I first met Ryan, a psychiatric patient, as he was coming in from a walk outside and I was trying to buy a coke from a vending machine in the lobby of the hospital. He saw me looking closely at the buttons and offered to help me. That was the beginning of a fruitful pastoral relationship. Though I am rarely in need of assistance, I am never offended if someone offers to help me out, especially if that someone is a patient.
Everyone knows me as “The blind Chaplain,” although I can peek out of one eye and see blurred forms. If I hold a book close enough I can even make out letters. As the blind chaplain, I use my blindness as an opportunity to empower patients, even if it makes me look more helpless than I am. So, I asked Ryan to select a Coke for me. And… “Kerplunk!” It rattled down the chute to the open bin. I feel strongly that patients, especially at psychiatric hospitals, feel so controlled and helpless, that to provide even the smallest opportunity to make them feel needed and respected can lift their spirits. When Ryan helped me buy a can of coke, it started a pastoral relationship that began with me trusting him, and later developed as he learned to trust me.
After our first meeting Ryan would always say hello to me. Occasionally he would ask for a prayer or tell me about some of the negative thoughts he was having that day. After several months, Ryan actually opened up and began to tell me about some of his more troubling thoughts and experiences.
One day he took me aside to a private area saying he wanted to talk about some things. I agreed, and when we had some privacy, I asked him what he wanted to talk about. Ryan seemed very nervous and finally he began to gush questions. He wanted to know what I thought of homosexuality. “Was it a sin?” “Did it mean that a person would go to hell?” “What about regular fucking (fornication) between a man and a woman? Was that just as bad?” “Did I think that a person could change if they were a homosexual?” “Wasn’t sex just love, and if so, why would love be a sin?” “What if it is rape?” And, “Is it a sin if someone has sex with you and you don’t want them to?” Ryan was clearly agitated about something.
That was a lot of questions! Many more than I had expected. And sex is always a “touchy” subject (pun intended). The rapid fire questions caught me off guard! I knew I couldn’t answer all of his questions then and there, but how to respond?
Several potential responses started running through my head. My natural instinct was, of course, to provide Ryan with simple yes or no answers based on my own faith traditions. Yet as a trained chaplain, I knew that simple answers would be unhelpful at best. Clearly his questions were part of a deeper inquiry that Ryan had been struggling with for a long time. He had probably heard all the simple answers before and he deserved a more complex response.
Furthermore, as I understand the role of a chaplain, it is not appropriate to just respond with answers from one’s own faith traditions. The proper response is to help each patient find their own answers within the patient’s faith traditions. This should be the philosophy of any one who claims the title of “Chaplain.” A Chaplain’s role is to offer pastoral care for all of his or her patients despite their beliefs, creed, or cultural context. It is important not to proselytize.
Of course I do have my own deeply held beliefs on topics of religion and morality, but foremost among these is my belief that all answers will be revealed in truth to the honest seeker. Jesus himself said, “Seek and you shall find,” and I believe Ryan was an honest seeker who would find God’s truth for himself with proper pastoral care and assistance. In fact I practice my Christian faith as a chaplain by assisting others in their search for understanding. My ministerial approach is not to convert people to a certain set of beliefs or doctrines, but to help them learn to seek out truth through reason, critical analysis, spiritual exercise, and heart felt intuition, with the hope and faith that an honest search will lead them to certain universal truths.
As Ryan asked me all of those questions, I began to fall back on my Chaplaincy training. I restated his questions in ways that challenged him to reflect on his own thoughts and feelings. “Why do you want to know about all of this?” “What do you think?” “Would God condemn someone to hell for being a homosexual?” “What is the difference between love and lust?” “How does forced heterosexual sex, i.e. rape compare to consensual homosexual sex?” And, of course, I asked him how all of this related to his own life.
Ryan responded with great sincerity. He explained that he believed himself to be both male and female. He said that his large breasts proved that he was a hermaphrodite. Ryan was a rather large, heavy, man, and to my dismay he lifted up his shirt and exposed his breasts! They were indeed ample!
Ryan went on to tell me that he had many sexual partners, both women and men. “But that’s ok,” he said, “because I am a hermaphrodite with different sexual urges.” Because he had breasts, it followed that he had a womb, so it was ok that he liked guys and girls, especially guys. “But, I’m not gay,” he insisted.
Then Ryan went even further into his story and told me that he was currently pregnant. He believed he was carrying the baby of a man who had forced him to have sex. Continuing, Ryan believed that being pregnant, also made him a mother. As a mother, it followed in his mind that he was in a family relationship with the man who had sex with him. Ryan concluded that because he was pregnant, “his child” could only have been conceived in love and not out of the violence of rape…therefor, he, Ryan, was not horribly abused, but rather respected and loved.
I conducted more research into Ryan’s status by looking over his chart, talking with his psychiatric team, and continuing our conversations. Like many of my patients the more I learned about his situation the more tragic and convoluted it became. I can never know the truth about his sexual history, but given the circumstances, it is likely that he had sex with various partners, both willingly and unwillingly. I agreed with his doctors that Ryan’s sexual identity was bound up with his schizophrenia.
It should be noted here that homosexuality was considered a mental illness by many psychologists until at least the 1970s. Homosexuality was officially declassified as a mental illness in the 1987 addition of the DSM-III(R). Since then, however, the classification of many “sexually deviant,” behaviors and orientations has been controversial. The current version of the DSM-V still classifies some forms of sexual orientation and identity as mental illness under the title of “Gender Dysphoria.” Though this condition seems to refer to the debilitating stress and anxiety caused by one’s confusion over his or her identity rather than one’s preferred orientation.
Ryan had been in psychiatric hospitals several times before. Though he appeared gentle to me, he was picked up at a homeless shelter on this occasion, saying that he wanted to, “break people’s necks and eat their souls.” This seemed incredibly violent for the mild mannered Ryan that I knew. In his defense the report did say that despite his verbal threats Ryan came peaceably and did not have any history of physical violence towards others just verbal threats.
Ryan told me that he was raised as a devout Jehovah’s Witness, and at the same time he was sexually abused by members of his family. He believed he was going to hell because he had “unlawful sex,” and the fact that he may have been forced made little difference. He also seemed to conflate these experiences with his sexual behavior as a teenager and as an adult. Sometimes he thought he was a rapist, sometimes he thought he was a victim, and other times he felt like, “a whore,” He was ashamed and confused and most of all scared. He had basically been abandoned by his family, and they had told him he was going to hell. During this stressful time in his life he would feel that he was being attacked by demons, or that he himself was a demon. He was a soul tormented by the forces of good and evil, and torn to shreds by the abuse of his family, faith, and himself.
Clearly the clinical diagnosis of acute schizophrenia was accurate, including his delusion of being pregnant and his confusion over his sexual identity. Like many individuals suffering with schizophrenia, Ryan’s delusions were far ranging and often reinforced his resistance to treatment. His delusional pregnancy not only reinforced his belief that he was a hermaphrodite, but it also gave him worth and value as a loving mother and part of a (non-existent) family. His supposed pregnancy was also a very convenient way of avoiding management of his mental illness.
He used his pregnancy to explain his sometimes erratic behavior, and as an excuse not to take medication prescribed by the psychiatrists. Ryan believed that because he was pregnant it was very dangerous for him, “and his baby,” to be on strong psychological medication. In addition, he was convinced that some of the medication that he was being forced to take was making him appear more manly than he actually was, or wanted to be. Overarching all of the clinical issues was Ryan’s terrifying belief that he was going to hell because of his “abominable” love for men and past sexual sins.
For many chaplains working with a schizophrenic patient can be complex, especially if the sexual identity issues are a primary component. When it comes to sexual issues, theology, traditionally, takes a very narrow and limited view with strong condemnation for any behavior other than the traditional monogamous male/female relationship. Typically there is a very negative view of homosexuality or any other sexual variation such as cross gender, bi-sexual, trans-gender, etc. Such ideas are often viewed as sinful and so it is traditionally the religious leader’s duty to help his parishioners avoid this sinful thinking and behavior by telling them to, “turn from sin through the help of Christ, “ or in more modern parlance “Pray away the gay.”
However a Chaplain’s job, being non-dogmatic by definition, is not to judge or enforce his or her denomination’s position or personal code of morality on such matters, but to help patients find their own path. This is especially true when working with schizophrenic patients as simply denying their delusions or suggesting their behavior is sinful is not at all helpful.
In an extreme situation like Ryan’s, where a patient is struggling so much with his sexual identity that it is consuming him with guilt, anger, and hatred, I believe the duty of a Chaplain is clear. The greater risk confronting the patient lies in being driven away from God by these negative emotions, and it is the chaplain’s duty to help the patient come to a peaceful understanding of his or her sexual orientation so that he or she can connect with God. Helping patients feel loved and accepted by God should be a chaplain’s top priority, even if the chaplain believes that homosexuality is a sin.
On a personal level I am not disturbed by questions of sexual identity. I believe it is neither abnormal nor sinful to be LGBTQ. I tried to counter act some of the more negative religious perspectives he had been told by telling him that, “It was ok to be gay.” Working with his beliefs I tried to impress upon him the notion that God loved and accepted him no matter what his sins might be. We had many conversations about the differences between love, lust, sex, and rape. Ryan gradually came to believe that, “Rape was an evil that did not contaminate the victim with sin.” After a few months of ongoing talk and prayers he came to the conclusion that homosexuality was not wrong, but that “it is wrong for me.” I saw this as great progress.
I worked hard to convince him that he was not hell bound and alienated from God. But it wasn’t until Holy Thursday when we were doing a workshop in the gym on different aspects of Holy Week and the passion story that, with the help of God, I was able to bust through Ryan’s self-hate, incrimination, and spiritual alienation.
On Holy Thursday, I was assigned to a station where I would provide communion bread and wine to anyone that wanted to partake. (Actually we had to use juice by law.) For many “Communion,” or ”The Eucharist,” or “The Last Supper,” is a baffling and mysterious ritual, and for some it is ridiculous. The meaning can be lost in theological interpretations, and on the face of it Communion can appear as an un-filling snack of Kool-Aid and crackers. But it is my belief that the transformative power of this ritual can be experienced by anyone and does not necessarily depend upon miracles and supernatural forces.
I had convinced Ryan to attend the Holy Thursday activities, though he was skeptical. When he arrived at my station, he was very unsure about taking communion as he still considered himself an unredeemable sinner. When I gave him the cup I was very intentional about my words. I said, “Drink this and know that you are accepted by Christ.”
Ryan hesitated for a long moment then bowed his head and drank the communion cup. I thought I felt the presence of God, but I wasn’t quite sure if it was real or just wishful thinking. Then Ryan smiled, thanked me, and went to the next station.
After this experience Ryan began to rapidly improve. A few months later on the eve of his discharge we were talking and Ryan said, “You know Pastor Paul, you might not remember this, but around Easter you were giving out communion.” I smiled and nodded knowingly. He said, “Do you remember what you said?” I did, but I said “I’m not sure, tell me about it?”
Then Ryan spoke: “’You said: drink this and know that you are accepted by Christ.’ I really had to think about that! But when I took that cup and drank it, I felt the Spirit of Love! For the first time in my life I knew that God really loved me and that I was ok!”
In conclusion, we could spend hours discussing the theology of communion and the legitimacy of using Kool-Aid and crackers as an earthly manifestation of God’s love. Theologians have written volumes about how and when God is present in the communion ritual. Irrespective of such weighty issues, in that moment with Ryan a simple cup of Juice and a cracker had been transformed into love and forgiveness that offered a taste of salvation for a tormented soul. Even though empirically nothing spectacular took place, I truly believe Ryan felt the presence and acceptance of God’s love in that Holy Snack and that sense of acceptance gave him what he needed to begin recovery.