Abstract
Chaplain and psychiatrist share professional concern for the improved psychological health of the distressed general hospital patient. Commonality of concern suggests regular consultative co-presence and associated interprofessional collaboration. This study of consultation within one teaching hospital finds that co-presence occurs in less than five percent of potential cases and that collaborative exchange in connection with those cases is rare, a condition supported by psychiatric staff and found regrettable by chaplains. “Case-typing,” guided by outlooks of secularization (chaplain), scientism (psychiatrist), and traditionalism (ward internist), provides an accounting of collaborative underutilization, supplemented by considerations of organizational structure and positional power.
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References
Frank, J., “Fereword.” Kiev, A., ed.,Magic, Faith, and Healing. New York, Free Press, 1964, p. viii.
For that matter, the Chaplain's Office has no precise knowledge of how many patients it itself serves: “Perhaps we should be keeping a record of this sort of thing, but we don't.”
It should be remarked that not all psychiatrists accept this convergence or are interested in contributing to it. Many prefer to remain strictly within the realm of traditional “mental illness” in their personal theory and practice of psychiatry.
In support of this position, see Lidz, T., and Fleck, S., “Integration of Medical and Psychiatric Methods and Objectives on a Medical Service,”Psychosomatic Medicine 1950,12, 103–107.
For further discussion of patient behavior as a basis for the internist's consultation request, see Meyer, E., and Mendelson, M., “Psychiatric Consultations with Patients on Medical and Surgical Wards: Patterns and Processes,”Psychiatry, 1961,24, 197–220.
Note that bizarre behavior is the sole case category in whichall three personnel types agree on the appropriate consulting agent. Few are yet ready to challenge the psychiatrist's priority in handling what we term “mental illness,” while theyare prepared to challenge or resist his claims as related to other case characteristics.
In response to the question of psychiatric consultation for a particular patient, one internist argued against it as follows: “So much of psychiatry is just common sense. I can tell you what [the psychiatrist would] say. He'd recommend ‘supportive therapy’ and all that goes along with it—things I think I do every day and don't need a psychiatrist to tell me how.”
A particularly skeptical internal medicine specialist suggested. “Psychiatrists are often sick. If I don't know a particular consultant, one of the first things I ask the house staff about him is, ‘Is he sick?’ As high a number as ninety percent might be.”
What a typical patient perceives as “safe” about the chaplain and “threatening” about the psychiatrist, leading to voluntary contact with the former and resistance to the latter, is reconceptualized by internist and psychiatrist so as to lead to an opposite practical outcome. That is, “safe” becomes “innocuous,” which is in turn translated to “lacking in substance.” This evaluational-descriptive outlook feeds a pre-existing stereotype of chaplain as low in scientific and medical value, countered by psychiatry's opposite claims in its own behalf and resulting in a greater likelihood of consultant contact precisely the reverse of the patient's desires, i.e., psychiatrist-without-chaplain rather than chaplain-without-psychiatrist.
Nor, as suggested earlier, is the situation much improved in those rare cases when chaplain and psychiatristdo come together. While chaplains usually value the experience, psychiatrists tend to regard it as an inconsequential departure from the routine sequence of events, neither significantly adding to nor detracting from their customary handling of a case. On the basis of such a neutral (at best) evaluation of the interaction, psychiatrists are not prone to seek or encourage more of the same.
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Tiedeman, G.H. Chaplain and psychiatrist as ally-rivals. J Relig Health 21, 193–205 (1982). https://doi.org/10.1007/BF02274179
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DOI: https://doi.org/10.1007/BF02274179