 400-hour program.  We go from Urgent Care, a section for economically disadvantaged people who need to use the ER for their family doctor, to the Pediatric and Adolescent ER, which has its own waiting room and caters to thousands of sick kids every year. The Comprehensive Psychiatric Emergency Program fills up everyday with folks who have emotional problems. The Adult ER has 28 gurneys. The Emergency Ward is a 15- bed hospital for patients who need to stay overnight. The various areas can treat 75 patients at a time and the beds change three or four times a day.

During my tour with the chaplain interns I relate Bellevue ER lore: If the President of the United States is injured when in New York City, he or she will be taken to the Bellevue Hospital Emergency Room, New York City’s major trauma center.  Lewis Thomas, M.D., the distinguished physician and essayist once remarked, “If I were to be taken in a taxicab with something serious or struck down in a New York street, I would want to be taken to Bellevue.” Part of the mythology of the ER is that people who are shot in NYC always say: “Bring me to Bellevue.”

Several years ago cramped with gut pain I went to a much smaller ER in a local NYC hospital. They lost me in plain sight for over two hours. The place was cold and my wife, Ann found a blanket for me and herself. To add insult to injury a nurse’s aid grabbed my wife’s blanket screaming, “The blankets are for patients only.”  No one is treated so callously or gets lost in Bellevue’s ER. Patients receive attention from 35 physicians, 63 residents in Emergency Medicine, 40 nurses, numerous aids and social workers. Chaplains and Chaplain Interns make their rounds throughout the day. 

Last summer I was taking Philip Ohriner, an intern from Jewish Theological Seminary, around the ER.  We stopped at the gurney of a woman who seemed to be a sheet of pain. Philip introduced himself. The woman shook her head yes when he asked her if she would like to speak to a chaplain. A commotion to my right drew my attention away from the pastoral event unfolding before me. I looked up and Dr. Lewis Goldfrank, Professor and Chief of ER Medicine, was motioning for me to come across the room. He stepped up to me and said: “Chaplain, chaplain. Over here we have a man who doesn’t feel life is worth living. He wants to give up. Surely he needs a chaplain.” I move across the area. Dr. Goldfrank says to the patient: “This is the chaplain.”

The patient is sitting on the edge of a gurney. It looks like he has just changed into the clean clothes the Social Work Department supplies. The standard issue new black sneakers sit on a stool beneath his feet. His feet are swollen like most of the homeless people you meet at Bellevue. The man is from South Africa.

Chaplain: So the doctor says you don’t want to go on living.

Patient:  I live to drink.

Chaplain:  Sounds like a tough way to live.

Patient: It’s my choice.

Chaplain: You’re not interested in any of the treatment programs we have at    

                 Bellevue?

Patient: I told you I live to drink.

Chaplain: It sounds so harsh.

Patient: My younger brother died last year in South Africa. Drank himself to

             Death.

Chaplain:  What a tragedy.

Patient: I live to drink, I drink to die.

Chaplain: It sounds so hopeless.

Patient: You have your job Chaplain. I appreciate you talking with me.

               My job is to drink myself to death.

Chaplain: I don’t know what to say – err – err – God bless you.

I walk back over to where Philip is ministering to the woman. A few moments later I glance across the room to the South African. Dr. Lewis Goldfrank, one of the most renowned Emergency Medicine Physicians in the world, is putting on the man’s sneakers. His tall, lanky frame is bent over the South African patient. He laces each shoe and ties each knot.

Philip and I move on to another gurney and while he is introducing himself to the patient I glance toward Triage and the Entrance. Lewis Goldfrank is holding the door open for the man who lives to drink and drinks to die.

The young woman* sitting at the head of the table nervously cleaned her glasses. She was meeting the certification committee for Readiness to Supervise. The candidate was queried about her nation of origin, Australia.

The question seemed to settle her and the conversation proceeded.

One of the committee members asked her about a phrase in her personal history: “You talk about your ‘forgiveness project’ in your history. Could you tell us more about that?”

The woman looked surprised and said: “Oh that. Several years ago I lived with a man. I allowed him to abuse me. My forgiveness project is trying to forgive myself for allowing such abuse.” A tear started to stream down her cheek. “I’ve been working with my therapist on it for awhile.”

The room quieted. No one spoke for what seemed like several minutes. Then Jack Gleason spoke. I can’t remember whether he stood up or it just seemed like his words were spoken like he was standing up. He looked at the woman and said, “I forgive you.” More silence. “I forgive you.” I don’t know about the rest of the committee members but I felt like I had just received absolution. Jack continued: “I know for me I can’t forgive myself unless someone else concurs in my forgiving myself.”

The woman said; “Thank-you.” I don’t remember anything else of what was said that morning. I’ll always remember that moment of grace –so pure, so amazing, so CPE.

I propose to the ACPE family a long over due forgiveness project.

In the last ten years we have had good and smart counsel in bringing our association up to snuff ethically and legally. Who would have ever thought that we would come to a time where some of our hospitals run a complete security check on potential CPE students. Were you ever arrested? is a common initial interview question. We have also learned how to operate as men and women in a professional setting. We have learned about the proper boundaries between students and supervisors. We sign documents about our ethical standards. We have come so far from those days in the 60s and 70s when the Cultural Revolution found its way into CPE. Our house is in order. We have covered all the legal and ethical bases. The Ethics Commission has done its job. Processes are in place to deal with offenders.

The Forgiveness Project I have in mind is to develop a process that will allow us to reclaim some of the offenders. And the wonderful thing is that we have seated on our Board of Reps 20 forgiveness experts. This isn’t a job for them to palm off on lawyers. This is a job clergy know more about then lawyers. Let the lawyers check out the finished product. Let the product come from the forgiveness experts on the Board of Reps. I am sure we cannot reclaim people convicted of felonies (even though Jesus did). I don’t see why we can’t reclaim supervisors who stepped over sexual, financial and administrative boundaries.

Why doesn’t the Board of Reps develop a process that will allow some of our fallen colleagues back into the fold? Develop criteria. Prepare a process. Get started on the ACPE Forgiveness Project. It won’t be easy to do.

Remember John Patton’s book Is Human Forgiveness Possible? (Forgive me John if I over-simplify your argument): Through several cases in which clients were unable to forgive a parent or sibling John reveals that they only came to the point of forgiving the parent or sibling when they became aware that they were no different than the person who was so unforgivable. The clients had to over-come their self-righteousness and recognize their human condition in order to forgive the unforgivable.

Many will say, “Oh, that’s the counseling situation. You can’t expect an organization to forgive people.” Hell, yes, we can. We all belong to organizations that are forgiving people everyday. The members of ACPE can expect our elected representatives, all forgiveness experts, to get started on our ACPE Forgiveness Project.

When I first came to NYC in the mid eighties I lived in the rectory of St. John the Evangelist Lutheran Church in the Williamsburg section of Brooklyn across the street from the oldest public housing in NYC. I paid for my domicile by conducting the Sunday liturgy for this little African-American church. The congregation had its own corps of deacons who assisted in the ornate, high church services. One Sunday Deacon Booker said to me, “Reverend, Deacon Johnson needs to say something after you read the Gospel.” I agreed and after the Gospel Deacon Johnson came to the lectern and said:

Fifteen years ago I was the treasurer of this church. You didn’t

know, but I embezzled $12,000 of your money. This week I paid back

the last dime. I am not proud of what I did. I am sorry for taking

advantage of you.”

Deacon Booker stood up and asked the congregation: “Do you forgive Deacon Johnson?” In one voice the congregation shouted, “Yes.”

As I sat there in the pulpit chair I thought to myself, “Holy Moly! This stuff really works!”

* The candidate gave written permission to use the story. All names, locations and people have been fictionalized except Jack Gleason’s. He ain’t no fiction. He’s the real thing.

Paul Celan’s parents disappeared in the Holocaust. He narrowly escaped the Nazi extermination camps. Celan’s poem Deathfugue is organized around an insistent chorus that begins each stanza:

Black milk of daybreak we drink it at evening
we drink it at midday and morning we drink it at night
we drink and we drink1

Milk, which is life sustaining, is transformed into something repellant and sinister –black milk. How can we live with the terror of unremitting suffering? How can we go on? Celan suggests that “we drink and we drink.” We do not choose this cup of woe. Drink we must. How can we survive otherwise? The grim opposites “black” and “milk” are bound together and suggest we cannot have one without the other.

Black milk is my metaphor for the literary resources that can enrich pastoral learning. Celan’s black milk was the Holocaust, an event so horrific it can barely be described in words. I do not intend to diminish his meaning by borrowing his image to describe other terrible suffering in people’s lives. Every day pastors witness patients drinking this scary potion – black milk.

The story, whether in narrative or poetry, alerts us without sentiment to the tragic in everyday life. Literary resources provide us intimations of our own mortality, our own tragedy. Peter DeVries’ novel, Blood of the Lamb is the story of Don Wanderhope who loses his faith as a child when his brother dies, and tries to recover it in adulthood when his daughter is dying of leukemia. Don Wanderhope drinks the black milk that life offers again and again. In his frustration he throws a pie at the statue of Jesus around the corner from Sloan Kettering Cancer Center. His eleven-year-old daughter, Carol dies. The story ends with Wanderhope’s recognition:  “how long, how long is the mourning bench upon which we sit, arms linked in undeluded friendship, all of us, brief links, ourselves in the eternal pity.” 2 Our enlightened culture of niceness, optimism and positive thinking tends to sponge up the black milk of a tragedy with a super absorbent paper towel.

Why would we need literary resources when we have clinical resources?  Clinical resources – the verbatim, the case study, and the self-study – are the bedrock of pastoral learning. Literary resources provide a common language. When students read Tolstoy’s The Death of Ivan Ilych and discuss it together it becomes a common point of reference throughout the training unit.

“She’s no different than Ivan’s wife.”  “Gerasim was too good to be true, just like you.”  “My patient was like Ivan in that he waited till the last to look over his life.”

The verbatim gives us a snapshot of the patient. We see the patient in a small frame. Literary resources provide a longer look at a person; provide not snapshots, but more of a series of photographs. Clinical language is short-cut language. Clinical language might describe a sad, anxious person as depressed. A word like depression doesn’t come close to the description of this mood as we find it in a poem like Psalm 88:

For my soul is full of trouble
and my life draws near the grave.
I am counted among those who go down to the pit;
I am like a man without strength.
I am set apart with the dead,
like the slain who lie in the grave,
whom you remember no more,
who are cut off from your care

The poem describes the black milk that the sad, anxious person drinks – “in the darkest depths,” “the lowest pit,” “eyes dim with grief.”  In William Styron’s, literary non-fiction masterpiece, Darkness Visible, an account of depression, he calls melancholy “a true wimp of a word for such a major illness.”3

Another advantage of using literary resources in pastoral learning is that it can enrich pastoral language. Instead of the universal CPE student responses – “that is hard” or “that is difficult” – why not a metaphor? “It sounds like you are drowning.” “It must be hell”. “You are down in the pit.” It’s as if God is on vacation.”  Donald Capps says: “pastors who take their pastoral care work seriously are deeply concerned with how things are said, and with why this rather than that word or phrase was chosen in a given context.”4 Language matters and literary resources show us the use of metaphor. Metaphor literally means, “to carry beyond.” It is the way language carries itself past its own powers, to enter new realms. A metaphor is a receptacle for diverse and deep experiences of suffering and joy.

Another use of literary resources is beauty. Literary art takes the worst black milk situation you can think of and puts it in a narrative or a poem. The most chaotic experience is given form, structure and beauty in poetry and narrative.  Poetry, novels and short stories do not diminish the suffering. They encase the terrible in beauty so that we can see it anew and from a different vantage. Gregory Orr observes, “its possible to say that the enormous disordering power of trauma needs or demands an equally powerful ordering to contain it, and poetry offers such order.”5 When you are bringing pastoral care to people down in the depths, where black milk is the drink of the day, beauty rests the soul.

The black milk metaphor looms a powerful reminder of the resilience of evil. It also seems a religious metaphor for slavery/salvation, suffering/redemption, death/life and as a Lutheran Christian, Good Friday, Holy Saturday/Resurrection. Black milk also stands next to another drink I imbibe, the cup of salvation offered to me in the Eucharist. That cup is a reminder of a suffering and dying God that offers life, sustenance and strength for the daily drinking and drinking of black milk.

The literary resources now suggested are grouped around what might be called pastoral care themes. The four units of CPE each year at Bellevue, for example, have a theme. The themes are discussed and written about each week in smaller groups we call Integration Groups.
Fall:  The Pastors’ and the Patients’ Illness Stories: literary resources: At the Will of the Body, Arthur Frank (creative non-fiction), and two short stories, Eudora Welty’s A Worn Path and Charlotte Perkins Gilman’s The Yellow Wallpaper.
Winter: Pastor as Person: Peter Devries, novel, Blood of the Lamb and the short story, Departures, John L’Heureux.
Spring: Pastors’ and Patients’ Grief and Loss: Leo Tolstoy’s The Death of Ivan Ilych and Anton Chekhov’s short story, Gusev.
Summer, Pastoral Response in a Multi- Cultural World: Anne Fadiman’s creative non-fiction, The Spirit Catches You and You Fall Down and short stories by Bharati Mukherjee, the Management of Grief and Nora Zeale Hurston, Conscience of the Court.
Poetry that befits the occasion is interwoven throughout the integration units sometimes in a formal way, often on the spur of the moment.
Most of the short stories can be found in The Norton Anthology of Short Fiction, R.V. Cassill and Richard Bausch, Editors, Sixth Edition, (New York: W. W. Norton and Company, 2000) On the list below I will only signal short stories not listed in the Norton Anthology. Novels and literary non-fiction will also be referenced. At the end of each section I will list poetry appropriate to the theme, which will be followed by one of the poems. At the end of the article I will include a bibliography of poets, titles, and publishers.

1.Pastoral Caregiving:
Alan Gurganus, It Had Wings: This two-page story from Harpers via Winter 1985 issue of Paris Review is a parable about CPE. It usually provokes a good orientation week discussion.
Eudora Welty’s A Worn Path is a moral story of conscience and unrelieved suffering – and redemption – by the poorest of the poor.
Charlotte Perkins Gilman’s, The Yellow Wallpaper depicts the terror of mental illness and the societal forces that keep it hidden from public view.
Arthur W. Frank’s creative non-fiction At the Will of the Body provides an illness narrative of Frank’s journey with cancer. The nature of being ill with its pitfalls and emotion is nowhere more beautifully said. Students see the course of an illness and reflect on how pastoral caregivers may have interacted with Frank on his journey. (Arthur Frank, At the Will of the Body, (New York: Houghton Mifflin Company, 1991).
Poetry: Langston Hughes, Sick Room; Abraham Sutzkever, Prayer for a Sick Friend; Sharon Olds, His Terror; William Stafford, Consolations.

Sick Room
Langston Hughes
How quiet
It is in this sick room
Where on the bed
A silent woman lies between two lovers-
Life and Death,
And all three covered with a sheet of pain.

2.Grief/Mourning:
Tillie Olsen, Tell Me a Riddle reveals many twists and turns as an older couple tramp through a thicket of life review and pre-mourning.
Bharati Mukherjee, The Management of Grief is the talkative excursion of an Indo- Canadian community’s response to a Lockerbee like plane crash that consumes many of its members. The nuances of grief revealed here is a welcomed relief from the canned responses to grief prevalent in self-help books.
Lee Smith’s Intensive Care chronicles the grief of a dying patient in the ICU. The nature of hope whispers from every page.
Poetry: Tess Gallagher, Yes and Wake and Moon Crossing Bridge; Gregory Orr, After a Death; William Stafford, Circle of Breath and In a Corner and Consolation; Jane Hirshfield, “Nothing Lasts.”

After a Death
Gregory Orr 6

I heard the front door close
and from my window saw
my father cross the moonlit lawn
and start up the orchard road.
Then I was with him,
my mittened hand in his,
and Peter, my brother, his dead son,
holding his other hand.
The way the three of us walked
was a kind of steady weeping.

3.Death/Dying:
Leo Tolstoy’s The Death of Ivan Ilych provides a cast of characters who respond in idiosyncratic ways to Ivan’s dying. His dying is meticulously recorded.  How would a pastor respond at each stopping place along the way? (Tolstoy is always in print at any bookstore.)
Anton Chekhov’s Gusev depicts a sick man returning with other sick men to the motherland. The men contend with each other, remember their lives. express strong opinions. Death is depicted in a surprising way at the end of the story.
Poetry: Raymond Carver, Gravy and No Need; Jane Kenyon, Otherwise and In the Nursing Home and Now Where; Sharon Olds, The Lumens and His Terror and His Stillness; Bertolt Brecht, To My Mother; Wendell Berry, A Meeting; Adam Zagajewski, To…, and Elegy for The Living

To My Mother
Bertolt Brecht

And when she was finished they laid her in earth
Flowers growing, butterflies juggling over her…
She, so light, barely pressed the earth down
How much pain it took to make her as light as that!

4.Vocation/Identity:
Joseph Conrad’s novella, The Secret Sharer tells the tale of a new sea captain and how he achieves his identity as a person and his vocation as a mariner through action. (Conrad’s novella is always in print at any bookstore.)
John L’Heureux’s Departures depicts the changing identities of a Roman Catholic priest as pastor, son and friend. Anthologized in Vintage Contemporary American Short Stories, Editor, Tobias Wolf, (New York: Vintage, September 1994).
Jonathan Rosen’s (the husband of a CPE Supervisor) Joy In the Morning may be the only novel whose protagonist is a woman rabbi and hospital chaplain.
Rosen is a teacher and the book offers a clear view of Jewish life and practice.
(Joy In the Morning, Jonathan Rosen, (New York: Farrar, Strauss and Giroux,
2004).
Poetry: Dietrich Bonhoeffer, Who Am I ? Mary Oliver, Wild Geese and Magellan and the Summer Day; Denise Levertov, Vocation and A Cure of Soul; Jane Kenyon, The Pear.

The Pear
Jane Kenyon

There is a moment in middle age
when you grow bored, angered
by your middling mind,
afraid.

That day the sun
burns hot and bright,
making you more desolate.

It happens subtly, as when a pear
spoils from inside out,
and you may not be aware
until things have gone too far.

5.Suffering/Redemption:
Eudora Welty’s A Worn Path challenges most of us privileged folk to envision anew a perspective on life and suffering through the eyes of a poor old woman and her sick grandson.
Flannery O’Connor’s A Good Man Is Hard to Find depicts the human condition in all its self-righteousness and violence. This is the human stripped to the bone.
Poetry: Bertolt Brecht, Everything Changes; Sharon Olds, The Struggle; Jane Kenyon, Notes From the Otherside; Gregory Orr, Three Biblical Songs; Denise Levertov, Strange Song.

Strange Song
Denise Levertov

Yet the fear nags me: is the wound
My life has suffered
Healing too fast,
Shutting in bad blood?
Will the scar
Pucker the skin of my soul?

6.Faith/Doubt:
Peter DeVries’ The Blood of the Lamb is the only full-length novel I use in my CPE curriculum. It has been out of print for years but can be found on the Internet at used book sites. (Blood of the Lamb, Peter DeVries, (New York Little Brown and company, 1961).
Poetry: Denise Levertov, Psalm Fragments and Suspended; George Santayana. Faith; Adam Zagajewski, In the Past; John Updike, Seven Stanzas at Easter.

Faith
George Santayana

O world, thou choosest not the better part!
It is not wisdom to be only wise,
And on the inward vision close the eyes,
But it is wisdom to believe the heart.
Columbus found a world, and had no chart,
Save one of faith deciphered in the skies;
To trust the soul’s invincible surmise
Was all his science and his only art.
Our knowledge is a torch of smoky pine
That lights the pathway, but one step ahead
Across a void of mystery and dread.
Bid, the, the tender light of faith to shine
By which alone the mortal heart is led
Unto the thinking of the thought divine.

7.Community:
Robert Condon’s Christmas at Bellevue appeared in the New York Herald Tribune, December 19, 1965. It depicts an unusual community bound together by hardship.
The Prologue to Scott Pecks The Different Drum: Community Making and Peace is a remarkable parable of multi-faith cooperation.
Poetry: Adam Zagajewski, In The Beauty Created By Others

In The Beauty Created By Others
Adam Zagajewski

Only in the beauty created
by others is there consolation,
in the music of others and in other’s poems.
Only others save us,
even though solitude tastes like
opium. The others are not hell,
if you see them early, with their
foreheads pure, cleansed by dreams.
That is why I wonder what
word should be used, “he” or “you.” Every “he”
is a betrayal of a certain “you” but
in return someone else’s poem
offers the fidelity of a sober dialogue.

8.Cross-Cultural:
Bharati Mukherjee, The Management of Grief.
Zora Neale Hurston’s Conscience of the Court looks at the interplay of the many cultures in a small southern town where Laura Lee Kimble, the daughter of slaves is on trial for roughing up a white man.
Anne Fadiman’s The Spirit Catches You  and You Fall Down is the harrowing story of an Hmong girl’s clash with modern American medicine in Merced, California. Fadiman is a must read for understanding our multi-cultural existence.
Poetry: William Stafford, Distractions and In the All-Verbs Navaho World and Is This Feeling About the West Real? Tu Mu, Kenneth Rexroth, trans., LXVIII, View From the Cliffs.

In the All-Verbs Navaho World
William Stafford

Left-alone grow-things wait, rustle-grass, click-
trunk, whisper-leaf. You go-people miss the hold-still
dawn, arch-over sky, the jump-everywhere glances.
This woman world, fall-into eyes, reaches out her
makes-tremble beauty, trolls with her body, her
move-everything walk. All-now, our breath always
life extends, extends. Change. Change your live-here,
tick-tock hours. Catch all the flit-flit birds,
eat the offer-food, ride over clop-clop land,
our great holds-us-up, wear-a-crown kingdom.

Bertholt Brecht asks somewhere “In the dark times will there be singing? Yes, there will be singing -  about the dark times.”  In the dark times, the times when black milk is the only brew being served, a distant song may be heard, a hand may be proffered, a tear may be shared, a groan may be the only telling, darkness may be the only friend. Literary resources provide the language we need when pain and suffering destroy language.

Poetry Bibliography
Wendell Berry, Collected Poems, 1957 – 1982,(SanFrancisco: North Point Press, 1985).
Dietrich Bonhoeffer, The Cost of Discipleship, (SanFrancisco: The Macmillan Company, 1978).
Bertolt Brecht, Poems 1913 – 1956,  (New York: Routledge, 1956).
Bliss Carmen, Editor, The Oxford Book of American Verse, (New York:  Oxford University Press, 1927).
Raymond Carver, A New Path to the Waterfall, (New York: Atlantic Monthly Press, 1989).
Tess Gallagher, Moon Crossing Bridge, (St. Paul, Minnesota: Graywolf Press, 1992).
Jane Hirshfield, Given Sugar, Given Salt, (, New York: Harper Collins, 2001).
Langston Hughes, Dig and Be Dug In Return, Selected Poems, (Seattle: Scriptor Press, 2002).
Jane Kenyon, Otherwise, (St. Paul, Minnesota: Greywolf Press, 1996).
Denise Levertov, Evening Train, (New York: New Directions Books, 1992).
Denise Levertov, Oblique Prayers, (New York: New Directions Books, 1984).
Denise Levertov, Poems, 1960 –1967, (New York: New Directions, 1967).
Denise Levertov, The Stream and the Sapphire, (New York: New Directions, 1997).
Sharon Olds, The Father, (New York: Alfred Knopf, Inc., 1992).
Mary Oliver, New and Selected Poems,  (Boston: Beacon Press, 1992).
Gregory Orr, The Red House, (Cambridge: Harper Colophon Books, 1980).
Kenneth Rexroth, Love and the Turning Year, One Hundred More Poems from the Chinese, (New York: New Directions, 1970).
William Stafford, Stories That Could Be True: New and Collected Poems, (New York: Harper & Row, 1977).
William Stafford, A Glass Face In the Rain: New Poems, (New York: Harper & Row, 1982).
William Stafford, Passwords, (New York: HarperCollins, 1991).
William Stafford, The Darkness Around Us Is Deep, (New York: Harper Perennial, 1993).
William Stafford, Even in the Quiet Places, (Lewiston, Idaho: Confluence Press, 1996).
John Updike, Telephone Poles and other Poems, (New York: Alfred A. Knopf, 1963).
Adam Zagajewski, Without End, New Selected Poems, (New York: Farrar, Straus and Giroux, 2002).