Hospital Chaplaincy in the Twenty-first Century

The Crisis of Spiritual Care on the NHS

Christopher Swift

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780754664161
• eBook ISBN: 9781317121176
• Edition: 1
• Topic: Theology & Religion
• Subtopic: Religion

Issues of faith and spirituality have been resurgent in the UK since the opening of the twenty-first century. This book charts the impact of shifting attitudes towards spirituality through the experiences of health care chaplains. Rooted in a new and challenging interpretation of the chaplain's work in the past, the book moves on to describe a current crisis in the nature of spiritual care. Using the tools of practical theology to analyze these experiences, fundamental problems are identified for chaplains as they work within the culture of 'evidence based practice'. As the National Health Service struggles to balance its books in the face of national economic uncertainty, chaplains will continue to come under increasing levels of scrutiny. Some chaplains have faced the prospect of redundancy or cuts to their budgets, while a growing number of NHS Trusts no longer offer chaplaincy to patients out of hours. In this context the nature of chaplaincy itself has come into question, and rival models of the profession have emerged. Is chaplaincy a new and distinct profession within health care, based on evidence and available to all? Or is it State-funded religious activity, theoretically open to all but in practice utilized chiefly by the faithful few? In responding to these questions the book concludes with a vision of how chaplaincy can both maintain its integrity - and be a valued part of twenty-first century health care.

Chapter 1 A History of the Chaplain

DOI: 10.4324/9781315587059-2

Introduction

The practice of assigning clergy to work in hospitals has been a part of life in England for a thousand years. Yet chaplains have been the subject of relatively little historical study, perhaps reflecting the fact that histories are most often written by those whose influence is in the ascendant. An absent history may be a contributory factor in the crisis of contemporary chaplaincy, emphasizing the lack of a clear sense of identity and forward momentum. In this chapter, the history of the chaplain’s presence in hospitals will be explored in moments of crisis and critical change. Through this approach, it will be possible to identify the shifting expectations that have surrounded the chaplain as well as the ways in which chaplains have regarded themselves at times of re-definition. It is a necessary and illuminating piece of work in relation to the subsequent examination of the current challenges facing chaplaincy.

Foundation

The moment when hospitals emerged in anything like their modern sense, as freestanding buildings with significant local governance, is difficult to pinpoint. In their study of hospitals in England, Orme and Webster doubt that such hospitals existed before 1066 ad. The diversity of institutions and the variability of evidence for this early period make them reticent about any definite claims. Their research, however, points to a particular expansion in the number of hospitals in the early part of the period between 1066 and 1540 ad. In just 150 years, starting in 1151 ad, 72 per cent of all the hospitals built between the Conquest and the Reformation came into being. While the exactness of this figure is open to question, the disproportionate number of hospitals founded in this short period is beyond serious doubt. It was a time of pastoral reform in the Church as well as a period that saw strengthening interest in the economy of salvation and the role of purgatory. Chantry Chapels (often existing within hospitals) were endowed with funds to guarantee prayers in perpetuity for individuals once they had died. In the view of Faye Getz, ‘the main purpose of hospital care was not to save lives but to allow the pious to exercise Christian charity through healing’.¹ To consider hospitals in this period is to enter a world which is at once familiar and strange. Architecturally, many hospitals featured a connection between the church or chapel and the infirmary halls. In all cases, if an altar was present, it was central to the layout of the building. These designs serve to emphasize the reproduction of a public narrative which is distinctive of the medieval period. In the teachings of the Church, and aided by the Crown, a Christian theology and cosmology was traced into every detail of human experience. Sickness was no exception. In the public spectacle of the York Corpus Christi play, the community was drawn into a story which brought together all aspects of city life, and set them under the keystone of temporal and spiritual authority: Jesus Christ. Tradition gave different parts of the play to the various Guilds of the city. In a way which exemplifies the understanding of a society over which the Son of God presides, the Barber Surgeons conclude their rendition of John the Baptist with a prayer that includes the following:

¹ Faye Getz, Medicine in the English Middle Ages (Chichester, 1998) p. 91.

I loue þe lorde, as souereyne leche,

That come to salue men of þare sore.

(I love thee Lord, as Sovereign Leech,

That comes to heal men of their sore.)

It may seem odd to modern readers, but as the perfection of all things – and within the context of a world seen through the prism of the spiritual – Christ is the ultimate leech: the sucker-out of human sin.

Yet if the mystery plays marked out the physical and spiritual unity of the city, the Church itself during this period was doing much to delineate the roles of physicians and clergy. In the Canons of Lateran Council IV, the relationship between the physicians of the body and physicians of the soul is made clear. It is the task of medical doctors ‘to warn and persuade’ the sick to see a priest before medical treatment begins, as sickness may sometimes be the result of sin, and if the priest can remove the ‘cause’ then the person will respond better to the bodily treatment. These instructions of the Council sit under the central truth of the times, that ‘the soul is more precious than the body’. In fact the physical exists to provide a visible analogy of the spiritual realm. Commenting on a sermon preached to hospital clergy by the French theologian Jacques de Vitry, Bird² argues that the first ‘line of treatment for bodily illness was reconciliation with God, and spiritual healing and preparation for death by confession and enjoined penance preceded bed-rest and medical treatment’. This overriding emphasis on the fashioning of the spirit can be seen in almost every detail of a hospital’s organization and operation, and is the central focus found in many hospital sermons of the time.³

² J. Bird, ‘Medicine for Body and Soul: Jacques de Vitry’s Sermon to Hospitallers and their Charges’, in P. Biller and J. Ziegler (eds), Religion and Medicine in the Middle Ages (York, 2001) p. 103. ³ A.J. Davis, ‘Preaching in Thirteenth-century Hospitals’, Journal of Medieval History 36:1 (2010): 72–89.

Under Pope Innocent III, the Canons of Lateran Council IV emerge as a major pastoral reform of the Church. Their impetus carried change forward long after his death and may be seen to be a partial explanation of the early explosion in English hospital foundations. The concern for sin and its expiation is more strongly regulated in the Council’s requirement for annual confession to a priest by every lay person at least once a year. As places where those close to death were brought, the importance of confession is beyond doubt in the early hospitals. In the years following Lateran IV, a relative explosion of writing occurred about the practice of confession. In a popular manual of confession from the diocese of Exeter – typical of several such works emerging in England after the Council of 1215 ad – the act of confession is described in close comparison to physical healing. In the Summula, confession is an activity in which the clergy are ‘performing an operation to repair those earthly desires’ that can leave the sinner oblivious to the perilous state of his soul. As the best physician, Christ ‘orders therapeutic baths through our outpouring of tears’ and the healthful diet of ‘fasts’. And the strongest and most effective medicine of all was penance. In the context of the hospital, an institution where the poor begged for assistance and the sick were admitted, the Church found an additional way to enact in public the forms of knowledge it believed to be right. As Koch says in his study of medieval epistemology, ‘knowledge of the world is useful only to make the word of God more clear’.⁴

⁴ A. Koch, ‘Interpreting God’s Truth: A Postmodern Interpretation of Medieval Epistemology’, International Social Science Review 57:3 and 4 (2002): 50.

When hospitals began to emerge as separate foundations, they nevertheless retained in full the religious character of the monasteries from which they sprang. As Risse puts it, ‘hospital inmates were viewed primarily as members of a new spiritual community, temporarily living in a locus religiosus’.⁵ This view is supported by an examination of the records pertaining to early hospitals. In the provisions and rules set down by Lord Walter de Langton in 1294 ad for St Leonard’s Hospital in York, no mention is made of the sick. Instead the document makes detailed statements about the conduct of the opus Dei, and the movement and accountability of the brothers and sisters. For example, at the start of the day the priest on duty is charged to hear ‘the accusations of sins and give correction’. Where brothers and sisters should go, how they should associate, which doors are to be locked and when, and what sins only the Master of the hospital can absolve, are all described in detail. It is striking how much provision in the document manifests a concern about a brother or sister being on his or her own, communicating with unknown persons or acquiring knowledge and learning beyond that required for their role. The underlying structure for the day continues to be that of the monastery, with its many offices. Into this world the sick-poor were admitted, re-clothed in a hospital livery (often with a cross motif) and put to bed in the infirmary. The basis on which they were admitted appears to have varied considerably. In some cases those of advancing years, and with modest means, could effectively buy lifelong care by purchasing a ‘corrodie’ in order to enter the hospital. This gave the hospital cash in the short term but created financial liabilities for the future. Even the process for admitting the sick-poor to the receipt of alms each day reflected the overarching religious narrative of the time. Orme and Webster describe the following policy practised in a medieval hospital in Fotheringhay in Northamptonshire:

⁵ G. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York, 1999).

three were welcomed on Sundays in honour of the Trinity, nine on Mondays to represent the nine orders of angels, five on Fridays for the five wounds of Christ and a similar number on Saturdays for the five joys of the Virgin. Here above all the poor were symbols, not just people.⁶

⁶ N. Orme and M. Webster, The English Hospital 1070–1570 (New Haven and London: Yale University Press, 1995) p. 57.

Within this religious economy of the hospital the chaplain was a key figure. Rawcliffe cites St Leonard’s at York, and later papal letters, which stipulate that chaplains should patrol the infirmary to ensure that those ‘at the point of death and when death is expected’ receive opportunity for confession and absolution.⁷ This was a place of religious immersion, an opportunity to demonstrate the faithful life a lay Christian could aspire to under religious direction. The silent presence of many hospital buildings, like the constant appearance of clergy, reminded the sick-poor of the eternity for which this life was simply a preparation. Hospitals also served a valuable purpose for the rich by getting the poor to pray for their endangered souls. They were institutions that extended the influence of the Church out of the monasteries and into the towns and cities alongside parish churches, providing the poor with shelter, food and basic care. Within all these functions and relationships, the chaplain was a central figure, ensuring the regular conduct of worship and usually overseeing the distribution of goods donated or purchased for the hospital. It would have been a demanding task if carried out faithfully, although there is significant evidence that in many instances it was not. Harper-Bell’s investigation of the charters for medieval hospitals in Bury St Edmunds found references at the end of the thirteenth century to the hospital’s staff ‘damnably converting charity into profit’. This theme occurs throughout the medieval period, although it is impossible now to estimate with any accuracy its extent within English hospitals or to ascertain whether such abuses were protracted or occasional. Both at the time of foundation and in subsequent years, what amounted to medical care largely took place away from the hospital. While there is evidence that some women caring for the sick had knowledge in the use of herbs, any cutting or puncturing of the body (for bleeding or surgery) either took place away from the hospital or involved someone coming in. Stell, referring specifically to York, identifies barbers, chandlers and brewers as those trades most closely associated with medical care in the early medieval period.

⁷ C. Rawcliffe, Medicine for the Soul (Stroud, 1999) p. 105.

In summary, whilst it is difficult to generalize the nature of hospitals in the 400 years before the events of the sixteenth century, some conclusions can be drawn with confidence. Whilst hospitals were founded by a number of different means, from ecclesiastical intervention to endowment by an individual, they all shared many characteristics of monastic life. Both in the structure of the buildings and in the division of the day, those living and working within early hospitals were required to relate to one another as occupants of ecclesiastical space. The scale and economic impact of hospitals may have varied from simple shelters to elaborate institutions, but the central activities of care, prayer and good administration remained the declared intention. In practice, the Church demonstrated a practical social endeavour alongside similar enterprises in education and the distribution of alms. But the creation of hospitals also enabled the Church to govern the conduct of some of the sick-poor, and to produce stories that bolstered its public narrative of sin, forgiveness, death and salvation. One example of this can be found in The Book of the Foundation of St Bartholomew’s Smithfield in 1174. Adwyn, who came to the hospital severely crippled, is cared for by charitable alms at the hospital until he makes a gradual recovery. At first he becomes fit enough to make some small items but ends up practising carpentry in the hospital church and through...

Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Illustrations
• Foreword to the 1st Edition
• Foreword to the 2nd Edition
• Preface
• Acknowledgements
• List of Abbreviations
• Introduction
• 1 A History of the Chaplain
• 2 The Chaplains' Professionalization
• 3 The Political Context
• 4 The Battle of Worcester
• 5 The Chaplain Today: An Auto-Ethnography
• 6 Religion, Secularization and Spirituality
• 7 Theological Voices and Ventures
• 8 Conclusion
• Bibliography
• Index