Tuesday, October 27, 2009

A Time for Dithering

Perhaps the Philosopher, author of Ecclesiastes, would add a new dyad to the verses in chapter 3. He begins with the powerful observation: “Everything that happens in this world happens at the time God chooses.” What follows are the words familiar to many. Then, I suggest the addition of this verse:
“He sets the time for dithering and the time for impetuosity.”

Former Vice President Cheney, and his supporters, accuse President Obama of “dithering” relative to a decision regarding the depth of our involvement in Afghanistan. “Send more troops” appears to be their desire! While entitled to their opinion, I am very pleased that President Obama is taking time about putting any more of our men and women in harm’s way.

Regardless of the choice made, “dither” is hardly an appropriate word! The dictionary offers these definitions:
Ø As a noun “dither” means an excited state of agitation!
Ø As a verb “dither” means to be nervously irresolute re: acting or doing!

The media reports suggest President Obama is being very resolute in his approach: talking with military advisors in the Pentagon, with Secretary of State, with elected members of Congress, and others who are knowledgeable about the issues in Afghanistan. There are no reports of his being “agitated”.

On the other hand, it might be an appropriate word for Mr. Cheney et al!

Tuesday, October 13, 2009

In Praise Of Doubt

Women and men in many significantly different denominations struggle to balance the “ancient Wisdom” passed down through generations and the “modern scientific knowledge” that is so much a part of our age.
* Intelligent Design or Evolution?
* Is homosexuality a sin or is it a sexual identity with its genesis in many aspects of life?
* Abortion – choice or killing?
* Living in harmony with neighbors of other faiths or still sending missionaries?

The list could go on – and, it seems, the challenge inherent in the struggle gets harder. Friends who were present at the most recent E.L.C.A. Assembly report they felt almost torn apart as they listened to the discussions. Whether or not the speakers was at a Red microphone or a Green microphone, my friends sensed that these were people of integrity, but for whom there was no resolution.

One friend in particular went home angry at the dilemma he felt. This is a devout person, well read, and active in the local parish. He is aware that our awareness of and about homosexuality in the 21st century is light years different from the time of Leviticus or the time of Paul. He is also aware of the important role of the Bible in our lives as Christians.

He resents having to choose between Relativism or Absolutism. He believes [and, I think he is correct] that such a choice results in personal and communal loss regardless of the decision!

Peter L. Berger [sociologist at Boston U.] and Anton C. Zijderveld [sociologist & philosopher at Erasmus University] have written a book which could be helpful to those bothered by such a stark choice. The title of their book is In Praise Of Doubt and the sub-title is “How to have convictions without becoming a fanatic”.

I strongly recommend the book. It is especially written with a concern for the religious and political challenges of this 21st century. They also have a concern that society needs a strong and vibrant religious and political life for survival.

Their descriptions of how “doubt” – not a “doubt” that keeps one from action because all is relative – reminded me of what Paul Tillich once wrote in a paper on Pastoral Care. Tillich believed that all pastoral care is directed towards acceptance of three important factors in life: mortality [we are all going to die], guilt [we can never pull off perfection] and doubt [our knowledge can only go so far and then faith has to step in].

The book is only 166 pages in length and it is published by HarperOne. It lists for $23.99 – but Amazon will get it to you cheaper.

Sunday, October 11, 2009

What are we so busy doing?

These thoughts are a follow up to the comment by Wendi Gordon (9/29/09) re: the comments titled “Where have all the clergy gone?” My thanks to Wendi Gordon for helping move this issue further along.
Ms Gordon adds another factor interfering with today’s clergy having time is this reality: “..most clergy today are consistently working at least 50 hours a week and simply don’t have the time to add another meeting….”
Her point about long hours appears to be true from my observations. Clergy do work many hours a week and, often, at times that significantly interfere with their obligations to families and selves!
However, it seems that has always been the case. Surveys from the 1960s and 1970s indicate clergy were putting in greater than 60 hours a week – and these figures were often cited as de facto evidence of their dedication to ministry.
That raises the question – What are we so busy doing?
That question reminded me of an article, I believe it was by Robert Leslie that addressed the mental health of clergy. [It was included in Wayne Oates’ book on The Minister’s Own Mental Health.] Leslie identified five roles that clergy must perform: Pastor, Priest, Counselor, Educator and Administrator. A survey of clergy asked for ranking by 3 questions:
Which roles are most important?
Which roles are most enjoyable for you?
How do these roles occupy your time?
The answers to the first: Pastor, Educator, Priest, Counselor, Administrator.
The answers to the second: Pastor, Counselor, Educator, Priest, Administrator.
The answers to the third: Administrator, Priest, Educator, Counselor, Pastor.
Is it any different in 2009?
What really drives our “busyness”. [An old joke tells of a young priest who, one day, sees Jesus at the window. He wants to know what to do and searches for help. His calls are passed along up the line: Monsignor, Bishop, Cardinal and then the Pope. The Pope answers – “Look busy.”]
Are we reading our members correctly as to how our time is prioritized?
And, if the answers to question # 3 are still so completely different than # 1 and # 2, might this be some clue as to the cause of so much depression amongst the clergy?
I look forward to your reactions.

Thursday, October 8, 2009


This could be an important lesson in these weeks following the 2009 E.L.C.A. Assembly. The young man’s questions – and Jesus’ answer – are strong reminders of the concerns at the beginnings of Christianity.
Being a follower of Jesus involved doing and not intellectual assent!
In this 21st century there are almost countless concerns at which our energies ought to be addressed.
Hunger is a national concern.
Many who are sick are unable to afford care, thereby suffering a higher rate of death.
Violence in our streets is killing our children.
Folks continue to lose homes as mortgages are foreclosed.

“How hard it will be for those who have wealth to enter the kingdom of God.” [Mark 10:23]

Jesus did not say “How hard it will be for those who don’t believe correctly to enter the kingdom of God.”

Maybe we might all take time these next 6-10 months to:
Take deep breaths – often!
Identify the poor in our areas – and make a commitment to serve them!

Just a thought.

Friday, October 2, 2009

Random Thoughts re: Health Care Reform - 1

As one who began working in hospitals 61 years ago, the current national debate about “health care re-form” greatly interests me. Indeed, the public debate often replicates the inner debate which has engaged me for years. Those of us who have spent years involved in the care of the sick have long recognized that there were/are problems.
Certainly the lack of insurance has been, and remains, an issue.
Certainly the amount of reimbursement for services, as well as its tardiness, is an issue.
Certainly the many agents that come between patient and physician – be that agent an insurer or a government bureaucrat, is an increasing issue.
Certainly the vast disparities of qualities of care across our nation are an embarrassment.
Certainly . . . . well, you can insert your own list of problems.

One activity of my own inner debate would involve lengthy periods of time wrestling with the question:
If given unlimited power and money, what would I do to “fix” the system?
The time spent in that wrestling, over decades, has increased my understanding of (and sympathy for) those leaders who have, seemingly, been unable to develop their own fix! “Power” [such legislation, licensing, etc.] and “financing” will not solve our many problems involved in the care of the sick. Indeed, one is even able to make a strong argument that they are among the causes of the problems.

However, the over six decades of involvement with the care of the sick plus the hundreds of hours spent in internal debate on ways to improve such care have given me ideas which often seem not to receive sufficient consideration. Those ideas will be the focus of this presentation [and, subsequent ones].

A. What’s in a name?

Whenever I was involved in purchasing a house in which to live my realtors almost always gave the same advice – “Location, location, location!” Everything else desired to make the home a more desirable residence could be added or re-modeled. But – you could do nothing about ‘location’.

A similar mantra ought to be attached to attempts at “health care reform” – Diagnosis, diagnosis, diagnosis! Unless we properly diagnose the problem, no “cures” will work.

The first concern for diagnosis in this process we have labeled “health care reform” is that very name!

Up until the 1960s our major institutions for the care of the sick were known as hospitals. They were places of refuge to which the sick and infirm could retreat. They were places of hospitality, in which the sick could feel secure as s/he sought healing and restoration. They were places that had either been started by religious groups or by community governments in recognition of the moral imperative to care “for even the least among us”.

Gradually throughout the 1960s and into the 1970s these institutions began shifting away from being “hospitals” to be Medical Centers. Certainly there were reasons for such a shift. Services other than caring for the sick were initiated! Many of these represented different “costing centers”. And, quite frankly, “Medical Center” sounded more prestigious than “Hospital”.

Then, in the late 1970s and 1980s another shift in name occurred. “Medical Centers” became “Health Centers”. Proponents of a “wholistic” approach to the care of the sick [or is it “holistic”] often felt constrained by words such as “hospital” or “medical center”. But Health Center – now there is a theme around which we can all rally!

Ahh, but wait a moment stated many of those who cared for the sick! We take care of the “sick” – and there are years of experience that help define shat “sick” means. What, though, do you mean by “health”? The nurses and doctors and therapists and technicians are trained in caring for the sick – trained, licensed; accredited and experienced.

But there is almost no universal agreement on the definition for “health”! None. Nada.
One issue has to do with our understanding of what disease means.
- Is disease the result of forces external to the self? Bugs, Germs, Physical traumas.
- Is disease the response of the self to those external forces?
Another issue would involve problems of social or behavioral concerns:
- Are wrinkles in one’s skin a “health” issue?
- Are smaller breast sizes or erectile dysfunction “health” issues?
- Are arguments between spouses a “health” issue?
- Is depression a “health” issue or a natural response to loss?
Also, we have the issue of death!
- Is death the antithesis to health and to be fought at all cost?
- Is death the ultimate in the process of homeostasis – the “final” solution?
- Is the “naturalness” of death to be determined by age? I.Q.? Social status? Wealth?
- Is the “naturalness” of death to be determined by theologies? Is anything less than all-out treatment an abomination before God? Or, as an act of love for others should death be welcomed – even sought?

There are studies which suggest the need for adequate diagnosis also exists in treatment approaches. The reliance on technologies has greatly hampered the process of diagnosis because it almost solely only looks at externals. Decades ago the act of diagnosis involved anamnesis – “out of the memory”. Patients were asked to tell/narrate the story of their sickness – and, almost always, that story revealed important criteria for treatment:
- Placement of a cardiac stent was complemented with help with stress, diet, etc.
- High blood pressure also involved styles of living.
- Obesity was not just a consequence of food additives.
- Etc.

And, because my involvement in the care of the sick was as a response to my vocation, what of the religious factors in the care of the sick?
Factors that can be positive assets for health as well as factors that can mitigate against health?
Are there any “meanings” for sickness? [How often do religious folk exclaim that such and such is God’s will?]
Is the role of the religious institution limited to times when medicine cannot treat and/or death occurs?
How do the religious institutions foster “healthier” [or, less dangerous] activities?

This is enough for the first installment. Hopefully the 2nd will come shortly.

Thursday, October 1, 2009

Random Thoughts re: Health Care Reform - 2

In my childhood none of our friends – or my own family – had “health insurance”. Since those were the 1930s and 1940s there was no “shame” associated with being “uninsured”. The uninsured were the majority!

Being “uninsured” did not mean, however, we had no care for when we got sick:
I broke both arms three times by the time I graduated from high school. Five [5] of those were diagnosed and treated in our living room without any diagnostic x-ray.
My father experienced a myocardial infarct [heart attack!] and was treated and recuperated at home! The doctor made routine visits and dad “rested”. It must have worked as he lived 18 full and productive years afterwards.
My sister was treated for bronchial asthma – all via home visits.

Were we wealthy? No. My father was laid off twice during the depression – and never had any “health insurance” until he was past 55 years of age! The same was true for most, if not all, of our friends. There was this expectation that life occasionally confronted you with illnesses or accidents – and treatments were usually paid from ordinary income. That was possible because:
Most families had a broad spectrum of home remedies. We put Vicks Ó on our chests; drank a milk-vanilla-sugar mixture with up-set stomachs; wrapped sprains; etc.
Physicians made house calls.
Physician fees were usually less than $5.00 per visit.

Gradually, however, more and more citizens obtained “health insurance”. While there were many reasons for providing such coverage, the major factors were as ways for industry to grow wages during WW II when wages were frozen and later when they sought tax-free ways of increasing remuneration. This new “benefit” was not a response to the dictum in Matthew to care for the sick!

However – little effort was directed towards understanding what “health” means. “Home” and “Auto” insurance policies operated quite differently as they became directed towards the “unexpected” and/or the “catastrophic”. One did not ‘expect” the ‘Home” insurance policy to cover a periodic paid job because the old paint peeled or one’s spouse wanted the house to look differently. Nor, did one expect the “Auto” insurance policy to cover a lube or oil change – even though such would add to the ‘well-being’ of the auto.

Society has taken different approaches with their “Health” insurance policies. There was a gradual reliance upon them to finance such treatments and care that are, in any society, part of what is the norm! Instead, since we did not define “health” – then there is too often the assumption that “health” is the absence of disease. And, even more of a problem, “disease” too often comes to mean anything that causes a person to experience “dis-ease”!

It is my belief that unless we focus time and energy towards redefining what it means to be “healthy” or just what is “sickness/disease”, no “Reform” was have a chance of resolving the problems. Such a new “focus” will not be easy. It will involve persons from every walk of life – care providers, educators, religious leaders, economists and politicians.

We must also seek ways to contain, or even lower, the costs of such care! Those ways will, in most circumstances, be complex. There are, however, ways to lower costs that are not complex [or are at least less].
Is the value of a super-specialist 4 or 5 times greater than a primary care physician?
Does society truly need all the free-standing care facilities? The multiple, and expensive, diagnostic machines?
If computers were to initiate a paper-less business atmosphere, can’t we increase that function to avoid the time-consuming redundancies when seeking care?
If death is truly a “natural” event, is it necessary to make it a “medical” concern? If a person opts to die in her/his own home, the process becomes very complex. It takes physician to pronounce one dead. It takes a coroner to make certain your death did not result from foul play.
Just some thoughts!

In the 3rd installment of these Random Thoughts, it will be my goal to explore how some of the resources of religion can also play a significant role in these efforts at Reform. Stay tuned!