Spiritual Care on the NHS: Chaplains or Charlatans?

This feature by DR ROBERT STOVOLD is based on a talk to he delivered
to the Brighton and Hove Humanist Society on January 7, 2009.

THE genesis of this article began on August 7, 2008, when I received an email from Richard Harlow, chaplain at the Princess Royal Hospital in Haywards Heath.  He said

We are currently consulting on the Spirituality Strategy for the mental health Trust that includes Brighton and Hove, and would be pleased for a response from the Humanist Society

I read through the strategy – a 13-page draft – and was at first unsure of how to respond.  On the one hand, some of its definitions of spirituality were certainly broad enough to include humanists.  For example, “[spirituality pertains to] the essence of human beings as unique individuals… the power, energy and hopefulness in a person”.  On the other hand, to take part in such consultations can be futile and even counter-productive.  Humanist views will rarely prevail against the religious majority, which, having got its own way can exploit your presence by claiming to be inclusive and saying, “Well, we did consult you!”

But as I carried on reading, I became more and more disturbed by what I’d read, and just had to say something.  The draft I received mentioned Baha’i, Buddhism, Christianity, Hinduism, Islam, Jainism, Judaism, Sikhism, Zoroastrianism, Paganism, Jehovah’s Witness, and even Scientology.  But not, of course, atheism, agnosticism or humanism.   Right through the document ran the self-serving and unsubstantiated assumption that all religions deserve respect.  I began my response by challenging that.  Humanists respect the rights of others to believe what they will, but draw a firm distinction between respecting a person’s right to hold a belief, and respecting the belief itself.  The world’s religions are mutually contradictory.  It therefore follows that all religions, or all but one of them, have to be wrong.  Why then, should they deserve our respect?

After a little research, I found a job description for an NHS hospital chaplain on the Internet, which contains the following passage: 10.  MOST CHALLENGING/DIFFICULT PARTS OF THE JOB – To distinguish in the experiences people share between what is genuinely spiritual and what is delusional or hallucinatory.   A patient who feels he has been “saved” by accepting Jesus as his personal saviour is, if we are being honest, deluded from an atheist’s or a Muslim’s perspective, and sane from a Christian one.  How does the Trust intend to resolve such serious contradictions – or does it intend to ignore them in the name of well-meaning but muddle-headed multicultural political correctness? If the Trust takes the reasonable view that false beliefs should not be propagated or legitimised by state-funded chaplains, it has two options:

• Fund no chaplains at all
• Identify the “one true faith” (good luck!), and fund only its associated chaplains

How might the Trust achieve the second of these objectives?  Well, I was relieved to hear that, according to the Strategy, “We will support research in the area of spirituality, with the same rigour as in other disciplines” (p.11).   Drugs that fail to pass clinical trials are rightly rejected by the NHS as a waste of money; if the Trust is being honest and consistent, it ought to apply the same rule to hospital chaplains. When scientists like Richard Dawkins rip into religion or “alternative” medicine, they are often seen as being too critical.  But once you understand how critical scientific enquiry is, you’ll appreciate that Dawkins isn’t being some kind of killjoy – he’s only being consistent.  He’s only asking for a level playing field – that spiritual remedies should be subject to the same standard of testing as conventional treatments.

Scientists don’t do clinical trials for the fun of it, and these trials don’t come cheap.  Scientists do it because such critical testing can be crucial in weeding out false explanations.  Does the NHS seriously intend to test the efficacy of chaplains “with the same rigour” as a pharmaceutical drug?   Just imagine the trials!  Some chaplains would dispense advice that genuinely reflects what their religion actually teaches, and others would have to give a kind of “dummy” religious advice as a placebo!

Of course, such rigorous trials will never be carried out – and the Trust should not try to pretend otherwise.

A recent large-scale scientific study into the effects of intercessory prayer in patients of heart bypass surgery found that “Intercessory prayer itself had no effect on complication-free recovery, but certainty of receiving intercessory prayer was associated with a higher incidence of complications”.  In other words, prayer was not associated with a difference when patients didn’t know they were being prayed for, and may have actually hampered a person’s recovery if they did!  Perhaps the fact that people knew they were being prayed for caused them to dwell on the gravity of their condition, and made things worse rather than better.

Has it occurred to the Trust that, religious or not, sick patients in a hospital ward may regard chaplains in much the same way as a sick animal regards vultures – as unwelcome harbingers of death?  The draft claims (p.1) that religion is “an essential part of many people’s self definition”, and proposes to “Make spirituality a central aspect of the care we provide” (p.6).  Yet as the draft strategy acknowledges, the West Sussex audit of 2005 revealed that only a minority of people said they would like to talk to a chaplain or faith leader.

I’m not saying that religion is all bad.  Religion provides a genuine sense of community and support for some people, and given that, I would not be surprised to find that visits from religious colleagues or leaders could speed a person’s recovery.  But by exactly the same logic, people who are passionate stamp collectors would likely benefit from visits by fellow enthusiasts.  I’m all for trying to make everyone, religious or not, as comfortable as possible in hospitals.  But the idea that religious communities should be privileged above secular ones must be challenged.  Again it comes down to consistency – to a rejection of double standards.  Let’s not have one rule for them, and one rule for us.

The draft cited a report which “recognised that spirituality is central to the recovery approach”.  The term “Recovery Approach” sounds reasonable enough, doesn’t it?  After all, you want people in a hospital to recover, don’t you?  But the report they cite, called “A Common Purpose: Recovery in future mental health services”, defines recovery in a subjective way:  “The current concept of recovery… has moved from professional definitions towards self-definition, such that the concept and experience of personal recovery is not limited by the presence or absence of symptoms, and disabilities, nor the ongoing use of services”.  So basically, you can “recover” and still be disabled and dependent on services.  “Recovery” was defined not in terms of living a full and purposeful life, but in terms of “[a] recovery of hope and ambition for living full and purposeful lives”.

Again we read that “Personal recovery can occur in the context of continuing symptoms or disabilities”.  The authors even distinguished their type of “recovery” from that which was “the focus of evidence-based practice and treatment”!   In other words, the Recovery Approach is not necessarily concerned with whether people recover, but with whether they feel more positive.   To be fair, the Recovery Approach wasn’t invented by scheming clerics as a means to sneak religion into hospitals.  It originated in the States as a means of treating substance abuse, and can be mostly or entirely secular in its application.

If patient’s condition can’t be cured, it’s perfectly reasonable to enable patients to identify and achieve realistic and rewarding life goals within their condition, although “Condition Management” would be a more honest label that “Recovery Approach”.   One problem with the Recovery Approach is its slide away from professional objective standards towards subjective self-definition – a problem that can only be compounded if the NHS facilitates a role for religion.  In a 2004 survey of mental health professionals, 39% thought that religion could protect people from mental ill health – and a larger number, 45% felt that religion could lead to mental ill health.

The draft speaks of “[moving] our organisation from a bio-psycho-social model of care to a holistic model that recognises people with mental health problems as whole persons with interrelated psychological, social, physical and spiritual needs” (p.6).  This sounds awfully like moving from a scientific model that works to religious mumbo-jumbo that doesn’t.  And, sure enough, page 1 of the final draft openly acknowledges that spirituality is about “going beyond the scientifically verifiable, and entering the realm of belief or faith” (p.1).  In other words, it’s about believing in things for which there is no good evidence.  So much for the Trust’s empty promise to apply “the same rigour as in other disciplines”!

The danger of a faith-based approach to the treatment of mental illnesses is encapsulated in the words of Friedrich Nietzsche:

A casual stroll through the lunatic asylum shows that faith does not prove anything.

The Trust stressed the need for hospital prayer rooms.  Given the horror stories we hear about patients left for ages in hospital corridors, I’m sure that the hospitals could put the space to better use.  And there’s also the cost – £4,159 in the case of the “sacred space” at Mill View Hospital.  Although a multi-faith prayer room sounds inclusive in principle, it can lead to conflicts, as evidenced by headlines such as “No legal action will be taken against a hospital porter quizzed by police after a row over a crucifix being covered up in a prayer room”.

If prayer actually worked, of course, religious people would be out of hospital in a jiffy.  Is this what the Trust actually observes?  Terms such as “prayer room” or “sacred space” employ religious terminology.  If we are to have such rooms at all, a more inclusive secular label would be “Quiet Room”. Different patients in a hospital have mutually incompatible spiritual beliefs.  Either a chaplain will be required to minister to those whose spiritual beliefs conflict with his own (in which case my earlier tongue-in-cheek remark about dispensing “dummy religious advice” might not be far off the mark after all!), or the make-up of the chaplaincy must reflect the make-up of the local community.  Hospital chaplaincies, it seems, are a muddled mixture of both.

Consider the job description to which I earlier referred.  It states that the chaplain will be sincerely committed to a particular faith community – indeed, ideally they will be an ordained member: 13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB: The Chaplain will have a live faith commitment and spiritual practice and be in good standing with her/his faith community.  Ordination is an advantage. But the chaplain must also fit the following criterion: 6. KEY RESULT AREAS – GENERAL: To be open to accept people as they are, and work with their theological and philosophical understandings of life, especially when hers/his differ from theirs. So they must passionately hold one belief, and be especially open to people who hold beliefs that contradict it?

So (for example) a Christian chaplain who sincerely believes than an unbeliever will be eternally damned should not intervene in order to try and save that patient’s soul?  I don’t doubt the kindness of many hospital chaplains, but with the best will in the world you could not regard their profession as being intellectually honest.  Can we respect such dishonesty in a chaplain?   Can a state respect the mentally ill by funding chaplains that lie to them?  The website of the Multi-Faith Group for Healthcare Chaplaincy states:

Modern chaplaincy works ecumenically and is inter-faith orientated, its prevailing culture and philosophy is predominantly humanistic.

The Oxford English Dictionary defines “ecumenical” as  “Belonging to or representing the whole (Christian) world”.  Although humanism can mean “pertaining to human interests”, most humanists use it in the sense of the following Oxford English Dictionary definition:

Any system of thought or action which is concerned with merely human interests (as distinguished from divine).

So there we have it.  A chaplain’s work belongs to the whole Christian world, yet is supposedly inter-faith orientated and distinguishes itself from divine interests!  A more absurd job description is difficult to imagine. If, by “hospital chaplain”, you simply mean “Someone in hospitals who goes around being nice to people of all religions and none, lending a sympathetic ear”, I have no objection to such people.  They’re called nurses.  They are in short supply, play a professional role far beyond mere bedside manner, and would doubtless be of more benefit to patients than chaplains.

The Trust’s strategy begins with a definition of the word “spiritual” that is broad enough to apply to just about everyone, including those who have no religion.   Perhaps tellingly though, by the time the actual number of chaplains gets discussed, the goalposts appear to have been moved, and people with no religious beliefs have been excluded: Chaplaincy staff should be fairly employed and represent the religious diversity of the local population (p.5).   The word “religious” must be replaced here, if the Trust is serious about being representative.  But what should it be replaced with?  The term “spiritual” is problematic, because it is so ill-defined.

As the draft itself acknowledges, spirituality “has no single, clear philosophy” (p.1).  Better, then, to omit worlds like “religious” or spiritual”, and simply seek to represent “the diversity of the local population”. Some of the draft’s definitions of the word “spiritual” are compatible with a scientific worldview.  “The essence of human beings as unique individuals” (p.1), for example, can be expressed in solely natural terms, as a person’s unique set of psychological traits.

But once again, the Trust moves the goalposts:  “[The Trust’s strategy] seeks to move our organisation from a bio-psycho-social model of care to a holistic model that recognises people with mental health problems as whole persons with interrelated psychological, social, physical and spiritual needs” (p.6).  Note that the term “spiritual” has now become something other than psychological.  A fundamental characteristic of the scientific method is methodological naturalism – only natural forces are used to explain things.  Once you take a scientific model (that is, physical, biological, psychological or social) and add a vague unscientific element like spirituality, the entire model becomes vague and unscientific.

It’s a bit like saying:

I took 347 mg of copper sulphate crystals, and dissolved them carefully in a large-ish container of green stuff which, well, looked a bit like Fairy Liquid.

It has been estimated that about 36% of people in the UK are humanist in their basic outlook, yet the Trust currently funds no Humanist chaplains whatsoever.  Presumably, 50% of hospital patients are women, some of whom will have gender-specific health concerns.   The needs of such women are unlikely to be met by most faith leaders, who are almost always men.  Again, how representative is the Trust in this area at present? The draft strategy states:  “The NHS has traditionally recognised 9 world faiths: Baha’i, Buddhism, Christianity, Hinduism, Islam, Jainism, Judaism, Sikhism and Zoroastrianism” (p1)

If the Trust is serious in its desire to be representative, it needs to consider the following:  According to the 2001 UK census, those of no religion are the second largest “belief group” (for want of a better phrase) – about three times as many as all the non-Christian religions put together.  Jedi Knights had 390,127 followers, and thus formed a larger group than several of the “major religions” [Sikhs (329, 358), Jews (259, 927); Buddhists (144,453)] or minor religions such as Jainism (15,132), Zoroastrianism (3,738) or the Baha’i faith (4,645).

As a representative of Brighton and Hove Humanist Society, I am keen to ensure that the make-up of local chaplains reflects the make-up of the local community.  According to the same census, Brighton and Hove has the lowest proportion of religious people in the country – although it does have the highest proportion of Jedi Knights.  “You will give the Jedi their fair share of hospital chaplains….”

The strategy notes that “This recognition and valuing of spirituality is not a licence for staff, service users or faith groups to impose their beliefs or practices on others.  Any individuals or groups using coercive or manipulative means of influencing others on Trust property will be constrained from so doing.  People experiencing mental illness can be at their most vulnerable.”

If telling a sick person they will be cured in an afterlife and re-united with their loved ones isn’t a manipulative way of influencing people, I don’t know what is!  If only such comforting ideas were well-supported by the evidence!  Then I’d be all in favour of teaching them!  As it is however, such beliefs are at best unsupported by the evidence, and at worst flatly contradicted by it, which is why I think it wrong for the state to legitimise such beliefs.  The strategy notes that  “Practices that have derived from religious traditions (eg Yoga, Reiki and spiritual healing) are valued by some service users and carers. If such practices are to be offered in our premises they will need to be subject to the same ethical scrutiny that we would expect of any new therapy”.

But religion falls at the very first ethical hurdle.  It’s wrong to offer people false hope, and most or all religions are false. The Trust’s aims of being “Positive about mental health”, and “Challenging stigma and discrimination” (p.3) are certainly shared by humanists.  The religious however, have traditionally stigmatised disabled people, regarding disability as punishment for the immorality committed in a former life, or a punishment from God.  The Old Testament states ““Who gave man his mouth?  Who makes him deaf or mute?  Who gives him sight or makes him blind?  Is it not I, the Lord?”  (Exodus 4:11).

The New Testament states that epilepsy and blindness are caused by demons.   This is not the kind of nonsense that the State should be legitimising in our hospitals.   Neither is the Roman Catholic stance that jabs for cervical cancer should only be permitted if girls aren’t told about artificial contraception.   As the draft strategy acknowledges, religions practiced in Sussex include the Jehovah’s Witnesses.  Jehovah’s Witnesses believe that yoga is the work of demons. Historically, they maintained (in the face of all scientific evidence) that:

Vaccination never prevented anything and never will, and is the most barbarous practice…   abolish the devilish practice of vaccinations.

When the Witnesses did change their stance, it was in response not to some new commandment from on high, or scientific evidence, but to the fear of being sued:

The matter of vaccination is one for the individual that has to face it to decide for himself…. And our Society cannot afford to be drawn into the affair legally or take the responsibility for the way the case turns out.

The Trust seeks to identify “Spiritual Champions” (members of staff who are more interested and “attuned” to spirituality than others).  Given the numerous doctrinal flip-flops that Jehovah’s Witnesses have undergone regarding which blood products are allowed and which aren’t, perhaps the Witnesses could benefit from the Champions to which the draft refers?   On reflection, given the Witnesses’ track record in medical matters, the Trust may not like to work with them.  And given that the Witnesses regard hospitals which perform blood transfusions as “bloodguilty organisations”, they many not fancy working with the Trust, either.

I recognise that religious beliefs are very important to a minority of people, and I have nothing against religious representatives coming into the hospital and ministering to such people – provided, that is, that they do not proselytise to anyone else.  What I am against, though, is the use of state money to subsidise any such ministry.

Atheists are constantly being told by religious people that a religious person’s faith inspires them to do good works.  Why, then, do they expect the State to pay them for ministering to sick members of their own flock?  Is it right to demand (for example) that Muslim and atheist taxpayers foot the bill for a chaplaincy that will doubtless contain a disproportionately high number of Christians? According to the website of the Diocese of London, there are 400 full time equivalent hospital chaplains in the UK.  And according to the Worcester Acute Health Care Trust, each chaplain costs £50,000 to maintain.  If those figures are accurate, chaplains cost the NHS some £20 million a year!

The number of deaths involving the bacterium Clostridium difficile in England and Wales rose by 28% between 2006 and 2007.  Rationalists are also realists, and realise that the hard-pressed NHS will never be perfect.  But they also know that the millions of pounds spent by the NHS on chaplains every year could and should be better spent.

I favoured a secular solution to the question of chaplains.  Don’t give us any money for humanist chaplains, and don’t give the religious people any money for religious chaplains either.  Perhaps as a result of this, Richard Harlow, the person who had first contacted me about the consultation, never contacted me again. I’ve now seen the final draft of the consultation.  It’s pretty similar to the earlier one, but now makes references to the need to provide “religious services” (p.5) in addition to religious prayer rooms.

The consultation states, “If recovery is about one thing, it is about the recovery of hope…” p.5. No it isn’t!  IT’S ABOUT ACTUALLY GETTING BETTER!  The consultation cites the words a satisfied patient (sorry, “Service user”) whose twisted logic sums up perfectly why spiritual healthcare is a recipe for disaster (p.3):

I now thank God for my illness as I am in a position to share my coping mechanisms with so many others.

WORKS CITED

Half-Time Post Of Community Mental Health Chaplain

Benson et al. (2006) Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal,  Vol. 151, Issue 4

Care Services Improvement Partnership, Royal College of Psychiatrists, Social care institute for excellence (2007), A Common Purpose: Recovery in future mental health services.(PDF)

Swinton, J. and S. Pattison, 2001, Come all ye faithful.  Health Service Journal, v. 111, p. 24-25.

Gerin Oil, by Richard Dawkins.  First published in Free Inquiry 24(1), p.9-11, 2004.

South Downs Health NHS Trust Charitable Funds Report For The Financial Year Ending 31st March, 2006 (PDF)

Crucifix row man’s relief  Manchester Evening News April 11 2008.

Multi-Faith Group for Healthcare Chaplaincy 

Ecumenical. The Oxford English Dictionary

Humanism.  The Oxford English Dictionary

17 million British Humanists

Communities and Local Government: Third Sector Strategy – Response from the British Humanist Association  (PDF).

Church drops its objections to girls’ cancer jabs – but at a cost

YOGA Just an Exercise or Something More? 

The Golden Age [Jehovah’s Witness periodical], 1921 October 12, Page 17.  The Watchtower, 1952, Dec. 15, Page 764  Blood.The Watchtower, June 15, 1978, p. 25: “Avoid bloodguilt from (1) eating blood [blood transfusions], (2) sharing in bloodguilty organizations…” 

New Religious Movements

Hospital Chaplains

Unholy row as chaplains get the boot

C. Diff. deaths ‘continue to rise’