Well, I finally finished Doing the Right Thing: An Approach to Moral Issues in Mental Health Treatment by John R. Peteet, M.D. I have a downloaded certificate recognizing this achievement, though I had to answer a lengthy evaluation of the “learning experience” before the print button kicked in. It was a little hard to elongate easy chair, bare feet, hazelnut coffee, green magic marker, and having a copy of the questions in my lap into the lengthy numerical information the company was seeking. As to the content, I did score 100% on the first shot, but as I say the questions were provided beforehand and the rules allow for two retakes before another payment is required, so this wasn’t exactly a tour de force of my brilliance. Between the course itself and the required book I estimate the cost at about $60.
The next course on the docket starting tomorrow is Borderline Personality Disorder. Trust me, you are encountering BP disordered individuals in your ministry—and worse, you may be working with one or for one—so that will be an interesting sojourn. But I do want to return to Dr. Peteet’s book today. It does not read like Gone With the Wind or even Listening to Prozac, the finest professional work on mental health I have come across in my lifetime. Listening to Prozac, nearly a quarter century old now, was actually a morality-based musing on the ethics of altering mood with psychotropic medication—specifically, continuing to prescribe antidepressants after depressive crises because the patient’s quality of life had improved remarkably. The author, Peter D. Kramer, M.D., essentially confronted his ambiguity of “playing God with peoples’ lives.”
Peteet’s work is more “text-book” style if you get my drift, but his terse and economic prose cuts to the chase. I was struck so often from his case studies by the fact that counselors and church ministers of every kind face parallel dilemmas of choice. Peteet’s work is directed toward the practitioner or counselor, but he cannot help but delve into the moral choices of the patients, too, and whether a therapist has the right to call out a patient for immoral conduct that produces stress. “Calling out” might be too strong a word, but I never felt a reluctance to address the issue. In my notes I would very often write, “the patient seems to have lost a north star for navigating decisions.”
To borrow from Peteet, the Church worker has to determine the propriety of integrating his or her values and moral philosophy into ministry itself. The most obvious point here is the assumption that a church worker has faith and values, or at least struggles to maintain them honestly. The option of doing and saying what you don’t really believe can be a significant mental stressor; it was the great psychologist Carl Rogers who coined the term “congruence” as a cornerstone of mental health, and needless to say for our purposes, the bottom line of spiritual integrity.
Beyond that, our present day Church lingo whitewashes this challenge in a number of ways. The simplest way is to deny that Athens (or the world) has anything important to say to Jerusalem (the Church), or that the social sciences have any meaningful contribution to make to the exercise of Church ministry. Such a belief is not consistent with Catholic scholarship and practice dating back to the great fathers Augustine and Thomas Aquinas, who in a variety of ways have maintained the maxim that “grace builds on nature, and nature builds on grace.” (If the Athens-Jerusalem estrangement is true, then why do we spend thousands of dollars on psychological evaluation of seminarians?)
Concurrent with the above paragraph is the erroneous sense that religion brings an entirely new world of reality. There is certainly truth to this, biblically speaking, but the people we serve live in this world and must navigate it daily. All of the answers to reality are not found in the Catechism, nor in the Bible. Neither text can tell us with accuracy how the world was formed—though both are eminently suited to teach why it was formed. It takes a certain seasoning in ministry to understand that there are limitations to propositional Church teaching, particularly in the areas of morality, and that raw imposition of a moral law without sensitivity to the existential life and conditions of the parishioner/student can be symptomatic of a minister’s pride (“I speak for God”), laziness in not exploring the complexity of moral discernment, overzealousness, or incompetence.)
Peteet sketches a number of moral dilemmas that face just about everyone in humanitarian positions. I recall in college that one of my professors put down an international charitable organization (possibly CARE, I just can’t quite recall) because the organization did business with black market and criminal suppliers in some very poor countries to get the maximum mileage out of every dollar of donations. In more recent settings, Peteet discusses the current healthcare delivery system in the United States and whether it is moral to tilt the board a bit to get third party payment approval for treatment. Just one example: insurance companies generally do not cover therapy for the personality disorders because there is no clinical evidence that “talking therapy” does much good. (This is not universally accepted in the mental health community.) But if a borderline disordered patient is anxious, could a practitioner code the service as anxiety treatment? (Did I ever do such a thing? How dare you ask.)
Catholicism is rife with these gray situations; the issue of receiving divorced and remarried adults to the communion table has received a lot of recent news coverage. I am not advocating disobedience to Church law, but anyone who is entrusted to teach it or minister under its provisions must maintain a morality about this responsibility: determining an ultimate sense of the universal good, study of Church teaching, the contemporary scholarship about the law (case study), and courses of action most likely to assist troubled souls rediscover God. This is the challenge of a moral minister of the church; we are not commissioned as evangelizers and faith formation personnel to read off of paper.