Nelson Osamu Hayashida Biography:

Nelson is an ordained member of the American Baptist Churches, USA.
Following four and a half years as the Baptist Campus Minister at the
University of Hawaii, Manoa,\
he and his wife spent seventeen years as missionary teachers in Zambia
and South Africa. Nelson became Associate Professor of Cross-Cultural
Studies at Eastern University, St. Davids, Pennsylvania, following
missionary service. He has held pastoral positions in California, Texas
and Washington states. He has taught as a visiting professor, adjunct
professor, and D.Min. supervisor at seminaries in California, Kentucky
and Pennsylvania. He is a published author of articles and books and
holds a Ph.D. in the Phenomenology of Religion from the University of
Edinburgh, Scotland.

THE CASE EXAMPLE

Steven, a man in his mid-20s, sought psychotherapeutic treatment because
of periodic bouts of mild frustration about his career, self-esteem
issues, and as part of a more extensive quest for self-development and
perfection. Although judged to be competent and successful by peers and
students, he had anxiety about his capacities and often felt flawed and
inadequate. He usually became involved with women who were accomplished
and "difficult." He generally played the role of caretaker. He often
came to resent his role of "healing wounded sparrows." In graduate
school, Steven became very interested in Asian thought. He read widely
in Asian philosophy and psychology and meditated on a regular basis.

Steven was the oldest of two siblings in a middle-class family. He was 2
years older than his sister. His parents were in their mid-30s when he
was born. His parents were atheists. Steven was raised as a secular
humanist. He described his parents as intelligent people who related to
each other in an affable but superficial manner. As a child, Steven and
his mother were close. Initially, he described her as kind and saintly.
He remembered her as a sensitive and curious woman who valued him very
much. He had fond memories of the time they spent together in his
childhood. In the course of therapy, he recovered childhood impressions
that she was controlling and infantilizing and used him as though he was
an extension of herself. She "wanted me to do what she wanted me to
do.... Everything had to be her way."

Their relationship changed for the worse when Steven was an adolescent.
At that time, family life began to revolve around the plight of his
troubled and enigmatic younger sister. She fought with teachers, took
various drugs including marijuana and cocaine, and openly defied
Steven's parents. Steven felt that family life was dominated by his
sister and that he was neglected.

Steven felt he had a distant and emotionally depriving relationship with
his father whom he described as a competent, critical, emotionally
constrained, and perfectionistic small business owner with a bad temper.
Steven feared that any affectively charged situation might ignite his
father's temper. He described his father as being susceptible to severe
periodic emotional outbursts accompanied by loss of temper, yelling, and
screaming. His father tended to become angry or panic when things did
not conform to his rigid expectations. Steven remembered making a secret
vow to himself that he would never lose his temper and become an
"animal" like his father. As the therapy proceeded, material about
Buddhism emerged periodically. We gradually came to understand that
Buddhism had taken on constructive, defensive, reparative, and
restitutive functions for Steven, simultaneously enriching and limiting
his life. Steven demonstrated a tremendous ability to access and
describe nuances of his thoughts, feelings, and fantasies. Meditation
practice seemed to cultivate this unusual degree of self-awareness. It
also reduced self-critical tendencies.

This increased awareness facilitated greater access to formerly
unconscious material. To cite one example among many: On several
occasions while meditating, Steven became aware of the formerly
unconscious hurt and rage he felt about the way his parents made him
feel responsible for family difficulties, and the extent to which they
encouraged him to fulfill their own needs and goals.

His stance toward these feelings also changed. Nonjudgmental
attentiveness -- the ability to experience thoughts and feelings
impartially -- replaced his perfectionistic father's criticalness. As
his capacity for empathic self-observation increased, self-recriminative
tendencies declined. Thoughts and actions that formerly provided
ammunition for him to prosecute himself no longer tended to upset him.
As he gradually experienced decreased self-criticalness and
self-punishment, he came to feel more patience and compassion.

Buddhist ideals were restitutive and restrictive. Buddhist emphasis on
self-purification and transformation had a dual unconscious function: It
provided a means of attempting to win his perfectionistic father's
approval and atone for his unconscious guilt over his imagined crime of
not saving and wishing to destroy his damaged sister. Perhaps if he was
perfect, then his father would accept him. Buddhism offered an
opportunity to offset his sense of badness and repair the damage he felt
he had committed. But Buddhism also became an agent of self-condemnation
and self-inhibition. The quest for purity of action, like his father's
demand for perfection, became one more ideal that he could never attain
and thus one more occasion for self-condemnation. He periodically spoke
of the guilt he felt when he was not meditating on a regular basis or
not living up to Buddhism's ethical ideals.

Buddhism's emphasis on cultivating "cool" rather than "hot" emotions,
equanimity rather than passion (Kramer & Alstad, 1993), actually
inhibited him in certain ways. For example, it reinforced his defensive
passivity. In attempting to develop such qualities as equanimity and
compassion, Steven focused on detaching from negative affects rather
than experiencing them.

As the treatment progressed, we treated Buddhism more like a dream than
a sacred monument, examining Steven's associations to it rather than
assigning it a standardized meaning. We attempted to illuminate its
unconscious meanings and purposes rather than assume that it was either
inherently pathological or unworthy of psychotherapeutic scrutiny. The
picture of Buddhism that emerges form such an approach is that of a
complex mosaic involving constructive, pathological, restitutive,
integrative, and transformative dimensions.

BUDDHISM AS A JOURNEY

Not being a Buddhist, I cannot speak about Buddhism with an insider's
insight, only with an outsider's surmises. So I must let the insiders
speak to Buddhism's appeal. It appealed to Steven, and we must seek to
get a sense of why it did and how it failed him, or rather how he failed
Buddhism.

Kadowaki (2002:156), raised in the Zen Buddhist tradition in Japan but
later becoming a Jesuit priest, concluded that: "In both Zen and
Christianity, the person who has reached the pinnacle of truth is simple
and docile, like a little child. In that simplicity, however, there lie
hidden infinite riches." Kadowaki, earlier in the book (ch. 9, 72 ff),
spoke of how Jesus taught something similar when he said we must become
like little children to enter the kingdom of heaven, and the one who
humbles himself like a child is the greatest in the kingdom of heaven
(Matt. 18: 1-4).

It is that knowledge of truth and awareness in childlike simplicity that
Buddhism proffers. But it is not knowledge in the Western sense of
stored bits of cognitive information, but a wisdom that emanates from
the body, the gut, and not the intellectual sphere. The Japanese call
this the wisdom from the 'hara,' the stomach (the body). Living life
from the 'hara' is living life as a child, trusting completely
(humility) with one's 'hara' the admonition or guidance of another
(person, authority, wisdom).

All this, as I understand it, is rooted in the Four Noble Truths of
Buddhism: a) There is suffering in the world (dukkha), b) the cause of
suffering is craving (tanha), c) there is cessation of suffering, and d)
the Noble Eightfold Path leads to the cessation of suffering.

a)  Everything is suffering since everything is transitory/temporary. It
    is ignorance that blinds us to the truth that life is impermanent,
    that there is no immortal soul, no self.

b)  All forms of craving/desire/thirst (tanha) lead to "samsara," the
    cycle of rebirth/reincarnation/existence. The sort of reincarnation
    one has is determined by the law of Kamma (karma).

c)  The extinction of suffering is possible -- the complete
    extinguishing of desire. This is only possible with one who
    recognizes that everything is fleeting, transitory, subject to
    suffering, without a self and thus faces everything with serenity.

d)  The way to enlightenment and liberation from sorrow/suffering is the
    Noble Eightfold Path that leads to "nirvana," which means
    "extinction" (goal of Buddhism) of the volitional drive manifesting
    itself in greed, hatred and

> illusion. [^1]

Buddhism's emphasis is this-worldly. It's truths concern one's life and
happiness now, in this lifetime. But the truths it advocates are not to
be accepted, known or understood with the rational mind (too
superficial), but to be 'grasped' penetratively ('hara') in order to
apply the teachings or wisdom to one's life to gain freedom from
suffering. Thus Buddhism is a religion/philosophy/psychology of action.
One has got to do it and live it for it to have any real value and to
reap the benefits (note Kadowaki's earlier statement, "there lie hidden
infinite riches").

Hence we come to the pathway to cessation from suffering, the Noble
Eightfold Path, the 'Middle Way.' It includes: Right View, Right
Thought, Right Speech, Right Action, Right Livelihood, Right Effort,
Right Mindfulness, and Right Concentration.

Phra Peter Pannapadipo (2001:87-91) gives us an explanation of the
Path's ethical code. I delineate it briefly only because it helps us to
understand how Steven can potentially embrace the wisdom of Buddhism to
bring his life into balance and peace. The Noble Eightfold Path:

> Right View or Understanding is the understanding of life as it
> actually is, not how we might wish it to be, or have become
> conditioned to see it through the accumulation of speculative
> opinions, concepts, and fixed views influenced by our own greed,
> cravings and aversions. It is also an understanding of the law of
> Kamma[^2] and cause and effect -- that our intentional thoughts,
> actions and speech, good or bad, will bring either a good or bad
> result.
>
> Right Thought is thought that is free from ill-will to other living
> beings, free from selfish desire and craving, free from hatred and
> violence; it is the right outlook on life. There are three obstacles
> to right thought: greed, anger and delusionary ignorance, or lack of
> understanding of the true nature of life. Greed, or craving and
> attachment in various guises, are the major causes of our suffering
> and dissatisfaction with life, since craving can never really be
> fulfilled and only leads to more craving.
>
> Right Speech means to not lie, not to use offensive or abusive
> language, gossip or slander, not to use vain or foolish speech, not to
> be irresponsible in the things we say, not to be deliberately hurtful
> in one's choice of words, not to use speech prompted by self-interest,
> and not to indulge in useless or frivolous talk.
>
> Right Action includes not causing harm to living creatures, not taking
> what is not given, not indulging in illicit sex, and not losing
> mindfulness to drink and drugs. Instead, we should develop compassion
> and love for others, generosity and unselfishness, to develop control
> over the senses, to be honest when dealing with others, and to
> maintain mindfulness at all times.
>
> Right Livelihood means avoiding occupations which are immoral, based
> on deception, or which cause harm to others. Instead, we should seek
> work that is honest, harmless and honorable, and which benefits
> ourselves and society.
>
> Right Effort is the development of willpower to enable us to overcome
> our bad, habitual or unwholesome qualities, and to cultivate good and
> wholesome ones. Right Effort (commitment) is needed to follow the
> Eightfold Path and to develop wisdom and concentration.
>
> Right Mindfulness is to be aware at all times of the actions and
> activities of the body and mind; to keep control of the senses and not
> to be led by wrong views and fixed ideas. Right Mindfulness develops
> through constant vigilance and meditation practice.[^3]
>
> Right Concentration is meditation practice, which helps the mental
> energy and willpower to follow the Eightfold Path, as well as leading
> to Insight-Wisdom, or penetrative understanding of the true nature of
> life.

Pannapadipo adds:

> The path leads to the elimination of Tanha, and therefore to the
> cessation of Dukkha. The Path leads to the development of wisdom, and
> the four great virtues -- the compassionate understanding of the
> plight and suffering of all living things (Karuna), a wish that all
> living things should be happy and free from suffering (Metta), joy at
> other's success or happiness(Mudita), and the ability to keep a
> composed and controlled mind in all situations (Upekkha).

Thich Nhat Hanh (1997:103) proposes that Buddhism leads one to
"transform" suffering into true love, deep understanding, and great
freedom. These changes are the result of disciplined practice, leading
to qualities of character transformations (keep in mind Kadowaki's
'hara') that bring happiness to ourselves and to others.

CLINICAL ASSESSMENTS

1)  How do you assess the spiritual needs of this patient, and what are
    they?

A way that spirituality is understood is to refer to its three
"relational" dimensions: pt's relationship with God/divine/holy/ultimate
reality; pt's relationship with others; pt's relationship with self.[^4]
These three dimensions give ultimate meaning/significance to the core of
one's life. When the chaplain, as spiritual diagnostician, determines
that the meaning/significance factor in someone's life had been injured,
she begins to name what those injuries are.

With Others:

In the case of Steven, we see what those psycho-spiritual injuries are.
Steven's experiences with his controlling, infantilizing mother caused
him to feel suffocated as a person, and injuries such as resentment and
anger should be explored.

Steven had conflictual experiences with his sister due to his troubled
sister's dominance in parental attention. He felt neglected. This
created resentment toward his parents and sister, guilt about his wish
to destroy his sister, and anger toward them all. His resentment and
anger toward his parents were rooted in feelings of betrayal and
abandonment.

Steven's story unfolds painful experiences with his father, whose
distant and emotionally depriving relationship brought hurt, loss,
self-pity, bitterness, diminished self-worth, and alienation. The
father's temper tantrums and rigid expectations may have triggered
feelings of despair, hopelessness, misery and rejection. All these
possible injuries need to be explored. A chilling development within
Steven is his vow never to become an "animal" like his father, which
shows disdain, a deeper state of anger.

Steven's relationship with other women became unhealthy and difficult,
creating feelings of resentment. Did he see in these accomplished but
complex women a reflection of himself?

With Self:

Steven's psycho-spiritual injuries due to conflictual relationship with
others (interpersonal) interpenetrated with his relationship with self
(intrapersonal) to produce self-blame, self-hatred, self-recrimination,
self-judgement, and self-punishment, affecting his self-worth. This
condition was exacerbated by the fact that, while Buddhism did much good
in Steven's life, it was not good enough, or he was not good enough, to
achieve absolute self-purification and transformation of character that
led to perfection to win his perfectionistic father's approval.

With the Divine:

In practicing Buddhist meditation, we see Steven's 'self'-condemnation
and 'other'-condemnation decline, and his patience and compassion
increase. We also see his ability in empathic self-observation increase,
and self-recrimination decrease. Yet he could never achieve perfection,
and his self-condemnation tendencies returned. Steven displayed guilt
and disgust in his spiritual imperfections. For instance, his guilt
about not meditating more vigorously or not living up to Buddhist
ethical ideals distanced his sense of personhood from his divine/holy
reality. Guilt then is seen to create a chasm between the person and the
divine reality within the person. Steven is seen operating from his
tarnished, flawed persona and not from his holy center. This divide is
the cause of Steven's suffering (dukkha). In a nutshell, he was not at
peace with his spiritual center, the divine side of his Buddhist
experience.

In consequence, Steven's injuries in these three realms fashioned
enormous needs for reconciliation, healing and wholeness.

2)  What is your pastoral intervention based on your spiritual
    assessment?

Pastoral intervention strategies should be sensitive to the discord
found in the three relational dimensions of spirituality. Intervention
with Steven should target those areas of fissure that unleashed
psycho-spiritual injuries.

Steven must reconcile with his father, mother and sister. Reconciliation
includes open communication that gives birth to truth-telling that leads
to acknowledgement of hurts and wrongs, giving and receiving
forgiveness, decisions on steps to take to allow for change to take
place. There is no growth to wholeness and optimal spiritual health
without change in the right directions. Steven's interpersonal dimension
can be healed from psycho-spiritual injuries through a process of
intervention involving each member of the family. Intervention
strategies can include both one to one and group spiritual counseling.
Referrals may also be useful.

Because Steven displayed serious and longstanding commitment to the
study and practice of Buddhism, the significance of his faith-practice
should not be undermined, marginalized or abandoned. Instead, Buddhism
may be the way to resolve the divine and intrapersonal conflicts,
whether the interpersonal conflicts are ever fully resolved.[^5]

Granted, one can claim that a problem exists with Steven's apparent
misuse or misunderstanding of Buddhism. For example, Steven saw Buddhism
in a utilitarian sense, which may have come from his family background
in secular humanism. Steven wanted Buddhism to produce a fix, a cure,
rather than allowing Buddhism to guide him over time *through* his
suffering and conflicts to healing and growth. Using Buddhism to fix
something is still "tanha" -- craving or greed, and tanha only produces
"dukkha" -- suffering.

The chaplain can help Steven realize that he must let go of all hurts,
all bitterness -- all aversions -- and all desires and cravings, and
allow the power of the Wisdom, the Mystery, the Buddha, the Ultimate
Reality, to give him peace and ultimately compassion. This can be
achieved only through the disciplines of the Noble Eightfold Path and
the realization of Right Mindfulness. This is the Buddhist response to
Steven's spiritual injuries in all three dimensions of relationships
described above. But it is a journey of increasing spiritual awareness
and liberation that takes time and patience, with pitfalls and
recoveries along the way.

In addition, in a sense Steven is found holding on to Buddhism. What
need does holding on to Buddhism fill in Steven's life? This may need to
be explored religiously and psychologically. So does the question, why
does Steven need to be punished by staying with Buddhism? Yet I still
contend, as articulated already, that Steven's immersion in Buddhism
offers the best opportunity to grow out of his conflictual tensions and
discover healing for himself at least. The chaplain should therefore
explore Steven's view of Buddhism or religion in general. Steven should
not allow religion to become addictive (stressful) and pathological,
thereby misunderstanding the 'path' of the Eightfold Path. There is a
natural flow in religious transformation.

The case of Steven is an example of how one's religion can be affirmed
as a dynamic component in the therapeutic care process.

3)  What do you see are the primary psych/social issues and how do you
    address these as a chaplain?

The need for restoration of healthy relationships between Steven and his
family members is obvious. Steven needs to find reduction of stress,[^6]
healing, growth, meaning and peace within himself as the foundation for
the challenges of interpersonal harmony.

As a chaplain, I would help family members explore unhealthy
generational patterns, relationship stressors, and major life events in
the life of the family that affected the homeostasis of the family. Done
in a non-threatening, participatory way, this can open doors for
confession, compassionate listening and understanding among family
members. Forgiveness and change in communication/behavioral patterns can
lead to personal and interpersonal growth and healing.

From the eastern tradition, Buddhism should be seen by Steven as not
simply utilitarian but as a way of life that has natural ebbs and flows.
Steven must learn to relax into it for the "mindfulness" to come as a
natural, wonderful consequence. In addition, Steven needs a supportive
Buddhist community, a caring Buddhist "family" or network of
relationships. There is no evidence in the case study that Steven has
found significant Buddhist role models and cohorts. Buddhism used
strictly as an individual exercise, as a psychological technique to
alter perceived problems, including the problem of one's own
imperfection, is not recommended.

4)  How does your understanding of this patient in the context of his
    culture, ethnicity, faith background, family dynamic, impact your
    assessment and intervention?

The special feature of this patient, his uniqueness, is his faith
background. Steven's Buddhist faith in the context of a Caucasian middle
class household makes this case quite interesting for assessing
spiritual needs and implementing intervention plans. For example, how is
Steven's upbringing in secular humanism any different from an Asian's
upbringing in secular humanism in Tokyo or Singapore, and what
difference does it make in pastoral care? How much does American culture
affect the spiritual assessment and intervention plans of a Caucasian
Buddhist? These are questions requiring input and collaboration from
various chaplains rooted in Buddhist and Christian traditions as well as
sociologists, phenomenologists and psychologists of religion.

Undoubtedly, the patient's avid adherence to Buddhist meditation,
beliefs, and ethical standards provide a positive spiritual opportunity,
and foundation, for his growth and healing from multiple wounds. But we
do not know to what extent Steven understands Buddhism as a
comprehensive way of life. The Eightfold Noble Path intends to encompass
all of everyday activity. Rather than doing the steps of the Path
sequentially, the steps should be done without sequence and whenever
they can be experienced or implemented, naturally and spontaneously. For
example, Steven's guilt about wanting to destroy his sister or his
feeling of being neglected as a result of his parents' forced attention
on his problematic sister are issues to be resolved. Right Action
prompts a Buddhist practicing meditation to also practice compassion and
love for others, and to develop control over the senses (guilt; remorse
over the neglect). Steven must be encouraged to match his contemplation
with energies related to relating to his sister with loving compassion
that begins to alleviate feelings of guilt and remorse. Steven can ask
himself, what can I do that will restore my relationship with my sister?
No meditation without actions, no action without meditation.

Steven's case reminds us that human suffering is universal in the human
family. Religions vary in the way they name the suffering and the
salvific formula or method apprehended and used;[^7] yet the outcome
sounds remarkably similar. For example, Buddhism calls Steven's
suffering from guilt and remorse 'attachment' to 'aversion.' Whether
conscious or unconscious, Steven desires to flee from the pain of guilt
and remorse over tattered relationships. According to Buddhism, that
very craving exacerbates the guilt and remorse (suffering). He must
follow the hard road of the Eightfold Path, matching his actions with
his meditation. Right Mindfulness can liberate him from guilt and
remorse by keeping control of the senses (anger, frustration, remorse)
and not be led by rigid, wrongful ideas or views. Right Mindfulness
guides one in being aware at all times of the actions, feelings and
thoughts of the mind and body. Right Effort must be incorporated as
well, but so must the other disciplines of the Path. The components of
the Eightfold Path interpenetrate and feed off one another in a
symbiotic manner. Again Kadowaki's 'hara' comes to mind. Steven failed
to live consistently from 'hara.' It is, after all, no small
achievement.

Buddhism gravitates toward peace \-- intrapersonally, interpersonally,
and with the divine. So does Christianity.

5)  As a chaplain, what would you contribute to the patient's medical
    care plan as a member of the interdisciplinary team?

I would provide a good spiritual screening and assessment that can be
used by social workers, psychiatric nurses, psychologists and others.
The chaplain's assessment should offer information that can corroborate
with others' findings or unveil new data helpful in exploring new
avenues of treatment or rehabilitation. In the case of Steven, the
chaplain can offer information regarding Buddhism and help the
interdisciplinary team understand its spirituality. For example, in
religion, especially Western Christianity, there is a steely bent toward
over-intellectualizing or overly emotionalizing faith experience -- the
faith experience as acted upon inside the church. We in the West do not
see as easily the spirituality, and hence spiritual healing, that comes
from simple everyday things outside the church, like gardening, charity,
volunteerism, etc. Buddhism helps us capture what, for example, the
hermits at The New Camaldoli Hermitage at Big Sur know.... work around
the grounds, baking, cleaning the room, washing dishes, engaging in the
arts all are sacred moments for creativity, prayer, contemplation and
healing, for they are opportunities to unite one's spirit with the
divine. All of life, then, is holy. The chaplain can help the team see
Steven's therapy from this religious angle. Buddhism needs to be
portrayed as a pragmatic faith and not so esoteric and 'other-worldly.'

Other care disciplines can then link their therapies to complement the
chaplain's spiritual care of the Buddhist patient, or to have a new
understanding of their intervention plan as a result of the chaplain's
spiritual insights or openness to Buddhism's religious contributions to
patient care.

6)  How does your faith background inform/influence your
    assessment/intervention of the patient and his crisis?

My faith as a Christian sees each human person as a sacred creation,
linked to God and linked to the human family. This assumes that even
though Steven is a Buddhist, and his family perhaps secularists or
agnostics, I treat Steven and each member of his family as holy members
of God's earth. My Christian identity does not alter the vital task of
seeking the best insight and methodologies for the suffering and
injuries in Steven's family. The different religious heritage of another
person should never deter me from my best care. My faith informs me that
I must seek to understand as many non-Christian religious heritages as I
can in the ministry of chaplaincy and to incorporate the patient's
religious and cultural heritage into a spiritual assessment and
intervention plan. I ought not to view a person, and her healing, only
in terms I am most familiar with. That would deny the person her
identity and her respect as a person. At the same time, my faith informs
me that the love I bring to the chaplaincy transcends religio-cultural
barriers. The truth of love is absolute, the skillful application of
that truth requires interfaith and intercultural awareness and
sensitivity.

Hunter (2001:20-25) suggests rather clearly that chaplains must not
neglect the reality of cultural pluralism in our 21^st^ century.
Chaplains must take into account as never before the increasing presence
of non-Christian faith traditions into spiritual care. CPE training must
do this as well. My Christian tradition should embrace the changes in
our global society. This is God's world, every single religious,
cultural one of us.

7)  In what ways would you consult, collaborate with or refer to other
    staff caring for the patient?

I would refer Steven to a psychologist. The task of the psychologist is
to discern the psychotherapeutic implications in the religious
expressions of the patient or the religious language of the chaplain
reporting. In the case of Steven, there appear to be pathological
tendencies that a psychotherapist should address from the psychological
vantage point. For example, the patient's perfectionistic father
transferred onto him a view of religion that had to be perfectionistic.
This needs to be explored from the psychological angle. It is not that
religion, Christianity or Buddhism, cannot address this problem from the
spiritual domain, it is simply wise to use skilled professionals from
other helping disciplines so that together a more comprehensive
opportunity for optimal health, psychological and spiritual, can be
achieved. Psychologists should reciprocate.

As a chaplain, I would investigate whether one's view of religion is
normally obtained from childhood experiences -- positive, negative or
ambiguous. If this is largely true, one's wounds from negative
experiences must heal in order for healing to take place in one's view
and practice of religion. For Steven, he had some healing to do.
Perfectionistic religious goals can quickly lead to self-recrimination
and even religious hyper-addiction.

8)  Share your insights in how you would minister to the patient's
    extended family and how this would serve as part of your
    intervention strategy.

I am not an expert in the genogram, nor in family therapy, but at some
point along the way the genogram can help the family visualize and
articulate family dynamics and conflictual relationships. This would be
especially constructive if the family is assisted to understand the
nature of their relationships and interconnections.[^8] Family systems
theory can then be explored together. Further group work or individual
therapy may be called for. Collaboration and involvement of
psychologists and marriage and family therapists are important
strategies. In the case of Steven, referrals are quite likely due to the
gravity and complexity of the relational injuries.

Also, the chaplain's role is not only to discuss with Steven his
Buddhist faith and what role he envisions he can make of it, but to
suggest to him some positive outcomes with the appropriate use of
Buddhism. The chaplain can aid in the family's understanding of Buddhism
in order to help them understand Steven, or even understand themselves
through what Buddhism teaches.

CONCLUSION

This paper has established that chaplaincy in our *increasingly*
pluralistic society will stretch Christian chaplains, Catholic, Orthodox
and Protestant, to *increasingly* function as pastoral counselors for
non-Christian patients. There are not enough Buddhist or Muslim or Hindu
or Jewish chaplains to minister to such patients. This burgeoning
reality has implications for continuing education for chaplains as well
as for CPE training, especially in cosmopolitan areas.

Secondly, I have sought to demonstrate that, however precarious it is to
minister to patients whose religious heritage is not one's own, it is
possible to acquire basic understanding of another religious tradition
in order to minister to a patient from that tradition.

Thirdly, it is not enough to learn some facts about another religion.
For the chaplain, how does one *incorporate* the wisdom of the religious
tradition into an appropriate spiritual assessment, intervention and
care? My operational premise is that it is possible to "bring on board"
the religious wisdom of the particular faith tradition of the patient
and integrate its distinctiveness into patient care.

Finally, this paper hints at the challenge of religious "pseudoism." In
this case, we must ask to what extent Steven's Buddhism was a reflection
of "pseudo-Buddhism." Again, I am not a Buddhist. I speak from the
outside. Yet the query begs an answer. In other words, can another's
faith be, in effect, "pseudo-Christianity"? The chaplain's role in many
cases, it seems to me, is to acknowledge the "pseudoisms" of religion in
the institutional marketplace of patients and address spirituality
concerns with a wellspring of honesty, sensitivity and skill, allowing
God's spirit to become the regenerative, healing presence in the
process. I suspect the chaplain's commitment to *self-care* in spiritual
growth becomes crucial to any spiritual care with patients, their
families, and staff of the institution.

EPILOGUE

Thomas Merton was once asked if he believed he could have presented the
Christian faith in a new or profounder way without his exposure to or
knowledge of Buddhism. After considerable pondering on the question,
Merton said, "You know, I think I couldn't understand Christian teaching
the way I do if it weren't in the light of Buddhism" (Aitken and
Steindle-Rast 1996:47).

ENDNOTES

[^1]: It is said that Siddhartha Gautama gained absolutely nothing by
    his enlightenment. One cannot gain what one already has. Although
    our Buddha nature is already within us, it is buried in the mind
    under so much conditioning and delusion, craving and aversion.

[^2]: The idea is that positive thoughts produce positive
    actions/consequences and negative thoughts evoke negative
    actions/consequences. In this way, I would contend that wholesome
    Kamma provides the psycho-spiritual base for personal and
    interpersonal healing.

[^3]: "Mindfulness" means to be aware of everything one does every day.
    It is a kind of light that shines upon all one's thoughts, feelings,
    words and actions. Mindfulness is the Buddha, the Holy Spirit, the
    energy of God (Thich Nhat Hanh 1999:5,18).

[^4]: See Lyn Brakeman's [The God Between Us: A Spirituality of
    Relationships]{.underline}.

[^5]: What else does Steven have if Buddhism is marginalized? In my
    view, it must be standardized (become the anchor) in Steven's life.
    According to Burton (439), "spiritual pain" is deeper than a focus
    on painful events, or on emotional responses, or on religious
    practices and terms. He believes meditation and contemplation opens
    the window to this deeper dimension of being. Unfortunately,
    Burton's article did not give a clear definition of this spiritual
    dimension where spiritual pain resides. What is this 'deeper
    dimension'? What really is 'spiritual pain'? Is 'pain' separate or
    identified with 'spirit'? Speaking from the Christian tradition,
    Burton seemed hesitant to enter into its depth and genius. For
    example, Gruen (111ff.) reminds us how the fourth century Desert
    Father Evagrius Ponticus affirmed the mystical value of deep
    contemplation. Evagrius experienced that in silence with God we
    transcend the ugly emotions and sufferings of our lives. As long as
    we attach ourselves to these, they become permanent fixtures. A
    Buddhist, I think, could not state it any differently! Gruen
    (105ff.) contends that what Evagrius advocated expresses what
    transpersonal psychology today calls 'disidentification.' In effect,
    we abolish our identification with our feelings, thoughts and
    perceptions. We acknowledge the chores we must do, but we
    disassociate our identity with them. I am not my job, even though I
    have one. I am not my anger, even though I feel it. This spiritual
    sphere, this inner core, is untouched by bitterness, fear or any
    feelings in my emotional dimension. Hence, feelings, passions and
    relationships have no power over the spiritual self/reality. For
    Evagrius, the mystery of being human is tied to the mystery of God.
    The spiritual realities are not dissimilar.

[^6]: Woolfolk and Lehrer (1984:357-364) report that stress was reduced
    systematically and significantly by religious meditational practices
    within Jewish, Christian and Hindu religions.

[^7]: See Dunne's [Spiritual Exercises for Today: A Contemporary
    Presentation of the Classic Spiritual Exercises of Ignatius
    Loyola]{.underline} (1991:128-137) for specific spiritual exercises
    in "Facing the Hurt with Christ," "Facing the Person Who Hurt You,"
    "Facing Your Compromises," "Facing Yourself," and "Facing the
    Future."

[^8]: Melito's article, "Values in the Role of the Family Therapist:
    Self Determination and Justice," speaks of the importance values
    play in ascertaining the function of the family therapist,
    especially the values of freedom and justice in relationships. The
    article also addresses how treatment methods embody these values of
    freedom and justice by defining how conflict arises and resolutions
    are attempted.