HEALTH MINISTRY AND COMMUNITY

Health Progress, Sep/Oct 2004 by Glaser, John, Buck, Kevin

Catholic Health Care Needs a New Emphasis on Its Communitarian Roots

The diminishing presence of "the sisters" is a phenomenon that no one in Catholic health care could miss. But something else is vanishing along with the sisters, and it is something we could easily miss-community ministry. It is not just that our ministry will have fewer sisters in the future; there will be less and less community in our ministry unless we carefully and consciously do something about it.

We, the authors of this article, intend to examine some aspects of the importance of, and cndangcrmcnt to, community in Catholic health care. Our thesis is briefly this: Whereas U.S. culture is fundamentally individualistic, Catholic health ministry is essentially communitarian; the powerful presence of community inherited from religious congregations can only be sustained with clear focus and hard work.

INDIVIDUALISM AND HEALTH CARE

U.S. health care is a mirror of American culture, and American culture is a culture of individuals. Our deepest affections, our spontaneous assumptions, our philosophical and political building blocks, all find their magnetic north in the ideal of the individual.

The roots of this fixation reach back to the beginning of our nation, whose founders were steeped in philosophers such as John Locke. The best-known early chronicler of our individualism is probably Alexis de Tocqueville, who described the American spirit trenchantly as one tending to a self-understanding that owes "nothing to any man; [Americans] expect nothing from any man; they acquire the habit of always considering themselves as standing alone and they are apt to imagine that their whole destiny is in their own hands. Thus, not only does commercial democracy make every man forget his ancestors, but it hides his descendants and separates his contemporaries from him; it throws him back forever on himself alone and threatens in the end to confine him entirely within the solitude of his own heart."1

This individualism can be seen in the subculture of medicine. Even when medicine focuses on ethics, it tends to do so in a way that focuses narrowly on issues affecting the welfare of the individual, rather than that of the community. Biocthics, for example, has spent three decades emphasizing and advocating individual patient autonomy. George Annas, a pioneer in U.S. bioethics, put it succinctly: "The core legal and ethical principle that underlies all human interaction in medicine is autonomy."2 As two medical sociologists have noted, this cultural myopia is "a widespread characteristic of the field of bioethics, one that generally manifests itself in the form of systematic inattention to the social and cultural sources and implications of its own thought."3

The culture of the individual is present in psychotherapy as well. The founding theory of modern therapy, psychoanalysis, was focused on the individual. Even after the advent of family systems theory in the 1960s, the majority of therapists continued to work primarily with individuals. One of the authors of this article, a clinician and graduate professor who has been associated for more than 12 years with the Marriage and Family Therapists program at Pepperdine University, Malibu, CA, has often heard other clinicians and students say that working with individuals is more attractive to them than working with groups, because it is less complex and therefore easier to manage. The fact that assessment and testing instruments are developed for individuals, and not for groups, also reveals psychology's bias for the individual.

Because organizational psychology had its origins in the larger conceptual world of individual psychology, it tends to focus on the individual, too. The authors know of many excellent instruments for the assessment and measurement of the strength and growth of individuals, but we have been challenged in our search for corresponding instruments for defining and measuring the strengths of teams. We are familiar with no instrument that specifically addresses the assessment of communities of leadership.

CATHOLIC MINISTRY: ESSENTIALLY COMMUNITY MINISTRY

Catholic tradition paints a picture of striking contrast. A pointed expression of Catholic communitarianism appears in the U.S. bishops' pastoral statement on the economy: "Human dignity can be realized and protected only in community. . . . The Christian vision of economic life . . . asks, 'Does economic life enhance or threaten our life together as a community?'"4

The ultimate source of the Catholic Church's view of community life is, of course, the mystery of the Trinity. We, in our being and doing, are the likeness of God-not persons in isolated individuality, but being-in-relationships. Community is thus not what happens when individuals come together; it is the very condition for the possibility of individuals. Community is the easily forgotten-even in Catholic theology-essential element of human dignity: individual-in-community. As with the Trinity, we are distinct but not separate.