You know how whenever Paul McCartney plays live he plays Beatles songs? Well, I am taking my own “Hey Jude” from the Recontextualize blog and posting it here.
Here are some thoughts that I compiled for a competency essay to (hopefully) meet APC Board Certification. (Disclaimer: I realize that my reading of Žižek would not be compatible with Žižek, so I am taking some liberties. However, I think his example is apt, and especially in comparison with Myra Bluebond-Langner’s theory of mutual pretense.)
Incorporate the spiritual and emotional dimensions of human development into the practice of pastoral care
I want to explore the topic of human development with a question a nurse asked: I wonder if “Adam” knows he is dying but is waiting for mom and dad to let him go.
Contemporary philosopher and cultural theorist Slavoj Žižek is helpful here as he draws on this level of disavowal and uses it as a lens to explore a contemporary example with our belief in Santa Claus. Žižek’s critique is that, at some point, the child knows that Santa Claus is not real, but a creation of their parents, but they play along in order to uphold a level of belief to keep their parents happy; or, as Žižek said:
“In short, they transfer their belief onto another. We do the same with our children. We go through the ritual of Santa Claus, since our children are supposed to believe in him and we do not want to disappoint them. They pretend to believe so as not to disappoint us and our belief in their naivety.”
There is a disavowal working on two levels: First, the child knows the reality but doesn’t want the parents to know that they know, and second the parents know but don’t want the children to know that they know. This creates a fantasy level in which both parties are working with an ideology. Žižek offers ways to confront ideology and correct them, but this falls outside the scope of this essay; what I am concerned with, however, is how the chaplain stands in the gap created by the ideology; in other words, how can we talk to a child about his/her death – while honoring the parent’s wishes as guardians – all the while taking the patient’s developmental progress into account and upholding the integrity of the family system?
First, it is vital for a chaplain to address a person’s capacity for understanding. In terms of pediatrics, the cognitive level of development is much higher than I think we give children credit for. Research has shown multiple answers to this question, but, as I hope my attention to the dignity of humanity mentioned above revealed [not included in this blog – sorry it’s boring theory], I view children as “purposeful, willful individuals capable of organizing their own behavior towards others.” I think this is the case for a number of reasons, specifically their interpretation of parent’s emotions, receiving of gifts, and previously punished behavior not receiving punishment. These may appear as superficial examples but they reveal that children are interpreters of their environments and are incredibly cognizant of their reality. So although patients may not completely comprehend the medical realities of care they do interpret their experiences and draw conclusions based on this data. There is a spectrum here: on one end, a patient may know every aspect of each medication, while at the other end a patient just knows that when this doctor shows up I get a shot! Therefore, yes, at some level, I do think “Adam” knew he was dying. Out of respect for Adam’s mom and dad I was never able to discuss this with him at length – nor with mom and dad as they were clear that they did not want to talk about it.
Once again I think this reveals that the disavowal is at the level of the parents not the child. This makes sense though. In my experience, parents are helpless and powerless in the face of a terminal disease. The parents get stripped of some traditional parental roles. So, although I am always ready to help families make meaning out of a circumstance I often fail to acknowledge the importance of upholding social order. Myra Bluebond-Langner describes this social order is akin to the moral order, so although it doesn’t make sense per se for a parent to act the way they do it makes less sense for them to abandon traditional parental responsibilities.
The best way to relate this back to Žižek’s Santa Claus analogy and real life chaplaincy is what Bluebond-Langner defines as “mutual pretense” where, “each party defines the patient as dying but acts otherwise.” I am a chaplain to this family during a small window of their overall journey. I am an invited pilgrim who meets them where they are and responds to their clues as to how we are to proceed. I cannot replace their myths if this will destroy their way of making meaning. Just like any myth encountered in patient care, a chaplain has to take multiple factors into account. An important factor in assessing each visit is socialization. Each visit is layered and multi-dimensional. I can begin a conversation with a family, but if the family is not ready to go there I cannot force the conversation (This, in my opinion, is spiritual abuse). Just as I mentioned above, the care team is witnessing an already existing family system and therefore cannot project and take a family to a place they are not ready to go.
Dealing with death and children is incredibly complex. We perceive children as images of a future which adults will never visit. In other words, children represent the future. Children represent innocence. Therefore, talking about death is not just talking about death; we are talking about a failure of the future and possibly the God who allowed it. Chaplains, therefore, are pilgrims on an already existing journey; hopefully adding wisdom while removing layers of myths.
 Developed in Violence: Six Sideways Reflections (New York, N.Y.: Picador, 2008); and The Puppet and the Dwarf: The Perverse Core of Christianity (Cambridge, Mass.: The MIT Press, 2003).
 Violence: Six Sideways Reflections, 96-97.
 Which Žižek describes as the set of ideas by which people make sense of their social world by covering over certain unwanted features of their governed social existence; or as Karl Marx described ideology, “they do not know it, but they are doing it.”
 Myra Bluebond-Langner, The Private World of Dying Children.
 Ibid., 7.
 Ibid., 216-217.
 Ibid., 230.
 Ibid., 199.