A Theology of Pastoral Care: The Quadrinity
I am working through the process of extending the conceptualization of the “Trinity.” For me, the view of God as “three-in-one” is problematic. From a counseling perspective, the “triangle” is a metaphor for maladaptive behavior characteristic – indicating transactional imbalance – of a dysfunctional system. Theologically, this metaphor arguably limits a view of the divine by separating God from creation by overemphasizing God’s transcendence at the expense of God’s imminence. This is due to “high Christology” that strongly promotes the idea of Jesus Christ as God using the metaphor of “logos” or “Word of God” as symbolic of Jesus Christ by apologists (John 1:1-4). This belief culminates in a view of a transcendent and judgmental God who “wills” calamity, ranging from sickness to motor vehicle collisions; as such, patients – when confronted with theodicy – often express the existential question of “why me?”
A more Jungian perspective, emphasizing opposites in “tension” to each other, may provide a more viable approach; the tension results from the balancing of transcendence – associated with “endlessness” – with immanence – associated with embodiment. A “Quadrinity” comprising two pairs of opposites is proposed: God (endlessness) operates in tension with Jesus (embodiment); whereas God equivocates to the Mysterium Tremendum, in Christ, all the fullness of the Deity lives in bodily form (Colossians 2:9). Likewise, the Holy Spirit (endlessness) operates in tension with creation (embodiment). The metaphor used biblically to explain the Holy Spirit is the wind; “when the day of Pentecost came, they were all together in one place. Suddenly a sound like the blowing of a violent wind came from heaven and filled the whole house where they were sitting” (Acts 2:1-2). Attempting to chase, grasp, or control the wind is a biblical metaphor used to connote futility and is considered a meaningless activity (see Ecclesiastes). Ruah – the Hebrew word for breath or spirit – creates the embodiment tension; God breathes life into humanity (Gen 2:7) as well as enabling the followers of Jesus to spread the kingdom of God (Acts 2:3-4). The Holy Spirit’s impact on the apostles and their followers was significant, allowing them to share all their possessions with those in need (Acts 2:42-47). As such, creation is revelation; the presence of the divine within nature is essential to the perception of “reality” to Jewish mystics (e.g., Kabbalah) as well as some process theologians (e.g., John Cobb). This theology is panentheistic; the divine is found within creation, yet the magnificence of the divine is greater than the creation itself.
Although impossible to operationally define “endlessness,” embodiment – the divine captured in organic form – provides a commonality of experiences useful in guiding pastoral care. Using Jesus’ journey toward transformation – a life anew – to assess patient spirituality, I propose a paradigm consisting of the three salient metaphors needed for transformation: suffering, death, and resurrection. Patient suffering frames the context for pastoral care; a health crisis creates disequilibrium in the lives of patients. No longer do familiar anecdotes, practices, and beliefs work as viable problem-solving strategies; as such, what was adaptive now becomes maladaptive. Patients must be “broken” – physiologically, psychologically, sociologically, or spiritually – to seek pastoral conversation and presence from chaplains. Creation evolves in a similar fashion; forms of creation – including humanity – change based on adaptation to contextual requirements. Suffering equivocates to needs not being met; to thrive, forms of creation must evolve by dynamically modifying to meet ever-changing contextual requirements. For chaplains, the suffering experiences of Jesus Christ – the prototypical embodiment – yields helpful metaphors denoting the varied expressions of patient suffering. Praying at the Garden of Gethsemane, Jesus voices “sorrow” at his upcoming fate (Mark 14:34), conveys “fear”, begging God to “take this cup from me” (Mark 14:36), and expresses “impatience” at his disciples inability to be present with him while he prayed (Matthew 26:40-41). During his crucifixion, Jesus cries out his feelings of “abandonment” by God (Matthew 27:46). As such, Jesus’ verbal and nonverbal expressions of “sorrow,” “fear,” “impatience,” and “abandonment” typify common patient emotions associated with suffering. Suffering, then, provides a metaphorical entry or beginning point for transformation.
In the context of a humanity limited by death, Jesus’ crucifixion provides an entry point for examining restrictive and / or toxic roles held by patients in times of crisis and disequilibrium. Contributing to disequilibrium, medical crises often occur by “chance” and are not anticipated by patients. In an evolutionary sense, practices that “worked” during times of physical, mental, and spiritual health now fail to meet patients’ needs. Arguably, a humanity separated from God fails to thrive; as such, Jesus’ death becomes the starting point for resurrection, a removal of the limitation of death (Genesis 3:23-24) and the realization of a new humanity (Romans 5:12-21; 1 Corinthians 15:20 ff). In nature, species unable to adapt given new contextual demands give way to more adaptable species. For patients in crisis, the death of “small gods” and “false gods” is requisite for patients to transform spiritually given their crises. Spiritual adherence to small gods often manifests in dogmatism, perfectionism, and authoritarianism; these patients require that God “fit” as a variable in a predictable formulaic outcome. Given unanticipated medical crises, patients worshipping small gods experience emotions such as anger, anxiety, guilt, and extreme sorrow. During on-call, examples of patients worship of “false gods” is pervasive, especially those admitted to Trauma or ICU for injuries related to drunk driving (e.g., alcohol) and gunshot wounds (e.g., power, greed).
The resolution of disequilibrium – a “new” equilibrium – connotes a new creation, a life anew. Patients in crisis shed nonfunctional roles and beliefs or they cling to maladaptive ones, becoming “stuck” in crisis. Transformation can be conceptualized as a “new birth.” Mary Magdalene identifies the resurrected Christ, proclaiming to the disciples, “I have seen the Lord” (John 20:18) much as a midwife would, seeing a newborn for the first time. In transforming, patients in crisis shed nonfunctional roles, behavior, and beliefs becoming life anew. The patient using mathematics, for example, as a new spiritual pathway to pursue the meaning of his life – shedding his old role of “medical victim” – is one example of transformation. His adaptation to his medical circumstances begins the process of forging a “new life.” Other possible spiritual pathways indicating transformation include: music, art, photography, conversation, quilting, flying, journaling, etc. Conversely, the patient clinging to fantasies of death (e.g., God “pulling her up” to heaven and making a pact with her grandfather to “die at the same time”) finds herself “stuck” in crisis; her lack of healthy adaptation to her medical circumstances prohibits growth and potentially is destructive. Other maladaptive expressions include: denial, deflection, repression, disassociation, etc. As such, transformation connotes adaptability not desirability. Illustrating this point, Jesus encounters a wealthy young man anxious to attain eternal life, yet chose his wealth over following Jesus; he was unable to adapt his lifestyle to meet the demands of the kingdom of God (Mark 10:17-25; Matthew 19:16-30; Luke 18:18-30). Tellingly, Jesus spells out what this evolution entails. “I tell you the truth,” Jesus said to them, “no one who has left home or wife or brothers or parents or children for the sake of the kingdom of God will fail to receive many times as much in this age and, in the age to come, eternal life” (Luke 18:29-30).
The Quadrinity embraces evolutionary change; as such, this model dismisses any notion of God’s immutability. If the embodiments are in tension with endlessness – God and the Holy Spirit – then God as a four-in-one whole changes as the embodiments change. Jesus advocated radical changes necessary for humanity to realize the kingdom of God. Only species of plants and animals able to adapt to the ever-changing ecosystems in which they reside survive. Instead of immutability, the key aspect of this theology is “change” and its necessity to survive and thrive spiritually. Such adaptability, arguably, is accomplished through relationships. The Quadrinity implies an ever-changing relationship between God and creation, including humanity. Both act mutually in a reciprocal fashion to change each other. The constant changes occurring within the systems of creation forge different pathways or journeys to the divine not realized in ancient times. The evolution from agrarian economies to more service-oriented economies, for example, involves theological identifications of God as more wholly loving than omnipotent and more relational than judgmental.
A hospital setting nested in a multicultural world places ever-changing demands on a pastoral theology. A Quadrinity approach expands God; that is, the demands associated with pluralistic cultural contexts demands inclusiveness. When encountering religions differing from Christianity, the Quadrinity allows chaplains to employ the embodiment paradigm of suffering, death, and resurrection to guide their pastoral care. During an on-call shift, I encountered an Indian Islamic extended family suffering the death of the family patriarch. Although I was not allowed to participate in any of the post-death ceremonies, I worked with three men of the family through the logistics of finding a suitable funeral home that respected Islamic traditions. By staying with this family through the morning – from 1AM to 6AM – we progressed through the family’s suffering together, ultimately evolving toward a death to the distrust and animosity traditionally felt by Christians and Muslims toward each other. Providing a presence for the family, staying with them until they were ready to leave the hospital provided a transformative moment. Before entering his car, one of the men extended out his hand for me to shake and told me, “Thank you John. May God bless you.” Touched by this, I responded, “May God bless you, also.” The transformation began for both of us in relationship.
A number of strengths characterize the Quadrinity view of God. Chief among these strengths is the belief in a balanced deity, one that balances immanency with transcendency. The Mysterium Tremendum quality of God – God undefined, without parameters – is balanced by God’s imminence, God’s presence as embodied in Jesus Christ and in creation. Such a balanced approach to God avoids the classical theism problem of theodicy; that is, how does an all knowing, all powerful, and all loving God allow humanity to suffer medical misfortune? Embracing change through evolutionary adaptation focuses on God’s imminent presence given the dynamics of ever-changing environments while, at the same time, acknowledging the mysteries of God by admitting God’s transcendence, that God is unpredictable and undefinable. As such, “chance” contributes to the demands of ever-changing contexts, connoting moment-by-moment ever-changing environments. God suffers with patients through the embodiment exemplified by Jesus Christ’s suffering before and during his crucifixion.
Reflecting on the embodiments of God allows chaplains the ability to spiritually assess patients using the metaphors associated with Jesus’ suffering, death, and resurrection. These metaphors provide chaplains with useful emotional, behavioral, and psychological “markers” assisting them in their presence with and pastoral care for patients. Such metaphors also allow chaplains the flexibility to cross ethnic and religious lines more easily in their pastoral care.
The weakness of this theology of pastoral care is its overall lack of simplicity and predictability. Classical theism emphasizes the transcendency of God, a belief embedded in the faith of many patients. Suffering often is viewed by patients as a direct consequence of God, either in an overarching belief in “God’s will” or in “God as tester.” Attributing unpredictable and unfathomable medical problems to a transcendent and judging God is an expedient, and arguably a “Band-Aid” theology. Yet, the attribution of consequence to God is often spuriously reinforced by patients’ past histories: medical, behavioral, or both. A Quadrinity theology posits adaptation to ever-changing environments, noting that chance plays a major role. God suffering with patients runs counter to the current embedded spirituality (omnipotence) held by many if not most patients.
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