Pastoral learning at Bellevue Hospital

Christian Century, August 30, 2000 by Chloe Breyer

AT THE END OF my first year at General Theological Seminary, in New York City, I spent eight weeks in clinical pastoral education at Bellevue Hospital. In case I thought that seminary was simply about mastering theology, General had arranged a summer's worth of practical education in pastoral care.

Being an assistant chaplain in a teeming New York hospital for mental and physical illnesses was the most emotionally challenging experience of that year. God's justice never seemed more confusing or the church more marginal.

Described by one of my professors as a "kind of spiritual EMT," a chaplain works differently than a parish priest. Historically, chaplains are appointed by states or private bodies as religious functionaries working at secular institutions such as schools, prisons, hospitals, or in the military. Chaplains rarely develop the long-term relationships that connect a priest to her parishioners. They are more like an emergency room staff--ready to sew up spiritual wounds and pass the patient along to primary-care providers. Clinical pastoral education for Episcopal seminarians resembled a medical internship. If we could cope with daily crises in hospitals, we might be able to handle the less frequent crises in a parish.

Clinical pastoral education, or CPE, is open to anyone wishing to learn about spiritual care, and it's required for everyone entering the Episcopal priesthood. In 1925 the first CPE program enrolled four seminary students for summer study at Westboro State Hospital in Massachusetts. CPE was the inspiration of Anton Boisen, a minister who had been hospitalized five years earlier for "catatonic schizophrenia" at Westboro. After he recovered, Boisen founded CPE to teach clergy to care for the sick and dying through firsthand experience.

Over 70 years later, Jewish, Christian, Islamic and Buddhist students seeking ordination in their own traditions enroll in the program nationwide. My classmates and I work in hospitals and hospices ranging from Christ Hospital in New Jersey, where Brad does 32-hour shifts once every eight days and performs many sacramental functions, to Columbia Presbyterian, where Mauricio takes part in a very structured program with preaching opportunities and strictly delineated pastoral responsibilities. I want to do my CPE at Bellevue Hospital because work in a large, ailing New York public hospital is guaranteed to be a "boot camp" experience. Also, our supervisor, Ernst Joseph, has been running CPE for 33 years; this would be his last program cycle before retirement. Joseph has chosen four of us from General, a Yale Divinity School student from the United Church of Christ, and a Benedictine monk who lives in Oregon.

Bellevue Hospital, located at First Avenue and 27th Street, lies within easy biking distance from General. Founded to serve "lunatics and paupers" in 1736, Bellevue is the oldest public hospital in the country. In films like One Flew Over the Cuckoo`s Nest and The Snake Pit, Bellevue is the archetypal insane asylum. But although New Yorkers tell tales about great aunts and dipsomaniacal uncles carried off to Bellevue, and the guides on Circle Line tour boats describe it as a mental institution, Bellevue is a general hospital.

For a seminarian, it's hard to imagine a building that contains much more of "the world outside." The locked psychiatric wards occupy only one small part of this 1,232-bed facility. In addition to the birthing center, medical and neurological ICUs, and dialysis clinic, Bellevue houses two libraries, a high-security prison, a fully accredited public school, a print shop, a Medicaid registration office, two chapels, a synagogue and one of the city's best emergency rooms. The hospital also has a community board, a palliative care unit and a world-renowned psychiatric program for survivors of torture and hostage taking. Alcoholics Anonymous and Narcotics Anonymous groups meet there, and relatives of schizophrenic and depressed patients find support groups. Art therapy programs serve children and adults who suffer emotional disorders.

AS A MICROCOSM of New York, Bellevue contains best and worst of life. At Bellevue I learned things I could have lived a long life without knowing. Surreal bits of information came my way. Catholic chaplains are wary of giving out rosary beads because patients have used them to display provocative gang colors. Bibles are no longer distributed in the locked psychiatric wards since patients sometimes use the pages as toilet paper.

My notions of right and wrong were challenged too. Level one trauma centers like Bellevue depend on a steady stream of violent-crime victims to maintain the reputation of their ER residency programs. In psychological intake exams, desperate people give answers that will guarantee admission because they'd prefer an indefinite period in the psychiatric wards to the New York streets. I learn that prisoners sometimes commit crimes that will return them to jail because they cannot handle the uneasy burden of freedom.