Healthy Spirituality

We aim to encourage and develop awareness of the many benefits of a healthy faith perspective. We explore the Mind-Body-Spirit connections. Sometimes we contrast a healthy religion with hidden idols of faith. Your editor is a pastoral psychologist & has been a facilitator with the Spiritual Growth Network of Kentucky for 15 years. www.sgnofkentucky.blogspot.com "Be careful lest the light in you be darkness." Luke 11:

Wednesday, April 28, 2010

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Tuesday, February 17, 2009

Narrative Medicine by Rev. Canon Whitmer, Wayne Oates Inst.

I am privileged to post this part of an online course on the Healing Power of Stories by Rev Canon Marlin Whitmer, sponsored by the Wayne Oates Institute of Louisville, Ky. Fruther attributions and references at the end. Paschal, Feb. 17

Narrative Medical
I (marlin speaking) have revised this medical section. Exciting narrative insights have been
taking place in the disciplines of literature and medicine. I have followed the development for 25 years in the Journal of Literature and Medicine.

The first edition in 1982 is subtitled: Toward a New Discipline. For the sake ofbrevity I can not begin to track the complete history.
The editor’s first column serves as a good source of quotes to give us an
idea of what this journal has been about. She starts her opening paragraph
with an orientation metaphor, “possibilize.� “In Paterson, William Carlos
Williams speaks of divorce as “the sign of knowledge in our time.� Yet the
counter theme of that poem is marriage, a conjunction of seeming
incompatibilities. It is to help “possibilize� (to borrow James Joyce’s term)
such a conjunction that this journal has come into being.� (Rabuzzi, page
vii)
Later in her introduction she describes the focus of an essay by Larry and
Sandra Churchill “the stories patients tell, emphasizes patient’s needs to
engage in the act of telling.� (Rabuzzi, page viii) I have been “possibilizing�
my agenda envisioned by Fred Kuether and actualized by the Befrienders
for some years now. We have a unifying factor with all of humanity,
regardless of disciplines. Mavoreen as a volunteer with the Auxiliary made
the same observation as the Churchill's. Human beings tell and listen to
stories.
Scientific medicine is beginning to team up with the humanities to recover
this unity. Many of us in Pastoral Care are already aware of our role on the
team by “being a part but not a part� to use Paul Tillich’s expression in
“Courage to Be.�
Dr. Rita Charon’s book Narrative Medicine: Honoring the Stories of Illness
can be called an outcome of the Literature and Medicine Journal. The book
will also give you a thorough history of this approach. She is a medical
doctor with a PhD in Literature who can speak with authority in seeing unity
in narrative and medical practice. (Arthur Frank’s Review)
Clinicians are challenged to “become fluent in the tongues of the body and
the tongues of the self, aware that the body and the self keep secrets from
one another, can misread one another and can be incomprehensible to one
another without a skilled and deft translator.� (Charon, 107) I have used the
word “translator� to describe pastoral care as we move from Scripture to
everyday life. My hope for this seminar is to improve our translator skills.
She also differentiates a number of influences on our work. “Unlike
communication theory or interpersonal relations theory, a reading theory of
the clinic encompasses the dynamics of the relationship between two
people, the teller and the listener, but also conceptualizes the narrative
itself as a dynamic partner in their intercourse, able of its own to alter what
happens between them.� (Charon, 108) The conversation with Mr.
Geibelstein altered what happened between us as he moved words from
others to tell his story. I see this a different from a psychological view
although that is not deleted. I had a spokesperson for this perspective talk
to chaplains when we met in Boston during the 80s. A number walked out,
unable to see the place of metaphor in the framing of the story. A few years can make a difference.

She also affirms the perspective I will be working from. The primacy of
metaphorical thinking appears not only literary acts but in all our acts of
thinking and living. (Charon, 119)
Part 3 of her book has three chapters which covers “Developing Narrative
Competence.� I see her title as a metonymy for “story listening skills� from
both a medical and literary perspective. In some ways her book parallels
pastoral care using different words although her approach is from a
medical/literary direction. Her first section in Part 3 discusses “A Close
Reading� where she approaches listening in the way you read a book. All
the elements apply: frame, form, time, plot, and desire.
The narrative features of medicine are identified --- “temporality, singularity,
causality/contingency, intersubjectivity, and ethicality.� (Charon, 114) In a
few pages we will see her list has features similar to the 9 metaphors
identified by Rachel Stanworth in her research with dying patients at St.
Christopher’s in London.

Her chapter 7 on “Attention, Representation, and Affiliation� has even more
connections with pastoral care. Attention is primary for Stanworth as well.
Charon means, “a state of focused attention that requires the clinician to
actively mute the inner distractions to concentrate full power of presence on
the patient.� (Charon, 132) By so doing the physician gives voice to what
the patient can not articulate. At the same time she admits, “This
suspension of the self is poorly understood, certainly by medical
doctors.� (Charon, 133) We will look at this again, several times or more, in
this presentation as well. The self emptying will be addressed under the
Pastoral and the Biblical.

There are other doctors who are approach story from a different angle.
Herbert Benson does so from a “Remembered Wellness� approach.
Placebo is redefined as "remembered wellness" (Benson, p. 20-1). When
people tell their story they can move from sad times to good times and in
so doing they engage in self care from a health standpoint.
The placebo effect yields beneficial clinical results in 60-90% of diseases
that include angina pectoris, bronchial asthma, herpes simplex, and
duodenal ulcer. Three components bring forth the placebo effect: (a)
positive beliefs and expectations on the part of the patient; (b) positive
beliefs and expectations on the part of the physician or health care
professional; and (c) a good relationship between the two parties. (Benson
and Friedman, p. 193)
Because of the heavily negative connotations of the very words "placebo
effect," he hopes "remembered wellness" will replace it. Remembered
wellness has been one of medicines most potential assets and it should not be belittled or ridiculed. Unlike most other treatments, it is safe and
inexpensive and has withstood the test of time. (Benson and Friedman, p.
193)

One of my stories with "remembered wellness" came shortly after I bought
Dr. Benson's book on Timeless Healing. We had stopped in Las Vegas to
visit my Aunt residing in a nursing home. At one of the meals I sat next to
an elderly lady who after preliminary remarks began to tell me about the
death of her husband. Tears streamed down her cheeks. She continued
with different parts of her story. Then she began to tell me about the birth of
her younger sister in the family home. It was in the middle of the night when
she was awakened. When she reached the hallway an older sister chased
her back into her room. She began to laugh. Her sadness was gone the
remainder of the meal. I was a witness to what I had been reading about,
"remembered wellness." The telling of her experiences gave witness to the
placebo effect.
I would include the peace experience of patients part of the "remembered
wellness" effect and the same components can be manifest in the
relationship any person has with another. Lay people, then, become new
clinicians on the front lines of the pastoral/spiritual/health care delivery
system facilitating this phenomenon since health care is out in the
communities in a variety of settings. I may write an article on Narrative
Caregiving to include the stories heard out in the community.

REFERENCES

References:
Herbert Benson; Timeless Healing: The Power and Biology of Belief;
Scribner, New York; 1996; 350 pages

Herbert Benson, MD, and Eileen M. Stuart, RN, C, MS; The Wellness
Book: The comprehensive Guide to Maintaining Health and Treating
Stress-Related Illness; A Fireside Book, New York; 1992.
Herbert Benson, MD, and Richard Friedman, PhD; “Harnessing the Power
of the Placebo Effect and Renaming It "Remembered Wellness’�; Annual
Reviews of Medicine; vol. 47; pages 193-199;
Rita Charon, MD; Narrative Medicine: Honoring the Stories of Illness;
Oxford University Press; 2006; 266 pages
Arthur Frank, PhD; Review of Narrative Medicine; Literature ad Medicine
26, no.2 (Fall 2007), pages 408-412
Bible with the Apocrypha, New Revised Standard Version, Oxford
University Press, 1991, 432 pages.
Davidson, Stuart. (1996, November/December). Tomorrow's medicine:
Placebos and nacebos,Healthcare Forum Journal, p. 48-50.
Esther de Waal; Every Earthly Blessing: Celebrating a Spirituality of
Creation; Servant Publications, Ann Arbor, Michigan; 1991; 148 pages.
Esther de Waal; The Celtic Vision: from the CARMINA GADELICA --- Orally
Collected in the Highlands and Islands of Scotland by Alexander
Carmichael; St. Bede’s Publications, Petersham, Mass; 263 pages.
Susan K. Hedahl, Listening Ministry, Fortress, 2001, 123 pages.
George G. Hunter III, The Celtic Way of Evangelism, Abingdon, 2000
Levine, Carol, and Murray, Thomas H., Ed.; The Cultures of Caregiving;
Johns Hopkins University Press; 2004; 187 pages
Pennebaker, James. (2000, Spring). Telling stories: The health benefits of
narrative,Literature and Medicine, Vol 19, No 1, p. 3-18.
Pennebaker, James, and Francis, Martha. (nd). Linguistic inquiry and word
count, University of Texas at Austin; Published by Lawrence Erlbaum
Associates, Software and Alternative Media, Inc.
Pennebaker, James (web site search name: James W. Pennebaker)
http://homepage.psy.utexas.edu/homepage/faculty/pennebaker/Home2000/
JWPhome.htm
Smyth J.M., Stone A.A., Hurewitz A., Kaell A. (1999, April 14). Effects of
writing about stressful experiences on symptom reduction in patients with
asthmatic or rheumatoid arthritis: a randomized trial, Journal of the
American Medical Association, 281:1304-1309.
Spiegel, David. (1999, April 14). Healing words: Emotional expression and
disease outcome,Journal of the American Medical Association, 281:1328-9.
Stanworth, Rachel; entitled originally 'Spirituality, language and depth of
reality" ; is reprinted from the International Journal of Palliative Nursing, Vol
3 No. 1, Jan-Feb 1997
Stanworth, Rachel; Recognizing spiritual needs in people who are dying;
Oxford University Press, 2003, 255 pages
K. B. Thomas; “The Placebo in General Practice’; Lancet; Vol 344; October
15, 1994; pages 1066-7
VanderCreek, Larry; “Tragic Events and the Benefits of "Cognative
Processing’ and "Finding "Meaning’.� The APC News, Nov/Dec 2002, page
15
Vaisrub, Samuel, Medicine's metaphors: Messages and menaces.Oradell,
NJ: Medical Economics Co., 1977, 124 pages.
footnote: Iʼll be sending a separate e-mail to explain

Tuesday, October 28, 2008

The Ten Silver Bullets That Prevent Aging
Secrets of Healthy Aging. How to Live to be 100/
Paschal and Janette Baute, Draft 4.0 October 2008

You already know some of these, but some you may not know. Most of these are supported by medical and health research. Yes, we now know ways that life can be prolonged. The first is the absence of bad habits, such as smoking, excessive sue of alcohol and drugs, (and we can say, anything to excess, including good food.) Research now exists to measure effect of health habits. For example, flossing is estimated to increase your longevity one year. We should eat smaller amounts at meals, and probably five smaller meals rathet than three large ones. We in this country tend to eat large portions, and larger than we need. Notice the waist lines at the supermarket.

You probably already know that a Mediterranean diet, low meat, high fish, vegetables, nuts, and fruits is conducive to living long. The best record in the world is held by Okinawans who have more centenarians than any county. That is not only their diet, but they tend to eat less, never to satiation. Are we headed toward a health crisis in this country? We already have one.

Regular exercise for heart, lungs, muscles is essential. A healthy heart is a healthy body and immune system. Probably few of us get enough exercise since our life styles have become more sedentary. Even young children exercise less because TV is used as a baby sitter. The younger generation does not play outside as did previous generations of children. Recent evidence is that life style for kids affects learning.

The next five Health Habits have to do with 1) faith, 2) love,3) relationships and connection. Those who live with a strong faith, no matter whether it is Christian, Hebrew or Muslim, live longer and have healthier immune systems. Fascinatingly, faith seems to be an evolutionary adaptation. Those who discover it, accept and embrace it, are stronger and have more resistance to stress.

It is healthier to be in a committed relationship. Monogamy is also an evolutionary adaptation. Those who work it out, the enormous challenges today in marital stability are better off, health-wise. The practice, habit or attitude of loving service seems also to be a longevity factor.

Diet, exercise, faith, commitment in a love relationship, and loving service: Five factors. We know that any active mind leads to a healthy body. Laughter and a sense of humor are also factors. There needs to be a place in life where one has a sense of play, fun, humor and laugher. Keep looking for ways to laugh at the human condition and at yourself. You will live longer.

Still other healthy habits exist. Few persons reach adulthood without setbacks and hurts, some loss and even tragedy. We have research to prove that those who face the negative energy of their past either with the “talking curew,� or who write and journal about it, are healthier –actually have healthier immune systems and deal better with stress. The regular practice of mediation is also a health factor in reducing the effects of stress. The last health factor can be combined into one. We need ways of living more fully in the present moment. This can be gardening, hiking, biking, swimming, skiing, or any activity that forces you to pay attention right now to your environment. TV does not count.

If there is a theme emerging after the physical aspects of diet, exercise and the absense of known bad health habits, it is eimply the power of love to heal and transform and add meaning to live. The mystics inall Wisdom traditions were right. I believe it is also important to risk oneself, to expose your vulnerability. That can be some kind of risk sport, or hobby. But if one is risking oneself in loving service, some volunteer community activity, social service, prison ministry, storytelling to children, this can stretch your mind and your heart regularly. You must get out of your box, stretch your envelope. No pain, no gain; No guts, no glory; no balls, no blue chips. Stretching yourself regularly to do more of something is a health factor.

Silver bullets to retard the aging process: was that seven or eight? You might add one of your own. Keeping an active mind and heart is certainly critical. We have friends who are avid bridge players, or who love cross word puzzles.

We called out children together about ten years ago as we were entering our seventies. We have some good news and bad news, so what do you want first. They hesitated. So we said., We will start with the bad news. We are going to spend your inheritance on downhill skiing. Don’t count on anything. What is the good news? Well downhill skiing, particularly the way your Mom and Dad do it is a risk sport. So we may go sooner than later. Amen.

Ten years later, although we live in Kentucky, we still ski weekly from December to March. Winter is or u favorite season. Carpe Diem. Noblesse Oblige.

--
Posted By Paschal Baute to 1. PaschalBaute.com at 10/05/2008 06:12:00 AM

Saturday, May 03, 2008

Exercie your brain, or .... by Hafner, NY Times

Exercise Your Brain, or Else You will die early.

SAN FRANCISCO — When David Bunnell, a magazine publisher who lives in Berkeley, Calif., went to a FedEx store to send a package a few years ago, he suddenly drew a blank as he was filling out the forms.

“I couldn’t remember my address,� said Mr. Bunnell, 60, with a measure of horror in his voice. “I knew where I lived, and I knew how to get there, but I didn’t know what the address was.�

Mr. Bunnell is among tens of millions of baby boomers who are encountering the signs, by turns amusing and disconcerting, that accompany the decline of the brain’s acuity: a good friend’s name suddenly vanishing from memory; a frantic search for eyeglasses only to find them atop the head; milk taken from the refrigerator then put away in a cupboard.

“It’s probably one of the most frightening aspects of the changes we undergo as we age,� said Nancy Ceridwyn, director of educational initiatives at the American Society on Aging. “Our memories are who we are. And if we lose our memories we lose that groundedness of who we are.�

At the same time, boomers are seizing on a mounting body of evidence that suggests that brains contain more plasticity than previously thought, and many people are taking matters into their own hands, doing brain fitness exercises with the same intensity with which they attack a treadmill.

Decaying brains, or the fear thereof, have inspired a mini-industry of brain health products — not just supplements like coenzyme Q10, ginseng and bacopa, but computer-based fitter-brain products as well.

Nintendo’s $19.99 Brain Age 2, a popular video game of simple math and memory exercises, is one. Posit Science’s $395 computer-based “cognitive behavioral training� exercises are another. MindFit, a $149 software-based program, combines cognitive assessment of more than a dozen different skills with a personalized training regimen based on that assessment. And for about $10 a month, worried boomers can subscribe to Web sites like Lumosity.com and Happy-Neuron.com, which offer a variety of cognitive training exercises.

Alvaro Fernandez, whose brain fitness and consulting company, SharpBrains, has a Web site focused on brain fitness research. He estimates that in 2007 the market in the United States for so-called neurosoftware was $225 million.

Mr. Fernandez pointed out that compared with, say, the physical fitness industry, which brings in $16 billion a year in health club memberships alone, the brain fitness software industry is still in its infancy. Yet it is growing at a 50 percent annual rate, he said, and he expects it to reach $2 billion by 2015.

From Hula Hoops to Corian countertops, marketers have done very well over the six decades guessing the desires of the generation born after World War II. Now they are making money on that generation’s fears, and it is not just computerized flash card makers with the money-making ideas. Doctors and geneticists have also tapped into the market.

Boomers believe they have ample reason to worry. There is no definitive laboratory test to detect Alzheimer’s disease. Doctors rely on symptoms to make the diagnosis, and most think that by the time symptoms show up the brain damage is already extensive.

By 2050, according to the Alzheimer’s Association, 11 million to 16 million Americans will have the disease.

“Most people when they turn 50 begin to look at forgetfulness with more seriousness,� said Dr. Gene Cohen, the director of the Center for Aging, Health and Humanities at George Washington University.

“When you misplace your keys when you’re 25, you don’t pay any attention to it,� he said. “But when you do the identical thing at 50 or older, you raise an eyebrow.�

Lisa C., 47, a clinical psychologist in the San Francisco Bay area, who preferred not to disclose her last name for fear that friends and colleagues would question her mental faculties, misplaced her cellphone one day a few years ago.

She called it from her home phone but heard nothing. Finally, while making dinner a few hours later, she found it — in the freezer.

She was so unnerved, not just by that but also by the poor results of a subsequent mental status test, that she had an MRI done on her brain. The diagnosis: perfectly normal. Dr. Cohen said people can also overreact, attributing absent-minded actions to failing brains, when it is actually simple distractibility that is to blame.

Nancy Cutler, 51, a publication designer in Piedmont, Calif., grew worried about her brain a few years ago when she drove her car to work one day, then, forgetting she had done so, took the bus home.

“It was pretty embarrassing to have my kid call me and say, ‘what do you mean you’re on the bus?’ �

Ms. Cutler reminded herself that she was preparing for her son’s bar mitzvah, going through a stressful period and was very distracted. But she was concerned enough to report the incident to her physician, and ask if there were certain supplements she should be taking. The doctor told her to take up activities that challenged her mind. (Ms. Cutler said she had not done anything yet, because it is “a real time commitment.�)

Dr. Cohen, who recently conducted a study of people born from 1946 to 1955, the first half of the baby boom, said he was struck by the number of respondents who believe they can do things on their own to enhance the vitality of their brains.

“There is a gradual growing awareness that challenging your brain can have positive effects," Dr. Cohen said. He said the plasticity of the brain is directly related to the production of new dendrites, the branched, tree-like neural projections that carry electrical signals through the brain “Every time you challenge your brain it will actually modify the brain,� he said. “We can indeed form new brain cells, despite a century of being told it’s impossible.�

In pursuit of his own dendritic growth, Dr. Cohen plans to take up the piano again after years of not playing. He is also sketching out a science-fiction novel he hopes to write.

Dr. Cohen says that although he understands the fear of Alzheimer’s, many people are unduly anxious about it.

“The bottom line question to ask is, Is your forgetfulness fundamentally interfering with how you function?� said Dr. Cohen. “If it doesn’t fundamentally mess up your work or social life, it’s among the normal variants.�

Relief — or heightened anxiety — can come with a better sense of one’s genetic risk. Start-ups like Navigenics, 23andMe and deCODE genetics are charging around $1,000 to test an individual’s DNA for various risk factors, including Alzheimer’s.

Mr. Bunnell, whose magazine, Eldr, is aimed at aging boomers, took the 23andMe test and learned that his genetic risk is below average. Still, Mr. Bunnell is not sure he trusts the report, as one of his grandparents had dementia, and his mother may have had Alzheimer’s although no diagnosis was made.

To keep such moments as his FedEx embarrassment to a minimum, Mr. Bunnell now does regular brain calisthenics, largely avoiding expensive software in favor of simpler solutions. He works at memorizing the numbers that swirl around his daily life — credit cards, PINs and phone numbers — and devises mnemonics for remembering people’s names. “Smart people find new ways to exercise their brains that don’t involve buying software or taking expensive workshops," he said.

Copyright 2008 The New York Times Company

Friday, April 11, 2008

GOD'S POETRY OF LOVE
AND LEFT-HANDED SHEPHERDS
subtitle: The Theology and Politics of Sexuality:
© Paschal Baute, 9/10/97, 31st draft:
Hope has two lovely daughters: anger at the way things are
and the courage to change them.
-Augustine

As a marital therapist working with many Protestant and Catholic couples for 25 years, and as psychologist and lay theologian, I connect many sexual and relationship difficulties to the inadequacy of the teaching on marriage and sexuality provided couples by their churches. In this paper I propose we have not yet developed a biblical spirituality of sexuality nor an Incarnational theology of marriage. I presume to propose a reframing. Sam Keen presents the predicament well:

What has happened to me? How am I to understand this sensuality and grace that pervades my body? As I reflect I begin to realize that neither the Christian nor the secular culture in which I have been jointly nurtured, have given me adequate ways to interpret such experience except in negative terms. Neither has taught me to discern the sacred in the murmurings of my body and the voices of my senses. Not only has Christian theology failed to help me appreciate the carnality of grace, but my secular ideology has failed to provide me ways to understand the graces of carnality. Before I can understand what I have experienced, I must see where Christian theology and secular ideology have both failed me.
(Sam Keen, To A Dancing God, paraphrased.)

The core question is: by what strange alchemy has the liberating gospel of Jesus who unconditionally accepted wounded humanity become translated into a contemporary sexual ethic that is restrictive, uninspiring and guilt forming? In this paper I strive to answer this, more often using the Catholic context as a larger frame for the Christian view.

Other questions that must be addressed are: How is it that Christian sexuality has been seen as opposed to spirituality? Is the purpose of sex biological or spiritual? What are the effects of Catholic teaching on sexual ethics? What are some remedies? What is the divine ethic for married love? Could sexuality be an archtype or metaphor for this mystery we call God? Pondering these issues in the perspective of our Protestant/Catholic traditions can illumine some of our dilemmas in sexual matters today. Eric Fuchs Sexual Desire and Love, a thorough theological study, is the inspiration for the first part of this paper.

We are speaking of a) a biblical spirituality of sexuality; b) an incarnational theology of marriage; and c) a Catholic context. Each of these is an aspect of the whole of
Christian mystical spirituality, of which a), b), and c) are the enfleshment. By
mystical, I mean the reality and experience of ourselves (individually, communally, insititutionally, earthly--as well as body, mind and soul) as being in immediate touch with God at the very center of ourselves, our whole selves, fully experienced.

My goal is to empower people to view themselves and their sexuality differently, positively as a gift. I am not attempting here to write a theology of love or marriage, but to suggest counter-points and new directions. I have divided the subject into these topics: the early Christian view, rational control over the body was the ideal, effects of a natural law ethic, sexuality is not primarily biological, a eight fold design, effects of Catholic teaching, linchpin of the Catholic system, and God's poetry of love. I begin with an historical perspective.

EARLY CHRISTIANS VIEWED SEXUALITY
AND SPIRITUALITY AS OPPOSED

The Hellenistic and Roman worlds at the beginning of the Christian era lived in the greatest sexual confusion. Understanding this milieu can help us grasp that the moral requirements of Christianity as they developed were accepted as true liberation for the victims of this anarchy and for those of sensitive consciences. Against Gnostic and Stoic influences which, from the chastity of Jesus, disdained marriage, the Fathers of the church allowed marriage as a God's plan for ordinary folk, but approved sexual desire only for procreation. Christian love between partners should be spiritual. (Clement, Strom. III, xi, 71)

It is clear that for the Fathers or early writers of the church in the first four centuries, the loss of self in the sexual act was felt to be a humiliation. A secret complicity between sexuality and sin was denounced. Sexuality was interpreted as discomposure, irrationality and revolt. The great thinker Augustine--the most influential theologian until Thomas Aquinas-- writes: I have decided that there is nothing I should avoid so much as marriage. I know nothing which brings the manly mind down from the height more than a woman's caresses and that joining of bodies without which one cannot have a wife. (Soliloquia I, x, 17.) Augustine speaks as a man who can only keep himself pure by avoiding women. He sees women as evil simply because they are women.

Sexuality was so tainted with the influence of sin that the question of how to avoid sex became a main interest. As Jerome said, The activities of marriage itself, if they are not modest and do not take place under the eyes of God as it were, so that the only intention is children, are filth and lust. (Comm. in ep.ad. Gal. III, v, 21.) Sexuality began to be considered as a consequence of original sin. After the conversion of Constantine and the Age of Martyrs ceased, the main way to be heroic for Christ was to renounce marriage and sexuality to remain a virgin or become a monk.

Virginity was eulogized. Had there been no original sin, sexuality would have been pure love, free from all desire whatsoever. Virginity makes one divine, or as John Chrysostom said, it makes mortals like unto angels. Or, in the words of Ambrose, A virgin marries God. Gregory of Nyssa said that purity alone is sufficient for receiving the presence and entrance of God. Yet for humans to aspire to be as angels is a rebuke against God, who created us as human. A theme constantly found in theological writing--for much of Christian history--is that marriage turns one away from God. (many quotations in Fuchs op. cit., Seabury, New York, 1989).

Thus the two fundamental thrusts in patristic teaching that mark Christian practice and thought for many centuries were the exaltation of virginity and a condescending acceptance of marriage, justified only by procreation. Integral to these views was a pervasive labeling of sexual desire as impure and ungodly: seducing us from rationality and that which is holy.

The spiritual life, for many Fathers and theologians, actually meant the non-flesh or non-physical life. This is false because it is not human. It reflects the Platonic or Gnostic mistake that humans are only SOULS, trapped in bodies. THE WHOLE HUMAN (body, mind, soul, individual, communal, institutional, with earth) lives the spiritual life. The spiritual life is the full and complete human life--including sexuality and love--seen in its luminosity, as the indwelling Spirit births forth each human life as the expression of Christ in the world (Massimini, 1993).

The difficulty in thinking positively of sexuality was accentuated by the juridical status of marriage under Roman law which established the procreation of children as the only goal of marriage. Therefore both the political and the moral context of the times made thinking of sexuality in terms of affection and love, or as a gift from God, quite difficult for Christians.

In addition, a deep pessimism marked the mentality of the first centuries of the Christian era, particularly concerning human nature and the future. Early Christians found a lofty and elaborate ethical system in the Stoics with whom they shared the same criticism of current sexual customs. The Stoic concept of natural law allowed them to define an objective moral standard, even while inheriting from Stoicism its distrust of the imagination and of passion, both of which upset the equilibrium of the sage and would-be saints. Jerome quotes Seneca respectfully: ...too much love for one's spouse is adultery...the wise man should love with his head, not with his heart...Nothing is more impure than to love one's wife like a mistress. Similar sayings, quoted with complete approval can be found in the writings of most church Fathers and Mothers, titles given to those who were prolific writers in the Patristic age. (Eric Fuchs, op cit., p. 102ff)

A New Testament professor believes that the sexual views of early Jewish Christians were strongly influenced by Old Testament laws on purity and uncleanness (Countryman, Dirt, Greed & Sex, 1990). For Israel , purity gave access to the temple and the temple to God. (p.79). Although sex is not a primary concern in New Testament writings, yet both Catholic and Protestant traditions made sex a primary concern. A private kind of morality that stresses sexual purity (sometimes hedging that purity about with prohibitions on dancing, dating, kissing, and so forth) has been widespread in Western Christianity. (p. 142). From the second century onward there were Christian sects that held salvation to be contingent on sexual continence, or that the material world was wholly evil and sex was to be rejected on that account (Marcionites and some Gnostics). In Countryman's opinion, the church in its accommodation with Constantine's empire, inherited the role of the early rabbis and the Pharisees.

Theology from the fourth century on was mostly the work of monks for whom women symbolize what they renounced. Women constantly threaten their special devotion to God. Celibate monks whose experience with women was through sins in their youth (like Augustine and Jerome) or through maternal love (like John Chrysostom) were hardly equipped to recognize women as the other whose otherness signifies the very otherness of God. For such as these, the otherness of woman signaled instead the otherness of the devil. Woman was seen pervasively as the temptress.

RATIONAL CONTROL OVER THE BODY WAS THE IDEAL

Given this beginning it is not at all surprising that Catholic ethics is based upon a hierarchical vision of man. Man was conceived as of two realities, body and soul. The soul was spiritual and immortal and the body was material and mortal. To this first hierarchy was added a second, related to man's destiny: as a natural being, man was called upon to go from a natural life to a supernatural one. Catholicism practiced a split level morality: one for the people in the church who must be taught basic morality (Ten Commandments and rules of the church), and an ethic following counsels of perfection for the elite of the church: clergy, religious, monks. These renounced sexuality and lived as virgins or celibates. The second ethic was to serve as the lighthouse, the ideal to the first, a sign for all of progression towards the highest of values.

For Augustine and the Fathers, all sexual acts have the nature of sin, because they are inherently lustful. The view that original sin was actually transmitted by sexual intercourse was accepted by Thomas Aquinas and remains today a powerful force within conventional Western Christianity today. Even Eckhart, for all his creation-centered approach, held that there is not physical or fleshly pleasure without some spiritual harm. Bernard of Siena stated that husbands and wives were guilty of mortal sin if they did not abstain from sexual intercourse before receiving Holy Communion. This teaching was typical of that of the Middle Ages. Only in the Thirteenth century, after the theological work of Albertus Magnus and Thomas Aquinas, could Christian marriage be regarded as a channel of grace. The Council of Trent in 1565 declared marriage to be a sacrament, to make a total of seven.

As a result, Catholic teaching has almost never succeeded in ascribing positive value to sexuality, i.e. associating it with love or seeing it as a positive experience of our humanity, leading to an acceptance of the mystery of otherness and of God's immense Love. Paul VI's encyclical, Casti Conubii, does equate unity in love as an equal goal with procreation, but since the Catholic natural law view of marriage strongly prohibiting contraception is vigorously upheld in the same document, this takes away with the left hand what the Pope seems to give with the right. Faithful Catholic couples today are still constrained to fear an unwanted child every time they express their physical love to each other regardless of the number of children they have. Creativity and spontaneity in sexual love are aborted by a natural law ethics not based on scripture.

Sexuality was surrounded with many images of danger to the spiritual life. The saint became the one who renounced all sexual life. Only those males who renounced sexuality could be priests. Many Catholics believe that to have celibate priests and nuns is essential to Catholic identity. Catholic ethics today remains mainly faithful to the patristic tradition: sexuality still, by and large, belongs to the order of impurity. Therefore marriage must have less value for the Kingdom than celibacy. Priesthood is reserved to celibate men as only they can be free to serve God totally as did Jesus who was celibate according to tradition.

EFFECTS OF A NATURAL LAW ETHIC

Catholic authority bases its sexual ethics upon its understanding of its concept of natural law, as if it were universally understood, as if morality can be the subject of a science which all men of good will should recognize as valid. But current sciences (the social and human sciences in particular) and other ethical traditions are denied the possibility of joining in, dialoging and confirming this rationality.

Thus the Church has a special knowledge of reality, which, without owing anything to scientific research, discovers objective real nature on its own. But this view produces an insurmountable dilemma: either it is real science which is thus capable of answering the demands of scientific research and being in dialogue with other sciences and faith systems, or if it is not a science but a philosophical or theological interpretation, it must admit that any pronouncement it makes is biased and partial. This dilemma is simply denied by Catholic authority.

The most serious consequence of this is that the critical task of a theology of sexuality or of marriage becomes impossible. We are left with an absolutized ethic that rejects dialogue and spurns rational, scholarly challenge from its own members: whether professional theologians, bishops, pastoral clergy, religious or laity. God can speak only through Rome, as the outstanding moral theologian, Dr. Charles Curran, supported by all his peers and the faculty at Catholic University, learned. Although twice elected president of the Catholic Theological Society and recipient of the prestigious John Courtney Murray award, he was fired from his tenured post at Catholic University for writing and teaching that challenged traditional views of sexual morality. Expertise counts for nothing without the bow to the proper icons, and must be discredited, as other Catholic theologians have discovered.

Catholic ethics of sexuality by refusing critical discussion and currently controlled by Rome, cannot maintain the concept of natural law except by depriving it of all rational coherence, and therefore of wide acceptance. The official expectation is that natural law teaching must be accepted on faith as simply required belief for the loyal Catholic. Natural law teaching requires either unquestioning or naive faith in Catholic authority.

Catholic natural law ethic promotes a precarious fiction: the presumed existence of a morality capable of being received by everyone everywhere, with no extenuating factors or contingencies. The Church speaks and its words ought to be suitable for everyone, everywhere! Only the Pope decides what can be discussed, and he does this unilaterally. The Catholic way to God, rather than the mystery we call God, has become absolutized. I propose that this is an unconscious transfer of the worship due the object of our Faith to our belief system itself.

Why natural law cannot be birthed forth and enfleshed in many different ways, according to various times, traditions and cultures is never addressed. The use of the concept of natural law as a universal absolute, masks, under a fictitious objectivity, the claim of a particular Eurocentric culture to impose itself on all others. The Vatican is not teaching true natural law in this matter. It is teaching is own narrow indoctrination, and further allowing no discourse.

Relying upon such principles by faith prevents Catholic morality from criticizing its own assumptions. It ends up as a moral postulating of absolutes lacking a scriptural basis and true spiritual depth. In this matter the church has become a totalitarian system because it refuses to be judged by an external criterion such as scripture, refuses dialogue and regards any questioning or rational challenge as disloyal. The Church requires the worship due to God to be given to itself. By asking for the church what should be given only to God, we are being asked, I suggest, to commit idolatry, to give to the church that which is due to God alone.

The uncritical use of the concept of natural law has resulted in valuing the biological function to the detriment of the symbolic or transcendent function of sexuality. Catholic Popes up to the present have held that the conjugal act is destined primarily by nature for the begetting of children: ...those who frustrate its natural power and purpose sin against nature and commit a deed which is shameful and intrinsically vicious. (Pius XI-italics added). Can one begin to imagine the fear, shame, confusion, and guilt, in their relationship with God and in their most intimate life that the imposition of such teaching has caused untold numbers of couples, for countless years? I suggest that this is extraordinary psychological coercion and actually amounts to a form of religious oppression: keeping people from God.

More recent church teaching tries to equate the goal of unity in love with that of procreation, but since the Catholic natural law ethic still insists that every marital act must be open to biological life, it cannot succeed in seeing real holiness in sexuality per se. What is still effectively devalued is the absolutely central role of bonding in creative sexual love: the inherent transcendent nature of sexuality. Spontaneity or freedom in the love-dance of the human couple is hardly possible under present Catholic teaching.

While Catholic ethics proposes to be an Incarnational theology, it rejects the possibility of sexuality as being an introduction into mystery of our humanness and our relatedness and further signifying the otherness of God. The Vatican appears willing to disregard the truth about human sexuality and marriage in order to maintain its position. We must begin to wonder about the political motives in this rejection. If sexuality can also signify and evoke the love of God, if the essential mystical nature of sexuality is its transcendence, how can one still presume to hold that ecclesiastical celibacy is superior?

Perhaps a more important question is can one allow the values of sexual morality to be still defined solely by celibates, if their situation is no longer morally superior? If virginity or celibacy is not really superior, how is this a sufficient basis for their de jure special authority? If we think at all about the situation today, we can begin to discover that the moral discourse by ecclesiastics on sex, perhaps even more than any other subject, conceals a discourse on power and privilege.

Now it can be clear why the perfect Catholic man has needed to be sexless, and for the sake of maintaining the system must continue to be sexless. One pastoral consequence is a gross inequity in the models for sanctity. Less than two percent of the canonized saints have been married, and fewer still were declared to be sanctified through their married life! We can begin to understand the present impasse in refusing to allow married or women priests is directly related to this tradition exalting virginity and devaluing marriage.

Every religious teacher should remember that Peter received the responsibility of feeding his brothers (John 21:15) only after the painful experience of his own renegade betrayal. In the past the Church has too often forgotten the silence of Christ, tracing in the sand with his finger while the Scribes and Pharisees fulminated against the adulterous woman. The Gospel is not found in denouncing those who break the law, but in the simple words of Jesus to the woman: Neither do I condemn you: go and sin no more (John 8:1). But just as often, the official church has been unable to conceive outrage at systemic abuse and oppression because it was allied with the status quo which was threatened by individual rights.

Any moral teaching that is not rooted in this kind of compassion, in a sharing of common vulnerability and humanity, can only be the mask of a hidden desire for power. One who preaches the gospel must stand inside the message, under the same judgment, never behind the message. Truth without compassion is not gospel truth. Further still, truth that is not open to dialogue and challenge cannot be gospel truth.

It can be seen that in Catholic teaching, a dualistic and gnostic pessimism assigns sexuality to the side of evil, sin or imperfection. In contrast, evangelical tradition--supported by the authority of Jesus--affirms that sexuality, a good creation by God, is part of humanity willed by the creator from the beginning. Let us examine this.

SEXUALITY IS NOT PRIMARILY BIOLOGICAL

Sexuality is given to man as a means of his humanization or socialization. In Jesus' quotes from Genesis he moves from nature (male/female) to culture (man/woman). Thus sexuality becomes human when it signifies this transition: recognition of the other (man or woman) in the impulse of sexual desire. The goal of sexuality is this unity--And the two become one flesh. This is confirmation that sexuality concerns first of all the realm of relationship and is not primarily biological.

Men and women become one not primarily to procreate but to encounter one another in the unique manner where, through sexuality, something of the ultimate mystery of life, as God calls it to be, is revealed. Western Catholic morality is not scriptural when it insists that procreation is the ultimate goal of sexuality. When Jesus speaks of sexuality (Matt 19: 4 and Mark 10:6), he says not one word about its procreative function.

For Jesus, sexuality is the token or the sign of the highest possible human vocation, that of being in relationship with God: Let no man put asunder what God has [made separate, to be] joined together. Thus sexuality is called upon to signify in the entire life of the human couple the immensely creative and superabundant love of God.

Jesus removed marriage from the natural or legalistic realm to submit it to prophetic challenge, with definite stakes for the sake of The Kingdom. Either it is recognized as the place of the promise and the grace of God, or it becomes the expression of a refusal to participate in the creative love of God (Fuchs, p. 187ff ).

The failure of loving service to one another in conjugal life is a failure of God's creative handwork in human beings. God's Love is expressed in creation and in the Covenant with His People. This is the reason the sexual relationship serves well as a parable of God's relationship between Christ and the Church in the New Testament. God makes
Himself vulnerable in the act of loving and revealing and surrendering Himself to us, just as lovers do with each other.

In contrast with Catholic use of natural law as the reference point, Protestant ethics looks for ethical models in the Bible. This focus leads to affirming the beauty, dignity and profound goodness of sexuality inhering in the conjugal bond as an order willed by God. Sexuality is viewed as more spiritual than biological.

Biblical tradition translates the Otherness of God into ethical terms by affirming that it signifies the priority of the couple over the individual. The long range objective of sexuality is not primarily procreation, but the couple. In Genesis 1, man is created as a couple, as part of a male/female relationship. In Genesis 2, Adam is really inscribed into the fundamental goodness of God's creation only when he receives Eve. What is in the beginning as Jesus says, is the couple.

What does it mean to be created in the image of God? It can now be understood as the presence within of the desire for the other, an openness and an incompleteness, as a sign that man can be fulfilled only through encounter with the Other, through love of a particular other being. It is a yearning for completeness to be found by joining with another and Another. Human relationship with God becomes discernible through the analogy of the relationship of a man with a woman. Therefore sexuality becomes an archetype for God, the great symbolic story of human desire in which we can find God's person and the ways of the Spirit.

A EIGHT FOLD PROJECT AND DESIGN

If then the love of man and woman is a sign of the love of God, the ethical task is to define how this sign can be concretely translated into the undertaking of the human couple today. The question is how do couples mediate grace to one another, or in more biblical terms, how do they sanctify each other in marriage? Incredibly this is hardly explained today in the theologies of marriage. We do not yet understand the awe-ful, awesome truth that we have the power through acts of love really to create one another. Love is the power to act-each-other-into-well-being. We either set free the power of God's love in the world or we deprive each other of the very basis of personhood and community. Our actions have awesome power to create or to destroy. We learn this only through the shared journey (Harrison, 1989 ).

Fuchs proposes that the couple carries a triple promise of being the place for projects of fidelity, freedom, and conjugality. I differ with his choice of freedom as the second project and prefer the project of compassion as more intrinsic, more biblical and leading to a deeper freedom. Then I propose five additional projects as demanded by our times: 4) that of intimacy as the sharing of one's inner life; 5) that of procreative fruitfulness, or procreativeness, but define it as the begetting of love before life; 6) apprenticeship in unconditional love: 7) marriage as Incarnational priesthood, and 8) through these projects achieved, an identification with Jesus and all the outsiders, the alienated and lost, least and least. Notice in the discussion how the challenge to respond to the otherness of the partner animates each specific design. I place these in the order of what seems to be their natural sequence.

The first project of conjugality, or the intimate binding of husband and wife, signifies that they not only live together but commit themselves publicly to one another. In response, the social group they belong to acknowledges them as a couple and commits itself to them.

This public bonding signifies the social dimension of love, as the commandment of Jesus shows (a new commandment I give you that you love one another...) that love is not just a feeling but a required service and responsibility. The minister at the wedding does not ask: Do you love each other?, but Will you love each other...for better or worse...? Making vows before a community and a minister signifies that both social and divine support are necessary for the progression of the couple in married love.

The closest neighbor Jesus commands us to love will always be our spouse. Yet such is our human frailty, our readiness to find fault, our idealization of ourselves and some inevitable disillusionment in romantic love that no one can accomplish this, I suggest, without grace and without regular recourse to prayer. This life-long task has never been viewed as heroic, but today, I suggest, in the world in which we live, it is ordinarily heroic in it's challenge to escape our pervasive egocentricity.

The second project of fidelity, based upon affirming the love of God as Creator, is not basically a faithfulness to a past commitment, nor faithfulness to personal growth, but faithfulness to the ongoing mutual co-creation of the conjugal couple. In this project, partners commit themselves to trust each other and to be challenged, changed, and transformed by one another as their life-long project.

We fulfill our deepest selves by being informed by the Otherness of our partner. We experience a further incompleteness both singly and as a couple that can be filled ultimately only by surrender to this mystery we call God. Both proximately and ultimately, sexual desire opens us to the mystery of Otherness. (Fuchs, p. 192ff)

The third project of intimacy is the emotional closeness that results from the shared life, faithful to the growth of themselves as a couple. Intimacy is one of the core interpersonal competencies required for coping with the development tasks in family life. Components of intimacy have been described by Catholic couples who rated their marital happiness as above average. These are: acceptance, respect and admiration, understanding, friendship and companionship, ease in communication, sharing, caring and concern, wanting to please, striving for mutual goals, interdependence, pride, trust, belonging together, similarity of thought, feeling and reaction, indebtedness, gladness and peace, expansiveness, reciprocity, and a sense that sexual relationships expressed and aided their total relationship. (Baute, 1968)

This project of intimacy has become so important that when it is not achieved by midlife, Christian women are ready to divorce their husbands because they do not feel valued as a partner and companion, but taken for granted. Women are typically better at emotional sharing than men. This becomes a classical impasse for many couples by their late thirties or early forties. Men must often learn a new language if the marriage is to be renewed. Can a male celibate mentality anticipate this midlife developmental need and speak to it when they themselves are blind to its urgency?

The fourth project of compassion flows from conjugality, fidelity and intimacy. To know the other from the inside is to experience compassion. Compassion is experienced as the result of listening, trusting, and growth in intimacy. Each is allowed to approach as one is, without expectations. The other is not reduced to an object to be possessed, manipulated or changed. On one hand, compassion results in appeasing deep insecurities and on the other hand, it makes possible the release of the rich potential within the other, because each experiences being loved as one is, warts and all, in their entire otherness. Being loved this way may be the greatest human gift, besides good health, that we can receive.

Compassion, like liberating mutual trust, means the enduring acceptance of the other as he really is. To endure here means allowing time to gradually reveal the authenticity of the deep desire for union that dwells within us, a mutual inhering or interpenetration of spirit that is a profound love and trust revealed in the heart of daily living. The result of compassion is an increased intuition of one another and a deep unity of the couple, which in turn becomes a witness and hearth for others.

The freedom Jesus lived was not a freedom from but a freedom for, a way of being that always strived to liberate the other from his alienation, whether this was self or other caused. Liberty for the conjugal relationship is first of all an appeasement of doubts and fears but at the same time a profound acceptance of the other. Each permits the other to live in her own authenticity, and to express her own richness in daily life. This is a refusal to treat the other as an object, but a fundamental trust and patient listening that means letting go of self-centeredness. This freedom signifies recognizing the other in the dynamic sense of that which one is called to be in the ongoing development of unique talents.

Jesus' compassion resulted practically in the liberation of others. Compassion lived results in mutual liberation and a liberating witness of compassion for the world. Such compassion is a healing and empowering grace that arises out of empathic understanding of our wounded humanity modeled by Jesus.

In the beginning was the Word, suggests there is spiritual life only when it is received as a gift. When we acknowledge this precedence of the Word of God, this makes our life both mystery and gift. Then our partner stops being a threat to our autonomy and becomes a sign of the otherness to which we are called. As we increasingly discern our life in this mutuality we accept the mystery of otherness as the deep meaning of the conjugal project.

The fifth project is the learning of unconditional love. The gamble of love the couple takes is to allow everything that happens to signify this giftedness, to allow love to organize all of existence as a symbol. Each activity becomes a type of communion, and all loving and living, including pain and disappointment, becomes a celebration of God's love, or the challenge to transcend all difficulty by the grace of the Risen Christ. Valuing one's partner's satisfaction and welfare as much as one's own becomes an apprenticeship in a new mutual life as the place where the Spirit of unconditional love gradually emerges and prevails.

To accept this discovery of the sacred mystery of married life and to live in the celebration of mystery and giftedness is to live counter-culturally, to reject the dominant ideology of Western society that turns everything and everyone into objects.

Flowing from the projects of fidelity, intimacy, compassion and conjugality is the sixth project of procreativeness, or better, fruitfulness of love and life in the image of the Creator. The couple produces and brings into being a new and original community of love. The procreation (or co-creation) of love precedes and is the matrix for the biological procreation of life. Love precedes new life. Divine Creative Love begets human life. Human life not sustained by love cannot endure but becomes destructive. The unfolding of each and every originality is a condition for the fruitfulness and riches of our common social life.

When each couple brings a new and unique love into the world, the world is changed, but not primarily by the biological fruits of this love. Out of this love, they create new life, spiritually, socially and perhaps even biologically. The natural law placing of biological life as the primary or more lately as the co-equal goal of marriage can now be seen as an overdetermined physicalist or materialist view of marriage. New life comes only from the new love. What the marital acts need to be open to is not always biological life (Catholic natural law, under pain of mortal sin because an intrinsic evil otherwise) but continuing growth in creative love.

Many marriages today fail for reasons that have nothing to do with biological life, procreation or sexuality, but everything to do with lack of commitment to continuing growth in creative love, that is, lack of fidelity to the ongoing mutual co-creation of their life as a couple. Christian churches do not expound fidelity to the ongoing mutual co-creation of the relationship as an ideal of marriage.

Mutual giving in love is the foundation for the birth of new spiritual life. With each couple something new is added to the cosmos and to the Kingdom. The project of fruitfulness is a co-creation of love and life in partnership with the creative grace of God. The goal of marriage is fruitfulness not fertility. This is the trust and responsibility of each couple given by God at creation without mediation of humans. Marriage, I suggest, is not designed to be supervised or adjudicated by celibate ecclesiastical authority. In fact, for the first thousand years of Christianity it was considered purely a secular matter with no interest from the church.

Marriage did not become a sacrament when the Council of Trent declared it so, nor when Albert and Thomas Aquinas realized marriage contained grace, nor when Jesus turned water into wine to grace the wedding feast at Cana in his first recorded miracle. Marriage is the great sacrament of nature, or of natural law, given us at the creation of the world. It has taken us this long to realize its power to transform us, to create or destroy us. Marriage is, I propose, Incarnational priesthood, with the power to evoke within us the shepherding of all being.

Marital commitment is the paradigm of the biblical covenant modeling God's enduring love for us in a far more extensive sense than St. Paul realized. We can now understand marriage as a process. Committed marriage evokes a transformation of love, with increasing self-giving. Therefore marriage is the sacrament which prefigures the self-emptying of the Incarnation in human gift. Marriage is the prototype or original pattern of Christian formation and discipleship, as it develops through every-increasing self-giving and a deepening of passionate love.

I suggest as the seventh project that marriage itself is the original Incarnational priesthood, designed as such from the beginning of the world. It is the first sacrament, given us at Creation, the one that antecedes all others, further sanctified in the Covenant Jesus keeps with us. In marriage spouses are the ministers, lifelong, since the wedding ceremony is just the public beginning of the celebration of love, and in a Christian marriage, Incarnate love. Marriage therefore, is meant to teach us self-giving love, to call us out of ourselves, to assist us in our journey to become shepherds of all being. Marriage is not merely secular reality even before Christ, but the earthly sign of God's self-giving to us, inviting us to every deeper sharing, compassion, and love and peace and justice.

Marriage represents the mystery of the Incarnation long before the birth of Jesus. Each partner is Word made Flesh to each other: sacrament to each other, gifts with outward form and inward grace. Loving self-gift evokes further loving self-gift in the other, yearning for the Perfect Love that exists between the Father and the Son, so total and overflowing that Love Itself is born as an outcome. This mutual self-giving is so complete that it becomes a Third, the Spirit. The mystery of the Trinity is real to the Christian couple because in grace they are living that mystery of self-giving (Baute, 1989).

Because of this calling to the shepherding of all creation, the eighth project is solidarity with the less privileged of our society. This also involves accepting the marginalization that will come from living counter-culturally. In the expansiveness of the self-giving and the awareness of one's own woundedness, and in the progression of the life of grace, there develops an openness and identification with the wounded of the world, the marginal, the last, lost, and the least. The full expression of married love, lived in Christ, will eventuate in personal commitment to peace and justice issues.

As marriage is meant to lead us deeper into the mystery of God's unconditional love, this project leads us into the passionate caring for others' welfare and the courage to change their circumstances. The passionate life, lived in Christ, can awaken a constructive anger that is willing to confront oppressive structures even at personal cost. This can also be expressed in many quiet, peaceful ways such as hospice care for the dying. So the expression of solidarity depends upon the temperament and gifts of the person but will always involve some care for one's community, for others.

One of the passions of Jesus life was his identification with the poor and alienated of the world. As Christian love grows between the couple, it reaches an expansiveness that must be extended to all others, particularly those who suffer. Although the early years of marriage were usually wrapped in children and family , the object of the couple's love soon extends to a much larger family and neighborhood. Solidarity with the poor and the marginal of the world is the sign and sacrament of the mature couple. Fulfillment of the Incarnational priesthood is that ministry becomes service to all, particularly the most needy.

Growth in these eight projects of conjugality, fidelity, intimacy, compassion, apprenticeship in unconditional love, procreativeness, Incarnational priesthood, and identification with the marginal of the world results in a deepening sense of the giftedness of everything, as well humility, justice and courage, and a cosmic connectedness. The more we respond lovingly and authentically to the mystery of the other person, the deeper we are led into divine mystery. The ultimate grace of the couple is to both express and give witness to the unconditional love of the divine indwelling of all creation. These projects leading to mutual sanctification are hardly explored in theology. One writer says that a survey of those who teach graduate level courses in marriage within the roman catholic tradition know of no in-depth text explaining mutual sanctification. (TePas, 1992). These eight projects are offered as a beginning discussion.

EFFECTS OF CATHOLIC TEACHING

A major task in the Church is to reverse the tendency in theology and spirituality to be suspicious of erotic love and human passion. Yet, for the Catholic church to re-examine its teaching on the spirituality of sexuality would be to challenge its entire hierarchical structure. But until it can, it is more invested in preserving the status quo and its prerogatives than in being led by the gospel and open to the Spirit.

When Catholic hierarchy declares that most perfect witness to Jesus must be sexless (virgins or celibate), and that only these, if male, are capable of full ministry of Word and Eucharist, this is not only not scriptural, but has enormous social and political consequences. In demanding loyalty for fallible teaching and punishing those who disagree, in using loyalty as a litmus test for the episcopacy, doctrine has become absolutized. To disagree with non-infallible teaching makes one disloyal and suspect, as the most revered and respected Catholic theologians have discovered. The ultimate temptation for the believer is to absolutize their way to God. In discussing these consequences, some icons are challenged.

1. Since only the married have the grace of marriage, they alone have true access to the fullest and deepest meaning of marriage. Celibates, who LACK THIS GRACE, are deeply mistaken and imperious when they speak for this grace or about this grace without ever seriously consulting the people who have it.

2. Only by truly listening to the inner reality, the felt experience of another can we begin to understand that person's separate reality. (Despite years of learning reading, writing, and maybe speaking, most have not had a single hour's training in listening,) Only with such empathic listening, can we have compassion, reciprocal friendship and true partnership. But this kind of listening is hard work. It requires the listener to be vulnerable: open to being moved to a different view and thereby changed. True listening is an act of love.

Catholic hierarchy cannot understand married sexuality because they have not yet been willing to listen to the experience of Catholic couples. They do not think such listening is necessary or useful. To be so closed is to prefer illusion to reality, all the more blind because resisting rational discussion. In these matters the blind are leading the blind from the top down. Catholic bishops follow their chief shepherd like good sheep. They refuse to believe that the Spirit can speak through the People of God in matters that most intimately concern the People of God and for which they have the grace of state. Hierarchy refuses to be vulnerable, to see ministry as SERVICE, as listening to experience divergent from their own, as being willing to learn. Yet they continue to judge and make rules for the most intimate life of these others. Those who did this in Jesus own time, were called Pharisees.

3. Only the true beauty, dignity, and creative playfulness of the symbolic and sacramental nature (the divine poetry) of sexual love, never valued by celibate clerics, (who have overstressed its demonic power) can inspire married couples today in their projects of fidelity, intimacy, compassion, conjugality, procreativeness, and Incarnational priesthood in a society that is chaotic, seductive, addictive, and non-supportive of Christian living.

4. Biblical sexuality is right brain functioning: metaphor, imagination, passion, story and poetry. Celibate teaching of sexuality is left brain functioning: linear logic, factual, rational analysis, rules, and consequences. Which view is more likely to inspire us? Which have we been given a chance to hear? Why can't we entertain both views? To insist that Catholic people express their sexuality with only a left brain ethic is not only to discount immediately about half of the population but further to demonstrate a gross misunderstanding of sexuality per se. This is like insisting that all Catholic people must use only their left hand (in their marital beds) and think only left-handedly elsewhere because hierarchy is left-handed. Better to laugh rather than weep since all good sex is right brain sex--metaphorical and symbolic--even for the left brain dominant. The bible says so in the stories and poetry it employs.

5. A true incarnational theology, by contrast with a natural law ethic that surrounds
sexuality with prohibitions and guilt, requires acceptance of the goodness and wonder of our physical bodies, a joyful, awesome, tender joy in them, and of our ability to respond sensually and sexually to another. Fr. Sebastian Moore, in a moving prayer-poem speaks of the accuracy of the flesh as the place of knowledge: Having known deeply and quietly the goodness of the flesh, I cannot follow the safe self-crucified men who say 'God alone'.

6. Does anyone find it strange that a group of men who have vowed to never express their sexuality under pain of sin should consider it their God-given right and duty to legislate the married sexuality of those whose have been given the grace of marriage to experience the transcendent fullness of sexuality to enrich their marriage? Is it possible that this teaching will be seen as unbiblical, unchristian, self-serving, and unjust as the teaching for 1850 years that the bible upheld the justification of slavery?

7. A faith inspired natural law view of marriage stressing biology (dating to the Stoics) has prevented spiritual and psychological understanding of the symbolic role of human love and sexual desire in God's giftedness. Catholic hierarchy confuses the will of God with the mandated quest of a sperm seeking to fertilize an egg, under pain of mortal sin--or going to hell!--a view with no scriptural basis! What an astonishing corruption of a truly biblical and Incarnational sexuality! In the opinion of this psychotherapist who has worked with Protestant and Catholic couples for 25 years, neither a fully adequate theology of marriage that speaks to the contemporary human condition, nor the spirituality of sexuality as a gift from God, has ever been developed.

8. Discourse about sex, love, and marriage reserved only to those who are celibate clerics certainly controls the discourse. The moral discourse by ecclesiastics on sex, perhaps even more than any other subject, conceals a discourse on power and privilege. A theology of marriage done by a celibate is an oxymoron: a contradiction in terms! Yet Catholic laity accept it with little public protest! The question is how functional is a faith system in which members simply ignore without protest some teaching or preaching to select only what suits them, and further, do not account for themselves on the same key personal issue that oppresses all their brothers and sisters in the world.

9. Those Catholics who marry are regarded as, in fact, second class citizens who are not capable of or trusted in decisions about their own state in life, nor the business of the church beyond local parishes, and even there are restricted. No juridical means exist at any level for laity to be heard. Neither laity nor priest have any voting rights, or any legal way to influence hierarchy. They are without any political power de jure and therefore without moral power within the system. Examine this more closely and you will discover that the ultimate outcome of the Catholic teaching on sexuality is to emasculate the laity! Anyone who does IT cannot have authority or power in the Church.

10. Because celibate theologians and bishops cannot understand the transcendent nature of human sexuality, they have no alternative to offer to public school sex education being taught at the same level as Automobile Transmission Education. Neither hierarchy nor public schools tragically have any clue that they should be teaching The Transcendent Fullness of Human Sexuality, with themes such as the eight projects suggested earlier.

11. The teaching of all Christian churches have surrounded lust or eros with shame and guilt. Yet the development of lustiness and sexual desire is a vital part of growing up healthy and adult functioning. Whenever this natural development is shamed and repressed in children and adolescents, adults cannot have healthy marriages or healthy adult relationships. Many have had their sexuality severely warped by Christian teaching. Therapists know that their sexually dysfunctional clients often must be taught to use fantasy and even to masturbate in order to have satisfactory sex in marriage. Adolescent masturbation (in the Catholic church, a mortal sin) is not only healthy and desirable but even necessary for healthy adult sexuality. Several questions are: How harmful and far-reaching has been the guilt and shame with which the Christian churches have surrounded the expression of sexuality? (Ask a psychotherapist!) Has this ecclesiastical forbiddenness (Catholic and Protestant) concerning sex not only aggravated the revolt against religious teaching but also served to promote sexual rebellion of all kinds?

12. When sexuality is an imperfection, condoned mainly for procreation in marriage, and to be denied or repressed for the sake of the Kingdom, this can give SEXUALITY tremendous power, overwhelming attraction and preoccupying focus. Furthermore, as Freud said, the penalty for repression is repetition. The question must be raised: how much has two thousand years of teaching by the Church of sexuality as unholy and to be repressed contributed to the secular preoccupation with sexuality and even to such perverseness as pornography?

13. When sexuality is relegated to the dark side of human nature, and men are required to repress and sublimate their sexuality in order to become priests without training in the dangers and long term effects of such repression, it is bound to emerge at times irrationally and explosively. Whatever is denied or forbidden is bound to become most attractive. The closed system itself is partially responsible for their vulnerability, for the effect of this on many others, and many losses to the church.

14. The shocking vulnerability we see in the current sexual abuses by Catholic clergy has one root in the quashing of critical discussion of a theology of sexuality for 25 years. When we make a non-biblical, non-Incarnational division between human love and divine love (as current Catholic teaching does), there is no way we can have an adequate theology of celibacy. In current Catholic teaching all passion is seen as imperfection. This is a disastrous mistake and a misreading of the bible.

15. Catholic hierarchy has contributed to making sex a huge problem for Catholic couples in modern life. In my professional practice, I have seen many kinds of sexual conflict and guilt, marital stress, sin-consciousness, sexual repression or preoccupation, conflicted pregnancies, marital unhappiness, and even divorce to be some of the direct consequences of this non-biblical, non-incarnational teaching about sexuality and marriage. Psychotherapists know that if you scratch a Catholic, you will find guilt, the more devout the more guilt.

Indirect and more subtle consequences of this teaching, in my opinion, are many: codependence upon a privileged clerical caste, systemic oppression or abuse of children, women and adults by a celibate clerical mentality. overpopulation, support for the superiority of men to women--world-wide machismo, making women into sex-objects, spouse-abuse, abuse of freedom in the Catholic third world countries, untold numbers of Catholics who have become nominal adherents or given up all religious practice, overpopulation, But perhaps the worst abuse from this assumption of superiority as the basis for claiming the prerogatives of power may be the dis-empowering of laity from full participation in ministry for the Kingdom of God as presiders, teachers and preachers.

16. The major negative achievement of Christendom, greatly supported by Catholic intransigence in the matter of the natural law ethics of sexuality, is the fact of having made sex into an obsession. Catholic moral theology has a very detailed list of sexual sins but very little on social, political or ecological sins. What is most significant in this context is that Jesus never focussed on sex, nor made any big deal about it. I suggest further that the sexual preoccupation of celibate theologians and hierarchs has prevented development of a desperately needed social and ecological ethic that can truly be heard in our modern world.

For several centuries, until recently, there was little development of Catholic social or political theology. The Industrial Revolution had over two hundred years of child labor, fourteen hour work days, and firing of anyone who spoke up, before the church recognized the rights of the working person to organize and to strike. Now the gains made in the Second Vatican Council are being reversed by the current regime in Rome that is convinced that the American Church in particular is degenerate and that the Second Vatican Council was misguided. The fact that so few in modern society listen to what the Church has to say must be laid partly at the feet of the Official Church. The fault lies, I suggest, just as much with the official messengers and the medium of the message as with the obstinacy and sinfulness of society.

17. We cannot have an adequate theology of sexuality or of love or of marriage because the official church has not been willing to listen to the behavioral sciences to learn what is healthy sexual functioning in adolescents or in adults, what is healthy sexual functioning in marriage, and how sexuality leads us into relationships, first and necessarily through fantasy and sexual desire and self-stimulation. Therefore this drawing us out of ourselves into our first experience with passion is more spiritual than biological. Ecclesiastics of all denominations start a priori, before the fact, with God says... and are ready to fill us with shame and guilt. That so few listen is not the perverseness of human nature so much as the people know the Emperor is without clothes and all his consorts are full of...pretending too.

18. A truly incarnational theology cannot avoid, prohibit or do away with some human things to arrive at the mystery of God. Rather it is in and through human loving that the love of God is made present and active in the life of the people. Realizing this Presence among us, this inspiriting, is both liberating and empowering. An adequate Incarnational theology of marriage and an understanding of the spirituality of sexuality would empower laity for ministry quicker than anything else.

LINCHPIN OF THE CATHOLIC SYSTEM

One sign of the ultimate scope of the Catholic view of sexuality is that the priest who resigns to marry is allowed to have no church status whatever no matter how many years of loyal and obedient service he has rendered. Until recently he must even vacate the geographical locality where he served. They are not permitted to serve at the altar even as an ordinary layperson is. They have become non-persons, juridically. Requests for laicization in order to marry are still routinely refused. The Vatican forbids any use whatsoever of these priests, although a few bishops ignore the warning and use them quietly in educational roles. Most curious is that Lutheran clergy and Episcopal priests already married are acceptable to be re-ordained as Catholic priests.

This practice is maintained in a pastoral context of worldwide shortage of priests. An estimated two thousand parishes in the U.S.A. alone lack priests. Bishops continue to close churches across the country for lack of priests. In particular the military (all branches) is currently short almost one thousand Catholic chaplains. The hierarchy would rather deprive people of access to the Word and the Eucharist than change its practice, even though it is admitted to be only a changeable rule or discipline and even though it is at least implicitly contrary to Canon Law: The supreme law of the church is the salvation of souls.(c. 1752)

At the Synod of Bishops in Rome in 1991, celibacy was taken off the agenda by the Pope, yet a vote upholding celibacy was taken before the synod concluded, unanimously passed by all bishops present. Such a vote with no discussion permitted adds up to, in the power politics of the assembly, no more than a vote of fealty, the required allegiance given to a feudal lord. Given the pastoral situation throughout the Catholic world, with an estimated 40+% of the parishes without priests, that vote was astonishing. Even more amazing, it received no known criticism in the Catholic press. Upholding the current rule (that could be changed by a simple fiat) is more important to the hierarchy than the command of Jesus to the Church to preach the Gospel, which is its most basic pastoral mission.

Requests from American bishops for the suspension of priests convicted of child abuse have been until recently refused by the Vatican. Does it appear that the status quo must be maintained at whatever human cost? Can we begin to understand the obstinacy of Catholic teaching on sexuality? The Catholic view of sexuality as a hindrance to holiness and ungodly is, I suggest, the linchpin of the entire hierarchical system. Change this and the entire pyramid collapses. The Holy Spirit may begin to speak directly to the People of God, unbidden and uncontrollably, wherever She will. We might become a Pentecostal church, where the Spirit flows freely instead of supposedly only from the top down with constant oversight required.
We might have to turn the pyramid upside down, with the hierarchy existing for the sake of the laity. This paradigm shift is now recognized as essential for the success of business management. Employees are now regarded as partners.

GOD'S POETRY OF LOVE

We must break with a one-dimensional view of sex which restricts our sexual consciousness to the genital area, or to our guilty dark side, or to a faith inspired view of natural law. The essential goodness and splendor of the erotic, the mystery and glory of the body in all its aspects must be recovered. Our bodies, not just our minds, are our bridges to the meaning of life and love, and to the Ultimate. The road to the sacred runs through the carnal. Not only the Bible but Life itself reveals that sexuality is more spiritual than biological. The erotic is God's poetry of love calling us out of ourselves to awareness of beauty and to an expansive creativity and giving of ourselves.

We must return to a biblical understanding of the unity of passion and spirituality, of sex and spirit. In the Old Testament, the source of evil was not in passion, but in hardness of heart, callousness and insensitivity. The New Testament pathway to God is through the human. We must be leery of any theology that strives to make human love and divine love of two different orders. There can be no growth in spirituality without the necessary basis of human loving and sincere affection.

To begin to rejoice in the wonder and the joy of sexuality is to experience something of the love that moves the sun and the cosmos. Such delight in all of creation and in people is, I propose, one of the marks of sanctity. To be a saint, is to become, in a sense, more intensely ordinary, more deeply human, more passionate, more responsive to beauty, to pain, to nature, to injustice, to everything one touches, more filled with the giftedness of every day, every moment, every creature. Such loving cannot be achieved without the giving and receiving of human affection and human love.

The wonder-filled aspect of this kind of loving is that all things begin to speak of grace, of the mystery of God: every person, every day, every encounter, the smallest of creatures, and every relationship. We can even begin to realize that coincidences are God's way of remaining anonymous. The more we love, the more we are able to love. In such persons, love that is both tender and passionate oozes from every pore.

When we strive to live like this we can begin to discover a sensual passion as deep and mysterious as the sea, as strong and still as the mountain, as insistent and changing as the wind, as warming and frightening as fire, and as soothing and cleansing as water. We discover through a loving relationship that beautiful and radiant face that God alone gave each of us long ago. The power through loving we have to create, or destroy, others is simply awesome.

If the glory of God is the human being, woman and man, fully alive, and in a co-creative partnership, then whatever limits or diminishes that aliveness/ partnership is, in fact, inimical to divine glory. Any teaching that does not recognize that aliveness / partnership, nurture and empower it, cannot be from God, from that Holy Fire that wants to be enkindled.

In poetry and in love, and in sexual desire, what is important is not what is said, but what is signified. Metaphor, analogy, parable and poetry are valid sources of theology, as Jesus and the Bible show us. Yet few Christians of any persuasion have ever heard a sermon preached on the one of the most beautiful, most poetic, and most erotic of all books of the Bible: the Song of Songs:

How beautiful you are, my love, how beautiful you are!
Your eyes behind the veil, are doves;
your hair is like a flock of goats
frisking down the slopes of Gilead.
Your teeth are like a flock of shorne ewes as they come up from the washing--each one has its twin, not one unpaired with another.
Your lips are a scarlet thread
and your words enchanting.
Your cheeks, behind your veil, are halves of pomegranate.
Your neck is the tower of David built as
a fortress, hung around with a thousand bucklers, each the shield of a hero.
Your two breasts are two fawns,
twins of a gazelle, that feed among the lilies...
You are wholly beautiful, my love,
and without a blemish. (4:1-7, Jerusalem bible)

Do you wonder why no homilies, Catholic or Protestant, are ever preached on this text or on the divine poetry of love and sexual desire? Could it be, perish the thought, that no one is really living it, that is, discerning the sacred in the murmurings of our bodies and the voices of our senses? Or that no one has been encouraged to live it? Or maybe that in church-stuff alone we should find this mystery we call God? Or could it be that if sex remains dirty and sinful, we have more guilt, and then we have more urgent need for the priest and for the official church?

For what we are beginning to wake up to today, as if from a long drugged sleep, is that we have for millennia structured our social institutions and our systems of values precisely in ways that serve to block, distort and pervert our enormous human yearning for loving connections...[it mus be noted] that our most famous story of human origins, the Genesis story of Adam and Eve, has absolutely nothing good to say about sex, love, or pleasure, that it presents the human quest for higher consciousness as a curse rather than a blessing, and that it does not even touch on the awe and wonder we humans experience when we behold or touch someone we love. (Eisler, Sacred Pleasure. 1995)

At this point we can scarcely imagine what such a life and such a value system would be.
Except that we can now grasp that it would be very different from that which now guides us.

What if the Catholic hierarchy truly grasped that their main function was to serve and empower the laity? With laity in true partnership with clergy, with laity empowered to carry witness to the Kingdom in every corner of the world, preaching, teaching, and presiding in exercise of their full Baptismal rights, a church truly living the gospel with radical discipleship? Hierarchy might see their ministry as service and trust the charisma of the laity to participate fully in all ecclesiastical affairs as partners and co-creators--yes, a more pentecostal and charismatic church. Yves Congar, one of the pre-Vatican II theologians whose writing inspired the council, said long ago that if the hierarchy ever turned the laity loose, we would witness a second Spring of the Church that could pale the first Pentecost.

Perhaps the Age of the Laity has already begun except hierarchy don't really know it yet.

If a writer is so cautious that he never writes anything
that cannot be criticized, he will never write anything
that can be read. If you want to help other people
you have got to make up your mind to write things that some men will condemn.
--Thomas Merton, The True Solitude (Selections)
END

Note: in preparation is Guidelines and Norms for an ethic of sexuality and spirituality for adolescents today, which 1) recognizes that while the ideals of abstinence or safe sex may work for some, this is not sufficient for many; 2) that young people are sexually active very early today, often from 12-14 on; 3) which would not assume from the start that teens are normally responsible in these choices; 4) would treat sex as fun, friendly, tender, wet, warm, and wild, as well as the introduction into Mystery that will surround the rest of their lives; 5) assumes that we adults of today are keepers of the cultural curriculum, and that it is we who are failing to create the wholesome experimental spaces teens need to make mistakes, learn safely, and begin to see that the erotic is an introduction into the Holy Fire of this mystery we call God. (Kegan, Robert, In Over Our Heads, Harvard, 1996)

ReferencesBaute, Paschal. Intimacy in the conjugal relationship: a descriptive analysis of the felt experience. Dissertation Abstracts, XXIX, 1, 1968. (Univ. of Penn.)
Baute, Paschal. Marriage, society, celibacy and the future of the church: connections. unpublished paper, 23 pp. 1989.
Countryman, L. William. Dirt, Greed and Sex. Philadelphia, Fortress Press, 1990.
Eisler, Riane, Sacred Pleasure. Harper, 1995.
Fuchs, Eric. Sexual Desire and Love. New York: Seabury, 1989.
Harrison, Beverly Wildung. The Power of Anger in the Work of Love: Protestant Ethics for Women and Other Strangers, Union Seminary Quarterly Review 36 (1980-81): p. 47.

Kegan, Robert, In Over Our Heads, Harvard, 1996

Massimini, Anthony. Personal communication, 1993.
TePas, Katherine M. Spiritual Friendship in Aelred of Rievaulx and Mutual Sanctification in Marriage, Cistercian Studies, 27:1 p. 63-76

Wadell, Paul. Friendship and the Moral Life. Notre Dame, IN: University of Notre Dame Press, 1989.

Wells, Carol G. Right-Brain Sex. New York:
Prentice Hall, 1989.
_______
COMMENTS, SUGGESTIONS INVITED:

Return to pbbaute@aol.com or snail mail: Paschal Baute, 4080 Lofgren Ct..
Lexington, KY 40509-952

Saturday, March 15, 2008

The role of EMPATHY: view of a medical student.

The Uses of Empathy: A Medical Student’s Perspective
11 March, 2008 11:14:00 James Fleming

Discussion of empathy in medical practice.

"Empathy is the feeling that 'I might be you' or 'I am you,' but it is more than just an intellectual identification… empathy brings emotion."[1]

While experienced health care practitioners may agree on a general definition of “empathy� and perhaps even recognize its theoretical appeal, they continue to disagree on its usefulness in clinical practice. For this reason, if we hope to discover its uses, then we must study empathy both in theory and through clinical experience. As Immanuel Kant once asserted, "Experience without theory is blind, but theory without experience is mere intellectual play." 2]

While I studied philosophy before medical school, I only began to understand the force of Kant’s dictum during my first clinical rotation as a medical student. In light of Kant’s advice, I will begin this essay by sharing a personal narrative.

***

I was half asleep in the library when my trauma pager flashed "Red Alert: female, motor vehicle collision, estimated time of arrival - ten minutes."

I raced to the Emergency Department. In the trauma bay I found a young woman covered with abrasions and contusions; she had been thrown from her vehicle. The resuscitation team, wearing blue non-latex gloves, surrounded her bed quickly. They intubated, administered intravenous fluids, inserted a Foley catheter, and ordered portable X-Rays. As suddenly as it had arrived, the ocean of blue gloves ebbed in all directions until I alone was left.

Our patient was not a candidate for immediate surgery. As a medical student on trauma surgery call, my job was to follow the surgical team. Nevertheless, because I already felt attached to this young woman I decided to stay by her side. What if she were to awaken? As her parents had not yet arrived, I wanted to stay close by.

Tom, her nurse, was adjusting the monitors and I remarked that her movements seemed purposeful, and that I did not think she was brain....

"Don't talk like that!" he yelled back at me.

At once I understood. She might be able to hear us. Tom turned to me and asked her name. Reaching for her hand I replied, “Her name is Sarah.�

Tom proceeded to call out to her loudly and with passion, “Sarah, can you hear us?� She did not respond. Yet, as I held her warm hand, I could not accept the possibility that her grip was mere reflex.

About this time I had to take on an unexpected role. Sarah’s parents had just arrived at the reception desk desperate for information. Yet, all of the residents who had cared for her that evening were busy treating patients elsewhere in the hospital. The staff at the reception desk wanted someone to take the parents to see their daughter immediately. As I had been with her throughout the night - to the CT scanner and through assessments by multiple consult services, and so on, it was clear that I knew the most about her injuries and current status. But who was I?

Surgery was my first medical clerkship, and I had only been on the service for a couple of weeks. What I knew of clinical medicine I had learned holding the camera in a handful of laparoscopic cholecystectomies. As I stumbled to the reception area, I knew that I could not rely on my two weeks of surgical training to get me through this encounter. I would have to rely on my twenty-six years of experience being human.

What would anyone do in this situation?

Well, I can tell you what I did. I identified with her parents emotionally. To tell the truth, I suffered with them.

When I had first arrived at Sarah’s bedside that evening, I had taken off my white coat and left it on a chair. As I went to find her parents, I grabbed it. Then I dropped it again; I could not hide behind the white coat any more than I could hide behind my two weeks of medical training.

From several paces away, I saw her parents. There was no mistaking them. Their eyes scanned the emergency department again and again, periodically and mechanically, like the strobe light on a light-house. I fixed my eyes on them, and they knew it was time to see their daughter.

"This way," I said. I took them close to Sarah’s bed, so they could look at their daughter as we talked. Then I tried to address their questions.

"I am not a doctor," I said. “I am a medical student who has had the honor to stay at Sarah’s bedside since her arrival at our hospital. What I can tell you is that she was involved in an unrestrained car wreck. She was flown in by helicopter immediately. She has multiple fractures, but her CT scan does not show any bleeding in the brain, which is encouraging.�

"We drove as fast as we could," the mother cried. The father was also in tears but less vocal. "Is she going to be OK?"the father eventually asked.

"I don’t know, but her doctors are doing the best they can. I’m sorry,� I said. “I can only imagine what this must be like for you."

Her parents began to speak to their daughter, "Sarah, Sarah, can you hear us? We love you. You are going to be alright. There are a couple of handsome doctors taking care of you and they are going to continue to take good care of you."

Around one o’clock in the morning, I left for the night. Sarah’s parents, however, were not interested in sleep. Even though rounds would not start for five or six hours, they waited anxiously for any report of her condition.

The next day I returned to her bedside, worried about over what I would find. I found Sarah's mother crying quietly. She had just been told that her daughter suffered from diffuse axonal injury (DAI), and might, or might not, wake up. The “handsome doctors� taking care of her could not do much more.

Nevertheless, Sarah’s mother managed to smile when I reassured her that Sarah looked much more comfortable in the ICU, without the bright lights and noise, than she had in the ER. She responded that she had also noticed that Sarah’s long brown hair had been combed free of debris from the accident. She thanked me for coming by.

I continued to visit Sarah during the two weeks thereafter- meeting her brother, her uncle, and her pastor on different occasions. As I became acquainted with each of them, I felt Sarah’s parents’ suffering more deeply. With each visit, I became slightly more nauseated from the anxiety I felt for the family. I would often delay my visit by stopping at the nurses’ desk to check lab values and progress notes – so that I could muster the bravery needed to stand in silence, yet again.

During the two weeks Sarah remained in the hospital, I found her in the neurosurgery ICU, then the burn ICU, and, finally, the trauma ICU. A busy hospital does not have enough free beds to keep a patient resting in any one place for long. Then suddenly, to my surprise, I returned to the ICU to discover that Sarah had been discharged to an outside facility. I had seen her for the last time.

I found myself wondering one afternoon, nearly four months later, whether Sarah’s condition ever improved. To find out, I looked to see whether she had been admitted to the hospital on any other dates since that discharge (the only information I was permitted.) I was relieved to discover that she had underwent several orthopedic operations as well as traumatic brain injury rehabilitation; Sarah survived her injuries and continues to recover. I continue to hope for the best.

***

Why did I experience so many feelings during my time caring for Sarah and her family? Where did these feelings come from? I was not yet a parent. I had not faced the prospect of losing a child. Nevertheless, I suffered from witnessing and then sharing Sarah’s parents’ suffering.

This sort of emotional identification is empathy as commonly defined. To revisit Howard Spiro’s definition, “Empathy is the feeling that ‘I might be you’ or ‘I am you,’ but it is more than just an intellectual identification… empathy brings emotion.�[1]

Richard Selzer adds, “The word empathy means the power of projecting one’s personality into the object of contemplation, and so fully understanding it.�[3]

Most everyone has feeling, but the ability to experience emotion does not automatically lead to the acquisition of emotional experience. One has to live life to appreciate the full range of human emotion. As Spiro also noted, to recognize sadness in a face, one at some time must have felt sad.[4]

While all of us have felt sad, a few of us have felt a deeper sadness. Several parents have told me that the loss of a child is one of the deepest forms of sadness; Sarah’s parents faced that possibility. Does the fact that I have not lost a child prevent me from relating to her parents’ sadness? I hope not; otherwise, the world would be a very lonely place. If we medical students listen carefully to a patient’s story and draw on the little experience we have, we can begin to imagine how the patient feels. In the process, we will suffer in proportion to our life experience. The discomfort brought on by such suffering will then compel us to ameliorate the patient’s suffering so that we might end our own.

Consider an analogy from the philosopher David Hume. In his work on human nature, Hume explains that with respect to our feelings we are each like strings on the same musical instrument, “As in strings equally wound up, the motion of one communicates itself to the rest; so all the affections readily pass from one person to another…�[5]

For example, who can bear the cry of a child? One feels compelled either to comfort the child or to leave the room. Perhaps “comforting the child� could be a metaphor for attending to patients - whether they require open-heart surgery or just a cup of ice chips. Perhaps “leaving the room� could be a metaphor for not listening to the patient long enough to determine if the patient understands the illness or treatment. Even the best protocols do not provide hope to the patient who does not understand the illness or the treatment.

Why do some physicians take the time to explain what is going on? I suggest that we look to empathy for the answer. The same empathy will enable the physician to recognize “the problems of living – existential, socioeconomic, and emotional�[4] that accompany major illness.

How does empathy function in this extraordinary way? Hume believed that we naturally identify with the emotions of others through an appreciation for cause and effect in the way that I have described. Hume described his own feelings as he witnessed the beginning of an 18th century operation:

“Even before it begun, the preparation of the instruments, the laying of the bandages in order, the heating of the irons, with all the signs of anxiety and concern in the patient and assistants, wou’d have a great effect upon my mind, and excite the strongest sentiments of pity and terror.�[5]

In this passage, Hume tells how the “signs of anxiety and concern in the patient,� rather than any knowledge of possible outcomes, aroused within him the feelings of pity and terror. In other words, the outward expression of emotion by the patient, once perceived by Hume, led to empathy.

Similarly, when I approached Sarah’s parents, I observed the distress in their eyes - a distress that I understood - even though I was no more a parent than Hume a victim of surgery. I listened as they told me that Sarah was a good girl and that they were proud of her. Their comments increased my empathy because they allowed me to feel how deeply her parents were suffering.

As a third year medical student, I have the luxury of time and limited responsibility. The technical aspects of patient care provided by the residents do not burden me. During my time caring for Sarah and her family, I now believe that my principle function was to care.

On the other hand, residents must master the technical aspects of patient care. That comes first in emergency room medicine. Does empathy add anything of value to their interaction with the patient?

Richard Landau, an experienced physician, says no and therefore argues for the �desensitization and de-empathization� of medical students in training.[6] He believes that the expression of empathy often undermines a physician’s ability to function in the health care setting. While I disagree with Landau’s conclusions, my opinions are mere theory without experience, as I am not yet able to satisfy the demands of Kant’s dictum (i.e. understanding requires theory and experience.) But with each patient encounter I get a little closer.

The residents involved in Sarah’s care did not have the luxury of visiting for the length of time that I did. Does this imply that they could not have empathy? Not necessarily. Empathy, like forming a diagnosis, is a skill that improves with time. Just as many family physicians can diagnose influenza within seconds of laying eyes on a patient, many experienced physicians can identify suffering, and respond appropriately, in less time than perhaps they would have required as a medical student.

Young physicians must also learn to maneuver from patient to patient without becoming “emotionally spent.� Otherwise, listening and identifying emotionally with one patient may come at some expense to the next patient. Aristotle first recognized this danger and cautioned us as follows, “It becomes difficult… to sympathize closely with the joys and sorrows of many, because one is likely to be faced with sharing the joy of one and the sorrow of another simultaneously.�[7] I have worked with physicians who seem to have met Aristotle’s challenge and perhaps some who have failed. Those who have succeeded are ideal role models for doctors in training.

If the concept of empathy is championed early in medical school training, where every doctor’s journey begins, doctors will ask the question, “What are the uses of empathy?� for themselves. As they choose different specialties, lifestyles, and patient loads, they will surely answer this question differently, but at least they will have been encouraged to ask it in the first instance. As for myself, as I advance from student to resident, I can only hope that the memory of caring for Sarah will serve as a reminder of what I should strive for in each patient encounter.

FRIEND MARGARET; IF YOU GOT THIS FAR, PLEASE LEAVE A COMMENT FOR ME.

References

1. Spiro, Howard. “Empathy: An Introduction.� Ed. Spiro H., Curnen M., Peschel E., St. James D., Empathy and the Practice of Medicine. New Haven: Yale University Press, 1993. 1-6.

2. Darwall, Stephen. Philosophical Ethics. New York: Westview Press, 1998. 23.

3. Selzer, Richard. “Foreword.� Ed. Spiro H., Curnen M., Peschel E., St. James D., Empathy and the Practice of Medicine. New Haven: Yale University Press, 1993. ix-x.

4. Spiro, Howard. “What is Empathy and Can it be Taught?� Ed. Spiro H., Curnen M., Peschel E., St. James D., Empathy and the Practice of Medicine. New Haven: Yale University Press, 1993. 7-14.

5. Hume, David. A Treatise of Human Nature. Oxford: Oxford University Press, 2004. 368.

6. Landau, Richard. “…And the Least of These is Empathy.� Ed. Spiro H., Curnen M., Peschel E., St. James D., Empathy and the Practice of Medicine. New Haven: Yale University Press, 1993. 103-109.

7. Aristotle. Ethics. Trans: J. Thompson. London: Penguin Books, 1976. 308.

Author's bio

This essay also appeared in Yale's Journal for Humanities in Medicine.