Back to MPD home page 
TopAN APPLICATION OF PASTORAL THEOLOGY
Recently someone asked a very practical question about the way things are usually done at Catholic Churches. I told her that I would have to think about the particular issue she brought up, and I think that answering her question here, presuming her permission, would be a good idea. This could be a good way to describe the process that goes on for clergy in making pastoral decisions, and knowing more about that might help it be more understandable. Sometimes it can seem like the minister or priest is just acting on personal whim (which can happen) but there is usually a careful process of considering a wide range of issues.
The specific question had to do with the reception of Communion. If there is a switch and a child personality is up front who would find it hard to receive Communion in the usual way, what should happen?
First, has this already been worked out? If not exactly this situation, has something close to it already been worked out? Are there rules or guidelines that would especially be involved? Is this something that could also serve as a model for future situations?
Second, what general principles are involved?
Third, how important is the issue for the individual person right now, as well as when it comes up in the future? Is there a special spiritual benefit or risk involved?
Fourth, whose decision is it really? Will it be made by the person involved, after receiving advice, or is the clergy making the decision? Are both?
Fifth, is there additional info or advice needed in order to deal with the question fairly?
It is in working through those questions that pastoral responsibility is carried out. It’s a cop out to avoid hard questions. You may as well recognize that there are going to be times when you will offend other people. It goes with the job. At the same time, it’s possible to start acting as if what you are most comfortable with should be the "standard" for the rest of the world.
This example has to do with Catholic Communion, but the same general process could be involved for other things as well. It is part of a community of faith seeking to live and work together.
There must be respect for the Sacrament of the Eucharist, and procedures fostering that respect are treated seriously. Just as important, anything that unnecessarily "blocks" or hinders someone’s reception of Communion should be avoided. To avoid prejudice or discrimination, a principle that helps sort things out is "like situations should be handled in like ways."
In Catholic practice, reception of Communion is delayed until the person is old enough to understand our belief that Christ is present in the Eucharist, to have had enough experience of the active Christian community at worship, and to freely choose to receive Communion. Currently, the minimum age is considered to be 7 years old. There could be exceptions for a child with serious sickness, if everything else still appeared appropriate.
What if the personality present is younger than that? Or the personality present has had little chance to understand what we believe about the Eucharist? Or is unsure whether she believes it, or even really wants to receive Communion? Is it still appropriate to receive?
I broadened the question in my own mind, seeking to come to something that could also serve as a general model. What if there is a flashback going on, and there is confusion as to what is actually occurring? What if there is a panic attack, or physical symptoms, or something else that would cause an internal problem?
I looked for a "like situation" and this seems similar to the situation of those who are physically sick. I have worked out a model for those situations over time, even though it’s not "endorsed" officially.
If I have a patient with a medical problem, such as someone getting chemotherapy for Cancer, I will clearly state that they should not be going to church (or receiving Communion if they felt worse after they got there) if it would end up being dangerous to their health, an "endurance contest" or a struggle in resisting nausea. They shouldn’t be struggling through pain, taking unreasonable chances with their health, or in other ways allowing the situation to turn into something other than a positive worship experience.
It really is up to the person to determine when receiving would be inappropriate, and nothing should be done that would "single out" the person or make it more uncomfortable for them. If I know that it clearly doesn’t make sense I can get much firmer, and at times will directly refuse to give someone Communion. An example of that would be someone who is on their way to surgery or just had stomach surgery.
Some might say "Well, if the person really wants to receive, what’s the problem." There is still the issue of respect for the Eucharist, and also inappropriate reception can be spiritually dangerous for the person receiving. I recognized that dynamic most clearly when I had a patient with terminal Cancer, awake and alert, who desperately wanted to receive Communion even though her mouth was filled with sores from chemotherapy. We made it as smooth as possible, but it hurt the lady terribly. From that day on, whenever she thought of Christ, she associated her faith with pain.
Using that as a model, what I am suggesting as a general statement is: "If because of switching or some other dynamic related to the MPD, at a particular time there is not the understanding, enough of a sense of security, or sufficient mature faith to participate fully, it’s better to wait."
If someone approaches at Mass to receive Communion, there will be no questioning by me as to whether it is appropriate. The person has already made that evaluation.
The same model could also be used for many other religious issues, not just sacramental ones.
I also think that a special concern would be to do things in such a way that no one ends up being embarrassed or singled out. I would be extremely uncomfortable if a personality felt "forced" into acting against their belief or stumbling through without enough awareness of what was going on.
A more general issue is how much should things be changed because of the MPD. I think there should be a sensitive consideration of the issues, and everyone is different. I think that the model developed should be something that could be used by an MPD person even in situations where others don’t know about the MPD. The model should be something that you can use in any parish or religious service. It should be something that as much as possible should be under your control.
Part of this section is to try to show how things are actually thought about or worked out, and I hope it’s helped that a bit. A whole range of ideas are considered, and a lot get thrown out in the process as not helpful or appropriate. There are things that are "out of bounds" and there is a point where it would be hard to come up with something that would justify what is being asked. Using the example of a medical patient receiving a Sacrament, here are some requests I received that were clearly (and hopefully charitably) rejected:
Sometimes things get interesting.
When in doubt, clergy work out what seems to be the most prudent possible in the circumstances, erring on the side of saying "yes", and trusting that God understands we’re doing the best we can.
It shouldn’t happen, but what about the situation where other people might draw conclusions depending on whether or not you go to Communion. That’s a tough one, and the issue is really none of their business. I don’t like the idea of feeling pressured about whether or not to receive Communion.
I know that for many the issue of not lying is very important. In this circumstance, someone may be asking for info that they not only have no right to, but where they are violating boundaries even by asking. The most truthful response to someone who asks about why you aren’t receiving Communion would be: "The question you ask is a violation of my spiritual right to privacy, and asking is abusive and contrary to Church law and practice. I refuse to answer and suggest that your curiosity is way out of line."
That may be too blunt, especially if the person asking wasn’t really intending to be so invasive. Under those circumstances it may be kinder to sidestep the question with something like "Sometimes my stomach gets really queasy." Perhaps on some other occasion it could be mentioned that comments aren’t supposed to be made about someone receiving or not receiving Communion.
Part of this process, too, is a growing knowledge of how things work for you. I have no idea how much of a problem flashbacks, or switching, or confusion might be for you at Mass. There may be times when it would not be a good idea to even try to go through the door into a church. A particular personality may be 5 years old but have a well-developed sense of the presence of Christ in the Eucharist, be able to receive appropriately and smoothly, and simply not have a problem. Assessing honestly, based on your knowledge of what goes on for you, is perhaps a part of "religious empowerment."
© Fr J Mahoney