Dolentium Hominum N.75

DOLENTIUM HOMINUM N. 75 – Year XXV – No. 3, 2010

JOURNAL OF THE PONTIFICAL COUNCIL FOR HEALTH CARE WORKERS (FOR HEALTH PASTORAL CARE)

ARCHBISHOP ZYGMUNT ZIMOWSKI,,Editor-in-Chief CORRESPONDENTS BISHOP JOSÉ L. REDRADO, O.H., Executive Editor REV.MATEO BAUTISTA, Bolivia MONSIGNOR J. JAMES CASSIDY, U.S.A. REV.RUDE DELGADO, Spain REV.BENOIT GOUDOTE, Ivory Coast PROFESSOR SALVINO LEONE, Italy EDITORIAL BOARD REV.JORGE PALENCIA, Mexico REV.GEORGE PEREIRA, India REV.CIRO BENEDETTINI MRS.AN VERLINDE, Belgium DR.LILIANA BOLIS PROFESSOR ROBERT WALLEY, Canada SR.AURELIA CUADRON REV.GIOVANNI D’ERCOLE, F.D.P. DR.MAYA EL-HACHEM REV.GIANFRANCO GRIECO REV.BONIFACIO HONINGS MONSIGNOR JESÚS IRIGOYEN EDITORIAL STAFF REV.JOSEPH JOBLIN REV.VITO MAGNO, R.C.I. DR.COLETTE CHALON DR.DINA NEROZZI-FRAJESE MRS.STEFANIA CASABIANCA DR.FRANCO PLACIDI DR.ANTONELLA FARINA REV.LUCIANO SANDRIN DR.MATTHEW FFORDE MONSIGNOR ITALO TADDEI DR.GUILLERMO QWISTGAARD

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Poste Italiane s.p.a. Spedizione in Abbonamento Postale - D.L. 353/2003 (conv. In L. 27/02/2004 nº 46) art. 1, comma 2, DCB Roma Contents

4 ‘By his wounds you have been healed’ 55 Priests, Pastoral Workers (1Pt 2:24) and Health-Care Staff: Message of the Holy Father on the Towards Reciprocal Integration Occasion of the Nineteenth World Day Prof. Fernando Poyatos of the Sick – 11 February 201 60 Pastoral Care: the Chicago Study Dr. Patrick Guinan ARGOMENTI Dr. Thomas Zabiega Dr. Christine Zainer 8 Science and Faith: a Life Choice 63 The Votive Temple of the Medical H.E. Msgr.Zygmunt Zimowski Doctors of Italy: the History of a Sanctuary and its Founder 14 There is Pain: the Body-the Soul Prof. Massimo Aliverti Prof. Pierluigi Zucchi, S.O. Prof. Bonifacio Honings, O.C.D. ANNIVERSARY CONSULTATION 31 Fr. Pierluigi Marchesi (1929-2002): 20 YEARS OF THE EUROPEAN CHAPLAINCY 2 a Father and a Teacher 10 YEARS OF THE ENHCC (EUROPEAN of Health-Care Policies NETWORK OF HEALTH CARE CHAPLAINCY) H.E. Msgr. José L. Redrado, O.H. LONDON, 16-19 SEPTEMBER 2010 Prof. P. Pietro Quattrocchi 66 Chronicle 40 Mourning: Healing Msgr. Dariusz Giers the Wounded Heart Rev. Arnaldo Pangrazzi, M.I. 67 Address of H.E. Msgr. Zygmunt Zimowski 43 The Hospital Chaplaincy: a Construction Site 68 Chaplains in the Future: for the Church of Communion Giving and Receiving Rev. Leonardo Nunzio Di Taranto Rev. Stavros Kofinas

The illustrations in this edition are taken from the book: Francesco e Chiara di Assisi Profeti di dialogo e di pace published by Editrice Velar, Gorle (BG)

DOLENTIUM HOMINUM N. 75-2010

MESSAGE OF THE HOLY FATHER ON THE OCCASION OF THE NINETEENTH WORLD DAY OF THE SICK (11 FEBRUARY 2011)

‘By his wounds you have been healed’ (1 Pt 2:24)

Dear Brothers and Sisters!

Every year, on the day of the memorial of the Blessed Virgin of Lourdes, which is cel- 4 ebrated on 11 February, the Church proposes the World Day of the Sick. This event, as the venerable John Paul II wanted, becomes a propitious occasion to reflect upon the mystery of suffering and above all to make our communities and civil society more sensitive to our sick brothers and sisters. If every man is our brother, much more must the sick, the suffering and those in need of care be at the centre of our attention, so that none of them feels forgotten or emarginated; indeed, ‘the true measure of humanity is essentially determined in relationship to suffering and to the sufferer. This holds true both for the individual and for society. A society unable to accept its suffering members and incapable of helping to share their suffering and to bear it inwardly through “com-passion” is a cruel and inhuman society’ (Encyclical letter Spe salvi, n. 38). The initiatives that will be organised in each diocese on the occasion of this Day should be a stimulus to make care for the suffering increasingly effective, also in view of the solemn celebration that will take place in 2013 at the Marian sanctuary of Altötting in Germany.

1. I still have in my heart the moment when, during the course of the pastoral visit to Turin, I was able to pause in reflection and prayer before the Holy Shroud, before that suffering face, which invites us to reflect on He who took upon himself the passion of man, of every time and place, even our sufferings, our difficulties, our sins. How many faithful, during the course of history, have passed in front of that burial cloth, which enveloped the body of a crucified man, and which completely corresponds to what the Gospels hand down to us about the passion and death of Jesus! To contemplate it is an invitation to reflect upon what St. Peter writes: ‘By his wounds you have been healed’ (1 Pt 2:24). The Son of God suffered, died, but rose again, and precisely because of this those wounds become the sign of our redemption, of forgiveness and reconciliation with the Father; however they also become a test for the faith of the disciples and our faith: every time that the Lord speaks about his passion and death, they do not understand, they reject it, they op- pose it. For them, as for us, suffering is always charged with mystery, difficult to accept and to bear. The two disciples of Emmaus walk sadly because of the events that had taken place in those days in Jerusalem, and only when the Risen One walks along the road with them do they open up to a new vision (cf. Lk 24:13-31). Even the apostle Thomas manifests the difficulty of believing in the way of redemptive passion: “Unless I see the

DOLENTIUM HOMINUM N. 75-2010 mark of the nails in his hands, and put my finger in the mark of the nails and put my hand into his side, I will not believe” (Jn 20:25). But before Christ who shows his wounds, his response is transformed into a moving profession of faith: “My Lord and my God!” (Jn 20:28). What was at first an insurmountable obstacle, because it was a sign of Jesus’ apparent failure, becomes, in the encounter with the Risen One, proof of a victorious love: ‘Only a God who loves us to the extent of taking upon himself our wounds and our pain, especially innocent suffering, is worthy of faith.’ (Urbi et Orbi Message, Easter 2007).

2. Dear sick and suffering, it is precisely through the wounds of Christ that we are able to see, with eyes of hope, all the evils that afflict humanity. In rising again, the Lord did not remove suffering and evil from the world, but he defeated them at their root. He opposed the arrogance of Evil with the omnipotence of his Love. He has shown us, therefore, that the way of peace and joy is Love: “Just as I have loved you, you also should love one another” (Jn 13:34). Christ, victor over death, is alive in our midst. And while with St. Thomas we also say “My Lord and my God!”, let us follow our Master in readiness to spend our lives for our brothers and sisters (cf. 1 Jn 3:16), becoming messengers 5 of a joy that does not fear pain, the joy of the Resurrection. St. Bernard observed: ‘God cannot suffer but He can suffer with’. God, who is Truth and Love in person, wanted to suffer for us and with us; He became man so that He could suffer with man, in a real way, in flesh and blood. To every human suffering, therefore, there has entered One who shares suffering and endurance; in all suffering con-solatio is diffused, the consolation of God’s participating love so as to make the star of hope rise (cf. Encyclical letter Spe salvi, n. 39). I repeat this message to you, dear brothers and sisters, so that you may be witnesses to it through your suffering, your lives and your faith.

3. Looking forward to the appointment of Madrid, in August 2011, for the World Youth Day, I would also like to address a special thought to young people, especially those who live the experience of illness. Often the Passion, the Cross of Jesus, generate fear because they seem to be the negation of life. In reality, it is exactly the contrary! The Cross is God’s ‘yes’ to mankind, the highest and most intense expression of his love and the source from which flows eternal life. From the pierced heart of Jesus this divine life flowed. He alone is capable of liberating the world from evil and making his Kingdom of justice, peace and love, to which we all aspire, grow (cf. Message for the World Youth Day 2011, n. 3). Dear young people, learn to ‘see’ and to ‘meet’ Jesus in the Eucharist, where he is present in a real way for us, to the point of making himself food for our journey, but know how to recognise and serve him also in the poor, in the sick, in our brothers and sisters who are suffering and in difficulty, who need your help (cf. ibid.,n.4).To all you young people, both sick and healthy, I repeat my invitation to create bridges of love and solidarity so that nobody feels alone but near to God and part of the great family of his children (cf. General Audience, 15 November 2006).

4. When contemplating the wounds of Jesus our gaze turns to his most sacred Heart, in which God’s love manifests itself in a supreme way. The Sacred Heart is Christ crucified, with the side opened by the lance from which flowed blood and water (cf. Jn 19:34), ‘symbol of the sacraments of the Church, so that all men, drawn to the Heart of the Sav-

DOLENTIUM HOMINUM N. 75-2010 iour, might drink with joy from the perennial fountain of salvation’ (Roman Missal, Pref- ace for the Solemnity of the Sacred Heart of Jesus). Especially you, dear sick people, feel the nearness of this Heart full of love and draw with faith and joy from this source, praying: ‘Water of the side of Christ, wash me. Passion of Christ, strengthen me. O good Je- sus, hear my prayers. In your wounds, hide me’ (Prayer of St. Ignatius of Loyola).

5. At the end of this Message of mine for the next World Day of the Sick, I would like to express my affection to each and everyone, feeling myself a participant in the sufferings and hopes that you live every day in union with the crucified and risen Christ, so that he gives you peace and healing of heart. Together with him may the Virgin Mary, whom we invoke with trust as Health of the Sick and Consoler of the Suffering, keep watch at your side! At the foot of the Cross the prophecy of Simon was fulfilled for her: her heart as a Mother was pierced (cf. Lk 2:35). From the depths of her pain, a participation in that of her Son, Mary is made capable of accepting the new mission: to become the Mother of Christ in his members. At the hour of the Cross, Jesus presents to her each of his disciples, 6 saying: “Behold your son” (cf. Jn 19:26-27). Her maternal compassion for the Son becomes maternal compassion for each one of us in our daily sufferings (cf. Homily at Lourdes, 15 September 2008). Dear brothers and sisters, on this World Day of the Sick, I also invite the authorities to invest more and more in health-care structures that provide help and support to the suffering, above all the poorest and most in need, and addressing my thoughts to all dioce- ses I send an affectionate greeting to bishops, priests, consecrated people, seminarians, health-care workers, volunteers and all those who dedicate themselves with love to treat- ing and relieving the wounds of every sick brother and sister in hospitals or nursing homes and in families: in the faces of the sick you should know how to see always the Face of faces: that of Christ. I assure you all that I will remember you in my prayers, as I bestow upon you my Apos- tolic Blessing. From the Vatican, 21 November 2010, the feast of Christ the King of the Universe.

BENEDICTUS PP XVI

DOLENTIUM HOMINUM N. 75-2010 Topics

Science and Faith: a Life Choice There is Pain: the Body-the Soul Fr. Pierluigi Marchesi (1929-2002): a Father and a Teacher of Health-Care Policies Mourning: Healing the Wounded Heart The Hospital Chaplaincy: a Construction Site for the Church of Communion Priests, Pastoral Workers and Health-Care Staff: Towards Reciprocal Integration Pastoral Care: the Chicago Study The Votive Temple of the Medical Doctors of Italy: the History of a Sanctuary and its Founder Science and Faith: a Life Choice*

Introduction reasons why science and faith, ways indicates an activity of in- albeit with their own originali- telligence which with rigour A little time ago, Professor ties and differences, may be studies a particular (material Nicola Cabibbo, who recently seen as sister experiences and and non-material) ‘object’ that passed away, and who was for friends, that is to say not extra- is identified with precision, many years President of the neous to one another or op- with a view to the drawing up Pontifical Academy of Sci- posed to each other. In the third of a discourse or a synthesis ences, stated that ‘the advances and last part of my paper I will that can be communicated in a in technology guided by sci- examine science and faith as al- comprehensible way. It should ence – which are rapidly chang- lied experiences which in a rec- be observed that the communi- ing our way of living and work- iprocal way support each other cation of a scientific fact is an ing and our relationship with to achieve the good of man. ineluctable commitment of sci- the planet earth – require scien- ence itself because it offers an tists to pay renewed attention to opportunity for verification or the ‘sapiential dimension’ of the 1. What do we Mean logic, whether instrumental or ultimate meaning of human by the Terms ‘Science’ and factual, by people who have a life… At the same time, the ‘Faith’? marked knowledge of the ‘ob- great discoveries of modern sci- ject’ itself. 8 ence, which open up new hori- Since the subject of my paper Having said this, it is advis- zons about the structure of liv- is often connected with a series able to observe that in common ing and inanimate matter – as of misunderstandings or com- discourse the term ‘science’ is they do about the structure and monplaces, it appears to me to applied for the most part to the history of the universe – are be advisable to clarify the way those disciplines that in an al- of crucial importance for the in which I understand the terms most exclusive way use obser- world of religion’.1 These of the tandem science/faith. As vation and calculation. This ap- words of this great Italian a consequence I will also bring plication is not erroneous, as in- physicist express in a clear and out what the non-acceptable deed one can easily understand, summarising way that way of meanings of these terms are. but it is certainly reductive. And thinking about the relationship This clarification is necessary it is above all else this way of between science and faith that both because we who are here understanding the term ‘sci- is typical of the Catholic today come from different edu- ence’ that is frequently under- Church. In these words one per- cational backgrounds and stood as being completely irrec- ceives a trust in the fertile and spheres of expertise and in or- oncilable with an experience of respectful relationship of these der to avoid conceptual dishar- ‘faith’. ‘Science’ understood as two distinct fields of the exer- monies that would prejudice the being an objective discipline cise of living of man in history. common effort that we will be which only deals with what is In addition, from them immedi- engaged in over these days of verifiable and concrete a for- ately emerges the hope that work and reflection. tiori is thought to be totally op- men of science and believers The term ‘science’ ordinarily posed to faith, differently from are unanimous on their pathway refers to that form of knowl- the experience of faith which is of listening to each other and edge about reality or objects or said to have, instead, a subjec- against all inopportune and situations or phenomena that tive character, and is said to sterile opposition. It is certainly are understandable in a suffi- concern realities or data that are the case that we are do not ig- ciently precise or complete way not phenomenal, are ineffable, nore the complex history – and thanks to the use of reason and and cannot be checked. a history not without its shad- the instruments of analysis that From a correct theological ows – of the relationship be- have been created over time. point of view and according to tween these two experiences. Science refers, in common un- the thought of the Catholic But I do not want to dwell upon derstanding, to the realm of pre- Church, ‘faith’ refers to a hu- this here. It is preferable to cision, verifiability and com- man act2 that would not be pos- point to the lights rather than to prehensibility. sible without the help of God.3 the dark aspects, because we One should observe, howev- It allows, on the one hand, the are interested in illuminating er, that in a rigorous sense ‘sci- establishment of a relationship the present and moving with ence’ is an analogical term, as a of familiarity with God who serenity towards the future, in result of which it can refer to freely encounters man. On the the name of the good of man more than one subjects with a other hand, it opens man to a and the search for truth. meaning that is not always the world of knowledge and of To this end, my paper is or- same but equally not always truth that has God Himself as ganised into three parts: first of different. From this point of its source. This experience in- all I will indicate what mean- view, the concept of ‘science’ volves man integrally; faith is ings I will employ for ‘science’ can refer to various spheres of not only an act of will or of and ‘faith’ in this paper of mine. knowledge, of research, of love: it is also that authentic Then I will throw light on the thought and of study, and al- and serious exercise of intelli-

* Magisterial paper by H.E. Msgr. Zygmunt Zimowski on the occasion of the Tenth National Congress of the AFAR, Brescia, 27 September 2010. gence which strives without as ‘sisters’ one must point out between these two experiences halting to understand both He certain tendencies which have and more easily leads to the who has revealed Himself (God developed during the course of mortification of initiatives of Himself) and what He commu- history which concern specifi- intelligence designed to under- nicatestoman.Itiswithinthis cally the relationship between stand the world and its structure framework that is located the these two experiences.5 ever more clearly and in an in- commitment of the community A first tendency has been that creasingly effective way. This of believers to communicate in according to which science is approach or tendency we could an ever more effective way its the ‘daughter’ of faith in the also define as being typical of own experience of faith: this is sense that it develops begin- the ‘ancient’ world, that world, theological activity which con- ning with the religious experi- that is to say, that preceded the stitutes an experience that can- ence. This is the approach this so-called ‘modern’ world, the not be renounced by those who is typical or most widespread in world when the centrality of believe and leads them to en- those forms of civilisation or man and his rationality were gage in a rigorous exercise of intelligence and constitutes an authentic scientific activity, even though it concerns the reality of God, His revealing of Himself, His relationship with man and history. After these clarifications have been made, in the observations that follow I will dwell 9 in particular on what I have defined as being the prevalent concept of science, that is to say what refers to knowledge that is connected with the dimensions of the visible, of the controllable, as happens in the sphere of medicine and disciplines connected with it; and, at least initially, by the term ‘faith’ I culture in which is privileged upheld and when science as will refer to intense religious the reality of the sacred com- knowledge developed with the experience in a general sense, pared to knowledge of the help of instruments of observa- even though in most of my ob- world, with this last being dealt tion. servations I understand faith as with in a strict dependence on The second tendency is that the Christian life or that way of the first. In other words, there which developed specifically being or living at whose outset are states and there are still beginning with the modern there is not ‘an ethical choice or contexts in which the world of epoch, when with the uphold- a lofty idea, but the encounter the arcane, of the divine, are ing of the autonomy of reason with an event, a person, which drawn upon in order to produce the right was upheld to develop gives life a new horizon and a a vision of the world, of man knowledge of the world that decisive direction’.4 and of reality. It should be ob- was not conditioned by reli- served that in this situation it gious prejudices or by ideas often happens that theories or present in Holy 2. Sister and Friend visions which in some fashion Scripture but was only the Experiences can be in opposition to what is outcome of objective observa- seen as the outcome of revelation. In this approach we find Although bearing in mind tion, or anyway strictly con- upheld such a distance between that in the course of time the re- nected with the experience of science and faith as to create an lationship between science and the transcendent or of the di- extraneousness at the level of faith has not always been har- vine, are avoided. fact between these two experi- monious, it is advisable not to I would like to make two ob- ences. This extraneousness allow ourselves to be exces- servations about this tendency. even becomes an opposition sively conditioned by this fact The first is that it is not difficult when the defenders of one or and this so that we can illumi- to see how this approach, which the other experiences seek to be nate the opportunities that are is typical of archaic cultures the only bearers of truth. In oth- offered today to those people and religiosities, is also present er words, it happens that men of wholiveinthefirstpersonthe in the experience itself of Israel science and believers arrogate experience of science and/or and Christianity, at least at cer- to themselves the right to be the the experience of faith. tain moments in their history. teachers of each other in fields The second observation is that of knowledge that are not their 2.1 Sister experiences this way of understanding the competence, thereby entering relationship between science into a conflict which it is diffi- To understand in what sense and faith in fact obscures or re- cult to resolve. science and faith can be defined moves the difference that exists The third tendency is that

DOLENTIUM HOMINUM N. 75-2010 which recognises the originali- sequence of believing in one reason8 or when the First Vati- ties and the differences of these God, ‘creator of the heaven and can Council states that faith is two experiences with respect to the earth, of all things visible an obsequium (obedience, from their different competences in and invisible’.7 As everything ob-audire, that is to say volun- an approach involving a peace- comes from Him, a ‘kinship’ tary listening and adherence) ful relationship, one of coopera- should exist not only between rationi consentaneum9. By tion and of integration. From a things but also between things these statements the Catholic historical and cultural point of and He who is their source, Church expresses three facts. view, this third way of under- their origin, their ‘father’. The The first is confidence in the standing the relationship be- Jewish-Christian of the one ability of man to find ‘traces’ of tween science and faith has God, the Creator, is the founda- God both within his own interi- been present for many centuries tion of a grandiose vision not ority and in the world that sur- in the experience and the think- only of man, defined by Holy rounds him. The second fact is ing of the Church, as is well Scripture as being in the ‘image the belief that experience of borne out by Albert the Great and likeness of God’ (Gen faith, understood as openness to and Thomas Aquinas who ‘Al- 1:27), but also of the relation- God who reveals Himself and though they insisted upon the ships between man and the as welcoming what He reveals, organic link between theology world. In virtue of his special is not a non-human act; it does and philosophy… were the first identity, conferred on him by not involve any reduction or to recognise the autonomy God, the human creature is in a suspension of our intelligence. which philosophy and the sci- condition to enter into a real The third fact, lastly, is made up ences needed if they were to and fertile dialogue with his of thinking that the experience perform well in their respective Creator. God granted him an of believing is not a ‘leap in the 10 fields of research’.6 This ten- intelligence and will that pro- dark’ (S. Kierkegaard) nor dency was later in perfect har- ject him beyond himself, mak- throwing oneself into the ab- mony with the sensibility of the ing him able to reach the surd but a free and loving en- men of the twenty-first century. threshold of the mystery of the trusting of oneself to that God Today we (commonly) hear Transcendent. Man bears in who, although He transcends that diversity constitutes riches himself a natural inclination to us, leaves a trace of Himself in and not a reason for struggle, transcendent Truth and to the the world and in history. and in addition we are aware of truths of the world which are a There is a further fact which the fact that the breadth of com- small reflection of it. In this contributes to enriching the petences and the plurality of sense, the experience of faith, Catholic vision of the relation- epistemologies impedes any that is to say of the relationship ship between science and faith, claim to dominance or exclu- with God who comes to man, is and it is the following. Man, because he is in the image of God, has been placed by the Lord in the ‘garden’ (Gen 2:15), that is to say the world, so that he may understand it, use it in a respectful way, and transform it for his own needs, without ever forgetting that he is purely a steward and not an owner of the creatures that surround him. For this reason, he is obliged to maintain with them a constructive and peaceful relationship. For that matter, according to the Bible, the world is not simply the stage of existence and human history but also the home (oikos) in which human beings cohabit with ‘brother Sun… sivity or absoluteness by any grafted in a serene way and in sister Moon… brother Wind… kind of research. From this continuity in the heart and the sister Water’.10 It follows from there comes the need for ab- mind of the human creature; this that the attempt to under- solute respect for the indepen- this does not require a suspen- stand the world, research direct- dence of the various fields of sion of reason or a forcing of ed towards a respectful use of research in which intelligence the will but simply a trusting nature, and study that helps us is exercised, without approach- and reasonable self-giving to to understand the structure and es involving suspicion or con- He who gives life to man and the working of reality, so as to tempt, with an approach of lis- seduces him with His own use its potentialities according tening and familiarity. beauty. to the design of the Creator, From a theological point of It is specifically to this conti- must be seen with satisfaction view, this way of understanding nuity in difference to which St. and joy, without fear and with- the relationship between sci- Thomas Aquinas refers when out limits, except for those that ence and faith is a natural con- he writes that faith supposes are imposed by respect for man

DOLENTIUM HOMINUM N. 75-2010 and the world itself. In this per- and faith. The first, in fact, ‘working hypothesis’ or criteri- spective one must acknowledge tended to make science and the on for comprehension. The that science and faith can be world of phenomena appear as Christian community recognis- seen as ‘sister’ experiences be- being the legitimate and exclu- es, indeed cultivates, the right cause they have their origin, in sive dominions of the exercise of science to proceed on its the ultimate analysis, in the of rationality, and faith as being journey in a rigorous and au- heavenly Father, even though an experience of a purely moral tonomous way. Indeed, it be- each is endowed with its own character or of a character pure- lieves that the certainty of faith originality, its own mission, and ly of the will, that is to say which leads the proclaiming of its own method. without any rational value or the existence of a God, who credibility. The Hegelian vi- benevolently and with elegance 2.2. Friend experiences sion, instead, became a matrix gives origin to all things, infus- for a minimalistic or ‘liberal’ es in the searcher after scientif- I do not ignore the fact that re-interpretation of the doctrinal ic truth an enthusiasm, an opti- the approach that has just been contents of Christian faith, ac- mism and a confidence, a outlined may appear utopian or cording to which the dogmas charge that plays a very posi- ingenuous. It is known, indeed, and the truths of faith proposed tive role as regards the endeav- that between science and faith in the course of history by our of understanding reality. In relationships of peaceful living Christianity had to be denuded other terms, faith in the creative together have not always exist- of all objective value and seen Trinity, if rightly understood ed or exist even now. Indeed, as as simple exemplifications or and lived, does not reduce the I have already observed, begin- models of the relationship of thirst for knowledge about the ning with the modern epoch an man with God. As a conse- world but instead ignites it and unbridgeable furrow appears to quence, the whole of the Chris- leads to people to look with 11 have been created between the tian experience came to lose eyes that are perennially thirsty two contexts of life and any claim to universality and with light at the wonders that thought, between science and was reduced to a pure contin- the various sciences are com- faith. Beginning with the Re- gent and limited expression of mitted to discovering and un- naissance, indeed, with the de- the encounter of an individual derstanding in the course of velopment of the experimental with God. time with their different com- sciences there took place, on As is well known, nowadays petences. the one hand, a gradual aban- there are by no means few peo- donment of that vision of the ple who continue to think, in an world that was based on the explicit or implicit way, that the 3. Allied Experiences Bible, a fact that nourished by experience of faith is not in the no means few disagreements least definable as an opportuni- The establishment of moder- between men of science and ty for the exercise of intelli- nity taught believers the need theologians. On the other hand, gence. It is continued to be be- not to presume that they will the gradual establishment of the lieved by intellectuals who are find the truth at any level sim- experimental model gave rise to not few in number that there is ply beginning with the fact of a dual phenomenon: first of all a substantial and insuperable faith. It is necessary to distin- it fostered the belief, which was extraneousness between these guish between the levels and legitimate, in the autonomy of two levels – the level of science the spheres of knowledge, us- research as regards the physical and the level of faith. Many ing an adequate epistemology, world and its laws, and then es- contemporaries, in fact, deny keeping firm in the belief that tablished the premisses for that the right of faith to inhabit the an ontological and logical har- exaltation of reason which in its ‘house’ of science because they mony exists in reality. turn had two relevant conse- believe that the religious expe- Instead, the contemporary quences – on the one hand, the rience will inevitably pollute, epoch, or the post-modern Kantian vision which stressed through its own prejudices or epoch, the epoch of the crisis of the limits of pure reason, ex- its own pre-understanding, the reason, marked by the great de- cluding God and transcendent objectivity of scientific re- feats experienced during the so- realities from the sphere of the search. called ‘short century’ (Eric J. exercise of reason, and, on the Is it possible to overcome Hobsbawm) has taught man, on other, the exaltation of reason these barriers that have been the one hand, to forgo any kind which led to a sort of ‘specula- created in the course of time? of ‘titanism’ of the intellect, and tive titanism’ which found in The Catholic Church thinks on the other, it has ignited nos- Hegel its most important expo- that it is because it openly talgia for unity and peace that nent and which tended to re- recognises the right of reason will help us in overcoming both duce the experience of Chris- to exercise its autonomy when the risk of mass globalisation tianity to a simple ingenuous this concerns the phenomenal, and the violent opposition of expression of the history of the visible and verifiable world. identities. Science and faith, in Spirit. The Church is not scandalised their own ways, today are living These two philosophical ap- when faced with a sort of in a dynamic towards what Paul proaches, the Kantian and the methodological a-theism which VI called the ‘civilisation of Hegelian, were pregnant with comes into play in those fields love’ in which good, truth and negative consequences for the of research where it is not nec- peaceful life together should relationship between science essary to resort to God as a find space. And they are called

DOLENTIUM HOMINUM N. 75-2010 to offer their practical contribu- well if not truth? It is not truth the contemporary cultural con- tion to the service of humanity that comes of itself through rea- text, and with a language that in concord, in dialogue and in soning but it is truth that is was different from our own, the mutual support. Science and looked for by those who use Angelic Doctor proposed ob- faith can and must become al- reason’.12 As Benedict XVI observations of great interest for lies, after many occasions when served: ‘wherever the search our subject that I would like to they have lived in an approach for truth takes place, this re- present with his own words. In of distance, distrust or even of mains as a fact that is offered Summa contra Gentiles St. opposition. and can be recognised as being Thomas wrote as follows: ‘ob- This approach of alliance already present in nature. In- servation of creatures is a part must achieve four kinds of ser- deed the intelligibility of the of the instruction of Christian vice: to man, to truth, to life and creation is not the outcome of faith… Observation of the to each other (science and the efforts of the scientist but a works of God is necessary for faith). Science and faith first condition offered to him in or- the instruction of human faith and foremost must serve man. der to allow him to discover the about the things of God. First, They are not self-referential ex- truth that is present in it’.13 On because from the study of what periences – they are open expe- the other hand, the Supreme it has achieved we can easily riences. For example, science Pontiff Benedict XVI contin- address, admire and observe di- that does not seek to enrich hu- ues, ‘reason… feels and discov- vine wisdom. Indeed, the things manity and above all that does ers that beyond what it has that are produced by art consti- not seek to serve the weakest reached and discovered, there tute art itself because they are would be a monstrous activity, exists a truth that can never be achieved according to its crite- one to be feared, exposed to the discovered beginning with it- ria… Second, this observation 12 risk of becoming a servant to self but only received as a free leads us to admire the very high power. In the same way, Christ- gift’.14 This truth, that is to say virtue of God and thus produces ian faith that forget that God re- the truth of Revelation, to in the heart of man reverence vealed Himself, became flesh, which one opens in faith, ‘is not for God. Indeed, the virtue of died and rose again for men and opposed to that achieved by artifice is conceived necessarily for our salvation, would be an reason; rather it purifies reason as greater to that of produced experience offensive to God be- and elevates it, allowing it, that things… Third, this observation fore being offensive to men. is to say, to expand its own ignites in the spirits of men love Science and faith also serve spaces in order to insert itself in for divine goodness… Fourth, man together when they contest a field of research that is un- this observation gives man a that widespread mentality that fathomable as mystery itself’.15 certain likeness to divine per- is expressed in the statement: ‘I Science and faith must also fection. Indeed, we have ex- consume, therefore I am’.11 be allied in service to life.In plained that God, knowing him- They must make it understood their own ways they are called self, knows in Himself all that ‘successful’ man is not a to proclaim and cultivate the things. Thus, since Christian prisoner of his own selfishness gospel of life and defend ‘the faith principally instructs man but a man who cultivates a greatness and inestimable value about God and with the light of sense of his own dignity and his of human life even in its tempo- divine revelation also makes own transcendence, going be- ral stage’,16 rejecting all threats him know creatures, in man is yond his own ‘fragmented’ his- and violence to human life, produced a certain likeness tory. openly professing the invio- with divine wisdom’.19 Science and faith, as well, lable value of every person, at To the conservations of must serve truth; indeed, they any stage or condition of his or Aquinas we can add that sci- must be moved by an authentic her existence, condemning the ence provokes the believer to passion for truth. Science that ‘culture of death… fostered by cultivate intelligence, always is not directed to serving truth powerful cultural, economic and above all when he (the be- would be a blind activity, easily and political currents which en- liever) reflects on what is the influenced by ideologies. In the courage an idea of society ex- most intangible and indescrib- same way, faith that did not cessively concerned with effi- able of realities: the reality of promote thirst for truth in be- ciency’.17 Men of science, in God. lievers as well would be an in- particular those who work in In its turn, faith, for the man tolerable experience. Faith that the field of health care, are the of science, is a permanent invi- eliminated intelligence, silenc- ‘servants of human life’;18 the tation to the ulterior, to look at ing it with formulas and morti- experience of faith confirms man, at reality and at history in fying its questions, would be an and strengthens this commit- awareness that there exists be- activity unworthy of God, as ment: those who love the living yond the world of phenomena well as offensive to human be- God cannot but love life, al- ‘a higher level that necessarily ings. ways, above all when it is weak transcends scientific predic- As I observed at the begin- and threatened. tions, that is to say the human ning of this paper, science and Lastly, science and faith are world of freedom and history’.20 faith, in their own way, are ac- allies because they provoke and As Fides et ratio observes, tivities that involve the use of help each other. On this point faith helps ‘to move from phe- reason; but ‘what comes’, allow me once again to refer to nomenon to foundation,astep asked St. Augustine, ‘to those Thomas Aquinas. In a cultural as necessary as it is urgent. We who know how to use reason context that was different from cannot stop short at experience

DOLENTIUM HOMINUM N. 75-2010 alone; even if experience does ing and his fulfilment, is seen Notes reveal the human being’s interi- with greater clarity above all 1 N. CABIBBO, ‘Introduzione’, in ority and spirituality, specula- when one works in the field of AA.VV., L’uomo alla ricerca della verità. tive thinking must penetrate to health care. Indeed, faced with Filosofia, scienza, teologia: prospettive the spiritual core and the illness, before a sick person, per il terzo millennio (Conferenza inter- 21 nazionale su scienza e fede. Città del Vat- ground from which it rises’. more than in other circum- icano, 23-25 maggio 2000), (Vita e Pen- Science helps the believer to stances, one can implement a siero, Milan, 2005), p. 107. For a survey perceive the order and the beau- verification of the intentions of this subject and observations regarding the contemporary direction of Catholic ty of every dimension of the that animate scientific research, theology, of utility is a reading of the fol- universe and the human; it and more precisely than in oth- lowing works: G. GISMONDI, Fede e cul- keeps him in humility faced er contexts, and faith as an ex- tura scientifica (EDB, Bologna, 1993); P. POUPARD (ed.), La nuova immagine del with the simultaneous complex- perience that is capable of mak- mondo. Il dialogo tra scienza e fede dopo ity and simplicity of the uni- ing people ‘grow in humanity’ Galileo, (Piemme, Casale Monferrato, verse. In this sense, science is a is put to the test. 1996); G. TANZELLA-NITTI and A. STRU- MIA (ed.), Dizionario Interdisciplinare di teacher of wonder for the be- Reasonandfaith,JohnPaul Scienza e Fede, Urbaniana University lieving man. As Benedict XVI II taught, are ‘two wings on Press/Città Nuova, Rome, 2002, 2 vols.); T. TORRANCE, Senso del divino e scienza observed: ‘faith for its part does which the human spirit rises to moderna (LEV, Vatican City, 1992). The not fear the progress of science the contemplation of truth’24 following web site should also be consult- and the developments to which and Benedict XVI emphasised ed: http://www.disf.org. 2 Cf. Catechism of the Catholic Church its conquests lead when these that ‘only together will they (CCC), nn. 154-155. are for man, his wellbeing and save man. Entranced by an ex- 3 Cf. CCC,n.153. the progress of the whole of clusive reliance on technology, 4 BENEDICT XVI, Deus caritas est (En- 22 cyclica, 25 December 2005), n. 1. mankind’. Faith, and here is reason without faith is doomed 5 On this complex subject see for ex- another aspect, helps science to flounder in an illusion of its ample R.J. RUSSEL, ‘Dialogo scienze- 13 not to stop ‘having daydreams’ own omnipotence. Faith with- teologia, metodo e modelli’, in G. TANZELLA-NITTI andA.STRUMIA (eds.), becauseitholdsupahopethat out reasons risks being cut off Dizionario Interdisciplinare di Scienza e does not end,23 that promised from everyday life’.25 We can Fede, vol. 1, pp. 382-395. and promoted by God Himself. without doubt affirm the same 6 JOHN PAUL II, Fides et ratio,n.45. 7 A symbol of Constantinople (year 381): DH, n. 150. 8 Cf. Summa theologiae,I,q.2,a.2,ad 1um. 9 Dogmatic Constitution Dei Filius, chap.3(DH,n.3009). 10 FRANCIS OF ASSISI, Cantico delle creature. 11 Z. BAUMAN, Consumo, quindi sono (Laterza, Bari/Rome, 2009). 12 De vera religione, 39,72. 13 Audience to those taking part in the international conference organised by the Pontifical Lateran University on the tenth anniversary of Fides et ratio,16October 2008. 14 Ibid. 15 Ibid. 16 JOHN PAUL II, Evangelium vitae (En- cyclical, 25 March 1995), n. 2. 17 Ibid., 12. 18 Ibid., 89; Cf. Charter for Health Care Workers, n. 1,1 (Pontifical Council for Pastoral Assistance to Health Care Workers, Vatican City, 1995) 19 II, c. 2. On the interesting subject of the use of the sciences by theologians cf. G. TANZELLA-NITTI, ‘Scienze naturali, And faith helps science not to thing about the relationship be- utilizzo in teologia”, in G. TANZELLA- be discouraged in the face of tween science and faith, above NITTI andA.STRUMIA (eds.), Dizionario failures, to combat resignation, all in the medical field: science Interdisciplinare di Scienza e Fede, pp. 1273-1289. to nourish confidence in a posi- and faith are like two tramways, 20 BENEDICT XVI, Address to those tak- tive sense to history and the certainly distinct and not to be ing part in the plenary session of the Pon- universe as a whole, to remem- confused with each other, jour- tifical Academy of Sciences (6 November 2006). ber that above every purely neying along which one pro- 21 N. 83. technical objective, the real end ceeds towards a future of light, 22 Audience to those taking part in the of research and scientific of solidarity towards humanity, international conference organised by the Pontifical Lateran University on the tenth thought are human beings; in and thanks to which man, a anniversary of Fides et ratio,16October this sense faith helps science to very noble creature amongst 2008. always remains on a ‘human other creatures of the world, 23 Cf. Encyclical Spe salvi. 24 Encyclical Fides et ratio (14 Septem- scale’. implements his very high po- ber 1998), n. 1. tentialities, and expresses and 25 Encyclical Caritas in veritate (29 safeguards his own dignity. June 2009), n. 74. Conclusion H.E. Msgr. ZYGMUNT ZIMOWSKI That science and faith have President of the Pontifical Council their principle reference point for Health Care Workers, in man, his dignity, his wellbe- the Holy See.

DOLENTIUM HOMINUM N. 75-2010 There is Pain: the Body-the Soul ALGOS AND PATHOS: FROM THE LEVEL OF NATURE (CREATION) TO THE LEVEL OF GRACE (REDEMPTION). ALGOLOGICAL, ALGO-PATHOLOGICAL AND PATHOLOGICAL ILLNESSES: NEW THERAPEUTIC ASPECTS.

Preface In entering this impressive rigorous medical-theological work the description emerges study deserves from readers. I am very happy to publish of the physio-pathological as- in the review Dolentium Homi- pects of algological illness, al- H.E. Msgr. ZYGMUNT num, as the new President of go-pathological illness and ZIMOWSKI the Pontifical Council for pathological illnesses (cf. fig. President of the Pontifical Council Health Care Workers, the med- 2), that make the algo-logical for Health Care Workers, ical-theological work ‘Pain: (corporeal) soul acquire the the Body-the Soul’, by Profes- physiognomy of the patho-log- sor Pierluigi Zucchi, an algo- ical (spiritual) soul. Introduction logue and clinician, and by From this point of view, this Professor Bonifacio Honings, a work seems to emphasise cer- The intention of this work is 14 moral theologian. These two tain points of the encyclical to study pain in the body in its rigorous researchers, already letter Caritas in Veritate of His unity with the soul so that it is well known in international lit- Holiness Bemedict XVI who adopted at the level of nature erature for their bridging stud- states (n. 76) that ‘the question (ordo creationis) as an imma- ies between medicine and the- of development [understood in nent, corporeal and human per- ology, wanted in this work to a broad sense] is closely ception, and at the level of analyse the delicate and diffi- bound up with our understand- grace (ordo redemptionis)asa cult subject of the relationship ing of the human soul… Devel- transcendent and redemptive between the body and the soul opment must include not just value. To give the study a scien- in the anthropological context material growth but also spiri- tific, bioethical and theological of pain. In this sphere they tual growth, since the human approach, we begin not from a have identified three new noso- person is a “unity of body and dualistic vision of man but from logical entities: algological ill- soul”… The emptiness in a dual-unitary vision. The body nesses, algo-pathological ill- which the soul feels aban- and the soul are not two sepa- nesses and pathological illness- doned, despite the availability rate elements (the dualistic vi- es, for which they have also of countless therapy for body sion) but distinct elements that suggested an original therapeu- and psyche, leads to suffering. together form the unity of the tic itinerary, thereby enriching There cannot be holistic devel- human being (the dual-unitary both the medical and theologi- opment and universal common vision). cal fields. The search for truth, good unless people’s spiritual which is always present in the and moral welfare is taken into Church, stresses that between account, considered in their to- 1. The Constitutive Elements science and faith an opposition tality as body and soul’. ofManintheOrder does not exist. Instead, an inte- As I have already observed, of the Creation gration exists for, as is pointed another unprecedented aspect out in the encyclical letter that appears in this original ‘Though made of body and Fides et Ratio of His Holiness study of these two distin- soul, man is one. Through his John Paul II, ‘Faith and reason guished researchers is that of bodily composition he gathers are like two wings on which having created a clinical-thera- to himself the elements of the the human spirit rises to the peutic scale of three levels – material world; thus they reach contemplation of truth; and the pharmacological, the ethi- their crown through him, and God has placed in the human cal and the spiritual (cf. tab. through him raise their voice in heart a desire to know the truth VIII), by which a health-care free praise of the Creator’.1 The – in a word, to know himself – worker can act in an appropri- Church for solemn ceremonies so that, by knowing and loving ate way according to the situa- and feast days, sings at the God, men and women may al- tions that he or she encounters. morning lauds: ‘Bless all the so come to the fullness of truth Because of the wealth of works of the Lord, the Lord, about themselves’. This con- new scientific-theological data praise him and exalt Him in the cept is also stressed by His Ho- which emerge from this de- centuries… Bless all the wa- liness Benedict XVI who, in tailed work, I hope, through ters, which are above the heav- his encyclical letter Caritas in this review that I edit and ens, the Lord… Bless, the sun Veritate, states that ‘Truth,in which is distributed in many and the moon the Lord, bless, fact, is lógos which creates diá- cultural contexts, that there the stars of heaven, the Lord’.2 logos, and hence communica- will be that suitable apprecia- For this task of living praise, it tion and communion’. tion and recognition that this is not licit for man to despise

DOLENTIUM HOMINUM N. 75-2010 the corporeal life, above all be- nature because he took on not “image of God”: it is a human causeheisheldtoseehisown only the full reality of the hu- body precisely because it is an- body as good and worthy of man soul, with its workings of imated by a spiritual soul, and it honour, specifically because it intelligence and will, but also is the whole human person that is created by God and destined the full reality of the human is intended to become, in the for resurrection on the last body. Everything that he is and body of Christ, a temple of the day’.3 The Biblical account ex- what he does, in his human na- Spirit’.12 presses the elements of the hu- ture, and thus also in his body, The doctrine of the Church man person with a symbolic derives from ‘One of the Trini- on the soul, from the Greek language when it says that ty’. The Son of God thus com- ‘anemos’ (wind, passion), finds ‘Then the Lord God took some municates to his humanity his foundation in Holy Scripture soil from the ground and personal way of existing in the where the term ‘soul’ often formed a man out of it; he Trinity. For this reason, both in refers to human life,13 or the hu- breathed life-giving breath into his soul and in his body, Christ man person as a whole (cf. Acts his nostrils and the man began expresses humanly the divine 2:41). It also refers to all of to live’ (Gen 2:7). The whole of behaviour of the Trinity (cf. Jn what is most intimate in man14 man is thus willed by God.4 For 14:9-10).8 Maninallhisactivi- and of greatest value,15 as a re- our work, it should be stressed ty, and his spiritual activity as sult of which, and this is a very that man as at one and the same well, is determined and condi- important point, man is particu- time a corporeal and spiritual tioned by his body, an essential larly the image of God. In addi- being who expresses and per- component of his personal uni- tion, and this is equally impor- ceives spiritual realities ty and a point of encounter tant, ‘soul’ also means the spir- through material signs and with God.9 John Paul II ob- itual principle of man.16 Now, symbols.5 In the medical field, served: ‘The Creator assigned specifically on the basis of this 15 for example, clinical-semiolog- the body to man as a task; man conception of the ‘soul’ as the ical signs, which are the char- does not have a body, he is his most intimate element of man, acteristics of a given pathology body, and thus his vocation is by which man is in a particular (for example pain in muscular- to become it’.10 way the ‘image of God’, and of tension headaches) indicate not the ‘soul’ as the spiritual ele- only physical pain that is ex- ment of man, the Church teach- tremely intense (algos) but also es that every spiritual soul is its internalisation in a moral- created directly by God – it is spiritual suffering (pathos). not ‘produced’ by the parents – and it is immortal. Thus the 1.1 The human body soul of man does not perish at the moment of death, of its sep- It is known that modern phi- aration from the body; indeed, losophy sees the human body at the moment of the final res- not only as something opposed urrection the soul will be reunit- to the soul but as the external ed once again with its body. expression of the human per- Thus after death as well there son in contact with the material remains, after a certain fashion, world and other beings (Man- a relationship between these cuso, 2007). This expressive two constitutive elements, the capacity makes the body capa- soul and the body, of the human ble of a real existential relation- person. All of this is very evi- ship and of full self-fulfilment. dent in the resurrection of In this way, the human body Christ. Indeed, the divine per- manifests not only the interior- son of Christ remained united ity of the soul but in a certain to his soul and to his body even sense also leads it from the ex- 1.2 The spiritual soul after their separation at the mo- ternal towards the soul. Man, united to the body ment of his death on the cross. created by God, as male and fe- ‘By the unity of the divine na- male, does not have a body but The duality of the human be- ture, which remains present in is a body. This existential and ing implies that the unity of the each of the two components of personalistic direction of the soul and the body is so pro- man, these are reunited. For as soul is in full harmony with di- found that the soul should be death is produced by the sepa- vine revelation regarding the seen not only as the ‘form’ of ration of the human compo- human body of the Word made the body: also, specifically nents, so Resurrection is Flesh.6 Taking up John’s ex- thanks to the spiritual soul, the achieved by the union of the pression, “the Word became body, made up of matter, is a two’.17 flesh” (Jn 1:14), the Church human and living body. The A significant confirmation of calls “Incarnation” the fact that spirit and matter, in man, are the anthropological importance the Son of Good assumed hu- not two conjoined natures: their of this unitary duality of the man nature in order to accom- union makes up a single na- body and the soul is offered by plish our salvation in it’.7 Thus ture.11 Because of its unity with the encyclical Deus caritas est: the Son of God manifests his the soul, the ‘human body of ‘Man is truly himself when his divinity specifically in human man shares in the dignity of the body and soul are intimately

DOLENTIUM HOMINUM N. 75-2010 united; the challenge of eros ‘I’ of the same humanity. The salvation, so that what we had can be said to be truly over- man and the woman are, with lost in Adam, that is being in come when this unification is an identical dignity, ‘in the im- the image and likeness of God, achieved. Should he aspire to age of God’. In their ‘being- we might recover in Christ Je- be pure spirit and to reject the man’ and ‘being-woman’ they sus.’.25 ‘For this reason Christ flesh as pertaining to his ani- reflect the wisdom and the experienced all the stages of mal nature alone, then spirit and goodness of the Creator.20 The life, thereby giving communion body would both lose their dig- ‘perfections’ of the man and the with God to all men’.26 Indeed, nity. On the other hand , should woman reflect something of the because in his incarnated divine he deny the spirit and consider infinite perfection of God: person Christ ‘united himself matter, the body, as the only re- those of a mother21 and those of after a certain fashion to every ality, he would likewise lose a Father and a spouse.22 man’, he offers ‘to everyone the his greatness. The epicure At this point we come to a possibility of coming into con- Gassendi used to offer determining conclusion of our tact, in a way that God knows, Descartes the humorous greet- analysis about pain, the body ing “O Soul!” And Descartes and the soul from a scientific would reply “O Flesh!”’.18 Now and theological point of view. to explain the relationship be- ‘God calls man and woman, tween eros and agape, Pope made in the image of the Cre- Benedict XVI makes clear that ator, who ‘loves everything that neither the body nor the soul exists’ (Wis 11:24), to share in alone love;itisman,theper- his providence toward other son, who loves as a unitary creatures; hence their responsi- 16 creature, of which the body and bility for the world God has en- the soul form a part. Only when trusted to them’.23 More con- both of them are truly fused in cretely, this means that God unity does man become fully makes the gift to men of being himself. Only in this way can intelligent and free creatures so love – eros – mature to its true as to complete the work of cre- greatness.19 What has been said ation, perfecting its harmony applies analogically to pain as for their welfare and the wel- with the paschal mystery’. He well, precisely because it is not fare of neighbour. Co-operators calls his disciples to take up only the body that suffers but who are often unaware of the their cross and follow him (cf. also the soul; in other words, divine will, men can deliberate- Mt 16:24) because he suffers man, the person, who suffers, in ly enter the divine plan through with us, leaving behind him an being a unitary creature does their actions, their prayers, but example for us, so that we may not suffer only physically (al- also with their sufferings (cf. follow in his footsteps (cf. 1 Pt gos) but also spiritually Col 1:24). They then become to 2:21). Indeed, he wants to asso- (pathos). For this reason, pain the full ‘co-workers of God’ (1 ciate his redemptive sacrifice involves not only the body but Cor. 3:9: 1 Ts 3:2) and his with those who are its first ben- also the mind. To complete our Kingdom (cf. Col. 4:11).24 The eficiaries.27 This takes place in analysis of man and pain, we human body can, therefore, be- an eminent way for his mother, will now dwell upon the dimen- come a point of encounter be- who is associated more inti- sion of human nature, upon between God and man, above all mately than any other person ing male and female. when he is suffering, as is with the mystery of his redemp- borne out by our communion tive suffering (cf. Lk 2:35).28 1.3 A unity in two: with the suffering of Christ, The Apostle also provides a one for the other that is to say the Christian moving testimony to this: ‘by meaning of pain in the design means of my physical suffer- Created together, man and of God. ings I am helping to complete woman were willed by God for what still remains of Christ’s each other. ‘It is not good for suffering on behalf of his body, the man to live alone. I will 2. The Meaning of Human the Church (Col 1:24). By these make a suitable companion to Suffering in the Order words St. Paul seeks to explain help him’ (Gen 2:18). None of of the Redemption the salvific value of a long jour- the animals can be this ‘in rela- ney which unravels specifically tion to’ man (cf. Gen 2:9-20). What Jesus did, said and suf- through suffering, in as far as it The woman that God ‘formed’ fered, had as its purpose that of is inserted in the history of man with the rib that had been taken re-establishing man in his prim- and illuminated by the word of from the man and that He takes itive vocation of being elevated God. This discovery of the val- to man brings forth from the to likeness to God, falling, ue of suffering leads him to say: man a cry of admiration, an ex- however, because of original ‘And now I am happy about my clamation of love and of com- sin. St. Irenaeus of Lyons sufferings for you’ (ibidem). munion: ‘At last, here is one of wrote: ‘When Christ became However much this discovery my own kind – Bone taken incarnate and was made man, of the Christian meaning of suf- from my bone, and flesh from he recapitulated in himself the fering is ‘very personal’, Paul my flesh’ (Gen 2:23). The man long history of mankind and of Tarsus wants the salvific discovers the woman as another procured for us a ‘short cut’ to meaning of suffering to be valid

DOLENTIUM HOMINUM N. 75-2010 for all men who suffer. Human 2.2 Pain pathways and Pain creates a language with the suffering not only provokes characteristics of the soul that leads to self-knowl- compassion and respect but al- language of the edge that becomes awareness in so, in its own way, intimidates relationship between pain a perfect synthesis between ra- because in it is contained the and the soul tio et fides. greatness of a specific mystery. Indeed, if the soul, a gift of Thus, states John Paul II, within The algic system is a neu- God of life, is seen as a princi- every human suffering there ronal system made up, ple of spiritual activities, it is must draw near, indeed unite, in schematically, of four function- clear that it has in the brain the a particular way, the reasons for al zones: 1. the area of recep- seat of the perception of pain a particular respect from the tion which is characterised by and in the mind the seat of the deepest need of the heart and the pain receiver; 2. the area of internalisation of pain. the profound imperative of transmissionmadeupoftheaf- From what has been said faith. The first reason, that of ferent pathways (spinothalamic hitherto we have reached the the need of the heart, orders us pathways: neo- and paleo- crucial point of the relationship overcome fear; the other, that of spinothalamic) which take the between pain and the soul and the imperative of faith, provides input of the pain receiver to the we would like to make clear the contents of mystery. Indeed, thalamus; 3. the area of the in- that physical pain (algos) per- in the name of and because of tegration of pain made up of ceived by the soul (mens)and these contents, we venture to the cortex; and 4. the area of re- received at the level of the brain touch what seems in every man turn made up of the efferent (ratio) is defined as having a so intangible; in his suffering pathways (above all of the cor- meaning that is not only imma- man remains an intangible mys- tical-bulb-spinal pathways). In nent, connected with the pain of tery.29 Now, given that man schematic fashion this can be the body (algos), but also tran- 17 through his earthly life walks in expressed in the following scendent, connected with the one way or another on the pathway: reception —› transmis- pain of the soul (pathos). In this way of suffering, we want to sion (afferent pathways) —› way an osmosis of the relation- encounter real man on this perception and integration (cor- ship between pain and soul is pathway, identifiable in the an- tex) —› return (efferent path- actuated which leads to search thropological context of the ways) (fig. 1). for algos (object) which is unity of the body and the soul From this model one can un- transformed into pathos (sub- of the human person, in the derstand how the individual ject) who acquires knowledge communal character of the hu- perceives pain above all when of the algos (perception of man vocation in the plan of this reality reaches the cortex of one’s own body), which be- God (ordo creationis) and our brains, the centre of the comes awareness of the pathos above all in the context of par- mental, motor and sensorial ac- (perception of one’s own self ticipation in the meaning of the tivities and in man the centre of by the soul-mind) in a whole in suffering of the passion of thought.30 Physical pain (algos) the Self-Individual (immanent Christ (ordo redemptionis). has its own language which being with pain = algos + However, for the sake of the bears upon the mind and in par- pathos) which is actuated, completeness of this study we ticular upon the soul, to which through Redemptive Grace, in will illustrate where pain comes it accedes, above all through the the Self- Person (transcendent from and how it is channelled. pathway of suffering (pathos). being, unity of the soul and the

Fig. 1. Pain pathways.

Somatic sensorial cortex

III order neuron

Thalamus (NVPM/NVPL)

II order I order neuron neuron Algogenic stimulus Receptors Spinal column

Schematic portrayal of the path followed by the algogenic stimulus NVPM = Ventroposteromedial nucleus of the thalamus NVPL = Ventroposterolateral nucleus of the thalamus

DOLENTIUM HOMINUM N. 75-2010 body) in a single projection means the involvement of the headache could be an example which is ascendant towards soul (a. algological) as the re- of pathological illnesses. God (Logos) (fig. 2), synaptic sult of interactions of the recep- In the two-systems theory Unity of the immanent system tor components beginning sole- that we propose, in which can (ordo creationis) and the tran- ly with the corporeal periphery be seen the synapsis between scendent system (ordo redemp- (algos); for algo-pathological the immanent system and the tionis) (the two-systems theory, illnesses the soul is the result (a. transcendent system, which is fig. 2). algo-pathological) of interac- actuated in the person, as a The interruption of the dio- tions of the peripheral receptor creature, unity of soul and logical relationship with God components (algogenetic recep- body, of the Creator, in the (fig. 3) leads to algo-logical ill- tors, algos) and the central re- sphere of neurophysiology, a nesses of the soul, with a reduc- ceptor components (limbic sys- drawing near occurs sponta- tion in the physical pain thresh- tem and cortex, pathos); for neously with the three-worlds old (algos); to algo-pathological pathological illnesses, the soul theory of the neuro-philosopher illnesses with a reduction in the is the result (a. pathological) of Karl Popper (and explained by threshold of mental-physical the interaction of the receptor the neurophysiologist, the No- pain (algos + pathos); and to components, above all the cen- bel prize winner, John Eccles). patho-logical illnesses, with a tral ones (cortex, pathos). Eccles posits a synapsis be- reduction in the threshold of An example of algological tween dendrons, cells of the mental pain (pathos) (fig. 2). illness could be cluster brain, and psychons, cells of the It is opportune to stress that headache; migraine could be an brain, through fields of quan- when speaking about algologi- example of algo-pathological tum probability, in which waves cal illnesses of the soul one illness; and muscular-tension (neurophysiological waves) are 18 said to modulate the release of Fig. 2. The two-systems theory: ordo creationis (God-Logos) neurotransmitters in the inter- and ordo redemptionis (God-Incarnated Logos). GOD (Logos), synaptic space. synaptic Unity of the immanent system (Pain, body) and The criticism of this theory Transcendent system (Soul, mind). by some researchers, for example Changeux and the Nobel PAIN: BODY-SOUL. BRAIN-MIND prize winner Edelman, as re- Ordo Creationis Ordo Redemptionis gards a synapsis between an or- (immanent system) (transcendet system) ganic system (the brain) and a functional system (the mind) PAIN SOUL can be overcome by the med- (body, brain) (mind, fides, ratio) ical-theological idea of the theory of the two systems (fig. 2), identifying in the soul (mind, psyche) of the person the ALGOS PATHOS synapsis between the two sys- (body-object) (soul-object) tems, one organic (brain-den- ALGOLOGICAL SOUL PATHOLOGICAL SOUL drons-soma) and one functional (mind-psychons-psyche),explainable in the close re- KNOWLEDGE OF ALGOS AWARENESS OF PATHOS lationship between physics and (body: perception (mind: perception consciousness, between ratio of one’s own body) of soul-mind) and fides: once again, in delicate medical questions, theological science comes to the aid I-INDIVIDUAL REDEMPTIVE GRACE I-PERSON of medical science. (Immanent being (Transcendent being with pain =algos + pathos) with pain = unity of soul and body) 3. The Theological Aetiology of Illnesses

Dialogical interruption between GOD (Logos) and man Interpreting the symbolism of Biblical language in an authentic way, the Church teach- 1) ALGOLOGICAL ILLNESSES (physical illnesses of the soul: es, in the light of the New Tes- a. algological; reduction of the threshold of physical pain tament and Tradition, that our (algos; tab. I.) first parents Adam and Eve 2) ALGO-PATHOLOGICAL ILLNESSES (mental-physical were created in a state of ‘original holiness and justice’.31 The illnesses of the soul: a. algo-pathological; reduction of the grace of original holiness was threshold of mental-physical pain (algos+pathos; tab. II.) ‘participation in divine life’.32 3) PATHOLOGICAL ILLNESSES (spiritual illnesses of the soul: This participation, and this is a. pathological; reduction of the threshold of mental pain very important for the search (pathos; tab. III.) into the causes of illnesses, strengthened all the dimensions

DOLENTIUM HOMINUM N. 75-2010 of the life of man by its radi- leased at the level of the for earthly goods and self-as- ance to an improbable point. synapses of our brain, but also, sertion, contrary to the dictates The Catechism of the Catholic and above all else, the result of of reason.36 St. Thomas Church states: ‘As long as he an incapacity as regards dia- Aquinas observes: ‘because of remained in the divine intima- logue with the transcendent original justice, the reason of cy, man would not have to suf- sphere (fig. 3). man was subjected to God, his fer or die (cf. Gen 2:17; 3:19; inferior faculties to reason and 3:16). The inner harmony of the 3.2 The radical cause: his body to his soul. But be- human person, the harmony be- original sin cause of original sin this bal- tween man and woman (cf. Gen ance was broken: and because 2:25), and finally the harmony Because of the sin of our first his reason was no longer sub- between the first couple and all parents, however, the original jected to God, the inferior fac- creation, comprised the state holiness was lost and as a con- ulties rebelled against reason called “original justice”’.33 This sequence that original justice as and his body withdrew from triple harmony, that is to say in- well which God, in His design, obedience to his soul because tra-personal, inter-personal and had envisaged for man. Indeed, of death and corruption’.37 cosmic harmony, is thus the tempted by the Devil, man al- What has been observed brings outcome of religious harmony, lowed trust in his Creator to be out that the originating cause of that is to say, of man’s familiar- extinguished (cf. Gen 3:1-11), illness is original sin, precisely ity with God. From their friend- and abusing his own freedom, because in interrupting the dia- ship with God derived the hap- he disobeyed God’s command- logue of love with God, its ef- piness of their existence in par- ment. Holy Scripture shows the fect, original justice, not having adise. The sin of this ‘original dramatic consequences of this to suffer or die, was lost. But, holiness’ is the fact that God interruption in the dialogical re- and this is equally important, 19 places man in the garden (cf. lationship between man and both mortal and venial sin drag Gen 2:8) where he lives “to till God. Adam and Eve were the person into perdition and it and keep it” (Gen 2:15); work afraid of God (cf. Gen 3:9-10) with the repetition of the same is not a burden (cf. Gen 3:17- of whom they had a false im- acts generates vice. Perverse 18) but rather the collaboration age, an image, that is to say, of inclinations derive from this of man and woman with God in a God jealous of His own pre- that obscure the conscience and perfecting the visible creation.34 rogatives (Gen 3:5). As regards alter the concrete judgement of the harmonies, these, too, were good and evil. In this way sin 3.1 The causes of a moral destroyed: the mastery of the tends to reproduce itself and order of illnesses spiritual faculties of the soul strengthen itself, even though it over the body was shattered.35 cannot destroy the moral sense From the relationship be- The ‘dominion’ over the world at its root.38 tween pain and the soul we that God from the outset had should ask ourselves whether granted to man was accom- 3.3 The proliferation of sin: the algic perception in certain plished first and foremost in the capital vices illnesses that produce not only man himself as mastery over physical pain (algos) but also, himself. Man was integral and Of a rather uncertain etymo- and above all else, mental pain ordered in the whole of his be- logical origin, the word ‘vice’ (pathos), is the clinical result ing because he was free of the undoubtedly refers to a heart obtained not only through the triple concupiscence (cf. 1 Jn that is not well disposed and stimuli of pain receptors led by 2:16), but now, and this should certainly not directed towards afferent pathways to the central be stressed, it is specifically God. A vice is a habitual incli- nervous system (CNS) and the this triple concupiscence that nation to sin, which has arrived hyper-production of certain made him a slave to the plea- totally or almost totally to the chemical substances that are re- sures of the senses, of the greed point of indifference and thus to the extinction of the remorse of Fig. 3. Aeitiopathogenesis of algo-logical illnesses, conscience.39 This applies first algo-pathological illnesses and patho-logical illnesses of the soul. and foremost in the case of venial sins which do not break the ORIGINAL SIN covenant with God but weaken charity inasmuch as they manifest a disordered affection for INTERRUPTION OF THE DIALOGICAL RELATIONSHIP created possessions. These sins BETWEEN GOD AND MAN obstruct the advances of the soul in the exercise of the virtues and the practice of 1) ALGOLOGICAL ILLNESSES PHYSICAL PAIN (ALGOS) moral good. In this sense, the vices can be catalogued in par- 2) ALGO-PATHOLOGICAL MENTAL-PHYSICAL PAIN allel to the virtues to which ILLNESSES (ALGOS + PATHOS) they are opposed or be connected to the capital sins. The 3) PATHOLOGICAL ILLNESSES MENTAL PAIN Christian experience calls them capital vices because they gen- (PATHOS) erate other sins, other vices, and

DOLENTIUM HOMINUM N. 75-2010 they are seven in number: a desire for transitory good’.42 component (sickness-ethos), pride, greed, envy, rage, lust, The capital vices are the cause which constitutes the emotional greed, and laziness or sloth.40 of the proliferation of sin, and value of pain described and ex- St. Thomas Aquinas compares thus of the interruption, if the perienced in the social context, the seven capital sins with the sin is a mortal sin, of the dia- creating culture and customs seven tendencies of vice of logue of love with God, and if (nomos). man, beginning from the fact it is a venial sin, they constitute, that the capital vices are such anyway, a con-cause of painful 4.1 Pain between nature specifically from a finalistic illnesses. Indeed, all sinners and culture point of view. Those vices are have been, and are, the authors deemed capital whose ends pre- of the passion of Christ. The Pope John Paul II observed: sent attractive fundamentals de- Roman Catechism emphasises ‘Medicine, as the science and signed to stimulate the appetite: specifically in relation to vices: also the art of healing, discov- and it is on the basis of their ‘We must regard as guilty all ers in the vast field of human differences that the capital those who continue to relapse sufferings the best known area, vices are distinguished. Now, a into their sins. Since our sins the one identified with greater thing can stimulate the appetite made the Lord Christ suffer the precision and relatively more in two ways: directly and by it- torment of the cross, those who counterbalanced by the meth- self and from this point of view plunge themselves into disor- ods of “reaction” (that is, the good stimulates the appetite as ders and crimes crucify the Son methods of therapy). Nonethe- an attraction whereas evil stim- of God anew in their hearts (for less, this is only one area. The ulates as a rejection indirectly he is in them)… Nor did the field of human suffering is and as a reflection, in the case demons crucify him; it is you much wider, more varied, and 20 for example of those who ad- who have crucified him and multi-dimensional. Man suffers dress an evil aiming at a con- crucify him still, when you de- in different ways, ways not al- nected good, or in the case of light in your vices and sins’.43 ways considered by medicine, those who flee from a good be- not even in its most advanced cause of the evil that accompa- specializations. Suffering is nies it. The capital vices thus 4. The Multi-Dimensional something which is still wider imply a disordered desire for Character of Pain than sickness, more complex four possessions of the sphere The algo-logical illnesses and at the same time still more that can involve concupiscence (of the soul) deeply rooted in humanity it- and a disordered flight from self.’ In the relationship be- three arduous possessions. The The terrain of human suffer- tweenmanandpainscience,in vice of sin concerns the disor- ing is multidimensional. The al- order to combat the various dered desire for excellence as a gological school of Florence painful pathologies, increasing- possession of one’s own spirit; defines ‘pain as a mental-phys- ly tends to use not only the ex- the vice of gluttony concerns ical entity, with universal val- perimental model but also, and the disordered desire for the ues, in the perception of which above all else, the anthropolog- conservation as a possession of different individual, cultural ical model, in order to counter one’s own body (food and and religious causes are at work the fracture between technolo- drink); the vice of lust concerns and in the contextualisation of gy and medicine, on the one the disordered desire for the which take part not only the hand, and philosophy and epis- conservation of the species as disciplines of medicine and bi- temology, on the other. In all one’s own corporeal possession ology but also those of the hu- branches of knowledge, and in (coitus); the vice of greed con- man sciences (philosophy and medical science in particular, cerns disordered attachment to psychology)’.44 From this defin- scientific language must be an- one’s own wealth; the vice of ition emerges the importance of imated by the search for the in- sloth concerns disordered flight creating, first of all, an excel- ternalisation of science in from one’s own good because lent relationship between the knowledge which must, in its of the evil that accompanies it, patient and the doctor, and three turn, be transformed into a dy- for example the corporeal trials fundamental components are namic awareness of man to- that accompany the acquisition emphasised: 1. the sense-per- wards other men in the princi- of a spiritual good; the vice of ception component (disease-al- ple of service. Only in this way envy concerns sadness at an- gos), which constitutes the will science rediscover Love, as other’s good, conceived as an physical and sensorial value of the only value that brings life. impediment to one’s own ex- pain described in terms of time In the perception of pain by celling; the vice of rage con- (acute and chronic pain) and the soul a synthesis is actuated cerns rebellion that leads to re- space (local and widespread between science, culture and venge.41 St. Thomas makes pain); 2. the cognition-assess- wisdom, and thus a union be- clear another important aspect: ment component (illness- tween the neurosciences, phi- ‘The process of the origin of pathos), which constitutes the losophy and theology, with the vices is not the same as that internally projected value of acquisition by the soul of a with virtues: this is because pain and the meaning that is at- symbiotic entity which can be virtues are caused by the subor- tributed to it. This is a matter of defined in neuro-philosophical dination of appetite to reason, how a person addresses pain terms as the algological soul, or to the eternal good of God; and how it is internalised; and algopathological soul and whereas the vices are born from 3. the affective-motivational pathological soul. This percep-

DOLENTIUM HOMINUM N. 75-2010 tionofpainbythealgological soul creates a therapeutic level Tab. I. Most frequent examples of algological illnesses (algos) of wisdom for health in balance Cluster headache Traumas with the laws of nature, where Trigeminal neuralgia Disc hernias the body constitutes the point of Arthrosis Arteriopathy encounter where the patholo- Arthritis Phantom limb gies of the body itself come to- Osteoporosis Cancer gether (algological illnesses, tab. I) with those of the soul (al- Tab. II. Most frequent examples of algo-pathological illnesses go-pathological illnesses, tab. II, and pathological illnesses, (algos+pathos) tab. III), transforming the phys- Migraine iognomy of the algological Fibromyalgic Syndromes (corporeal) soul towards the Muscular Fatigue Syndromes physiognomy of the pathological (spiritual) soul (fig. 2), a Tab. III. Most frequent examples of pathological illnesses transformation which for the (pathos) Christian believer is connatural. Muscle tension Headache Given the close connections that the soul has with the body, Depression the (therapeutic) improvement Depressive Syndromes of physical pain (algos) leads to Psychological illnesses derived from capital vices an improvement of mental pain (algos + pathos), of spiritual repentance. The purpose of Creator and His creature in an 21 pain (pathos), and of social pain penance is to overcome evil, always new form of language. (ethos), creating behaviour of which under different forms lies From a functional point of the person that is lifestyle and dormant in man. Its purpose is view, pain manages to interfere witness (nomos). also to strengthen goodness in the anatomical centres of lan- Despite the fact that pain is both in man himself and in his guage, creating the value of a above all a physical, corporeal relationships with others and semantic entity that is always and material perception, and especially with God’.46 renewable and different. Lan- specifically because it is mater- In the light of faith, bodily guage has specific anatomical ial it is mater e matrix, because pain becomes, as penitence of seats in our encephalon which of its dual unitary character the soul, a stage in redemption are called Broca’s area and (body-soul) it creates, in this and in dialogue between the Wernicke’s area (fig. 4; 4a). concept, a holistic understanding of the various passages from algos to pathos, from Fig 4. The centres of language. pathos to ethos and from ethos Broca’s area and Wernicke’s area (schematic vision) to nomos. This holistic understanding Parietal lobe Motor and these related qualitative area stages correspond to the full in Christianity to personal and so- Somatic-sensitive Frontal area cial anthropology and to the re- lobe Wernicke’s lationship that God has with area suffering man. Broca’s area 4.2 Pain between nature Occipital lobe and faith Temporal lobe Little brain ‘People who suffer become similar to one another through Encephalic trunk the analogy of their situation, the trial of their destiny, or Fig 4a. The centres of language. through their need for under- Broca’s area and Wernicke’s area (anatomical vision) standing and care, and perhaps above all through the persistent Motor Isthmus of the question of the meaning of suf- area cingulate gyrus 45 Motor area of the oral Wernicke’s fering’. An important aspect of area suffering is profoundly rooted cavity Broca’s Hearing area in the entire Revelation of the area Old and above all the New Covenant. ‘Suffering must serve for conversion, that is, for the rebuilding of goodness in the subject, who can recognize the divine mercy in this call to

DOLENTIUM HOMINUM N. 75-2010 The Centres of Language incke’s area. Lesion of these hemiplegia. At the level of clin- Broca’s area (Paul Pierre two centres is expressed in a ical completeness, it is correct Broca: Sainte-Foy-la-Grande, disturbance of language called to add that dysphasia is a par- 1824-Paris, 1880). aphasia. There are two princi- tial disturbance of the expres- Wernicke’s area (Karl Wer- pal types of aphasia: Wern- sion of language. nicke: Tarnowitz, 1848-Dor- incke’s sensorial aphasia, or Every event of our lives, rberg im Geratal, 1905). perception aphasia, and Bro- whether pleasurable (listening Language is actuated in our ca’s motor aphasia, or expres- to pleasant music: the Mozart brains through visual and hear- sion aphasia. Wernincke’s effect. Cf. Zucchi, Honings, and ing systems; the motor system aphasia is characterised by ver- Voegelin, 2005) or painful actuates oral and written lan- bal deafness, that is to say the (trauma. Cf. Zucchi, Honings, guage. The centres of language patient does not understand the and Voegelin, 2003, 2004), and are Broca’s area and Wer- words that are heard, it is as this includes prenatal or neona- nicke’s area (fig. 1; 1a). Bro- though they belonged to a for- tal events (Bellieni, 2004), is ca’s area (discovered in 1864) eign language, and by verbal configured in specific areas is located at the foot of the third blindness, that is to say the pa- (fig. 5; 5a) and re-evoked in left frontal circumvolution of tient does not understand writ- specific conditions, constituting the motor (cortex) area and is ten words (alexia or visual the phenomenon of memory. engaged in the formulation of aphasia). In Wernincke’s apha- From this one can understand movements that are of use in sia the spoken language is flu- how important the experience oral speech. Wernicke’s area ent but its understanding is of a person is, above all in fieri, (discovered in 1874) is located compromised. Broca’s aphasia that is to say when he or she is in the upper surface of the left is characterised by an inability in his or her mother’s womb. 22 temporal lobe (between the to speak, even though the pe- For the memory and learn- hearing area and the isthmus of ripheral language apparatus is ing, as well, very precise the cingulated gyrus of the sen- integral, that is to say phona- anatomical-functional seats ex- sorial cortex) and is used for tion and articulation. The pa- ist in man (fig. 5; 5a). the perception of information. tient knows what to say but The medial temporal lobe Between the two areas, as was does not manage to speak. In and three regions of the dien- posited by Wernincke, connec- this form of aphasia spoken cephalon (anterior nucleus and tions exist and the gravity of language is disturbed but com- medial-dorsum of the thalamus the two types of aphasia de- prehension is relatively intact. and the mamillary bodies of the pends on how much the cortex This is the most common form hypothalamus are the areas in- is damaged beyond the perime- of language alteration which is volved in the elaboration of ters of Broca’s area and Wern- very often associated with right memory and learning. The medial temporal lobe Fig. 5 Areas involved in the elaboration of memory and three regions of the dien- and learning (schematic vision) cephalon (anterior nucleus and medial-dorsum of the thalamus Somatic-sensitive and the mamillary bodies of the area hypothalamus) are the areas in- Motor Parietal lobe area Medial-dorsum volved in the elaboration of Frontal nucleus of the memory and learning. At this lobe thalamus point we ask ourselves what ill- Cyngulate Temporal lobe nesses of the soul are, that is to Anterior say those illnesses connected nucleus of Mamillary bodies the thalamus of the thalamus above all with pathos. Occipital Diencephalon lobe 5. Algo-Pathological Temporal lobe Little brain and Pathological Illnesses (of the Soul)

For John Paul II: ‘Suffering Fig. 5a Areas involved in the elaboration of memory is something which is still and learning (anatomical vision) wider than sickness, more complex and at the same time still Fornix Medial-dorsum more deeply rooted in humanity Anterior nucleus of the thalamus of the thalamus itself. A certain idea of this problem comes to us from the distinction between physical suffering and moral suffering. This distinction is based upon the double dimension of the human being and indicates the bodily and spiritual element as Mamillary bodies of the thalamus the immediate or direct subject of suffering’.47 Thus, ‘Insofar as

DOLENTIUM HOMINUM N. 75-2010 the words “suffering” and man of the Old Testament lives event leads to an authentic “pain”, can, up to a certain de- his sickness in the presence of anatomical injury. gree, be used as synonyms, God. It is before God that he physical suffering is present laments his illness, and it is of when “the body is hurting” in God, master of life and death, 6. The Treatment of Illnesses some way, whereas moral suf- that he implores healing…It is fering is “pain of the soul”. In the experience of Israel that ill- From this analysis of the fact, it is a question of pain of a ness is mysteriously linked to causes of illnesses it emerges spiritual nature, and not only of sin and evil’. Meanwhile we that algo-logical, algo-patho- the “psychological” dimension take as emblematic depression, logical and pathological illness- of pain which accompanies which can be seen not only as a es have a shared origin: the loss both moral and physical suffer- medical illness, but also, and of the original holiness of the ing The vastness and the many above else, as one of the ill- intimate dialogue between man forms of moral suffering are nesses of the soul which in the and God. However despite this certainly no less in number than medical sphere is most devas- sharedaetiology,ananalysisof the forms of physical suffering. tating and recurrent and can the treatment illnesses must But at the same time, moral suf- lead to suicide. create a distinction between fering seems as it were less therapies that concern algo-log- identified and less reachable by 5.2 Depression ical illnesses, algo-pathological therapy’.48 illnesses and patho-logical ill- Depression, or rather depres- nesses . The first (tab. I) are the 5.1 Spiritual pain sive syndromes, can be also responsibility, prevalently, of seen as authentic illnesses of medical doctors; those of the In seeing man as a psycho- the soul which not only create second (tab. II) and the third 23 physical ‘whole’, that great injury at the level of a sick indi- group (tab. III) are the responsi- book of suffering, Holy Scrip- vidual but also at a social level, bility of medical doctors and ture, often conjoins ‘moral’ suf- that is to say to those people priests. Therapies for illnesses ferings with the pain of specific with whom the patient, in- of the body (algo-logical ill- parts of the organism: of the evitably, comes into contact. nesses and algo-pathological bones, of the kidneys and of the This pathology creates injury illnesses) concern the order of heart. One cannot deny, in fact, to the plasticity of the brain of the creation, the immanent or- that moral sufferings also have the spiritual patient and those der, and will be increasingly ap- their ‘physical’ or somatic around him or her. The burn-out preciated in the clinical/genetic component, and that often they syndrome (syndrome of the sphere (Serra, A. 2008). Thera- are reflected in the state of the negative internalisation of oth- pies for patho-logical illnesses whole organism.49 Here are er’s people’s problems; Mayou, concern the order of redemp- some examples from the Old 1987) which takes place in tion, the transcendent order, and Testament. The prophet Jeremi- health-care workers who are in are also followed in the reli- ah exclaims: ‘My sorrow can- contact with an algological pa- gious and not only medical not be healed; I am sick at tient can be explained very well sphere. The health of the body heart’ (Jer 8:18). As an unhap- from the neurophysiological is achieved through spiritual py man but at the same time as point of view with reference to health which creates a style of a penitent man, the Psalmist the plasticity of our brains, a life that predisposes man to turns to Jehovah, saying: ‘Be- quality that creates a functional love. From this point of view, cause of your anger I am in capacity to restructure itself and Javier Lozano Barragán defines great pain; my whole body is thus to change on the basis of theconceptofhealthverywell: diseased because of my sins. I acquired experiences.50 ‘health is a dynamic towards am drowning in the flood of The physiopathological physical, mental, social and my sins; they are a burden too mechanism of depressive spiritual harmony and is not on- heavy to bear… I am worn out episodes can be interpreted fro ly absence of illness: it enables and utterly crushed; my heart is a medical-theological point of man to carry out the mission troubled; and I groan with pain. view in the following way: the that God has entrusted to him, O Lord, you know what I long experience of the interruption according to the moment of his for; you hear all my groans. My of the dialogue with God (fig. life in which he finds himself’.51 heart is pounding, my strength 3) creates an imprinting in a Algological and pathological is gone, and my eyes have lost part of our encephalon (the illnesses of the soul can be, and their brightness. My friends plastic part) which gives rise to must be, treated as long as the and neighbours will not come a functional mutation of certain patient is invited by his or her near me, because of my sores, areas of the brain (fig. 5; 5a) medical doctor to follow a even my family keeps away which through the phenomenon pharmacological and ethical from me’ (Ps 38:4-5; 9-12). of memory facilitates the repeti- therapy and by his or her priest What is striking in this pain of tion of the pathological event. to follow a spiritual-behaviour- the soul is the fact that the suf- Thus the interruption of a spiri- al therapy. fering person is before God, in- tual relationship for the believ- Pharmacological therapy capable of dialogue with God, er, or a relationship involving constitutes an obligatory point with the transcendent sphere. values for the agnostic, leads to to follow in the protocol to be The Catechism of the Catholic a functional alteration which followed in patients afflicted by Church observes here: ‘The with the perseverance of the algological illnesses where the

DOLENTIUM HOMINUM N. 75-2010 presence of the physical com- One point, the one at the (tab.IV)whichreferstothe ponent of pain (algos) is un- bottom, refers to the condition pathway that a medical doctor pleasant and impelling. In these of absence of pain; the other, should follow according to the conditions the intensity of pain that at the top, refers to the intensity of the pain of the pa- is assessed according to the condition of maximum pain. tient. The lowest level (level VAS scale of Scott-Huskisson This scale is given to the pa- 3) in clinical terms involves (1976, 1979, fig. 6). The VAS tient who has to indicate on it light pain which has to be ad- scale of Scott-Huskisson has a the intensity of his or her own dressed by following a phar- vertical line 10cm. in length pain. Subsequently, thanks to macological therapy based on with two points at its end. the measuring in millimetres non-steroid anti-inflammato- of the segment between the ries: acetylsalicylic acid, Fig.6. VAS Scale: L is a end of the scale which corre- paracetamol, dicofenac, with segment on which the patient sponds to the absence of pain the possible support of support marks the level of pain and the point indicated, one steroids (methylprednisolone, perceived. The segment obtains the conversion of the dexametasone, medroxiprog- between the marked point algic intensity into a given esterone acetate). The middle and the point of “no pain” is number which can be used in a level (level 2) refers clinically measured in centimeters. statistical computation. At the to moderate pain which is present time the VAS scale is treated with a pharmacologi- L the most sensitive method cal therapy based on weak MAXIMUM 10 cm there is for the assessment of opiates (codeine, destro- PAIN pain (and above all acute pain) propoxiphene) together with in the clinical setting. Unfortu- FANS and possible support 9 nately, this method cannot be steroids. The highest level applied to individuals in a (level 3) refers clinically to 8 state of confusion or with an very intense (unbearable) pain intellectual deficit, even which has to be addressed 7 though in it pain is simplified with a pharmacological thera- in a linear representation. With py based on strong opiates this method a medical doctor (morphine), with the possible 6 PAIN has a specific measurement of addition of FANS and sup- pain for the algological pathol- ports (steroids; psychotropic PERCEIVED 5 ogy of the patient being exam- drugs). ined and can implement a 4 pharmacological therapy that To provide an overall pic- is certainly appropriate by fol- ture, it must be borne in mind lowing the guidelines suggest- that weak opiates, differently 3 ed by the WHO (World Health from strong opiates, all have a Organisation). ceiling effect, that is to say 2 above a certain dosage their The Three-Level analgesic power does not in- Analgesic Scale crease, with the appearance, 1 The WHO suggests the however, of greater side ef- NO three-level analgesic scale fects. This effect explains why PAIN 0

Tab. IV. Three-level Analgesic Scale POWERFUL OPPIATES (Morphine) + Level 3 Anti-inflammatories (FANS) +/– Supports (steroids; psycotropic drugs)

INTENSE PAIN WEAK OPPIATES (Codeine, Dextropropoxyphene) + Level 2 Anti-inflammatories (FANS) +/– Supports (steroids)

MODERATE PAIN

Anti-inflammatories (FANS) +/– Supports (steroids) Level 1 LIGHT PAIN

DOLENTIUM HOMINUM N. 75-2010 after about thirty days it is necessary to move from weak opi- Tab. V. Therapies of pain for algological illnesses ates (codeine) to strong opiates at a physical level: algos (morphine). F.A.N.S. (non-steroid anti-inflammatories): Unfortunately, because of (acetylsalicylic acid , diflunisal, indometacine, ibuprofen, unfounded fears which are ketoprophene, naproxen, indoprophen, diclofenac, piroxicam) present above all in the Latin culture both of medical doctors Fluorate corticosteroids and patients, the use of opiates (desametasone, betametasone, triamcinolone, fluocinolone) in the fight against pain is at a very low level, with Italy rank- Non-fluorate corticosteroids ing 102 in the world in the use (cortisone, idrocortisone, frednisone, frednisolone, of these substances, whereas metilprednisolone, prednolene) the United States of America Anti-convulsives and Sweden occupy the first (diazepam, carbamazepine, difenilidantoine, pregabalin, and second positions. gabapentin) The Clinical-Therapeutic Central antalgics (tramadol, codeine, oxicodone, morphine) Three-Level Scale: Pharmacological, Ethical Placebo and Spiritual Similarly to the analgesic scale suggested by the WHO Tab. VI. Therapies of pain in algo-pathological illnesses at (tab. IV), which examines the the mental-physical level: algos + pathos. 25 intensity of pain above all in 1) Antidepressants the oncologic field above all Tricyclical anti-depressants 3) Lithium salts from a quantitative point of Imipramine Desipramine view, we propose the clinical- therapeutic scale (tab. VIII) Trymipramine Clomipramine 4) PLACEBO which the medical doctor and Amitryptiline Nortryptiline priest should follow, also bear- Doxepine Protryptiline 5) PRAYER ing in mind the qualitative pa- Butryptiline Maprotyline rameter of pain (algos, pathos), on the basis of pathologies that 2) Inhibitors of monoaminoxidasis are underway, that is to say al- Iproniazide gological illnesses (physical Isoniazide pain), algo-pathological ill- Alpha-methyl-tryptamine nesses (mental-physical pain) and pathological illnesses 3) New antidepressants (spiritual pain). Amineptine Mianserine Dotiepine Noxiptiline Level 1: Trazodone Nomiphensine pharmacological therapy Melitracen Fluoxetine Pharmacological therapy (tab. V), which is obligatory Viloxazine Adenosilmetionine for algo-logical illnesses Sertraline where there is present above all else the physical compo- Tab. VII. Therapies of pain of pathological illnesses nent of pain (algos), is to be suggested also in algo-patho- at a spiritual level: pathos. logical illnesses where there is Classical music (Mozart effect) and placebo present above all else the inter- Ethical therapy nalisation of physical pain in Behavioural therapy moral suffering (algos > pathos; level 2) and in pathological illnesses where pain of health-care worker inviting the L., Honings, B. and Voegelin, a spiritual kind is present patient to engage in meditation M. R. 2001; 2003; 2005; 2008. (pathos; level 3). and prayer with the aim of ob- In these last two nosological taining a strengthening of the Level 3: spiritual therapy entities (algo-pathological ill- effect of the medical therapy Spiritual therapy involves nesses and pathological ill- and an improvement in his or opposing capital vices with the nesses) is to be suggested her condition of physical pain cardinal virtues of prudence, above all else ethical therapy (algos), physical-mental pain justice, fortitude and temper- (level 2) and spiritual-behav- (algos + pathos ) and spiritual ance (behavioural therapy) ioural therapy (level 3). pain (pathos), as suggested by proposed by the priest and also Zucchi, P. L. and Honings, B., by the medical doctor, with the Level 2: ethical therapy 1996; Ratzinger, J. and support of music and ethical Ethical therapy involves the Bertone, T., 2000; Zucchi, P. therapy (tab. VIII).

DOLENTIUM HOMINUM N. 75-2010 Tab. VIII Three-level clinical therapeutic scale Level 3 SPIRITUAL THERAPY obtained by: 1) Classical music (Mozart effect) Patho-logical illnesses (tab. III) and placebo Treatment of pain 2) Ethical therapy at a spiritual level (pathos) 3) Behavioural therapy (opposition of the cardinal virtues to the capital vices)

Level 2 ETHICAL THERAPY Antalgics and antidepressants Algo-patho-logical illnesses (tab.V+tab.VI) (tab. II) + placebo + prayer Treatment of pain at a physical-mental level (algos —> pathos)

26 Level 1 PHARMACOLOGICAL-ANTALGIC THERAPY FANS, cortisone, central antalgics (tab. V) Algo-logical illnesses (tab. I) + placebo + prayer Treatment of pain at a physical level (algos)

This therapeutic approach joys and thus when it has per- action of God and also express suggested by us and which we fect love it will enjoy perfect the very essence of liberation like to define as the three-level health’.53 Here the advice that from evil, which brings in it- clinical-therapeutic scale must John Paul II provided us with self the definitive and absolute be implemented taking into ac- in his apostolic letter Salvifici perspective on suffering. Thus count the ethical-religious ap- doloris is very illuminating: the very verb ‘to give’ indi- proach of the patient (whether we must turn our gaze towards cates that this liberation must believer or agnostic) and in the revelation of divine love. be accomplished by the only full cooperation with him or We must welcome the light of begotten Son through his own her. Revelation not only because it suffering and it is in this that is expresses the transcendent or- manifested the infinite love of 6.1 The therapy of love der of justice but also because both the only begotten Son and it illuminates this order with the Father. It is love for man, In the view of St. John of the love, as a definitive source be- for the ‘world’, given that man Cross ‘love of God is health of cause it is the ultimate source not only ‘may not die’ ‘but the soul’.52 In outlining this of meaning for everything that have eternal life’. Indeed, Pope concept this Spanish mystic exists, and thus also of illness- John Paul II points out, ‘Man (1542-1591) emphasised that es and their treatment. Love is “perishes” when he loses spiritual health constitutes the also the fullest source for the “eternal life”. The opposite of premiss for a capacity of love, answer to the question of suf- salvation is not, therefore, only and wrote in his spiritual song: fering, and this answer was temporal suffering, any kind of ‘the soul, denied perfect love, given by God to man in the suffering, but the definitive does not have perfect health cross of Jesus Christ.54 suffering: the loss of eternal because in remaining sick it re- life, being rejected by God, mains without health. In this 6.1.1 Jesus Christ: suffering damnation. The only-begotten way when it does not have any defeated by love Son was given to humanity level of love, the soul is dead: In his conversation with primarily to protect man whereas if it has some level of Nicodemus Jesus declared: against this definitive evil and love of God, however small ‘For God loved the world so against definitive suffering. In this may be, the soul is alive, much that he gave his only his salvific mission, the Son but it is very delicate and in- Son, so that everyone who be- must therefore strike evil right firm because of the small lieves in him may not die but at its transcendental roots from amount of love that it has. The have eternal life’ (Jn 3:16). which it develops in human more love grows, the greater These words introduce us into history. These transcendental will be the health that soul en- the centre itself of the salvific roots of evil are grounded in

DOLENTIUM HOMINUM N. 75-2010 sin and death: for they are at we would like to observe, the sexuality within the person and the basis of the loss of eternal words of God ‘For God loved thus the inner unity of man in life. The mission of the only- the world so much that he gave his bodily and spiritual being. begotten Son consists in con- his only Son’ throw upon the Sexuality, in which man’s be- quering sin and death. He con- whole of this dimension of longing to the bodily and bio- quers sin by his obedience un- painful illnesses and all suffer- logical world is expressed, be- to death, and he overcomes ing a new light, the light of sal- comes personal and truly hu- death by his Resurrection’.55 At vation, the light of the Good man when it is integrated into this point, and this is most im- News. the relationship of one person portant, John Paul II further to another, in the complete and makes clear that ‘When one 6.1.2 Therapy through the lifelong mutual gift of a man says that Christ by his mission moral virtues and a woman. The virtue of strikes at evil at its very roots, ‘In his mercy God has not chastity therefore involves the we have in mind not only evil forsaken sinful man. The pun- integrity of the person and the and definitive, eschatological ishments consequent upon sin, integrality of the gift’.61 St. suffering (so that man “should ‘pain in childbearing’ (Jn 3:16) Thomas Aquinas makes clear: not perish, but have eternal and toil ‘in the sweat of your ‘chastity is that value by which life”), but also – at least indi- brow’ (Gen 3:19), also embody man dominates and regulates rectly toil and suffering in their remedies that limit the damag- sexual desire according to the temporal and historical di- ingeffectsofsin.Afterthefall, requirements of reason (illumi- mension. For evil remains marriage helps to overcome natedbyfaith)’.62 The virtue of bound to sin and death’.56 In- self-absorption, egoism, pur- chastity has as its specific, that deed, the suffering of man can- suit of one’s own pleasure, and is to say authentic, object, sex- not be detached from original to open oneself to the other, to ual pleasure, which should be 27 sin and also from what John mutual aid and to self-giving’.60 placed, desired, used and regu- calls ‘the sin of the world’ (Jn This divine help in defeating lated according to a just order.63 1:29), that is to say from the the proliferation of sin and thus And thus it is evident that the sinful background of personal of suffering seeks to return to virtue of chastity defeats ill- actions and social processes of man his self-mastery, which is nesses caused, for example, by human history.57 necessary for him to give of resort to contraceptive devices, The Catechism of the Catholic Church observes: ‘After that first sin, the world is virtually inundated by sin. There is Cain’s murder of his brother Abel (cf. Gen 4:3-15) and the universal corruption which follows in the wake of sin.58 Likewise, sin frequently manifests itself in the history of Israel, especially as infideli- ty to the God of the Covenant and as transgression of the Law of Moses. And even after Christ’s atonement, sin raises its head in countless ways among Christian (cf. 1 Cor 1- 6; Ap 2-3). Scripture and the Church’s Tradition continually recall the presence and the universality of sin in man’s history’.59 To summarise: one cannot forgo the criterion that at the basis of painful human ill- himself and to enter the thera- to masturbation or hypsation, nesses there is a multiform in- py of love. It should be ob- prostitution, homosexuality, volvement in sin and thus we served, however, that however paedophilia and all other kinds must necessarily resort to the much one is dealing only with of sexual abuse. However, and therapy of the divine love, to the help of marriage, the atten- this is very important, for the the victory of the crucified uation of the damage of sin is defeat of the capital vices as Christ over sin and the risen extended at the level of the cre- causes of a moral order of ill- Christ over death. It should be ation to the whole of the being nesses, the virtue of chastity is said, realistically, that victory of man, soul and body. Indeed, only a part of the cardinal over sin and death do not abol- self-mastery, in the sphere of virtue of temperance. The ish the temporal sufferings of sexuality, is the outcome of the virtue of temperance, indeed, human life, nor does it free the cardinal virtue of chastity, does not moderate only the dis- entire historical dimension of which is a potential virtue of ordered search for sexual plea- human existence from suffer- moderation. ‘Chastity means sure at an individual and social ing. However, and this is what the successful integration of level, it also moderates disor-

DOLENTIUM HOMINUM N. 75-2010 dered desire for pleasure as re- and expertise is made more ef- der of redemption, that is to gards the use of alcohol and fective by an ability to under- say in the transcendent sphere. eating at an individual level. stand the sick person. An ap- The heart of man, heavy and According to Catholic morali- proach full of humanity and hardened, requires God to give ty, ‘Temperance is the moral love for the patient, called for man a new heart. For this rea- virtue that moderates the at- by an integral human vision of son, the therapy of conversion, traction of pleasures and pro- illness and helped by faith, is of interior penitence, is first vides balance in the use of cre- written into this therapeutic ef- and foremost a work of the ated goods. It ensures the will’s ficacy of the relationship be- grace of God who makes our mastery over instincts and tween the medical doctor and hearts return to Him. The sa- keeps desires within the limits the patient.69 cred author of Lamentations of what is honourable. The exclaims: ‘Bring us back to temperate person directs the 6.1.3 The therapy of penitence you , Lord! Bring us back! Re- sensitive appetites towards From a theological point of store our ancient glory’ (Lam what is good, and maintains a view, it should be observed, as 5:21). In discovering the great- healthy discretion: ‘Do not fol- regards the subject of the treat- ness of the love of God which low your inclination and ment of illnesses, and with re- gives us the strength to begin strength, walking according to spect to their causes of a moral afresh, our hearts are shaken the desires of your heart’ (Sir order, that further words are by the horror of sin, by the in- 5:2: cf. 37:27-31).64 Temper- required on the therapeutic terruption of the dialogue with ance is often praised in the Old Testament: ‘Do not follow your base desires, but restrain 28 your appetites’ (Sir 18:30). In the New Testament it is called ‘moderation’ or ‘sobriety’, We ought ‘to live sober, upright, and godly lives in this world’ (Tit 2:12)’.65 In this broader moral sense the Apostle writes to the Romans: ‘So then, my brothers and sisters, because of God’s great mercy to us I appeal to you: offer yourselves as a living sacrifice to God, dedicated to his service and pleasing to him. This is the true worship that you should offer. Do not conform yourselves to the standards of this world, but let God transform you inwardly by a complete change of your mind. Then you will be able to know the will of God – what is good and is pleasing to him and is perfect’ (Rom12:1-2). As regards the illnesses caused value of interior penitence. In- God, and is converted looking by drug addiction,66 by alco- deed, ‘sackcloth and ashes’, at he who was pierced by our holism67 and by smoking,68 the fasting and mortifications, re- sins (cf. Jn 19:37).72 The heart cardinal virtue of temperance main works of sterile and false of Jesus which knows the is the most specific and proper penitence without a conver- depths of the love of his Father winning force. We may add sion of the heart, without inte- wanted to reveal to us the that in almost all the illnesses rior penitence.70 This penitence abyss of his mercy in a manner of the body it has by now been is a radical redirection of the full of simplicity and beauty in demonstrated that a psycholog- whole of one’s life, a return, a the words of the merciful Fa- ical component is a co-cause conversion to God with one’s ther (Lk 15:11-24). The fine and a resonance. This is ad- whole heart, a break with sin, clothes, the joy of the father: dressed first and foremost by an aversion to evil, together these are the most significant clinical psychology which in with rejection of the bad ac- features of the process of con- the sphere of psychosomatic tions that we have engaged in. version, a radical treatment of medicine supports the thera- This conversion of the heart is the causes of illness both of the peutic value of the relationship accompanied by healthy pain body (algological illnesses) between the medical doctor and sadness, what the Fathers and (above all else) of the soul and the patient. A health-care called ‘animi cruciatus’ (afflic- (pathological illnesses). worker must attend to relation- tion of the spirit), ‘compuntio To sum up: the authors of ships with the patient so that cordis’ (contrition of the this article wanted to examine his or her humanitarian sense heart).71 the following points: 1. pain strengthens professionalism We are to the full in the or- (algos + pathos) which be-

DOLENTIUM HOMINUM N. 75-2010 comes of transcendent value the soul constitute a perfect 28 Cf. CCC,n.618. 29 Cf. JOHN PAUL II, Salvifici doloris, towards God because of the synthesis between the Ordo n. 4. physiological relationship that Creationis and the Ordo Re- 30 Cf. Dizionario italiano, De Mauro, it has with the soul, both of demptionis. heading ‘cervello’. 31 Council of Trent, DS,n.1511. which are essential con- 32 Second Vatican Council, Lumen stituents of the unity of the hu- Prof. PIERLUIGI ZUCCHI, SO gentium,n.2. man being (the dual-unitary vi- Lecturer in illnesses of the 33 CCC, cf. nn. 375-376. 34 Cf. CCC,n.378. sion); 2. the placing in the the- locomotive apparatus and physiatry 35 at the Faculty of Medicine and Cf. CCC,n.400. ological and medical-scientific 36 Cf. CCC,n.377. Surgery of the University of Florence 37 sphere of three new nosologi- Super Epistolas Sancti Pauli Lec- and lecturer in the physiopathology tura,inRom. IV, Lect. 1, n. 333, cal entities: algological illness- and treatment of pain and headaches 38 Cf. CCC, n. 1865. es, which are characterised at the Faculty of Medicine and 39 Cf.B.HONINGS, Dizionario Enci- first and foremost by physical surgery at the Università Campus clopedico di Spiritualità, Edizioni Studi- Bio-Medico of Rome. um, Rome, 2, heading, pp. 2028-2029. pain (algos); algo-pathological 40 Consultor to the Pontifical Council Cf. CCC, n. 1866: illnesses, which are charac- 41 Cf. St. Thomas, Summa teologica I- for Health Care Workers, II, 84, a. 4; B. Honings, heading cited. terised by mental-physical theHolySee. 42 Ibid., ad 1. pain; and pathological illness- 43 Roman Catechism, 1,5,11, quoted es, which are characterised by Prof. BONIFACIO HONINGS, in CCC, n. 598. 44 Cf. ZUCCHI, PL., VIVALDI FORTI,C., spiritual pain; 3. the two-sys- OCD MILANESI, E., and OBLETTER, G., tems theory (fig. 2) which ex- Emeritus Professor of Moral ‘Definizione del termine dolore’, in plains the physiopathological Theology at the Pontifical Lateran ‘Test di personalità proiettivi University and the Pontifical (Rorschach, T.A.T.) e non proiettivi aspects of algological illness- Urbanian University, Rome. (M.M.P.I.) nella cefalea psicogena e nel- es, algo-pathological illnesses Consultor to the Congregation for la cefalea da tensione muscolare. Indi- and pathological illnesses, ex- the Doctrine of the Faith, rizzi terapeutici’, Algologia, 1 (1983) 29 Consultor to the Pontifical council 41-82. amining the components of the 45 JOHN PAUL II, Salvifici doloris,n.8. for Health Care Workers, 46 immanent system (ordo cre- JOHN PAUL II, Salvifici doloris,n. ationis) which are internalised Ordinary Member ad vitam of the 12. Pontifical Academy for Life, 47 JOHN PAUL II, Salvifici doloris,n.5. in the person towards the com- the Holy See. 48 JOHN PAUL II, Salvifici doloris,n.5. ponents of the transcendent 49 JOHN PAUL II, Salvifici doloris,n.6. 50 Acquired experiences-learning- system (ordo redemptionis). In memory. Acquired experiences consti- this new theory it has been tute the phenomenon of learning in man stressed that the soul (of the and animals which also gives rise to the phenomenon of memory. Eric Kandel person) constitutes the synap- Notes demonstrated in the aplisia californica,a tic unity of two systems (the small sea snail, that following an ac- immanent and the transcen- 1 Pastoral Constitution on the Church quired experience, in its neuronal struc- in the Contemporary World, Gaudium et ture (in this case made up of ganglion dent), overcoming in this way Spes (GS), n. 14. chains) molecule were released that were the criticism of Changeux and 2 Song of Daniel, 3,57. different from those of examples of oth- the Nobel prize winner Edel- 3 Cf. GS,n.14. er small sea snails which were not stimu- 4 Cf. Catechism of the Catholic lated by the same learning. man of the science fiction ex- Church (CCC), n. 362. 51 JAVIER LOZANO BARRAGÁN,Mes- planation of the synapsis be- 5 Cf. CCC, n. 1146. sagge for the World Day of the Sick, 11 tween dendrons of the brain 6 Cf. Dizionario Enciclopedico di February of the Jubilee Year 2000, Vati- Spiritualità, Studium, Rome, edited by can City. (body) and psychons of the Ermano Ancilli, I, sub-heading, pp. 467- 52 Cantico Spirituale, 11,11. mind (soul), given by the neu- 468, henceforth Dizionario. 53 Cf. Ibidem. 7 CCC, m. 461. 54 Cf. Salvifici doloris,n.13. ro-philosopher Karl Popper 8 Cf. CCC, n. 470. ‘The unique and al- 55 Cf. JOHN PAUL II, Salvifici doloris, and the neuro-physiologist and together singular event of the Incarnation n. 14. Nobel prize winner John Ecc- of the Son of God does not mean that Je- 56 JOHN PAUL II, Salvifici doloris,n. sus Christ is part God and part man, nor 15. less in the three-worlds theory. does it imply that he is the confused mix- 57 Cf. Ibidem. 4. The placing from a thera- ture of the divine and the human. He be- 58 Cf. Jn 6:5-12; Rom, 1:18-32. peutic point of view of the came truly man while remaining truly 59 Cf. CCC,n.401andGS,n.13. God. Jesus Christ is true God and true 60 CCC, n. 1609. clinical-therapeutic three lev- man’ (CCC,n.464). 61 CCC, n. 2337 els scale (tab. VIII) where 9 Cf. Dizionario,I,p.467. 62 Somma Teologica,II-II,q.151,a.1. pharmacological therapy (level 10 In an address of 8 April 1981. 63 Cf. Somma Teologica,II-II,q.151, 11 Cf. CCC, n. 365. a. 2. 1), ethical therapy (level 2) and 12 CCC,n.364. 64 ‘My child, as you go through life, spiritual therapy (level) are 13 Cf. Mt 16:25-26; Jn 15:13. keep your appetite under control, and subject to examination. 14 Cf. Mt 26:38; Jn 12:27 don’t eat anything you know is bad for 15 Cf. Mt 10:28; 2 Macc 6:30. you. All food doesn’t agree with every- To sum up: a) pain and 16 Cf. CCC, n. 363. one, and everyone does not like the same body-soul can be seen as two 17 CCC,n.650. kinds of food. Don’t feel that you have to symbiotic physiognomies of a 18 Cf. R. DESCARTES, Oevres, edited have all sorts of fancy food, and don’t be by V. Cousin, vol. 12, Paris 1824, p. 95 a glutton over any food. If you eat too single ontological unity of the ss, quoted in Deus caritas est,n.5. much, you’ll be sick; if you do it all the human person (the dual vi- 19 Cf. Deus caritas est,n.5. time, you’ll always have stomach trou- 20 Cf. CCC, n. 369. ble. Gluttony has been the death of many sion); b) pain (algos) and its 21 Cf. Is 49:14-15; 66:13; Sal 131, 2- people. Avoid it and live longer’ (Sir. wise internalisation (pathos) in 3. 37, 27-31) the redemptive cross of Christ 22 Cf. Os 11:1-4; Jer 3:4-19: 65 CCC, 1n. 809. 23 CCC,n.373. 66 John Paul II observes: ‘Using drugs belong to the full to Christian 24 CCC,n.307. is anti-life. “One cannot speak of ‘the spirituality and the Catholic 25 St. Irenaeus, Adversus haereses, freedomtotakedrugs’norof‘therightto doctrine of the immortality of 3,18,1. drugs’, because a human being does not 26 Ibid., 3,18,2; cf. 2,22,4. have the right to harm himself and he the soul; c. in the salvific plan 27 Cf. Mk, 10:39, Jn 21:18-19; Col cannot and must not ever abdicate his of God pain of the body and of 1:24. personal dignity which is given to him by

DOLENTIUM HOMINUM N. 75-2010 God,” and even less does he have the (Libreria Editrice Vaticana (LEV), Vati- sione: fenomeno clinico, antropologia right to make others pay for his choice’ can City, 1999). biblica, fede cristiana’, Dolentium (Address to the participants at the Inter- CHANGEUX,J.P.,La natura e la rego- Hominum, 55 (2004) 16-20. national conference on Drugs and Alco- la alle radici del pensiero (Ed. Cortina, SERRA, A., ‘L’incanto del cervello e hol, Nov. 23 1991, n. 4, quoted in Charter Milan, 1999). l’enigma della mente’, La Civiltà Cat- for Health Care Workers, Vatican City, DAMASIO, A. R., and DAMASIO,H., tolica, 4 (2008 ) 228-238. 1995, note 195, n. 96, hereafter Charter. ‘Brain and Language’, Scientific Ameri- ZUCCHI P.L., and HONINGS B., ‘Faith 67 ‘Unlike taking drugs, alcohol is not can, 267 (1992) 88-95. as a Transcendent Element Facilitating in itself illicit: “its moderate use as a ECCLES,J.,Come l’io controlla il suo Therapeutic Results in Suffering Pa- drink is not contrary to moral law.” cervello (Rizzoli, Milan, 1994). tients’, Dolentium Hominum, 3 (1996) Within reasonable limits wine is a nour- EDELMAN,G.,Un universo di co- 16-28; Algologia, 2 (1996) 4-31. ishment. “It is only the abuse that is rep- scienza (Ed. Einaudi, Turin, 2000). ZUCCHI P.L., HONINGS B, and rehensible”; alcoholism, which causes GONZALES, L. J., Terapia spirituale VOEGELIN M.R. ‘Pain Faith Prayer. Ther- dependency, clouds the conscience and, (Libreria Editrice Vaticana (LEV), Vati- apeutic effect of Faith and Prayer on in the chronic stage, produces serious can City, 2003). Subjects with Painful Pathologies. Blind harm to the body and the mind’ (Char- KANDEL, E. R., SCHWATZ,J.,andJES- Study on a Group of 1104 Patients’, ter,n.97). SEL,TH.M.,Principles of Neural Sci- Compendium of Pain Semantics,11 68 ‘With regard to tobacco also, the ence,3rd. edn. (Appleton-Lange, Nor- (2001) 1-384, published by the Institute ethical unlawfulness is not in its use but walk, Conn., 1991) (Italian edition: Prin- for the Study and Therapy of Pain- Via in its abuse. At the present time it is es- cipi di Neuroscienze, Casa Editrice Am- Venezia n. 10- 50121 Florence-Italy). tablished that excessive smoking dam- brosiana, Milan, 1989). ZUCCHI,P.L.,HONINGS, B., and ages the health and causes dependency. LOZANO BARRAGÁN,J.,Definizione di VOEGELIN, M. R., ‘Effetto della lettura This leads to a progressive lowering of salute, confirmed by da H.H.. John Paul evangelica meditata sulla area iperalge- the threshold of abuse’ (Charter, n. 99). II in his Message for the World Day of sia e sulla percezione del dolore nella 69 Cf. Charter, n. 104. the Sick (11 February of the Jubilee Year sindrome algica lombare’, Dolentium 70 Cf. CCC, n. 1430. – Vatican City). Hominum, 53 (2003) 44-51; Algologia, 71 Cf. Council of Trent, DS, nn. 1676- MANCUSO,V.,L’anima e il suo desti- 1/2 (2004) 67-90. 1678: 1705: Roman Catechism 2.5.4; no (Raffaello Cortina Editore, Milan, ZUCCHI,P.L.,HONINGS, B., and CCC, n. 1431. 2007). VOEGELIN, M. R., ‘Dolore-Musica- 72 Cf. CCC, n. 1432. MAYOU, R., ‘Burn-Out’, Br.Med.J., Preghiera. Valutazione degli effetti della 295 (1987), 284-287. musica e della preghiera sull’efficacia 30 POPPER,K.,andECCLES,J.,L’io e il della terapia farmacologica in soggetti suo cervello (Armando Editore, Rome, affetti da cefalea muscolo-tensiva (do- Bibliography 1996). lore cranio-facciale)’, Dolentium SCOTT,J.,andHUSKISSON,E.C., Hominum, 60 ( 2005 ) 14-30; Algologia, BELLIENI,C.V.,L’alba dell’io (Soci- ‘Graphic Representation of Pain’, Pain, ½ ( 2005 ) 134-182. età Editrice Fiorentina, 2005). 2 (1976) 175-184. ZUCCHI,P.L.,HONINGS, B., and BENEDETTO XVI, Lettera Enciclica SCOTT,J.,andHUSKISSON,E.C., VOEGELIN, M. R., ‘Dolore-Placebo- “Deus Caritas est” (Libreria Ed. Vati- ‘Vertical or Horizontal Visual Analogue Preghiera.Aspetti clinici, terapeutici ed cana, Vatican city, 2006). Scale, Ann. Rheum. Dis., 38 (19799 558- etici’, Dolentium Hominum, 68 (2008) Catechismo della Chiesa Cattolica 559. 12-29; Algologia, Special Number, (nn. 599; 1502; 1849; 1855; 1863; 1866) SARAIVA MARTINS, J., ‘La depres- (2008) 1-55.

DOLENTIUM HOMINUM N. 75-2010 Fr. Pierluigi Marchesi (1929 – 2002): a Father and Teacher of Health-Care Policies*

Introduction Adviser and of Provincial of the practised, expressed and mea- Province of Lombardy and sured to the point of self-sacri- It is not easy to speak about Veneto, a service he gave from fice. men and religious like Fr. 1968 to 1976. At the General Marchesi who was a volcano, a Chapter of 1976 he was elected man impassioned of the sick Superior General and remained 1. Restoring a Human Face whom he loved and defended at the head of the Order for two to Health Care forcefully with intelligence and mandates until 1988. with great responsibility. At the moment of his death His passion was expressed in It is not easy to speak about he was Provincial Councillor an original way in 1981 in a Fr. Marchesi, a religious whose and Director of the Centre for text that contained a provision prefigured social and ec- Studies and Formation of his gramme written in the form of a clesial questions. It is not easy religious Province. At an eccle- letter to all the Provincial Fa- to speak when a ‘personage’ sial level as well, Fr. Pierluigi thers of the Hospital Order of has the charism of living hospi- made his wise contribution: the Fatebenefratelli. Its title was tality and thus is a creator and from 1986 he was member of intriguing: ‘Humanisation: Re- an inventor, when this ‘person- the Pontifical Council for Pas- sponse of the Religious of St. 31 age’ was a prophet of hospitali- toral Assistance to Health Care John of God to a Historic Turn- ty, although recognised for this Workers and was also the Pres- ing Point’. This text is seen to- only after his death, because ident of the Association of day as a classic of health-care during his lifetime a prophet is Catholic Hospitals and in this literature because of the spon- difficult and is welcomed only capacity he was a delegate of taneity and the revolutionary outside and not inside his own the Holy See as a representative concreteness of its proposals country. A prophet has to die to at important international con- which could be implemented be recognised, and this is what ferences and meetings. outside structures that were happened with Fr. Marchesi. During his service as Superi- managed specifically by reli- Such was the case with the or General he gave a notable gious. A precise design which Prophets of the Old Testament impulse to the renewal that took sought to involve all those who and with the figure of Jesus of place after the Second Vatican worked in health care in not go- Nazareth in the New Testament. Council through important doc- ing beyond man, in preventing Such has also been the case uments and important speeches patients from not losing their with the history of the Church, which deeply marked the life of humanity, in establishing rela- at the present time as well, and his Order and the world of tionships of solidarity-inspired so it will be in the future as health and health care. reciprocity as human, healing well. He died in Milan on 2 March and healed, persons responsible We are very happy that at this 2002 at St. Joseph’s Hospital of for a shared destiny. The project conference organised by Cardi- the Fatebenefratelli. of every man which according nal Fiorenzo Angelini space has to Christianity is to grow, to be- been given to remember Fr. come an adult person and to Marchesi. We have written this help other people to grow: a di- paper with a great deal of affec- I. HUMANISATION vine project endangered by the tion and with a great deal of AND HEALTH-CARE risks of illness, of suffering and love; with the same affection POLICIES of decay which is intrinsic to and admiration that we felt for human beings. him when he was alive. People who leave their mark For this reason, a dehumanis- on history with their passing ing culture which based wellbe- have the ability to discover new ing solely on economic and so- Bibliograpical Notes concepts and to formulate new cial categories had to be op- on Fr. Pierluigi Marchesi ideas but in particular to man- posed by a culture understood age to create connections which as an active process of humani- Fr. Pierluigi Marchesi was make their thought original and sation to protect human life, to born in Cardano al Campo (VA) their action creative. In our case develop the intellectual facul- on 22 March 1929. Still of a this was a matter of connecting ties of man, and to reduce the young age, he became an Aspi- the three concepts of humanisa- aggression and the violence that rant of the Fatebenefratelli Or- tion, health care and policy in a threatens his very existence on der in Brescia. He professed the theoretical/practical dialogue the earth. If we do not live on simple vows of poverty, chasti- and pointing out their attainable the basis of man, we cannot ty, obedience and hospitality in objectives through a balanced manage to help those who suf- 1946 and professed his solemn harmonisation of their respec- fer and perhaps we will not im- vows on 20 March 1953. He tive needs. In this terrain the plement any project of Christ- held the posts of Superior Gen- prophetic spirit and the very life ian humanism – such was the eral, of Superior, of Provincial of Ft. Pierluigi Marchesi was thinking of Marchesi.

* Paper given at the Conference “Il volto delle creature ad immagine e somiglianza di Cristo”, Rome, 9-10 October 2010 The promotion of health-care Charity always precedes jus- metanoia, a revolution of hearts humanisation involves wise at- tice and directs it. It eludes reg- which led to a preferential tention being paid to cultures ulation and requires an interior choice for the poor and the but above all else it constitutes approach and not only exterior needy, above all the suffering a decisive orientation in the di- behaviour; it is freely-given and and the sick. The health-care rection of caring for the weak, stimulates love for the disinher- revolution dreamed of by Pier- the liberation of the poor, and ited. Christian love does not luigi Marchesi consisted of giv- the defence and the cultivation make distinctions or effect ex- ing people who suffered a sense of the desire to live typical of clusions but is disinterested, of their own dignity and the sa- man. All this is represented by and thus precedes and supports credness of their lives which the human face of care. Indeed, justice. The cultural movement nothing and nobody can tram- if man remains unknown, he is of humanisation overall has led ple on or eliminate. Thus hu- immediately marginalised. If us to see that despite the enor- manisation became a stimulus the sick person is not at the ser- mous advances of health care, so that all workers of all pro- vices dedicated to health – the attention of workers and in- fessions could overcome fears Marchesi often observed – then stitutions has concentrated on linked to roles, to bureaucracy other subjects run the risk of the technical and on administra- and to selfishness so as to cre- taking his place, but they are all tion, moving from the true cen- ate new ties of solidarity and usurpers. tre of things – man. friendship. There could be not The end and centre of every Thus ancient pietas is in cri- true health, care or healing health-care institution must be sis and it appears to be true al- without authentic interpersonal the sick person to whom is though paradoxical that today relationships based upon empa- dedicated the service of other whereas illnesses are treated thy and love. 32 people, his or her fellows, ded- better, man is less cared for. In this sense all of the forma- icated and directed towards his And not only this: society gen- tion of health-care workers had or her wellbeing. The dehu- erates new illnesses, new forms to be directed, as Fr. Pierluigi manisation of health care is the of dependency on drugs, on loved to repeat, by passion for outcome of a separateness, technologies and on medical man. The pathway of humani- which is not always a matter of products, to which health care sation required specifically chance but which can be de- does not adapt easily. Humani- formed and educated people to tected in historical terms, be- sation, instead, must inspire recognise the structures of the tween the healthy and the sick: love for the other in every situ- sacredness of the human being, an existential moral barrier ation of need to give to every- to interpret his or her aspira- which leads people to take one that affection that allows tions and to assure his or her refuge in the cold neutrality of sick people to meet their own growth and fulfilment. bureaucratically conceived moral, spiritual and supernatur- professions. The threats of ill- al, as well as their psychologi- ness that destabilise a person, cal and social, needs. The task 3. Ethics and that weaken him or her even in of health care, therefore, is to Health-Care Policies his or her own family and his assure justice to the sick with or her world, must be coun- treatment that is rich in exper- Although in various writings tered by understanding man tise, as well as being efficient and speeches one can find with a welcoming that is able and effective. But health care points of health-care policy to restore dignity to those who also has the task, beyond hu- throughout the spiritual path- suffer as well as the hope of so- man health-care laws, to respect way of Marchesi, he addressed lutions to the maladies of soci- the sacred right of a suffering this specific subject during the ety. In breaking down barriers, person to his or her own digni- last part of his activity which one discovers that being with a ty, to an understanding of all his was dedicated to meetings and sick person is more important or her needs and to solidarity. debates in which he took part, that doing something with him To the question of whether often agreeing to interact with or her. humanisation is an act of justice people connected with health- and charity, we reply that it is care policy and management. both. An act of justice because His thinking about humanisa- 2. The Humanisation it meets a fundamental right tion led him to think about the of Health Care: an Act and an act of charity because it very topical subject of the rela- of Justice and Charity meets a need for care that no tionship between ethics and human law can regulate. Love, health-care policies. At a time Following the model of Je- charity, must enter the picture of epochal change, which was sus, the great saints involved in even more where human law also marked by scandalous social works, basing them- has not yet managed to protect events as regards the manage- selves on Christian principles man as a whole, and is called to ment of health care in Italy, he and moral values, did not wait point out the pathways of jus- spoke about ethics and humani- for law to uphold the recogni- tice to be followed. ‘Charity is sation with the secret hope of tion of, and respect for, man, not happy with evil’ (1 Cor making the values at the level but prefigured this through 13:6) said St. Paul to the Chris- of ideals of Christian morality charity, in conformity with the tians of the first century AD, es- and those of his own religious teaching of the encyclical Deus tablishing a direct equation be- Order enter health-care re- caritas est (nn. 26-29) of Bene- tween justice and charity. The forms. In particular, health-care dict XVI. Christian revolution was policies has the task of con-

DOLENTIUM HOMINUM N. 75-2010 tributing to the planning of a Catholic health care but it is al- had to reaffirm, through a ser- society in which values were so visibly constitutes the basis vice adapted to modern times, translated into public, personal for an educational project for the perennial joy of being with and institutional behaviour that those who are involved at a pro- sick people and those in need was transparent, verifiable and fessional level and for society. with their own style of life, controllable. If they wanted to Formation in values and for- bearing witness to the sacred- achieve these goals, politics had mations in humanisation are ness of man and the real love to reconnect with ethics. From fused in the thought of Pierluigi that God feels for man himself. the idea of a paternalistic state Marchesi in a programme of In caring for man, Marchesi that provides everything and professional education and tirelessly repeated, we are even seeks to enter individual ethics of all health-care workers called to listen to the voice of consciences in order to decide whom he would have liked to man who asks to be welcomed the most intimate choices, it have involved in ongoing train- in his entire humanity and sated was necessary to move to an ing to bestow a strong sense of in his wish for care. Because idea of a project-state directed responsibility on administra- never so much as today is man towards the constant authentic tors, politicians, owners and impoverished financially and exercise of rights and capable professionals who are often even more in sincere and disin- of establishing suitable spaces been led by historical events to terested relationships. As often for the integral growth of all cit- lose the meaning of their mis- occurs in the documents that izens. sion. bear the name of Marchesi, the The ideal of humanisation subject of care for man, or bet- advanced by Marchesi was ex- ter of passion for man in line pressed in other forms: ethics with the experience of St. John had to assure respect for the II. WELCOMING MAN: of God, evokes the reciprocal 33 centrality of the human person THE CHALLENGE and complementary act of faith in every public activity and in FOR THE in the love of God. Indeed, with political life itself. This meant FATEBENEFRATELLI much courage he stated that the respecting the wish of every visible and dynamic expression man to live in good health, alle- 1. Hospitality Towards of faith involves dedication to viating pain in illness, and im- the Year 2000: every man who is seen as a proving quality of life. Thus as Listening to Man brother, a neighbour, another a return to those Christian oneself. ethics that were at the origins of The healthy Christian realism the most aware movements of that animated the thought of the modern social Catholicism, for Fatabenefratelli looking to- which the primary goal of poli- wards the new millennium in- tics is human promotion as a spired a document with a pro- ‘shared good’. Thus, politics gramme of great breadth. In had to become responsible for 1986 the document ‘Hospitality the health of citizens, for their of the Fatebenefratelli Towards education, and for environmen- 2000’, which was in harmony tal health care so as to construct with the previous document on a liveable future and create con- humanisation which had ani- ditions for the development of mated the debate about health the spiritual faculties of man. In care over the previous four other words, the idea of psycho- years, was sent to the Order of physical wellbeing which was St. John of God. also adopted by the World Reflection on the new mil- Health Organisation was an lennium led, from the point of idea involving a rule and con- view of religious hospitality, to cerned everyone inasmuch as it an observation of the radical was a moral requirement. changes that had taken place Health-care policies are not within all health-care systems. immune to this logic if they Within the context of the in- want to have the right to inter- evitable changes in forms of vene in the reality of health care providing care and pastoral which today strongly runs the care, the task of integral care Thus, even though necessari- risk of falling prey to a mercan- based on the charism of hospi- ly hospitality in the future tilist capitalism that rejects the tality was restated. From this would have to change its oper- rules of ethics. The health-care point of view, religious were ational models, there should economy, based on a healthy called to the duty to recognise never be an absence of the ca- policy of the common good, the burning truth that they were pacity to bear witness to the must employ the models of no longer exclusively responsi- new commandment entrusted healthy company management ble for the sick and did not have to us by Jesus as a characteris- but it cannot see health care as a the right to impose upon them tic of our identity as Christians, mere ‘business’ that can be their own religious view of life that mutual love which should governed by private investors and health. Having lost the become a true criterion of plan- alone. Such a health-care policy more typically professional ning, administration and as- directed by values is an ideal of functions of the past, a religious sessment of health-care ser-

DOLENTIUM HOMINUM N. 75-2010 vices in an outlook coherent quote him. He said to the fa- The courses on renewal last- with Catholicism. thers of the Synod: ‘It is always ed from November 1978, the edifying to take sick people to month when the International sanctuaries, at least those who Meetings for the ‘Animators’ of 2. Reconciling Oneself with can do this, even though they Courses was celebrated, until the World of the Sick are not always those who most November 1979, when the Ex- need this: today it is first and traordinary General Chapter be- As Prior General of the Fa- foremost necessary for the gan. These were moments of tabenefratelli, Fr. Marchesi was Church to engage in a pilgrim- great enthusiasm and good re- sent in 1983 as an observer to age in hospitals where in many sults. Certainly, at that time the Synod of Bishops which countries more people go to some had more hope than oth- was held on the subject of rec- than is the case with parishes ers. This was a strong moment onciliation in the Church. Ap- and where the presence of for the whole of the Order; I pointed by Pope John Paul II, Christ who wants reconciliation myself experienced this by he set about preparing himself is alive. And he ended his holding a course and then to make a contribution on be- speech in the following way: teaching it in the Provinces of half of sick people. ‘let us not forget that we will all Spain, of Italy and of Portugal. I can still here his voice on one day also belong to the peo- It was an unforgettable experi- the telephone from Barcelona. ple of the sick and the dying: ence. It was a moment of the It was evening and he wanted help or rather wanted to share his contribution with, and make it choral amongst, the Fatabene- 34 fratelli. And soon he thought of what he had to do: a short, realistic and incisive document on ‘Reconciliation in the World of Health Care’. I felt the honour of being a protagonist of that document which Marchesi sent in printed form to every father of that synod. And then there was his speech. I will leave to your imaginations the tone, the vigour and the emotion of that this will be an inevitable way of Spirit who blew on the whole of brief performance of Fr. Pier meeting the Christ who recon- the Order. Luigi Marchesi. He gave a ciles us and invites us to East- To this context should be at- short and direct speech on sick er’. I can still hear the echoes tributed the International Com- people, on illness, and on the the applause that rang out in the mission for Pastoral Care in pastoral care that he wanted: or- hall of the synod. The Holy Fa- Health. This was another instru- ganised, planned and forceful. ther himself came down to em- ment in the hands of the Gener- The deep insight that formed brace him amidst reciprocal al Curia for the service of re- the basis of his speech took as a emotion, as he himself liked to newal. And we set to work – recurring and unstoppable remember. this is something that I say with theme the subject of the unity healthy pride. The engine was of the human person, the centre Fr. Marchesi; I was the chair- of our care. Just as medicine 3. The Promotion of Pastoral man of this commission and has often been accused of turn- Care in Health with the other members of that ing the sick person into a parcel commission we began our work and reducing him or her to his The subject of pastoral care with responsibility. The first or her pathologies, it was asked in health inside the Order was meeting was chaired by Fr. whether the Church had not not an isolated chapter but was, Marchesi in Rome. At this perhaps shared in this division rather, a part of the large move- meeting the commission and its by being exclusively concerned ment of renewal called ‘renew- role were organised: its goals, with the souls of the sick and a al of hospitality’ which began its structure and its methodolo- superficial religious sentiment specifically one year after the gy. Reflection, animation and without looking at the complex- election of Fr. Pierluigi March- the tasks of this commission ity of the sick person. In this esi as Superior General of the were its strong points. context, which had been at Order. International meetings This first stage of the com- times dramatic as regards its for ‘renewal of hospitality’ soon mission (1978-1983) was a mo- deleterious consequences, the began and the first took place ment to learn about the realities Church was courageously on 26 October to 2 November of the Order and a great stimu- called, through the voice of a 1977 in Rome. Two study com- lus for the Provinces. The com- simple hospital brother, to be- missions were appointed: the H mission began its work with a come reconciled with the man Commission on Hospitality and major meeting in Barcelona (28 who suffers because of too little the R Commission for the Or- April-2 May 1979): this was a or too much medicine. ganisation of Courses on Re- historic date – new pathways And please allow me to newal. were opened up for pastoral

DOLENTIUM HOMINUM N. 75-2010 care in health and pastoral care All of this was a challenge; it which in the world of health in health became a subject for was the seed that pastoral care care and health finds its clearest history. This was the first inter- had made available to renewal. and most powerful actuation’. national meeting where Fr. Another outcome of this pas- In this way the originality of a Marchesi as Superior General toral work was the following vocation which was not only was present (cf. the documen- publications of the commission: strictly religious was identified tation on it in the review Infor- Cos’è la pastorale sani- and we wish rapidly to analyse mación y Noticias, n. 62/1979). taria?(‘What is Pastoral Care in this vocation by entering the After this first meeting the Health?’); Pastorale degli In- existence of a courageous inno- courses on pastoral animation fermi nell’ospedale e nella par- vator as regards health care. multiplied in number and they rocchia (‘Pastoral Care for the were in various languages: in Sick in Hospitals and Parish- English in Dublin; in German es’); and Dimensione apostoli- 1. His Specific Vocation in Salzburg; in French in Paris, ca dell’Ordine Ospedaliero di and then there were the courses San Giovanni di Dio (‘The One of the first impressions in Los Molinos (Spain) and in Apostolic Dimension of the that his interlocutors had was Monguzzo (Italy) and also in Hospital Order of St. John of his clear and direct identifica- Latin America (Mexico, God’). tion with his own hospital reli- Ecuador, Colombia, Peru) from These were rich and strong gious family. He was conscious July to September 1981. moments. There was no ab- and inwardly proud of that im- After this first stage we be- sence of difficulties, but we mediate identity/belonging, as gan a second period with the were welcomed and we were is borne out by his writings and Commission on Pastoral Care animated in carrying out our his work over sixty years of un- (1984-1988). This was a moti- work. We saw in our Superiors, tiring service. It was not rare to 35 vating stage because we be- and especially in Fr. Marchesi, hear from him words of regret came aware of the role of the leaders, people with enthusi- at the low level of attention that commission as an ‘agent of asm. He believed in us, he gave was paid both within the change’. The basic work had al- us confidence, and we believed Church and in politics to the ready been done and now we in him; and this enthusiasm voice of his Order and in gener- sought to work in relation to made our commitment to ser- al to the calls of all the hospital goals, to define in a good way vice to a common cause grow – Orders which perceived the real the important fields of our ‘the renewal of hospitality’ – in needs of sick people and health work, such as the sensitisation which pastoral care in health care. In a certain sense it seems and formation of agents, inte- occupied an important position. to us impossible to establish a gration and pastoral practice. These were years when we felt separation between the fea- The fruits of this work of a strong breath of the Spirit. tures/values that were charac- ours, amongst others, were: the teristic of the man from those appointment in every Province that were typical of the reli- of a brother responsible for pas- gious. In him these two realities toral animations; the course on III. A RELIGIOUS WITH coincided and in a surprising pastoral care in Rome for the A HUMAN FACE way the riches of natural talents Provincial coordinators which were developed and embodied was held in November 1984; The approach we give our- in the practical life of this hos- and animation for linguistic selves to sketch the profile – if pital brother. groups… one speak thus in a more deeply He was born as we know in At the General Chapter of human way – of Fr. Pierluigi is 1929 in hard-working Lom- 1988 an assessment was pre- suggested to us by reflections bardy and he had around him, sented on the journey that had offered by Cardinal Fiorenzo as he loved to recall, very hu- been taken and in comparing Angelini after the death of a man models of workers and the positive and negative as- man whom he described as a peasants who were constantly pects we realised that the results ‘friend and fellow worker’. At- involved in obtaining a liveli- were clearly positive. A giant tributing to his fellow work the hood, for themselves and their step forward had been taken tact of authentic intellectual and families, with the sweat of their within the whole of the Order moral humility, His Eminence brows. His father and mother, as regards pastoral care in identified in that virtue the who both worked in a factory, health and a strong influence source both of his inexhaustible were for him a moral reference had also been exercised in local creativity and of a courageous point and also recurred in cer- Churches. tenacity in following the poor tain reflections of his on respect The conclusions and the pri- and suffering Christ. The Cardi- for rules, honesty and ties in the orities pointed to the following nal declared that ‘Fr. Pierluigi, a company in which one works: ideas: a strengthening of the co- religious and not a cleric, was these were all elements that ordination of pastoral care; the both an apostle and a prophet: came together in deciding his creation of a specific style with- an apostle because he felt by way of thinking about, and pre- in the Order; the training of vocation sent to proclaim the senting the meaning of, mem- pastoral workers; the integra- Kingdom of God and heal the bership of his religious family tion and motivation of members sick (Lk 9:12); a prophet be- and its works. Even in his en- of the lay faithful; and the ani- cause he intuited that true and thusiastic choice of his beloved mation of pastoral care in effective evangelisation in- football team he expressed his health in local Churches. volves an ecumenism of works loyalty as an authentic sports-

DOLENTIUM HOMINUM N. 75-2010 man and keen former football where this was not expected (to to the renewal of the Order, to player. use St.Paul’s phrase) –to com- pastoral care, to formation, to The initial direction of his municate and express his ideas, humanisation, to alliance with personal vocation was generat- his dreams and his visions, at the lay faithful, to looking to- ed by his meetings with broth- times sharply, although never in wards the year 2000, and also ers who were older than him an unpleasant way, which, how- great openness to the universal and whom he had met when he ever, he did not always manage Church. This is particularly was young. Indeed, in 1940 he to persuade everyone to under- suggested by his appointment entered the apostolic school of stand or accept. Once again, by the Holy Father as observer the Fatabenefratelli of the reli- with this style and wish to be a to the Synod on Reconciliation gious Province of Lombardy communicator, one could see in 1983 and his protagonism, and Veneto after finishing ele- how this man became the in- together with that of Cardinal mentary school where the edu- strument of this hospital reli- Angelini, in the creation of the cation of this teenager were gious and all of his life force Pontifical Council for Pastoral grafted onto those princi- was directed towards the good Assistance to Health Care ples/values that helped to form of the sick and to the coherent Workers. These were the facts the character of this man and growth of his religious family. and the life of Fr. Marchesi, his brother: a feeling of belonging, In all of this we can recog- fundamental work as Superior enthusiasm in service to the nise specific features of the spe- General. These were moments sick, devotion in carrying out cial vocation of a religious who strong in animation and he the role that had been assigned was an apostle and prophet of a knew to take advantage of the to him, adherence to the indica- different kind of health care, power of slogans such as: ‘re- tion of his Superiors, something purified through the charism of newal to humanise’ or ‘the sick 36 that is very different, as reli- hospitality and shaped around man is our master, our school, gious know, from mere obedi- the project of humanisation. In our university’. ence. him were expressed in the form And thus begun a journey of The originality of this adher- of a seed the vitality of a service that was hard, slow, dif- ence characterised the first charism that was not only a per- ficult, ‘unpopular’, not always years of his religious life but it sonal endowment but also a call welcomed, and this he himself also characterised his last years. that forced us to see gifts of an- knew, it was not something that Even when, still a child, togeth- other nature which would have he concealed. His definition of er with the companions of his made him a tormented, polemi- it was as follows: ‘To be the Su- course, he was called to live and cal and indispensable leader for perior General of a religious Or- work next to the sick during the our time. der means having the duty of long nights when he was carry- prophecy, at the price of being ing out his valuable traineeship unpopular and making ene- with the hospital family of St. 2. The Service mies’(cf. Per un ospedale più John of God. It was specifically of Government of his umano, E. Paoline, ‘Premessa’). to that time, in welcoming, see- Religious Family Thus he interpreted his ser- ing and ‘touching’ the martyred vice as listening to the times bodies of people who were vic- From the biographical notes and a search for innovation. Af- tims of the Second World War, one can note the quantity of ter a number of years of reflec- that we can attribute the seed of posts that were held by Fr. tion on spiritual renewal, two the ideal of humanisation that Marchesi within his own Order, revolutions were indicated – would be clearly formulated at in particular the Superior Gen- that of humanisation and that of the end of the 1970s. eralship of 1976-1988, twelve new models of hospitality. At a A young religious’s response years of responsibility as Prior historic meeting in 1987 with to the vocation to be a hospital General, where one can see the Camillians Marchesi of- religious often directs him more clearly his personality, his fered a perfect summary of his while he is still undergoing for- thought, and his ‘passion’ for project for government: ‘The mation towards care for special hospitality. It is true that he first, humanisation, has as its people in need such as the men- reached the highest and most principal task that of transform- tally ill, of whom there are a prestigious level but this high- ing our relationship with pa- large number in the health-care est level had to be expressed in tients, placing in this the same institutions of the Fatabene- better service: this is what Jesus humanity that Christ ‘di- fratelli. These were the most teaches in the Gospel and Fr. vinised’, that aspect of humani- disinherited of the sick people Marchesi was truly a servant, ty represented by feelings, by who had and still have most an example of service. emotions, and by the heart. need of humanisation in being In all the positions that obe- ‘Love your neighbour as your- received and cared for. dience entrusted to him, Fr. self’, the commandment re- In those years there emerged Marchesi manifested impas- minds us, strengthened by that his clear abilities as a commu- sioned service to man, to the wonderful statement of Jesus nicator both through words and sick; to them he dedicated time, ‘Everything that you do for one writing. This was because he intelligence, words and facts. of these little ones, you did it did not like rancorous silences As Superior General he for me’. One is dealing with a amongst religious or fellow placed all his energies at the rediscovery, a clear ideological workers. For him it thus be- service of the charism and mis- turning point, which also in- came necessary to speak – sion of hospitality; all his ener- volves all our fellow workers, where this was expected and gies were directed in particular above all those who have be-

DOLENTIUM HOMINUM N. 75-2010 lieved that to achieve therapeu- activity not so much to the func- has the gift of everywhere dis- tic ends scientific culture is suf- tion of technical leadership but covering positive resources: ficient, technical culture with to that of moral leadership in who does, is not afraid of diffi- its extraordinary advances and our works. This is an undertak- culties but draws an incentive rational knowledge. For we re- ing which is not easy for any of from them to increase his com- ligious, in particular, this has us; c) courageously adopting mitment’. His personal charism been a push, a valuable oppor- the role, which is still overly ne- had an innate sense of history tunity to ‘revisit’ our charism. glected in our lives, of being a joined to a prophetic vision The second revolution of hospi- critical conscience in the world from which came his courage tality with man, which has just of health and health care. A role as regards ideas and his impas- been announced, concerns the that links us to the precise need sioned hope as regards the fu- role of the Fatebenefratelli. to modify the contents and ture. A man of frontiers and not How, that is to say, to be ‘func- methods of our own basic for- of barricades, he exposed him- tional’ over future years in the mation so as to be able to edu- self to the most tiring interac- light of the foreseen and fore- cate in serene and constructive tions without boundaries, al- seeable transformation in the criticism, in lucid analysis and ways directing his gaze to real field of the demand for well-be- where appropriate without problems, but with innovative ing from society to man. Fore- pulling any punches, in study wisdom. So many religious, ec- seen and foreseeable transfor- and research; d) avoiding allow- clesiastic, trade unionists and mations in the field of respons- ing ourselves to be dragged for- lay fellow workers remember es as well, responses which will ward by events, by the ‘va- him this way and with them he be increasingly detailed, com- garies’ of fashion, by the peace- prophesied that Catholic health- plex and not manageable by ful tramlines of consolidated care institutions had to be re- one person or only one func- custom, so as to be forerunners, founded, being monopolised as 37 tion. These two revolutions utopians (but I would prefer say they were by old and narrow were born from the increasingly prophets) in the world of health mental habits. From his con- evident observation of an in- care. We must know how to cern about the future came his creasing state of dissatisfaction identity from this moment – so interior worry which prevented felt by us, on the one hand, and as to be able to then worthily him from stopping at the road- by sick people, on the other’. welcome – those in need at the side to be very happy at the re- end of this century and at the sults that had been achieved. In- beginning of the twenty-first stead, it pushed him forward to century. This task, as well, has look beyond the usual narrow too often been left to other peo- horizons and understand the ple: we, too, were in a better meaning of history. And he did condition speedily to come to this, even when he proposed to the help of that part of humanity innovate the forms and the which every now and then is ‘style’ of the presence of reli- ‘discarded’, marginalised by gious within health care, with medical science and by society the certainty that this would al- itself… This is a conditionm- so have improved the quality of sine qua non to achieve the care. goals that we established for In this sense, one can affirm ourselves. We must, that is to that he was a religious who say, also transform ourselves in- knew how to recognise the to researchers, overcoming the essence of being the Church in From this came a project for a temptation to abandon old Eu- health care, not only in owning new hospitality which is still of rope because it is more difficult hospitals that had to be man- contemporary relevance as re- to find there the poor, the needy; aged but also and above all else gards its contents and which in reality, we find ourselves ad- in taking on in a responsible was also prophetic in terms of dressing forms of poverty that way the constitutive ministry of its inspiration: ‘In detail, our do not relate so much to having overall assistance and care for programme can be outlined as as to being, and thus they are sick people as Christian witness follows: a) the abandonment of much more grave and more dif- in the health-care world. the idea that it is enough to per- ficult to help: one need only The fact that he was a son of form tasks of the past of a think here of loneliness, of the Church within a hospital prevalently operational charac- abandonment, and of a lack of Order had formed in him the ter so as to enrich our inner affection’. belief that he had an ineluctable lives, cultivate our capacity for duty to involve bishops and the love, and embody the role of top of the ecclesial hierarchy in witnesses who are ready to re- 3. His Prophetic Intelligence becoming agents of health and ceive the appeal that humanity in Understanding salvation through pastoral care addresses to us. We must al- his Time in health and the promotion of ways bear in mind that we be- governance of institutions that came religious not to direct, not ‘In a society full of prophets was in conformity with the to be well in the corridors of of misadventure’, observed principles and values of power, but to bear witness to an Cardinal Angelini, ‘Fr. Pierluigi Catholic ethics. It is worthwhile authentic and total interest in was a prophet of hope. Who remembering that he wanted a those in need; b) directing our does, does not judge; who does, School of Hospital Manage-

DOLENTIUM HOMINUM N. 75-2010 ment, a School of Bioethics, reality of the facts: history had those dramatic moments he had and humanistic formation for proved him right. In the history two models to whom he was in- his brothers and fellow workers of the Church as well – the cre- timately bound: St. John of God to provide solid bases for the ation of the Pontifical council and St. Benedetto Menni, as constant changes that agitated, for Pastoral Assistance to well as an example who was and still today perturb, the Health Care Workers; certain very close to him, his brother health-care world. specific initiatives of Popes; and Superior General, Fr. Mosè Indeed, his being a prophet certain passages in Consecrated Bonardi. Although he spoke was not reduced to simple ap- Life; and the rich literature of with modesty and timidity peals and abstract ideas but is to the prestigious review, Dolen- about his entrusting of himself be defined as an interpretation tium Hominum – can be led to God, being afraid that he did and concrete response to the back to the cultural movement not have suitable words to do challenges of his time. In that he launched and promoted this, his way of praying in si- chronological order, the follow- with sacrifice that was also of a lence and weeping before God, ing were consigned to history: personal nature. showed him, to those who were the titanic project of the renew- When one looks at the liter- near to him, in his authentic hu- al of his Order which involved ary production that derived manity and patience when faced him from 1976 to 1982; the pro- from his speeches and which with dying. motion, together with other reli- were published in the volume gious Orders, of the Religious entitled ‘Humanizzazione. Sto- Association of Social/Health- ria e Utopia’ (‘Humanisation: Care Institutions; the cultural History and Utopia’), edited by campaign for the humanisation the Hospital Order of St. John 38 of health care; and the decision of God, and published by Velar that was epoch-making for Italy in 2006, one understands, in all to prepare, in cooperation with his positions both as Superior the public authorities, for the General and as the head of the placing of Catholic institutions Office for Studies, as a sick within the National Health Ser- man or as a healthy man, even vice. These were moments of though outside the centres of that ecumenicalism of works in- government of his beloved reli- voked by Cardinal Angelini, by gious Order, that his passion re- which one wins the ‘wager of mained intact. The 1980s and charity’ (Novo Millennio Ine- the 1990s were important years unte, n. 49) and which the when his approach of being an Church must carry out in its ca- ‘elderly man’ allowed him to pacity of yeast in the dough of show his human face and in ad- We find an echo of this in a health-care systems. dition his strength of character. text that was published by the In particular, I am happy to In accepting posts that he had review Fatebenefratelli of Mi- stress how from his humanity not requested, he affirmed with lan in a special edition dedicat- emanated the prophetic charge determination the strength of ed to Marchesi and in which ap- contained in his project for the his ideas that his ardour and his pear certain intimate reflections, humanisation of health care. personal involvement made perhaps a prayer composed in His sensitivity allowed him to credible even though from cer- previous years as a very confi- prefigure the future by intro- tain points of view they were dential and tender conversation ducing the concept of the hu- contestable. between a creature and his Fa- manisation of the health-care ther: ‘One should receive illness and welfare world to achieve a as though it was a letter, given full sharing and implementation that it is intended to reveal of the charism of hospitality. CONCLUSION: something to us. Illness is a In his Order he was a strenu- ENCOUNTERING THE weakness that tests our real ous promoter of an alliance FACE OF CHRIST strength. A forge where a sick with lay fellow workers, with man becomes the good creator whom he shared the values of Perhaps those who will look of his character. An interval in a the charism of hospitality. With at him in the future will under- life of selfishness and vanity by vehemence he challenged stand him better than was the which to change tempo as re- members of the laity and reli- case with his contemporaries, gards the earthly symphony. A gious with the words ‘if we do but his serene approach when crossroads where one can halt not have the courage to mea- faced with his final suffering for a little while and choose the sure ourselves with men, we and the parting caused by death road to take and look at one’s cannot speak about humanisa- compel us to reflect on what Fr. goal. A stop where one can tion, rather we should speak Pierluigi can still tell us. His weigh the value of things and about the rationalisation of ser- death as an impoverishment and measure the stature of men. A vices’, and in trust in being at elimination of self, in openness retreat where one can recite the thesideofGod. to the will of God, identifies miseries of sin and the litanies His insights about the future him as the righteous man of the of patience… An altar before development of the health-care Bible: ‘at that time his deeds are which one can repeat the third world, with the passing of time, revealed for everyone to see’ invocation of the Father. But were proved to be right in the (Sir11:28). To guide him during hard weeks or months or years,

DOLENTIUM HOMINUM N. 75-2010 drops, streams or rivers, go on where you were going, with your commitment, your to the sea. The ocean always re- fear, with suffering, but also courage, your prophecy and flects the blue of the sky. And with joy and hope; you left with your idea of renewal; thank you this is the time to interpret one’s a tired and suffering body be- for giving a new face to our Or- own illness. Thus, after contem- cause of so many tests and so der; thank you for your love for plating the afternoon and the many therapies. our Order, the Church, the sick evening, we are pushed to the You have left. I almost can- and our fellow workers. May verge of that mystery that seals not believe it. You left when in all of this be for you an ‘identi- our brief earthly lives. Let us your diary there were so many ty card’ that allows you to em- put it briefly… In reality, it is projects, appointments, and so brace the Lord, with John of long enough to allow us to see, much to do. With your wish to God, one of whose successors to understand and to judge our- live you wanted to carry them you were in its animation as its selves. It is certain that when out with commitment, with Superior General! observing the journey that has will, with responsibility in rela- Thank you. So many thanks! been made hitherto, only a few tion to our Order, your religious May you ignite in us your gestures emerge from the grey- Province, our dicastery for pas- courage, your faith, your love ness of years. Often our errors toral care in health of which and may your death be for all of are of an exasperating monoto- you were one of the greatest us a seed which produces these ny. And from the gorges, in promoters from its creation un- fruits. You have departed, Fr. which we are reflected with too til today. Precisely a few hours Marchesi, but you will remain much pleasure, there still come before your death, when finish- alive in our hearts, in my heart. miasmas from stagnant waters. ing the programme of the next Vatican City, 2 March 2002. And now I am here, with my international conference to be life behind me, at times tepid held in November on the sub- 39 like a breath, at times far from ject of Catholic health-care in- TO THE SECRETARIAT dying. I am here, with that little stitutions, we remembered your OF THE OSSERVATORE that I have achieved with diffi- name and we assigned a paper ROMANO, VATICAN CITY culty, and thinking of that great to you, with the doubt, I confess deal that I could have done in to you, as to whether you would The President Archbishop, doing good. But the sack is be able to come at that moment, the Father Under-Secretary and empty and the road is almost at and unfortunately such was the all the Officials of the Pontifical an end. This is the hour for a case. You will not be in the pro- Council for Health Care Work- deeper examination of con- gramme but nonetheless you ers join in Faith and prayer with science. I must weigh myself will be present, a protagonist; His Excellency the Secretary, and measure myself, before my we will remember you with af- Msgr. José L. Redrado OH and judge does so. I am a grain of fection. the whole of the Order of the sand. I am a blade of grass. And You have departed, Fr. Fatebenefratelli, on the return this is the hour of my last wish- Marchesi, and you have to the House of the Father of es. Well, I would like to die in reawakened in me feelings and the Most Reverend Br. Pierluigi your grace, O Lord. I would like experiences. I remember you Marchesi OH, member of this my last hour to come when I am with affection and with love. dicastery from its creation, and working. I would like to depart For me, for my vocation in hos- they remember his zeal and his happy at having dreamed my pitality, you were a point of ref- qualified work, in particular life’. erence, a model, because of during his time of service as your enthusiasm, commitment, Superior General of the dedication and love for our Or- Fatebenefratelli, made available TO FATHER PIERLUIGI der and the sick. to the Pontifical Council for the MARCHESI, I admire your courage and promotion of respect for sick WITH AFFECTION AND your insight. For me you were a Man and the defence of life at WITH LOVE, mediation that encouraged my all times, being grateful for the vocation, that led it to greater expert role performed hitherto + José L. Redrado, OH service, that filled it with a as the coordinator of the Inter- great experience. national Association of I am moved. Your death Much of the renewal that has Catholic Health-Care Institu- reawakens in me feelings, taken place in the pastoral care tions (AISC), and they remem- memories and experiences. in health of our Order is due to ber, edified, his witness of Your death, which was almost your prophetic vision! My hos- Christian fortitude in accepting expected, when we learnt about pital episcopate also has a great with serenity and great Faith his your grave illness, but always deal to do with this mysterious sufferings of his last moments. with a thread of hope, thinking journey of life and the media- 4.3.2002 that it would not be so quick. tions that have occurred in rela- And it was so quick, almost tiontoit. H.E. Msgr. JOSÉ L. REDRADO, hurried, hastened, always mov- For me and my vocation, for O.H. ing, like a bell that chimes and my role in the service of the Or- Secretary of the Pontifical Council for Health Care Workers, reminds us of an appointment. der and the Church a mediation the Holy See. You departed knowing that you for which I give thanks and had begun a voyage with a dif- which I remember with affec- Prof. Rev. PIETRO ficult return; you left in the tionandloveinmyheart. QUATTROCCHI knowledge that you knew Thank you Fr. Marchesi, for Associate of the Fatabenefratelli.

DOLENTIUM HOMINUM N. 75-2010 Mourning: Healing the Wounded Heart

One cannot conceive of life produced by a separation, and graines, difficulties with diges- without linking it indissolubly this is even more the case if that tion and so forth. to the presence of death. From a separation has been dramatic, If, instead, these feelings are child being born to the dying upsets a person, interferes with received and channelled posi- man who utters his last breath, his or her sleep, impedes his or tively, with the passing of time the whole of the trajectory of her concentration, blocks his or they tend to become weaker existence is marked by thou- her capacity to take decisions and to foster the healing of the sands of ‘small adieus’ or sepa- and often his or her wish to go heart. rations which prefigure the fi- on living. nal detachment – death. The mind is inhabited by a 3. The healing of life The death of a loved one, es- thousand questions about why pecially if it takes place in un- the event took place, by a need Theresultofachangeina expected circumstances, is in- to be in contact with the person ‘way of thinking’ is reflected in stinctively rejected because it who has died, and by a search a ‘way of feeling’ and this in its upsets one’s life and destroys a forwhattodowithtimeandsi- turn bears upon the ‘behaviour’ myriad of dreams and projects. lences. of a person. Then, slowly, the days of loss Criteria by which to measure Every significant loss pro- and tears are followed on the a positive working through of duces a change in identity be- 40 part of those who stay behind grief relate to the ability of tween the self of the past and by elements of a smile and the those who remain to change the contemporary self, a change commitment to move on. their habits, to look at the event that bears upon the internal and Many people are able to with a wiser and more realistic social horizons of the person. manage their sorrow by draw- approach, to become reconciled The itinerary of gradual healing on their own strengths and to the precariousness of exis- ing envisages, after an initial resources; others need to en- tence, to learn to take small de- stage of dismay and once the trust themselves to the help of a cisions and to adopt a construc- most intense reactions have professional (a psychologist, a tive approach towards the pre- been overcome, the person be- psychotherapist, a psychiatrist, sent. ing able to recover energy, pro- a medical doctor, a priest…) in ducing new projects and hon- order to receive support from 2. The healing of the heart ouring his or her own family, him or her during critical mo- social and professional respon- ments, and yet others resort to Health of the mind passes by sibilities. theuseofpillssuchassleeping way of the mediation of the For some people this adapta- pills or tranquillisers in order to heart where the feelings and tion requires a very long time, alleviate the stress of inter- emotions provoked by the loss for others a shorter period of minable sleepless nights. are located. These feelings in- time according to the motiva- A small group of people take voke welcome and citizenship tions that are present in individ- advantage of the support of- in order not to be relegated to uals, the resources that have feredbymutualhelpgroupsin oblivion. been activated and the choices order to work through mourn- Feelings that are recurrent in that have been made. ing in which they experience a grief are: shock and incredulity, release of feelings and solidari- a feeling of emptiness and lone- ty with, and nearness to, other liness, anxiety and fear, anger Pathways of Healing people in difficulty. and resentment, sadness and bitterness, regret and a feeling In every wounded person of guilt. there dwells a patrimony of hu- Recovering from Mourning: At times the states of mind man and spiritual potentialities a Global Process are intense and lasting; in other that play a role of primary im- circumstances they are more portance in healing pain. The Mourning depends on the ca- tenuous and transitory. Two ap- process of gradual healing as pacity of those who remain to proaches that are diametrically regards mourning can follow find reasons and purposes so as opposed and equally ineffective seven pathways, according to to redesign their own life pro- in managing these feelings are, the history, the values and the jects. on the one hand, the tendency sensibility of each individual. The process of a healthy to impulsiveness with a loss of working through of a loss bears control and, on the other, an in- 1. The spiritual pathway upon three dimensions: the clination suffocate them, to de- or the pathway of faith healing of the mind, of the heart ny them or to repress them. and of behaviour. Ignored feelings do not dis- For many people the medi- appear but as is the case with cine that alleviates pain is of a 1. The healing of the mind frustrated children they return spiritual nature. The spiritual di- to the centre of the scene and mension is a part of the human The first step involves heal- call for attention through psy- being, independently of whether ing the mind. The laceration chosomatic malaises, mi- he or she adheres or otherwise

DOLENTIUM HOMINUM N. 75-2010 to a particular creed or attends a hauer), works of music (Back, ilies are numerous, at others church, a synagogue, a mosque Mozart) or schools of psycholo- they have few members; in or a pagoda. It concerns the re- gy (the logotherapy of V. Fran- some families a healthy air and lationship with God or with the kl) which were created against a an air of nearness between the transcendent and the pursuit of background of the personal suf- family members is breathed; in values such as peace, forgive- ferings of the artists concerned. others there prevails coldness or ness, acceptance, altruism, hope Just as birth pangs generate interpersonal detachment; and and so forth. At the heart of the precious gift of a new crea- some families are communica- spirituality, for many people, ture, so encounter with death al- tive and open to society where- there is the search for God lows some people to bring forth as others tend to be closed and and/or the need for meaning. an unexplored dimension of isolated. Every tragedy places the themselves or unknown talents. The family humus fosters or question of meaning at centre Nothing like melancholy or impedes the process of recovery stage: concern at one’s own nostalgia awakens the aesthetic from the events of mourning. powerlessness, the perception or imaginative potential of indi- Secondly, every individual of the presence or absence of viduals. For some people the has to opportunity to rely, in ad- God in pain, and questions voyage of self-discovery finds dition to their family, on their about the life beyond. expression in poetry, for others friends and those they confide On the one hand, suffering in the pages of a diary which in, who are often people who reveals to man his fragility but, narrate fragments of their own are not conditioned by the fam- on the other, it releases his internal history, and for yet oth- ily dynamics and are freer to virtues. ers in painting or the use of ma- harmonise with the needs of On some occasions a detach- terial for the externalisation of their interlocutor. Being able to ment is accompanied by a radi- flashes of their interior land- rely on friends facilitates the 41 cal change in the values that are scape. expression of thoughts and feel- adhered to. A person can pass ings and allows time and space from a material style of life for recovery and relaxation. which is shallow and selfish to A third horizon of support is the choice of genuine values, to characterised by the support the sharing of his or her posses- that is received from work col- sions, to a social commitment leagues or members of a group, that would have previously the community or an associa- been unthinkable. In these cas- tion to which an individual be- es, adversity is transformed into longs. profound existential conversion. At times the circumstances of The spiritual dimension or mourning also foster unfore- the support of a religion per- seen encounters that lead to form for many people a thera- new affective ties which attenu- peutic and healing function dur- ate the loneliness that is experi- ing events involving mourning. enced and open up new doors Spiritual comfort can be ex- for tomorrow. pressed through resort to prayer or meditation, abandonment to 4. The pathway of self-care God, the need for forgiveness or reconciliation with the past, a At times the introspective Separation from someone, greater involvement in the prac- voyage is fostered by attending like love for that matter, em- tice of one’s faith, attending courses of psychology or cours- braces the physical, mental, prayer groups or groups that lis- es connected with self-esteem psychic and social spheres. ten to the word of God, taking in order to foster a more au- Pain can lead the survivor to part in pilgrimages, listening to thentic understanding of them- neglect himself or herself, to religious programmes on televi- selves. find a thousand excuses for not sion or radio, and the belief that In a few words, creativity of- being involved in daily activi- life on earth is not a destiny but fers an opportunity to reveal ties, to become embittered and a journey that leads on to a des- oneself and fulfil oneself. close himself up in his or her tiny. own world, and to take refuge in 3. The pathway of affective ties an excessive consumption of al- 2. The pathway of cohol or drugs to reduce his or self-discovery Mourning is not only aware- her pain. ness of what has been lost, it is A reliable thermometer of A gift that is frequently ig- alsoaninvitationtobegrateful health is the motivation of the nored or concealed in the shad- for what has remained. For the individual as regards taking ow of pain is human creativity. majority of people, the family care of himself or herself. The Creativity expressed down the and its components (parents, commitment to caring about centuries by philosophers, nar- brothers/sisters, spouses, chil- oneself is expressed first and rators, poets, painters and sculp- dren and grandchildren) consti- foremost in the practice of a tors who have transformed their tutes the vital nucleus of refer- healthy diet and physical exer- own grief into works of art. One ence in grief. cise, through healthy walks may think of philosophical sys- Every individual grows up in amidst nature or going to a tems (Kierkegaard, Schopen- a different family: at times fam- gymnasium. Other forms of

DOLENTIUM HOMINUM N. 75-2010 caring for oneself include pay- A wounded heart heals when intensity of their pain and use ing attention to hygiene and affective energy that was previ- time and resources in a positive one’s own image, the practice ously centred around a loved way, many couples find com- of yoga or breathing exercises, one who has died is channelled fort in being able to immor- in order to obtain self-control and invested anew in other re- talise the memory of their loved and counter anxiety and many cipients or new goals. one through a project or a foun- disturbing ideas, and engaging In practice the dismay and dation named after them. One is in some hobby or pastime in or- emptiness produced by an adieu not dealing, therefore, only der to find areas of gratification becomes an appeal to open with memories linked to a place and relaxation. one’s heart to a family or to a (for example a visit to a grave larger community that can ben- in a cemetery or the laying of 5. The cultural pathway efit from one’s time and one’s flowers around a tree where a solidarity. child died) but of creating an Many people seem to find in initiative with a good purpose cognitive stimuli a fertile ter- and of maintaining the memory rain by which to heal pain, of that person alive in time. At nourishing the mind with grati- times this project involves giv- fying stimuli and opening it to ing study grants to help young the opportunities of the present. people who are without eco- The closed mind is a trap which nomic resources to study; in turns out life and obscures the other cases it involves the spon- present. The mind, wrote soring of projects involving sci- Bergler, is like a parachute: it entific research. 42 functions when it opens. A project projects into the fu- To open oneself to healing ture and at the same time makes means working to ensure that present a person who is absent. mourning does not become a prison but, instead, opens up to knowledge and where this is Voluntary work is a privi- Healing Life possible leads to wisdom. leged pathway for many people This journey is the pathway by which to heal pain and trans- Each of the itineraries proof those who strive to under- form it into love. There are poses refers to the power of stand in a better way the experi- those who belong to an associa- transformation contained in ence of mourning though the tion or a group involved in visit- pain. Some people deal with reading of books and articles on ing elderly people or sick peo- grief by privileging the path- the subject, taking part in cours- ple in institutions or at home, way of the mind (reflection, es involving education or infor- that gives a few hours to teach creativity, cultural expansion), mation about the working Italian to immigrants or a help- others privilege the pathway of through of loss, and contact on ing hand to the poor, or that is the heart (affective ties, altru- internet with other people bear- involved in ecological volun- ism and gestures of self-giving the burdens of mourning. tary work or in ambulance ser- ing), and yet others privilege Openness of the mind em- vices. Membership of self-help the pathway of the spirit (the re- braces the possibility of signing groups for losses becomes a lationship with God and with up to a voyage, encountering constructive pathway by which the community, the strengthen- different cultures and traditions, to be helped and to help. Each ing of spirituality). learning a language, attending group is an university of pain: There are those who entrust courses for the elderly, debating one learns observing, listening, themselves to a specific itiner- current affairs, and taking part communicating and engaging in ary to heal pain and those who in cultural or artistic events dialogue in a constant process avail themselves of the contri- After a certain fashion, en- of giving and receiving. bution of various pathways; counter with death forces re- there are those who start with flection and the articulation of a 7. The pathway of projects man and those who start with new philosophy of life. God. Beyond the good that has Fertile pain expands horizons When one loses grandparents been lost and the consequences and gives depth to existence. or parents the grief is about the that are suffered, the indispens- loss of the past; when one loses able conditions to heal a 6. The pathway of self-giving a spouse, a fiancé or an intimate wounded heart require an ap- friend, the grief is about the loss proach open to life, the motiva- For a myriad of people, the of the present; and when one tion to grow, a readiness to master path by which to heal loses a child or a grandchild the adapt to changes, the need to pain is love. In truth, the best grief is about the loss of the fu- love and to feel loved, and the way to help ourselves lies in ture. In general the most searing creativity to compose music finding opportunities to help loss is the loss of a son or a with the strings that remain. other people. Often, however, daughter. Usually, children pain impoverishes and makes bury their parents, and it is a Rev. ARNALDO PANGRAZZI, us egoists: many people are led dramatic thing if parents bury M.I. Lecturer in Pastoral Care in Health, to fold in on themselves and to their children, to whom they the Camillianum International interpret reality through the ex- gave life. Institute, clusive lens of self-reference. In order to try to alleviate the Rome, Italy

DOLENTIUM HOMINUM N. 75-2010 The Hospital Chaplaincy: a Construction Site for the Church of Communion

(THE RESULTS OF DOCTORAL RESEARCH)

1. Introduction: the observations cited above, element of absolute innovation Chaplaincies and emphasises its particular pur- here as regards the pastoral ac- Hospital Chaplaincies poses: ‘a chaplaincy is an eccle- tion of hospital chaplaincies siastical entity created through was specifically the possibility John Paul II, on the occasion the legacy or donation of a of having other pastoral figures of the nineteenth international faithful, especially for the cele- as well as priests. Before this conference on ‘palliative care’ bration of Masses at a specific pastoral note, reference had organised by the Pontifical altar of a church’.4 In more never been made to hospital Council for Health Care Work- summarising form, a dictionary chaplaincies by the Italian ers on 11-13 November 2004, of the Italian language defines Bishops’ Conference or a pastor observed: ‘The Church intends ‘chaplaincy as the ministry and of a local Church. to continue to offer her specific office of a chaplain’.5 As a con- In the subsequent sections contribution through the hu- sequence, according to what is (nn. 79-81) of this document man and spiritual accompany- indicated above, the term ‘hos- reference is also made to the ing of the sick who wish to pital chaplaincy’ should also be principal purposes of this new 43 open themselves to the mes- understood as a religious or pastoral body, those that are ad sage of love of God, who is al- spiritual service that is princi- intra, i.e. the health-care con- ways attentive to the tears of pally cultural and sacramental text, and those that are ad extra, those who turn to Him (cf. and which is carried out by one i.e. the parish community and Psalm 39:13). Here emerges or more chaplains (priests) the local area: ‘The principal the importance of pastoral care within a health-care structure. objectives of a hospital chap- in health in which hospital laincy are as follows: to have in chaplaincies, which contribute 1.2 The new meaning of the a health-care institution an ac- so much to the spiritual good term ‘hospital chaplaincy’ cessible ecclesial sign which of those who are in health-care makes possible missionary ac- structures, have a role of spe- The official date of the birth tion; being a place where, cial importance’.1 This is an of the ‘hospital chaplaincy’ en- through people, aptitudes and authoritative and significant dowed with a new name may gestures, including sacramental statement both because of the rightly be seen as 30 March ones, God reveals His tender- tones that are used in relation 1989, a ‘historic’ day in the life ness, and which places itself at to ‘hospital chaplaincies’ and of the Italian ecclesial commu- the service of man in order to their pastoral action for the nity because this was the date accompany him in his tribula- sick and health-care workers, of the document – which was tions, helping him to live until and because of its recipients, defined as a ‘pastoral note’ – the end; promoting and coordi- who had gathered together at entitled ‘Pastoral Care in nating all the forces that are an international assembly in Health in the Italian Church’, present in the hospital commu- which took part qualified men which had been drawn up by nity through suitable instru- of science and people involved the National Council for Pas- ments and initiatives (pastoral in pastoral care in health. toral Care in Health and ap- advice…); and contributing to proved by the Standing Council the involvement of Christians 1.1 The ancient name of the Italian Bishops’ Confer- who are in the local area in the of chaplaincies ence.6 For the first time in an promotion of health and care official document the subject of for the sick’.7 The term ‘chaplaincy’ was pastoral care on health was tak- already used, according to A. en into consideration and there 1.3 The bibliography on Caro, before 1566 and was de- was an – albeit brief – reference hospital chaplaincies fined as an ‘ecclesiastical entity to a new pastoral body. created for the purposes of wor- An essential definition of this After the publication of the ship’.2 The Zanichelli ency- body is given in this document: above-mentioned pastoral note, clopaedia repeats the same def- ‘A hospital chaplaincy is an ex- and above all during the second inition but adds the reason for pression of the religious service part of the 1990s, in Italy there its creation: a chaplaincy is an provided by the Christian com- took place a marked increase in ‘ecclesiastical entity created for munity in health-care institu- interest in hospital chaplaincies, the purposes of worship by the tions’. The document also lists understood in the new pastoral will of, and because of the do- the pastoral workers who can sense, not only on the part of nations or bequests of, one or belong to it: ‘It should be made those directly involved (hospi- more faithful’.3 An illustrated up of one or more priests to tal chaplaincies, pastoral work- dictionary of the Italian lan- whom can be attached deacons, ers, the directors of diocesan of- guage, for its part, after making religious and lay faithful’. The fices or other pastoral bodies),

DOLENTIUM HOMINUM N. 75-2010 but also on the part of the Mag- Provincial Ministers (CIMP- ences without fundamental cri- isterium of the Church. Both Cap), the Secretariat for Pas- teria of verification, will be Pope John Paul II and the bish- toral Care in Heath organised a matched by a lack of clarity at ops of local Churches began to national conference on the sub- the level of terms, an ambiguity turn their attention to hospital ject ‘The Chaplaincy. A Kairòs as regards contents, and an in- chaplaincies in order to point for Pastoral Care in Health’ correct rooting in the pastoral out policies so that their full es- (1996).21 reality of the Italian Church. tablishment could be achieved.8 In dictionaries the heading Thus within the context of If one observes in greater detail ‘hospital chaplaincy’ found its the journey that the Italian the bibliographical production own interesting space. In the Church has been engaged in on hospital chaplaincies in a na- Dizionario di bioetica (1994), over the previous four decades tional context from the begin- Guido Davanzo dwelt upon the (1960-2000), and taking into ning of the 1960s until the end hospital chaplain and referred account the various experiences of the 1980s one finds writings to the experience of chaplain- which had been underway for a of a varied character and vary- cies,22 but the analysis of A. Br- number of years in the local ing levels of importance in usco in the Dizionario di Teolo- Churches, my doctoral research which reference is made to the gia Pastorale Sanitaria (1997), had the principal purpose of en- need to open pastoral care in although it referred to an analy- gaging in a theological reflec- health to cooperation with sis that had begun a few years tion on hospital chaplaincies;a members of the lay faithful.9 previously,23 was more detailed drawing up of their Biblical This subject was already be- as regards the various aspects foundations; an attempt to de- ing addressed at a national con- of pastoral realities that are ad- fine their identity and compo- ference on pastoral care in dressed and was presented nents; an in-depth analysis of 44 health which was organised by again24 in the first Manuale di their evangelising mission; and the Minor Capuchin Friars at S. teologia pastorale sanitaria the beginning of a survey of Giovanni Rotondo (1984) when (1999) which he wrote together their openness to their local ar- the testimony of a French lay with S. Pintor.25 eas. For this reason, an attempt pastoral worker (a woman) who was made to ‘read’ the renewed was active in a hospital chap- 1.4 The need for a deeper pastoralcareinhealthofthe laincy was listened to.10 How- and more overall analysis hospital Christian communities ever, there was no lack of qual- in the light of the ecclesiology ified hospital pastoral workers From this summarising ex- that was developed by the Sec- to pay attention to the experi- amination of the principal liter- ond Vatican Council, to read the ences of hospital chaplaincies ature in the field, I drew the renewal of the universal Church in European countries in order conclusion that at the present which took place after the Sec- to posit experimentation with time Italy does not have a spe- ond Vatican Council, and to them in Italy. For example, ref- cific study involving an overall read the signs of the times ex- erence should be made to the theological analysis of hospital pressed in the evolution of the Capuchin, Rev. Stefano Bambi- chaplaincies. Certainly certain health-care world, within the ni,11 the Camillians, Rev. Ange- insights exist, reference is made horizon of team work made up lo Brusco,12 Rev. Luciano San- to possible theological hori- of the multiple component parts drin,13 Rev. Silvio Marinelli,14 zons, stress is laid on the need of the people of God. and Rev. Rosario Messina,15 for, and the urgency of, a re- With the help of theological and one should not forget the newal of pastoral action in the ‘suggestions’ made by Mario papers given by Msgr. Elio health-care world, but this was Midali (the importance of the Sgreccia16 and Msgr. Giorgio not followed by the develop- kairological stage in theological Beconcini.17 ment of a study and more seri- analysis) and by Bruno Forte Side by side with the voices ous analysis of the subject. (the three defining elements of of individuals, reference should By now the need for a broad- the Church at all times: koinon- also be made to the regional er and deeper theological analy- ia, diakonia and martyria), I or- conferences concerned with the sis of this pastoral body which ganised the chapters of my re- pastoral experience of hospital was beginning to advance in the search on hospital chaplaincies chaplaincies: that held in Cal- health-care/hospital structures along the following lines: chap- abria (April 1992)18 and that of our country was seen as inter I – the three kairological held in Liguria (May 1993).19 eluctable. It is true that ‘ortho- events of the birth of the hospi- These were the beginnings of praxis’ is important in the life of tal chaplaincy; chapter II – the an analysis engaged in by peo- the Church but it is equally true hospital chaplaincy as ple who were personally en- that ‘theory’, that is to say re- koinonia: identity and compo- gaged in pastoral work and flection on pastoral experience nent parts; chapter II – the hos- wanted to make it known about in the light of faith, is also use- pital chaplaincy as diakonia: in wider contexts. At the Third ful and indispensable. These are vocation and mission; chapter Conference of the National both important and element ele- IV: the hospital chaplaincy as Council for Pastoral Care in ments in daily experience and martyria: witness. The author is Health of 1995 a study group Christian tradition. Otherwise happy to offer a summary of the on hospital chaplains was es- thereistheveryrealriskthat results of his doctoral research tablished,20 and a year later, un- the abundance of analyses that entitled ‘The Hospital Chap- der the auspices of the Italian are engaged in at a number of laincy: Koinonia, Diakonia and Conference of Capuchin levels, and a variety of experi- Martyria of the Church in the

DOLENTIUM HOMINUM N. 75-2010 Changing World of Pastoral achieved practical expression son in communion to advance Care in Health’ to the readers of in socio-cultural phenomena his or her community in the the international review Dolen- and ecclesial facts with an evi- same dimension. tium Hominum, the official dent impact in the religious The icon of a Samaritan voice of the Pontifical Council sphere; and c) the ‘horizons’ communion clearly emerges for Health Care Workers.26 that were broadened by the re- from the consciousness of the newal and development of pas- fathers of the Second Vatican toral care in health and which Council. They imagined a 2. The Three Kairological were embodied in new figures Church that knew how to write Events of the Birth of the and new bodies within the hos- in every epoch and in an origi- Hospital Chaplaincy pital world. These three events, nal way that parable of making read within the context of pas- oneself a neighbour to those Beginning with the belief toral care in health, may be who are in need which Jesus that hospital chaplaincies in seen as special factors that led embodied, first of all. Italy did not arise suddenly to a maturation of the need for, The countenance of a Church and that the idea of hospital and the birth of, hospital chap- where ‘all are responsible’ in chaplaincies and the need for laincies. the ministry of pastoral care in them developed gradually over health was already outlined and four decades (1965-2006), I 2.1 The ‘seeds’of the attention took on over the following analysed the slow journey of paid by the Second Vatican years increasingly precise traits the Church in recognising signs Council to pastoral care in as a result of the notable contri- of the times in this develop- health bution of John Paul II and the ment, in line with the observa- journey of the Italian Church tions of Gaudium et spes: ‘the When examining the texts of engaged in by the National 45 Church has always had the du- the Second Vatican Council Council, and then by the Na- ty of scrutinizing the signs of there emerges the perception of tional Office, for Pastoral Care the times and of interpreting a Church already attentive to in Health. them in the light of the Gospel. the sick and to the promotion of The two features of a community that is a maestra and a ministra in the originality of the insight of John XXIII were read from the point of view of the concern of the mother Church with the good of the multi-factor health of humanity and individuals. I believe that it is not difficult to see these four characteristics brought together in the pastoral agency of the hospital chaplaincy which may legitimately be defined as: unity of communion; a community of communion; a communion of the Samaritan ministry; a community of shared joint responsibility; and a community of health/salvation.

2.2 The ‘values’of the founding law of the Thus, in language intelligible to health, albeit in the perspective National Health Service each generation, she can re- of a theology of suffering in spond to the perennial ques- conformity with those years. I The creation of the National tions which men ask about this stressed four cardinal points of Health Service in Italy, read present life and the life to this Church of the Second Vati- through the hermeneutical prin- come, and about the relation- can Council: ciple of the basic values of the ship of the one to the other’.27 I The ecclesiology of commu- first section of law 833, was identified three signs of the nion was a point of departure seen by me as a river into times: a) the ‘seeds’ of the at- which had in itself the seeds whose bed flowed the essential tention paid to the Second Vati- that were developed during the and very important values of can Council to the sick and to journey taken after the Second civil society. I am convinced the promotion of health which Vatican Council. I was thus able that the creation of the Italian grew into plants and fruit dur- to observe that as the people of NHS ‘can and must constitute a ing the period after the Second God the Christian community is real ‘sign of the times’, a solici- Vatican Council; b) the found- achieved in communion and tation, a push, a privileged op- ing ‘values’ of the law which lives for communion. Each portunity that should intensify created the National Health member receives in baptism the and accelerate the commitment Service (n. 833/1978), which mission to grow in the first per- – which is already for other rea-

DOLENTIUM HOMINUM N. 75-2010 sons underway – to the creation as yesterday, continues to be 2.4 From the signs of the of authentic local Christian that of offering a specific con- times…to the time of signs communities’.28 tribution to its mission of the to- I analysed these values with tal salvation of man and to act The world of health care – a reference to the community of so that these enunciations are complex and emblematic mir- the Church. In this way I exam- not denied at a practical level. ror of the broader society of our ined a) the value of health un- We may see these principles as time – poses various chal- derstood in its most overall strong ‘pro-vocations’ as well, lenges to the Church: bioethical sense; b) the equality of citizens understood as impetuses to new challenges as regards research as regards health-care services; and original calls to embody the and experimentation; chal- c) the connecting bridges be- missionary nature of the Christ- lenges relating to the beginning tween hospital structures and ian community and as chal- andtheendofhumanlife;chal- their local areas; d) the recogni- lenges for a renewal of pastoral lenges connected with turning tion of the socio-political and care in health both in the hospi- hospitals into companies; and ecclesial value of volunteers; tal world and in local areas as challenges involving the hu- and e) the therapeutic value of well. manisation of health care, to the service of religious assis- mention only a few. ‘The tance. 2.3 The ‘new horizons’of the Church, in the field of health pathway of pastoral care in and health care as well, is called health to listen to the hopes of men and to read those signs of the Lastly, I considered the re- time that constitute a ‘code and newal of pastoral care in health language of the Holy Spirit’’.33 46 as a third ‘sign of the times’ The request for health, in its which led the Italian Church to various expressions and the di- open itself to the suitability of versity of the problems that it the idea of hospital chaplain- raises, is a ‘sign of the times’, a cies. This renewal was charac- pro-vocation’ to which the terised by a series of events Church community is called to that were connected to each respond as a healing communi- other and also causally related ty, as an effective sign of inte- to each other: the steady estab- gral salvation.34 However, if we lishment of the characteristics consider the point well, we can of the identity of this form of state that our time is not only pastoral care in health was fol- pregnant with ‘signs of the lowed by an expansion of its times’ but can also be defined operational frontiers, by the as a ‘time of signs’, that is to discovery of new pastoral say a time that wants and be- Indeed, the founding princi- workers and the creation of lieves in visible gestures on the ples of the NHS may be seen by new bodies of communion and part of the Christian communi- the Church as an authentic animation, by the re-assess- ty. We can state this about every grace of God and a kairòs of the ment of the person of the hos- field of the pastoral action of Spirit which call upon the con- pital chaplain, and by the idea the ecclesial community and science of each citizen and each of the creation of hospital thus also about the field of pas- Christian. With the texts in my chaplaincies. toral care in health. hands, and carefully examining I was reinforced in the belief, Today, the health-care world the sections of the founding law which was not only my own, needs a therapeutic presence of the NHS, I identified numer- that pastoral care in health ex- and a presence of healing ac- ous pastoral points which con- perienced during those years a tions that meet the deepest stitute a ‘strong appeal to our series of advances which were hopes of the human spirit. commitment as a Church to ser- stressed by various theolo- ‘Health is not only a ‘place’ vice to life from its beginning gians31 and which deserve spe- where God extends to us im- to its end’,29 and I strove to cial attention. These ‘advances’ pelling invitations to read His bring out the human and reli- were recognised and almost rat- presence; it is also the ‘place’ gious value of each principle ified in the pastoral note of the where Christians must create and to emphasise its connected Episcopal Commission for the new ‘signs’ where the presence horizons for opportunities a re- Service of Charity and Health.32 of God can also be read by gards pastoral care. In a few words: pastoral care in those who do not believe, a Thus we must ‘be happy at health engaged in a large num- challenge that the Church these enunciations which al- ber of initial journeys which en- makes to the world’.35 ready in its constitutional text abled it to acquire greater visi- and now in the statements of bility in the Church. A concrete this law are marked by the con- sign of this advance was the 3. The Hospital Chaplaincy tribution of Catholic thought idea of a hospital chaplaincy as KOINONIA : Identity and are in conformity with the which had in itself various of and Component Parts Christian vision of the person the proposals made by what and human life’.30 The task of was a renewed form of pastoral After identifying the ‘three the Christian community, today care in health. signs of the times’ that in-

DOLENTIUM HOMINUM N. 75-2010 creased consciousness of the age, and not a common and 3.3. In the third stage Idi- need for the hospital chaplaincy shared destiny. And it is then rected my attention to the world – an expression of a Church of that illness, in not being recog- of health care, read through the communion that allows a nised as a form of life, be- icon of the therapeutic covenant greater appreciation of the vari- comes horribly painful and in- understood both as a relation- ous charisms of the people of curable’.38 On the other hand, ship and cooperation between God – I addressed myself to suffering itself enables us to the various professionals of providing a Biblical and theo- live existential experiences of health to achieve the same end logical foundation for this new special solidarity and commu- and as a relationship between pastoral body and to outlining nion with the other: ‘in an en- these professionals of health the physiognomy of each of its tire life there is nothing more and their patients. I then argued component parts. My analysis important than bending down that this world of health care followed four stages. so that another person, his neck can extend its therapeutic bound, can stand up again’.39 covenant to the Church as well, 3.1. In the first stage I briefly which is rightly called the analysed the phenomenological 3.2. In the second stage I ‘community of the covenant’ event of illness and suffering, dwelt upon an illustration of the and is legitimately present in an event seen above all else as a Biblical covenant seen as a red places of suffering and care season of loneliness, of solidar- line in the history of salvation above all through the action of ity and of communion/charity. I and as an event of communion the hospital chaplaincy. embraced the belief that the in- between JHWH and Israel, His Through the evangelising work terlocutor of theology today is chosen people. In this covenant of its various members, the hos- no longer the atheist but the JHWH reveals above all else pital chaplaincy can offer its man who suffers. ‘The partner that He is a) a father (and moth- qualified contribution in order 47 of dialogue with contemporary er) who cares about and takes to respond to the troubling theology is no longer the en- care of His people; b) a shep- questions of scientific research lightened unbeliever’ but ‘the herd who loves His flock; and and the expectations of those man who suffers: the individual c) a physician who heals those who suffer. who experiences the situation who trust in Him and entrust of non-salvation in its various themselves to Him. I illustrated 3.4. In the fourth stage Ifo- forms…In this experience of and explored these three as- cused in on the harmonious or- suffering we do not encounter pects of the face of God which ganisation of the hospital chap- peripheral phenomena…but al- are significant not only in them- laincy which was seen as a ways the human condition as selves but also as regards the community of the covenant and such…As a result a theology health-care world, where the as a healing mosaic, describing that acts from the experience of sick, their family relatives and the specificity of each of its pain of men is not dealing with the whole hospital community component parts with reference marginal phenomena but with need to experience divine fa- both to its problematic aspects the centre and the depths of the therly and motherly love; where and its valuable new opportuni- human being’.36 Suffering, for the need is perceived for a com- ties: the chaplain priest as the that matter, ‘is an experience munity that requires secure representative of ‘Christ the that is clarified gradually as it is guidance and to live a journey shepherd’; the deacon as the approached: it requires an ap- of fraternity; and where every principal qualifying feature of proach that is measured and re- person aspires to restore his or the ‘service’; the non-clerical spectful, an approach of seri- her health and receive divine men religious and women reli- ousness, because it bears upon salvation. gious characterised by a special the mystery of man and also In the salvific event itself, the ‘consecration’; and the (men bears upon the mystery of God. identity and the mission of Is- and women) members of the It always concerns the mystery rael are presented as being in lay faithful with their gift of of being’.37 communion with its Lord, in baptism and their animation of Suffering/illness is an expe- communion within its social earthly realities. rience of loneliness and of di- life, and in the joint responsibil- I ended the second chapter by vision, of marginalisation and ity of its members. These three stating that hospital chaplain- of neglect: ‘illness demon- horizons of communion also cies came into being in our strates more than anything else constitute the essential require- country through a providential that the world is divided in ments of the Christian commu- shared flow of different factors two. It is synonymous with nities present within health-care or events: the ecclesiology of separation and loneliness. Peo- institutions. Naturally, I ob- communion of the Second Vati- ple with a heart feel compas- served how these three features can Council had an impact at sion, others feel ill at ease, and of YHWH were incarnated in the same time as the creation of yet others are bothered and Jesus Christ, the visible face of the National Health Service and even irritated, but in these dif- the Father, the good shepherd its reforms; the development of ferent ways they give the same who gave his life for his sheep, the theology of the lay faithful message of detachment. They the physician and saviour both took place at the same time as reassure themselves and com- through words (preaching and the appreciation of the ‘genius’ municate to the other that ill- parables) and through therapeu- of women; the ageing of hospi- ness is an exceptional and ex- tic and salvific actions in rela- tal chaplains was accompanied traneous condition, like old tion to sick people. by the crisis of vocations as re-

DOLENTIUM HOMINUM N. 75-2010 gards the priestly ministry and ality of communion and lives The various presences inside consecrated life; and the sur- communion both with Jesus the Church are united by a sin- prising phenomenon of so- Christ and between its various gle purpose: to work for the ad- cial/health-care voluntary work components, necessarily it vent of the kingdom of God ac- was enriched by the discovery lives a missionary communion cording to the different voca- of Church charisms and min- and becomes a missionary tions, situations, charisms and istries. community. John Paul II stated ministries that exist. ‘This vari- These anthropological, soci- with clarity in 1988: ‘Commu- ety is not only linked to age, but ological, theological and pas- nion and mission are profound- also to the difference of sex and toral factors taken as a whole ly connected with each other, to the diversity of natural gifts, created a large mosaic of ‘signs they interpenetrate and mutual- as well as to careers and condi- of the times’ which called upon ly imply each other, to the tions affecting a person’s life. It the conscience of the Christian point that communion repre- is a variety that makes the rich- community to find new re- sents both the source and the es of the Church more vital and sponses to the new needs of the fruit of mission: communion concrete’.45 men and women of our times: gives rise to mission and mis- B) Naturally, the ‘variety of ‘Attentive to the signs of the sion is accomplished in com- presences and charisms’ in a times, communities must look munion’.41 single pastoral body is a great towards the future, trusting in The specific purpose of my gift of the Spirit to the Church the fact that the Lord precedes study at this point was to out- of our times but it is also a great us in history and mission, sus- line the evangelising face of the responsibility because it re- taining us on our journey. hospital chaplaincy with requires the contribution of each Christian communities, togeth- spect to the features that it of its component parts to the 48 er with the other builders of shares with every Christian transformation of the hospital pluralist society, must seek to community and its characteris- chaplaincy into a community of be bearers of the memory and tic traits as a body that is pre- ‘communion, joint responsibili- the prophecy of the Spirit’.40 sent and works in the vast hori- ty and cooperation.46 These I thus defined the experience zon of suffering and care. Ex- characteristics constitute an ‘in- of the hospital chaplaincy as a pressed in more concrete terms: divisible triad’, the Italian bish- ‘building site for the Church of I analysed the vocation and the ops wrote after the national communion’ both from the mission of the hospital chap- Church conference held in point of view of the internal life laincy in the following terms: Verona, and they outlined in an of relationships and love and in effective way the countenance terms of the creation of a ser- 4.1. The mission of evangeli- of a Christian community that vice directed towards recipients sation inside hospitals consti- goes forward together with a in the world of health and tutes the principal task of a style that appreciates every re- health care. Its purpose is to chaplaincy, whose original source and every sensibility, in manifest the ‘most beautiful identity and whose specific role a climate of brotherhood and of face’ and ‘face in colour’ of the I identified in three characteris- dialogue, of frankness in ex- Church of Christ to the benefit tic elements: a variety of pres- change, and of meekness in of the hospital community with ences and charisms; commu- searching for what corresponds its multiple component parts. nion, joint responsibility and to the good of the whole com- cooperation; and planning and munity.47 intelligent coordination. C) The hospital chaplaincy, 4. The Hospital Chaplaincy A) The defining feature of a an ecclesial reality that is essen- as Diakonia: hospital chaplaincy, which im- tially based on communion and Vocation and Mission mediately emerges from its spe- its multiplicity of pastoral cial identity, is its variegated workers, cannot but engage in After dwelling at length, and overall composition: ever the choice of planning and pro- through a detailed analysis, on since its first description in a ject-making for its pastoral ac- the identity and its component Church document, it has been tion: its specific identity and the parts of this ecclesial body of defined as a body of priests, fecundity of its life depend a joint responsibility, seen as deacons, men and women reli- great deal on this scientific, koinonia,thatistosayasa gious and members of the lay professional and apostolic community called to be in con- faithful;42 and some twenty methodology. It must be constitutive terms a reality of com- years later the second pastoral cerned to ‘place gospel ele- munion and to live the riches note described it as a ‘variety of ments in the vast sector of of unity in Christ, founded on presences and charisms’.43 This health care and assistance with baptism and a variety of variety expresses in an impor- projects of catechesis and for- charisms, in the third chapter I tant way the reality of the mation’, and at the same time directed my attention to anoth- Church of communion, as is re- its pastoral workers, ‘by pro- er aspect of its physiognomy, peatedly observed in the docu- moting projects designed to that is to say its equally funda- ments of the Magiterium and in make the environments of mental dimension of being di- the thinking of theolo- health and health care more hu- akonia, understood as a service gians:‘This diversity of services man, and by cooperating in for the preaching of, and bear- in the unity of the same mission those projects that are already ing witness to, the Gospel. If makes up the richness and underway, are called to offer to the hospital chaplaincy is a re- beauty of evangelization’.44 them the specific contribution

DOLENTIUM HOMINUM N. 75-2010 of their Christian vision of roads of humanity,theworldof and directed towards salvation, man’.48 health is also a land of the and the moment of illness and It has been wisely stated that Gospel. In this setting where death can receive in addition to ‘communion and cooperation various pathways intersect, the support of science and hu- cannot be effectively promoted where generosity and selfish- man solidarity also the support without the move from impro- ness, materialistic claims and of the grace of the Lord’.54 vised action to engaging in pro- the wish for spirituality, the The evangelisation of the jects and without an intelligent proclamation of rights and actu- health-care world thus includes coordination of the resources al injustices, co-exist, the the four aspects of human exis- that are present in the commu- Church is called to offer the tence: on the one hand, the nity: the extraordinary ministers light and the direction of the proclamation of, and witness to, of Communion, pastoral and Gospel’.51 Despite the process the Gospel of life and health; on health-care workers, the volun- of secularisation that has affect- the other, the approach and light tary workers of the various as- ed health care, ‘a hospital still of the Gospel of suffering and sociations, the family relatives remains a privileged place of death. In the first sphere of the of patients, and the patients evangelisation’.52 If evangelisa- sacred and inestimable value of themselves’.49 tion is and remains ‘a profound- life, I analysed four specific ly ecclesial act’, it also ‘calls roles: being ministers of life; 4.2. A chaplaincy is called to upon all the various workers of the ethical problems and ques- be a missionary community. the Gospel, each according to tions of being born; the promo- Thus all of its component parts their charisms and ministries’.53 tion of the new culture of hu- are required to have the specific Hospital chaplaincies as well, man life; and the approach of requisites that are needed to be with all their component parts, theGospeloflife.In the sphere effective workers of evangelisa- (priests, deacons, men and of the value of health I empha- 49 tion in the vineyard of the Lord. women religious, lay people) sised the pathway of the promo- There was still a lack of publications and studies that point out the most important features of those who are called in a pastoral sense to be present and operative in the world of health and health care and so I pointed out certain indispensible requisites that pastoral workers in hospital chaplaincies should have. These I identified as a vocation to pastoral ministry, human and Christian maturity, specific formation, spirituality of service, and a mandate or ‘missio’. Each element was analysed in the light of the relevant documents of the universal Church or the local Church of Italy. see this responsibility to live tion of health: from that of the 4.3. A hospital chaplaincy, as and proclaim the Good News of body to that of the person, from an ecclesial community that is the love of God according to the demand for health to nostal- present and operative in health the specific gifts and means of gia for salvation, and from the care, in order to achieve fully the civil and ecclesial status of initial theology of health to the its identity cannot but grow in each individual. The potentiali- commitment to the incarnation the belief that its essential and ties of this pastoral body in this of the gospel of health. priority mission is specifically field are by now enormous and As regards suffering/illness,I that of evangelising: ‘The frac- constitute riches of the Spirit outlined certain pastoral itiner- ture between the Gospel and for the Church of our times. aries of evangelisation: living existing culture in Italian soci- The most important settings suffering between resistance ety is also reflected in the world of evangelisation for hospital and surrender, promoting a new of health care. The process of chaplaincies have been empha- consciousness as regards ill- secularisation has reduced the sised on various occasions and ness, restoring individuality to spiritual and moral sensitivity in various documents of the the sick person, and conjoining of by now means few believers Magisterium. In 1989, with ex- the Gospel of suffering to the as well, leading them to adopt a treme clarity, the four pathways Gospel of charity. Lastly, I defensive stance if not rejection of evangelisation in the health- dwelt upon an exploration ‘of as regards transcendence and care field were already being the eloquence of death and res- spiritual and moral values’.50 In pointed out: ‘the ecclesial com- urrection’, addressing the ethi- its commitment to evangelisa- munity, indeed, has the task of cal problems of death and dy- tion, a hospital chaplaincy be- working so that the values of ing, the spiritual and pastoral gins with a certainty: ‘a cross- life and of health are respected accompanying of the dying, the

DOLENTIUM HOMINUM N. 75-2010 celebration of the paschal mys- apostolic programmes. The God’.57 Of this alphabet it al- tery at funerals, and presence at principal recipients of its evan- ready possess certain verbs the side of people and families gelising vocation may be which by now have become in mourning. placed in three groupings:the consolidated in its practice and sick and their family relatives planning: listening and dialogu- 4.4. Today at a theological- who are seen as the objects and ing, accompanying and hoping, pastoral level there is an subjects of evangelisation; being communion and becom- awareness of the vastness of the health-care workers in their ing community, planning and operational horizons of evange- broad diversity of jobs and in cooperating, becoming respon- lisation in the world of suffer- particular medical doctors and sible and making responsible, ing that must promote every- nurses; and the heads of health- evangelising and humanising, thing that can embody in con- care structures, that is to say the preaching and caring, welcom- temporary society the activity protagonists of their political- ing and celebrating, being born of Jesus for suffering people. In social and ‘structural’ dimen- and growing, and living and dy- referring to concrete and urgent sions. It is specifically in the ing in Christ. endeavours we may cite: the setting of health care that the defence of the health and well- need for ‘pastoral care that is being of the sick; the fight closer to the lives of people, 5. The Hospital Chaplaincy against illness and pain, its less hurried and complex, less as Martyria: causes and its consequences; dispersive and more incisively Witness in Local Areas cooperation in integral care for unitary’56 is most urgent. the sick person in all his or her In the last chapter of my re- needs; help for families that 4.5. I ended the third chapter, search the aim was to dwell up- 50 suffer the consequences of ill- which was the longest, by stat- on the hospital chaplaincy as an ness; solidarity in the world of ing that one may define a hospi- ecclesial community that opens health and health care (the giv- tal chaplaincy as a ‘laboratory to its local area with the tesk of ing of blood, organ transplants…); cooperation to ensure that structures, institutions and technology are at the service of patients and not other interests; the defence of the rights of sick people; denuncia- tion of abuses and injustices in the health-care world; the growing humanisation of care; and the accompanying of the terminally ill.55 A hospital chaplaincy has many opportunities in front of it to live its missionary and evangelising action in and for the community that works in health-care institutions. At the level of recommendations, I recommended seven pathways of experiences’ of the healing being witness (martyria), that is which in my own view are the Church, because, like every to say the animation of the most urgent and the most in other Christian community, it parish as regards the promotion conformity with its vocation must experience in the first per- of health and care for those who and mission today: witness, the son the healing of the paschal suffer, building bridges of com- ‘sacrament of presence’ which mystery in order to transform munion and cooperation. ‘Oth- is expressed in visits and effec- itself into a community that er forms of integration are tive help relationships, humani- heals those to whom it is sent needed and urgent to support sation, proclaiming, the sacra- with its gospel message. A hos- families, joining forces and op- ments, charity, and ecumenical- pital chaplaincy, if every day it timising the resources that are ism that also includes inter-reli- performs well its mission available. Here it is appropriate gious dialogue. amongst the sick and health- to remember at least the inte- care workers can become a let- gration through adequate for- 4.5. The hospital chaplaincy ter of Christ ‘who wrote this mation of the ministry of com- holds the first responsibility for letter and sent it by us. It is fort and the ministry of commu- the evangelising action of the written not with ink but with nion with the sick, the fertile in- health-care/hospital institituion the Spirit of the living God, and tegration of the hospital chap- in which it is located; the pro- not on stone tablets but on hu- laincy with the parish commu- claiming of the Gospel remains man hearts’ (2 Cor 3:3-4) and nity, and the coordination of the principal mission of its con- will know how, ‘in ordinary ex- Church socio/health-care asso- stitiution; and witness to a God periences..to find the alphabet ciations through the National who loves life and the living is by which to compose words Forum of Social/Health-Care the heart of every one of its that express the infinite love of Association’.58

DOLENTIUM HOMINUM N. 75-2010 This move of pastoral care in pointing out a different direc- cal area with the ecclesial visi- health from the hospital to its tion in order to ‘relocate’ the bility of all its many members local area does not mean, of chaplain in a service provide by (priests, deacons, religious, lay course, neglecting or abandon- the Church where the counte- people), with the proposal of a ing one to privilege the other; nance of the Church is transmit- healing community, and with instead, it involves the strength- ted through a multiplicity of the memory of a constant role ening of the service for hospi- services and greater coopera- in pastoral care in health. The talised patients and at the same tion both inside and outside the second question was: ‘what in time the expansion of bound- hospital’.61 its turn can a parish offer a hos- aries, an extension of responsi- A second step was then re- pital chaplaincy?’ The answer bility in favour of the civil and quired ‘from the hospital chap- is: memory of communion and religious community. Openness laincy to the Church communi- openness to the diocesan to the local area, in addition, ty in the local area’. ‘A chap- Church, openness to the local constitutes an authentic ‘pro- laincy that does not project it- area and to families, and care vocation’ for the hospital chap- self into the local area remains for the old and new poor of so- laincy as well, which cannot half of what it is and destined to ciety. limit the concerns of its work to fall into isolation’.62 By the the troubled wals of health-care ‘Christian community of the lo- 5.2 The hospital chaplaincy structures: ‘As health care grad- cal area’ is meant the Church and the parish together ually moves out of the narrow community that has the face of for… confines of a hospital and be- the local or diocesan Church, of comes rooted and expanded in the parish that is belonged to, of If the Italian Church today the local area, so also does pas- the vicariate or deaconate, of a rightly speaks about ‘integrated toral care at the side of suffer- possible ‘pastoral unity’, of the pastoral care’, of pastoral unity, 51 ing people lose its limited con- community of men and women of the building of bridges, and notation of ‘hospital pastoral religious, and of Church associ- of overcoming forms of self- care’ and become increasingly ations, groups or movements. reference, we can deduce that to defined as ‘pastoral care in At a more concrete level, in my these approaches also belong health’’.59 research reference was made in cooperation between hospital Ever since the 1980s the Ital- the main to parishes. Certainly, chaplaincies and parishes. ian Church has perceived the an authentic pastoral conver- These two communities, when problem of the extension of its sion is required on the part of they exist in the same local pastoral care from hospitals to priests, chaplains and pastoral area, cannot ignore each other. local areas and has called on workers, involving mutual en- Implicitly, this openness is al- communities to achieve this richment: in looking for path- ready envisaged by the Code of ‘paschal’ conversion. Indeed, in ways of cooperation, a chap- Canon Law which states, when the pastoral note of 1989 it was laincy works both for the addressing the question of stated that ‘in pastoral care in strengthening of its experience chaplainsofallkinds,andthus health there emerge certain ba- and for its future as a Church also hospital chaplains: ‘In the sic needs that deserve especial that provides care and heals. exercise of his pastoral func- attention’ and amongst these it tion, a chaplain is to preserve a placed specifically the follow- 5.1 The hospital chaplaincy fitting relationship with the pas- ing approach: ‘the field of ac- and the parish: an tor’ (Latin text:: ‘debitum coni- tion cannot end with the area of enriching relationship unctionem’)’.63 Naturally, here hospital structures but must be reference is made to the parish extended to the whole of the lo- In recent years Italian bish- priest of the local area where cal area in which the lives of ops have paid especial attention the chaplain engages in his citizens are lived, rediscovering both to parishes and to pastoral ministry. In the analysis of the the natural relationship between care in health. In 2004 they hospital chaplaincy it is licit to patients and families, families drew up a fine pastoral note on expand this ‘due relationship’ to and the civil and ecclesial com- ‘The Missionary Face of all the pastoral workers of the munity. Indeed, a hospital is by Parishes in a World that is ecclesial team with the parish now defined as a service that is Changing’. A year later they re- community, which must evi- integrated with other health- flected together on pastoral care dently be filled with contents, care structures that are open to in health at their general assem- and as a consequence, with the participation of citizens and bly and a few months after that knowledge and cooperation, are no longer the sole point of they approved another pastoral with relationships and with reference for being treated and note – ‘Preach the Gospel and pathways of service for health healed’.60 Heal the Sick: the Christian and the sick. By now a need that cannot be Community and Pastoral Care In addition, this ‘relation- postponed was maturing in the in Health’ (2006). I posed two ship’ of cooperation between conscience of the Christian questions and I attempted to two communities is further jus- community: in pastoral care in find specific answers as well. tified in the light of what the health in health-care institutions The first question was: ‘what same Code of Canon Law states the first step to take was ‘from can a hospital chaplaincy offer about the duties of a parish: ‘In the chaplain to the chaplaincy’: to the parish?’ The answer is: a order to fulfill his office dili- ‘this is not a matter of coining a hospital chaplaincy helps the gently, a pastor is to strive to different word but rather of Christian community of the lo- know the faithful entrusted to

DOLENTIUM HOMINUM N. 75-2010 his care. Therefore he is to visit ‘signs’, in pastoral care of con- and health, like a pilgrim who families, sharing especially in tinuity, and in the appreciation had reached his goal I felt the the cares, anxieties, and griefs of Sunday and the celebration need to look over my shoulders of the faithful, strengthening of the Eucharist. to ‘make an assessment’ of the them in the Lord…With gener- I ended the fourth chapter by study that had been carried out. ous love he is to help the sick, stressing the need for the hospi- Above I observed the three particularly those close to tal chaplaincy, gaining nourish- sources on which I had drawn death, by refreshing them solic- ment from the sources of prayer for my work: the documents of itously with the sacraments and and the liturgy and opening it- the Magisterium of the Church; commending their souls to self to the new horizons of the the thought of the theology of God; with particular diligence local area with pastoral creativ- pastoral care in health contaned he is to seek out the poor, the ity, to become ‘capable of great in the publications of authors of afflicted, the lonely, those ex- hope’ and a ‘minister of great our times; and personal pastoral iled from their country, and hope for others’:65 an active experience in the health-care similarly those weighed down hope that knows how to fight so world. I then in summarising by special difficulties’.64 The that ‘the world may have life, form presented the most inter- hospital chaplaincy, with its ex- and have it in abundance’ (Jn esting results achieved by this perience in the sector, can offer 10:10). new pastoral body. The first re- a contribution to the parish sult of my research was the fact priest, and to the community of that a hospital chaplaincy may the local area, so that it can bet- be seen as a response of the ter perform, and with greater Italian Church to the voice of ‘diligence’, one of its principal the Spirit which in previous 52 duties. decades (1960-1990) spoke in a In a more specific way, the strong and clear way through parish and the hospital chap- three kairological events. The laincy can enrich each other in second result was the certainty their knowledge about the iden- that a hospital chaplaincy is a tity and life of each community, ‘Church project’ in the health- in the exchange of pastoral ser- care world which has a Bibli- vices, in the appreciation of the cal-theological basis, its own World Day of the Sick, in specific form, its own objec- knowing and visiting people in tives and its own large number hospital in the local area, in the of individuals. The third result animation of associations and was the awareness that the groups, and in the promotion identity of the hospital chap- and formation of voluntary laincy is being developed, that workers. is to say that it is experiencing and will experience in the near 5.3 The hospital chaplaincy future an evolution in its experi- and the parish for the ence. Other results worthy of health and treatment of sick attention were the centrality of people the person of the chaplain- priest in the life of a chaplaincy, As regards the promotion of In this way it makes itself the appreciation of all the health, the two communities obedient to its Lord and imple- charisms of the people of God, have before them a broad unex- ments his ‘commandment’ fully the vastess of the horizons of plored horizon. I tried to posit to perpetuate his memory. the evangelisation in health certain pathways: the construc- ‘When Jesus ordered his com- care, and the relationship be- tion of a healed and healing munity “do this in memory of tween a chaplaincy and its community, the rediscovery of me” he not only asked for the parish which should be com- the missionary consciousness rite that he had celebrated to be pletely invented and experi- of all Christians, the formation remembered and repeated, he enced. of pastoral workers, catechesis also asked for that ‘self-giving’ Lastly, I listed the problems on ethical subjects connected expressed in the breaking of connected with the hospital with life and suffering, pastoral bread and the sharing of the chaplaincy that have remained care for the various age bands, chalice to be translated onto an unresolved and which await an education in health and the pro- existential plane’.66 answer from pastoral experi- motion of a healthy lifestyle, ence, from theological reflec- knowledge about the philoso- tion and from the Magiserium phy of health care and the or- 6. Conclusions of the Church over the next ganisation of health-care struc- years: its most appropriate tures. In caring for the sick as At the end of my long re- name, the juridical and volun- well, the two communities can search, carried out with pa- tary dimension of pastoral cooperate in knowing about the tience and enthusiasm, on hos- workers, the relationship be- mosaic of illnesses and sick pital chaplaincies, which are tween a hospital chaplaincy and people, in holistic care for the present and operational in the the hospital council for pastoral person, in the pastoral care of ‘sacred’ settings of suffering care, the possibility of an ecu-

DOLENTIUM HOMINUM N. 75-2010 menical hospital chaplaincy, pastoral workers of all forms of Notes and the need for, or the possibil- membership of the Christian Rev. Leonardo N. Di Taranto, a Ca- ity of, establishing a new min- community, and for those who puchin friar, has been a hospital chaplain istry for the working members care about the presence and the since 1976. Since 1986 he has been the di- of a hospital chaplaincy. action of God and the Church in rector of the Office for Pastoral Care in Health of the archdiocese of Bari/Bitonto. Summarising the elements of the season of health and suffer- Since 1997 he has led the hospital chap- all the definitions given during ing. laincy, of which he is the current coordinator, at the hospital company of the Con- this research, I attempted to The pathway of the itinerary sortialPolyclinicofBari.Thoseinterested summarise and specify the most of study was demanding and in getting in contact with the author can important aspects of the identi- enormously exceeded in size use the following: Strada San Girolamo, 34 – 70123 ty and action of a hospital chap- what had been envisaged. The BARI. Tel. 080-5341232; 3389154744. laincy: it is based in theological initial project, set out in general Web site of the hospital chaplaincy: terms upon the missionary and schematic terms, gradually http://www.cappellaniapoliclinicobari.it E-mail: leonardoditaranto@cappella mandate of Jesus given to his became clear as the research niapoliclinicobari.it Church to ‘preach the Gospel progressed: I realised that the The text of his thesis has become a and heal the sick’; it is created horizons were constantly ex- book: Leonardo Nunzio Di Taranto, La cappellania ospedaliera: cantiere di by a juridical mandate of the panding and becoming almost a Chiesa comunionale, preface by Giuseppe bishop of the local Church for a challenge. The result that was Cinà, 382pp. Ed. Servi della Sofferenza, health-care/hospital communi- achieved is offered to all via IV novembre, 41 – 74027 S. Giorgio Jonico (TA), tel. 099 5918824 – fax 099 ty; it is made up of various ex- Church communities and indi- 5925111; e-mail: info@servidellasoffe pressions of the people of God: viduals so that they may renza.org priests, deacons, men and achieve the stimuli that are women religious, men and needed to achieve what has 1 GIOVANNI PAOLO II, ‘Evitare ogni for- women members of the lay been pointed out in these pages. ma di eutanasia’, in DOLENTIUM 53 HOMINUM. CHIESA E SALUTE NEL faithful; it engages in ordinary After reaching my goal I am MONDO, review of the Pontifical Council pastoral action within the aware that I have produced a for Health Care Workers, n. 58, XX, n. 1 health-care field that is dedicat- work which from some points 2005, p. 8. 2 M. CORTELAZZO and P. ZOLLI, ed to sick people, their family of view may be seen as being Dizionario etimologico della lingua ital- relatives and workers of various incomplete because a great deal iana, vol. 1/A – C (Zanichelli, Bologna , professional categories and the remains to be explored in theo- first edition 1979). 3 EDIGEO (ed.), Enciclopedia whole hospital community; it logical reflection, to be planned Zanichelli (La Repubblica, Rome, 1995). seeks to achieve the multiple in individual communities and 4 G. DEVOTO andG.C.OLI, Vocabo- goals of pastoral care in health to be experienced in the field. lario illustrato della lingua italiana (Se- lezione dal Reader’s Digest, Milan, 1983) which are listed in the Pastoral Like the learned scribe in the vol. 1. Note of 1989 (n. 20) and the Kingdom of Heaven, ‘new and 5 Dizionario della lingua italiana (Sig- norelli, Milan, 1985). Pastoral Note of 2006 (n. 23); old things’ (Mt 13:52) have 6 CONSULTA NAZIONALE CEI and it is expressed in practical been taken from the draw of the PER LA PASTORALE DELLA SANI- terms in various forms of pas- Church and harmonised into a TA’, La pastorale della salute nella Chiesa italiana. Linee di pastorale sani- toral action and help: humani- single pastoral project. It is in- taria (PSCI), 30 March 1989. sation, human promotion, psy- dispensable to stress that the 7 Ibid., n. 81. chological support, help rela- limits of this research are inher- 8 Cf. GIOVANNI PAOLO II, ‘Messaggio per la XI Giornata mondiale del malato’, tionships, spiritual accompany- ent in the very nature of the published with the date of 2 February ing, evangelisation and catech- work that has been carried out: 2003, in DOLENTIUM HOMINUM. esis, liturgical celebrations, this was the first time that such CHIESA E SALUTE NEL MONDO,n.51, XVII, n. 3 (2002), pp. 4-6. In this docu- sacramental grace, ecumenical a subject was addressed at a na- ment the Italian phrase ‘cappellanie os- and inter-religious dialogue, tional level. pedaliere’ is translated into the principal and the building of bridges of These limits should not be languages in the following ways: ‘chaplaincies’ (English), ‘aumoneries’ cooperation with the parish seen as negative elements but (French), ‘seelsorgern’ (German), ‘servi- communities of the local area. as ‘pro-vocations’ and almost cio de los capellanes’ (Spanish). ARCID- IOCESI DI TORINO. CURIA METRO- challenges for other chaplains, POLITANA, ‘Cappellania ospedaliera. pastoral workers and theolo- Orientamenti programmatici’ in RIVISTA 7. A Work of Research gians so that they may continue DIOCESANA TORINESE, February 2002. as Service to the Italian to develop that analysis that has 9 Cf.P.SCHREUR, ‘I laici nella pastorale Church been begun and enrich and ospedaliera. Un’esperienza olandese’ in broaden its contents and per- AA. VV., L’operatore pastorale nel mondo della salute oggi. Alla ricerca di una The work of this research spectives. The ‘conclusion’ thus nuova identità,(SALCOM,Brezzodi was very long and required spe- remains ‘open’ to further hori- Bedero (VA) 1971); S. BAMBINI,‘Nuove cial time and energy: it was ex- zons: the subject of hospital prospettive di un’assistenza religiosa nel- l’ospedale moderno’, in Atti del VI con- perienced not only with the chaplaincies is of great contem- vegno nazionale cappellani ospedalieri goal of offering a concrete con- porary relevance and of great cappuccini, La Mendola (Trento) 3-7 Sep- tribution to the field of pastoral interest for the mission of the tember 1973, edited by O. NALDINI. 10 G. PEZARD, ‘Verso nuove esperienze care in health but also and Church. pastorali nel mondo della sofferenza’, pp. above all else with the intention 69-74inO.NALDINI, Uomini a servizio di of performing a useful service Rev. LEONARDO NUNZIO uomini, Atti del convegno nazionale dei DI TARANTO Padri cappuccini ospedalieri, S. Giovanni for the Church in Italy.These- Rotondo 15-19 ottobre 1984.During this cret hope is that it can become a Director of the Office for Pastoral conference the bases were established for Care in Health, the ‘Associazione Nazionale Cappellani e useful concrete point of refer- the Archdiocese of Bari/Bitonto, Religiosi Ospedalieri’ (ANCRO) (‘The ence for hospital chaplains, for Italy National association of Hospital Chap-

DOLENTIUM HOMINUM N. 75-2010 lains and Religious’), which subsequently for the Theology of Health Pastoral Care 42 Cf. PSCI,n.80. became the ‘Associazione Italiana di Pas- ‘Camillianum’, which forms a part of the 43 PVCM, n. 66. torale Sanitaria’ (A.I.Pa.S.) (‘The Associ- Pontifical Faculty of Theology ‘Tere- 44 PAUL VI, Apostolic Exhortation ation for Pastoral Care in Health’). sianum’ of Rome. Evangelii nuntiandi on evangelization in 11 S. BAMBINI, ‘Cappellania ospedaliera 27 GS, n. 4. Cf. JOHN XXIII, Gaudet the modern world, 8 December 1975, n. e comunità cristiana’, in ANIME E COR- Mater Ecclesia; EV 1/55*. 66; hereafter EN. PI, rivista bimestrale medico-psicologico- 28 L. CICCONE, ‘Contributi biblico-teo- 45 CfL, n. 45; cf EN, nn. 67-73. pastorale della sofferenza, edited by logici al problema della salute’, in 46 CONFERENZA EPISCOPALE OARI., 136 (1988), pp. 197-212. AA.VV., Chiesa e riforma sanitaria, p. ITALIANA, pastoral note Rigenerati per 12 A. BRUSCO and G. BECONCINI,‘La 48. una speranza viva” (1Pt 1,3): testimoni cappellania ospedaliera: Aspetti teologici 29 Ibidem. del grande ‘sì’ di Dio all’uomo dopo il 4° pastorali. Esperienze pratiche’ in ANIME 30 E. SGRECCIA, ‘Il servizio pastorale convegno ecclesiale nazionale,29June E CORPI, 156 (1991), pp. 381-403. nelle nuove strutture delle unità sanitarie 2007, n. 23. Hereafter: RSV. 13 A. BRUSCO and L. SANDRIN, Il cap- locali’, in AA. VV., Riforma sanitaria e 47 Cf. Ibidem. pellano d’ospedale. Disagi e nuove op- comunità cristiana,p.66. 48 PSCI, n. 21. portunità (Camilliane, Turin 1993), pp. 31 Cf.A.BRUSCO, ‘La pastorale sani- 49 PVCM, n. 59. 101-110. taria nell’attuale contesto sociale’, in I. 50 PSCI, n. 21. 14 S. MARINELLI, Il cappellano os- MONTICELLI (ed.), Progettualità ecclesiale 51 PVCM, n. 18. pedaliero. Identità e funzioni (Camilliane, nel mondo della salute, Atti del III con- 52 Ibid., n. 66. Turin, 1993), pp. 162-170. vegno della Consulta nazionale della CEI 53 EN, n. 78. 15 R. MESSINA, ‘La Consulta nazionale per la pastorale della Sanità, 23-25 aprile 54 PSCI, n. 1. e le Consulte regionali e diocesane della 2005 (SALCOM, Brezzo di Bedero (VA), 55 Cf. J. A. PAGOLA, ‘Evangelizzazione Sanità’, in A. BRUSCO (ed.), Consulta 1995), pp. 17-46; A. PANGRAZZI, ‘Pas- e mondo della salute’, in DTPS,p.429. Nazionale CEI, Curate i malati, pp. 203- torale della salute. Il guaritore ferito’, Il 56 CONFERENZA EPISCOPALE 212. 16 E. SGRECCIA, ‘La Cappellania ospedaliera: un progetto di comunità pastorale’ in INSIEME PER SERVIRE,3 (1990), pp. 42 - 46. 17 A. BRUSCO and G. BECONCINI,‘La cappellania ospedaliera: Aspetti teologici 54 pastorali. Esperienze pratiche’ in ANIME E CORPI, 156 (1991), pp. 381-403. 18 CONFERENZA EPISCOPALE CALABRA, CONSULTA REGIONALE PER LA PASTORALE DELLA SANITÀ, Evangelizzazione e testimoni- anza della carità oggi, in ospedale. La cappellania ospedaliera, Atti del Semi- nario di studio per cappellani ospedalieri, religiose, operatori sanitari, Gizzeria Li- do (Catanzaro) 20-21 April 1992 (Editori- ale progetto 2000, Cosenza, 1992). 19 S. BAMBINI, ‘La cappellania ospedaliera’, in CONSULTA PAS- TORALE SANITARIA REGIONE LIG- URIA, La sofferenza nel mistero di Cristo, Atti del convegno regionale, maggio 1993 (Tipolitografia Emiliani, Rapal- lo, 1993). 20 AA. VV., Progettualità ecclesiale nel mondo della salute, Atti del III convegno della Consulta nazionale della pas- regno-attualità, 10 (1998), 351-360; L. ITALIANA, pastoral note Il volto mis- torale della Sanità della CEI, 23-25 aprile SANDRIN, Fragile vita. Lo sguardo della sionario delle parrocchie in un mondo 1995, edited by I. MONTICELLI, SAL- teologia pastorale, pp. 83-84. che cambia, 30 May 2004, n. 21. Here- COM (Brezzo di Bedero (VA), 1995). 32 COMMISSIONE EPISCOPALE after VMPMC. 21 CONFERENZA ITALIANA MIN- PER IL SERVIZIO DELLA CARITÀ E 57 Ibid.,n.12. ISTRI PROVINCIALI CAPPUCCINI, LA SALUTE, pastoral note “Predicate il 58 UFFICIO NAZIONALE CEI PER SEGRETARIATO PER LA PAS- Vangelo e curate i malati”. La comunità LA PASTORALE DELLA SANITA’, La TORALE DELLA SALUTE, La cappel- cristiana e la pastorale della salute,4 famiglia nella realtà della malattia, XVI lania. Kairòs per la pastorale della salute, June 2006. Hereafter PVCM. Giornata Mondiale del Malato, 11 feb- Atti del convegno nazionale, Cavallino 33 PONTIFICIA OPERA PER LE VO- braio 2008 (Camilliane, Turin, 2007), n. (VE)6-9maggio1996, by edited M. STEF- CAZIONI ECCLESIASTICHE, Nuove 5. FAN (Mestre (VE), 1996). Vocazioni per una nuova Europa (Libre- 59 UFFICIO NAZIONALE CEI PER 22 Cf. G. DAVANZO, Cappellano os- ria Editrice Vaticana, Vatican City, 1997), LA PASTORALE DELLA SANITÀ, La pedaliero,inS.LEONE and S. PRIVITERA p. 47. comunità cristiana luogo di salute e di (ed.), Dizionario di bioetica, EDB-ISB, 34 CEI, UFFICIO NAZIONALE PER speranza, VI Giornata mondiale del mala- 1994; cf. also G. DAVANZO, ‘Negli os- LA PASTORALE DELLA SANITÀ, to, 11 febbraio 1998 (Camilliane, Turin, pedali non solo i cappellani’, in SETTI- Domanda di salute nostalgia di salvezza, 1997), n. 2. MANA, settimanale di attualità pastorale VII Giornata mondiale del malato, 11 feb- 60 PSCI, n. 21: ‘L’estensione della pas- (EDB, Bologna), n. 15 (1991), 3. braio 1999, (Camilliane, Turin, 1998), torale dall’ospedale al territorio’. 23 Cf.A.BRUSCO and G. BECONCINI, ‘Sussidi e Documenti’ series, n. 4. 61 BAMBINI S., ‘Cappellania ospedaliera ‘La cappellania ospedaliera. Aspetti teo- 35 Ibidem. e comunità cristiana’, in ANIME E COR- logici e pastorali. Esperienze pratiche’, in 36 W. KASPER, Il Dio di Gesù Cristo PI, 136 (1988), p. 206. ANIME E CORPI. (Queriniana, Brescia, 1987), pp. 216, 217. 62 Ibid., p. 209. 24 Cf. A. BRUSCO, Cappellania os- 37 G. CINÀ, Sofferenza e salvezza. 63 CCL,can.571. pedaliera,inG.CINÀ,E.LOCCI,C.ROC- Fenomenologia e riflessione teologica, 64 Ibidem, can. 529 - § 1; cf CIC, can. CHETTA, and L. SANDRIN (eds.), “Camillianum”. Istituto Internazionale di 530: ‘The functuons enstrusted to the Dizionario di Teologia Pastorale Sani- Teologia Pastorale Sanitaria, “Sussidi”, n. parish priest in a special way are the fol- taria (= DTPS) (Camilliane, Turin, 1997), 1, Rome, 1997, p. 14. lowing:… 3. to administer Viaticum and pp. 165-169. 38 L. PINTOR, Servabo. Memoria di fine annonting of the sick, with the provision 25 Cf. A. BRUSCO,S.PINTOR, Sulle secolo, Turin, first edition April 1991, p. of can. 1003,§§2and3always applica- orme di Cristo medico. Manuale di teolo- 84. ble, and betwoing the apostolic blessing’. gia pastorale sanitaria (EDB, Bologna, 39 Ibidem,p.85. 65 Ibid., n. 34. 1999), pp. 209-212. 40 VESCOVI BRASILIANI, ‘Missao e 66 UFFICIO NAZIONALE CEI PER 26 This thesis was defended on 24 Octo- mistérios dos cristaos laigos e leigas’, in Il LA PASTORALE DELLA SANITÀ, La ber 2008 and my examiner was Prof. regno-documenti, 17 (1999), p. 587. sofferenza è stata redenta, n. 4. GIUSEPPE CINÀ, dean for a number of 41 JOHN PAUL II, post-synodal Apos- three-year terms, and my co-examiners tolic Exhortation Christifideles laici on Prof. LUCIANO SANDRIN and Prof. MASSI- the vocation and the mission of the laity in MO PETRINI, respectively the current dean the Church and the world, 30 December and vice-dean of the International Institute 1988, n. 32; hereafter CfL.

DOLENTIUM HOMINUM N. 75-2010 Priests, Pastoral Workers and Health-Care Staff: Towards Reciprocal Integration

1. The Needs of People who this reason, as another docu- How beautiful it is when a are Admitted to Hospital ment of that hospital, Pro- priest exhorts his faithful to grammes for Pastoral Visits, turn to him when they are sick 1.1. Usually in hospitals observes: ‘pastoral workers so that he can place his hands there exists an affable disasso- perform an integral role within on them and pray for them, as ciation between the representa- the health-care team’. takes place with reconciliation, tives of the Church and the one of the sacraments of heal- health-care staff, even though ing. Some priests, indeed, ex- they care for the same people. 2. Priests: Successors ercise a powerful ministry of However, today more than to the Apostles and evangelisation and healing, ever before, integration be- Ministers of Healing and this is what the Canadian tween them can be of benefi- Emiliano Tardif (whose cial effect in addressing the A few years ago the Spanish process of beatification is un- health-care world which has Bishops’ Conference referred derway) did. I met him many before it growing prospects of to ‘healing care in the whole of years ago. In reality, however, grave moral and spiritual con- the dynamic of diocesan pas- any priest, because of his con- 55 sequences. toral care, with the acquisition secration, is equally invested of a more vital awareness of by the Holy Spirit and, as the 1.2. In his document The the salvific power borne by a American Jesuit, Robert De- Philosophy of the Hospital,Dr. Church faithful to Jesus Grandis, who is famous Chalmers of Fredericton, Christ’ (Spanish Bishops’ Con- throughout the world, said: Canada, where he engaged in ference, 2007, pp. 103-104). In ‘the ministry of sacramental pastoral care for sick people this dynamic the first instru- healing should be seen as a (which he now engages in ment is the priests, the succes- part of the priestly vocation’ every day at the Palliative Care sors to the Apostles, who are (DeGrandis, 1996, p. 62). In- Unit of Algeciras (Cadiz, called to continue the ministry deed, the Twelve were sent out Spain), recognises the triple re- of Jesus who ‘sent them out to to ‘heal every kind of illness ality of the person: body, mind preach the Kingdom of God and infirmity’ (Mt 10:1)). One and spirit. and heal the sick’ (Lk 9:2) in testimony to the fact that our We believe that our best at- their bodies, minds and spirits. Church encourages us to exer- tempts to attend to all the needs Jesus told the Irish Clarissan cise this ministry is the volume of patients, whether they are nun Sister Briege McKenna, Prayer for Healing which was physical, social, emotional or whom I met in Indiana in 1978 published in the Vatican and spiritual, are the outcome of during a seminar on prayer and was the outcome of an interna- the joint efforts of the members healing and who exercised a tional conference that took of our unit. Indeed, if there is great ministry of evangelisa- place there in the presence of 1 an imbalance between these tion and healing with retreats archbishop, 5 bishops, 8 three components, the other for priests (up to a thousand priests, 1 deacon and physi- two will be affected as well. I people in 2006 in Ars, the na- cian, 1 woman religious and 5 can remember cases where a tive town of St. John Vianney), lay people (the Pontifical physical illness or a traumatic to communicate the following Council for the Laity/ICCRS, crisis (produced, for example, to bishops and priests: ‘It is not 2005). by a grave accident) has made humility to deny the power of the faith of a personal vacillate the priesthood, but it is humili- when this was not sufficiently ty to recognise that I have cho- 3. Health-Care Workers strong (‘why is this happening sen them… not for them to be and the ‘Christian Visit’ to me?’); or how major anxiety saints… but for my mercy, my of the Believer has continued to cause diges- love and my compassion for tive disorders; or when the fact mankind’ (McKenna, 2005, p. When in December 1978 I of a person not forgiving her 92). was talking to Mother Teresa mother (justifiable from a hu- The apostle James, when re- in her nunnery in Calcutta I man point of view but not from ferring to the sacrament of the said to her that I was a univer- a spiritual one) led a daughter anointing of the sick, which sity lecturer in Canada and she to place her mother in the psy- was established by Jesus answered me: “so try to radi- chiatric ward of my Canadian Christ, says: ‘Are any of you ate Christ as he is”. Should hospital, although after speak- ill? You should send for the this not be the motto of all ing and praying with her twice, Church elders, who will pray those who care for those who she began, at least, to recognise for them and rub olive oil on suffer, that is to say: ‘radiate that ‘certainly, in the final them in the name of the Lord’ Christ’? Indeed, one can visit analysis she is my mother’. For (Jm 5:14). a sick person in three ways: a)

DOLENTIUM HOMINUM N. 75-2010 as pagans, that is to say even ing’, as Paul VI well put it, in- years old, before dying in the by saying to them such foolish spires in sick people anxiety, Palliative Care Unit, gave me a things as “anyway you do not fear, desperation and rebellion cassette of when for the whole deserve this”, “go and under- against God; that in their de- of Europe she was ‘India’, one stand why God has sent you bilitated state these sick peo- of the top singers of the fa- something like this if you have ple are vulnerable to his at- mous Pilar López company. not done anything bad to any- tacks but they are also vulner- The cassette was entitled one”, or as an aunt of a termi- able to the grace of God, a ‘Amor y espinas’, a very ap- nally-ill girl once said to me: grace that must flow through propriate title, as I explained to “This is an injustice”; b) as our ministry, assuring them Dioni with words that apply to tepid and ‘discreet’ believers that Jesus holds them fast to all sick people: “Jesus died for who are unable to speak a the same cross on which he your salvation, he loves you word of Christian hope, are died for them; that as a result with an infinite love and he is never concerned about pray- we must discern the level at your side, allowing you to ing with a patient or, like his where we must help them to share in his thorns”: love and brethren, are not interested in encounter God, explaining to thorns. Carlos, who was fifty- his spiritual health because it them that we come from God seven years old, was also in is believed that these are ‘very andthatwegotoHimandHe the Palliative Care Unit and personal things’, or in how he Himself, even though this is was paralysed, after spending should really be; c) through a not realised; says: ‘Perhaps in years obtaining his livelihood Christian visit, answering the their suffering they will try to as a ferocious mercenary lead- revelation of Christ: “I was find me’ (Hos 5:15); that for ing dangerous and always fatal missions. He repented the first 56 time that he fell ill; now he knew that the Lord was with him, and he so much appreciated my prayers that at times I had to dry his tears.

4. Prayer and Sacraments in Pastoral Care for the Sick

4.1. Our prayer – a subject analysed in depth in my book entitled ‘Estuve enfermo y me visitasteis’ – must always be spontaneous (even though often, according to the circumstances, we end with an Our Father, an Ave Maria and a Glory) and, naturally, change according to the person. In this way we establish that necessary intimacy that leads us to discover problems such as sick and you visited me” (Mt this reason we must ensure hopelessness, a distancing 25:36). To sum up, one is deal- that this painful experience from the Church or an inability ing here with accompanying a helps to make them draw more of forgive. For this reason, the sick person, knowing: that we closely to God and to make famous French psychiatrist are there, humbly, but as the them understand that their suf- and deacon Philippe Madre – ambassadors of Christ (2 Cor fering is purifying them spiri- who converted after seeing the 5:20) whose constant compa- tually and that this is the most healing of a schizophrenic af- ny, and the company of his important form of healing ter two hours of prayer – says Spirit, we must always ask for through which they, like that a part of the vocation of a in this ministry; that, as St. Christ, will overcome death; health-care worker is to help a Paul assures us, ‘our battle is that in addition to including patient to open his or her own not against creatures made of them in our daily prayers of heart. My personal experience flesh and blood but against… intercession, we must ensure is that only in this way can one evil spirits’ (Eph 6:12), be- that we pray with them asking achieve a beneficial non-sacra- cause in addition to the reality Jesus to fill them with his mental confession that can that we perceive at the level of peace and – always with dis- lead to a sacramental confes- our senses, there is a spiritual cernment – ask for their heal- sion with a priest. reality where God acts ing or relief of their pain; but through the Holy Spirit, al- this should never be a solely 4.2. Some people, however, though his enemy, the devil, ‘a social encounter. live illness with true faith. Peo- perverted and perverted be- Dioni, who was sixty-five ple such as Harry, a Canadian

DOLENTIUM HOMINUM N. 75-2010 non-Catholic friend who two Holy Mass, or for the patient her family relatives present, days before dying said to me: anointing with oil, is worth because this means promoting “How much I wish to meet my more than all the statuettes of ecumenicalism. I have very Creator!”. Or Ángel, a drug saints, the flowers and the can- grateful memories of Moroc- addict who died of AIDS. dles that they place in front of can men and women that I When he was looking at his images. looked after in the Palliative Bible (which he knew thanks Care Unit: their affability and to certain Evangelical friends) 4.5. As regards anointing their gratitude as regards my he said to me “I know that he with oil and the patient, the visit, a kiss, an embrace (al- is here”. Other people, howev- Catechism of the Catholic ways corresponded) and prayer, are afraid of dying or have Church (n. 1516) observes: ‘It ing with them to our one God, wounds from the past that re- is the duty of pastors to in- asking for His mercy, and quire ‘inner healing’. We carry struct the faithful on the bene- making clear that I did this out our ‘healing mission’ by fits of this sacrament’ – the through Jesus. I liked to speak accompanying, by listening medical doctor should offer to to them about the Biblical fig- and by transmitting the com- the patient treatment that he or ures present in the Koran, for fort of the Word of God, as in she has not asked for his or her example: Adam (even though Isaiah 43:5 ‘do not be afraid own good – and ‘The faithful he repented and thus did not because I am with you’, or in should encourage the sick to transmit the effect of original Philippians, on how to obtain call for a priest to receive this sin); Noah; Abraham (the fa- this peace of God who ‘sur- sacrament’. The Code of ther of faith, from whose son passes all intelligence’. Canon Law states (n. 1007): Ishmael the Arabs descend); ‘Anointing of the sick is not Lot (who preached against ho- 4.3. At times, however, one bestowed on those who obsti- mosexuality); Jacob; Joseph; 57 should pray so that patients nately persevere in manifest Moses (to whom, they believe, can forgive, a recurrent theme grave sin’. This is one of the God handed the Torah); David of the conference of the Inter- reasons why a health-care (to whom, they believe, God national Christian Medical worker enters into intimacy gave the psalms); Salomon; Foundation, to which I was in- with a sick person and his or Elijah; Job; Jonah (who man- vited in 1984 by its president, her family relatives. aged to convert Nineveh; the American surgeon William With respect to the sacra- Zachariah, the husband of Reed, the author of a book on ments, one evening in Vaasa, Elisabeth; John the Baptist; care for the whole person: in Finland, in a conversation the Virgin Mary (the woman body, mind and spirit (Reed, with the parish priest of a that they most venerate, to 1995). I remember the testimo- Lutheran church, I spoke to whom the angel Gabriel an- ny of William Wilson (who him about the high level of sui- nounced the birth of her son); held the chair of psychiatry cides in that country and in and Jesus (the greatest prophet and was director of the Christ- Japan. He replied to me, with after Muhammad), whom they ian Psychiatry Programme at total conviction, that the level believe received the gospels the prestigious Duke Universi- was much lower amongst from God, worked miracles ty) on the total healing, five Catholics because of the fact and healed people, ascended years ago, on the basis of that they accede to the sacra- to heaven and will return at the prayer sessions, of a case of ment of confession. Indeed, end of the world (which will migraine that had lasted for those of us who care for the be marked by moral deca- eight years, when the woman sick believe that to receive or dence, signs in the sky and the patient could in the end forgive not to receive the sacraments appearance of the Anti- her husband who had betrayed can mean their eternal salva- Christ), even though they do her many times. tion or their spiritual suicide. not believe in his death and If we bear in mind the spiri- resurrection. The Archangel tual aspect of sick people we 4.6. Lastly, we do not forget Michael, who for them, as for must try to know if there is to interact with a patient us, is a protector (for a Muslim someone who cannot forgive, through the medical staff – patient it is a pleasant surprise aware that this is doing that medical doctors, nurses, auxil- to receive a statuette of him person a great deal of harm. iary staff, that is to say through with a prayer in Arabic). We know, and this is con- those who have to relate in We do not ignore the fact firmed by Philippe Madre, that some way with the patient – so that the Catechism of the one of the best ways of pray- that God will help them in Catholic Church (quoting Lu- ing with sick people for their their work and their decisions. men gentium of the Second recovery is to reawaken in Vatican Council) states: ‘The them the need to forgive or to plan of salvation also includes ask for forgiveness. 5. Ecumenical and those who acknowledge the Inter-religious Experience Creator, in the first place 4.4. In addition, we must en- in Pastoral Care amongst whom are the Mus- courage patients and their fam- lims; these profess to hold the ily relatives who have drawn Personally, praying with a faith of Abraham, and together away from the Church to be- patient greatly appeals to me, with us they adore the one, come reconciled with the for example with an evangeli- merciful God, mankind’s Church, assuring them that one cal, and even better with his or judge on the last day’. (n. 841).

DOLENTIUM HOMINUM N. 75-2010 6. Health-Care Personnel non-verbal communication and after Barbara had prayed Faced with the Whole (where we addressed the vari- for her, the next day was sit- Person: Body, Mind ous aspects of the interaction tingonabedandeatingabowl and Spirit between women nurses and pa- of soup. tients or between medical doc- I remember with affection 6.1. The atheist Alexis Car- tors and patients) recommend- the Canadian woman nurse rel, who won the Nobel prize ed to me a book of a great val- who looked after me when I ar- for medicine in 1912 (for his ue by two women nurses on rived at the urgent patients’ de- suture technique for blood ves- spiritual care in their profes- partment with an attack of sels and organ transplants), sion (Fish and Shelly, 1978). In asthma. Years later I had the converted after seeing the com- this book one can read that ‘ill- privilege of helping her spiritu- plete healing in Lourdes of a ness afflicts a person in his to- ally and of bringing her com- woman who had tubercular tality, not only his body or munion when she was a termi- peritonitis, was about to die, mind or spirit’ and that ‘the nally-ill patient. Indeed, was emaciated and had a very care of a nurse must be centred William Reed, who always swollen stomach. He later on the person as a unity’ (p. prays for his patients when he wrote that prayer ‘is the only 32). It emphasises the fact that is operating on them, says in force in the world that seems to a nurse for her patients can and the above-mentioned book that overcome the so-called ‘laws must be a ‘channel of the love the operating theatre ‘is a place of nature’’. of God’ (p. 49). In this book where lives are suspended be- Seeing every day in the Pal- the essay Interpersonal As- tween life and death. There the liative Care Unit the compas- pects of Nursing, by a famous soul sleeps, the body is sense- sion and the affection of all of American lecturer on nursing, less, and the spirit dwells in 58 the health-care personnel, with- Joyce Travelbee, who died at communion with God. In the out forgetting about the clean- the age of forty-seven, is quot- hands of the surgeon and the ing staff as well, I ask myself ed: ‘A woman nurse does not anaesthetist there is not only a whether they realise that it is only try to relieve physical life, but also a soul and a spirit God that places these feelings pain or provide physical treat- that can be influenced, for in their hearts. Philippe Madre, ment, she attends to the person good and evil, by words, ac- with his dual medical and spiri- in a spiritual sense. She attends tions and thoughts’ (pp. 23-24). tual experience, says that ‘the to the individual, not to a part And the lecturer on medicine priority for health-care staff is of his body. The existence of and Italian researcher Giuseppe to exercise mercy’. physical, mental or spiritual Moscati († 1927), who was I have already referred to the suffering is what concerns the canonised in 1987 by John Paul surgeon William Reed and his nurse’ (p. 59). II, observed: ‘Blessed are we integral care for the person – In this book it is stated that doctors if we remember that in body, mind and spirit – be- ‘one of the personal resources addition to bodies we have in cause, as the influential Christ- of a nurse is knowledge of front of us immortal souls ian Swiss physician, Paul Scripturesoastobeabletouse which demand the gospel pre- Tournier (1965, p. 61), ob- the Word of God therapeutical- cept that we should love them served: ‘Man – body, mind and ly’ (p. 110), naturally not in an as ourselves. There lies the sat- spirit – is a unity. The life that indiscriminate way but always isfaction; and in not hearing lives in his body corresponds with discernment. ourselves proclaimed the heal- to the live that lives in his mind A Canadian friend of mine ers of a physical malady’ and to the life that lives in his who is a nurse, Lynn Young, (Sicari, p. 181). spirit…The spirit…is neither managed to win the favour of a That doctor/saint, with his mind nor body. It constitutes very unpleasant patient who extenuating day as a medical the personal relationship of others avoided because she doctor, also said that ‘those man with God, and shapes the asked for God’s help. And I who always take communion mind and the body on the basis can also think of the former every morning have with them of this relationship’. nurse Barbara Shlemon (fa- an energy that never goes With respect to medical doc- mous for her ministry, her away’ (Sicari, p. 174). It was tors, we hope that each one of books and her intercession very beautiful to hear in the them will recognise, as the centre in Florida) whom I met above-mentioned conference Book of Sirach says, that ‘he in 1978 during the course of the testimonies of those med- gave medical knowledge to hu- that seminar on prayer and ical doctors – who pray with man beings, so that we would healing with Sister Briege their staff and their patients – praise him for the miracles he McKenna. Her life changed in about extraordinary and even performs…the doctor will use 1964 when a sick young miraculous recoveries and their them to cure diseases and ease woman in a comatose state conversion. I myself benefited pain…The doctor’s prayer is with her stomach swollen as as regards the treatment of my that the Lord will make him though she were nine month’s terrible bronchial asthma able to ease his patients’ pain pregnant, without any hair, which had lasted for seven and make them well again’ (Sir yellow, indifferent to almost years after William Reed had 38: 6-7, 14). every stimulus, and already prayed for me. And I was not breathing very badly, after re- surprised by the fact that al- 6.2. In 1981 two student ceiving one night the sacra- though he was an Episcopalian nurses of one of my courses on ment of anointing of the sick he read the Book of Sirach

DOLENTIUM HOMINUM N. 75-2010 (one of the seven books not in- sion for photography, I like to Bibliography cluded in his Bible). ‘My child, give family relatives some- Conferencia Episcopal Española, De- when you feel ill, don’t ignore thing that afterwards pleases partamento de Pastoral della Salud. For- it. Pray to the Lord and he will them a great deal: for example mación, 10: Acoger, comprender, acom- make you well. Confess all a family picture of Generosa pañar (Madrid, 2007). Pontificio Consiglio per i Laici/ your sins and determine that in with her husband, children and ICCRS. Prayer for Healing (Rome, the future you will live a right- dog to remember that Sunday 2003). eous life…Then call the doctor when they made her come DEGRANDIS,ROBERT. El ministerio de sanación (Madrid, SERECA, 1996). –for the Lord created him – down to the patio on her FISH,SHARON and JUDITH ALLEN and keep him at your side; you wheelchair; or for Andrés, a Shelly, Spiritual Care: The Nurses’s Role (Downers Grove: InterVarsity need him. There are times picture of him with his uncle Press, 1978). when you have to depend on Manolo, a simple and affec- MCKENNA,BRIEGE, Los milagros sí his skill. The doctor’s prayer is tionate man from the country- existen, p. 92 (Madrid, SERECA, 2005). Miracles Do Happen (Ann Arbor, Ser- that the Lord will make him side, who always accompanied vant Publications, 1987). able to ease his patients’ pain him: “every time that I look at POYATOS,FERNANDO. I Was Sick and and and make them well again’ that photograph, tears come to You Visited Me: A Spiritual Guide for Catholics in Hospital Ministry (New (Sir 38: 9-14) my eyes”. ‘It is better to give York, Paulist Press, 1999); Estuve enfer- than to receive!’ (Acts 20:35). mo y me visitasteis: testimonio de pas- As John Paul II said: ‘We be- toral sanitaria (Barcelona, Centro de Pastoral Litúrgica, 2002). 7. A Ministry for the Future gin by thinking that we give to REED,WILLIAM S. Surgery of the them and we finish by realising Soul: Healing the Whole Person: Spirit, There would be a great deal that they have enriched us’. Mind and Body (Tampa, Christian Med- ical Foundation, 2nd ed. 1995). moretosaybutIwillonlycite SICARI,ANTONIO, Retratos de santos, here what I call my ‘photo- Prof. FERNANDO POYATOS vol. 2 (Madrid, Ediciones Encuentro, 59 graphic ministry’. Only occa- Professor Emeritus, 1996). sionally and with discernment, The University of New Brunswick, TOURNIER,PAUL, The Healing of Per- Canada sons (San Francisco, Harper&Row, taking advantage of my pas- 1965).

DOLENTIUM HOMINUM N. 75-2010 Pastoral Care: the Chicago Study*

At this time of reexamina- Fifteen years ago Fr. Guild undertook to survey the tion and restructuring of health Richard McCormick, S.J., twenty-one Catholic hospitals care in the United States, it is wrote a seminal paper, “The of the Archdiocese of Chicago. appropriate to briefly review Catholic Hospital Today: Mis- Its purpose was to “take the an important aspect of sion Impossible.”4 His summa- pulse” (to coin a phrase) of the Catholic health care, and that ry was depressing. He stated Catholic mission of our hospi- is the pastoral care of our pa- that “the circumstances of the tals. To this end, we designed a tients. Given the economics of late twentiethcentury United simple one-page checklist the Obama health-care legisla- States have weakened and (Figure 1) which we sent to the tion, spiritual concerns may be sometimes dissolved the cul- twenty-one directors of pas- overlooked, but they should ture of the Catholic health-care toral care as identified in the not be. These concerns include facility, the strength and trans- The Official Catholic Directo- mandates for immoral cooper- forming power of its vision.”5 ry 2009.7 An introductory letter ation in abortion and a lack of Was Fr. McCormick’s pes- was sent to the pastoral-care protection for the conscience simism justified? directors, along with the ques- rights of health-care workers. The Catholic Physicians’ tionnaires and mailing instruc- A review of pastoral care is Guild of Chicago feels that the tions to return the survey. To in order for three reasons: 1) Catholic identity of our hospi- simplify analysis most ques- 60 the spiritual components of tals is uniquely rooted in their tions were in a “Yes-No” for- health and wellbeing are in- pastoral programs.6 If Fr. Mc- mat. There were five broad cat- creasingly acknowledged as a Cormick is correct in thinking egories: identification, Mass, legitimate aspect of medicine.1 that the culture of the Catholic Sacraments, ethics, and natural 2) Since Vatican II there has hospital is dysfunctional or ab- family planning (NFP). The been a shift in Catholic hospi- sent, then our programs are in survey is shown in Figure 1. tal ministry from clerical dom- serious trouble. But is that the Since patients were not in- ination to a lay orientation.2 3) case? volved in this survey, institu- Finally, the Catholic identity of tional review board approval our Catholic health-care sys- was not required. Responses tem has been called into ques- Materials and Methods from pastoral-care directors tion.3 This latter concern is not were voluntary with no incen- of recent origin. The Chicago Physicians’ tives provided. Figure 1. Hospital Checklist. The name of your hospital: ______1. Identification: a. There are Catholic images (statues, pictures, crucifixes) present. Yes___ No___ b. The hospital is identifiably Catholic. Yes___ No___ c. The word “Catholic” is in the mission statement. Yes___ No___ 2. Hospital Chapel: a. Is there a chapel? Yes___ No___ b. Is it open daily? Yes___ No___ c. Mass is offered? Indicate times; if not offered place an X. SMTWTFS d. Is information about Mass times and location given to Catholic patients upon admission? Yes___ No___ 3. Sacraments: a. How many pastoral care personnel are there? (full-time equivalents) Number_____ b. Is the Sacrament of the Anointing of the Sick available 24 hours per day? Yes___ No___ c. Is this provided by an in-house priest or the patient’s own parish priest? In house___ Parish___ d. Communion is available from pastoral care ministers. Yes___ No___ e. Is confession available from a priest if the patient so requests? Yes___ No___ 4. Ethics Committee: a. Is there a Catholic priest on the Ethics Committee? Yes___ No___ b. Is the Ethics Committee guided by the Ethical and Religious Directives? Yes___ No___

5. Is Natural Family Planning available to those women who request it? Yes___ No___ If your hospital provides additional Catholic services please list them below. Also, should you have any additional comments we would appreciate them. Please return this form in the self-addressed stamped envelope.

DOLENTIUM HOMINUM N. 75-2010 Results statues of saints, crucifixes, ately named Mercy Hospital.10 and holy pictures. Three quar- In most instances these reli- Response: ters (15 of 21) of the hospitals gious hospitals were organized In all, 20 of the 21 hospitals had daily Mass in their to fill a need for health care for responded. A checklist for the chapels. One hospital had poor immigrants. The socially non-responding hospital was Mass only one day a week. and economically advantaged completed by a Catholic Nineteen of the twenty-one had their own private clinics. Physicians’ Guild member on hospitals (91 percent) had the By 1990, 12.5 percent of its staff. As the questions were sacraments available twenty- hospitals, 15.1 percent of beds, objective in nature, this was four hours a day, seven days a and 15.6 percent of admissions not felt to introduce bias into week. Of interest was the large were provided by Catholic the survey, and their responses number of personnel on duty. health care. Given the current are included. There were eighty-six full- health-care debate, it is impor- time equivalents, or 4.1 per- tant to note that 14.5 percent of Identification: sons per hospital. This includ- health care (80 billion dollars All 21 hospitals were identi- ed fifty-two religious and thir- of a total of 512 billion dollars) fiably Catholic. ty-four lay persons. Also of expenses are incurred by note was the fact that there Catholic hospitals.11 Mass: were twelve priest chaplains in Statistics can tell us only so Of the hospitals surveyed, spite of the fact that there is an much. Of far more importance 15 had Mass daily in the acknowledged shortage of is what the sisters brought to chapel. Five hospitals had priests. About one-half of the health care. They were reli- Mass six days a week. hospitals had a priest on their gious before they were nurses One hospital had Mass two ethics committees. Finally, or administrators. They spent 61 days a week. NFP was essentially not pro- their formative years, even be- moted by any of the hospitals. fore they arrived on the hospi- Sacraments: One hospital did not have an tal wards, in their novitiates Nineteen hospitals had the ob-gyn department. and convents, becoming per- sacraments available 24 hours fected in a religious life dedi- per day, one 16 hours per day, cated to God and service to and one not specified. There their fellow men and women. were 86 full-time equivalent Their mission remained es- pastoral-care personnel, in- sentially unchanged until after cluding 52 religious. Vatican Council II when di- minishing members of hospi- Ethics: tal-based women religious Ten respondents (47.6 per- prompted a reassessment. A cent) had a priest on the ethics decline in priestly vocations committee. There was insuffi- also occurred. Pastoral care cient data to determine prior to Vatican II consisted of whether the ethics committees a priest chaplain who conduct- were guided by the Ethical ed a sacramental ministry. He and Religious Directives of the said Mass, distributed Com- United States Conference of munion, heard confessions, Catholic Bishops, so this result and administered the last rites. was not included in the final He was also available for spir- analysis.8 itual advice and support. With the decline in the number of NFP: both priests and religious In all but one hospital, NFP women there was, of necessity, was not available. Because of an increase in what became this, NFP was not included in Discussion known as lay ministers. Inci- our final analysis. dentally and relatedly, there Catholic health care (or at had also been a shift in The results warrant some least the hospital component of Catholic hospital board control comments. Twenty of the that care in the United States) from the respective orders’ re- twenty-one hospital pastoral- can be dated to 1823 when St. ligious sisters to lay persons care programs (95 percent) Elizabeth Seton and the Sisters who oftentimes did not have replied. For a voluntary ques- of Charity staffed the Balti- the years, or decades, of reli- tionnaire, this is a good re- more Infirmary, which subse- gious formation that the sisters sponse. The questionnaire for quently became the hospital of had. the nonresponding hospital the University of Maryland.9 The emphasis prior to Vati- was completed by a Catholic Many other orders of religious can II was on the sacraments: Physicians’ Guild doctor on women founded hospitals fol- the Mass, Communion, that hospital’s staff. All hospi- lowing Mother Seton. The first Penance, and Extreme Unc- tals were identifiably Catholic. hospital in Chicago was tion. Since Vatican II there has, This included not only the founded by the Sisters of Mer- understandably, because of the name but also the presence of cy in 1851 and was appropri- decline in the number of

DOLENTIUM HOMINUM N. 75-2010 priests, been a shift to health- pastoral care, and all major cludes that pastoral care re- care counseling. This includes non- Catholic health-care cen- mains strong. Pastoral coun- end-of-life counseling, griev- ters have pastoral-care depart- seling and sacramental min- ance assistance, family be- ments. In Chicago these in- istry are the strengths of pas- reavement efforts, and sup- clude Northwestern University toral care, and our commit- portive therapy. As more pas- Medical Center, the University ment to them must remain toral-care and counseling of Illinois Hospital, and the strong. As long as it does, the courses and academic pro- University of Chicago Hospi- Catholic Physicians’ Guild of grams become available over tal (which calls its component Chicago does not share Fr. the Internet, this trend will “Religious Care”). Catholic Mc- Cormick’s pessimism. continue. Indeed, there has health care is unique in that a arisen a cottage industry of significant aspect of its spiritu- PATRICK GUINAN, M.D. seminars, retreats, and degree al care is in the form of the THOMAS ZABIEGA, M.D. programs (M.A. and Ph.D.) to sacraments. Catholic hospitals CHRISTINE ZAINER, M.D. provide the academic tickets in all probability will be con- for nowmandated pastoral- fronted with expanded pas- care certification require- toral-care needs. They will * The authors wish to recognize the ments.12 therefore have to be even more invaluable advice and support of Sister Clara Frances Kusek, C.R., executive The results of the Chicago creative in the use of their re- vice-president for Mission of the Resur- Study suggest that pastoral sources in this regard. Perhaps rection Health Care System. care in Chicago Catholic hos- local parishes can share pitals remains strong and well priests, but this would require supported by the boards, approval by the local bishop. 62 CEOs, and administrations of Recruiting motivated volun- the twenty-one Catholic hospi- teers and then supporting pas- tals. We are encouraged by toral-care certification for this. Because of this commit- them is another option. Ade- References ment to Catholic hospital iden- quate funding must be provid- 1 H.G. KOENIG ET AL., “Religious tity, the Catholic Physicians’ ed by the hospital, no small Perspectives of Doctors, Nurses, Pa- Guild of Chicago feels that, feat when hospital budgets are tients, and Families,” Journal of Pas- where possible, Catholic doc- tight. toral Care 45 (Fall 1991): 254–267. 2CHRISTOPHER J. KAUFFMAN, Min- tors should consider referring istry and Meaning: A Religious History their patients to Catholic hos- of Catholic Health Care in the United pitals. States (New York: Crossroad, 1995). 3DANIEL P. SULMASY, “Then There We must note, however, the Was One: The Unraveling of Catholic lack of commitment to natural Health Care,” America (March 16, family planning in Chicago 2009): 11–14. 4RICHARD MCCORMICK,“The Catholic hospitals. This is an Catholic Hospital Today: Mission Im- important aspect of health-care possible,” Origins 24 (1995): 648–653. ministry, and we encourage its 5 Ibid., 653. 6PAUL HARRINGTON,“TheCatholic more widespread promotion. Hospital,” Hospital Progress 42 (June One final point. While pas- 1961): 68–70. Germain Kopaczynski, OFM Conv., “Catholic Identity in Health toral-care coordinators are be- Care,” Linacre Quarterly 64.2 (May coming better trained and 1997): 26–35. more professional (given the 7 The Official Catholic Directory 2009 (New Providence, NJ: National workshops and degree pro- Register Publishing, 2009). grams), they should not lose 8 See USCCB, Ethical and Religious sight of the primary role of the Directives for Catholic Health Care Ser- vices, 4th ed. (Washington, D.C.: USC- Sacraments in Catholic health CB, 2001). care and ultimately in the eter- 9CHRISTOPHER KAUFFMAN, “Catholic nal salvation of our patients’ Health Care,” in the Catholic Encyclope- dia (1995), 262–265. souls. Pastoral care should 10 THOMAS BONNER, Chicago Medi- promote the primacy of the cine (Madison, WI: American History Sacraments: Mass, Commu- Summary Research Center, 1957). 11 “2006 American Hospital Associa- nion, reconciliation, and the tion Annual Survey,” January 2008, sacrament of the sick. This Pastoral care is an essential http://www.aha.org/aha/research-and-tren emphasis is specifically articu- component of Catholic hospi- ds/health-and-hospital-trends/2006.html. 12 American Association of Pastoral lated by the local bishops tal ministry. There is concern Counseling, “What Is Pastoral Counsel- when they oversee “the cele- that Catholic identity has erod- ing?”(2009), http://aapc.org/content/ bration of the Sacraments for ed with the decline in religious what-is-pastoral-counseling. 13 National Conference of Catholic the sick in healthcare set- sisters in direct hospital ad- Bishops, “The Pastoral Role of the tings.”13 ministration, as well as the de- Diocesan Bishop in Catholic Health Care It might be noted that pas- crease in hospital priest chap- Ministry” (Washington, D.C.: U.S. Catholic Conference, 1997), 5; Pontifical toral care is not unique to lains. The Catholic Physicians’ Council for Pastoral Assistance, “Charter Catholic hospitals. The Joint Guild of Chicago has surveyed for Health Care Workers” (1995), Commission on Accreditation pastoral care in the twenty-one http://www.vatican.va/roman_curia/pont ifical_councils/hlthwork/documents/rc_ of Healthcare Organizations Catholic hospitals in the Arch- pc_hlthwork_doc_19950101_charter_en (JCAHO) has guidelines for diocese of Chicago and con- .html.

DOLENTIUM HOMINUM N. 75-2010 The Votive Temple of the Medical Doctors of Italy: the History of a Sanctuary and its Founder

In a letter of 19 December Carlo Cambiano was born in preciation towards those who 1941, the Bishop of Como, Candilo, in the Province of with commitment and self-de- Msgr. Alessandro Macchi, ex- Turin, on 6 February 1868. He nial were engaged in the med- pressed himself in the follow- was ordained a priest in 1897 ical profession, in 1937 ex- ing words: ‘When I think of and sent to Duno in 1899, in pressed his esteem for those God, my heart fills with joy. A the Lombard lower Alps, as medical doctors who were lost town on a hill, an almost the spiritual vicar. Duno was a working in the difficult context unknown time, now famous small town in Valcuvia, then in of the Spanish Civil War. for its votive temple, raised up the Province of Como (at the When he learned that in the by a creative mind, Msgr. present time it belongs to the university world the idea was Cambiano, in memory of a Province of Varese. It is high to create a sacrarium for med- class so worthy for its humani- up compared to the valley be- ical doctors and students who ty, but at times whose true val- low (525m above sea level) had sacrificed themselves for ue is not always appreciated. and it was difficult to reach (it their country he took the deci- Praise be to its creator, keenly- could only be reached by a sion to build a temple that felt gratitude to all those who mule’s path or by journeying would commemorate all med- have helped in the magnificent along a steep and difficult ical doctors, living and dead, 63 undertaking of Msgr. Cabiano, path). who had been and were ready sincere congratulations to he to sacrifice their existence to who with an intellect of love care for suffering humanity. In thought of illustrating the the intentions of this priest small town of Duno. May St. there was also the creation of a Luke, the patron saint of rest home for elderly medical physicians, always help these doctors who had retired from great benefactors in the exer- their profession (this last pro- cise of their most notable work ject, however, never say the and may they be, as the Holy light of day). Spirit wishes, always full of To build the temple Don love!’. Cambiano thought of a using a The church to which this house and its land in the centre bishop referred in his letter of the village which had been was consecrated by him on 25 donated by a woman parish- August 1938 and dedicated to From the moment of his ar- ioner with a clause which said Our Lady of the Rosary and St. rival Don Cambiano began to that a church had to be built Luke the Evangelist, the pa- attend untiringly to this small there. After he had the house tron saint of physicians. On 3 mountain settlement and its in- demolished, in December October of the same year this habitants, and he became with- 1937 he began the building church, called the ‘votive tem- in a few years a tireless engine work following a project ple of the medical doctors of of the religious and civil life of drawn up by the architect, Ce- Italy’ was raised to the dignity Duno. Amongst his initiatives sare Paleni. The work was fin- of being a sanctuary. In addi- we may remember the con- ished in May 1938 and so the tion, on 5 May 1940 the ad- struction of a nursery school, new church could be conse- joining sacristy was inaugurat- the building of road for vehi- crated in August 1938. A little ed, a sacristy dedicated to all cles from the valley to the time afterwards the building those medical doctors who had town, the public aqueduct, and work on the sacrarium began, given their lives for their coun- an institute for the deaf and and this last was inaugurated try and for humanity. This vo- dumb. in May 1940. tive temple had in the mean- Don Cambiano also found Don Cambiano, who already time achieved a certain fame at time to dedicate himself to lit- enjoyed the title ‘Knight of the a national level, as is borne out erature and he published Crown of Italy’ which had by the first two pilgrimages of works of local interest (such as been conferred on him for the medical doctors which were Monografia di Duno or Duno care that he had provided to held respectively in November e il Tempio Votivo dei Medici military men who during the 1938 and June 1939. d’Italia), of religious medita- First World War controlled the This votive temple of the tion (such as Il figlio del tri- territory of Duno, in October medical doctors of Italy was bune on St. Martin), and of 1938 was appointed ‘Rector of raised thanks to the initiative aphorisms of a health-care the Sanctuary’, and in Septem- and the perseverance of Don character (such as Medicus ber 1940 he was also made Cambiano who at that time in and Medicus bilinguis). ‘Monsignor and Chaplain Ex- Duno was engaged in the prac- Don Cambiano, who felt tra Urbem of H.H. Pius XII’. tice of his priestly ministry. feelings of gratitude and ap- Msgr. Cambiano stayed at

DOLENTIUM HOMINUM N. 75-2010 Duno until his death which Cambiano, custody of the fight the implacable enemy took place on 12 June 1943 af- sanctuary was entrusted to the and that at the decisive mo- ter a long illness. Servants of Charity of the ment science, which is a hu- The Votive Temple of the work of Don Guanella, who in manthing,isnolongeruseful. Medical Doctors of Italy is a December 1941 were entrust- Then non-human science can small and compact building, of ed with the running of the intervene – knowledge of God. rather classical features, locat- parish of Duno which has just God can help, illuminate and ed specifically in the centre of been brought into being. infuse that extreme courage the town and surrounded by TheVotiveTempleofthe that raises up those who are houses that are lived in. It is Medical Doctors of Italy, de- about to fall. Light is also a made up of two separate areas spite its initial fame and a weapon. He has believed that which are connected: the number of pilgrimages of one had to say to physicians church with a circular plan and medical doctors which took that Faith is a force. And he the adjoining sacrarium. place during the first years af- wanted to say this by raising up a church for them, dedicat- ing it to them and offering it to them as a gift. And thus the Temple for Physicians of Duno was born. It is the house of their spirit which expresses at one and the same time hope and gratitude towards the Almighty. Nothing has been 64 done in Italy, indeed in the world, which is similar. And not only this. This most pious of priests wanted to dedicate a sacrarium to medical doctors, he wanted that in this sacrarium would be written the names of those medical doctors who had fallen in performing their duty, both in The entrance door of the ter its inauguration, ended up peace and in war. It launches church, the work of the sculp- by falling into a slow but them into eternity without an ture Enrico Magrini, portrays steady decline. Only at the end exhibition of allegorical, in a summarising and symbol- of the 1990s (thanks to the grandiose and invasive monu- ic fashion the human and pro- joint initiatives of the Italian ments, which are often created fessional characteristics of a Society for the History of more because of the vanity of physician; numerous specialist Medicine, the Order of Med- those who remain than the contexts in which the medical ical Doctors of the Province of piety of those who have left’. profession expresses itself are Varese and the Faculty of also illustrated. Above the en- Medicine and Surgery of the Prof. MASSIMO ALIVERTI, trance door there is an image University of Insubria) was the Professor of Medicine, of St. Luke the Evangelist, the sanctuary of Duno able to re- the University of Milan-Bicocca, patron saint of medical doc- turn to its ancient splendour. Lecturer in Psychiatry, the University of Milan. tors. The inside of the church, In recent years this votive which has marble tablets, has a temple, at a time near to the Via Crucis made up of ceramic feast of St. Luke (18 October), pictures and a wooden bas-re- has been the location of a cere- lief portraying Our Lady of the mony when medical doctors Rosary with her child Jesus in who have recently died in the her arms. At the sides of the al- practice of their profession are Bibliographical References tar there are two votive lamps remembered by their bio- F. BOLDRINI, ‘Simbologie della medi- that commemorate, respective- graphical data being placed in cina nel portale del Tempio di Duno’, in ly, living and dead medical a specific register and their Terra e gente. Appunti e storie di lago e doctors. The sacrarium, which names being engraved on a di montagna (Comunità Montana della Valcuvia, 2006). has circular walls, has marble marble tablet in the sacrarium. C. CAMBIANO, Duno e il Tempio Voti- tablets in which are engraved To go back to Msgr. Carlo vo dei Medici d’Italia, (Edizioni d’arte the names of medical doctors Cambiano, the creator and Pavoni, Milan, 1942). G. POZZI, ‘Duno: il Tempio votivo dei who gave their lives, respec- founder of this sanctuary for Medici d’Italia’, in E. Anklam and G. tively, for their country and for medical doctors, in 1942 the Armocida (eds.) Medicina e ambiente humanity. The building is journalist Giovanni Cenato (Atti del XXXVIII Congresso Nazionale della Società Italiana di Storia della completed by a bell tower with wrote of him: ‘Don Cabiano is Medicina, Ispra-Varese-Cuveglio 16-19 its belfry and a small door not a doctor but as a doctor he ottobre 1997). which leads on to the sacrari- has studied the soul, he has un- L. VIOLONI, ‘Il Tempio di Duno tra passato e futuro’, in Terra e gente. Ap- um. derstood struggles and sacri- punti e storie di lago e di montagna (Co- After the death of Msgr. fices. He has thought that these munità Montana della Valcuvia, 2006).

DOLENTIUM HOMINUM N. 75-2010 Anniversary Consultation 20 Years of European Chaplaincy 10 Years of the ENHCC (European Network of Health Care Chaplaincy)

London, 16-19 September 2010 Chronicle LONDON, 16-19 SEPTEMBER 2010

On 9 July 2010, at the Pon- Vandenhoeck and this was fol- the need for awareness as re- tifical Council for Health Care lowed by two papers which il- gards one’s vocation. A chap- Workers, a meeting took place lustrated experiences in the lain should know how to dis- between Rev. Dr. Stavros K. French context (Pierre Bouis- tinguish between spirituality Kofinas, an Orthodox priest, set/Anne Hummeau, ‘The and religion; spirituality also the coordinator of the Euro- Hospital Chaplaincy in France involves the ecclesial dimen- pean Network of Health Care Today’, and in the English sion, but there should be an Chaplaincy (ENHCC) and the context (Richard Lowndes, avoidance of the promotion of coordinator of the Network for ‘The Chaplaincy/Spiritual one’s own religious communi- Pastoral Care in Health of the Care in England. National Ex- ty. It is fundamentally impor- Ecumenical Patriarchate, and periences and Envisaged De- tant that the chaplain to con- H.E. Msgr. Zygmunt Zimows- centrates on spiritual care and ki, the President of the Pontifi- not on psychological coun- cal Council. Following this selling as such: he is called to meeting, Msgr. Dariusz Giers, heal rather than to treat. an Official of the Pontifical The next session examined 66 Council, was sent to the An- the subject ‘Chaplains and Per- niversary Consultation of the sonal Growth’ (Kirsti Aalto), ENHCC, which took place in and this was analysed in depth London on 16-19 September by a representative of Dutch on the occasion of the tenth an- chaplaincies (Anneke Kem- niversary of the creation of this per) and Irish chaplaincies network. Fifty-three partici- (Kathleen O’Conor). It was pants went to London, the rep- stressed that in the context of a resentatives of the hospital global (economic and moral chaplaincies of forty European crisis) and also with reference countries (amongst whom to the personal crises (burn- were many Catholic chap- out) of chaplains, it is impor- lains), both religious and lay tant not to become discour- people. aged, to try to advance in spir- The opening ceremony took itual terms, and to grow in place in the famous St. Paul’s faith. In order to obtain bal- Cathedral of London and was velopments’). During the sub- ance and integrity as regards preceded by evensong. During sequent debate the following one’s own personality, the help the ceremony Msgr. Giers read problems were pointed out: the and support of colleagues and out in English the address of dual task of a hospital chaplain teams is essential. greeting of the President of the who, on the one hand, must With respect to chaplains Pontifical Council for Health understand the language of a who are priests, Pierre Bouis- Care Workers. health-care system and, on the set and Anne Hummeau, rep- All the sessions of this meet- other hand, must make the resentatives of French Catholic ing were held in the Westmin- medical staff understand that chaplaincies, emphasised that ster Thistle Hotel and were on within this system he performs their presence in health-care the subject ‘Chaplains in the a specific function; it is thus centres is an important ‘sign’. Future – Giving and Receiv- important for the chaplain to “Often today”, they observed, ing’. have an approach of openness “the teams of a chaplaincy do The workshop was organ- towards health-care workers. not include the figure of the ised into four sessions in the Stress was laid upon the utility priest. However, his presence following order: an initial proof documentation on the work is special. A priest is appointed lusion; an introductory session carried out by the chaplain (ev- by the bishop to accompany with two supplementary pa- idence), although the difficul- the team and to implement pers; an examination in small ties of this were also pointed through his presence the con- groups of the questions ad- out (privacy). nection with the local diocesan dressed; and, lastly, a shared The second session ad- church. In the name of the analysis of the conclusions dressed the subject of ‘The Church he accepts what is ex- proposed by each group. Chaplain and Religious Com- perienced by the members of The first session, which took munities’ (Dana Kalnina-Za- the team and expresses open- place in the morning of Friday ke), seen from a Scottish per- ness towards acceptance of the 17 September, began with a spective (Ewan Kelly) and a gift of God. He is a ‘sacramen- prolusion entitled ‘The Chap- Belgian perspective (Axel tal presence’ at the side of the lain and Changes in the Liegeois). As regards this sub- sick and the elderly: he recon- Health-Care System’ by Anne ject, emphasis was placed on ciles people with God, anoints

DOLENTIUM HOMINUM N. 75-2010 with consecrated oil, and in had been expressed in her, ac- liberations of the meeting were union with the team celebrates cepted with gratitude her new training, quality of service, Holy Mass, thereby manifest- post and presented the guide- transparency, humility, spiritu- ing how much the whole of the lines at the level of its pro- al growth, witness and faith. mission with the sick and the gramme for the future of the To strengthen their faith, the suffering is rooted in the Eu- association. It was decided that organisers of the London con- charist”. the next consultation of the sultations planned daily prayer During the final session of ENHCC would take place in meetings in churches, in a hos- 19 September the handing on Holland in 2012. pital chaplaincy, and during of the position of coordinator The meeting took place in a the sessions. of the ENHCC took place. Fa- friendly and respectful atmos- More detailed information ther Kofinas was replaced by phere and seems to have on the Anniversary Consulta- Dr. Anne Vandenhoeck, a Bel- achieved its goal, that is to say tion 2010 can be obtained by gian and a teacher of theology an exchange of experiences as consulting the web page of the at the Catholic University of regards European hospital ENHCC: Louvain, who was elected chaplaincies, in order to assure www.eurochaplains.org unanimously by those taking to sick people more adequate part in this Anniversary Con- and efficient spiritual care. Msgr. DARIUSZ GIERS sultation. The new coordinator Here it should be pointed out Official of the Pontifical Council of the ENHCC, after express- that the terms that were most for Health Care Workers, ing her thanks for the trust that frequently used during the de- the Holy See.

Address of H.E. Msgr. Zygmunt Zimowski OPEN CEREMONY – ST. PAUL’S CATHEDRAL, LONDON – 16 SEPTEMBER 2010

Dear Rev. Dr. Stavros Kofi- and your dedication to our sick XVI, who in these days is vis- nas, Coordinator of the Euro- brothers and sisters. In recog- iting England, spoke very in- pean Network of Health Care nition of your work I awarded spiring words on the future. In Chaplaincy, you the Good Samaritan a homily that he gave this year Dear chaplains, representing Medal, which the Pontifical in the Basilica of Saint Paul’s many Churches and denomi- Council for Health Care Work- Outside the Walls in Rome on nations of numerous European ers gives to those who serve the vigil of the feast of the countries, the sick and suffering in an ex- Holy Apostles Peter and Paul And all those taking part in ceptional way. Indeed as you (28 June 2010), he said: ‘The this opening ceremony, which noted ‘we had an open and Church is young and open to is taking place in this beautiful honest dialogue that formed the future. And I repeat this to- cathedral church dedicated to the foundation for a relation- day, close to the tomb of St St. Paul, Apostle of the Na- ship for cooperation in the fu- Paul. The Church is an im- tions, ture’. mense force for renewal in the At the outset let me express The topic you have chosen world. This is not, of course, my deepest gratitude for the to reflect upon throughout this because of her own strength invitation to take part in this Anniversary Consultation con- but because of the power of Anniversary Consultation in cerns the future: ‘The Chap- the Gospel in which the Holy London while you celebrate lain in the Future – Giving and Spirit of God breathes, God twenty years of European Receiving’. Nowadays many Creator and Redeemer of the chaplaincy and the tenth an- people are anxious and even world. The challenges of the niversary of the foundation of scared about the future, seeing present time, the historical and the European Network of it as insecure and unstable. For social and, especially, the spir- Health Care Chaplaincy (EN- those of us who are involved itual challenges, are certainly HCC). in pastoral care in health, we beyond the human capacity. It Fr. Stravros Kofinas, I great- face a challenge concerning sometimes seems to us Pastors ly appreciate the mission and how we can continue to serve of the Church that we are reliv- work of the ENHCC and, let and minister to the spiritual ing the experience of the me say this loudly, it was a needs of those who suffer Apostles when thousands of great honour for me to receive within a society that has be- needy people followed Jesus you at my offices in the Vati- come secular, pluralistic, rela- and he asked them: what can can this summer. I was able to tivistic, and often hostile and we do for all these people? learn from you about the story aggressive towards faith and They were then aware of their and activity of the Network religious values. powerlessness. Yet Jesus him- and also to admire your zeal The Holy Father Benedict self had shown them that with

DOLENTIUM HOMINUM N. 75-2010 faith in God nothing is impos- heaven is close at hand. Cure the sick, assisting those who sible and that a few loaves and the sick, raise the dead, cleanse perform a service for the ill fish, blessed and shared, could the lepers, cast out devils. and the suffering, so that the satisfy the hunger of all. How- Freely you received, so freely apostolate of mercy they carry ever, there was not and there is give” (Mt 10:7-8). And down out will increasingly respond not hunger solely for material the centuries the health care to new demands’ (Apostolic food: there is a deeper hunger ministry has been an excellent Constitution Pastor Bonus,n. that only God can satisfy.Hu- example of satisfying the spir- 152). man beings of the third millen- itual hunger of people, of re- Therefore, I want to express nium want an authentic, full ceiving from God’s grace and my closeness to all chaplains, life; they need truth, profound giving to those who suffer. especially to those associated freedom, love freely given. And I am persuaded that there with the European Network. In Even in the deserts of the secu- is no other future for the a spirit of union and brotherly larized world, man’s soul Church and for its ministers love, I bless everyone of you thirsts for God, for the living than freely giving what we and your work and I pray that God’. have received from the bounty you will continue to be a light Since its foundation, the of God. of hope for the future of the Church has taken to heart the In conclusion, I would like health care ministry in Europe mission entrusted to it by its to say that I am the head of a and the entire world. Teacher, not only to give food very special Dicastery of the With respect and admira- to the hungry but also to care Roman Curia. Its name is the tion, and wishing you a very for their souls and bodies. Je- Pontifical Council for the successful meeting, sus sent out the Twelve Apos- Health Care Workers. It was 68 tles with power to cast out un- instituted in 1985 by the Ser- H.E. Msgr. ZYGMUNT ZIMOWSKI clean spirits and to cure all vant of God, Pope John Paul President of the Pontifical Council kinds of diseases and sickness- II. The main purpose of this for Health Care Workers, es. He said: “as you go, pro- Pontifical Council is ‘to mani- theHolySee. claim that the kingdom of fest the Church’s concern for

Chaplains in the Future: Giving and Receiving OPEN CEREMONY – ST. PAUL’S CATHEDRAL, LONDON – 16 SEPTEMBER 2010

It took ten years for our Net- (1996), and in Rome (1998). – the strengthen and the de- work, which has now travelled There, in Rome, it was decided mocratic legitimacy of Euro- for ten years, to be founded. that the next consultation be pean institutions The journey started in the hosted by the Ecumenical Pa- – the improvement of the ef- Holy Land when Sten Ludgren triarchate in 2000 and would fectiveness of European insti- was travelling from Sweden. take place in Greece. tutions Sten was then head of the Pas- The journey of European – the establishment of eco- toral Office of the Free Church chaplains was rewarding, but nomic and monetary union of Sweden, a staunch ecu- the question that was posed in – the development of the so- menist and a sincere pastor, a Rome was a serious one: cial dimension of the EU mentor for many. As he was where are we going? For the Community travelling, he encountered a meetings of European Chap- – the establishment of a chaplain from another country. lains seemed to be a journey common foreign and security They started to talk about without a destination. policy. chaplaincy and, seeing how re- Parallel to this journey, an- warding their exchange of ex- other journey was taking In 1995 the EU members periences was, they came up place, that of the European implemented the “Schengen with the idea of calling togeth- Union! The 1990s were the Agreement” which gradually er chaplains from Europe to- decade of rapid steps toward a allowed people to travel with- gether so that they too could united Europe. With the col- out having their passports have the same joy of sharing. lapse of communism across checked at the borders. Mil- So it was that the first meeting central and Eastern Europe, lions of people were able to of representatives from Euro- Europeans become closer open up even more channels of pean Chaplaincies gathered in neighbours. With the signing cooperation and communica- October 1990 in Berlin. After of the ‘Maastricht’ Treaty on tion, made easier, more and that, meetings followed in Up- European Union in 1992, the more, through the rapid use psala (1993), in the Nether- dreams of a Common Market and continual development of lands (1994), in Bath, England materialized, emphasising: internet and mobile tele-

DOLENTIUM HOMINUM N. 75-2010 phones. Thus, Europeans be- should we, have a Single Unit- gious community of Europe, came concerned about how to ed Hospital Chaplaincy? It we had to reach our Ithaka, an act together in areas of other was evident that, if we were Ithaka of mutual respect, of common concern, including going to exist within a Euro- sharing and learning from one that of health care. The Treaty pean framework, there was a another, an Ithaka of high of Amsterdam signed in 1997 necessity to have more cooper- quality standards for European laid down new principles and ation between our respective Chaplaincy, an Ithaka that ex- responsibilities in the field of chaplaincies and a need for a presses concern and care for the common foreign policy, common standard that quali- all. On the last day, after much with the emphasis on project- fied what health care chaplain- discussion and in the final ing the EU’s values to the out- cy was and how it was prac- hour, on Saturday, the 11th of side world, protecting its inter- ticed. November, it was agreed that ests and reforming its modes At the onset of the delibera- the European Network of of action. It formed a more tions, the answer to this ques- Health Care Chaplaincy (EN- consolidated structural basis of tion seemed rather simple: HCC) be formed and the Cre- representation from the Mem- “Yes!” “Of course!”. It was tan Declaration was adopted. ber States so as to plan and im- commonly agreed that the time In leaving Crete, the only plement common strategies. had come when the chaplain- thing that we had agreed on cies of Europe should come to- was a name. A small organiz- gether under some sort of or- ing committee was formed ganization. The participants made up of myself, Fred initially felt that there were Coutts, who offered to set up a more things that each shared in website, Michael Möller-Herr common than things that sepa- of the Lutheran Church of 69 rated them. In fact, some of the Germany and Kirsti Aalto of national chaplaincies were al- the Lutheran Church of Fin- ready “networking” them- land, who graciously offered selves with other national to host the next consultation in chaplaincies. There were, 2002. The main task of this though, some initial concerns working committee was to regarding the formation of a prepare a draft of the Stan- “united” chaplaincy due to the dards for Health Care Chap- underlying differentiations in laincy in Europe. Meeting in the administration of each Constantinople, today’s Istan- chaplaincy, its relationship bul, at the Ecumenical Patriar- with its Faith group authority chate, we collaborated, using and the different perceptions what we had learned from the of the meaning of spirituality. Cretan Consultation to form The main difficulty was the the draft. use of language in defining Our meeting in Finland was these differences, particularly panegyrical! The Standards within their specific cultural were adopted, a coordinator contexts. The greatest clash was elected, and a network came in defining chaplaincy committee was appointed. within a faith-centred context Dublin, Lisbon and Tartu, Es- or in a secular context. Here, tonia, were the sites of the fol- our discussion became intense. lowing consultations. During Until the last hour of delibera- these meetings, a Constitution tions, it seemed as though the was adopted setting the prece- journey toward some type of dent for a firm infrastructure, By the time the 23 represen- oneness would remain unful- taking great efforts in explain- tatives from 15 chaplaincies filled. Laistrygonians and Cy- ing and helping others to un- arrived on the island of Crete clops, the wild and angry Po- derstand who each of us was at at the Orthodox Academy for seidon had surrounded our a theological, clinical and cul- the 6th. European Consultation ship. Tensions rose, but our tural level. In Lisbon and Esto- of Hospital Chaplaincy, the so- thoughts and excitement re- nia, we began discussing spe- cio-political background of mained high. Our persistence cial areas of concern, issuing a Europe had rapidly changed. in maintaining open communi- statement on palliative care In the far horizon, with the de- cation and understanding pre- and addressing end of life is- velopments that had taken vailed. We all knew that if we sues. More importantly, each place in Europe, the journey brought these tensions along time we met, a strong bond of that the chaplains had begun in inside our souls, if our souls professional and inter-personal 1990 was acquiring a sense of set them up in front of us, al- relationships was formed. direction. In Crete, it was clear lowing our differences to po- After the founding of our that we were all now part of larize us, they would harm us. Network, great efforts were One United European Com- We all knew that if chaplaincy made in establishing relation- munity! The question that had was going to survive within ships across the Atlantic, with to be posed was: could we, the socio-political and reli- the American Association of

DOLENTIUM HOMINUM N. 75-2010 Professional Chaplains and work would have never pro- learn from one another, while with the Association for Clini- gressed in its course of travel. serving as a reference source cal Pastoral Education (whose After ten years of journey- for the bodies that we have representative is attending our ing, our Network has reached a been collaborating with over Consultation for the first time). peak, or I should say a plateau, the past years. The survey was We have opened pathways to- in our history. Over the past an important trail to test how ward the Council of European two years, some firm steps we truly work together and Churches (CEC), the EU Poli- were made. One was that we contribute in a collective way. cy Advisor for Religious Dia- established a dialogue with the Unfortunately, this effort logue and with the Office of Pontifical Council for Health failed. Only eleven participat- the EU Commissioner for Pub- Pastoral Care. This is impor- ing organizational bodies con- lic Health, visiting their offices tant in that some 15 national tributed. regularly and taking part in chaplaincies of the Roman The failure of this collective several EU dialogue meetings. Catholic Church have partici- effort raises some basic con- In fact, it was because of our pated in the Network. In my cerns about the future of our initiative that a special meeting meeting with the members of Network. Has our journey to was called by the office of the the Council in Rome this past find Ithaca come to a stand- EU Commissioner on pallia- July, it was agreed that health still? Have we lost our sense of tive care. care chaplaincy in Europe is motivation? Have we become entering a difficult phase due engulfed in the disenchant- to a more secular understand- ment of a United Europe, a ing of what is termed as “spiri- disenchantment that pervades tual”, the attempt to minimize our day and time, causing us to 70 whatever is religious, particu- retreat into ourselves? larly whatever is considered As stated in the Cretan Dec- ecclesiastical. The Pontifical laration that was adopted at the Council will assist us to con- onset of our journey, our Net- nect with more countries in work was founded on two ma- Eastern Europe, which has jor factors: been difficult in the past, and 1) a clear understanding of to work with the Council of ourselves and how we relate to European Bishops’ Confer- one another at a theological, ences, an important body of cultural, psychological and the Roman Church. practical/clinical level In June of 2009, we met 2) the promotion of a high again with the directors of the standard of spiritual health Church and Society Commis- care within our national orga- sion (CSC), a commission of nizations, in Europe and the the Conference of European world at large. Churches (CEC), with the As Homer writes in the Deputy Secretary of the Office Over the past ten years as Odyssey about the journey to of the EU Commissioner of the Network’s Coordinator, it Ithaka, “Many cities did [we] Public Health and the Policy has been my firm belief that visit, and many were the na- Advisor for Religious Dia- the existence of our Network tions with whose manners and logue in the EU. What became depends on one more impor- customs [we were] acquaint- apparent at all of these meet- tant factor: our ability to con- ed…” ings was the request that we, tribute to the challenges of Throughout these ten years, as a renowned European orga- health care at all levels by those that have been elected to nization, offer our knowledge building bridges of communi- serve the Network Committee and skills so as to enrich those cation, forming relations hips have been in continual com- who are concerned with health of trust and cooperation and munication, meeting once in care in Europe. Instead of ask- by being a expression of care. Dublin, once in Leuven and ing for recognition from EU This last point is the denom- three times at the Ecumenical officials, we were placed in a inator that can give us the in- Patriarchate in Constantinople. position where we were asked centive to move on. We cannot Without the cooperation and to contribute to the “Great exist just by inertia, by re- dedication of those that served Event of the European Union”. maining self-centred and self- the Network Committee, we Following this request, the confining in our national situa- would have never progressed Network Committee decided tions. We are professionals as we did. Here, I must under- that a small conclusive survey who proclaim the message of line the work done by Rev. should be done so as to show hope through care. Thus, our Fred Coutts, our webmaster, how end of life issues are dealt contribution to the challenges who created and developed with in each of our respective of today’s European society our website, making it a point countries and chaplaincies. and in health care particularly, of reference for us all. I can This was also a good follow- is not a theoretical or academ- honestly say that without up from our last consultation. ic one. It is a way of express- Fred’s energetic effort and ab- This comparative survey ing our concern for those that solute commitment, our Net- would be useful for all of us to areinneedofacarethatonly

DOLENTIUM HOMINUM N. 75-2010 we can offer. If we retreat into in these troubled times, to re- inatimeofhistorythatthatis our national situations and do gain their faith in a Philan- encountering many storms. In not make efforts to look at thropic God and to learn how examining who the chaplain of ourselves as part of a whole to except genuine care. For, as the future will be, we must al- and expressing care for that Ecumenical Patriarch so define how the chaplain can whole, we will dwindle, not Bartholomew told us when we be a vessel of care, an example only as a Network, but as care- met with him, our mission is to of how one can give and re- givers. Our Journey will come be a living expression of God’s ceive. In doing this, we must to an end. Philanthropy. It is a mission also examine how our Net- We are entering a difficult that does not know geographi- workcanalsobeabetterves- time in history in which all the cal boundaries, does not dis- sel of care. How we can find institutions and establishments tinguish race, people or lan- betterwaysingivingtoone that once offered a sense of guage, is directed indiscrimi- another and receiving and ac- stability are being questioned. nately and without exception cepting one another at a per- Well defined social and cultur- to all men and women, who sonal and cross-national level? al entities of the past seem to are created in God’s image. As in Crete ten years ago and have liquidated. In the name of So it is that, as at all of our all our following consulta- “multi-culturalism” and “multi previous gatherings, we are tions,Iamsurethatifwewill faithism”, all seem to be one, called upon to make this an- keep Ithica in our mind, we but there appears that we have niversary meeting a historic will continue in our continual lost the “One”, that there is not one. A new coordinator will be goal of networking. a “Someone” outside our elected, as my term is ending. selves that keeps us together. In these coming days, we will Fr. STAVROS KOFINAS This poses a new challenge to have to seriously discuss how Coordinator 71 chaplaincy organizations to our journey will progress in of the European Network work together: to help people, the sea in which we are sailing of Health Care Chaplaincy

DOLENTIUM HOMINUM N. 75-2010 http://www.vatican.va/roman_curia/pontifical_councils/hlthwork/index.htm