Posted by Helen on: 10.27.2006 /
In comment #24 on Class #4, NCxian wrote:
Eliza, are there times as a physician when you don’t share your doubts and uncertainties with a patient? Do patients sometimes want answers and certainties and sometimes you decide that is what to give them?
I love this question! I think it applies to all of us to some extent in that, as we share information with other people, we are making choices about what we share and what we withhold. So I’d like to generalize NCxian’s question and ask:
Comment by: Helen
1 10/27/06 4:40 AM | Comment Link |Pastor David already posted some relevant thoughts on this in comment #22 on Class #4, so I have copied them here:
Comment by: Julie Marie
2 10/27/06 5:16 AM | Comment Link |Good question! Speaking for myself, from my experience, I wish I’d been more protected from the drama of my parents divorce and the stress of career building. I was only 15 and felt like the world was on my shoulders to a) help support the family - I worked 3 jobs and went to school and b) be the sounding board for my mother so she could ventilate enough steam to allow her to keep functioning.
It made for a very serious young lady with no idea what a healthy boundary was. I wish I’d been allowed to just be a kid.
From more modern experience, I’ve found with my fundie friends, I keep my questions and my evolving faith to myself. They have demonstrated they cannot handle my truth right now. My silence on these matters is self protective to a degree, but also I’m trying to be kind to them. Seeing someone who was as conservative as I was shedding doctrines upsets them.
Comment by: David H
3 10/27/06 6:45 AM | Comment Link |Pastor David’s thoughts rang true to me. The former pastor of my church had a chronic depressive illness. He was a shepherd in every sense of the word, but he felt everything the went wrong anywhere in the world as his personal failure while in a depressive state. He sometimes spoke in sermons about his doubts and fears as well as his struggle to trust God in the midst of those things. I heard many people complain that he was just too down. Many people don’t want doubts, confusion and fear communicated by a pastor. They want a safe faith.
Eventually this pastor had to leave the church. The primary cause was his illness became overwhelming. But several people in our small congregation seemed glad to see him go.
It is wrong and dangerous to not allow pastors to be human. But some people see no value in a spiritual leader who is just like me.
Comment by: ncxian
4 10/27/06 10:39 AM | Comment Link |I’ve thought of two examples where I have not/will not share my doubts and uncertainties. Maybe by the time I type them out, some insight will come to me as to why these seem like appropriate circumstances for that.
My mother-in-law is terminally ill and will not live much longer. I plan to assure my children (7 and 11) that her death is not the end of her. I am not certain what will become of her, but I will not share a lot of my wondering about that at this painful time for them. I am not certain that her personality, her uniqueness, her individuality will continue after her death. But I don’t think I will go into that with my children. I also will say that I “believe” that she will have a life after her death but what I have is more like “hope”.
Another example is in my work. I interview and assess people to determine what their needs for our services might be, then match them with the proper resources. There is occasionally a person who, after two hours of assessment, I am not sure that there is a resource on the planet to meet their needs, much less one I have at my disposal. But I would never say anything that would lead them to believe I think that they are a hopeless case.
There, now I have said “hope” in both situations. Perhaps I choose not to admit my doubts and uncertainty when my doubts and uncertainty would cause another person to lose hope?
Comment by: Julie Marie
5 10/27/06 10:51 AM | Comment Link |I’m sorry to hear about your mother in law, NC. :( I think you are wise to not go into your wonderings with your children.
I think that is a good point. I remember the first oncologist I spoke with about my mothers CA diagnosis. He said, with bluntness and certainty “your mother has 6 months to 1 year and that is being optomistic.” I was shocked. I understand not wanting to build false hope, but I didn’t want her treated by someone that insensitive. We found another onc - who phrased it this way: “I do not know how long you have. What I know is your time is limited. We will do everthing we can to extend it and keep the quality high.”
What a difference. She actually lived 2 years after that.
Comment by: Karen
6 10/27/06 12:06 PM | Comment Link |Julie wrote:
Wow - I could’ve written that myself. Except I was about 11 or 12 when I pretty much lost my childhood, for the same reasons you did.
It’s definitely a damaging thing to have to grow up and take on adult responsibilities that early in life. :-( I’m so glad my children have been able to really be kids while they’re young.
Comment by: Julie marie
7 10/27/06 12:26 PM | Comment Link |I looked back at my mess of a post in #5, I realize, what I was trying to say, is sometimes allowing for uncertainty is hope enhancing.
Comment by: Pastor David
8 10/27/06 12:33 PM | Comment Link |Reading David H’s post, and thinking about it some since the question was first raised in the Class #4 thread, I have had a couple of observations about this.
1) We all have personas that we use. We are not the same with our parents, as we are with our co-workers, as we are with our spouse, as we are with our children, etc, etc. Sometimes this is for the benefit of the one we are interacting with, sometimes it is for our benefit, and sometimes it is merely because of a different culture/context/environment. At times we are very aware of this difference in our personas, at other times it happens naturally and we don’t even notice it. In fact, it is considered a mental illness when a person cannot self-censor, when a person’s mind cannot distinguish between private thoughts and public thoughts.
This is especially true for persons whose work places them in the public eye. Pastors, teachers, public officials, law enforcement personel, and many other persons have a career that requires a public persona.
2) This is a phenomena that cuts both ways. It certainly has its beneficial aspects, and is necessary for functioning in the world. However, it can also have a downside. It is possible to lose oneself in the persona; or to compartmentalize and not have one part of your life affect any other.
This is the real risk for clergy and others with a public persona. An image of yourself of the “superpastor” (or whatever) can build up in your head, until it drives your personality.
Rob Bell describes the need to “kill your superwhatever,” and to a degree I think he’s right (when it becomes an unhealthy part of your life). But there is also a need for balance: for a public life and a private life, for a public persona that strengthens, enables, and feeds the whole you.
Comment by: Eliza
9 10/27/06 5:21 PM | Comment Link |Thanks for separating this out, Helen - what an interesting discussion!
Like Julie and Karen, I too come from parents who divorced when I was a kid (11 yrs old), and I too got put in the middle of their mess and in a position of being the parent to my parent (giving moral support, etc, to one of them), had to grow up faster and get a thicker skin, I think. Not a good path for a kid (though there are worse). In my case, I had one parent who coped well, including never putting me in the middle and never badmouthing the other parent, and one parent who did not cope gracefully and dragged me into it. I don’t know how much of “coping well” in this case was hiding things from the kid. It seemed to me more that the adult in one case was just keeping the two roles separate: “divorced adult with a former spouse to communicate with” and “divorced parent with a child to communicate with”.
Comment by: Eliza
10 10/27/06 5:59 PM | Comment Link |Going back to NCxian’s post #24 from Class #4 thread:
Just want to point out that my response specified “teacher” who would keep uncertainties veiled. But, then, I see teaching/learning as a wondrous discovery, an exploration of the unknown, with the teacher as a guide. In this model, uncertainties add an intriguing spice, a clue to a direction to search, and a hint of future discoveries (or fascinating questions) to come. Uncertainty on the part of the teacher doesn’t have to be a negative at all, in my model, unless the teacher therefore leads the learner far astray - but, then, acknoweldging uncertainty, one or both of them can look to other resources to self-correct. (It seems, forced certainty may be more likely to lead the learner astray - see the writeup of class #1, in which the students were taught that Paul approved the canon of the NT.)
Working with patients, I don’t think I go overboard pointing out areas of uncertainty, but I do think it’s really important to give people (well, most people) a sense of what’s clear, what’s confusing, what the issues are (and also how we might get more information to help clear up confusing areas, if applicable). (Some people want to hear something concrete, in which case I tell them I am saying something concrete because they want me to.) I can think of so many examples of situations in which something is uncertain in medicine, it’s hard to come up with a pithy summary of my approach, or any one example to crystallize my thinking on this. Alot of the examples we all think of, or have experienced, will be around terminal conditions, but discussions of uncertainty come up all the time in medicine. (I often tell people, “boy, it would be great if we had a crystal ball…”)
I can say that I never like to tell people how long they are going to live with any particular disease or diagnosis…because we really don’t know. We get it wrong all the time! And it depends on so many factors, including someone’s “will to live.”
However, it often is very helpful to patients & families to hear a sense of how fast the condition is progressing (do they have a long time? a little time? does it depend? if so, on what?) so they know whether to get their affairs in order (if that’s what they want to do) or go ahead & plant bulbs this fall for the spring. I think I try not to squash hope, yet also let people know in a caring way when it looks to me like the handwriting is on the wall. (And, stick with them, addressing whatever is bothering them as best we can.)
Example from clinic very recently of a healthy woman in her 80’s, widowed last year; I could see her just sag when I told her (during her exam) that I was feeling a lump in her left breast.
So, is that a simple situation ["breast lump, needs standard evaluation"] or a complicated, human one [breast "lump" sounds like cancer to her ears, what is she thinking? She'll die from it? She'll need surgery & chemotherapy but her husband has died so who will be her support & who will drive her? Is she thinking about all the people she has known with cancer? And what am I thinking - this feels like it's probably a benign lump, rubbery and mobile like a lymph node, but that determination really can't be made by physical exam so we really should get a mammogram & ultrasound, the standard way to image something like this, and she might need a biopsy; and I don't want to give her false hope but I also think it's fair to tell her what about the lump makes me think we should be cautious & careful & work it up, but that probably it will be OK? And then what if I'm wrong, like 2 weeks ago with the lady with the fluid in her abdomen that didn't seem to be ovarian cancer but then turned out to be ovarian cancer? But that's not something I'm going to tell this lady with the breast lump about, that was just one of those situations where the real diagnosis doesn't jump up and bite you on the nose, those happen but not all that often.]
What can you do but do your best and make sure you are as open with people about what’s going on with them as they want you to be, trying to gauge how much detail they want about the facts and the possibilities, the certainties and the uncertainties, because all of those things are part of every day.
Comment by: NCxian
11 10/27/06 9:01 PM | Comment Link |Eliza, I had noticed that you specified teacher. I agree, it is a much better experience from a learner’s standpoint when the teacher and learners are going down the path together, with transparency on both sides.
I wonder if the pastor who is teaching your class has some difficult role conflicts. yes, for the purposes of this class, he does stand in the position of a teacher. But for many of those folks, he is also the pastor. Maybe he feels like his role as pastor keeps him from being tranparent about his doubts and uncertainties, even thought that would be a better way to teach?
My personal preference is transparency of pastors as well as teachers, but I don’t think that is the traditional model in the church. I have eavesdropped on an online conversation of emerging church leaders for the past several years, and one of the recurring themes is the burn-out that pastors experience in the traditional setting because they can’t be transparent, and feel they must be all things to all people. I believe they hope that emergent communities will have different expectations and that they will be able to be more true to themselves.
Comment by: Helen
12 10/28/06 6:34 AM | Comment Link |I think part of the complexity of this is, what meaning do other people derive from what we say? And how much should we care about that (because after all, that’s really their problem, not ours)
For example, what if Eliza tells a patient there is an outside chance her symptoms could imply something serious, and the patient dismiss the ‘outside chance’ part and conclude they do have something very serious wrong with them, and gets very discouraged and worried? Is this a reason for Eliza to not communicate very unlikely possibilities, or not?
NCxian wrote:
Yes - I think this is why pastors often might choose not to say too much about their own doubts and uncertainties. They don’t want to be responsible for destroying anyone’s faith or taking away their hope.
Comment by: Eliza
13 10/28/06 12:45 PM | Comment Link |NCxian said:
I hadn’t really thought before this conversation (& Pastor David’s & others’ comments in the Class #4 thread) about how hard it must be to wear several hats in which you are expected to express/feel certainty, with little or no outlet for your own very human uncertainties.
This does come up a bit when medical students are considering what field to go into - how they feel about uncertainty and errors can be important considerations. For example, surgeons have to be able to come to certain decisions about whether or not to take someone to surgery, & once there what to do, & if problems occur what to do about them - all in a timely fashion - and have to feel comfortable with the decisions they’ve made. There’s no sitting around, watching and waiting, if the problem is pressing or (even if it’s not) once you’ve decided to go ahead w/ surgery. But that seems like a profession in which one really has to feel that certainty, not just project it. Not that surgeons don’t learn from cases that don’t go well - they do - but they can’t get all tied up in knots about how their actions and their decisions caused the problem, otherwise they’d be nonfunctional as surgeons pretty quickly.
That’s an interesting question. My guess is no, because when I’ve gone up to him after class & pestered the pastor with my questions, his responses are exactly along the same lines as his presentation in class, & come across as quick & certain & (for the most part) internally consistent. (The only response that threw me as potentially not ‘internally consistent’ was after class #2, when he seemed to indicate that a book expressing doubt about the creation account in Genesis was OK for his flock to read, because it was anti-Darwinian. I would have guessed that he would have thought that avoiding exposing them to anti-biblical teachings was of greater importance; it’s not that there weren’t other books, pro-creation, to suggest to them…)
Comment by: Eliza
14 10/28/06 12:49 PM | Comment Link |Yes, I think you hit it on the head, Helen - this is what could be at stake if/when a pastor expresses doubt publicly.
Comment by: Marty G.
15 10/30/06 11:17 AM | Comment Link |Speaking as a former minister, it was frustrating to not be able to express doubt while working in the church. For one, it wasn’t healthy for me to not be able to voice these things that were inside me. Many times, I had to seek outside listeners. It’s unfortunate but when a minister admits his doubt to the wrong person, he can wind up unemployed. Nowadays, I am not a minister (employed by the church) but I still hold my doubts in check because so many Christian folk don’t want to hear about it. They continue in their “shiny, happy Christianity” as if everything is hunky-dory. Thankfully, my wife and I have found a church where the admission of doubt isn’t met with frowns of disapproval. We attend two separate discussion groups where issues like doubt can be discussed. It is quite refreshing.
Comment by: Pastor David
16 10/30/06 2:43 PM | Comment Link |The “several hats” issue raised by Eliza (#13) is a very real one. I think that many lay persons are unaware of the many roles that a pastor has … this is partially our fault for not always being honest about the demands of ministry, and partly the reality that (like so many other things) you can’t see it unless you experience it.
Hats I wear as a pastor:
1) I am first a disciple
2) I am a husband, son, and brother
3) I am a teacher
4) I am a counselor and confessor
5) I am a priest (ceremonial leadership)
6) I am an administrator
7) I am a representative of our congregation and of the Gospel in the wider community
8) I am a representative of the wider church to this congregation, and a representative of this congregation to the wider church
9) I am a mentor
10) I am a liturgist (charged with shaping our worship)
And these are just some of the roles that most pastors see themselves in. Other clergy see their job as encompassing many other roles as well.
Comment by: Pastor David
17 10/30/06 2:46 PM | Comment Link |Yes, in response to a question further up the thread, pastors do feel a certain responsibility for the faith of those who are entrusted to their care. I don’t know that it is always healthy, but it is a reality.
The older term to speak of pastoral ministry was the “cure of souls,” or the “care of souls.” It is very traditional to speak of the faith of a congregation being entrusted to the care of the pastor/priest. I think that, kept in check by a healthy sense of one’s own limits and a humility about one’s abilities (or lack of them) and failings, this can actually be a very helpful model of ministry.
Comment by: Karen
18 10/31/06 7:49 AM | Comment Link |AH! so that’s where the (mostly British, I guess) “curate” comes from, then?
I love finding word origins. :-)
Comment by: Pastor David
19 10/31/06 10:20 AM | Comment Link |Karen …
Yes, “cure” comes from the latin cura meaning care or concern. Curate means one who is entrusted with the care of souls. (from the latin plural form of the verb, curatus, also where we get the word “curator”).
In the Anglican (Church of England) usuage, it has come to mean the deputy/associate/assistant priests on a congregation/parish. The senior priest is the Rector (from latin, “ruler, governor, guide”).
Comment by: Meg
20 11/3/06 12:38 AM | Comment Link |i love finding the meaning of words too! i think i like the idea of curates better than rectors! being cared for is much nicer than being ruled!!
Comment by: Roy Gathercoal
21 11/3/06 1:25 PM | Comment Link |Two other occupations/situations come to mind when I think of “not sharing doubts.” Looking at what they have in common might be helpful.
It might also help to look at a couple of occupations/situations in which expressing doubt is expected, even required.
First, the two “never show doubt” groups.
*politicians. For whatever reason, we have gotten ourselves (this “ourselves” includes a huge chunk of humanity) into a situation in which politicians have to appear as though they do not make mistakes and as if they knew all that was required to know about some topic.
In particular, I think of President Bush’s frequent statements that he did not make any mistakes, and VP Cheney’s statement that given the opportunity to do it all over, he would not handle Iraq any differently.
Of course these are for the purposes of campaigning. But they do seem to be found more often toward the right side of the dial.
The second is military commander. The model is that, while in the field, there is to be no indication that the commander has any doubt about the situation or course of action. If you have questions, you talk about it later, but you really are not supposed to have questions. Your trust should be total and absolute.
I suspect that an extension of this brings in captains of ships and pilots of aircraft. It does seem as though the model is to always exude absolute confidence. And in these settings that means “admit no doubt.”
On the other hand, journalists are expected to have doubts and to express them, even to the extent of “making up doubts” if they do feel certain of what they are reporting.
And it seems that research scientists are supposed to express doubts–and that someone who doesn’t express doubts is looked at warily, as if they can’t be trusted.
In thinking about these examples, the only characteristic that jumps out at me is that those who are expecting to come up with some understanding/fact/perspective are expected to “keep an open mind,” to admit, even at the last minute, that they may be wrong.
On the other hand, those upon whom people are expected to rely (and in environments where asking a bunch of questions could make things much worse)are supposed to be absolutely confident.
Perhaps applied to clergy, in those faiths/traditions where the pastor/rabbi/scholar is expected to have much more technical knowledge (i.e., seminary training)they are more likely to think of their role as one of airplane pilot or military commander.
And perhaps in those traditions in which clergy are expected to be “the seekers-in-chief” it is feared that a lack of tentativeness may be a sign of a closed mind(?)
And maybe it makes sense that in those where the clergy is the one who sits with families in the emergency room, witnesses an extraordinarly large portion of deaths, and is called upon to assume the role of “God’s herald”, expressing lots of doubts might not be helpful.
Perhaps a clergy member primarily in a different role (teacher, perhaps) would be expected to have and to voice doubts?
This is only a stab (bloggers are also supposed to have reservations/ doubts, aren’t they?) so does anyone see other similarities in the situations that are and are not prone to deny certainty?