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In a few weeks I hope to be back counseling part-time for a small rural health clinic operated by my diocese’s Catholic Charities. The prospect of returning to the field has added some fire to my efforts to complete my own Continuing Education credits for the State of Florida to keep my own medical license current. Now as it is about 75% cheaper to take the courses on-line, I have been doing that since returning from vacation, sitting down every mid-afternoon with the required texts and answering the questions for course completion.
Given that all of the mental health codes were changed the day I closed my practice (good timing or what) I need to at least have a passing knowledge of the new numeral-alphabetic diagnostic coding as I return to fill out charts again. So I registered for a coding course that, not surprisingly, came with a textbook—or more accurately, I had to buy the book separately from Amazon. So I started this week when the book arrived, and I noticed that some of the sentences had no verbs. This is always troubling. Then, when I went to answer the questions from the first chapter, I discovered that two of the multiple choice questions contained no correct answers, which was equally troubling. So I checked the Amazon reviewers’ section of the book’s website, and I read a complaint from another reader whose book had no index of contents. The author wrote on-line to tell her that future copies of the book would have indexes, and that he was sending her one to replace her first purchase. My book does have an index of contents, but it became fairly clear to me that the book itself, and the test provided by the author presumably, were “rush jobs,” hurried to print without vetting. There are plenty of people to blame, actually—the author, the publisher, and the continuing ed company that sold me the course in the first place. But the person who is most responsible for this predicament is me. I did not take time to assess the educational company before entering a year’s contract with it. My primary interest was economy, and my common sense should have warned me that a $60 annual fee for unlimited courses was not buying my way into Harvard Medical School. So…I should have followed the frequent advice offered here on Wednesdays. In the world of Catholic education—particularly on-line but not limited to it—there is a lot of junk, too. Sorting out the wheat from the chaff is time consuming and difficult. Hopefully you have people in your chancery who undertake such work, but even the USCCB cannot keep up with the barrage of homespun, inept, or ideologically skewed educational courses put forward for laymen and catechists. Your time, like mine, is precious. An ounce of prevention (and a few more dollars) are worth a pound of retooling.
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Every now and then I am asked if I would return to the active ministry of the priesthood if the Western Roman Church changed its position and permitted a married clergy. The assumption of the questioner is that, like Tim Tebow, I am jumping up and down on the sidelines waiting to get back into the football huddle [although Tim, I understand, is now attempting to play major league baseball.] In fact, I emphatically state here and now that I would not. The mental and spiritual tranquility of the past two decades seems to verify a belief I arrived at some years ago, that I am better suited as a mediocre layman than a depressed priest.
However, I love the priesthood and the religious life very much. The struggles of my Franciscan Order to maintain its fruitful ministries in the face of aging, declining numbers, and rising costs are also my pain. The friendships, the education, and the idealism of the friars in my early years in particular were a gift that no man deserves, and this appreciation only grows with the passing years. I wish I could help the friars more [and truthfully, I wish they would ask more.] I worked here in Orlando for most of my priestly years, so most of the priests I knew and still know are associated with this Diocese. While many are retired, a good number are active pastors and administrators, and as an active member of my parish and diocese, I can observe the pastoral battles in the trenches up close. The terrain of the battle ground is certainly different from 1993, my last year, and there is no doubt in my mind that the work of a pastor is harder today than it was back then, one reason being the explosion of instant social media. Today’s pastor catches hell from above and below—an environment in which I could never work with any measure of spiritual tranquility. I follow the political news like most of you, and while the Café does not offer political commentary—God knows you can find that anywhere—it is impossible to deny that priests and catechists, for the next three months at least, will have to do their work among parishioners of many and varied political stripes. To deny that election year politics will creep—or bulldoze—into parochial life seems to me overly optimistic. It is well known by now that non-profits like parishes cannot endorse candidates without risk of losing tax exempt status, but churches are permitted to publish candidates’ positions on issues of social justice derived from Catholic teaching. The United States Conference of Catholic Bishops, in fact, provides at its website an educational service for Catholic voters, and I copied the bishops’ present-day list of social priorities here: The ongoing destruction of a million innocent human lives each year by abortion • Physician-assisted suicide • The redefinition of marriage • The excessive consumption of material goods and the destruction of natural resources, harming the environment as well as the poor • Deadly attacks on Christians and other religious minorities throughout the world • Efforts to narrow the definition and exercise of religious freedom • Economic policies that fail to prioritize the needs of poor people, at home and abroad • A broken immigration system and a worldwide refugee crisis • Wars, terror, and violence that threaten every aspect of human life and dignity. The reader is left to decipher whether this list is arranged in order of (1) moral gravity; (2) issues most likely to be affected by the outcome of a federal election; (3) priorities of the USCCB; (4) episcopal orders of priority for parishes and their educator/catechists at the local level. In my experience, any parishioner or organization in my parish can (or in my case, could) attack me for my “indifference” as a pastoral leader to any issue on this list, and such criticisms come from all sides of the political spectrum, left, right, and green. With the internet tools available today, it is possible to vilify parishes, priests, and parish ministers as well as divide a parish community electronically over clashes in political/pastoral priorities. “Back in my day” all I had to worry about were the occasional irate parishioner, anonymous hate mail, and typical over-the-fence gossip. Going back to the bishops’ list, it is noteworthy that everything mentioned is complex. Moreover, there is continuing debate among Catholic bishops and professional theologians about the actual meaning and moral status of issues cited here (“ordinary” versus “extraordinary” means of preserving life, for example.) Were I a pastor today—heaven help that congregation—I would promulgate the USCCB letter with the following advice from the pulpit: [Clearing my throat.] “The election guide for Catholic voters provided by our American bishops highlights many of the important moral issues facing our nation, and we as a community of faith with a tradition of moral discernment have significant contributions to make to the welfare of our nation. All of them listed here are matters of serious discussion and reflection. Even where the way is clear, as in elective abortion, we do not fully understand the motivations of those who seek or those who defend the practice, and this is a critical first step before making public arguments for our tradition here. In many of the other moral issues cited here, such as the evils of warfare, the terrain is so vast that faithful Catholics themselves may disagree over the means to achieve peace, human rights, health care, and worthy employment. The Church’s teaching on the rights of all peoples to dignified living and freedom of conscience is what we are bound to believe; with unity in our hearts on this basic principle, we are better able to address strategies, mindful that the struggle with sin and evil is a cross we bear until the coming of the New Jerusalem. With our enormous task ahead of us, it is important to recognize that the embodiment of the New Jerusalem will never be contained in the platforms and policies of the handful of candidates for the presidency and other major federal offices. The very freedom of conscience we advocate for others most certainly applies to the Catholic in the voting booth; the moral imperative to vote is serious, and thoughtful reflection upon one’s choices is necessary, allowing for the imperfections of any office seeker. The history of American politics teaches that our election cycles often generate more heat than light. Matters such as those put forth by our bishops are too serious for the quick and frenetic debate of modern presidential elections, and in truth few issues even reach public recognition. Thus it is important that during the remainder of 2016 we begin to educate ourselves on our rich Catholic moral traditions for the elections of 2018, 2020, and beyond. I pledge a new intensity of our faith formation programs here in the parish on the social justice teachings of our Church, specifically for adults, as we are the ones who vote. I encourage personal study and reflection; Catholics are the best educated segment of the American population, and our reading shelves, Kindles and discussion groups should reflect the best of Catholic academia as well as the wise secular observers and analysts of the world condition. For it is the latter group we must engage. Finally, I am mindful of the late Congressman Thomas “Tip” O’Neill, who famously observed that “all politics is local.” It is true that charity begins at home. It is also true that social justice begins in the thousands of city and county elections, not to mention school boards, retention of judges, state and local amendments, and local budgets. These referendums demand our attention as moral and civic duties.” One thing is still true. I still can’t give a short sermon. In all matters involving health and legal issues in ministry, the civil laws of your state and the policies of your working diocese take priority in any crisis or controversy. Know the law.
Last Wednesday on this stream I alluded to a particular personality disorder in which the risk of suicide is considerably high. I do not want to leave the impression that risk of suicide is limited to some particular disorder or population, but it remains a distinct possibility across the board in all populations. If you are a church minister for some years, you will come in contact with the trauma and tragedy of suicide. Most times this will involve the survivors, but on occasion you may be confronted with an individual in your family or your ministry who freely speaks of the desire to die, or more specifically, elaborates a plan to do so. It is my personal opinion that we will never reach a point where we can “save everyone” from suicidal attempts, any more than we will successfully identify every potential killer or mass annihilator. In the present debate over guns and mass murders, the argument for greater mental health intervention and screening, while certainly defendable on paper, places too much credit upon the mental health community to identify high risk individuals and what their future behaviors might be. This is not to say that years of collective practice by health care personnel have not yielded an algorithm of likely clues of suicidal thinking or intent; but rather, the two major problems remain that likelihood is not the same as certainty, and the practitioner, and certainly the non-professional, generally does not have access to an individual’s history, previous attempts, current medications, etc. The questions on all of our minds, of course, is what should I do in the presence of suicidal suspicion, and equally importantly, what does civil law require me to do in possession of such information? This is very complicated on a lot of levels. Civil responsibilities of church workers are a complex issue of law, as we have seen in such matters as child abuse over the past twenty years or so. The issue of suicidal potential receives less attention, though it is my impression that societal concern about suicide is spiking, particularly when it involves family annihilation or harm to others. Twice in recent times professional airline pilots have committed suicide by taking down loaded commercial planes. In my experience in church work I have heard some priests (outside of confession) and particularly lay youth ministers make the rather grandiose claim that “you can say anything,” the clear implication being that the lay minister enjoys some sort of airtight confidential status by virtue of working for the church, or that any information revealed in church ministry stays in the group, so to speak. Let’s carry that out to its logical conclusion. A parish conducts a weekend overnight retreat, and a group of teens and a church leader sit around a camp fire and talk. In the seemingly safe environment of the setting, one of the minors admits to the group that he or she has thought about killing themselves, has in fact made some previous attempts, and adds that he or she had come on retreat with the plan of killing themselves during the event, except that a beautiful song played that afternoon had caused a change of heart. My guess is that regular readers of the Café have already sniffed out the acute danger. If a teenager has planned to take his own life on a retreat, then the odds are that he has also brought the means to do so—likely a weapon or a large quantity of illicitly obtained medication. There is a lot of research done on “psychiatrists’ fantasies,” and the leading fantasy is that the provider can cure the patient, period. My guess is that this is a powerful ministerial fantasy, too, particularly as the “treatments” invoked in church life are spiritual or infallible, thus granting infallible status to the minister. An inexperienced or hubris-bound minister who is leading the group described above may jump to his feet and lead the group in a rousing chorus of “Now Thank We All Our God,” proud that his group facilitation and compassionate listening has saved another soul on the brink. As the colorful ESPN college football guru Lee Corso would say, “Not so fast, my friend.” The unfortunate young suicidal person at the campfire is unglued and at serious risk despite appearances. The proper response is to keep the individual in one’s presence until the parents can be notified and the appropriate hospital/psychiatric facility is determined and safe transportation arranged for. Or, 9-1-1 can be called immediately if the individual becomes belligerent or hostile. There is a certain shock effect in making that kind of call, as if the caller is sending a friend to a Boris Karloff Bedlam Sanitarium, but the actual hospitalization experience is generally tame and restful, often less than 72-hours if involuntary. The patient, in the better facilities, gets diagnostic attention and a treatment plan for follow-up service is drawn up. What would happen if the intervention ended with the hymn by the campfire? We can’t say for sure. But the percentages are high that trouble may be lurking soon: the individual has previous attempts in his history, he has probably left previous treatment against advice, his mood is as fragile as a soap bubble, and he has actively planned the event with means and forethought. Reading the clues is a critical skill; it is not the same as diagnosis, which can only be undertaken legally by a health care professional, but rather it is more along the lines of first aid and getting help as soon as possible. Given that ministries and schools are ramping into gear for the fall, issues surrounding suicide and other mental health issues seem like an excellent area for continuing institutional education. Such training involves multiple components. The first is an introduction to the kinds of issues one is likely to face in ministry—depression, narcissism, suicidal tendency and legitimate threat, etc., as well as the appropriate and at times legally required intervention. This takes us into legal matters, where diocesan attorneys can explain precisely what must be done in crises, the chain of command, the limits to confidentiality, the sharing of medical information, etc. It is ironic that there is no stigma attached to a peanut allergy and schools go to great pains to protect students from exposure. By contrast, what about the student who returns from a hospitalization after a legitimate suicide attempt. Do his teachers need to know this? Matters of this sort would make for an interesting in-service day—or week. |
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