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TopCHAPLAINCY AND MPD
Fr J Mahoney
INTRODUCTION
Chaplaincy involvement as part of an MPD Team can occur in several different ways. A Chaplain may provide part of the usual MPD psychotherapy, act as a resource in understanding religious issues, or directly address the religious ideation of the patient. I would like to focus on this last aspect.
For those who have been abused as children, working toward the resolution of religious issues can be very important in the healing process. Careful and systematic attention to those issues can help even in ways that are not at first apparent.
Abusers frequently involve religious ideation in the abuse. First, they may claim a distorted religious justification for the abuse. ("Spare the rod and spoil the child.") Second, they may project a rationale for the abuse upon the victim. ("She deserves it because she is evil.") Third, they may use religious language to ensure secrecy. ("You must honor your father and mother. God will condemn you to Hell if you break that Commandment by talking.") All three may be reported by the same patient.
The religious understandings and stance used by an abuser may be a reflection of his own emotional illness or dysfunction, may also be espoused by a larger community, or may be simply a facade created for self-justification. It is also possible that the abuser’s stated religious views existed only to help control the child.
At times the views espoused by an abuser are bizarre and extreme distortions of the theology of a major denomination or Church. At times they are fairly accurate reflections of the extreme views of a sect or cult. They may even reflect the views of a group that directly espouses commitment to evil or the intentional abuse of children.
The survivor of abuse may have already engaged in a life-long struggle to come to grips with the religious ideation to which they were exposed. True resolution of the religious issues may be impossible without addressing the context of abuse in which they arose. An attempt to deal with the abuse in treatment without directly addressing the religious issues may retard the process or leave the patient to "figure it out on her own.."
There is a cultural pattern in many Western societies of seeking out clergy to help in dealing with questions of value and meaning. That quest for meaning would seem to be especially acute for those who have been abused. Often parish clergy are the first contact for someone seeking help for emotional problems and are often consulted by patients in treatment. If the patient seeks out pastoral help on her own, given the dynamics and complexity of MPD treatment, there is always the risk of sabotage or a splitting of therapy.
A Chaplain with a solid grounding in theology and pastoral care, with ecumenical sensitivity and practical experience, and with a good understanding of the dynamics of the Dissociative Disorders can be an important part of the Team working with these patients. Based on my experience to date, I would like to suggest a systematic methodology for addressing religious issues, describe an attitudinal approach that I have found helpful, and describe some techniques that have been especially effective.
METHODOLOGY
THE FIRST CONTACT
At the first contact with the patient, in addition to beginning to establish rapport, an explicit contract is made: "I will not lie to you for any reason at any time." That radical promise is the basis for all other contacts.
I will not make any statement, even based on trance logic in the midst of an abreaction, that I do not believe to be true. I will certainly never violate my own religious integrity by performing, for example, a "therapeutic exorcism." Any promise I make will be fulfilled. Any conflict between "being therapeutic" and truth-telling will be resolved in favor of the truth.
Dynamically, this helps the patient in dealing with the usual trust issues and encourages a "looking through other eyes" as a balance and challenge to her highly personalized inner world. Once a "track record" of truthfulness is established, the patient can more readily and effectively challenge cognitive misperceptions and distorted views of self-worth.
Clearly identifying my own areas of uncertainty about a wide range of issues, including some having nothing to do with treatment, aids the patient in calibrating their own proportionate levels of certainty. This eventually helps in facing the uncertain accuracy of memories without having to label each as either a truth or a lie.
At the first contact the issue of confidentiality is also addressed. The patient may request or presume higher levels of confidentiality from a Chaplain than would be expected by other Team members. It is the Chaplain’s responsibility to directly and clearly reach agreement on the issue with the patient. Will the Chaplain chart? How extensively? Who will have access? Under what circumstances can there be a granting of greater confidentiality or absolute secrecy? Clear understandings, once reached, may need to be written down or restated later for different personalities. In my opinion any true breach of confidentiality by a Chaplain is intolerable.
THE INITIAL RELIGIOUS ASSESSMENT
An initial determination is made about the patient’s past contact with organized religious groups and the source of her religious ideation and understandings.
If the patient was exposed to a bizarre distortion of the theology of a major denomination or religious group, my treatment plan will include helping her examine the beliefs of that group. The aim would be to identify the distortions of the abuser.
During treatment, as the patient presents the religious understandings to which she was exposed I will present the "main-line
theology of that Church. In effect she is learning to question and "cross-check" what she has been told. At times the issue being discussed may be very simple, at times theologically very difficult. When in doubt, I will consult with a representative of that group.
Ultimately the patient may make a clear choice to accept or reject that religious group. It is important that it be based on an understanding of what is actually taught and generally believed.
The patient may feel an impulse to convert or join the church of the Chaplain. That should be avoided until a clear choice can be made about accepting or rejecting the original Church. There should also be a clear absence of pressure or even the appearance of attempting to convert the patient.
If I assess the original Church to be a "cult," dedicated to evil, or an organized facade intended to cover the abuse of children or adults, that assessment is discussed with the patient. I would discourage direct involvement in the same way that I would discourage other self-abusive behavior.
DEVELOPMENT OF A PERSONAL THEOLOGY
Throughout the treatment process, there is an exploration with the patient of her own view of God, freely sharing my own view on a personal and experiential level. In direct opposition to the experience of childhood, the patient’s questions are valued and "it is now safe to ask them."
Questions are encouraged and celebrated, no matter how difficult or confrontational. Several key questions can be expected: "Where was God when the abuse was happening? Why was it allowed to go on? Why did God abandon me? Where is God now and how does he feel about me?" Sadly, as children, patients often went to religious figures or those who proudly affirmed their belief in God. They tried, carefully, hesitantly, and with shame to suggest or reveal the horror of their lives. They usually met with disbelief, with inaction, or with condemnation: "How could you say that about your father? God will condemn you for your lies." For adult survivors now, another brutally honest question would be: "Where were those who said that they believed in God?"
Part of the "methodology" involves a healthy, ongoing transference (especially acute when you are called "Father!") How God views the patient is reflected in how the Chaplain relates. Alters who are agnostic, atheist, witches, highly religious, demonic, protectors, etc., all become involved in aspects of the transference. Even in contacts in which nothing "religious" is directly discussed, the identity and role of a Chaplain is automatically a part of the contact. I believe that extra care must be taken, as an authority figure, to foster "empowerment" of the patient.
The Chaplain must know at least some details of the abuse for the patient to have the startling awareness that "He knows and hasn’t walked away. He didn’t even flinch." The patient frequently challenges the Chaplain’s commitment not to abuse her emotionally or sexually, and crushes by teen-aged alters can be expected. The sensitivity with which those dynamics are handled is very important.
The process of challenging and reinvestigating religious issues can be expected to continue throughout the treatment process. By remaining available, the Chaplain can help celebrate significant developments, offer interpretation of religious concepts or issues, and serve as a resource for specialized interventions. Interventions may include helping the patient develop memorial services for reported dead or sacrificed children or with permission helping home clergy to understand and to support the treatment process.
ATTITUDINAL APPROACH
"Though I pass through a gloomy valley, I fear no harm; beside me your rod and your staff are there, to hearten me." In working with the survivors of abuse there is enough gloom to last a lifetime, even second-hand. A Chaplain must decide with eyes open whether to take that walk, and "only volunteers need apply."
To be of help as the staff of God at times means being half a step ahead, gently inviting the patient forward. At other times it means lagging a bit behind, helping to consolidate the courageous step just taken. We are useless if we walk too far ahead or lag too far behind, and we must acknowledge that the patient sets the pace. Throughout, the Chaplain is a sign of hope who is able to "Stand in lightening, and watch the thunder, and believe in a rainbow."
The Chaplain’s own faith is challenged by the life experience of the patient. There are humbling challenges in seeing the traumas she has suffered, the innocence she has preserved, the spark of light that she has nurtured. Each patient invites a deepening of the integration of theology and experienced faith.
SPECIAL TECHNIQUES
In addition to the usual pastoral care approaches and skills, there are several techniques that have been found especially helpful.
First, the world that the patient knows best is often the internal world. Models and examples can be used from that structure. For example, to express my understanding of God, I might use admired characteristics of alternate personalities:
"God is much like Clara who sits in her rocking chair, holding a bloody cloth and grieving for the babies who have died. She cries buckets of tears. God’s sadness is so great that his tears would form a river, but I think the tears would be mingled with joy over what innocence the (inner) children were able to cherish in their hearts."
"God respects the freedom to choose that was given each human being, even when there is pain over what people have chosen to do with it. Inside, you know that Sandy is always willing to come out and fight for the rights of each one inside. Even if she hates a decision someone makes, she will use all the skill and intelligence of a lawyer to defend the right of choice. She is willing to face death rather than have self-respect and dignity stripped away. God also respects you, and because of his love holds on to you and will never walk away. God holds on even more tightly than when little 4-year old Susie holds my shirt and begs me to "Stay!" "
"I’ve been told that the Poet, Trish, feels every emotion and treasures them as jewels. You’ve often told me "You don’t understand" and I’ve said "I understand partly. Help me understand better." Well, God is much better at it than I am, and has an "understanding heart." God has touched every pain, every hope, every dream, even when they had to be hidden under the fear of death. It has had meaning when I said "I see you--all of you" even when all hadn’t even met each other. God even more fully knows you, and has always known you even when you were hiding in fear. This is the God I believe in, a God who loves, a God that the Poet calls "The Great Good God in Heaven who lives where only the purest of white doves fly."
Second, the insights of one patient can speak powerfully to another. When appropriate, without violating confidentiality, I may quote those insights:
"What did Lazarus do with the rest of his life?"
"Now I lay her down to sleep. I pray God too her soul will keep."
"Where is a child to turn when even the angels turn their backs and walk away?"
"I guess God has MPD too. There are three people and outsiders expect them to answer to the same name. One of them got a body of his own and even got a new name. He had a hard time. First he was a carpenter, then he got turned into a Jewish rabbi, then it seemed like they wanted him to go to West Point. Finally they got mad because he wouldn’t be what they wanted and they killed him. I guess one difference is that they never fight between one another and don’t seem to have gaps. A priest told me, though, that when God forgives he wipes the slate clean, so maybe God does have gaps when he wants to."
"A lot of the saints used to get what they called stigmata. We get "body memories" so are we sort of saints too?"
"There was a powerful king called Herod who wanted to kill the Child you worship, but Mary and Joseph ran away and hid him in a safe place. The Child inside is important to us and must also be protected within. Maybe the day will come when she can be allowed to wake up, but until then we will protect her and die before we will allow her to be touched by the Cold."
Third, it is often necessary to address the concept of "God the Father." This may be a difficult area for any abused child, especially in the case of incest. As humans, we concretize and to some extent do "make God into our image" as well as the other way around. I encourage the patient to form a picture of what a parent should be and apply that image to God as far as possible. "God the Father I Dreamed of Having" can then become a source of nurturing, support, and healing, and serve as a model for the patient’s own parenting.
Fourth, in any discussion of prayer or praying with the patient the focus is on the positive. Rather than focusing on the darkness, we welcome in the Light. Rather than praying against evil, we welcome in the love and warmth of God. Laughter is presented as a special gift of God.
Last, I have found it helpful to think in terms of the dynamics of reconciliation.
The concept of inner reconciliation can be an effective model. Theological language and concepts can be sensitively used to describe healing from self-alienation. The self-alienation was not a result of "personal sin" but the patient was a victim of a disaster. The sense of guilt and shame that the patient nonetheless feels separates both inwardly and from "those outside."
During treatment, the alter personalities are often "at war" with one another. Some are outcast, holding memories and impulses that others find intolerable. Some are persecutors, attacking after having lost sight of their original role as protectors. Some are "the coldly indifferent" turning from the pain within. The process of reconciliation in the truest sense involves naming "what happened" with direct honesty, coming close together again with "an understanding heart," renewing allegiance and hope, and then going forth to life in this world.
At times, the patient will hear comments that trivialize the abuse or ignore the complexity of the healing process, often expressed in religious language. From a stance of religious authority, it is helpful to label such comments for what they are: "bovine scatology."
CONCLUSION
Chaplaincy and pastoral care has much to offer in the treatment of patients with MPD or other Dissociative Disorders. I believe that the effectiveness of that involvement can be greatly increased by sharing clinical experience. There is also, I believe, a role of support to other professionals working with these patients and an obligation to work for community education about abuse. "Where are those who say that they believe in God?"
© Fr J Mahoney