Pastoral and Spiritual Care Across Religions and Cultures II: Spiritual Care and Migration [1 ed.] 9783666564659, 9783525564653

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The editors Isabelle Noth, PhD Habil., BSc. Psychology, MAS Counselling, is professor for Spiritual Care, Psychology of Religion and Religious Education at the University of Bern / Switzerland. Claudia Kohli Reichenbach, PhD Habil., Th.M. (Spirituality) is director of the continuing formation program in Pastoral / Spiritual Care at the University of Bern / Switzerland.

Pastoral and Spiritual Care Across Religions and Cultures II — Spiritual Care and Migration

Contributors are Duane Bidwell, Pamela Cooper-White, Claudia Kohli Reichenbach, Isabelle Noth, Daniel Schipani, Bhikshuni Trinlae, and Hansjörg Znoj.

Isabelle Noth Claudia Kohli Reichenbach (eds.)

This diverse compilation of contributions explores the pressing topic of how to provide appropriate spiritual care in the context of human migration. Based on the premise that failures to cultivate deeper respect for diversity risks cultural misunderstandings and relational harm in the context of helping relationships, this volume considers questions and strategies from divergent points of view. The psycho-spiritual dimensions of suffering particular to human migration, such as social exclusion, alienation, and various types of trauma, are considered from various disciplinary perspectives.

Pastoral and Spiritual Care Across Religions and Cultures II — Spiritual Care and Migration Isabelle Noth Claudia Kohli Reichenbach (eds.)

Isabelle Noth / Claudia Kohli Reichenbach (eds.)

Pastoral and Spiritual Care Across Religions and Cultures II Spiritual Care and Migration

Vandenhoeck & Ruprecht

Bibliographic information published by the Deutsche Nationalbibliothek: The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data available online: http://dnb.de.  2019, Vandenhoeck & Ruprecht GmbH & Co. KG, Theaterstraße 13, D-37073 Gçttingen All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without prior written permission from the publisher. Cover image: Tim Engel (DURCHZWEI Atelier fþr Gestaltung, Bern) Typesetting: 3w+p, Rimpar Vandenhoeck & Ruprecht Verlage j www.vandenhoeck-ruprecht-verlage.com ISBN 978-3-666-56465-9

Contents

Isabelle Noth/Claudia Kohli Reichenbach Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Isabelle Noth Spiritual Care, Human Dignity, and Migration . . . . . . . . . . . . . .

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Pamela Cooper-White Women Migrants, Gender-Based Trauma, and Spiritual Care . . . . . .

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Duane R. Bidwell Spiritual Care, Migration, and Multiplicity : Care in the Context of Complex Religious Bonds . . . . . . . . . . . . . . . . . . . . . . . . .

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Daniel S. Schipani Caring Host Communities and Migrants: Two Models for Description and Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Claudia Kohli Reichenbach Religious Communication in Hybrid Zones. Pastoral Care in Intercultural Contexts . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Bhikshuni Lozang Trinlae Buddhist Liturgy as a Transformative Mode of Spiritual Care . . . . . .

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Hansjörg Znoj What comes after? Aspects of Bereavement from a Psychological Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Isabelle Noth/Claudia Kohli Reichenbach

Preface

Addressing human spiritual needs in today’s pluralistic societies requires understanding and appreciation of diverse perspectives and identities. Failure to cultivate deeper respect for diversity risks cultural misunderstandings and relational harm in the context of helping relationships. Therefore, personal encounters and scholarly exchanges between Muslims, Jews, Christians, Buddhists, Hindus, Sikhs, people without religious affiliation, and atheists are critically important and unquestionably valuable. Of equal significance is the cooperative approach of the disciplines concerned – in particular the disciplines of psychology and theology. Each scholarly field contributes unique and valuable insights to the topic of culturally competent spiritual care in increasingly pluralistic contexts. The International Association for Spiritual Care IASC, founded in 2015 in Bern, Switzerland, is dedicated to the promotion of richer interdisciplinary dialogue amongst people from different cultural and religious backgrounds. The inaugural conference of the IASC was held at the University of Bern and in the House of Religions in June 2016, and was focused on the pressing topic of migration in today’s world. Inevitably, migration prompts topics such as social exclusion and alienation. In the case of forced migration, traumatic experiences are a critical issue for spiritual caregiving. Conference attendees gathered to explore the particular psycho-spiritual dimensions of suffering related to migration, and appropriate strategies for healing. For instance, how might various methods of self-healing be better supported by spiritual caregivers? How can faith communities cultivate more supportive contexts, responsive to the particular needs prompted by migration? Selected papers have been published in this volume. This publication solely reflects the views of the authors. The conference sponsors cannot be held responsible for any actions based on the information contained herein. Given the fact that the authors hail from different countries and scientific disciplines, there has been no standardisation of formats for the various contributions. We thank all participants of the conference and those who continue to engage this most urgent matter: How can we provide appropriate spiritual care in migration contexts? The IASC continues to engage the complexities of human migration in its ongoing gatherings and research dialogues. Bern, March 2018 Isabelle Noth and Claudia Kohli Reichenbach

Isabelle Noth1

Spiritual Care, Human Dignity, and Migration

Abstract This essay examines the function of spiritual care in the context of migration, calling for solidarity, respect, and dignity. The biblically-founded unconditionality within the theological language of human dignity is emphasized, indicating the universal equality of all people independent of their race, gender, and other orientations of identity. It is argued that to disregard another person does not diminish that person’s inherent dignity, but it disregards our own destiny to live in God’s likeness.

1. Introduction The theme of the International Association for Spiritual Care (IASC) 2016 Conference, “Spiritual Care and Migration,” responds to a phenomenon that began the previous year, referred to by the media as the European refugee and migration crisis. More than 2 million people – a mere fraction of those who fled their homes to move to the west and north – managed to enter an EU Member State.2 Currently, more than 35 million non-native persons reside within EU Member States. Such startling shifts over the past two years make migration an urgent political topic in Europe. Of course, the issue is pressing for the entire international community ; worldwide, more than 65 million people were displaced and seeking resettlement in 2015. In 2016, shortly before his death, the critically acclaimed Polish sociologist and philosopher Zygmunt Bauman (1925–2017) published Strangers at Our Door, a searing appraisal of the migration crisis.3 It was published in German with the evocative title, “Fear of the Other : an Essay on Migration and Fear1 Professor of Spiritual Care, Psychology of Religion, and Religious Education, Faculty of Theology, University of Bern / Switzerland. Email: [email protected]. 2 http://ec.europa.eu/eurostat/statistics-explained/index.php/Migration_and_migrant_popula tion_statistics/de (accessed 12-29-17). 3 Zygmunt Bauman (2016): Strangers at Our Door, Polity Press (Cambridge).

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Mongering.”4 Bauman diagnoses us as seized by a “veritable ‘moral panic,’” a widespread fear “that some evil threatens the well-being of society.”5 In fact, this “evil” is comprised of our fellow human beings. Moreover, the raw statistics of these “strangers,” who are actually our neighbors, hardly justify the extremity inferred by the term “crisis.” Bauman argues that the true impact of their presence is that we cannot avoid facing the possibility that we, too, could suffer displacement and upheaval. Such persons “remind us, irritatingly, infuriatingly and horrifyingly, of the inevitable vulnerability of our own position and of the endemic fragility of our hard-won well-being.”6 Rather than carefully considering the societal consequences of neoliberalism and globalization, we become unreflective and defensive instead, expressing hatred for “foreigners.” These migrants fleeing unlivable conditions now serve as convenient scapegoats. In a Gadamerian sense, Bauman sees hope in a “fusion of horizons,” enacted through relationships and personal encounters.7 For Bauman, “there is no exit from that crisis other than the solidarity of humans,”8 which is necessarily rooted in mutual respect for the dignity of one another.

The tangible functions of spiritual care emerge in such a context, calling for solidarity, respect, and dignity. The first functional task is rooted in the educational impetus of spiritual care. A second is the overcoming of fear with love (1 Jn 4:18). With regards to education, interdisciplinary dialogue is critically necessary. Spiritual care practices that integrate accounts from across genres, such as Bauman’s sociological analysis, deepen understanding and broaden perspectives on complex concepts such as “migration panic.”9 In addition to crossing disciplinary boundaries, it is also crucial to seek a diversity of voices across the boundaries of gender, race, and other orientations of identity. Bauman’s analysis, for instance, lacks an account of gender as an essential factor in the context of migration; such matters of inclusion are given special consideration in the contributions within this volume. The second function of spiritual care is accomplished by drawing from tradition in relevant, fortifying ways. This task will now be illustrated with the example of the term human dignity, which is particularly relevant in the context of refugees and their treatment.

4 Zygmunt Bauman (2016): Die Angst vor den anderen. Ein Essay über Migration und Panikmache, Suhrkamp Verl. (Berlin). 5 Zygmunt Bauman (2016): Strangers at Our Door, Polity Press (Cambridge), p. 2. 6 Ibid., p. 16. 7 Ibid., p. 19. 8 Ibid. 9 Ibid., p. 2.

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2. Human Dignity as an Abstraction Students of psychology and cognitive science will be familiar with the following classic experiment, which seeks to illustrate the dimensions of human memory : The instructor asks the students to remember a series of words, spoken aloud in a list: bread knife, parrot, pencil, hamster, canary, motorcycle, tulip, train station, encyclopedia. Then, the students are asked to recall the words they have remembered. In the second round, the instructor names a different list of words: virtue, morality, contradiction, hope, meaning, knowledge, reason, consent, sensibility. The experiment shows students how and why their brains function. Students find memorization of the second list to be much more difficult than the first. Why? The answer is simple, but crucial to our theme: The first list was comprised of concrete words that prompt images, which are visually and verbally coded. Abstract words, by contrast, resist easy elicitation of pictures; they are only coded verbally. Our memory-related functions are enhanced when we can generate a visual image of a word. Human dignity, of course, is clearly an abstractum, and belongs on the second word list. Thus, it also resists easy association with images or visual notions. We do not immediately relate an objective, definitive, universal object with the abstraction of human dignity! First, we must visually code the abstract concept. Theological tradition, specifically within the domain of Christian theology, principally accomplishes this task with the help of the scriptural notion of humanity created in the image of God. In this way, Gen. 1 provides the fundamental biblical text from which to exegete a theological understanding of human dignity, and to articulate implications for spiritual care in the context of human migration.

3. The Human Being in God’s Likeness – Biblical Foundation Although “not a major topic of Old Testament theology,”10 the biblical account of the human being’s likeness in God’s image establishes a decisive reference point and a valuable theological contribution to discourse on human dignity. 10 Andreas Wagner (2018): God’s Body. The Anthropomorphic God in the Old Testament. London: T&T Clark, p. 167.

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The central text for this theological notion appears in the very first chapter of the Hebrew Bible, Gen 1:26a: Then God said, ‘Let us make humankind in our image, according to our likeness and let them have dominion over the fish of the sea, and over the birds of the air, and over the cattle, and over all the wild animals of the earth, and over every creeping thing that creeps upon the earth.’

Here, we find that both the being and the destiny of humanity are determined: the human being is wrought within the image of God, with dominion as its destiny. The likeness to God, which also includes the “visible, external formsimilarity,”11 is unconditional. For a human being to be human, no caveats are stipulated, no pre-requisites or limiting adjectives are noted. In other words, to be created in God’s image does not equate with any of the conventionally valued aspects of humanity – beautiful, smart, powerful, male, obedient, willing or friendly. Rather, the human, in God’s image, is simply…human. In fact, this Genesis passage is even gender neutral! Notably, the Priestly source of this text is “otherwise patrilinear” as well as “androcentric.”12 In fact, the historiography of this passage reveals multiple efforts to limit or qualify humanity’s creation in God’s image. Though Paul wrote in Gal. 3:28 that neither men nor women, but all were one in Christ, we find in 1 Cor. 11:7, “For a man should not cover his head, since he is the image and reflection of God; But the woman is the reflection of the man.” Conversely, the Hebrew meaning of “Adam” connotes a collective definition of humanity, inclusive of both male and female. The divinity of the human being lies within its very nature, and such divinity affects its physicality, unconditionally and universally. To quote my Bernese colleague, Old Testament scholar Andreas Wagner : “This is truly the embryo of the world-wide concept of the equality of all mankind.”13 Such an insight, indicating the universal and historical essence of human dignity, is a powerful kernel which yields a vast bounty of possibilities.

4. Theological Interpretations An important task remains: to concretize the abstract term, „human dignity.” Developing one’s own understanding of human dignity is deeply idiosyncratic. Conflicting and contradictory differences abound between various understandings of this term. One who speaks of human dignity cannot depend on universally agreeable definitions. 11 Wagner, p. 176. 12 Wagner, p. 173. 13 Wagner, p. 173.

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As previously noted, a definitive starting point for human dignity within Christian theology is found in Gen. 1. And yet, it is not the case that Christian theology has served as the architect of the modern protection of human dignity, and the human rights resulting from it. Only in the 20th century, after overcoming many obstacles, was Christian theology transformed into a full advocate for human rights. This makes the matter all the more momentous: the universal equality of all people, in the fullness of their differences, is forged in Gen. 1. Something has been planted here which has slowly evolved and bloomed. Two further insights illustrate the theological constructs beneath the universal dignity of all humanity : 1.) The first observation comes from Heinz Rüegger.14 He refers to a problem of particular interest within contemporary discourse: aging with dignity, and dying with dignity. I want to age with dignity, and die with a sense of self-worth. If I can no longer wash myself, feed myself, or know my own name – my dignity is lost, as is my sense of worth. Such talk of dignified aging and dying implies that an undignified life and death might be prevented by active euthanasia. Only a self-determined death is a worthy death. Clearly, human dignity is inextricably linked to issues related to quality of life, cognitive ability, and capacity for selfdetermination. “A decline in one’s quality of life is perceived as a loss of dignity – consequently, this leads to an understandable fear of aging and dying!”15 2.) The second observation comes from Frank Mathwig: he sees a “connection between the decline of the social importance of the churches and the tendency to an increasingly relativistic attitude towards the unconditional protection of human dignity.”16 The church’s voice fades from these discussions, according to Mathwig, and so also fades a very central criteria for a theological grounding of human dignity : unconditionality. Such an insight speaks to why I believe the theological, biblically-based approach to human dignity is critically important. Perhaps no one more aptly captured the essence of theological understanding of human dignity as did Jürgen Moltmann when he wrote, “There is no more 14 Heinz Rüegger (2006): Das eigene Sterben. Auf der Suche nach einer neuen Lebenskunst, Göttingen (Vandenhoeck & Ruprecht). 15 Ibid., p. 57. 16 Frank Mathwig (20073): Den Menschen ins Recht setzen. Menschenrechte und Menschenwürde aus theologisch-ethischer Perspektive, SEK Position 6, Bern (Verl. Schweizerischer Evangelischer Kirchenbund), p. 13.

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human dignity or less; there is only either-or.”17 Such bold and unequivocal clarity is exceptional; it carries concrete implications for how we relate to ourselves and one another. Moltmann elegantly summarizes the point when he writes: “(…) the likeness to God is a relation, namely the relation in which God puts himself to the human being. The likeness of God therefore applies in all human conditions, whether the person is healthy or sick, old or young, disabled or not disabled, born or unborn. This relation, the relation of being in the image of God, if it is understood in the light of God, is true for the whole human person, body and soul (…).”18

Relevance to the Theme of Migration How does all this apply to our theme of migration? The biblically-founded unconditionality within the theological language of human dignity clearly invalidates any constraint or incursion upon one’s entitlement to dignity, including any limitations based on mental or cognitive abilities to articulate or understand such dignity. Every human being has inherent dignity, and this prerogative is inalienable and universal. One may disrespect, disregard, or deny the dignity of one’s neighbor, but a human being’s inherent dignity is ultimately inviolable. As a theologian, and particularly as a practical theologian, I cannot speak of human dignity in theory without also the witness of human dignity in practice. We might best learn of the nature of human dignity from those for whom it might be seriously denied: in our era, these persons are refugees. What we see today is a grave challenging of human dignity, and an attempt to abstract it, and decouple human rights from it. I contend that such disregard of another human does not ultimately diminish the person’s dignity. Rather, the person who fails to respect another’s dignity, also fails to live into the future God holds for her/him, so clearly articulated in Gen. 1: that we might each live fully as God’s image in the world. To disregard another is to disregard our own destiny to live in God’s likeness. As a practical theologian, I would like to broaden the implications of this insight. If we speak theologically about the dignity of human beings, we must enact and embody such understandings ourselves. Mere abstraction will not suffice. 17 Jürgen Moltmann (2012): Ethics of Hope, transl. Margaret Kohl, Minneapolis (Fortress Press), p. 87. 18 Ibid., p. 87–88.

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Through the course of life, we all acquire experiences of injustice, and experiences of the harm we cause ourselves. An understanding of one’s own dignity becomes all the more important, for it reminds us of an essential and inviolable integrity. Every human being possesses something of God that transcends injustice, abuse, shame, and humiliation. Any violence to the contrary does not ultimately affect one’s dignity. Reflecting upon human dignity may offer us better understanding of one another. When asked what Jesus Christ meant to him, Helmut Gollwitzer replied: “He makes people dear to me. Some of them are dear anyway, many others are not. He tells me that he loves those who are alien, indifferent or even unattractive to me. In so doing he helps me to behave in a different way, to be capable of talking, listening to others as openly and seriously as I would like them to listen to me and take me seriously, never writing anyone off, never pronouncing a final judgment on anyone, always attempting new things with them in hope. In this way, he extends my horizons towards those who are further afield: to those outside my milieu, to the needs of society, to the Third World. They all become my neighbors.”19

6. Conclusion In this essay I argue that the disrespect of the dignity of another person does not diminish that person’s inherent dignity. Instead, such disregard signals the hindrance of one’s purpose as articulated in Gen. 1: to represent and reflect God in the world. Let us dare to hold fast to our dignity, and to respect the dignity of our fellow human beings. Perhaps this is expressed no better than through the verses of Marianne Williamson: Our Deepest Fear Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world.

19 Dorothee Sölle (1990): Thinking about God: An Introduction to Theology, Eugene, Oregon (Wipf and Stock), p. 105.

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There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.20

May the fruits of the 2016 IASC Conference contribute to our liberation.

20 Marianne Williamson (1992): A Return to Love: Reflections on the Principles of A Course in Miracles, New York (HarperCollins), p. 190.

Pamela Cooper-White1

Women Migrants, Gender-Based Trauma, and Spiritual Care2

Abstract Nearly half of migrants worldwide are women, but politicized images of migrants as dangerous young men dominate the media. Scholarly literature on migrants rarely discuss women’s gendered experiences of migration but, rather, focuses on political violence and terrorism; literature on women migrants rarely addresses sexual and domestic violence, although genderbased violence is endemic to women’s experience of migration. This essay puts current multi-cultural approaches to trauma care in dialogue with accounts of women migrants’ gender-based experience of violence. The author recommends a stance of solidarity, in which spiritual caregivers value witnessing over “fixing,” listening without prior assumptions about what women migrant survivors of violence really want and need, and supporting self-healing and liberation. Migration, Violence, and Gender : Facts vs. Denial “Sometimes I think it was just a nightmare, but then I feel the pain and remember it was not” – “Norma,” detained in the U.S. by Immigration and Customs Enforcement (ICE), from El Salvador, fleeing the M18 gang members who raped her and threatened her children because her husband was a police officer. (UNHCR 2015b:5)

“Globally, at least 35 % of women have suffered from gender-based violence.” (UNFPA 2016; WHO 2012) “Worldwide, almost one third (30 %) of women” have experienced intimate partner violence, and “[g]lobally, as many as 38 % of murders of women are committed by an intimate partner.” (WHO 2012) Rape and other forms of sexual violence are routinely used as a systematic tool of war. In disasters and humanitarian crises, women are more likely than men to suffer from food insecurity. Even though women produce half of the world’s food, they comprise 70 % of the world’s hungry. Of the more than 125 million 1 Christiane Brooks Johnson Professor of Psychology and Religion, Union Theological Seminary in the City of New York, 3041 Broadway, New York, NY 10027, USA. Email: [email protected]. 2 A briefer version of this paper was presented to the International Association for Spiritual Care, annual conference on the theme “Spiritual Care and Migration,” Bern, Switzerland, 21 June 2016.

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people in need of humanitarian assistance” according to the UN, “over 75 % are women and children. In 2015, 61 % of maternal deaths3 occurred in 35 countries experiencing emergency situations. Their average maternal mortality ratio was on a par with England’s between 1800 and 1850.” (UNFPA 2016) Migrants, of course, include both immigrants (those who voluntarily leave their country of origin seeking better economic, health or other opportunities) and refugees (those who flee violence in their country of origin to seek asylum elsewhere – a category that includes many more persons due to economic violence, starvation, and now climate degradation, than are listed on official counts) – and there is some overlap as well with victims of human trafficking.4 The United Nations estimates that close to 60 million persons are now forcibly displaced – that is, officially recognized as refugees – either internally (within their countries of origin) or externally. (UNHCR 2015a) This is a staggering new high, up 20 million in the last two decades, due primarily to “wars, conflicts, and persecution.” (UNHCR 2016b) And “the average time of displacement among the world’s 60 million refugees, half of whom are women and girls, has now reached 20 years.” (UNFPA 2016a) Violence experienced by women migrants includes: Violences sexuelles: violation, sodomie, tortures sexuelles, sequestration puis n8gociation pour 8changer la ou les filles, harcHlement sexuel, exhibition forc8 comme danser nue devant les autorit8s, exploitation sexuelle – prostitution forc8; violences psychologiques: menaces, reclusion, injures; violences physiques: frapper avec des b.tons, gifler, g%te de l’eau bouillante sur le corps, tubasser ; practiques traditionelles: multilations sexuelles; etc. (Keygnaart et al., 2008, cited in Laacher 2010:13) (Sexual violence: rape, sodomy, sexual torture, sequestration then exchanging sex with a woman or her daughters for protection, sexual harassment, forced exhibition such as dancing nude in front of authorities, sexual exploitation – forced prostitution; psychological violence: threats, isolation, verbal abuse; physical violence: hitting with clubs, slapping, throwing boiling water on the woman’s body, beatings; traditional practices: sexual mutilation; etc.)5 3 According to the World Health Organization, “maternal death” is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. WHO (2016b). 4 It is beyond the scope of this paper to address the problem of trafficking in persons. There is a difference between migrant smuggling (transporting migrants illegally for profit) and trafficking (enslaving persons against their will, within or across borders), although there is some overlap. Statistics on trafficked persons vary widely, from estimates of 40,000 to 20 million. For more information on human trafficking, see UNODC (2014), US Dept. of State (2015a, 2015b). For information on the related issue of “mail order brides,” see Simons (1999). 5 French translations in this essay are my own.

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Sexual and gender-based violence is endemic. (UNHCR 2016c) In one study of a refugee camp in northern Ethiopia, “all female informants experienced physical violence against female refugees in the camp” (Gebreiyosus 2014:38), with sexual violence being the most common form (p. 44). The author of this study, Yonas Gebreiyosus, wrote, “Despite serious consequences of sexual violence, most incidents of sexual violence of female refugees in different parts of the world go unreported due to the various socio-cultural as well as legal constraints.” (p. 44) Sonia Nazario, the author of the Pulitzer-prize winning book Enrique’s Journey – an account of one young boy’s journey to find his mother across the U.S. border – details horrific stories of gang rapes of central American women and girls along their escape route (e. g., pp. 97–98), committed by both bandits and local authorities – many of whom are indistinguishable from one another because of the collusion of violence among civilians and police. (p.74; see also Kaltman et al., 2011) These are the facts of life for 30 million women in national crises from which – and even to which – migrants flee throughout the world. (See also UNHCR 2015b.) Nearly half of all migrants are women. (UNFPA 2015) Yet, the prevailing image of “immigrants” is of young men: “male, non-white, unproductive and uncontrolled.” (Chell-Robinson 2000:117; see also Boyd & Grieco 2003: 1; Freedman and Tarr 2000:1; Gebreiyosus 2014: 31; Laacher, 2010:12–13,17–18) Regarding refugees, erstwhile American presidential candidate Ben Carson erroneously stated, “We don’t know whose [sic] those people are, and the majority of them are young males, and they could easily be people who could be infiltrated by terrorists.” (Schleifer 2015) The current U.S. President, Donald Trump, painted an even more prejudicial gendered and raced image of immigrants on the campaign trail, creating a manipulative “us-them” dividing line when he said, “When Mexico sends its people, they’re not sending their best. They’re not sending you. They’re not sending you. They’re sending people that have lots of problems, and they’re bringing those problems with us [sic]. They’re bringing drugs. They’re bringing crime. They’re rapists.” (And as an afterthought, “And some, I assume, are good people.”) (Lee 2015) In academic literature the same gender bias – or blindness – largely obtains. Women migrants in general were largely ignored in the literature on immigration until the 1980s. (Knörr & Meier 2000:9) In a survey of books published since the year 2000 on migrants and trauma, there were few or no references to “women” or “gender” in the book indices until very recently, and in several edited volumes specifically on women/gender and migration, there is virtually no consideration of sexual or domestic violence. (Knörr & Meier, 2000; Morrison, Schiff & Sjöblom 2008; Piper, 2008; Arya & Roy 2006)6 In the 6 Note that this is slowly changing, both in more granular studies of specific geographical locations and cultural contexts, and in more general publications. E. g., Anthias & Lazaridis (2000); and Esp&n & Dottolo (2015).

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field of psychology, a comprehensive volume entitled Post-traumatic Stress Disorder in Refugee Communities: The Importance of Culturally Sensitive Screening, Diagnosis and Treatment (McDonald and Sand, 2010), there were only two specific references to women at all – and these were made in passing – among the 50 pages (pp. 6, 8). Only slightly better, in his single-author book Counselling and Therapy with Refugees and Victims of Trauma, Van der Veer includes a 10-page, fairly rudimentary chapter (out of 168 pp. total text) to treating “women and sexual violence,” in which he addresses sexual violence toward both men and women. (Van der Veer 1998:141–150) Most recently it has been a pastoral theologian, Jan Holton (2016), who does take sexual violence into more than passing consideration in her ethnographic research on forced migration, war trauma, and the theological as well as psychological experience of homelessness. In books on economics and so-called (economic) “development,”… Despite what some researchers have called the feminization of international migration (Donna Gabaccia et al, 2006), economics have been slow to incorporate gender into their migration research in a substantive way. When gender enters into their economic migration models, it is rarely the focus, but rather, a simple control variable – what Monica Boyd and Elizabeth Grievo (2003) call an ‘add women, mix, and stir’ approach. (Morrison et al. 2008:12)

Even in a recent edited volume entitled Migration, Gender and Social Justice (Truong et al 2014), the issue of gender-based violence is only discussed in one chapter (approx. 6 pages out of 400). This book does highlight, however, the rise in economic exploitation of women migrants – a form of violence recognized by the UN : “Export-oriented production and women’s international migration since the 1970s have evolved into mechanisms that incorporate women from the South[ern hemisphere] into wage labor for the North…[especially] the urban service sector.” (Truong et al, 2014: 7) In sociology, in an edited volume on women and immigration in France, Freedman and Tarr (2000) write, Whilst they make up very nearly half of the populations of immigrant origin in France, within dominant representations of women of immigrant origin are more often than not either ignored or represented in stereotyped categories. Older women are portrayed as wives and mothers, responsible for the ‘integration’ of the family into French society, whilst when young people of immigrant origin are discussed it is usually the problems of young men which come to the forefront. Young women are often forgotten, ‘as if their experiences posed no problem’ (‘comme si leur v8cu ne soulevait aucun problHme’). Only an explosion of media and public interest in an issue like that of the Islamic headscarves in French schools brings the problems of young women of immigrant origin to the foreground, albeit in a very limited manner. These stereotyped representations, which portray women of immigrant origin as wives, mothers or daughters, supports for the process of ‘integration’ of immigrant

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communities into France, or ‘victims’ of patriarchal Muslim cultures, are clearly obstacles to the full understanding of the heterogeneity of identities and representations of the multiple dimensions of problems and difficulties that touch these women’s lives. (pp. 1–2)

And in the field of anthropology, while studies of women and migration in general have increased dramatically “since the 1970s when migrant women were largely invisible” (Knörr & Meier 2000:9), the issues of trauma and gender-based violence against women is still largely neglected. In countries where U.S. military presence has been strong, as in Iraq, American servicemen’s and local translators’ patriarchal assumptions easily collude to produce a “good girl/bad girl binary” around the figures of women. “Good” Arab women are uneducated, na"ve, domestically and sexually subservient, and require protection because otherwise they might be victimized by other men outside the family (although they will be blamed, and may be killed by male relatives if they engage in any relations with outside men, or even if they are raped – known “honor killings” – for bringing shame on the family.) “Bad” women are “sexually dangerous,” predatory, and like to “party.” “In the final analysis there are only two mutually exclusive options available: either an agent (representing and asserting himself or herself) or a victim (the passive object of chance or cruelty)” (Asad 2007:79, cited in Campbell 2016:98) “Female [Iraqi] subjects, imaginable as double victims – first of a tyrannical regime and now of senseless terrorism – faced an imperative to construe themselves as unknowing and nonagential vis-/-vis US power.” (Campbell 2016:98) Women refugees are similarly viewed as passive and na"ve in western countries of asylum, if they are seen at all, because patterns of sequestration continue after immigration. In some contexts where both political and sexual violence are endemic, women may have no choice other than “strategic invisibility” as a survival tactic; however, this perpetuates their isolation and ongoing disempowerment. (Rojas-Wiesner & DeVargas 2014:211) Even when such violence is acknowledged, it is not granted the same psychological status of trauma as political violence. Portrayals of conflicts by media across the globe ignore, minimize, or normalize women’s quotidian experiences of gender-based violence, while covering clashes between civilians and military or para-military forces in horrific detail. As just one example, in Mexico… Representations of both migration and ‘2006’7 are frequently portrayed as visible sources of shock, trauma, panic, transcultural psychosis, and PTSD, domestic

7 “2006” in this quotation refers to a 7-month violent clash that year between state and national military forces vs. “tens of thousands” of teachers and others demanding social and political change.

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violence is portrayed as a type of normalized traumatic stressor that contributes to a range of diffuse symptoms but not PTSD. (Duncan 2016:221)

Sma"n Laacher (2010) describes a similar phenomenon regarding refugees in France: Certes, la faim, la soif, l’extrÞme fatigue, se faire escroquer et les trHs mauvaises conditions de voyage doivent Þtre consider8s comme autant de violences et de traumatismes. Mais ceux-ci sont relativement assum8s et support8s, car c’est le prix / payer pour parvenir au bout du p8riple. En revanche, les violences sexuelles ne sont jamais, et en aucune maniHre, assum8s ou accept8es…ainsi, les violences physiques et sexuelles faites aux femmes sont trHs largement sous-estim8es parce qu’elles sont invisibles: la parole est ici barr8e, pour le longtemps, par la honte et la souillure. Ce qui est spectaculaire, et suscite compassion et indignation, c’est l’arriv8e devant les cameras et les ONG, dans des embarcations de fortune, de jeunes migrants assoiff8es et mourant de faim. Les violence faites aux femmes restent invisible parce que les femme demeurent inaccessibles: non de leur fait, non par choix social ou moral, mais parce que ces femmes son sous la domination et le pouvoir des hommes qui gouvernent leur parole et leur degr8 de visibilit8 dans l’espace public. Ce mÞmes hommes qui peuvent abuser d’elles ou les violenter. C’est encore et toujour eux qui prennent la parole sur les malheurs survenus lors du voyage; des malheurs en g8n8ral [emph. orig.] valent pour tous, sans distinction, renvoyant / des topos milles fois r8p8t8s devant des journalists…” (pp. 11–12) (Certainly hunger, thirst, extreme fatigue, fraud, and the very bad conditions of the voyage must be considered likewise as forms of violence and trauma. But these are relatively expected and supported, because such is the price to pay to reach the end of the journey. On the other hand, sexual violence is never, and in no way, expected or accepted…thus, physical and sexual violence against women are very largely underestimated because they are invisible: to speak is barred, indefinitely, by shame and a sense of defilement. What is spectacular, and solicits compassion and indignation, is the arrival before the cameras and the NGOs, in the bounty hunters’ boats, of young migrants, parched and dying of hunger. Violence against women stays invisible because women remain inaccessible: not by their own doing, nor by social or moral choice, but because these women are under the domination and the power of men who control their speech and their degree of visibility in the public space – the same men who can abuse or rape them. It is still and always [these men] who assume the privilege to speak about the adversities survived throughout the voyage; of adversities in general, applying to everyone without distinction, returning again and again to tropes repeated thousands of times before journalists…)

One large exception to this blindness toward gender-based violence toward women has been the work of the United Nations High Commissioner on Refugees, the UN’s agency for refugees worldwide. The UN defines genderbased violence as…

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violence that is directed against a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty. (UN Women 1992, General Recommendation No. 19, article 6),

corresponding to similar definitions by the World Health Organization (2012).8 Gender-based violence according to the UNHCR encompasses five forms: sexual violence, physical violence, emotional and psychological violence, harmful traditional practices, and socio-economic violence (UNHCR 1995: 17) and includes “physical, sexual and psychological violence perpetrated or condoned by the State, wherever it occurs.” (UN Women 1995: Section D, 113c) At the famous World Conference on Women in Beijing, China, in 1995, these were further detailed to include “forced sterilization and forced abortion, coercive or forced contraceptive use, female infanticide and prenatal sex selection, women’s human rights violations in situations of armed conflict particularly murder, systematic rape, sexual slavery and forced pregnancy, and hostage taking.” (UN Women 1995: Section D, 113–115) And while migrant smuggling and human trafficking are separate crimes, there is documented overlap between them; 70 % of trafficking victims are women and girls. (US Dept. of State 2015b; UNODC 2014) Economic exploitation was further added in 2003. (UNHCR 2003:45) The UNHCR further recognizes that gender is a social construct, and does not conform to essentialist definitions. As stated in a 2003 publication: In order to understand the nature of gender-related persecution, it is essential to define and distinguish between the terms ‘gender’ and ‘sex’. Gender refers to the relationship between women and men based on socially or culturally constructed and defined identities, status, roles and responsibilities that are assigned to one sex or another, while sex is a biological determination. Gender is not static or innate but acquires socially and culturally constructed meaning over time. Gender-related 8 The World Health Organization (WHO) has also defined sexual violence as “any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using force by any person regardless of their relationship to the victim, in any setting,” and intimate partner violence as “behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours” – both “mostly perpetrated by men against women.” (WHO 2012). In the same report from the WHO, “population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. The first report of the “WHO Multi-country study on women’s health and domestic violence against women” (2005) in 10 mainly low- and middle-income countries found that, among women aged 15–49: between 15 % of women in Japan and 71 % of women in Ethiopia reported physical and/or sexual violence by an intimate partner in their lifetime; between 0.3–11.5 % of women reported sexual violence by someone other than a partner since the age of 15 years; the first sexual experience for many women was reported as forced – 17 % of women in rural Tanzania, 24 % in rural Peru, and 30 % in rural Bangladesh reported that their first sexual experience was forced.

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claims may be brought by either women or men, although due to particular types of persecution they are more commonly brought by women. (UNHCR 2003:111)

UNHCR (1995, 2001, 2003, 2015b) has sponsored a number of conferences and publications since the mid-1990’s specifically addressing gender violence against women (recently including transgender women – UNHCR 2015b), with a focus on documenting the prevalence of sexual assault, abuse, and domestic violence, and making policy recommendations at a meta- or general oversight level. It is questionable, however, given the prevailing lack of attention to these issues in both academic and popular consciousness, whether these recommendations have had much force for implementation even in UNHCR monitored camps and other sites. (Cf., Gebreiyosus 2014) Feminist studies specifically investigating the condition of refugee women point to continued isolation, and lack of care and advocacy for women facing gender-based violence and trauma. Immigrant women are among the most vulnerable to exploitation, abuse, and human rights violations. (National Network on Immigrant and Refugee Rights, 2000) Because they are caught at an intersection9 of being immigrants, women, and often ethnic or religious minority status, immigrant women are vulnerable to triple discrimination and marginalization.” (Berger 2013) Lesbian immigrants face additional hurdles of discrimination and lack of legal status. (NNIRR 2000:37) In one study of Sri Lankan Tamil immigrants in Toronto, widespread domestic violence led to “several Tamil women who had jumped to their deaths from their apartment building” one winter, their isolation exacerbating “an already existing situation of powerlessness with no family here to intercede on [their] behalf.” (Morrison et al. 1999:155) In a comparative study of Somalian and Filipino migrants in Italy, Chell-Robinson (2000) states: Both groups of women, Somalian and Filipino, indicated that local government organizations, trade unions, and voluntary organizations, were little able to attend to or recognize the specific concerns of these women (issues such as domestic violence, pregnancy and hospitalization, counselling for the emotional distress caused by integration, and for Somalian women the issue of infibulation [usually caused by female genital mutilation]). (p. 117)

The UN has recognized “acts of sexual violence, family/domestic violence, coerced family planning, female genital mutilation, punishment for transgression of social mores, and discrimination against homosexuals” as “gender-based persecution” since 1951 in its Convention relating to the Status of Refugees and again its 1967 Protocol relating to the Status of Refugees. (UNHCR 2003: 110) This constitutes grounds for asylum according to the UN, although as the UN recognizes, such declarations by the UN do not 9 Note that the term “intersectionality” itself, now frequently used to describe many forms of multi-layered discrimination, was first coined in the context of describing domestic violence/ gender-based violence against African-American women (Crenshaw 1991).

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have the force of law – again – the actual implementation of these resolutions is only a “guideline,” frequently disregarded in individual countries where asylum is sought. Furthermore, as noted in the UNHCR’s Guidelines for Prevention and Response to Sexual and Gender-based Violence, “[g]ender based violence against female refugees can occur during all phases of the refugee cycle: prior to flight, during flight, while in the country of asylum, [and] during repatriation and reintegration.” (UNHCR 2003:19 – emphasis added; see also Morrison et al. 1999; Simons 1999) And it should be noted that these statistics and protocols refer only to refugees, and do not begin to address the sexual and domestic violence perpetrated against millions of women immigrants do not qualify for refugee status internationally (even though according to UN protocols they would be eligible) – these women also flee political, military, economic, and domestic and street violence in their countries of origin (including extreme poverty exacerbated by global climate change),10 suffer further sexual violence and degradation en route to their hoped-for destinations, and find themselves at even greater risk than officially recognized refugees from coercion, threats, and continued trauma because of lack of legal recourse and fear of retaliation and deportation. (Boyd & Pikkov, 2008:3611) In a recently published study of women fleeing Central American countries, “All women interviewed fled their home countries because they could not find protection.” (UNHCR 2015b:[41])

Trauma and Women Migrants “Claudine saw a lot of stuff, I don’t know if I can say some of them, but they were raping women and Claudine saw all of that and they did that to her and they killed even her uncle in her eyes. She saw a lot…But you know, sometimes when you already have a lot of shocks in your life, it’s very difficult to go back, you know, to be really, really normal. And we try. We try, we try everything. And even (Claudine 10 As documented in personal interviews by the Rev. Dr. Michael Cooper-White and students from the Lutheran Theological Seminary, Gettysburg, PA, on a study trip in Honduras and Guatemala, January 2016. 11 “A harsh reality for undocumented immigrants is that they are vulnerable to deportation at any time for any infraction of the law. While this has grave implications for trafficked women, undocumented immigrant women who suffer physical abuse at the hands of their spouses are also vulnerable. In response to this susceptibility, battered women’s advocates pressured the US Congress to create a provision in the 1994 Violence Against Women Act, or VAWA, which reserves green cards for undocumented immigrant women who have been physically abused (though the abuse must be suffered at the hands of a citizen or lawful permanent resident spouse), and allows them to petition for permanent residency without the knowledge or support of their husbands. By 2001 17,907 women had applied under the provision.” (Boyd & Pikkov 2008:36)

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Mukankindi’s) daughter. The daughter tried everything … but … we lost her.” – Kihonia, Congolese refugee in Pittsburgh, PA, describing her friend Claudine who died of a heart attack at age 36. (Beras 2014)

The term trauma has been used so loosely, particularly in western media and popular culture, that nearly any upsetting experience might be labeled as “traumatic.” However, it takes more than an emotional upset per se to rise to the level of “trauma” that can in turn cause Post-Traumatic Stress Disorder. The most recent western psychiatric definition in the DSM-5 (2013) links PTSD causally with exposure to a traumatic event – the only diagnostic category in the DSM to rely primarily on a wholly external etiology.12 A traumatic event is defined as follows: actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual: directly experiences the traumatic event; witnesses the traumatic event in person; learns that the traumatic event occurred to a close family member or a close friend (with the actual or threatened death being either violent or accidental); or experiences firsthand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related). The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individual’s social interactions, capacity to work or other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs or alcohol.13

Trauma thus overwhelms and shatters an individual’s ability to “function” – or in more personal terms, to live one’s life as usual, with all of one’s usual abilities intact. A meta-analysis of PTSD across multiple studies of refugee populations found that close to 1/3 of all refugees suffer some form of PTSD, and that women14 and older refugees tended to be more affected; other analyses report rates of PTSD among refugees from 3 % to as high as 86 %). (McDonald & Sand 2010:8; Schouler-Ocak 2015:3) Yet, what precisely constitutes a traumatic event, one’s emotional response and subjective interpretation of what the event means, and one’s social and cultural 12 The criteria for PTSD in ICD-10, F43.1 (WHO 2010) are similar but less detailed. http://apps. who.int/classifications/icd10/browse/2010/en#/F43.1. Accessed 8 July 2016. ICD-10 also includes a provision for long-term personality changes after a catastrophic experience – see ICD10, F62.0, which includes concentration camp experiences, disasters, prolonged captivity with imminent possibility of being killed, exposure to life-threatening situations such as being a victim of terrorism and torture – but not chronic sexual abuse or sexual violation. http://apps. who.int/classifications/icd10/browse/2010/en#/F62.0. Accessed 8 July 2016. 13 Note that the criterion of “sexual violation” was added in DSM-5 as a change from DSM-IVand previous versions. This change has not yet been reflected in the ICD. 14 Women are found to have higher rates of PTSD than men in general, taking into consideration cumulative experiences of violence and gender socialization as well as biological factors. (User 2015.)

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environment are also factors in whether or not a person will experience “PTSD” – and to what degree – as defined by the DSM or other western diagnostic models. (McDonald & Sand 2010; McNally 200315) What constitutes a ‘trauma’ then is not entirely dependent on the nature of the event but also on the personal meaning assigned and the social interpretation of the event, including responses of the affected person, their family and community, as well as the society at large. Culture influences the individual and collective experience of trauma at many levels: the perception and interpretation of events as threatening or traumatic; modes of expressing and explaining distress; coping responses and adaptation patterns of help-seeking and treatment response. Most importantly, culture gives meaning to the traumatic event itself, allowing individuals, families, and communities to make sense of violence and adversity in ways that may moderate or amplify their impact. (Kirmayer et al. 2010:156; see also Pedersen 2015:10)

The DSM’s diagnostic working committees have become increasingly sensitized to cultural factors over the years and through various editions of the manual. However, there is still no detailed guidance in the DSM-5 regarding culturally-sensitive or culturally-adapted understanding of trauma and post-traumatic effects in their complexity across the globe. Following anthropologists Hinton and Good, therefore, a further understanding of trauma in its cultural complexity, with its multivalent impact on unique persons in particular cultural, social, and political contexts, also calls for what they term a “multiaxial approach to the trauma survivor’s ontology.” (Hinton & Good 2016:51)16 In addition to one-time events of extreme horror, this approach takes into greater consideration the cumulative impact of repeated acts of violence, both physical and emotional – sometimes called “complex trauma” – a dynamic that is well known in clinical experience with violence against women and children which is more often than not a chronic situation of continuing abuses, some overtly violent, and some more subtly and psychologically coercive but also damaging. In this understanding, as noted by Sara El Bulbeisi (2016), trauma is not just an event but a process. Pastoral and spiritual caregivers might note that, along with the more typical psychiatric considerations of physiology, and social and emotional aspects of trauma, eleven analytic perspectives can be brought to bear in understanding the trauma survivor, including justice, religion, and spiritu15 McNally has been criticized for appearing to support the backlash movement against therapy for recovered memories of sexual trauma, especially by clinicians working with adult survivors of childhood sexual abuse. However, his book lifts up important complexities around definitions of trauma, PTSD, and the variable ways in which traumatic memories are (and are not) available for recall by victims/survivors. (The related controversy over repressed memories during the 1980s and 1990s among US trauma researchers is beyond the scope of this paper.) 16 Figure 1, “Culturally Sensitive Assessment,” reprinted with permission of the University of Pennsylvania Press, 17 December 2018, PERM3288.

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Figure 1. Culturally Sensitive Assessment

ality. (Hinton & Good 2016:50–51ff; the significance of religious beliefs is also noted briefly in McDonald & Sand 2010:22) Note also that gender is identified (along with age) not merely as an epidemiological or demographic statistic, but as one of the central influential factors in the trauma survivor’s experience. (pp. 51, 82–83) Cultural analysts and feminist scholars have further critiqued western psychiatric approaches to trauma. Hinton and Good (2016) themselves describe “debates about the legitimacy of focusing on trauma and trauma treatment in global humanitarian settings,” pointing out that critics of economic “development” (i. e., of so-called “under-developed” or “developing” nations by “developed” nations in the west) are skeptical of the concept of trauma and the term “PTSD” as a “pseudocondition,” representing a form of “psychological imperialism” that risks pathologizing whole societies: Many, including anthropologists and cross-cultural psychiatrists…have strongly criticized the labeling of acute responses to traumatic violence as a mental disorder, arguing that this represents a pathologization and professionalization of normal forms of human suffering a form of globalized medicalization of human responses to disaster and violence.” (Hinton & Good 2016:8)

Such authors “question the increasing role played in humanitarian settings of complex emergencies over the past several decades.” (Ibid.) For example, Kimberly Theidon critiques a “trauma industry,” imposed from the west, in which indigenous people are viewed as “backward and incapable of abstract thought, a people whose complaints required translation into the modern language of trauma to be comprehensible. A history of colonialism and racism thus shaped the view of indigenous people and the need to code their

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experience in the reality-based, modern language of trauma and PTSD in order to devise mental health responses.” (Theidon 2015: 24–25, cited in Hinton & Good 2016:8) Pupavac further argues that western strategies for prevention and intervention may “actually ‘jeopardize local coping strategies.’” (Pupavac 2001, cited in Hinton & Good 2016: 9) This concern is also not unknown in the practice of pastoral and spiritual care, as chaplains and other spiritual caregivers often must walk a fine line to avoid becoming captive to the instrumental values of the institutional health care system. (e. g., Nauer 2015, 2016; see also Sullivan 2014) Such scholars rightly point to the importance of women’s own voices, agency, interpretation of events, and self-determination. As Freedman and Tarr (2000) have stated, “Although women of immigrant origin find themselves at the intersection of dominations and exclusions based on gender and ‘race,’ this does not mean they are passive victims without voice and agency of their own.” (p. 217) There is increasing resistance in academia to 17 The issue of female circumcision, genital cutting or genital mutilation, and whether or not it is de facto a violation of women’s sexual and medical rights, is particularly subject to debate, as the various terms for it in English imply (Cooper-White 2012: 10, 270) FGM is considered as a human rights violation against women and girls by the WHO, the UN, and increasing numbers of citizens in the countries in which it has been traditionally practiced (UNICEF 2016). Rajkotia (2008) argues that although female genital mutilation (“FGM”) is against the law in both Britain and in Sierra Leone, girls should be granted the freedom of choice to participate in Bondo initiation – which includes FGM – when they are better able developmentally to make their own decisions. She defends the perspective of those who choose not to circumcise their daughters, stating that this is not a monolithic imposition of western culture on the African traditional practices: “migration may enable new perspectives but does not create them” (p. 238). However, choice should remain for young refugee women, respecting the testimony of many of the girls from Sierra Leone was that it signified an important recognition “as ‘women’ by other women,” and as “becoming a part of something” in a new land where cultural identity is so often suppressed or marginalized. (p. 231) Paradoxically, her informants stated that the secret Bondo societies were first formed in Sierra Leone “to protect the initiation prospects of their daughters, now threatened by widespread rape and sexual violence… due to lack of security in the countryside during the recent conflict in Sierra Leone, large numbers of internally displaced people arrived in the capital, Freetown, and were forced to carry out the traditional practices in their new setting” (i. e., apart from the traditional, more supportive context provided to girls for the ritual.) It should be noted that although some attempts at medicalization have been made re: FGM, vast numbers of girls are subjected to unsanitary, extremely painful and dangerous procedures in the secret societies, where no medical care is sought or made available. According to the World Health Organization (WHO), “Procedures can cause severe bleeding and problems urinating, and later cysts, infections, as well as complications in childbirth and increased risk of newborn deaths. More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. FGM is mostly carried out on young girls between infancy and age 15.” (WHO 2016). The WHO together with the UN consider FGM to be a human rights violation of girls and women. (WHO 2016). In 22 out of 29 countries where FGM is frequently practiced, UNICEF (2016) has documented that more than half of women and girls now oppose the practice (in 16 countries 75 % to 95 % oppose it); and in 12 out of 18 countries more than half of boys and men also opposite it (79 % to 96 % in 10 countries). See also Dugger 2011; Moon 2010.

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hegemonic representations of immigrant women either as passive, voiceless and invisible victims, or as the trope of the “exotic Other.” Ralph Grillo (2008) writes regarding “the presumed plight of young women, for example in respect of marriage”: This is especially noticeable with regard to the ‘Muslim’ family. Ansari (2004: 252–297) draws attention to the predominant western view of Muslim women as ‘passive and docile, subject to patriarchal traditions, and lacking any active agency to change their condition; also as exotic, ruthlessly oppressed victims of religion,’ and western feminists (for instance) sometimes argue that it is the Muslim family which is the ‘key element’ in their oppression, with the Islamic faith underpinning conceptions of the family and legitimizing violence against women. In German public discourse, says Ewing, the Muslim woman is ‘cast as the embodiment of the ‘other’…oppressed by her ‘culture’ and in need of liberation by enlightened western saviors (Ewing 2006: 267; see also Moch 2005:104), with the trope of the rebellious adolescent girl constrained by her ‘traditional Turkish family’ replayed over and over in media accounts, in cinema and literature and in social science scholarship.’ (Ewing 2006:270) Similarly in France, Rassiguier (2003:12) shows that it is women who, while ‘robbed of any real agency, are conjured up to capture the cultured distance between the French and their post-colonial others’. There is a perception of the unintegrable African family (predominantly Muslim) built round images of alien customary practices (polygyny, female circumcision, endless children, patriarchy) through which the African woman is constituted. Consequently the African woman – the iconic alien – is discursively seen only in the context of the family and male dependency (the existence of the autonomous woman is effectively denied), and this is reinforced through legal practices. Women stand metonymically for the family, and in Germany, as in France, the assumed obligatory wearing of the hijab is taken as a sign of the Muslim family’s oppressive character. (Ewing 2006:107) (Grillo 2008:22, citing Ansari 2004, Ewing 2006, Moch 2005, and Rassiguier, 2003)

These critiques are not confined only to criticisms of western depictions of immigrants from “foreign” lands, but also to non-western voices as well. For example, Snel and Stock (2008) strongly critique Ayaan Hirsi Ali’s writings on the abuse of women in Islam (e. g., Ali, 2006) as “grounded in an outdated and problematic ‘essentialist’ notion of culture and religion,” (p. 124), giving ammunition to forces of backlash against Muslims, and falling back into “cultural fundamentalism.” (Ibid.) Nevertheless, Snel and Stock also deplore violence against women, and recognize that it is “a serious problem that has been neglected for too long by tolerant (or indifferent?) multiculturalists and by the general public. It is the merit of Hirsi Ali and other female authors…to bring this issue onto the public agenda.” (p. 123) Their point is that “fighting for women’s rights [does] not necessarily mean fighting against Islam.” (p. 131) In every context, it is listening directly to women’s voices that draws back the curtain on repeated, horrific forms of sexual and domestic violence, and these

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experiences certainly fit any definition of the word traumatic. But the DSM diagnosis, even in its most recent revision DSM-5, does not account for the complexity of accumulated suffering, nor the gendered, raced, or cultural meanings and interpretations of layered traumatic experiences. (Hinton & Good 2016, Introduction, p. 6) In the words of anthropologists Hinton and Good (2016), challenging Bessel van der Kolk and other western trauma specialists: [W]hile neurobiological, cognitive, and developmental issues may be important in determining who is at heightened risk for failing to recover from traumatic experiences [the prevailing western medical view], current social and cultural factors – such as lack of social support, continued adversity, or inability to make sense of traumatic events – may be even more important. (p. 15, emphasis added)

Allan Young, a medical anthropologist whose critique of PTSD as an historical “invention” has sometimes been used to dismiss its application to global contexts (particularly in more complex, culturally-cognizant terms), nevertheless states: “On the contrary, the reality of PTSD is confirmed empirically by its place in people’s lives, by their experiences and convictions…” (Young 1995:5–6, cited in Hinton & Good 2016, Introduction, p. 4) What is required, then, in addition to a multiaxial conceptualization of trauma as described above (Hinton & Good 2016:51), is attention to the “heteroglossia” – the multiple ways – in which individual women “may give voice to a multiplicity of cultural references” in telling their specific stories of trauma in context. (Grillo 2008:22; see also Porter & Haslam 2005) As one example, Whitney Duncan, in her study of women in Oaxaca, Mexico, an area of “mass out-migration” due to both poverty and violence, documented “extremely high levels of domestic violence as well as childhood sexual assault.” (Duncan 2016:205) She quoted one woman, “Flor,” describing herself as “feeling ‘closed, very deep in a hole, dark and where I can’t find the exit.’ She had never heard of PTSD.” (Duncan 2016: 228) While Duncan acknowledges the pitfalls of using the western psychiatric label “PTSD” to “arguably pathologize women’s distress,” she points out that gender violence has so long been considered “part of their life structure,” (p. 230) that sexual and domestic violence were not even considered by “the local clinical ethos” (p. 230) to be traumatic. Depression was a recognized mental health diagnosis for women – and even recognized to be related to domestic violence – but PTSD was not considered.18 She endorses localized “psichoeducacijn” about PTSD not as a method to further pathologize women, but to empower them with language to describe their own experiences of suffering. (For a similar argument from other contexts, see Hagelund 2008:86–87; White et al. 2001.) 18 Similar to a study in Sweden which found refugee women more at risk for depression than refugee men (Hollander et al. 2011:12), but did not consider gender-based violence among the possible causes.

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Such examples describe the underlying violence and trauma that often precedes women’s decision to emigrate, even before the ordeals and perils of migration begin.

Toward Practices for Healing: Three “Foci for Practice” “ …when I’m feeling sad and filled with depression, when I come [to the group] it’s like a vent and when I return home, I see things differently.” – Lourdes, a Mexican immigrant to the U.S. describing her experience with Mujeres Unidas y Activas, a grass-roots Latina immigrant group in San Francisco. (NNIRR 2000).

American modes of trauma diagnosis and treatment have made numerous breakthroughs in the last 3 decades, incorporating knowledge from historical, sociological and social-psychological studies (especially of war veterans and survivors of sexual abuse – Herman, 1992, 2015), feminist efforts especially in the 1980s and 90s to break silence about the sexual abuse of women and children (Cooper-White 1995, 2012; Herman, 1992, 2015), and neuroscientific studies of the effects of trauma on the brain and especially on the different mechanisms of “normal” vs. traumatic memory (e. g., Van der Kolk, 2014). However, resulting models for healing such as “emotion regulation skills,” “attachment-focused family therapy,” “a sensori-motor approach to psychotherapy,” “trauma-sensitive yoga,” and “mindfulness-oriented interventions,” (Trauma Center 2007) – the latter two of which paradoxically represent appropriations of eastern spiritual practices into western secular psychology – may ring false when considering accompanying traumatized persons toward greater healing and self-empowerment in an intercultural, interreligious context. I would like to propose three “foci for practice” for intercultural and interreligious spiritual care for survivors of trauma, in keeping with IASC’s theme this year of migration, and in particular, with a view toward the particular sufferings of women migrants—both refugees and immigrants. I say “foci for practice” and not “methods” or “techniques,” because while I believe that healing is often helped by the empathic presence of another, I do not believe there is any one-size-fits-all method or technique – or trauma “treatment” – that can effect a “cure” for trauma across all cultures and contexts. These three “foci for practice,” which should apply across various methods and techniques of healing, are: honoring self-determination, witnessing, and supporting self-healing and liberation.

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Honoring Self-determination If one dynamic of trauma is the overpowering of a person against her will, then replicating the power-over dynamic in our approach to intercultural caregiving must in some sense also be understood as a form of re-traumatization, or at the very least, a failure to attend to the actual suffering by women that is taking place in a given context. (Cooper-White 2012: 52–61,19 239–240) Processes for effecting change in long-accepted or invisibilized forms of violence against women are most successful when they are initiated and carried out by leaders of local communities and not imposed paternalistically from outside without dialogue. For example, McDonald and Sand (2010) note how common western therapeutic approaches, such as Cognitive Behavioral Therapy (CBT) and Narrative Exposure Therapy (NET), initially dominated the literature on helping refugees heal from trauma. Using the example of a program in Kosova, they illustrate how community-based treatments, designed to “move away from standard western treatment protocols that may feel foreign to refugees (such as having a dyadic therapist/client relationship that focuses solely on the individual – and adapted to be more congruent with refugee beliefs and practices (such as involving the family or friends in the therapeutic environment)” have been more successful approaches to healing. (p. 31; see also Lartey, 2003). These authors recommend “community-based multifamily interventions” which focus on building strengths and fostering access to services, using multi-ethnic teams, combining individual and group therapy, family therapy, art, dance, and occupational therapy, and drawing consultation from other key personnel (e. g., teachers and other social service workers) to ensure continuity of care. (p. 32; see also Singh 2009) The most effective efforts come from women within the impacted communities themselves. For example, the Southall Black Sisters (2004; cited in Grillo 2008:22) in London represent an activist group of pan-African women activists combatting domestic violence in the immigrant community ; Mujeres Unidas y Activas provides groups for grass-roots support and advocacy among Latina immigrants in San Francisco, California. (NNIRR 2000) In another example, in Iraq, the most successful efforts to end genderbased violence and discrimination in refugee communities, in Campbell’s words, were not manufactured resettlement attempts to understand Iraqi ‘culture,’ but were initiatives developed by varied Iraqis. Certain immigration and resettlement policies that attempt to be culturally sensitive have regrettably played a role in reproducing 19 For a feminist typology of power, with further critical analysis and theological reflection, see Cooper-White (2012), “Power and Violence against Women” (pp. 40–63).

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gender inequalities in the diaspora. Rather than perpetuating reductive notion[s] of gender that miss the mark of ‘cultural understanding,’ immigration and resettlement policies might strive to create similar opportunities for men and women alike. Such an effort might begin with the rethinking of strategies that empower Iraqi men as caseworkers and placing Iraqi women to live with families; they can continue with more robust support in the way of housing, job placement, and education, so that all refugees—men and women—could have the chance to realize the futures that they envision. (Campbell 2016:210)

Campbell goes on to affirm the importance of complex stories, which do not reify essentializing stereotypes about women or men: What is clear is that their stories [the stories of Iraqis] – revealing much about the occupation of Iraq, the war on terror of which it was a part, and the broader conditions of legal and cultural citizenship …—are not stories that can be reduced to victims and villains; good and bad girls; protectors, traitors, or terrorists. [Their] agency…cannot be boiled down to a metanarrative. These young men and women are as complex as the historical moment that they find themselves in, as multifaceted as the diverse currents o discourse they straddle, and as powerful as the unique processes of subjectivication they occupy as former US allies in Iraq, and now Iraqi refugees in the United States [and elsewhere.] (Campbell 2016:210–211)

There is probably no doubt that the ease of global communication and the increase of worldwide movements to end violence against women have had an impact on [local] women’s activism, but it is local ownership of such advocacy that gives it credibility. (e. g., Cooper-White 2012: 10 re: indigenous efforts to end FGM in Senegal, also citing Dugger 2011) But advocacy and services alone, even when locally initiated or empowered, do not address the internal and often unspoken depths of suffering that trauma survivors experience. Especially with the general lack of awareness – or blindness – toward gender-based violence against women, and women refugees in particular, trauma survivors also need someone to recognize their pain. This leads to the second “focus for practice,” witnessing.

Witnessing A key task of all spiritual care, I believe, is to witness – to see and to hear the suffering that is really there, in an encounter, a conversation, an immersion in a context. We are not called upon to take precipitous action (except in the case of a situation of immediate violence in which we have the competence to intervene). Rather, we are called to be present to all the ways in which trauma has marked a person’s being – body, mind, and soul – and to give the gift of recognition to that other person by extending ourselves in genuine empathy

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and non-self-interested concern. As Christina Puchalski (2016) has stated, “witnessing is not fixing.” Shelly Rambo (2010) in her recent book on trauma and pastoral care also advocates “compassionate witnessing,” which refrains from premature meaning-making or giving answers. (See also Bidwell 2016; Hunsinger 2015.) Care and counseling is not (just) a set of skills, as it sometimes seems in some of the counseling psychology literature, but rather a disposition of the heart: a capacity to be-with, to honor intersubjectivity – both conscious and unconscious – and mutuality of emotional exchange, and to wait upon the other’s self-discovery. (e. g., Cooper-White, 2007, 2014) As relational psychoanalysts have emphasized, the human person from birth requires recognition from a (m)other – beginning with the first caregiver(s) in infancy – to develop a sense of self at all. In relationship, as analyst Donnel Stern has written, “we are called into being by acts of recognition by the other.” (Stern 2009:110, cited in Cooper-White 2014:29) Stern names this recognition the act of “witnessing.” Conversely, as cultural anthropologist Katherine Pratt Ewing (2000) states, “Refusal to recognize the other as a person is an assault on self-esteem, an act of violence.” (p. 265) As I have written elsewhere, about suffering, the practice of witnessing is sacred…As suffering is recognized, new images, symbols, words, narratives, and meanings emerge in the context of a relationship where both partners can truly be seen and known. This process in turn promotes inner transformation…The appropriation by psychoanalysis of the term witness is striking because of its resonance with theological language. The term witness in English is the translation of the [Christian] biblical Greek word martys, or martyr. I do not want to suggest that as [spiritual caregivers] we sacrifice ourselves in an unhealthy way or lose our healthy boundaries in ministry with survivors of trauma or those who suffer. However, there is an unavoidable cost – a kind of martyrdom or giving of one’s self – to the work of witnessing to another’s pain. By being willing to be witnesses, we commit ourselves to a costly walking alongside those who suffer.” (Cooper-White 2014:29)

And often, this is best not done alone, but in the company of others, in solidarity. (Ibid., 30) Given the pervasiveness of silence shrouding the many forms of violence against women, and obscuring the gender-based traumas suffered by women refugees and migrants, our first task then must be a solidarity of companionship, and a “hearing the other to speech.” (Morton 1985:128) But how, exactly, besides sitting quietly and listening do we do that? Are there intercultural and inter-religious competencies we need to learn, in addition to having a heart for empathy? This leads to the third “focus for practice,” that of supporting selfhealing and liberation.

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Supporting Self-healing and Liberation Few American trauma specialists have the same worldwide and intercultural expertise as Dr. Richard Mollica. A professor of psychiatry at Harvard, Mollica has developed a model for healing from trauma that transcends therapeutic fads and is grounded in considerable clinical experience across the globe. He is attentive to issues of gender as well as race and culture in his approach to healing from trauma, and has profound respect for what he calls people’s “inherent ability to heal themselves” from trauma, just as physical wounds heal naturally. (Mollica 2006: 94–109) His approach focuses on facilitating the telling of “the trauma story” by survivors, but this is not a shallow or popular notion of simply recounting over and over the facts of one’s suffering, or a throwback to fin-de-siHcle methods of cathartic “abreaction” in the mode of Janet, Breuer, or the early Freud. Mollica identifies four elements to a trauma story that heals: first, a factual accounting – in which often very precise details are disclosed; second, recognitions of the cultural meanings of the trauma – in which the person’s context – past, present, and future – shape the ways in which the traumatic event is being interpreted by the survivor ; but then, further, what he calls “working behind the curtain,” in which deeper insights are probed, including spiritual beliefs and truths, as well as liberating defiance against harmful cultural norms, taboos, and suppressive political rhetoric that have perpetuated suffering or impeded healing. As Ewing (2000) has stated, [The] significant distinction is… between immediately experienced violence/trauma and the gaps of discontinuities in self-experience it creates on the one hand, and narrativized acts of violence and trauma, through which an individual may establish new relationships and identity, and through which a social movement may mobilize adherents, on the other hand. (pp. 250–251, emphasis added)

It is important to note, however – perhaps in the context of spiritual care especially – that meaning-making is not simply an intellectual exercise, but is also emotional and experiential. (Lartey 2016) If the goal of pastoral and spiritual care is not only restoration of a certain baseline of mental functioning, but also creating conditions for holistic healing, transformation and liberation, then there is a prophetic dimension to meaning-making that resists oppression (e. g., Dillen & VandenHoeck 2011, Doehring 2015, Nauer 2015, 2016) – whether western or non-western, traditional or institutional, social or political. Compassionate, witnessing care therefore must make space for spiritual struggle (Weiss 2016) as well as devotion and obedience to received religious precepts. Meaning-making takes place in the context of relationship. And finally, these three elements of the trauma story depend upon a fourth: “the listener-storyteller relationship.”

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Not unlike psychoanalyst Donnel Stern’s emphasis on intersubjective recognition and the empathic role of the witness, or “partner in thought” (Stern 2009), Mollica from a quite different psychiatric perspective also emphasizes the importance of the listener’s “emotional and physical vulnerability to pain.” (p. 47) One does not simply sit down and take an oral history. Sexual trauma in particular will not be disclosed readily by victim-survivors. Nevertheless, patience and sensitivity may gradually overcome “shyness” as the natural healing process is evoked by the empathy of the listener. Mollica writes: A listener’s patience and sensitivity are crucial to an essential element of the trauma story : the listener-storyteller relationship. The trauma story does not in fact completely exist unless it is told to someone else; the listener must choose to become a part of the story. But there is a price to be paid in terms of time, attention and pain as the storyteller transfers some of her suffering over to the listener…[This] also requires an appreciation that all traumatic stories are personal as well as historic account by ordinary people who want to heal themselves while also teaching others about survival and healing…Under ideal conditions, the storyteller is the teacher and the listener is the student. (p. 48)

“Although it flows out of our bodies and minds, self-healing still needs physical presence in society” (p. 105) – self-healing requires the deep empathic recognition of a witness. Mollica cautions that not all trauma stories are helpful or healing. “Storytelling is a healing art.” (p. 113) Trauma stories that solely focus on the recitation of “brutal facts” only “disclose rage,” he says, and are “too toxic.” “Ventilation” in and of itself is not always helpful, and often may best occur spontaneously as offhand comments during everyday activities. In my own clinical experience, sometimes trauma survivors re-traumatize both themselves and others in the telling of their stories, seeking empathy as victims but unconsciously re-perpetrating the horror onto others. At the extreme, there is too much horror for the listener to take in–in Mollica’s words, “they neither evoke empathy for oneself or for others.” (pp. 113–114) “Good storytelling” is about “finding the right balance,” between being able to fight for justice and also believing in human goodness. (p. 127) Mollica suggests that a “good trauma story” makes a mark on the world, a contribution, which transforms the survivor’s suffering “into a powerful healing force for others, for her family, and for herself.” (p. 133) This does not happen all at once, of course, and in my experience the listener must be willing to stay with the recitation of horrors, and even internalize the pain, in order to provide the recognition that is transformative toward new life. Mollica points to spiritual and religious practices as a significant locus of healing:

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Both biological research and clinical experience confirm that unhealthy body changes associated with negative life experiences can be brought under control [sic] by spiritual and humanistic practices such as prayer, meditation, religious rituals, and groups that focus on self-care. When our morals and values are shattered by violence, strong beliefs can halt our decline into disillusionment, anger, and despair…Unfortunately survivors are not often taught how to deal with their overwhelming emotions; as a result, they become lost in a storm of negative feelings…But when self-healing expresses itself through spiritual action, thought and emotions do not run wild. The emotions are contained by concrete rituals and practices, which give survivors a specific time and place where feelings can be expressed and understood. Participation in spiritual practices requires the discipline to control one’s feelings and the commitment to make sense out of them. (p. 177)

Based on my own experience in religious communities I would have to caution that this is an idealized and perhaps religiously naive view ; many religious institutions and practices can aggravate feelings of isolation, shutdown, and empathic rupture. It is part of our vocation as spiritual caregivers to guard against and even to protest uncritical uses of doctrine and practice that have historically exacerbated and further invisibilized women’s experiences of gender-based violence and trauma. (Cooper-White, 2012) Nevertheless, as pastoral and spiritual caregivers we do have the particular potential – and, as well, the vocation – to accompany traumatized individuals through their religious, theological, and spiritual questions. We can inquire directly of them what spiritual resources have been most helpful, and those that have been sources of harm and alienation. Learning from them, we can also discover healing qualities within our religious practices and communities, and encourage the signs of hope – as well as resistance to injustice and defiance of death-dealing taboos – that such religious and spiritual engagement might engender.

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UNHCR (2001). Prevention and response to sexual and gender-based violence in refugee situations: Inter-agency lessons learned conference proceedings 27–29 March 2001 – Geneva. Online at http://www.unhcr.org/3bb44cd811.pdf. Accessed 6 June 2016. UNHCR (2003). Sexual and gender-based violence against refugees, returnees and internally displaced persons: Guidelines for prevention and response May 2003. Online at http://www.unhcr.org/3f696bcc4.pdf. Accessed 6 June 2016. UNHCR (2016a). Syria regional refugee response: Inter-agency information sharing portal, last updated 1 June 2016. Online at http://data.unhcr.org/syrianrefugees/ regional.php. Accessed 6 June 2016. UNHCR (2015b). Women on the run: First-hand accounts of refugees fleeing El Salvador, Guatemala, Honduras, and Mexico. Online at http://www.unhcr.org/ publications/operations/5630f24c6/women-run.html. Accessed 3 June 2016. UNHCR (2016b). Worldwide Displacement Hits All Time High as War and Persecution Increase, 18 June 2016. Online at http://www.unhcr.org/news/latest/ 2015/6/558193896/worldwide-displacement-hits-all-time-high-war-persecutionincrease.html. Accessed 6 June 2016. UNHCR (2016c) Report warns refugee women on the move in Europe are at risk of sexual and gender-based violence. 20 January 2016. Online at http://www.unhcr. org/en-us/news/press/2016/1/569f99ae60/report-warns-refugee-women-moveeurope-risk-sexual-gender-based-violence.html. Accessed 7 June 2016. UNICEF (2016). Female genital mutilation/cutting: A global concern [pamphlet]. New York: UN. Online at http://www.unicef.org/media/files/FGMC_2016_bro chure_final_UNICEF_SPREAD.pdf. Accessed 6 June 2016. United Nations Office on Drugs and Crime (UNODC) (2014). Global report on trafficking in persons. Online at https://www.unodc.org/documents/data-andanalysis/glotip/GLOTIP_2014_full_report.pdf. Accessed 7 June 2016. US Department of State (2015a) Human trafficking and migrant smuggling: Understanding the difference. Online at http://www.state.gov/j/tip/rls/fs/2015/ 245175.htm. Accessed 7 June 2016. US Department of State (2015b) Seven things you should know about human trafficking. Online at http://blogs.state.gov/stories/2015/07/27/seven-things-youshould-know-about-human-trafficking. Accessed 7 June 2016. User, Inci (2015). Gender and trauma. In Schouler-Ocak (2015) (see above), 109–138. Van der Kolk, Bessel (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books. Van der Veer, Guus (1998). Counselling and Therapy with Refugees and Victims of Trauma, 2nd ed. Chichester, UK: John Wiley & Sons. Weiss, Ruchama (2016). Healing hatred: Instruments of pastoral care and counseling applied to the Israel-Palestine conflict II. Paper presented to the Inaugural Conference of the International Association for Spiritual Care (IASC), Bern, Switzerland, 20 June 2016. White, Judy, Tutt, Sherrie, Rude, Darlene, Mutwiri, Betty & Senevonghachack, Oudalay (2001). Post Traumatic Stress Disorder : The lived experience of

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immigrant, refugee and visible minority women. Project #24, Prairie Women’s Health Centre of Excellence, Saskatchewan, Canada. Online at http://www.pwhce. ca/ptsd-immigrant.htm. Accessed 2 June 2016. World Health Organization (WHO) (2010). International statistical classification of diseases and health related problems, 10th revision. Geneva, Switzerland: WHO. Online at http://www.who.int/classifications/icd/en/. Accessed 8 July 2016. WHO (2012). Violence against women, intimate partner and sexual violence against women. Fact sheet no. 23, December 2012. Online at http://www.who.int/ mediacentre/factsheets/fs239/en. WHO (2016a). Female genital mutilation. Fact sheet 241, updated February 2016. Online at http://www.who.int/mediacentre/factsheets/fs241/en/. WHO (2016b). Maternal mortality rate (per 100 000 live births). Online at http:// www.who.int/healthinfo/statistics/indmaternalmortality/en/. Accessed 10 June 2016. Young, A. (1995). The harmony of illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.

Duane R. Bidwell1

Spiritual Care, Migration, and Multiplicity : Care in the Context of Complex Religious Bonds

Abstract Experiences of migration and of complex religious bonds (that is, being shaped by more than one religious tradition simultaneously) create intersecting contexts for spiritual care. Some migrants come from communities where religious multiplicity is structural and therefore a cultural norm; others comes from contexts where migration and colonization shape both voluntary and structural religious multiplicity. Sources of suffering among people who experience migration and/or complex religious bonds include social exclusion, alienation, trauma, existential anxiety, and an inability to articulate experience. Working within the comparative theological paradigm of pastoral theology, this chapter turns to the Book of Ruth from the Hebrew bible and the Siga¯laka Sutta from the Pali canon of Buddhism to identify normative, ethical obligations for effective care among migrants and neighbors living with complex religious bonds. Drawing from these sources, the paper advocates for contemporary practices of befriending, witnessing, and hearing as appropriate responses to migration and religious multiplicity. Finally, the paper recommends (a) appropriate goals for spiritual care in these contexts and (b) reflexive practices by which care givers can prepare themselves for effective, reciprocal, and caring relationships aimed at the repair of alienation and social exclusion as common sources of suffering for both migrants and people who maintain complex religious bonds.

Spiritual Care, Migration, and Multiplicity : Care in the Context of Complex Religious Bonds In 2014 the American writer Quan Barry published a lyrical, haunted, and haunting novel that traces a Vietnamese family’s migrations during the eras of French colonialism and the American War, through a failed attempt to escape by sea during Vietnam’s subsequent economic collapse, a second attempt at 1 Professor of Practical Theology, Spiritual Care, and Counseling, Claremont School of Theology, Claremont, CA, USA. Email: [email protected].

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escape by land during the ¯Di¨ i Mj’i “renovation” of the 1980’s and 1990’s, until today, when the surviving matriarch is under house arrest. She is visited by a Viet Kieu, or “overseas Vietnamese,” woman from the United States, a migrant who has returned to Vietnam seeking to understand her ancestral heritage. The book’s title, She Weeps Each Time You’re Born, contains a certain religious ambiguity : Who is it, exactly, that weeps each time we’re born? At times, the pronoun seems to reference the Buddhist bodhisattva of mercy, Quan ffm (or Gua¯n Yı¯n in Chinese): She Who Hears the Cries of the World. Vietnamese people revere Quan Am, who in some depictions holds a vase of water with the power to remove suffering, purify defilements, and lengthen life. She pours out this water for the healing of the world. At other times, the title seems to evoke the Mother Goddess (or Holy Mothers) sect known as ¯Da. o M.˜ u, a universal, indigenous Vietnamese spirituality (Vu, 2006; Nguyen, 2012) that incorporates aspects of nature worship, ancestor veneration, Taoism, Confucianism, and Buddhism. Once outlawed by the government, ¯Da. o M.˜ u is primarily a women’s tradition; its worship is led by women who function as shamans, mediums, priests, and ritual leaders. They serve the feminine power that creates and sustains life, which includes not only an array of goddesses but also the deification of practitioners’ own mothers. In this context the novel describes a patrol of Korean soldiers working for the American military. The soldiers encounter and kill a pregnant woman known only as Little Mother, burying her body outside the shack where she lived with extended family. Three days later, the father of Little Mother’s child returns from the jungle. He finds a fresh grave in the yard, hears noises from below ground, and impulsively unearths the coffin, unzips the body bag, and lifts out an infant girl. The baby survived the attack on her mother. Born below ground in her mother’s grave, the girl’s name is Rabbit. As Rabbit grows she learns that she can hear the dead: Those first years I listened. The world was full of them. Everywhere we went. In the paddies. In the ditch beside the road. In the temples. In the rivers. A nation of people who have been dying from war for over a thousand years. Everywhere their faces buried in the road. . . . I don’t understand it myself . . . . I hear them stretching their voices out to me. They call to me and they tell me things and I say, I hear you. The simple act of someone hearing them, an acknowledgment, and then they can go wherever it is they go. (Quan, 2014, loc. 2182)

Rabbit’s key phrase—“I hear you”—points toward a central practice of care with people displaced from their homes and with people who migrate among religious and spiritual traditions. In order to speak that phrase with integrity and authenticity, Rabbit must first remain present to the voices stretching out to her, no matter how frightening they seem. She must witness their presence in the space between life and death without trying to resolve the tension of the in-between space. She must meet them where there are without trying to enter

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the space herself. Only then can she say, “I hear you” in a way that allows them to change their location. Rabbit’s capacity to befriend, witness, and hear the dead provides an orienting rubric for the tasks of care with migrants and people with complex religious bonds: How do we befriend, witness, and really hear people whose lives transgress boundaries established by others, in the process becoming defined by those transgressions? How do we open ourselves to new (or simply unfamiliar) manifestations of religion and spirituality? And what could it mean to cherish religious traditions other than our own?

My Aim This chapter explores these questions, first by braiding insights from Buddhist, Christian and Jewish texts, clinical and pastoral experience, and the scholarship of pastoral, practical, and constructive theologies, and second by offering a plausible account of how to effectively befriend, witness, and hear people who have been displaced and/or who claim complex religious bonds. The practices of befriending, witnessing, and hearing are useful because both migration and complex religious bonds can create isolation, distorted relationships, and existential anxiety—sufferings that are amplified by traumatic experience and by social exclusion from the broader community. Religious multiplicity—the experience of having simultaneous bonds to more than one religious tradition—is a norm around the world. Migration and religious multiplicity often intersect; each involves living “in between” communities without being fully at home in any. Migration can complicate religious multiplicity in several ways. First, it removes people with complex religious bonds from cultural settings where their multiplicity is expected, supported, and understood, and transfers them to contexts where singular religious bonds are expected. Second, migration creates opportunities for complex religious bonds to emerge through intermarriage and through cultural hybridity (Bidwell, 2015b). Finally, migration can disclose the painful, colonial origins of complex religious bonds (Bidwell, 2011). Unfortunately, scholars writing about religious multiplicity have not sufficiently accounted for the personal, familial, and cultural-religious effects of migration on people’s spiritualities and mental health. How then should spiritual caregivers respond to the migrants and religious multiplicities in our midst? Further, how can they articulate a compelling social imaginary to shape public policies for the benefit of migrants and religiously multiple people (Miller-McLemore, 2004)? Two personal situations shape my approach to this issue. First, I am na"ve about both the recent refugee and migration crisis in Europe and the ongoing debate about immigration in the United States. My understandings of

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migration are shaped by personal familiarity with the worldwide Vietnamese diaspora, which began in 1975, and by the intergenerational effects of migration that “show up” in my clinical and pastoral work with religiously multiple people. My thinking, therefore, is influenced less by the immediate crisis of relocation than by the ongoing and intergenerational effects of migration that emerge over time. Second, this chapter continues my effort to articulate a comparative theological paradigm for pastoral theology (Bidwell, 2015a), a “caring across traditions” that attends to and engages theological constructs beyond Christianity. It is not sufficient to position spirituality as an aspect of human diversity ; we must also engage lived religious traditions as normative sources for practices of care. Three norms guide my approach (Bidwell, 2015a). First, Christian approaches to care are bounded, malleable, and partial; therefore, we should disrupt Christian privilege in spiritual care by engaging parallel claims from other religions and from the experiences of religiously multiple people. Second, religious multiplicity is ubiquitous. Religious singularity is an important spiritual, cultural, and historical phenomenon; while we cannot ignore it, we should not privilege it. Effective spiritual care acknowledges, affirms, and responds to multiplicity rather than assessing its possibility, legitimacy, or cohesiveness. Third, it is an act of care to engage religious diversity and religious multiplicity as gifts and resources for care rather than as conundrums to be solved or paradoxes to be reconciled. I seek to privilege engagement over apologetics (defense of faith), understanding other traditions on their own terms rather than through Christian doctrinal categories. I am less concerned with a tradition’s cognitive content or congruence with gospel than with its authoritative insights and resources as a historic, contemporary, and lived religion. Shaped by these assumptions, this chapter unfolds in three movements. First, I describe complex religious bonds and migration as contexts for spiritual care. Second, I turn to sacred texts for normative insights into relational care in the contexts of multiplicity and migration. Third, I propose some goals and strategies for care givers responding to the alienation and exclusion experienced by people displaced from their homes and/or claiming complex religious bonds.

Movement I: Migration and Multiplicity in Context I use the phrases “complex religious bonds” and “religious multiplicity” (Greider, 2011) as umbrella terms for the experience of being formed by, claiming, or being claimed by more than one religious tradition at the same time: Hinjews, JuBus, Buddhist Christians, Christian Muslims, Yoruba priests who are Jewish and Christian. While this can seem unusual—even impos-

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sible—to some Western monotheists, it is a norm in much of the world, particularly parts of Africa and Asia. Yet the literature of spiritual care primarily assumes that people are mono-religious (Greider, 2010), and North Atlantic cultures continue to norm binary faith—a person can be either this or that, Christian or Buddhist, but not both/and. This creates difficulties, however, when we recognize with comparative theologian Paul Knitter (personal communication, Oct. 29, 2014) that religious diversity today is not simply—or primarily—cultural, but also personal and existential. Individuals and communities are multi-religious too. My first overt encounter with complex religious bonds involved a Vietnamese woman and her Amerasian son granted political asylum by the United States. As I have written elsewhere (Bidwell, 2018), Ms. Nguyen’s first action on arriving in the United States was to create an altar in her new home. She placed a Buddha image on the left, for luck; a crucifix on the right, for guidance and protection; and, in the center, a photo of her son’s father. In the midst of migration, thrust into an unfamiliar place, Ms. Nguyen and her son turned to spirituality : a mix of Buddhism, Christianity, Confucian ancestor veneration, and Taoism. But they quickly learned that the dominant culture—and their sponsoring Christian congregation—does not recognize or affirm complex religious bonds. The implicit communication was that they needed to hide their full religious selves, keep them secret and marginalized, in order to protect themselves and to navigate their new home successfully. Factors Shaping Care in the Context of Complex Religious Bonds Experiences like this can lead to isolation, social exclusion, and existential anxiety, not only among migrants but anyone who expresses complex religious bonds in a setting that perpetuates binary identities and mono-religious norms. Consider an older white man arriving at the hospital early in the morning for elective surgery : He is alone, and he is anxious. The admitting nurse reads brusquely from a computer screen, and the man murmurs a sleepy response to each question. The nurse seems bored; she repeats each question hundreds of times a week to people arriving for surgery. She moves down the list: ‘Religious preference?’ The man smiles. ‘Part of me is Tibetan Buddhist,’ he says, ‘and part of me is Catholic.’ The nurse looks at him for the first time. ‘Which part is having surgery today?’ ‘Both.’ The nurse peers over the top of her glasses. ‘Sir, the form only allows you to have one religious preference. Will it be ‘Buddhist’ or ‘Catholic Christian’?’ ‘I’m both,’ the man repeats.

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Duane R. Bidwell ‘I’ll just check ‘Other’,’ she says. ‘Unless you prefer ‘None’.’ He doesn’t respond, and she moves to the next question. After surgery the man learns that his official hospital record reads ‘No Religious Affiliation.’ (adapted from Bidwell, 2018)

On one hand, this exchange seems innocuous, even funny ; surgery goes well, and the man doesn’t suffer materially from this misidentification. But he does suffer in existential, psychosocial, and deeply personal ways: The hospital silences his sense of the sacred, denies his religious identity and his spirituality, because he doesn’t fit into official categories. This is a microaggression—a tiny, almost invisible slight against personhood that can, over time, wear people down, keep them on the margin, and communicate their lack of value to the dominant culture (Sue, 2010; Campbell & Manning, 2014). Microaggressions are an active form of bias (Marshall, 2016) that keep people from flourishing (Sanders & Yarber, 2015), and flourishing is a spiritual and religious value—a norm and criterion for care (McClure, 2010). People with complex religious bonds, like the man preparing for surgery, have told me repeatedly about the suffering that results from microaggressions. Nonetheless, most religiously multiple people are remarkably resilient. They are accustomed to negotiating multiple boundaries simultaneously, living in the “middle space” between traditions, communities, and identities despite cultural binaries that ask them to choose sides, to limit their practices and identities to one tradition or another. Their experiences have taught me a lot (see Bidwell, 2018). I want to highlight three learnings that are relevant to the focus of this chapter : • Complex religious bonds are usually not a choice. Most of the time, complex religious bonds are inherited from culture or from family. Structural (as opposed to conative) pathways to multiplicity play a greater role than the literature recognizes. Complex religious bonds are often remnants of Christian colonial activity and thus point toward oppressed identities and intergenerational trauma. In addition, migration in the United States and Europe often creates the conditions from which religious multiplicity emerges, especially voluntary or chosen multiplicity. • Complex religious bonds are more complex than we realize. Religious multiplicity can emerge from a kaleidoscope of influences, and it involves a shifting matrix of decisions, priorities, benefits, problems, needs, and concerns that vary from context to context. Pragmatic concerns are often at the forefront; in the midst of migration, people may adopt a second (or third) tradition because it offers political, physical, and economic advantages. Religious multiplicity can begin as pragmatic accommodation or strategic resistance and then assume a life of its own, placing people among competing interests. Monica Coleman, a constructive Christian theologian and scholar of African religions, argues that people with

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complex religious bonds negotiate these realities in three ways: They pass as mono-religious, engage in code-switching, or live with double-consciousness (personal communication, Oct. 15, 2015). • Religiously multiple people are rarely concerned about “salvation.” Complex religious bonds are not primarily doctrinal and logical, but embodied, relational, and performed. They represent entangled commitments and values; what holds them together is love. Privileging Christian categories like “sin,” “salvation,” “idolatry,” and “orthodoxy” isn’t helpful in care with religiously multiple people. We cannot force them to privilege one tradition or to become mono-religious. Yet migrants sometimes experience subtle and not-so-subtle pressure to affirm Christianity ; doing so can increase their chances of receiving help, jobs, or documents. Consider this statement from a Vietnamese Khmer refugee from Cambodia: When I escaped from Cambodia to Thailand, as soon as I arrived there [at the refugee camp], the first thing they handed me was a Bible, not food. … I felt like these people treated me and my people like monkeys. Look at us, we have over two thousand years of history, two thousand years of civilization. Who are these Christians who came here giving us the Bible? Don’t they know that we have our own literature, our own great authors, great civilization? (Thach, 2003, p. 266–267)

How can we befriend and witness people with complex religious bonds, let alone say “I hear you” with authenticity, when we know little about their contexts or the bonds and identities they carry with them? Similar difficulties shape spiritual care among migrants. Factors Shaping Care in the Context of Migration and Forced Displacement Pastoral theologian M. Jan Holton (2016) identifies four aspects of people’s lives than can be harmed by involuntary migration: relationships, meaning making, security, and belonging. People forced from their homes not only experience physical and material suffering, but also lose any sense of ontological security, “a sense of continuity and order in events, including those not directly within the perceptual environment of the individual,” according to sociologist Anthony Giddens (Giddens in Holton, 2016, p. 112). As a result, migrants live in nearly constant existential anxiety, which is magnified by practices of social exclusion in the communities where they resettle. Holton (2016) suggests that almost all migrants are identified as “foreigners” in the communities where they resettle, a designation that is “simultaneously a rejection of any claim to a common lineage or heritage and a resistance to making new paths of remembrance” (p. 102). Holton notes that this exclusion happens to people who have already left behind sacred spaces, religious leaders, and religious communities that provide a sense of continuity and belonging. I would add that many migrants also leave behind literal and

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spiritual ancestors, a particularly devastating loss for those whose spiritualities are closely tied to specific places, communities, and landscapes. Practices of exclusion prevent us from authentically befriending, witnessing, and saying “I hear you” to migrants. Repairing this alienation and social exclusion, Holton argues, is central to care for people forcibly displaced from their homes. “Displacement starts out being about a need for place,” she writes, “but quickly becomes about a need for repairing relational woundedness between persons without home and the communities in which they seek shelter” (p. 166). Flourishing relationships help migrants regain a sense of agency, safety, and psychological ease, which are markers of ontological security in a chaotic world (p. 113). Yet the trauma experienced by migrants “often results in alienation from others and oneself, expectations of further maltreatment, and other lasting breaches in the normal connections and relationships between people” (Briere, 2012). Trauma refers to the ongoing effects—psychological, physiological, relational, spiritual, and existential—of an event or experience that cannot be assimilated. Trauma breaks into the present without warning, disrupting daily life and shaping the future in unaccountable ways; its aftermath is a “tentative and vulnerable quality of life” (Rambo, 2010, p. 184). The traumas encountered by migrants are well documented. They range from pillage, rape, torture, enslavement, informing on friends and relatives, stepping on dead bodies to escape, spending years in squalid refugee camps, even, as Duc Nguyen’s chilling film Bolinao 52 (2010) reveals, resorting to cannibalism to survive. A well-documented effect of trauma is an inability to articulate what is happening; trauma overwhelms the brain to such an extent that people cannot communicate to others what they have experienced or are experiencing. How can we say “I hear you” to people unable to put their experience into words? This involuntary silence is not easily broken. Years after resettlement, the traumas of migration can be reactivated; this inevitably shapes marriage, friendship, and a parent’s relationship with children. In addition, the effects of trauma are not limited to those who directly experience or are told about tragic events (Rambo, 2010); the intergenerational—even genetic—transmission of trauma has been well documented in people descended from survivors of the Shoah (also called the Holocaust); people descended from African slaves brought to the United States; and children and grandchildren of Cambodian refugees who escaped the Khmer Rouge (Kong, 2003). Often, the ongoing traumas of migration—the persistent and unarticulated presence of past suffering in the present—are the price of survival. Social worker and Buddhist monk Chhean Kong (2003), for example, calls Cambodian refugees “a population whose need to survive has become intimately intertwined with a necessity to migrate” (p. 78). He states: Pain is both physical and emotional because they remember these tragedies forever. … They have been uprooted from their soil, their homes, their ancestors, and made to

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move from one place to another, to new environments, new atmospheric and climatic conditions unknown to them before, in order to rebuild their lives afresh without any means of subsistence or any implements or tools provided for the purpose. Under such harsh conditions, no life could possibly thrive. Though most unwilling to abandon their native land, in order to save their lives they have been forced to flee to the neighboring countries with just what was on their bodies. (Kong, 2003, p. 74)

Such migrants can endure an “unending effort to reconcile the sense of two lives that are distinct from each other, yet constantly intertwined through memory, resulting in a continual reworking of a schism in the self brought about by this upheaval” (Becker, Beyene, & Ken, 2000, p. 321). How can we say “I hear you” with authenticity to migrants engaged in this unending negotiation?

Witnessing Care in Contexts of Migration and Multiplicity Writing about Christian understandings of trauma, constructive theologian Shelly Rambo (2010) makes an implicit call for a “witnessing care” among people whose lives repeatedly place them in liminal spaces where past and present, life and death, mingle together in ways impossible—or at least not easy—to understand or articulate. The remainder—and reminder—of the past becomes an open wound, and trauma survivors must “move on and envision life where no signs of life can be found” (Rambo, 2010, loc. 364); they endure “in a world in which the boundaries of life and death no longer seem to hold, to provide meaning” (Rambo, 2010, loc. 155). People with complex religious bonds also live in these types of liminal spaces; not so much between literal life and death or past and present as between divergent communities, conflicting doctrines, and mutually exclusive experiences. In these contexts, witnessing care requires us to turn toward people in liminal places; to endure our inability to know their experience or truth without moving to premature meaning-making or closure; and to recognize and affirm their suffering without needing to clearly identify or place boundaries on it (Rambo, 2010). Holton considers the two most frequent questions she hears from refugees—“Don’t they know we are suffering?” and “Will you remember me?”—as expressions of “a deeply ingrained expectation that others in the human family care about our suffering and carry some measure of obligation to respond” (p. 167–168). In short: Do you hear me? Yet, as described above, it can be difficult to establish relationship, promote security and belonging, and engage in meaning-making in contexts of migration and complex religious bonds. Given these realities, what are some ways to approach care with people who have experienced migration and/or complex religious bonds? How do we prepare ourselves to engage them in ways that can allow us to say “I hear you”

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with authenticity? Sacred texts offer some clues, pointing toward ethical postures for responding to migrants and neighbors in the Buddhist, Christian, and Jewish traditions.

Movement II: Insights from Sacred Texts Drawing on my own complex religious bonds as a Presbyterian minister who practices Theravada Buddhism, I want to engage two texts that suggest normative ethical obligations for those seeking to befriend, witness, and hear the stranger. First, I turn to the book of Ruth from the Hebrew bible, which is authoritative for Jews and Christians. Then I explore the Siga¯laka Sutta from the Pali canon of Buddhism. Finally, I explore the implications of both texts for care in contexts of migration and multiplicity. The Book of Ruth In the Hebrew bible, the Book of Ruth stands as an interlude between weightier accounts of history and theology. In its Jewish contexts, it is traditionally read as a story of conversion and blessing. But its initial verses speak of crisis and relocation; before anything else, this is a story of migration.2 In the past, Naomi and her family, Israelites, relocated to Ruth’s territory because of drought and hunger ; now Ruth, a Moabite (as she is always called in the text), chooses to migrate as well. After the deaths of her husband and father-in–law, Ruth chooses to protect herself, secure her future, and maintain bonds with her mother-in–law Naomi by returning to Naomi’s ancestral home, Bethlehem. “Where you go,” she tells Naomi, “I go; where you lodge, I lodge; your people, my people; your gods, my gods” (verse 1.16, my translation). In Bethlehem, Ruth the Moabite—whose name means “Beloved”—forages the fields for leftover grain, which is her legal right as a resident-alien. Like many immigrants, she survives on what others have left behind, and in doing so Ruth is simply claiming her due under the law. But her initiative impresses the landowner, who praises her, offers food and water, extends ongoing protection, and blesses her—twice—in the name of God. The landowner is Boaz, a man of wealth and independence whose name means “Strong (or Powerful) One.” Eventually, Ruth and Boaz marry. Their son Obed fathers Jesse and becomes grandfather to King David. In the Christian traditions, David’s lineage leads to Jesus, the Messiah and Christian savior. Ultimately, Jesus is born of migrant roots. 2 I would argue that it is also a story about complex religious bonds, but that’s a different chapter altogether!

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There is much to be said about Ruth as an immigrant and a culturally and religiously hybrid person (take a look at Jennifer L. Koosed’s masterful text Gleaning Ruth: A Biblical Heroine and Her Afterlives (2011), for example). For my purposes here, however, I want to focus on Boaz and the ways this strong, rich, powerful man, guided by his religious commitments, responds to a vulnerable yet beloved migrant. Six elements of Boaz’s response catch my attention: • He accepts Ruth’s initiative and the claims she makes on him; he doesn’t chide her for being culturally inappropriate, reject her overtures, or expect her to assimilate. He acts from the beginning as if he recognizes that he has a relationship (and responsibility) to her by virtue of being human. • He applies local law to a stranger. He doesn’t ask whether she is deserving, and he doesn’t demand that she prove her need. He simply accepts that local laws govern her, no matter her origin. • He immediately provides food and water. After meeting her immediate, basic needs, he extends ongoing protection by directing his workers to keep her safe. In the instability of migration, Boaz identifies and maintains a space where Ruth can relax and attend to her needs. • He ensures ongoing material support by permitting her to glean all season. He tells her what he will provide and how long to expect it. • He praises her virtue, loyalty, character, and integrity. By naming her strengths and assets, Boaz positions Ruth as a person with resources rather than a person with deficits. He recognizes what she brings—and contributes—to the situation. • Finally, he blesses her twice. He invokes his religious tradition, communicating that he doesn’t perceive her as a religious “other” but as someone who shares the bounty of his tradition. This is risky, of course; invoking one’s own tradition can easily lead us to colonize the stranger’s religious and spiritual traditions. But Boaz offers blessing not as one-upmanship or polemic; it is a part of extending hospitality, welcoming. Clearly, Boaz meets Ruth at her point of need. He never overtly says “I hear you,” but his actions and words signal that he sees and understands Ruth in historical context and in her current situation. A proper posture toward the migrant in this text, then, includes responding to their initiative, ensuring the protections provided by law, providing ongoing material support and physical protection, offering praise and highlighting strengths, and extending blessing. Of course, Boaz responds to Ruth as a new migrant, someone in crisis. How do we respond to migrants who are no longer in crisis? To refugees and other displaced people who have lived among us for years or even generations as neighbors, friends, and companions? The Sı¯ga¯laka Sutta of Buddhism describes an appropriate posture toward these neighbors, as I describe below. The Book of Ruth’s ethical norms resonate with Buddhist approaches,

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but Buddhism prescribes a more reciprocal obligation than we see between Ruth and Boaz: Not a relationship between the Beloved and the Powerful, but a relationship between equals dedicated to each other’s flourishing and liberation. The Siga¯laka Sutta: The Laity’s Code of Discipline The historical Buddha placed great importance on friendship, identifying “good friendship, good companionship, and good comradeship” as the entire practice of a “spiritual life” (Bodhi, 2005, p. 240–241). This practice, variously called good, virtuous, or admirable friendship, requires a virtuous friend to exhibit maturity, virtue, faithfulness, discipline, generosity, and wisdom in relationship with others (Bodhi, 2005, p. 124–125). These qualities are made concrete in the Siga¯laka Sutta (Bodhi, 2005), where the Buddha outlines ten reciprocal obligations among friends who wish each other to be “at peace and free from fear” (p. 116–118). This teaching emerges spontaneously after the Buddha observes a young householder, Siga¯laka, paying homage to his deceased father. Early in the morning, Siga¯laka cleanses himself and goes to the forest, joining his palms in reverence to the six directions: east, west, north, south, upper, and lower. The Buddha asks why he is praying in this manner, and Siga¯laka explains that he is following his father’s instructions. “But that isn’t the correct way to worship the six directions!” the Buddha says. Siga¯laka replies: “Then teach me the proper way.” In the discourse that follows, the Buddha shifts Siga¯laka’s focus from an occasional, solitary ritual in the forest to the quality of his daily relationships. The proper way to honor the six directions, the Buddha says, is to be in right relationship with others. He then commends ten concrete practices— identified as “obligations”—by which friends and companions appropriately minister to one another. The first five obligations seem congruent with Boaz’s treatment of Ruth: • • • •

Giving gifts (Boaz provides Ruth with food and water), Offering kind words (Boaz offers Ruth a blessing), Attending to the other’s wellbeing (Boaz allows Ruth to glean in his field), Treating the other as oneself (Boaz brings Ruth under the protection of his household and his workers), and • Keeping one’s word (Boaz swears to honor his commitments to Ruth). The Buddha’s remaining five “obligations of friendship”—positioned as responses to the first five—move beyond Boaz’s actions to provide a richer account of right relationship than in the book of Ruth. To me, these five practices seem particularly salient among migrants and people with complex religious bonds. These five reciprocal obligations are:

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• Attending to companions who are distracted by their life situations, • Attending to the property of those who are distracted and unable to properly attend to their belongings, • Being a refuge in the midst of fear, • Remaining loyal in trouble, and • Showing concern for the children of one’s companions (which I read in the cultural setting as a concern to ensure a viable future). The Buddha intends these ten obligations to provide a foundation for a virtuous life and a pathways to harmonious community. The latter five, in particular, strike me as cultural correlates to ensuring secure psychological attachment and ontological security in the face of chaos. These Buddhist obligations, then, are instructive for caring relationships with migrants and religiously multiple people (as well as people from religious minorities who learn to function in religiously multiple ways as a condition for successfully navigating a dominant religious monoculture).

The Texts’ Implications for Spiritual Care These texts, one Jewish-Christian and one Buddhist, describe clear obligations to strangers, friends, and companions: We are to provide nourishment, ongoing material support and physical protection; offer praise; extend blessings; extend and enact legal rights and protections; be honest, trustworthy, and loyal; provide a physical, spiritual, and psychological refuge in the midst of fear ; work for a viable future; and attend to them and their property when they are unable to attend to themselves. All of these practices are engaged for relational purposes, and the Buddha positions these practices as an act of worship. In a similar fashion, Holton argues that practices of care among the displaced must first turn toward relational ends (p. 179); that is, human connection and right relationship take precedent over other types of caring acts and, in fact, create the conditions by which other practices can be effective. For Holton, this focus on relationality is both a human responsibility and a religious obligation. In short, caregivers must befriend, witness, and hear refugees, migrants, and religiously multiple people in the present, attending both to the ongoing presence of the past in their experiences and to the formation of a future in which they—and we—might flourish. Care becomes a relational process of re-membering communities and creating conditions for a better future.

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Movement III: Responding to Migration and Multiplicity In light of three considerations—(a) Rambo’s call for witnessing care in the aftermath of trauma, (b) the contextual realities of alienation, social exclusion, trauma, and existential anxiety among migrants and religiously multiple people, and (c) the impossibility of fully articulating the experiences of refugees and people with complex religious bonds—the obligations outlined above point toward some goals for spiritual care in contexts of multiplicity and migration. These goals include: • • • • •

Repairing alienation and social exclusion Enhancing agency Building on strengths to prevent further harm Contributing to ontological security Witnessing to the “in between” without promoting binary thinking or premature meaning

Engaging in this type of care with refugees, other migrants, and religiously multiple people—that is, being an admirable friend and a witness who can hear authentically what they communicate—can stretch us. We must play these roles without triggering old traumas or creating new ones. In my practice this requires some “inner migration” of my own, a reflexive move—and willingness—to dislocate myself from my every-day experiences, positions, and knowledges to enter imaginatively into a world that lies “in between” life, death, past, present, and discrete communities, traditions, and identities. The most difficult aspect, for me, is noticing and bracketing an automatic tendency to think in binaries: this or that, voluntary relocation or forced relocation, Christian or not. Three reflexive practices—described below—help me remain “in between” categories as admirable friend and listener. Taken together, these practices function as formative exercises; they are engaged outside of helping encounters as a way of preparing for care. I frame them as ongoing formation for myself, but they could be generalized for teaching, formation, and clinical training of spiritual care providers. First, spiritual caregivers can watch films, read novels, and marinade themselves in autobiographies written by and about refugees, migrants, and religiously multiple people. Reading fiction, in particular, strengthens empathy, enriches a person’s theory of mind, and correlates with stronger social support (see Mar, Oatley, and Peterson, 2009). There are many excellent resources for this practice. For example, Nguyen Duc’s documentaries “Bolinao 52” (2010) and “Stateless” (2012) thrust the viewer into the experience of Vietnamese refugees; Yaa Gyasi’s novel Homegoing (2016) maps the migrations of multiple generations of an African family whose roots lie in the Gold Coast of Africa; and the memoir Dreaming Me by Jan Willis (2012)

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chronicles her life-long experiences being black, Baptist, and Buddhist. The television series Transparent also wrestles with generational effects of migration and multiplicity. Second, caregivers can reflect on their own complex religious bonds and multiplicities. By this, I mean attending to the intersectionality (Ramsay, 2014) of our social, cultural, racial-ethnic, sexual, gender, and religious identities. Have we always been a part of the religious tradition that is our primary location now? Are we influenced by or have bonds to other traditions? What traditions shaped each of our parents? Our grandparents? Who are our spiritual ancestors and what traditions shaped them? In what ways do we perform our religious and spiritual selves differently in different contexts? When do we mask or minimize religious and spiritual identities? How do we attend to disclosing invisible identities that could contribute to stigma? A goal of this reflection is to increase our awareness of how and when we “stand between” categories and identities in our own life. A second goal is to identify the strategies we use, explicitly or implicitly, to navigate the tensions of these “in between” places where overlapping identities increase complexity, offer resources, and challenge the status quo. Third, caregivers can learn and document how migration shaped their families. How many generations back did your ancestors migrate to your current location? Were your grandparents or parents forced to relocate by the Great Depression? Who went to war? Which of your family’s friends had experiences as refugees, displaced persons, or asylum seekers? What are your family stories about migration? How and when do they surface? In what ways does migration continue to influence your feelings, thoughts, behaviors? A goal of this reflection is to become more aware of how common migration and relocation are in human experience. Another goal is to better understand your relationship to “home,” whatever and wherever that is, and to identify generational traumas from migration that continue to influence your assumptions, attitudes, and values.

Conclusion One character in She Weeps Each Time You’re Born engages in precisely these sorts of reflections. Near the end of the novel, Rabbit receives a visit from an American born in Vietnam. The woman has come to re-member her racialethnic identity, to understand the complexity of her identities, to see what was lost and what was gained through her family’s migrations. When Rabbit sees this woman for the first time, she is flooded with an image of young rice plants “carried by hand from field to flooded field” (Quan, 2014, p. 256). She thinks:

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Transplantation. The green stalk putting down roots. What you want to say to her : ‘Wherever you go in the world, even if you find yourself in a strange land among strangers who love you, know that someone will always be listening who loved you first,’ but there is no need to say this as the woman already knows, a presence at her shoulder keeping watch as she has always suspected. When you take her hand in yours, a symphony of voices rises from her skin, ancestors multi-various like branches of a tree. . . . The woman is not looking for anything or anyone. She is not asking you to listen on her behalf. She knows she does not walk alone and never has. And now in the light of this room where she stands in the presence of one who might bring her face-to-face with her origins, she lets the awareness wash over her. Consequently, please do as you have always done and say, ‘I hear you,’ and leave it at that (p. 256).

This, I suggest, is how we offer a counter-narrative to a despairing world. This is how we begin to decenter dominance and violation: We befriend, witness, and say, “I hear you.”

References Barry, Q. (2014). She weeps each time you’re born: A novel. Kindle edition. New York: Panetheon. Becker, G., Beyene, Y, and Ken, P. (2000). Memory, trauma, and embodied distress: The management of disruption in the stories of Cambodians in exile. Ethos, 28 (3): 320–345. Bidwell, D. R. (2011). Dis/orientations: Pastoral counselors, possibilities, and a spirit of skewed perspectives. Plenary address for the American Association of Pastoral Counselors Annual Conference, Phoenix, AZ, April 2. Bidwell, D. R. (2015a). Religious diversity and public pastoral theology : Is it time for a comparative theological paradigm? The Journal of Pastoral Theology 25 (3): 135–150. Bidwell, D. R. (2015b). Deep listening and virtuous friendship: Spiritual care in the context of religious multiplicity. Journal of Buddhist-Christian Studies, 35: 105–112. Bidwell, D. R. (2018). When One Religion Isn’t Enough: The Lives of Spiritually Fluid People. Boston: Beacon Press. Bodhi, B. (Ed.). (2005). In the Buddha’s words: An anthology of discourses from the Pali canon. Boston: Wisdom Publications. Briere, J. (2012). Working with trauma: Mindfulness and compassion. In C. K. Germer & R. D. Siegel (Eds.), Compassion and wisdom in psychotherapy, 265–279. New York: Guilford. Campbell, B., and Manning, J. (2014). Microaggression and moral cultures. Comparative Sociology 13 (6): 692–726.

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Greider, K. J. (2010). Soul care amid religious plurality : Excavating an emerging dimension of multicultural challenge and competence. In J. Stevenson-Moessner and T. Snorton (Eds.), Women out of order: Risking change and creating care in a multicultural world, 293–313. Minneapolis: Fortress. Greider, K. J. (2011). Religious multiplicity and care of souls. In I. Noth, C. Morgenthaler, & K. J. Greider (Eds.), Pastoralpsychologie und Religionspsychologie im Dialog/Pastoral Psychology and Psychology of Religion in Dialogue, 119–135. Stuttgart: Verlag W. Kohlhammer. Gyasi, Y. (2016). Homegoing: A novel. New York: Knopf. Holton, M. J. (2016). Longing for home: Forced displacement and postures of hospitality. New Haven and London: Yale University Press. Kong, C. (2003). On Buddhism and psychotherapy. In S. Chan (Ed.), Not just victims: Conversations with Cambodian community leaders in the United States, 65–91. Interviews by A. U. Kim. Urbana and Chicago: University of Illinois Press. Koosed, J. L. (2011). Gleaning Ruth: A Biblical Heroine and Her Afterlives. Studies on Personalities of the Old Testament, James L. Crenshaw (Ed.). Columbia, SC: The University of South Carolina Press. Mar, R.A., Oatley, K., and Peterson, J.B. (2009). Exploring the link between reading fiction and empathy : Ruling out individual differences and examining outcomes. Communications, 34: 407–428. Marshall, J. L. (2016) Collaborating Hope: Joining the In-Between Spaces. Journal of Pastoral Theology, 26 (2): 77–90, DOI: 10.1080/10649867.2016.1247618. McClure, B. J. (2010). Moving beyond individualism in pastoral care and counseling: Reflections on theory, theology, and practice. Eugene, OR: Cascade. Miller-McLemore, B. J. (2004). Pastoral theology as public theology : Revolutions in the ‘fourth area.’ In N. J. Ramsay (Ed.), Pastoral Care and Counseling: Redefining the Paradigms (45–64). Nashville: Abingdon Press. Nguyen, H. D. (2010). Bolinao 52 [Motion picture]. United States: Right Here in My Pocket Productions. Nguyen, H. D. (2012) Stateless [Motion picture]. The Philippines/United States: Right Here in My Pocket Productions. Nguyen, T. X. (2012). Religions in Viet Nam. Ho Chi Minh City : The Gioi Publishers. Rambo, S. (2010). Spirit and trauma: A theology of remaining. Louisville: Westminster John Knox. Ramsay, N. J. (2014). Intersectionality : A model for addressing the complexity of oppression and privilege. Pastoral Psychology, 63 (4): 453–469. Sanders, C. J., and Yarber, A. (2015). Microaggressions in ministry : Confronting the hidden violence of everyday church. Louisville, KY: Westminster John Knox Press. Sue, D. W. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. Hoboken, NJ: Wiley. Thach, B. (2003). The Khmer Khrom. In S. Chan (Ed.), Not just victims: Conversations with Cambodian community leaders in the United States, 259–274. Interviews by A. U. Kim. Urbana and Chicago: University of Illinois Press.

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Vu, T. A. T. (2006). Worshipping the Mother Goddess: The ¯Da. o M.˜ u movement in northern Vietnam. Explorations in Southeast Asian Studies, 6 (1): 27–44. Willis, J. (2012). Dreaming me: Black, Baptist and Buddhist—one woman’s spiritual journey. Somerville, MA: Wisdom Publications.

Daniel S. Schipani1

Caring Host Communities and Migrants: Two Models for Description and Analysis

Abstract Several areas of research await systematic consideration regarding the relationship between migration, religion, and spiritual care. One of them has to do with the possible place and function of local faith communities as care providers, given their unique social location between families and the larger social context. Indeed, it can be argued that those religious communities can become effective ecologies of care as they address the challenges and struggles of migration in their midst as well as in their surrounding context. Another topic that needs attention in the field of spiritual care is the dynamic interaction between host communities and migrants; a special focus in this case is how to understand and address the negotiation involving issues of identity and integrity in tension with those pertaining to peace and community building. In light of such twofold challenge and opportunity, this chapter explores both sets of questions from the perspective of practical theology.

Introduction This essay highlights the place and function of faith communities as a necessary focus in the study of the relationship between migration, religion and spiritual care. It starts with a brief account of my personal and professional experience in connection with the topic, which led me to articulate a number of hypotheses concerning the mediating function of faith communities. That section is followed by an illustration – a comparative case study – provided by a colleague in the field of Practical Theology2. The third 1 Psy. D., Ph. D., Professor of Pastoral Care & Counseling, Anabaptist Mennonite Biblical Seminary, Elkhart (Indiana), USA. Email: [email protected]. An earlier version of this essay appears in Daniel S. Schipani, Martin Walton, & Dominiek Lootens, eds., Where Are We?: Pastoral Environments and Care for Migrants: Intercultural and Interreligious Perspectives (Dusseldorf: SIPCC, 2018), 211–222. 2 Practical Theology is here understood as a discipline whose epistemological structure has empirical-descriptive, hermeneutic (interpretative), evaluative (normative), and pragmatic-strategic dimensions. For a clear presentation of that understanding, see Richard Robert Osmer,

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section consists in a proposal on the potential of religious communities to become ecologies of care. And the fourth and final part of this essay presents a case study of migration as experienced by German-speaking Mennonites in Paraguay, South America. In the third and fourth sections I propose two conceptual tools that I developed in order to facilitate observation, analysis, and evaluation of communal practices related to migration. Readers are invited to ponder the potential usefulness of these tools in light of their reflective work of caregiving with, and for, migrants in their own social context and particular institutional settings.

An Account of Reflective Experience, Observation and Practice My interest in the intersection of migrations and caregiving has a number of sources related to family and personal experience as well as vocational inclination and professional practice. My four Italian grandparents were immigrants in Argentina, so I grew up in an Italian-Argentinian sub-culture with strong incentive to become integrated into the larger culture. That subculture was, in turn, significantly influenced by my parents’ active participation in the life of a Christian evangelical faith community in the town where I was born. Several years later, I went to the United States to work in theological education and became an immigrant myself in that country. I thus joined the ranks of millions of dual-culture (or culturally “hybrid”) individuals living in North America. This has become all the more the case as I have developed strong relationships and collaborative ties in Latin America and the Caribbean.3 I continue to experience both the benefits and challenges of “transnationality”;4 at the same time, my participation in the life and ministry of a local congregation has continued to be a major source of socio-emotional and spiritual nurture as well as support and accountability. My work in pastoral and spiritual care across cultures has led me to pay special attention to the situation of migrants in diverse socio-cultural contexts. That vocational commitment found particular expression in fifteen years of volunteer work as a pastoral counselor at a community health care center that offers affordable care to socio-economically vulnerable care seekers. Many Practical Theology : An Introduction (Grand Rapids: Eerdmans, 2008). The present essay is meant as a report on practical-theological work on migration and faith communities with focus on caregiving practice. 3 I am a regular visiting professor in Colombia, Cuba, and Guatemala, in addition to having occasional involvements in Argentina and M8xico. 4 I use the term transnationality to denote active participation in the host culture of the United States as well as in Latin American cultures where Spanish is the main language. This situation is somehow facilitated by the fact that I hold dual citizenship (Argentina and United States).

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patients happen to be Mexican and Central American immigrants with different measures of religious affiliation but, mostly, Roman Catholic. In any event, I have found that the significant role that Catholic and Evangelical/ Pentecostal faith communities play as mediating “spaces” between society and the family, can hardly be exaggerated. Not only are they safe and sacred places that immigrants can call their spiritual home, those faith communities also make available many resources for immigrants to navigate the ways of the host culture; first generation immigrants, especially, are offered orientation and support while encountering issues related to schooling, work, and health care, among others. In addition to personal and professional experience, systematic observation and analysis of the dynamics involving migration and religion in different cultural settings can also help to appreciate the place and function of faith communities. That is the case, for example, regarding studies of migration with focus on the church and hospitality as central value and practice (Sweeden, 2015). I can also refer to multiple examples I have become well acquainted with, such as the following, very different three. First, “Casa Migrante” in Amsterdam, the Netherlands, has welcomed immigrants and refugees, first from Spain and then also from Latin America, for several decades. Started by Carmelite priest Theo Beusink in 1962, the program offers legal and psychosocial as well as spiritual assistance and is connected to the parish of Saint Nicholas Church (Beusink, 2017, p. 24–27). Second, the political and economic realities in Cuba have been a major factor regarding emigration. Churches have had to develop strategies and programs focusing on both those wishing to leave the country as well as relatives, friends, and also other members who choose to stay or cannot emigrate. The impact of Cuban emigration on the family is a particular concern (Ar8s Muzio, 2014, p. 16–29; Perera Pintado, 2014, p. 40–45). Third, a migrant Muslim faith community in Boise, Idaho (USA) has become a significant resource not only for immigrants coming from the Middle East but also for the community at large, including interreligious dialogue and multifaith cooperation. Further, that particular religious community has made it possible for women to assume leadership responsibilities in their midst which, in turn, appears to be an occasion for contextually pertinent and functional Islamic renewal at the local level.5 Those and many other instances of observation, interfaith reflective dialogue and collaboration, and active engagement in research and practice have led me to propose a number of hypotheses regarding faith communities as mediating spaces. These hypotheses are presented below in italics followed by some clarifying remarks. They presuppose interdisciplinary understand5 Reported and discussed as a case study by Rev. Kim Cran for my D. Min. course, Multicultural Care and Counseling at San Francisco Theological Seminary (July, 2016). Rev. Cran is the pastor of the United Church of Christ congregation in Boise, Idaho. Together with other members of her church she has become personally involved in those experiences of multidirectional hospitality.

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ings involving the social and behavioral sciences and, especially in the case of Christian communities, theology (particularly ecclesiology, but not exclusively).

Four Main Hypotheses Faith communities can function as mediating spaces between the cultural, socio-economic, and political realities of society at large and those of the family. Further, that can happen in uniquely contextualized ways in terms of their seemingly fundamental or transcultural design; that design consists of interrelated practices of worship (“up- reach”), community life (“in-reach”), and service ministry (“out- reach”). I am well aware that such a threefold design – worship, community, and mission – can functionally define the very nature of the Christian church.6 It remains to be further explored collaboratively whether that threefold pattern is also (analogously) present in the other two “Abrahamic faith traditions,” namely, Judaism and Islam. Preliminary interreligious collegial conversations suggest that the pattern is somehow shared by those traditions and that, possibly, it might correlate with their fundamental normative theological convictions regarding love of God and love of neighbors close and far. Membership and consistent participation in those religious communities are inherently formative and, at least potentially, transformative. Faith communities can thus be viewed as ecologies of nurture, support, care, and healing with unique potential regarding the relationship with migrants. It is well known that faith communities can also foster toxic religion and spirituality. This is the case, for instance, as manifested in diverse forms of fundamentalism, harmful practices related to medical treatment, corrective discipline of children, and others. Toxicity is not, however, a major focus of this study. Faith communities can therefore play a major role in terms of primary, secondary, and tertiary prevention7 in the face of migration crisis and trauma, the latter always the case of migrants as refugees; that role can be explored in the case of both, “releasing”(letting go) and “receiving/welcoming” those who migrate. The notion of “primary prevention” denotes adequate and defensive mobilization of resources before a critical or a traumatic situation presents itself; its purpose is to hinder or neutralize the onset of a crisis or trauma 6 This broad characterization of the church is assumed to be theologically adequate across the broad spectrum of Christian theological traditions and denominations. Systematic ecclesiologies can offer distinct and comprehensive theological grounding, for example, for a sacramental view articulated in Trinitarian terms (Boff, 1988; LaCugna, 1993). 7 For the use of the terms “primary”, “secondary”, and “tertiary” prevention I follow Gerald Caplan’s classic contribution on preventive psychiatry (Caplan: 1964).

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resulting from such situation. “Secondary prevention” connotes timely care made available as soon as a crisis or trauma begins to develop; in other words, it consists in prompt intervention aimed at lessening the impact of the severe crisis or trauma that forced migrations always cause. The notion of “tertiary prevention” refers to the caregiving efforts made available in order to facilitate recovery and re-orientation towards a new “normal”. Comprehensive pastoral and spiritual care of migrants always necessitates paying attention to bio-psycho-social-spiritual factors and dynamics at play. Further, systemic strategies and approaches are always preferred. Hence, caregiving needs to be implemented together with adequate forms of communal and social action. As far as migrants’ spirituality as a focus of spiritual care is concerned, both care seekers and caregivers can engage in supporting, guiding, healing, and empowering processes on different levels (family, individual, institutional, communal, and social). One of the main, commonly shared goals is to foster spiritual growth in terms of meaningmaking, connectedness and communion, and life orientation and purpose (Schipani, 2013, p. 149–166). The following section has the account of a recent multi-site case study led by my Colleague Rachel Miller Jacobs. (Miller Jacobs, 2018)8 It is included here with her permission.

A Comparative Case Study The purpose of this multi-site case study was to find out more about how three Christian congregations negotiated, practically and theologically, the reality of migrants in their midst. These congregations were chosen for the length of time (twenty years or more) they have been engaged in this project and their general representativeness in location and size within their denomination. In each congregation, the researcher interviewed three people: the lead pastor (dominant culture), a dominant culture congregational member, and an immigrant. She used an interpreter for the interviews with the immigrants; she collected about half as much volume of data from the interviews with immigrants because of way translation slowed the pace of the conversation, though it is possible that the quality of their reflections was deepened because that measured pace gave people a chance to think more carefully about what they wanted to say. One fascinating and unexpected result of the presence of interpreters was the lively conversations that ensued between translator and interviewee. 8 Rachel Miller Jacobs and I collaborated in a year-long (2017) study of migration together with other members of the Faculty at the Anabaptist Mennonite Biblical Seminary.

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The questions the researcher asked in this study focused not only on individual and congregational practices but also on issues such as how those practices affect, and are affected by people’s motivations, commitments, engagement with the Bible, and spirituality.9 She states that case studies are especially helpful in thinking about everyday practice and that congregational life is overwhelmingly about the everyday. Further, she finds that they are also suggestive rather than comprehensive: their value lies in what they reveal about what is being studied and what that information might suggest for other, similar situations. Thus while the data gathered and analyzed reflects the thinking and experience of a small number of people (three people each in three different congregations), it raised some interesting possibilities and suggests some fruitful areas for further study. The most unexpected finding was that immigrants/refugees and dominant culture pastors have more in common with each other (at least in the areas investigated in that study) than they do with dominant culture congregational members. Both groups have personal motivation for building an intercultural church; both draw on the Bible specifically and in significant ways to support that vision; both speak about God’s presence and guidance in their lives and depend on God in practical ways. For them, this is personal. In contrast, dominant culture congregational members are much less invested in an intercultural church. For the most part, they became members of the church before the vision for, or reality of, an intercultural church emerged in any strong way, so they have simply remained in place while things changed around them. This does not mean that they oppose that vision; it simply recognizes the reality that it is not the organizing principle for their understanding of the church and their engagement in it. In this, they probably represent a significant majority in two of the three congregations; in the third, which has been intercultural from its inception, it is likely that more members are more committed to an intercultural ecclesial vision than is reflected in the data. It was found that for dominant culture congregational members, an “accommodation” posture is actually very sustainable over time, and power relationships characterized by care, nurture, and protection may be both attractive to Christians schooled in compassion, hospitality, and service, and 9 Each person interviewed was asked the following five questions: – What motivates your congregations to welcome immigrants? (In addition, for immigrants) What motivated you to come to this congregation? – What specific practices has your congregation undertaken in that welcome? – How widespread is ownership/engagement in these practices? Is this a mission of a few, or imbedded in the congregation’s life and practice? – What biblical texts or ideas about God or the church are important in thinking about the integration of immigrants in your congregation? – How are you or your congregation experiencing God’s presence and guidance in what you’re doing? How has God comforted and challenged you?

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difficult to release in favor of more challenging forms of power sharing. With the exception of “segregation,” the varieties of ways of interacting10 seemed to all be present to some extent in the congregations studied; this variety signals both that no group, of any size, is likely to be monolithic, and also fleshes out some of the reasons why changing cultural culture is such a slow and often protracted process. Furthermore, moving from being a monocultural church to becoming an intercultural church, requires “a concept of culture that is dynamic, heterogeneous, and negotiated within a field of power relations” (Brazal & de Guzman, 2015, p126). Miller Jacobs observes that analyzing and negotiating power relations is a crucial practice for congregations to develop more widely than they have so far ; and that their capacity to move more fully into interculturality depends on it. Brazal and de Guzman have noted that “[i]ntegral to the ministry of an intercultural church is advocacy to equalize power relations with the country of origin and within the receiving society” (p. 127) and, Miller Jacobs adds, within the congregation itself. In this respect, she finds that Brazal and de Guzman’s suggestion of the intercultural church as a “third space” that moves beyond the either/or of immigrant or dominant culture holds promise for further theorizing and theologizing. They suggest three theological motifs to undergird an intercultural, “third space” church: the motif of Pentecost (mentioned by a pastor in this study), the New Testament motif of “the way,”11 and the doctrine of the Trinity, “the mystery of the one God characterized by relationality, equality in diversity, and creativity” (p. 131). Miller Jacobs suggests that one further area that may be worth additional investigation and reflection is the spirituality of an intercultural church, and the spiritual disciplines that could undergird that spirituality. On this question she quotes Gemma Tulud Cruz, who proposes that a spirituality of suffering (Cruz, 2014, p. 140), a spirituality of pilgrimage (Brazal & de Guzman, p. 131), and a spirituality of hope and life (p. 146) characterize the ways that, for migrants, “the invisible heart of God is made visible in the world” (p. 151). She also acknowledges that those are all deeply rooted in Christian faith and it is less clear that they connect vitally to dominant-culture congregational members, especially middle class ones. She recognized that, if there is interest in fostering and nurturing intercultural congregations, there need to be points of attachment for everyone. And she suggests that one possibility is that what the migration experience offers immigrants in terms of immediacy needs to be “made up for,” in the case of dominant culture members, by spiritual disciplines. 10 Rachel Miller Jacobs here alludes to the model I developed—“Host communities/cultures and immigrants: Five ways of interacting”—which is presented and discussed in the final section of this essay. 11 See also Gemma Tulud Cruz, Toward a Theology of Migration: Social Justice and Religious Experience (New York: Palgrave MacMillan, 2014), 143 ff.

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The dynamics of hospitality is then a focus of special interest for which Miller Jacobs connects with the contribution of Jessica Wrobleski. Writing through the lens of the hospitality offered in Catholic Workers houses, Wrobleski notes that “it is fitting to speak of disciplines rather than simply practices” because, while spiritual practices may be engaged in occasionally, “a discipline indicates a regular and committed practice” (Wrobleski, 2012, p. 48). She suggests five pairs of spiritual disciplines that are especially “relevant to hospitality :” spoken prayers and prayers of silence, solitude and fellowship, fasting and celebration, service and rest, and confession and forgiveness (p. 53). Her list of spiritual disciplines is tailored to hospitality characterized by caring, nurturing, and protecting. Miller Jacobs concludes that this raises the question of what spiritual disciplines might strengthen the capacity of all, but perhaps especially dominant culture people, at the service of reconciliation and the formation of a “new humanity”. In light of the material presented thus far, the remainder of this essay presents two related models. I created them to function as heuristic tools for studying certain aspects of the relationship between migration and religion. The first model helps to visualize programs and practices that faith communities can develop and offer while realizing their vocation as mediating spaces between the larger culture and the family. The second model suggests a way to assess diverse patterns of interaction and power dynamics between immigrants and host communities and cultures.

Faith Communities as Ecologies of Care In principle, and by their very nature, those practices that define and characterize a given faith community as such can contribute to both formation and care on an ongoing basis. That can be the case of Christian congregations to the extent that their lived experience is consistent with their theologically defined vision of becoming a sacrament – that is, sign, symbol, and instrument – of divine love (broadly viewed, including justice with peace) in the world. Brief reference to the church’s threefold reason for being, alluded to above – worship, community, mission – can illustrate the point, especially in connection with the realities of migration, as suggested below. Worship practices of praise and thanksgiving, confession, testimony, and instruction can reinforce a sense of identity and peoplehood that transcends ethnic and cultural boundaries. Community building practices of hospitality and solidarity in mutual care, communication and conflict transformation, and material and other forms of assistance (legal aid, for instance), among others, can foster a sense of “spiritual extended family.” And mission-oriented practices of advocacy, material and other forms of care (for example,

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translation services), offering sanctuary, and others can nurture a sense of vocation and overall life orientation. The study reported by my colleague Rachel Miller Jacobs, identifies some of the opportunities and challenges facing immigrants and host faith communities alike in the ongoing life of congregations. It also suggests the potential complementarity between those practices pertaining to the indispensable areas of worship, community, and mission on the one hand and, on the other, contextually programmatic activities that can be planned, implemented, evaluated (and, eventually, discontinued) at a given time. The following chart can be used to visualize the place and function of the latter, both within and beyond or outside the faith community.

All the dotted lines indicate that it is neither possible nor desirable to establish a clear distinction or separation between related categories. Thus, continuity is suggested between formation and transformation processes; the same may be said concerning primary, secondary, and tertiary prevention. Similarly with regard to the relative difference between those practices, settings, and programs located inside and beyond/outside the faith community. The content included in the four quadrants is meant to illustrate just a few possible specific activities and focus. Readers can, of course, supply additional examples.

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This chart depicts the model in a way that can serve as a one-page panorama of a faith community’s “explicit curriculum” regarding dynamics of migration in its midst. That is to say, it can represent its declared and intentional plan of action. Ideally, such public agenda is consistently supported by the “implicit curriculum.” The significance of the latter can be assessed, for instance, in light of actual budget priorities and allocation of financial and other resources, the usual ways migrants are addressed and treated, uses of language, opportunities for collaboration and creative power, and so on. The operative ethical-theological norm undergirding those programs and practices points in the direction of communal integration as imperative. In other words, it is claimed that the hospitable welcoming of immigrants can realize, at least partially, the ideal of contextualized expressions of “new humanity”12 in solidarity, equality, and mutuality in diversity. That ethical-theological norm can be invalidated in practice, however. When the implicit curriculum contradicts the good intentions of the explicit one thus becoming truly “hidden curriculum”, the potential for serious conflict and various forms of violence increases. Another source of trouble for a faith community has to do with the so-called “null curriculum” which, paradoxically enough, is important because it does not exist.13 This is the case whenever significant issues, situations or conditions, are suppressed from awareness and thus remain unattended, such as sexual abuse and other forms of exploitation suffered by migrants and refugees. Finally, a brief word on migrant agency is in order. Much of the reflection on migration from psycho-socio-theological perspectives tends to assume that migrants are always victims and always vulnerable. Our discussion so far could also be viewed in that light, which is the reason for adding the preposition “with” to “caring for” whenever possible. A helpful corrective in migration studies and therefore also in the praxis of care and social action, should also include the focus on “the agentic dimensions of migrant lives,” in sociologist Federico Settler’s terms (Settler, 2017, p. 11). His threefold proposal regarding the significance of migration in the intersecting fields of religion and migration states that (1) it disrupts the idea of the nation state, and who belongs and who does not; (2) it expands understandings of church and pastoral practice; and (3) it raises some key questions about authority, dogma, and taxonomies of religion and theology that emerges from the contexts of migration (Settler, 2017). Considered on the local level, the case of the Muslim faith community of Boise, Idaho, briefly mentioned earlier in this chapter, is an interesting illustration of the potential “agentic” resourcefulness of 12 The term “new humanity” is here associated with the thought of the Apostle Paul as registered in the epistles to the Galatians 3:28, Ephesians 2:1122, and Colossians 3:11. For Paul, the vision of new humanity and new creation must also be understood eschatologically, that is, as the culmination of history in cosmic reconciliation. 13 For the notions of explicit, implicit, and null curriculum, I am indebted to the late religious educator and practical theologian, Maria Harris (1989).

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migrants; not only can they help transform faith communities but they can also make a significant contribution to the larger society. The following section presents a case study that illustrates the central place and role of religion and faith communities in the survival and flourishing of migrants and refugees. It also serves the purpose of illustrating a heuristic model developed to describe and analyze different ways of interaction involving immigrants and host societies.

Case Study : Mennonite Experience in Paraguay “We envisioned a future Mennonite state… A particular advantage of the Paraguayan Chaco is the fact that no culture exists there [sic]. There is no danger that the Mennonites, with their German culture, will disappear into a foreign culture.” Those were the words of a prominent leader reporting to the second Mennonite World Conference in 1930. He was alluding to an international effort to relocate more than 100,000 Mennonites from the Soviet Union (Goossen, 2016a, p. 13). Mennonites went to Paraguay, South America primarily as refugees – cultural refugees from Canada, political refugees from Russia. They started immigrating in 1927 under a unique law (Law 514) specially passed by the Paraguayan Parliament in 1921 that was crafted to favor Mennonite immigration. This was the first law in Latin America dealing with people who refused to join the army and the military draft. Those immigrants went to the Chaco, Paraguay’s extensive wilderness region west of the Paraguay River, in an area characterized by a complete absence of the state. They settled in a territory disputed by the nations of Bolivia and Paraguay, owned legally by a Spanish-Argentinian corporation but historically the habitat of the Enlhit native people who were not aware that several other institutions claimed ownership of their territory. Mennonite immigrants were given a geographic space in the land where they would enjoy considerable autonomy. The Paraguayan Parliament simply ignored the presence of indigenous peoples in the area while also seeking to neutralize its conflict with the neighboring country of Bolivia (Goossen, 2016b, p. 237–240). The immigrants brought the colony system, and the Raiffeisen-Genossenschaft (co-operative) system from the Soviets, and introduced them into Paraguayan society. Further, Mennonites in Paraguay were the main concern and object of help in the first decades of the existence of two major agencies and programs of the Mennonite Church in North America, namely Mennonite Central Committee (MCC), and Mennonite Economic Development Associates (MEDA) (Goosen, 2016b, p. 246–254). These immigrants arrived in South America with a rather confused mosaic of citizenships. The first group arrived with Canadian national identity and

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passports; the second group with no citizenship at all; and the third group with German citizenship and experience with the Wehrmacht, though they had been born in Russia. Over the decades, they developed from extreme poverty to become one of the wealthiest social groups in Paraguay ; per capita income in their immigrant communities was at least ten times higher than the national average (Goosen, 2016b, p. 240–245). After just a few decades of life in the host country, one of the current principal leaders of the Mennonite Church in Paraguay has asserted that the “Mennonite experience in Paraguay might be one of the most significant epochs in Mennonite history with respect to what theologian John Howard Yoder called “mission by migration.” With strong, first generation Anabaptist-Mennonite churches within five native ethnic groups in the central Chaco, and about one hundred local churches in the Spanish-Paraguayan cities and countryside, the Mennonite experience in Paraguay is multi-ethnic. The past meets the future. The ethnic immigrant stream will sooner or later be a Mennonite minority” (Goossen, 2016a, p. 13). The Mennonite experience in Paraguay can also be studied in terms of the different ways that immigrants and refugees interact with host cultures. In fact, that is a topic that can be explored afresh in light of the complex realities of migration. The following paragraphs will describe those ways of interacting as they apply to the case study, while also helping to illustrate the potential value of the heuristic model. Accommodation is a necessary initial transitional phase after the arrival of immigrants. Both hosts and guests need to accommodate. The receiving/ welcoming party needs to negotiate space and “make room” available. There must be adaptation from both sides. The expectation is that the hosts will provide resources and services that concretely contextualize welcoming the outsiders. In that sense, we can say that the hosts will ideally exercise power for (that is, in favor of) the immigrants in light of key values such as compassion, hospitality, respect, and service. Theologically viewed, from the perspective of the hosts, the focal motif is welcoming the stranger (as welcoming God, the Christ). In any event, accommodation is transitional in that, in due time, there will be movement toward either separation (or segregation), assimilation, or integration. In the case of Mennonites who arrived in Paraguay, initial accommodation very soon led to separation. Actually, separation was the desired alternative for both immigrants and host culture. Mennonites would live and, eventually, thrive in enclaves protected by law. For the most part, German-speaking Mennonites have resisted full assimilation to the larger Paraguayan culture. Dynamics of separation and assimilation are discussed in the next two paragraphs. Interaction leading to separation can be either a relatively settled option or another transition beyond initial accommodation involving immigrants and hosts cultures. On the one hand, separation can be imposed with different rationales that justify power against. On the other hand, separation can also be an expression of resistance to assimilation and of the will to survive. In certain

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instances, a relatively peaceful separation/segregation can be the means to maintain a privileged situation on the part of a minority culture, as in the case of Mennonite immigrants in Paraguay. In more extreme cases, withdrawal and avoidance of interaction can be attempts to avoid social conflict. Therefore, key values involved in separation may include preservation, purity, and survival. Viewed theologically, and especially in cases of forced segregation, it could signify the belief of having been exclusively chosen, together with the condemnation of the other (that is, playing God). Assimilation denotes a process of identification with the host culture that tends to minimize difference. Therefore, in principle it implies significant loss of identity and tradition. The assimilation process can be expected, encouraged, or somehow forced by the dominant culture upon immigrants. In other words, it can be relatively “benign” (for example, linked to the ideology of the “melting pot”) or hostile; in any case, it always involves diverse forms of power over, in the endeavor to “absorb,” so to speak, the immigrants. This process could be called “assimilation from above” and power over (control, domination). By contrast, assimilation “from below” could then be the name of the process of adoption or, sociologically speaking, “upward assimilation,” determined, for example, by the lure of economic opportunity and better political conditions. In this case, immigrants can exercise a relatively greater degree of agency, power to (possibility). The undergirding values and the power dynamics at play are different for each case: identity, tradition, and homogeneity correlate with “assimilation from above,” the key theological motif being “re-making the other” in the image of the powerful or oppressor (another way of playing God). Adaptation, upward mobility, and prosperity are key values undergirding “assimilation from below”; key theological motif could be Promised Land or, in some cases, a heroic yielding (“kenosis”) for the sake of peace. In addition to those Mennonite immigrants who arrived with German citizenship, it has been relatively easy for most German-speaking Mennonites to obtain German citizenship while also holding Paraguayan citizenship. This is a clear illustration of desired transnationality facilitated by consistent use of the German language, education in German-language schools, and participation in church services. For those Mennonites living closer to urban populations, it has not been difficult to become acculturated yet not assimilated into the larger culture. “Acculturation” is understood here as cultural modification of a group of people by adapting to or borrowing traits from another culture. On the one hand, it can be demonstrated that, increasingly, “ethnic Mennonites” in Paraguay “adopt” the Paraguayan society and its cultures (adoption) by way of voluntary acculturation. However, full integration within the larger culture remains elusive for the majority of Mennonites who live in several economically prosperous colonies. This is more readily the case, however, among those located in predominantly urban localities.

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In sum, it should be clear that, in terms of power dynamics, there is a key difference between the processes of assimilation (including “upward assimilation” that I have called “adoption”), separation/segregation, and integration. In assimilation, the main assumption as well as the goal is that the immigrants are responsible for becoming like the host community and culture. In separation/segregation, power against defines the dynamic of exclusion, often with the purpose of maintaining identity and integrity, whether “from above” or “from below.” In the process of integration, host communities and immigrants consider each other as equal in power and are open to mutual cultural enrichment as well as correction. The power dynamic is primarily collaborative, or power with. Key undergirding values are, then, solidarity, mutuality, diversity, and creativity. And the main theological motif is reconciliation and fashioning “new humanity.”

Conclusion Caregiving and social action practiced by faith communities as mediating spaces between families and the larger society and culture involve careful consideration to dynamics of interaction between migrants and host cultures. Maintaining cultural and religious integrity and identity, and building peace in (just) communities are two indispensable axes in the normative framework that guides those practices and programs. The chart at the end of this essay summarizes the model. It is offered as a heuristic device created with those two main sets of variables in mind. It is, of course, understood that the five “ways of interacting” are far more complex and dynamic than suggested on paper. In any case, I tried to keep in mind the relationality always involved between immigrants and hosts in order that each of the five situations could be visualized from the perspective of each. The desired, normative direction is, then, preferred movement toward integration in which those two main sets of variables converge. Obviously, it is often the case that full integration cannot or should not be realized for a variety of reasons. It is almost always the case that it cannot be reached quickly and simply by moving towards it from the initial process of accommodation, let alone from situations of separation or segregation. Nevertheless, the rationale for such a bias towards integration can be stated in terms of converging interdisciplinary views of the “good society” on psycho-sociological, politicaleconomic, and theological grounds. Given that ideal, perhaps the words from Psalm 85:10 can inspire us on the way forward in care giving and social action with and for migrants. They express divine and human longings for communal wholeness: “Steadfast love and faithfulness will meet; Justice and peace will kiss each other.”

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References Ar8s Muzio, P. (2014). La emigracijn y su impacto en la familia cubana. Didaj8 (5), 16–29. Becker Sweeden, N. (2015). Church on the way : Hospitality and migration. Eugene, OR: Pickwick. Beusink, T. (2017). Mi actitud de creyente frente a los refugiados, Ventana Europea (109), 24–27. Boff, L. (1988). Holy Trinity : Perfect community. Maryknoll, NY: Orbis Books. Brazal, A. M. & E. S de Guzman. (2015). Intercultural church: Bridge of solidarity in the migration context. Borderless Press. Caplan, G. (1964). Principles of preventive psychiatry. New York, NY: Basic Books. Cruz, G. T. (2014). Toward a Theology of migration: Social justice and religious experience. New York: Palgrave MacMillan. Goossen, B. (2016a). Legacy of a Mennonite state, Mennonite World Review, 94(8), 1–13. Goossen, B.W. (2016b). Mennonites in Latin America: A review of the literature. The Conrad Grebel Review 34(3), 236–265. Goossen, B.W. (2017c). Chosen nation: Mennonites and Germany in a global era. Princeton, NJ: Princeton University Press. Harris, M. (1989). Fashion me a people: curriculum in the church. Louisville, KY: Westminster/John Knox Press. LaCugna, C. M. (1993). God for us: The Trinity and Christian life. San Francisco, CA: Harper Collins. Miller Jacobs, R. (2018). Congregational Welcome of immigrants. Daniel Schipani, Martin Walton, & Dominiek Lootens, eds. Dusseldorf: SIPCC, 195–210. Perera Pintado, A. C. (2014). Religiosidad y migraciones en Cuba. Didaj8 (5), 40–45. Schipani, D. S. (Ed.). (2013). Multifaith views in spiritual care. Kitchener, Canada: Pandora Press. Settler, F. (2017) “Reforming space: Religion and migration.” Oral presentation given at the conference of the International Academy of Practical Theology in Oslo, Norway, April 21, Retrieved from http://www.tf.uio.no/english/research/iaptcon ference/material/reforming-space:-religion-and-migration.pdf Wrobleski, J. (2012). The limits of hospitality. Collegeville, MN: Liturgical Press.

Claudia Kohli Reichenbach1

Religious Communication in Hybrid Zones. Pastoral Care in Intercultural Contexts

Abstract This essay illustrates religious communication in hybrid zones using a case study in which the funeral of a family member that committed suicide was prepared. It further designates areas of potential conflict of pastoral care in the intercultural context and its objectives. In particular, spiritual care is tasked with promoting tolerance to meaninglessness, ambiguity, but also faces the challenge of discerning cultural differences in pluralistic societies.

1. Hybrid Zones The following article broaches the most important form of communication in Christian practice, pastoral care. Based on the case study method, which is customary in Anglo-Saxon countries, I will begin by relating an actual experience: Six months ago, a friend of mine called Theo2 contacted me. He was distraught. He told me that his youngest brother had committed suicide. In the course of our telephone conversation, he asked me whether I would be willing to help the family prepare for the funeral. Although the deceased brother had turned his back on the church, Theo believed that it was important for someone with a religious background to be involved. Among the relatives was the second brother, Franz, a mountain farmer from Switzerland’s Bündnerland. Theo also told me about a woman called Rosina who had been the partner of the deceased for many years. They had split up, but she had still been in regular contact with him and the two of them had often gone to cultural events together. Rosina was also going to be involved in the funeral arrangements, as was her daughter Ann who was a professional body therapist. Ann had had a close relationship with the deceased since her teenage years. We met in the attic apartment of the deceased in a Swiss city : Theo, Franz, Rosina, Ann and myself. Ann was very involved in the conversation right from the outset. The 1 Director of Continuing Education Program in Pastoral Care and Pastoral Psychology, Faculty of Theology, University of Bern / Switzerland. Email: [email protected]. 2 Names changed to protect the identities.

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death was a tremendous shock to her. She tried to take the lead, and was the first to come up with a suggestion for the funeral. Her idea was when the weather got a little warmer, we should all meet up at the location where the suicide had taken place. Ann came up with the proposal of what she called a ritual in nature, in which the ashes of the deceased would be distributed and thereby we would all be symbolically connected with the deceased and what she termed “Mother Earth”. Rosina was able to envision this, being someone who is spiritually at home in the ideas of anthroposophy. Theo nodded, but he said that he also wanted a psalm to be read and the Lord’s Prayer to be recited. He needed to find some solace from traditional rituals. He was unwilling for the Church to have no involvement in the ceremony at all. He argued that a Christian setting also offered a form of protection. It took a long time to agree on a funeral arrangement that was acceptable to everyone. I moderated the discussion, trying to understand and translate what was important to Ann and Rosina from their spiritual perspective, and also what was important to Theo and the somewhat inscrutable Franz. I was asked to organise a ritual in nature and a short ceremony in the church nearby.

In our discussion in the attic apartment, we had stumbled into what I call a hybrid zone – an exchange of ideas between an urban-based professional body therapist and a mountain farmer from Switzerland’s remote Bündnerland; an encounter between the traditions and customs of Christian religion and western forms of spirituality that have their roots in the East. They intermingled, bounced off one other, and finally arrived at a plan for a funeral, which was attended by some 60 acquaintances and friends of the deceased one fine, spring day a month later. The concept of the hybrid zone comes from biology. In a hybrid zone, related species meet, interact and generate new genetic life forms. The concept of the hybrid zone is also common in architecture. Hybrid zones are associated with innovative construction projects where architecture and art overlap.3 However, my particular interest is hybrid zones in the area of pastoral care. These zones are characterised by the coming together of different religious and cultural ideas.4 3 Cf. Sibylle Omlin/Karin Frei Bernasconi (Hg.), Hybride Zonen. Kunst und Architektur in Basel und Zürich, Basel 2003. 4 The extent to which a religious hybrid is visible at the end of the funeral would need to be investigated. In a 2013 study about religion in post-traditional contexts an interdisciplinary research team examined the concept of religious hybrids, which had until then received little attention, in regard to three groups (church building associations, estate associations and alternative communities). The study did not identify a new type of religious person but the idea of the in-between, one that does not yet and perhaps will never have a fixed form (cf. Peter A. Berger/ Klaus Hock / Thomas Klie (Hg.), Religionshybride. Religion in posttraditionalen Kontexten, Wiesbaden 2013, 24.). Berger et al. place the term in the open space between religion and culture and make it oscillate between religious and non-religious forms of meaning (cf. ibid., 27). Its distance from dogmatic conventions is what marks it out; what matters is what is negotiated and manifested in everyday situations (cf. ibid., 23).

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A small group of Swiss met in a city apartment. I present the following on the basis of the thesis postulated by the Bonn-based theologian Eberhard Hauschildt, which he repeated in a contribution to the German periodical Interkulturelle Theologie in 2015:5 Interculturalism should not just be considered in terms of separate national and linguistic cultural identities. There are, in fact, also pertinent differences within a nation’s own culture. The theory of environmentalism also points to this. According to Hauschildt, conversations on matters relating to spirituality between people with contrasting spiritual points of view often reveal no presumed agreement on the content of the norms such as how to handle the norms and conversational behaviour6. Not only differences between groups but also those within a group should be taken into account – a requirement which African researchers such as Emmanuel Lartey, who is from Ghana and teaches in the USA, have been pointing out for some time.7 I support his call to broaden the concept of intercultural pastoral care to include a nation’s intracultural diversity. Intercultural communication is now the norm. This fact is currently being discussed in detail in the research and practice of spiritual care. I address this in part (2). In part (3), I highlight areas of potential conflict in which religious communication takes place within hybrid zones, and in part (4) I outline objectives of religious communication in pastoral care based on a theological perspective.

2. Intercultural Communication as a Norm: Spiritual Care Nursing care, or more specifically palliative care, is the original home of the contemporary western tradition of spiritual care. It was realised that spirituality was an important resource for many patients facing illness and death. The multi-professional and interdisciplinary concept of spiritual care has been transferred to various other areas of care outside palliative care. From the outset, the discourse on spiritual care showed an openness and willingness to practice intercultural and interreligious sensitivity. Those who speak of spiritual care deliberately operate with an open concept of spirituality. Not only Christians from the industrialised West, but also Muslims, Hindus, Christians from the southern hemisphere are taken into account. This also factors in those indigenous patients, who are not or are no longer rooted in a specific religious tradition and are, nevertheless, according to what they say, 5 Cf. Eberhard Hauschild, Kommunikation und Seelsorge zwischen religiösen und kulturellen Welten, ZMiss 1/2015, 45–59. 6 Cf. ibid., 49. 7 Cf. Emmanuel Lartey, In Living Colour. An Intercultural Approach to Pastoral Care and Counselling, London 2003 (1997).

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spiritual. In contrast to traditional church-going people, other ideas take centre-stage for this group of people. A German-American corpus linguistic study has investigated changes in religious communication by identifying those words associated with “religion” and those associated with “spirituality”.8 The spiritual construction of meaning prefers the terms “spirit” to “rules”, “nature” to “church”, “connectedness” and “harmony” to “reconnection” and “tradition”. If the original focus were on changes in the interpretation of reality outside traditional institutions, recent studies on socalled “spiritual turn” show that they also take place within.9 Epistemologically, spiritual care is a new and distinctive discipline and a hybrid in terms of its character. It asks what contributes to spiritual help from a medical, psychological and theological perspective. Spirituality emerges as a travelling concept, a concept that is not clearly assigned to any discipline, but is defined in various disciplines and in conversation. Hybrid zones are risky areas, because they involve a lot of negotiation. The allusion to spiritual care makes it clear that this negotiation in the area of religious communication takes place within theology and beyond in other domains. Regarding the findings, for example, from our discourse on spiritual care, I shall proceed by designating areas of potential conflict that come about through determining religious communication in hybrid zones.

3. Areas of Potential Relational Conflict in the Intercultural Context 3.1 Between Vagueness and Precision In the wake of his brother’s suicide, Theo wanted a psalm to be read at his brother’s funeral. The familiar language of religious ritual captured his feelings of grief and anger ; words expressing the incomprehensible, which were not his own personal words, but words cloaked in tradition. Theo’s suggestion that the mourners should recite the Lord’s Prayer was rejected by Ann. The words of the Lord’s Prayer did not resonate with her in the least. A negotiation then took place. Christian culture is still embedded in the make-up of people in the West. Ann was familiar with the content of the Lord’s Prayer, but this prayer had no spiritual significance for her whatsoever. Her spirituality defined no personal 8 Cf. Stefan Altmeyer, Spiritualität und spirituelles Lernen in der religiösen Erwachsenenbildung, in: C. Kohli Reichenbach/I. Noth (Hg.), Religiöse Erwachsenenbildung. Zugänge – Herausforderungen – Perspektiven, Zürich 2013, 83–97, 88–91. 9 Cf. Eckhard Frick/Andreas Hamburger (Hg.), Freuds Religionskritik und der Spiritual Turn. Ein Dialog zwischen Philosophie und Psychoanalyse, Stuttgart 2014.

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counterparty, but images of transcendence influenced by Western interpretations of Eastern traditions. A feeling of connectedness with all that is, letting go to all that is – these are the words she used at the meeting. What people say in encounters that have a spiritual dimension and what they express in terms of their spirituality, is sometimes diffuse. The use of the word “diffuse” is sensitive, because the word conjures up negative associations. By the word diffuse, I mean “without clear contours, not directly readable, wandering, still open”. In a spirit of openness and respect, it is important to listen to and respect the spiritual needs expressed by others. This is also the guiding principle in the whole debate on spiritual care, in which, as I have already pointed out, there is broad understanding on the concept of spirituality. Traugott Roser, who was then first incumbent of a co-professorship in spiritual care in Munich, expressed this very pointedly when he said: Spiritualität ist genau – und ausschliesslich – das, was der Patient dafür hält.10

The question remains what happens when religious communication moves on to spirituality and its welter of words when it embraces terms such as “harmony” and “connectedness” with their vast reservoir of meanings, staying compliant, vague, consciously diffuse. At stake, I think, is the strength and resistance of precision. The reflections of the Bochum theologian Isolde Karle deserve consideration. Karle appreciates, but also critically questions, Roser’s plea for blurring in religious communication. She maintains: “Seelsorge lebt wie religiöse Kommunikation überhaupt von der ‹markanten Physiognomie› einer kontingent gegebenen Religion […]. Religion ist in ihrer historisch gewachsenen Gestalt immer auf konkrete Inhalte, Rituale und Sozialformen bezogen und kommunikativ verfasst. Wird Religion abstrakt und vage definiert, wird sie entkörperlicht und entsinnlicht, formalisiert und schematisiert.”11 Religious communication, which also ventures into realms of unfamiliarity – for example, when it resorts to edgy texts from the Old Testament for prayers and attempts to interpret incomprehensible texts about the Resurrection. This communication has its own power of action. For purposes of illustration, I refer to the Isenheim Altarpiece: Sick people were brought to the monastic church of the Antonine monks so that they could see 10 Traugott Roser, Innovation Spiritual Care. Eine praktisch-theologische Perspektive, in: E. Frick/ Ders. (Hg.), Spiritualität und Medizin. Gemeinsame Sorge für den kranken Menschen, Stuttgart 2011, 45–55, 47 (Spirituality is precisely – and exclusively – as the patient defines it.). 11 Isolde Karle, Perspektiven der Krankenhausseelsorge, WzM 62/2010, 537–555, 552. On the conflict between Roser und Karle, cf. also Claudia Kohli Reichenbach, Spiritualität im CareBereich. Begriffsklärungen zu Palliative Care, Spiritual Care und Spiritualität, in: I. Noth/ C. Kohli Reichenbach (Hg), Palliative und Spiritual Care. Aktuelle Perspektiven in Medizin und Theologie, Zürich 2014, 11–22, 21 f. (Pastoral care, like religious communication, lives on the “distinctive physiognomy” of a specific contingent religion […]. In its historically evolved form, religion always relates to actual content, rituals and social forms, and is written in a way that is communicative. If religion is defined in vague and abstract terms, it is disembodied and desensualised, formalised and structured.).

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the image of Jesus suffering on the Cross. This is a striking and powerful painting that was designed to resonate with the patients’ own suffering. In the case of the funeral for the brother that had committed suicide, many of the mourners would have found the rigidly dogmatic Christian language incomprehensible, and Ann and Rosina might even have found it coarse. I have explored their imagery and sought consoling power in their spirituality. At the same time, as a pastoral caregiver recruited to serve in this situation, I could not and would not turn my own back on my religious tradition and its strange-sounding language. Not just because of Theo. Religious communication in the intercultural context takes place in the tension between vagueness and precision. Finally, the question about the role of religious tradition with its distinctive physiognomy in the intercultural context must be addressed. 3.2 Between Powerlessness and Testimony I will now address a second area of conflict. In principle, this is the so-called power question in the analysis of conversational situations. Feminist theology, in particular, endeavours to draw our attention to this, asking the question: who communicates with whom and in what position of power? How is this power reflected? How is it used? Even though a pastoral caregiver still converses with the other party in non-directive manner, there is an imbalance in power between the pastoral carer and the other party, who (unlike the carer) usually introduces his or her story into the discourse. The other party’s story is then discussed, while the pastoral caregiver is granted at least some power of interpretation. There were power differences at large even in the attic apartment. I found myself in the company of four grieving and distressed people, listening to what they had to say. There was no question of whether there was a power imbalance between them and me. However, it was still unclear where I stood in this hybrid zone. In religiously homogenous circles, the pastor may still take on the role, in the view of Western Christians, of the more or less unchallenged representative of the universally-accepted Christian faith and the church. This was not the case in the attic apartment. While Ann and Rosina tolerated and welcomed the presence of a person with religious credentials, any strong pastoral approach shown on my part would have made the conversation difficult. The funeral was a matter of negotiation; and it was by no means clear that it would be taking place in a Christian framework. Accordingly, it was by no means clear that I, as a Christian minister, had the invitation and right to take the initiative. This is exemplary for shifts that have taken place in various areas in recent decades. The question is how these shifts should be interpreted in terms of a social context that has a diversity of cultural and religious points of view. Michel de Certeau, a French intellectual who died at the end of the 20th century and who explored culture, literature and theology, offered what I

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consider to be a helpful interpretation. A collection of his essays was published posthumously entitled “faiblesse de croire”12. Certeau does not want the weakness of faith and the weakness in faith to be negatively construed. He does not formulate an accusatory cry for help and does not cling to apologetics. Rather, he captures the loss of meaning and relevance of the Christian faith and the institutional church in theological terms. According to Certeau, the core of the belief lies in the experience of powerlessness and the lack of authority. One cannot have God and one cannot get hold of God. This experience forms the basis of Christian belief, because everything in Christian belief is based on the idea of a disappearance (or, as Certeau would call, “une disparition fondatrice”13): This begins with the experience of the women who came to tomb and were not able to find the body of Jesus. He has been absent ever since. In particular, mysticism would have internalised this experience of seeking and not having, as Certeau expounds in his work “La Fable Mystique” (The Mystic Fable): “He or she is a mystic who cannot stop walking , and with the certainty of what is lacking, knows of every place and object that it is not that”.14 People of faith must embrace what they do not know. According to Certeau, you have to embrace the unknown in order to make headway in your journey. The stranger (the gardener) was the man who turned out to be Christ. Without resignation, the person of faith has weak faith because he knows about the particular place of his truth. The particularity of one’s own truth becomes especially evident in the intercultural context. Based on Certeau’s work, I believe that a mode of communication that dispenses with the linguistic demonstration of power is part of the awareness of particularity because it does not take on any airs and graces. This renunciation also contains its strength. Since the body of Jesus is not in His empty tomb, the believer continues to search, not having, but constantly referring to what is ardently missed.15

12 Michel de Certeau, GlaubensSchwachheit, hrsg. von Luce Giard, Stuttgart 2009. Cf. also Claudia Kohli Reichenbach, Spiritualität und Sprache. Michel de Certeaus Sprachanalyse als Meisterstück der Spiritualitätsforschung, in: R. Kunz/C. Kohli Reichenbach (Hg.), Spiritualität im Diskurs. Spiritualitätsforschung in theologischer Perspektive, Zürich 2012, 197–207. 13 Michel de Certeau, La fable mystique, XVIe–XVIIe sciHcle, Paris 1982, 109. 14 Michel de Certeau, The Mystic Fable (English translation by Michael B. Smith), Chicago 1992, 299. 15 At this point I refer to the publication of Esther Maria Magnis, who in her autobiographical notes on the death of both her father and her brother finds a language that oscillates brilliantly between impotence and the search for God. Cf. Esther Maria Magnis, Gott braucht dich nicht. Eine Bekehrung, Reinbeck bei Hamburg 2012.

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3.3 Between Empathy and Decaffeination In the intercultural context, one is pointedly confronted with the perception of one’s own reality and that of the other. Pastoral care in an intercultural context requires a high degree of sensitivity to the reality facing the other party, and this reality may be clearly different from that of the pastoral caregiver. In order to be able to talk to Ann after the suicide, I had to try to understand her spiritual convictions and accept these as her point of view. Understanding what one does not know is an immense challenge, just as it is difficult to decipher the truth behind the reflection from a mirror that distorts what it has in front of it. Empathy, a key attribute in effective pastoral care, also finds itself in an area of conflict. While trying to practice empathy, is the other person’s otherness accepted? Zˇizˇek speaks of the “decaffeinated other”16, of the other who no longer gives us side effects. Empathy for the other must not dissolve into the intercultural context through a sterile detoxification of the other. An important tool for understanding, especially for casual situations and situations involving pastoral care, has recently been provided by Kristian Fechtner with his analysis of “discrete Christianity”.17 Fechtner offers an analysis of those who are sociologically defined in terms of the expression “distanzierte Kirchlichkeit” (literally “distanced churchliness”, i. e. people who have detached association with the church). Fechtner is convinced that the people who go to church on festive occasions, casual Christians and the occasionally religious have long been accepted and rehabilitated into theology and the Western Christian church, but this is primarily for religious and sociological reasons and on the basis of the church’s theoretical insight and not on the basis of theological conviction. Fechtner states: “Im theologischen Selbstbild der Kirche und in der kirchlich-religiösen Vorstellung eines bewusst gelebten Christseins […] kommen sie nicht recht unter.”18 In his analysis, Fechtner notes that shame plays a key role: Shame marks the interface between the church and those that have a detached relationship with it. Discussing matters of faith is not simply taboo; it is an intimate and private area, which remains more or less closed to the outside world. According to Fechtner, the reality of church-based Christianity can be understood in terms of “discreet Christianity”. This relates to the way these members of the church keep their distance in terms of their affiliation to it. Discreet Christianity 16 Slavoj Zˇizˇek, Liberal multiculturalism masks an old barbarism with a human face, The Guardian, October 3, 2010. Cf. also the critique of a decaffeinated concern, Frank Mathwig, Worum sorgt sich Spiritual Care? Bemerkungen und Anfragen aus theologisch-ethischer Sicht, in: Noth/ Kohli Reichenbach, Palliative und Spiritual Care, 23–41. 17 Cf. Kristian Fechtner, Diskretes Christentum. Religion und Scham, Gütersloh 2015. 18 Ibid., 174. (They do not quite fit into the theological self-image of the church and into the church’s concept of a practising Christianity).

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describes a feeling of faith that is somewhat hidden in the life of an individual and only becomes apparent when one does not have to disambiguate oneself in regard to the church or reveal one’s religious convictions.19 The fact that pastoral caregivers attempt to respect the preservation of personal boundaries is, according to Fechtner, key. He develops this point in various aspects of religious life and points out where it is almost impossible in today’s practice to safeguard personal boundaries adequately.

4. Religious Communication and its Objectives In such a sensitive situation, in the wake of a suicide, what can be said to people who have, to a certain extent, different cultural and religious outlooks? What could be said that might be of substantial benefit? The question of how spiritual communication can help develop the freedom to live is key.

4.1 Tolerance of Lack of Meaning The first objective focuses on the question of meaning.20 I return once more to the research area of “spiritual care”. Spiritual care has also found wide acceptance in non-theological circles, as empirical studies have shown that the processing of the question of meaning has a positive impact on coping strategies in matters relating to health and disease. Many approaches in spiritual care understand that its role is to help provide meaning. Based on centuries of tradition, Christian theology, on the other hand, also knows that there are many situations which simply do not seem to offer any meaning. At least no meaning is apparent – or it would be cynical, as it were, to dare to postulate any meaning. This is also the case in the suicide situation I have described. Experiences of meaninglessness have been reflected in the biblical tradition. Theology maintains that there is meaningless suffering, and sometimes all that is left is sorrow. It recalls that the beautiful word “meaning” is sometimes out of place because it can cause pressure. Contrary to the “Sinnfindungsterrorismus”21 (terrorism of finding meaning) – an expression coined by Birgit and Andreas Heller – spiritual care is tasked with promoting tolerance to meaninglessness. 19 Cf., ibid., 173 f. 20 Cf. also Claudia Kohli Reichenbach, Spiritualität und Gesundheit, in: S. Ehm/A. Giebel/U. Lilie/ R. Prönneke (Hg.), Geistesgegenwärtig behandeln. Existenzielle Kommunikation, Spiritualität und Selbstsorge in der ärztlichen Praxis, Neukirchen-Vluyn 2016, 42–56. 21 Birgit Heller/Andreas Heller, Spiritualität und Spiritual Care, München 2014, 39.

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4.2 Tolerance of Ambiguity Promoting tolerance is part of what spiritual communication aims to achieve: promoting the tolerance of ambiguity. Ann was extremely upset about the suicide. She suggested a ritual that sounded very harmonious, trying to combine everything in a positive way and aiming for a sense of wholeness. Would there have been enough room to accommodate the difficult and the unfathomable, if the ritual had been performed as originally conceived? I believe, and history has shown, that Christian theology has great potential for withstanding breakages and breakdowns, and not passing over them too hastily. The Holy Communion always commemorates the broken body of Christ. The fragility of human (and divine) existence is always internalised. This theological perspective has important contributions to make in helping us come to terms with fragility and the fragmentary nature of reality. In this context, I invoke the approach of the practical theologian Henning Luther. The Leibzig theologian Gunda Schneider-Flume aligns with him when she guards against the “Tyrannei des gelingenden Lebens”22 (tyranny of the successful life). This is often based on a religiously charged utopia of holism. Pastoral care has the role of helping people to endure and come to terms with crises and ambivalence. It can promote tolerance of ambiguity. The freedom from which pastoral communication emanates and to which it can lead is ambiguous, provisional and precarious. Meaninglessness and ambiguity push people to their limits. The attempt to cross the boundaries is sometimes naive (the attempt loses itself in the romance of a holistic approach) and sometimes sacriligious (when the attempt pays homage to the tyranny of perfection). When pastoral care helps people to learn to live with limitation, it takes on an important function, be it in conversation with a senior citizen in the nursing home or in helping the bereaved come to terms with a suicide. When pastoral care helps people get back on their feet despite their sense of limitation, it helps to bring about an empowerment that incorporates a sense of realism. If pastoral care can communicate to that person that he or she is enough because God has enough to give, the communication is successful. Justification is at the very centre of Christian theology. For spiritual communication, justification has to be rethought over and over again in every hybrid zone so that people can enjoy the liberating experience of always being accepted and spoken to. For me as a Christian theologian, the reason and hope of pastoral care are encapsulated in Galatians 5:1: “It is for freedom that Christ has set us free”.23 The understanding of what is the strength that constitutes 22 Gunda Schneider-Flume, Leben ist kostbar. Wider die Tyrannei des gelingenden Lebens, Göttingen 32008, 83. 23 Holy Bible, New International Version, NIV.

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this freedom will continue to embed itself in my intercultural and interreligious conversations. The present context demands that pastoral caregivers open themselves and hear how those who are detached from the church, the spiritually virtuoso, and those that have left the church, experience this power of freedom. When it comes to these people, pastoral caregivers must continue to search for chinks in the frozen structure of life, exposing the view of the other. 4.3 Empowerment In practice and in theory, Christian pastoral care currently faces the challenge of discerning cultural differences in pluralistic societies, even within groups that are homogeneous in terms of their nationality and language. It should also be noted that many people from other religions live in our societies and that they also have needs for pastoral care. Structures, for examples, for Islamic forms of spiritual care are being developed for international contexts. Christian spiritual care can look back on a rich tradition of research and teaching. The fact that it supports other religions in further developing their ideas and provision is part of the exciting and important task offered by kairos.

Bhikshuni Lozang Trinlae1

Buddhist Liturgy as a Transformative Mode of Spiritual Care

Abstract Meditation is by nature a covert process, going on behind the eyes in the cognitive, affective, and somatic experiences of the meditator, opaque to observers. In the Vajraya¯na tradition of Tibetan Buddhism, meditation is often performed with the aid of lyrical scriptural guides (sa¯dhana, sgrub thabs) and behaviorally appears as ritual. When performed in groups, the ritual becomes an interpersonal liturgical experience. To what extent can Buddhist ritual and liturgy serve as spiritual resources for the care of self and others? How can such activity be characterized as transformational care? This paper introduces and summarizes a qualitative practical theological dissertation investigation into the subjective experience of a popular Buddhist contemplative liturgy traced to the 11th century whose contemporary form was composed in the 16th century. After a brief discussion of inter-theological terminology, findings of the contemplative and spiritual care elements of the liturgy are presented and discussed. Multiple compelling questions are uncovered, and having heightened the sensitivities of the reader, directions for possible further investigations are explored.

Buddhist Liturgy as a Transformative Mode of Spiritual Care Walking into a Tibetan Buddhist monastery in the Himalayas performing the lengthy contemplative liturgy (pu¯ja¯) of Amita¯yus, the metaphysical Buddha of Immeasureable Life, our senses would be saturated with colorful images, melodic sounds of Tibetan chanting and religious musical instruments, the aroma of fragrant herbal incense, and, if we stayed long enough, even the tastes of barley cake and snack food treats delivered to us by monks or nuns. We would likely see an enormous sixteen-foot tall statue representing the historical Buddha Shakyamuni, Siddhartha Gautama, with physical form filled with scriptures and relics symbolizing his body, speech, and mind in a 1 B.Sc., Ed.M., Ph.D. InsightSupport.org + Luminous View Refuge for Meditation Retreat ans Spiritual Care. Email: [email protected].

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metaphysical stylization. Many of the prayers comprising the long ritual, which are more properly thought of as guided meditations, would be familiar daily “offices” for those in attendance. In 2012, this contemplative liturgy was performed publicly with a group of 300 to 500 European lay devotees in western France. Since a translation for the liturgy does not yet exist outside of the Tibetan language, Western Buddhist devotees, most of whom are illiterate in Tibetan, performed parallel meditations directed by the principal teacher while the colorful and dynamic liturgy was performed over the period of a week-long retreat. There is no standardized or systematic way of knowing if attendees’ conceptions of what they were witnessing in the liturgy correctly reflected the contents and contemplative processes prescribed by the liturgical text and foreign – sounding, sensually stimulating, live performance. What were their theological interpretations? Did practitioners find their way toward the deeper contemplative meanings alive beneath the very charismatic public performance? In 1991, my first Buddhist teacher and senior Buddhist theologian, Venerable Geshe Lobsang Jampa, left his fifty-four year old body after an unusually long encounter with cancer in Boston. He was thousands of miles away from his native Tibet and refugee monastery in India and his familiar food, language, social networks, fellow theologians, and vibrant religious culture. Having become a monk at nine years old, while profoundly alienated from his life-long companions and familiar social-culture during his four years in New England, I witnessed Geshe-la make a peaceful albeit painful departure from his life by relying on his forty-five years of contemplative training with its familiar meditations serving as inner companions. Will such spiritual resources be used by the estimated 150,000 Tibetan diaspora living in south Asia, Europe, and North America? Given the interpersonal and public nature of liturgy, could it serve as a spiritual care resource for Tibetan Buddhists from any ethnic group, and those in need from other dharma traditions with similar religious cultures? In the accountabilitydriven worlds of clinical chaplaincy and pastoral theology, what valid basis is there to claim that Buddhist contemplative liturgy can function as a mode of spiritual care? If the Buddhist liturgy practice has care characteristics, what are they and how are they to be discerned and affirmed with confidence? Is there something more to ritual practice than devotion and faith in ancient meditations? Through my experience with Tibetan Buddhism spanning several decades that includes extended periods of traditional, solitary contemplative training, I have formed some intuitive answers to these questions. Yet I wondered how the contemplative ritual experiences of others might be methodically observed and communicated. With these aims and others in mind, I set out to answer such questions over a six year period of formal preparation and investigation. In this contribution, after discussing some inter-theological and inter-

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disciplinary language issues, I summarize this research, present findings, and identify areas ripe for future research.

The Challenge of Inter-Theological and Interdisciplinary Language Emic Buddhist Praxis Culture In Tibetan Buddhism as well as the Therava¯da and Chinese Maha¯ya¯na Buddhist traditions, while there are no obvious direct equivalents of the terms “practical theology” or “pastoral theology,” a critically reflective process, or praxis, is fully integrated at the levels of Buddhist systematic theology and spiritual formation. For example, the emic Buddhist learning steps of listening, thinking, and meditation (s´ruta, cinta¯, bha¯vana¯) combine with mindfulness practice to apply what we learn while the ahimsa and benevolent altruistic motivations guide daily life action. This process˙can be viewed as a Buddhist hermeneutic praxis cycle, as shown in figure 1.

Figure 1. A Buddhist hermeneutic praxis cycle

Theological Language in Buddhist Contexts The use of the word “theology” in the context of Buddhism has been established by Buddhist scholars writing in English, although the usage remains rare in both scholarly and colloquial exegetical translations. The late

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Rita Gross, for example, defined theology as “constructive normative Buddhist thought.”2 Similarly, I have adopted what I consider to be a Buddhist – friendly definition of practical theology based on the introduction to Gerben Heitink’s Practical Theology text: “Practical theology should be understood as an empirically descriptive and critically constructive theory of religious practice.”3 With this working definition in mind, my research proceeds following the larger framework of Richard Osmer’s hermeneutic of procedurally approaching description, interpretation, normative prescription, and pragmatic action as distinct processes, or “tasks.”4 “Contemplative liturgy” is to be taken in the Greek sense of publicly performed, communal ritual, where “contemplative” indicates that the ritual is principally a guided meditation more often used as an intrapersonal contemplation. The contemplative liturgy therefore is a deliberately enabled context for expressing interpersonally that which is otherwise intimate, private prayer and meditation. When expressed in lyrical and visual aesthetic forms, this artistic richness and profundity of word and meaning in the form of the liturgy are a shared communion event among spiritual companions, and is often available for witness and participation by the public at large.5

What exactly is “Spiritual” about Spiritual Care? I have employed the terms “spiritual” and “spirituality” in the manner related by Ursula King in the sense of Walter Principe’s definition as “the way in which a person understands and lives within his or her historical context that aspect of his or her religion, philosophy or ethic that is viewed as the loftiest, the noblest, the most calculated to lead to the fullness of the ideal or perfection being sought.”6 This is a very general rendering suitable for a variety of interdisciplinary and inter-theological work and has the further egalitarian 2 Rita Gross, “Buddhist Theology?,” in Buddhist Theology: Critical Reflections by Contemporary Buddhist Scholars, ed. Roger R. Jackson and John J. Makransky (London: Routledge-Curzon, 2000), 53–60. 3 Gerben Heitink, Practical Theology : History,Theory, Action Domains: Manual for Practical Theology, Studies in Practical Theology Series (Grand Rapids: Eerdmans, 1999), Translated by Reinder Bruinsma. See also Bhikshuni L. Trinlae, “Prospects for a Buddhist Practical Theology,” International Journal of Practical Theology 18, no. 1 (2014), accessed March 15, 2017, doi:10.1515/ijpt-2014-0002, http://www.degruyter.com/view/j /ijpt.2014.18.issue-1/ijpt-2014-0002/ ijpt-2014-0002.xml, where the rationale is elaborately established. 4 Richard R. Osmer, Practical Theology: An Introduction (Grand Rapids: Eerdmans, 2008), 4–12. 5 Druk Amitabh Mountain Nunnery, “Grand Amitayus Puja for Longevity (Tshe dpag med zhi wa lha mangs cho ga),” Drukpa Publishing, accessed April 11, 2017, https://youtu.be/ GCKL4 fGfRlk?list=PLeSr5WhBhlaGmcOZOl54Tbw6NzxIu8Nr_. 6 Ursula King, “Spirituality,” in A New Handbook of Living Religions, ed. John R. Hinnells (Oxford: Blackwell Publishers, 1997), 668. I go into more detail about this usage in my forthcoming dissertation publication.

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benefit of not privileging any one particular spirituality, religious or philosophical tradition, or denomination above others.

Translational Research – Clinical and Academic Contexts Buddhist pastoral theologians and chaplains serve clients in secular clinical environments of hospitals and so forth. We also support teachers and students in “congregations” (sangha-s) as well as scholars working in theology, Buddhist religious studies, and the emergent academic field of contemplative studies.7 Therefore, it is not enough for Buddhist theologians to satisfy pastoral theological disciplinary requirements alone for spiritual care but also the diverse requirements of interdisciplinary academic and congregational partners. For this reason, for my research purposes I have formulated a provisional pastoral theology – friendly “psychospiritual transformation” construct based on historical, traditional Buddhist theological references to spiritual care, pastoral theological constructions of spiritual care, and clinical nursing classifications of spiritual care. The Nursing Outcomes Classifications (NOC) have a number of patient status constructs used in the standardization of medical information and record-keeping, quality assurance, and care protocols.8 One such classification is the “comfort status” of “psychospiritual ease,” given to us as “related to self-concept, emotional well-being, source of inspiration, and meaning and purpose in one’s life.”9 In using clinical indicators, it is important to keep in mind that in clinical contexts such as hospital chaplaincy, clinical goals are typically focused on eliminating or minimizing pathology and are less preoccupied with long term positive aims such as sustaining wellness. Literature from academic pastoral theology and spiritual care, especially that useful for Vajraya¯na Buddhist contexts and the role of ritual and liturgy in spiritual care have also informed the provisional, translational “psychospiritual transformation” construct. In particular, Howard Clinebell’s notions of 7 In the USA, for example, Brown University, Emory University, Rice University, and San Diego University all offer contemplative studies programs to students, while in Europe, Max Planck Institute has been very active in this area. Contemplative studies as an inter-disciplinary area has been developed primarily by contemplative tradition scholars, cognitive scientists, clinical psychologists, and philosophers. 8 Marion Johnson and Meridean Maas, Nursing Outcomes Classification (NOC) (St. Louis: MosbyYear Book, 1997). The reliability and validity testing of the NOC was also completed, although follow up regarding the psychospiritual ease construct would be informative to investigate from a clinical spiritual care perspective. See Meridean Mass et al., “Evaluation of the Reliability and Validity of Nursing Outcomes Classification Patient Outcomes and Measures,” Journal of Nursing Measurement 11, no. 2 (2003). 9 Mosby’s Dictionary of Medicine, 8th ed. (St. Louis: Elsevier/Mosby, 2009), accessed May 1, 2015, 403. Full development of the construct can be seen in the publication of this research, forthcoming.

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“trustful belonging in the universe” and “moments of transcendence” have been adopted,10 while Csikszentmilhalyi’s “flow emersion” experience from research psychology has also informed the construct.11 From Buddhism, a number of primary canonical sources refer to caregiving,12 while an entire holistic medical science was developed in historical commentarial material. Although pre-modern in its development, traditional Tibetan medicine is still popular and widely practiced, and is fundamentally based on Buddhist understandings of emotions, the mind, and their roles as conditions underlying physiological symptoms.13 Probably the most widely known Buddhist canonical reference to psychospiritual care in Buddhism comes from a text in the Pa¯li Canon known as the “Questions to King Milinda,” or MilindapaÇha of the Khuddaka Nika¯ya collection of short discourses: Whatever medicines are found In the world – many and varied – None are equal to the Dhamma. Drink of this! And having drunk The medicine of the Dhamma, You’ll be untouched by age and death. Having meditated and seen – (You’ll be) healed by ceasing to cling. – The Buddha14

From these authoritative scriptural verses and others like them come the Buddhist doctrinal paradigms of spiritual teacher as doctor, student as 10 Howard Clinebell, Basic Types of Pastoral Care and Counseling: Resources for the Ministry of Healing and Growth (Nashville: Abingdon, 1984), 96; Howard Clinebell, Counseling for Spiritually Empowered Wholeness (New York: Hawort, 1995), 81–84. See the full discussion in Bhikshuni Lozang Trinlae, Vajraya¯na Buddhist Contemplative Liturgy of Kun-mkhyen Pad-ma dKar-po as a Living and Caring Tradition of Transformative Experience: A Phenomenological Investigation of Amita¯yus Practice ((Forthcoming), 2017). 11 Mihaly Csikszentmihalyi, Flow : The Psychology of Optimal Experience (New York: Harper & Row, 1990), 6. 12 Trinlae, Vajraya¯na Buddhist Contemplative Liturgy of Kun-mkhyen Pad-ma dKar-po as a Living and Caring Tradition of Transformative Experience, forthcoming. 13 Lung-rigs bsTan-dar, Gso ba rig pa spyi dang bye brag tu dam pa’i chos dpal ldan sman rgyud bzhi’i chos ’byung tshul dri med ba’i durya’i me long [History of Medicine] (New Delhi: Tibet House, 1977), [Lung-rigs bsTan-dar, b. 18th C; TBRC W17680]. 14 [Canonical Buddhist Su¯tra – Pa¯li Recension], “The Healing Medicine of the Dhamma (Miln 5),” in Access to Insight (Legacy Edition): Readings in Therava¯da Buddhism, ed. Access to Insight (Access to Insight, 2013); [Tripitaka: Khuddaka: MilindapaÇha (Miln 5); Excerpt translated ˙ from the Pa¯li by Andrew Olendski], accessed August 7, 2016, https://web.archive.org/web/ 20160807185058/http://www.accesstoinsight.org/tipitaka/kn/miln/miln.5x.olen.html; the fourth line has been further edited by this article author to omit the gendered term “monks.”

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patient, and religious instructions as medicine; communication skill as a form of care; and care for others as religious and spiritual praxis. More recently, the late Chögyam Trungpa’s teaching themes of vulnerable letting-go into direct experience, non-aggressive acceptance of self and others, and radical awareness of self-deceptive spirituality are seen to mirror certain Western factors of psychospiritual wellness.15 The chaplain and CPE supervisor Thomas Kilts has also connected traditional Vajraya¯na Buddhist mandala – based meditation systems with spiritual care as models of ˙˙ conceptualizing identity and interpersonal functioning in care contexts.16 These literature – based indicators for the “psychospiritual transformation” construct are thus seen to be compatible with clinical spiritual care, pastoral theology, secular psychology, and emic Buddhist theological constructions. Although a mutually dialogical, inter – disciplinary critical correlation remains to be elaborated in more detail, these fundaments of “psychospiritual transformation” are sufficient for pragmatic exploratory research purposes,17 as shown in figure 2. With this construct and indicators in hand, I set out to determine if such characteristics could be found in the experience of a particular Buddhist contemplative liturgy. Table 1. Correlation of literature-based Western and emic Buddhist indicators of “psychospiritual transformation” Western Factors

Buddhist Factors

Trustful Belonging in Uni- Mandala and deity as symbols of “the unity of self and ˙˙ verse (Clinebell) cosmos; working directly with what prevents our inherent enlightened natures from being just as they are” (Kilts 2008, 274) Moments of Transcendence (Clinebell)

Mandala identity ; clearing obstacles (Kilts) ˙˙

Flow-Emersion Experience Letting-be with experience (Trungpa) (Csikszentmihalyi)

15 Chögyam Trungpa, John Baker and Marvin Casper, Cutting Through Spiritual Materialism (Boston: Shambhala, 2008), 55. 16 Thomas Kilts, “A Vajrayana Buddhist Perspective on Ministry Training,” Journal of Pastoral Care 62, no. 3 (2008), 273–74. 17 Trinlae, Vajraya¯na Buddhist Contemplative Liturgy of Kun-mkhyen Pad-ma dKar-po as a Living and Caring Tradition of Transformative Experience: A Phenomenological Investigation of Amitayus Practice, (Forthcoming,) 2017.

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(Continued) Western Factors

Buddhist Factors

Emotional Well-Being (Nursing Outcomes Classification [NOC])

Empowerment of impermanence, becoming open and self-trusting; non-aggression; sufficient vulnerability, self-acceptance, self-appreciation, non-aggressive confidence and humorous ease; Five Buddha Families as acceptance of emotional nature. (Trungpa) Five Buddha Families as a model of healthy psychospiritual functioning; integration of functioning and identity (Kilts)

Source of Inspiration (NOC)

Five Buddha Families; Deity-Yoga. (Kilts); Care Efficacy of Dharma (Medical Tantras)

Meaning and Purpose in Life (NOC)

Spiritual direction as spiritual care including care for physical ailments (Biographical Narratives of Buddhist Saints) Care Efficacy (Medical Tantras) Reducing and preventing suffering of self and others (Trungpa) Dharma as medicine and care; communication skill as care competency ; care for other as Buddha/Guru devotion (Shakyamuni)

Self-concept (NOC)

Integration of functioning and identity through the Five Buddhas and Deity Yoga. (Kilts)

Amita¯yus Contemplative Liturgy : Scripture and Experience The experience of the contemplative liturgy is directed and formed by the group performance of the liturgical text. Therefore the text and its norms direct the contemplative experience. The Abundant Peaceful Deities of Amita¯yus The contemplative liturgy performed in contemporary times known as the Ritual of the Abundant Peaceful Deities of Amita¯yus Satisfying the Wishes of Those Desiring Immortality is an elaborated revision of a scripture composed by the Buddhist theologian Kunkhyen Padma Karpo in 16th century Tibet.18 18 Pad+ma dKar-po, Tshe dpag med zhi ba lha mangs kyi cho ga ’chi med ’dod pa’i re skong nag

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The tradition of this meditation was brought to Tibet in the 11th century by the Tibetan saint Rechungpa, who himself had brought it from northern India where he had learned it from the female Indian saint, Siddhara¯jÇı¯. The lineage of the Amita¯yus meditation practice originates with the Maha¯ya¯na Buddhist Sanskrit scripture dating from the early first millennia, the “Exalted ¯ rya-aparimita¯yurImmeasurable Life and Wisdom” canonical works A jÇa¯na-na¯ma-maha¯ya¯na-su¯tra (now extant in nineteen Tibetan recensions), among others. The main meditation, preceded by preliminary prayers honoring the practice lineage and preparation of ritual substances for offering to the senses such as butter lamps and incense, consists of meditating with altruistic purpose on the enlightened qualities of Buddha Amita¯yus. The virtues of wisdom and compassion in particular, expressed as qualities of infinite life and wisdom, are visualized as multiple manifest forms of Buddha Amita¯yus within the purified environment of a three-dimensional celestial mansion, or mandala. As entities, the scripture makes explicit their symbolic instrumental ˙ ˙ for meditation consistent with Buddhist doctrines of interdependence. nature Through contemplation, participants are directed to nondualistically enter into communion with the enlightened qualities of perfect wisdom and compassion of a Buddha, and celebrate these manifoldly. The liturgy concludes with prayers dedicating the liturgy performance for the benefit of all living beings, and for those who can benefit from extended life and vitality in particular. In my detailed presentation of this investigation, I show how the quality of the nondual experience related to contemplation of enlightened wisdom and compassion would in general be proportional to the prior religious education and spiritual cultivation of the participant by way of formal learning, meditation practice, and so forth.19 Such a sequence of epistemological frames of experience is a common formal presentation structure in the systematic theology of Tibetan Buddhism and the Vedic (Hindu) traditions that preceded and accompanied classical Buddhism in first millennia India.20

’gros su bkod pa bzhugs so [Ritual of the abundant peaceful deities of Amita¯yus satisfying the wishes of those desiring immortality] (Darjeeling: Rdor gling ’brug sgar dpe mdzod khang, 2003), [’Brug-chen IV Kun-mkhyen Padma-dkar-po, 1527–1592; TBRC W10736; Edited contemporary version also known as “Zhi ba lha mangs”]. 19 Trinlae, Vajraya¯na Buddhist Contemplative Liturgy of Kun-mkhyen Pad-ma dKar-po as a Living and Caring Tradition of Transformative Experience; see chapter 3. 20 Geshe Lhundup Sopa and Jeffrey Hopkins, Cutting Through Appearances: Practice and Theory of Tibetan Buddhism (Ithaca: Snow Lion Publications, 1989), 107–323.

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Phenomenological Descriptions of Liturgical Experience After the liturgical performance, eight participants were interviewed about their subjective experiences after giving informed, written consent. Participants represented diverse ages and Himalayan ethnic groups. However, due to the 2015 earthquake in Nepal and destruction of the nunnery there, it was not possible to interview more than one nun, and therefore all other participants were male. A short series of questions about their somatic experiences were presented, interesting in themselves but also asked as an aid to orienting participants within the scene and recollecting their experience. They were then asked about their experiences of theological themes indicated by the scripture as well as questions explicitly related to healing and well-being. For each question topic, participants were asked to report on what they considered to be psychospiritually transformative qualities of their liturgical actions and experience. The transcendental qualitative phenomenological research method developed by Moustakas was used to construct the essential description of the experience.21 Each individual’s interview transcript was searched for indicators of psychospiritual transformation previously identified in the Western and Buddhist literature sources. Emergent emic contemplative theological themes were also identified and collected. A description of this level of experience was compiled for each participant respectively, and these were thereafer combined into a single, composite textural description. This process was repeated again using more universal, general categories of experience, whereby individual structural descriptions of experience were created from each individual interview which were then compiled into a composite structural description. The two composite textural and structural descriptions were then combined together to create a master synthetic phenomenological description of the contemplative liturgy experience. An exemplary excerpt reads: Anything can be seen as a manifestation of Amita¯yus and the Peaceful Abundant Deities. The Triple Body [trika¯ya] serves as an ultimate healer. During and after the liturgy, the body and mind feel light, relaxed, and compassionate. Wisdom feels increased and altruistic acts seem easier to do. There is a feeling of body-mind refreshment and appreciation for the lineage masters and teachers, for one’s companions in the liturgy, for all living beings, and for using the precious human life for the virtue of benefiting oneself and others. Serving others through the Abundant Peaceful Deities of Amita¯yus, the contemplative ritual is a peaceful skillful means of transcending self-cherishing thought and action through exemplifying and creating 21 Clark Moustakas, Phenomenological Research Methods (Thousand Oaks: SAGE Publications, 1994), 84–102.

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the luminous Amita¯yus in a sustained liturgical continuum fused with wisdom and compassion. It is simultaneously an intrapersonal and interpersonal experience dedicated to the well being of all others and in such ways is conveyed in situ to future generations through this medium of communicative expression. (Trinlae 2017)

Interpretation of Liturgical Experience These phenomenological descriptions and their verbatim sources were further searched for the indicators earlier identified in the scholarly and Buddhist literature sources. Although results must be regarded as provisional pending confirmatory studies, my analysis of the phenomenological descriptions, performed as a distinct subsequent procedure, indicates that the experience of the practice of the Amita¯yus contemplative liturgy can indeed be said to exhibit certain transformative characteristics. Each characteristic, or provisional factor, is indicated by participant report themes, which in turn are supported by verbatim quotations. Reported emic contemplative experiences principally included: Table 2. Provisional emic contemplative factors experienced through Padma Karpo’s Amita¯yus liturgy Provisional Contemplative Factors

Phenomenological Indicators

Attention

Enabler & sustainer of transcendence; cause or result of flow ; emotional benefits of recollection; mindfulness redirecting to purpose

Refuge

Faith/devotion/confidence quality ; refuge in dharma & sangha (congregation): instructions from teachers; refuge in dharma & sangha: protection; refuge in dharma: covenant duties; refuge in sangha: shared cultural familiarity

Rejoicing

Joy & happiness affect; joy in virtue; joy of appreciation

Compassion

Altruistic motivation; as meaning-making input; others vs. self; as path of transcendence; via altruistic dedication; via flow continuity ; via vast intention

Equanimity

Enables meaning-making; enabler of flow continuity

Wisdom

Wisdom actualization; pure vision; thinking & perception; wisdom experience; view of Buddhas

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(Continued) Provisional Contemplative Factors

Phenomenological Indicators

Deity Yoga/Proxy Representation

Ground for self-concept; transcendence process; nature of mind meaning; deity yoga idealization; Buddha as primordial example; deity yoga as communication; deity yoga as flow continuity

Feeling Blessed

Somatic response; blessing from companionship; feeling peaceful; emotional affect result; feeling relaxed; blessing via flow continuity ; feeling cared for by Padma Karpo

Purification And Heal- Dharma as medicine; clearing obstacles to health & life; ing extending life to benefit others; purifying negativities & obstacles

As a modality of spiritual care, the contemplative liturgy experience was also found to be characterized by the literature – based psychospiritual transformation factors by way of their experiential indicators. Table 3. Provisional spiritual care factors experienced through Padma Karpo’s Amita¯yus liturgy Provisional Care Factors

Experiential Indicators

Trustful belonging

Blessing from companionship; dharma & sangha protection through covenant commitments; feeling cared for by Padma Karpo; enlightened view of Buddhas; shared cultural familiarity ; oral transmission from sangha

Moments of transcendence

Somatic response of feeling blessed; wisdom pure vision; transcendence as process proxy ; via attention as enabler of transcendence; via compassion for others vs. self-ness; via selflessness wisdom; compassion as a transcendence path; changed thinking and perception; healing obstacles to health and life; Maha¯ya¯na vast intention

Flow experience

Attention as a cause or result of flow ; compassion flow continuity ; feeling blessed through flow ; wisdom flow continuity ; equanimity enabling continuity ; deity yoga continuity

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(Continued) Provisional Care Factors

Experiential Indicators

Emotional wellbeing

Joy or happiness affect; joy of appreciation; feeling blessed as peaceful; emotional benefits of recollection; feeling blessed as affective result; feeling blessed as relaxation; healing of negativities & obstacles

Source of inspiration

Deity yoga idealization; joy in virtue; dharma instructions from teachers; Buddha as primordial example

Meaning and purpose in life

Altruistic motivation; wisdom actualization; via faith, devotion, and confidence; via dharma as medicine; compassionate meaning-making; opportunity for virtuous actions; mindful re-directs to purpose; realization of natureof-mind meaning; via altruistic dedication; extending life to benefit others; equanimity for meaning-making; deity yoga as communication

Self-concept

Liturgy as enabling ground for self-concept

Questions Answered and More Questions Raised From the above reported preliminary results, much more information is immediately available about what is going on in the subjective experience of the participants during this particular liturgy practice, and possibly others like it, compared to what one might be likely to guess even as an educated observer. For example, Buddhism’s introspective contemplative character is well known. Yet we can see that factors such as the presence of spiritual companions and external sources of inspiration play roles in the experience of contemplative liturgy as a mode of spiritual care that can enable pychospiritual transformation. Similarly, Buddhism is often portrayed as a rationalist philosophy, with no requirements or necessity for sentimentality or faith. Yet possessing faith, or at least a healthy confidence, in a beneficial purpose for participating in the liturgy was consistently reported as the most significant qualitative factor needed for deriving benefit from the activity, while emotional factors were also widely prevalent.22

22 Trinlae, see chapters 5–7.

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Focused Particular Questions These preliminary results also inspire more general questions, such as: – Is the caring nature of experience significantly different for older practitioners versus younger? – Do nuns have a different experience than monks? – Are there experiential differences when practitioners perform the liturgy in another language? – How does the experience change when Buddhists from outside of the Himalayan region practice the liturgy? – How is the experience for those who have converted to the Drukpa Buddhist denomination from Christianity or Judaism, and so forth? There are many more similar questions. For example, how does the experience in general, and experience of psychospiritually transformative characteristics in particular, compare with other contemplative liturgy practices from within the same denominational tradition? How about when compared with Amita¯yus liturgies experienced by those from different Tibetan Buddhist traditions such as the Nyingma or Gelug denominations? Or, when compared with practitioners of Chinese or Japanese Buddhist Amita¯yus liturgies? Or, when compared with practitioner’s experiences of non-Buddhist liturgies from Eastern Orthodox Christianity, for example? Given the radically different respective epistemologies and philosophies of divinity, would reporting on psychospiritually transformative experiences through liturgy show different trends across the care categories probed? Or would similarities predominate in a manner akin to how we find the same historical patterns of naive confessional submission to uncritical engagement with race, gender, and ethnicity repeating across profoundly diverse religions over generations? Such probing questions are conveniently answered using statistical methods. Absent a repeated confirmatory investigation, the results reported here are best thought of as preliminary. However, from these qualitative phenomenological descriptions, questionnaires can be devised to more saliently appraise the indicators using the same liturgy in similar populations and in similar contexts while increasing the number of participants to a hundred or more. Thus the reliability of the indicators and the factors they indicate can be tested. Thereafter, validity across further populations could be checked by testing levels of factor invariance. From this process, after establishing reliability and validity of the factors and their indicators, comparative group responses across ages, genders, ethnicities, and cultures could be conveniently investigated using statistical tools.

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Deeper Foundational Questions A preliminary correlation of psychospiritual theoretical constructs was set forth for the pragmatic purpose of investigating their presence and role in a particular Vajraya¯na Buddhist contemplative liturgy. A thorough critical correlation, however, would make an exhaustive, mutually dialogical exploration between this ancient but alive Buddhist tradition and contemporary pastoral theological explications. This task remains constrained by the excruciatingly limited amount of primary source literature in a common language, such as English, relative to the number of volumes of extant Tibetan language literature. When systematically searched, this vast literature including its abundant narrative biographical genre will surely shed light on numerous accounts of spiritual care in the contexts of bereavement, trauma, conflict, and so forth. Broader Foundational Questions The investigation into the subjective experience of one particular Amita¯yus contemplative liturgy as a mode of spiritual care in Vajraya¯na Buddhism at the level of phenomenological description is only one concentrated scope of focus. A complete, holistic portrayal would integrate multiple scopes. For example, individual subjective experience must be considered in light of complex contextual conditions that an ethnographic investigation could reveal. A detailed, methodical narrative investigation would offer rich descriptions of how the Western Christian and secular categories and notions of psychospiritual transformation and care are more broadly interpreted and estimated, and perhaps even negotiated and applied, throughout the lives of Himalayan Buddhists. A grounded theory investigation might reveal additional emic categories of psychospiritual transformation and spiritual care from Buddhist perspectives. Further Explorations Inspired to Illuminate and Inform Spiritual Care Praxis For me the most interesting areas of further exploration are the epistemological processes central to liturgical experience and their potential to inform the intersubjective relations of spiritual care (and self-care) praxis. Pursued within frameworks of pragmatic relevance and norms of preventing inadvertant suffering incidental to benevolent pious agendas, a lot can be learned from the complex intersubjective relational dynamics prevalent in Buddhist contemplative liturgy. For example, like practical theologians engaged in reflexive, critical hermeneutics, the contemplative liturgant nimbly negotiates first, second, and

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third – person relations by way of diverse roles, goals, and contexts. Second – person, I – thou relationships persist with respect to teachers, the liturgical scripture, and the scripture’s author as well as the elaborate theological construction representing a Buddha’s divinity. These shape the discursive practice of liturgical care. As liturgical performer and master of ceremonies, the first – person and third – person roles are further assumed. At the intrapersonal, contemplative level, the liturgy itself prescribes meditation in all three roles, thereby opposing the purpose-driven ego compulsions of naive, uncritical self – consciousness in an intersubjectivist transcendence of dualism, however fleeting. Thus, within the discursive context, the contemplative liturgy proceeds further to engage an interactionist mode of communication. Like the Zen ko’ans, the dualistic grasping nature of the mind itself is used as the very ground through which the fundamental I – thou separation may be directly and momentarily experienced as fused, with all of the scripture-led deliberation of the liturgical text and author (and Buddhas, by proxy) serving in their passive, third – person roles of historical cofacilitators. In an empowering spiritual care relationship, I prefer to transcend my transactional care-giver role of prayer-dispenser or “Reverend Fix-it” moodelevator-in–chief. Rather, I seek to kindle empowerment by including, but moving beyond, my more passive “non-anxious presence” witnessing role. To actualize this somewhat prophetic mission, I move beyond the mesmerizing, pleasureable, ego-gratifying sensations of feeling needed and appreciated in my role of an anxiety-diffusing peace-maker and instead clarify inner and shared spaces within which the client can take the active role. I seek to become a conspirator with my clients, enabling their transition from circumstantial second – person victims or third – person spectators to become pro-active authors directing their own outcomes with steady yet smooth immediacy. In this process, I cultivate a habitus of discursive practice and interactionist communication using my own body, speech, and mind, and leverage my own direct experiences of the manifold caring roles of contemplative liturgy practice. In such ways the psychospiritually transformative nature of the contemplative liturgy is pregnant with its promise to empower the cared for as well as the caregiver.

References [Canonical Buddhist Su¯tra – Pa¯li Recension]. “The Healing Medicine of the Dhamma (Miln 5).” In Access to Insight (Legacy Edition): Readings in Therava¯da Buddhism. Edited by Access to Insight. Access to Insight, 2013; [Tripitaka: Khuddaka: ˙ MilindapaÇha (Miln 5); Excerpt translated from the Pa¯li by Andrew Olendski]. Accessed August 7, 2016. https://web.archive.org/web/20160807185058/http:// www.accesstoinsight.org/tipitaka/kn/miln/miln.5x.olen.html.

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Clinebell, Howard. Basic Types of Pastoral Care and Counseling: Resources for the Ministry of Healing and Growth. Nashville: Abingdon, 1984. –. Counseling for Spiritually Empowered Wholeness. New York: Hawort, 1995. Csikszentmihalyi, Mihaly. Flow : The Psychology of Optimal Experience. New York: Harper & Row, 1990. Druk Amitabh Mountain Nunnery. “Grand Amitayus Puja for Longevity (Tshe dpag med zhi wa lha mangs cho ga).” Accessed April 11, 2017. https://youtu.be/ GCKL4 fGfRlk?list=PLeSr5WhBhlaGmcOZOl54Tbw6NzxIu8Nr_. Gross, Rita. “Buddhist Theology?” In Buddhist Theology : Critical Reflections by Contemporary Buddhist Scholars. Edited by Roger R. Jackson and John J. Makransky, 53–60. London: Routledge-Curzon, 2000. Heitink, Gerben. Practical Theology : History,Theory, Action Domains: Manual for Practical Theology. Studies in Practical Theology Series. Grand Rapids: Eerdmans, 1999. Translated by Reinder Bruinsma. Johnson, Marion, and Meridean Maas. Nursing Outcomes Classification (NOC). St. Louis: Mosby-Year Book, 1997. Kilts, Thomas. “A Vajrayana Buddhist Perspective on Ministry Training.” Journal of Pastoral Care 62, no. 3 (2008): 273–82. King, Ursula. “Spirituality.” In A New Handbook of Living Religions. Edited by John R. Hinnells, 667–81. Oxford: Blackwell Publishers, 1997. Lung-rigs bsTan-dar. Gso ba rig pa spyi dang bye brag tu dam pa’i chos dpal ldan sman rgyud bzhi’i chos ’byung tshul dri med ba’i durya’i me long [History of Medicine]. New Delhi: Tibet House, 1977. [Lung-rigs bsTan-dar, b. 18th C; TBRC W17680]. Meridean Mass et al. “Evaluation of the Reliability and Validity of Nursing Outcomes Classification Patient Outcomes and Measures.” Journal of Nursing Measurement 11, no. 2 (2003): 97–117. Mosby’s Dictionary of Medicine. 8th ed. St. Louis: Elsevier/Mosby, 2009. Accessed May 1, 2015. Moustakas, Clark. Phenomenological Research Methods. Thousand Oaks: SAGE Publications, 1994. Osmer, Richard R. Practical Theology : An Introduction. Grand Rapids: Eerdmans, 2008. Pad+ma dKar-po. Tshe dpag med zhi ba lha mangs kyi cho ga ’chi med ’dod pa’i re skong nag ’gros su bkod pa bzhugs so [Ritual of the abundant peaceful deities of Amita¯yus satisfying the wishes of those desiring immortality]. Darjeeling: Rdor gling ’brug sgar dpe mdzod khang, 2003. [’Brug-chen IV Kun-mkhyen Padmadkar-po, 1527–1592; TBRC W10736; Edited contemporary version also known as “Zhi ba lha mangs”]. Sopa, Geshe L., and Jeffrey Hopkins. Cutting Through Appearances: Practice and Theory of Tibetan Buddhism. Ithaca: Snow Lion Publications, 1989. Trinlae, Bhikshuni L. “Prospects for a Buddhist Practical Theology.” International Journal of Practical Theology 18, no. 1 (2014): 7–22. Accessed March 15, 2017.

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doi:10.1515/ijpt-2014-0002. http://www.degruyter.com/view/j/ijpt.2014.18.issue1/ijpt-2014-0002/ijpt-2014-0002.xml. –. Vajraya¯na Buddhist Contemplative Liturgy of Kun-mkhyen Pad-ma dKar-po as a Living and Caring Tradition of Transformative Experience: A Phenomenological Investigation of Amita¯yus Practice. (Forthcoming), 2017. Trungpa, Chögyam, John Baker, and Marvin Casper. Cutting Through Spiritual Materialism. Boston: Shambhala, 2008.

Hansjörg Znoj1

What comes after? Aspects of Bereavement from a Psychological Perspective

Abstract In this chapter, the loss of an intimate person is explored from a psychological perspective. Bereavement is a normal normative life-event and as such embedded in a cultural context. Still, for the bereft individual the experience of loss can be extremely painful and even lead to an emotional disorder or somatic illness. Several models of grief including a biological approach lead to a better understanding of the underlying process of learning and adaptation. During the adaptation process, coping strategies and social support are important predictors of well-being. The experience of pain is often not constructive in terms of the adaptation process. Instead, empirical evidence supports the idea that the experience of positive emotions is highly adaptive during bereavement. Spirituality and religious coping can have a strong impact as has been shown in several studies. In the Bern Bereavement study the theodicy of a punishing God has shown detrimental effects, while religious coping activities relating to outcomes could not be established. Still, despite the great distress of bereavement, many parents reported personal or spiritual growth. The last part of this article discusses grief as a disorder and treatment options, including the known principles of successful interventions.

Introduction Bereavement after a loss is a normal but threatening life event that can lead to serious consequences, such as anxiety, sleep disorders, problems of adaptation, depression, and even death. The loss of a person is often shared among many individuals who each have developed different bonds with the deceased person. Henceforth, grief is often a shared experience but bereavement is rarely the same for different individuals. Besides individual coping with loss, there are cultural aspects of grief and bereavement that also have to be accounted for. Evidence exists indicating that grief can become a disorder 1 Professor of Clinical Psychology, Department of Health Psychology and Behavioral Medicine, University of Bern / Switzerland. Email: [email protected].

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similar to other emotional disturbances such as anxiety disorders or disruptive aggression (Shear et al., 2011). When we think of loss, we immediately have in mind a certain expression of desperation among the bereft who were the most intimate relations of the deceased. But we often forget that what we indicate with the term “grief” is largely determined by culture and implicit cultural norms in particular. What we feel and how we behave in situations of loss may feel “natural” to some degree but it is also shaped by the belief system and culture that may employ rather precise rites for handling the transition of life to death or after-life. Grief is usually shared with others in the community but the individual is none the less alone with her or his feelings. In addition, the state of grief lasts longer than is usually assumed and is accompanied by intense emotions but also a feeling of desolation (and numbness), such as being cold toward others. Individuals often are overwhelmed by thoughts or feel as though they have no thoughts at all. They may overreact and become overly active, or, at the other extreme, look for tranquilizers such as alcohol or drugs. Coping strategies, adaptive as well as maladaptive ones, may be pronounced in bereavement. Despite the diverse cultural determinants of expression, a strong universal emotional expression is predominant. Darwin was one of the first systematic researchers of emotion in humans and animals (Darwin, 1872) and he described the state of desperation as: “Infants, when suffering even slight pain, or discomfort, utter violent and prolonged screams. Whilst thus screaming their eyes are firmly closed, so that the skin round them is wrinkled, and the forehead contracted into frown. The mouth is widely opened with the lips retracted in a peculiar manner, which causes it to assume a squarish form: the gums or teeth being more or less exposed.” (Darwin, 1872, p. 146–147). The basic emotion of sadness has the same expression as disappointment. In the western culture, we belief that the expression of feelings often may follow the cause, but this is one belief that has not been validated empirically. Wortman and Silver (1989) described five myths of loss that have been widely accepted but are not indicated by evidence. These myths are: – Following the death of a loved person, there is necessarily depression and high emotional distress – The experience of high emotional distress is a necessary prerequisite for healing – The loss must be worked through psychologically to get complete rehabilitation – After successful grief-work, the loss becomes meaningful – Not experiencing an emotional crisis or not experiencing much grief is a sign of a pathological development

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Some of these beliefs stem from psychodynamic thinking, namely, from Freud (1917), who postulated that grief can become pathological when the loss has not completely worked through. As he stated: In what, now, does the work which mourning performs consist? I do not think there is anything far-fetched in presenting it in the following way. Reality-testing has shown that the loved object no longer exists [for the bereaved,] and it proceeds to demand that all libido shall be withdrawn from its attachments to that object. This demand arouses understandable opposition-it is a matter of general observation that people never willingly abandon a libidinal position, not even, indeed, when a substitute is already beckoning to them. This opposition can be so intense that a turning away from reality takes place and a clinging to the object through the medium of a hallucinatory wishful psychosis. Normally, respect for reality gains the day. Nevertheless its orders cannot be obeyed at once. They are carried out bit by bit, at great expense of time and cathectic energy, and in the meantime the existence of the lost object is psychically prolonged. Each single one of the memories and expectations in which the libido is bound to the object is brought up and hypercathected, and detachment of the libido is accomplished in respect of it. Why this compromise by which the command of reality is carried out piecemeal should be so extraordinarily painful is not at all easy to explain in terms of economics. It is remarkable that this painful unpleasure is taken as a matter of course by us. The fact is, however, that when the work of mourning is completed the ego becomes free and uninhibited again. (Freud, 1917 in MOURNING AND MELANCHOLIA, 245).

Humans share as other social animals the capacity to build long-lasting social relationships. Attachment is perceived as a natural basic need and we are attached to others in various ways, as dependent children and lovers, or because we share the same living circumstances. Following the work of Bowlby (e. g., 1980), the loss of an attachment figure may lead to massive stress, even resulting in death. In a biological sense, grief is the price humans pay for the capacity to form social bonds, groups, and communities. Grief is the individual emotional response to separation distress, which is related physiologically to a genetically provided subcortical network (Panksepp and Watt, 2011) leading to emotional responses such as panic, sadness, and a diminished strive for dopamine-driven activities. Indeed, many bereaved parents expressed their grief in metaphors relating to bodily loss (Znoj, 2016). Following the work of Stroebe and coworkers (Stroebe and Schut, 2001), the intensity of the grief response is more related to the relationship of the deceased person and less to other circumstances of the loss. This corroborates the notion that grief and related disorders are consequences of a breakdown of the bonding system and therefore constitute a specific form of threat.

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Models of Grief A variety of models aim at explaining grief. Phase models of bereavement are still popular by providing a system that is both logical and dynamic. After initial shock and disbelief, the bereaved is assumed to go to further stages of adaptation, namely to realization of the loss and grief work that includes gradual disengagement from the target person and finally the resumption of emotional life and the capacity to form new intimate relationships. These phases are generally conceptualized as sequences. However, most researchers agree that this view is oversimplified. Some models focus on coping with losses. The task model (Worden, 1996) suggests four tasks to adjust to bereavement. In contrast to just passively experiencing the loss, it focuses on active coping with the challenges, namely : accepting the reality of the loss, experiencing the pain, adjusting to an environment without the deceased person, and finally finding a new understanding with the deceased. Coping models often focus on various coping styles, such as avoidant coping or rumination (e. g., Nolen-Hoeksema, Parker, & Larson, 1994) that often lead to elevated depression and higher distress levels later on. In contrast, problem-oriented coping is associated with better adaptation and includes distractive coping and even cognitive avoidance (e. g., Bonanno, 2004). Positive meaning and meaning reconstruction following bereavement have been linked to positive outcomes following loss: the capacity to display positive emotions during bereavement predicts better outcome after the loss of a spouse (Bonanno and Keltner, 1997). Taken together, these results may indicate that too much avoidance as well as too much confrontation may be detrimental to adaptation following loss. Stroebe and Schut (1999) proposed the dual-process model that integrates both stress and coping theories as well as psychosocial models, such as the two-track model (Rubin, 1981) addressing both, the biosocial responses to bereavement and the transformation of attachment that may include a new ongoing relationship with the deceased person. The integrative dual process model of grief takes into account the empirical evidence and postulates an oscillation between loss-oriented coping and restoration-oriented coping. Loss-oriented coping includes positive reappraisal versus rumination, wishful thinking, revisions of personal goals, positive and negative event interpretation, and expressing emotions and mood states such as dysphoria or positive effect toward the deceased. On the other hand, restoration-oriented coping is focused on attending to life changes, doing new things, distracting oneself from the grief, and finding new roles and identities. For stress–response disorders in general, Horowitz’ (1978) model of working through a traumatic event posits an oscillation between phases of intrusion and avoidance as necessary process for adaptation. A good fit can be found between the dual-process model (Stroebe and Schut, 1999) and deepened

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investigation of risk factors as has been shown for cognitive–emotional changes after bereavement (Znoj, 2016). For instance, anger about the circumstances of the death of a loved one could lead to more severe grief, specifically when the death is perceived as unjust, such as in the case of the death of a child. A general model of psychopathology developed by Grawe (1998, 2006) is based on the notion of consistency. The loss of an attached person challenges the balance of basic needs and the possibility to satisfy them. The biological as well as psychological process of bonding form a desire to receive signals of presence. As long as a person is not convinced of a definitive loss she or he will continue to yearn. In terms of the consistency principle, a bereaved person is under tension because the expectation to consume the presence of the attached person is violated. This model integrated parts of Freud’s (1917) assumptions “that people never willingly abandon a libidinal position” as quoted before and can explain why the extensive tension of the loss experience activates brain activity up to a point to hallucinatory experiences. Generally, feelings of presence and even extremely vivid dreams are reported even in psychologically sane persons. Under normal circumstances however, reality gradually will lower the impact of the loss experience because learning sets in and the “emotional brain” rebuilds the inner world-model. However, the consistency model also explains why vulnerable persons may not be able to adapt. The principle of consistency has to reduce degrees of freedom both experientially as well as behaviorally in order to function under the chronic condition. In addition, certain beliefs or assumptions may hinder the adaptation process. In Western societies, the belief often exists that grief should be resolved within 12 months (Wortman and Silver, 1989). Zisook and Schuchter (1986) described persons within the first year of widowhood. While the majority had adapted well after 4 years, some individuals still felt responsible for the loss and reported symptoms like preoccupation with thoughts of the spouse, or had clear visual images; moreover 40 % reported elevated levels of depressive symptoms. Overall, the symptoms degraded slowly over time. Obviously, the process of grief lasts longer than usually assumed by the general population. Some of the symptoms clearly have a negative impact on well-being, such as intrusive longing, pain, bouts of crying, and worrying. However, depressive thoughts may also hint toward personal growth and the stimulation of human resilience (e. g., Znoj, 2006). An important question arises here: Is pain really a prerequisite of healing from loss? For bodily wounds pain is not helpful for healing; modern medicine tries to prevent pain after a medical intervention. The reason for this is chronic pain. Chronic pain as a condition is more likely when nociceptors are signaling too intensely and too long into the central brain. A “painmemory” can be the result of this process. Pain can be learned like other signals that are processed in the brain after repetition and when they are

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experienced as relevant (i. e., via emotional processing). They build a schemalike structure. How compatible is this with the notion that we have to go through emotional pain in order to “heal” from loss and bereavement? Bonanno and Keltner (1997) made the observation that positive emotions during bereavement are an active way to find tolerable states of mind. In fact, they investigated the non-verbal expressions of relatively newly bereaved persons (average five to six months post loss) during a videotaped task. In this study, the bereaved persons have been left alone with the task of remembering three memories and then report these. While reporting, their faces have been analyzed with help of the “FACS” (Facial Analysis Coding System, Ekman & Friesen, 1978). This system allows the deriving of basic emotions out of muscular facial expressions. The results of these analyses have been used to predict grief-related symptoms 14 and 25 months post-loss. The authors found extremely strong correlations between expressed positive emotions and grief symptoms in the long term, predicting lower grief-symptoms. In contrast, the sum of negative emotions (sadness, anger and anxiety) predicted higher symptoms. This was only the first of many studies coming to the same conclusion: namely, that down-regulating negative feelings is not only important but even more important is to allow positive emotions to arise and abide when remembering the deceased loved one. Hence, the importance of emotional regulation and the “dosing” of dreadful states is evident for “healing” after loss. Healing here means that the loss has to be integrated into one‘s biographical narrative and hence into the sense of self (identity).

Reaction to Loss Vivid memories, emotional turmoil, high levels of anxiety, and depression are seen as normal reactions to the loss of a beloved person in adults. Information about grief reactions in children or young adults is scarce. Depending on the age and developmental stage, a child or young adult will have different concerns. In each of the developmental stages, grief can become overwhelming and a source of intense distress. Complicated grief (CG) can be observed in any of these stages and is usually characterized by deterioration of social aspects as well as depression, including regressive states, phobias, loss of emotional and behavioral control, or reduced cognitive ability. Because the cognitive and emotional apparatus is changing, Oltjenbruns (2001) observed the phenomena of regrief, meaning that at a later developmental stage, the loss can be reexperienced and more intense than before. In this perspective, the loss of a mother at 4 years of age can have a different but no less powerful impact on a young woman of 17 years of age, when she would need her motherly advice and support to develop her own life in the transition to adulthood. Silverman and Worden (1992) investigated 125 children from 6 to

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17 years of age within 4 months of the death of a parent. After 4 months, the effective response stabilized fairly for most children; however, 74 % reported headaches or other somatic problems, one-third had sleeping problems they attributed to their parent’s death. Further problems included difficulties concentrating in school, hassling by peers, or uneasiness at the absence of one parent. To remain connected with the deceased parent seemed to be a strong motive for children and youths at least in this study. In sum, “the deceased parent continued to be a real presence for many of the children who carried on a relationship similar to the one prevailing before the death” (Silverman and Worden, 1992: p. 100). Balk and Corr (2001) estimated that the risk of depression following the death of a parent is seven times higher than the norm. In an effort to shed more light on this underinvestigated area, Schwartz (2003) interviewed 39 children and young adults between 10 and 22 years of age in the Bern study within 6 months to 5 years after the loss of a parent. For more than 50 % the death came suddenly and unheralded. Eighteen percent of the bereaved children and young adults had clinically relevant levels of depression. Avoidance and retreat were closely related to depression (r = 0.50, p < 0.01), whereas support – seeking was negatively related to depression. Although 50 % reported as not being religious, almost all wanted their parents to be well off in Heaven [or after life] and almost 75 % uttered the opinion that their deceased parent can hear them, and therefore tried to contact them via prayer. Almost half of the bereaved children indicated having vivid dreams and feelings of presence of their deceased parent. One-third even heard their deceased parent as if he or she would still be alive. Levels of [active] spirituality and religion were positively correlated with social support, especially through grandparents (r = 0.49, p < 0.01), and also correlated with feelings of presence (r = 0.33, p < 0.05). In terms of long-term consequences of childhood adversities, Cuijpers et al. (2011) also looked at bereavement in a large population sample in The Netherlands. While childhood adversities in general had very high impact on the disease burden in adulthood, the death of a parent had no effect. This suggests that bereavement in childhood might not necessarily lead to longterm negative consequences. However, this finding needs to be replicated. Child loss is one of the most challenging losses a person can experience. In the Bern study of parental bereavement (Znoj, 2016, 2012), we found extremely high levels of intrusions as measured with the Impact of Event Scale (Maercker and Schu¨ tzwohl, 1998). Bereaved parents also reported high levels of depression; they often experienced the loss as if they were physically amputated and in physical pain. The loss of a child can be seen as a serious risk factor for prolonged grief. For elderly people, the loss of a close person is a normal event and especially old age is a time of multiple sequential losses. As Moss and Moss (1986) found, 40 % of persons over 60 years of age had already experienced the loss of a sibling. Conjugal bereavement, i. e., the death of a spouse, is also an important

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topic and often the bond persists and continues beyond the death. Following Lopata (1996), loneliness is among the most mentioned consequences of widowhood. Most widows and widowers live alone but many acquire new skills and develop in positive ways. The impact of the loss may be less intense than in younger years but the emotional distress and grief dissipate more slowly among older persons (Moss et al., 2001). Mortality risk is elevated, especially for widowed men (e. g., Verbrugge, 1989). Moreover, a special situation arises when there is a generational violation, especially when a child dies before an elderly parent. In addition to intense emotional distress, such a loss may imply a breakdown of the supportive system and may have serious health consequences. Research is rare, despite the fact that adult children play a major part in the social and emotional world of parents throughout their lifetime (Moss et al., 2001). The death of an old person, on the other hand, is often experienced as relief (because the person’s suffering has ended) and may lower the emotional impact of the loss for close persons.

Spirituality and Personal Growth I have changed a lot since he died. In the first time I learned to accept help from others. … And I think that I became more open – as for myself I know better what I really want from life, what I am afraid of and also who I am. And I stay myself even in company with others. … And yes, I think I can really be proud of myself that I have managed everything so well. All these things have prevented me from going crazy : I had to be a mother for my children and I had to worry about all these financial things, otherwise we would be broke by now. … And sometimes I think of myself as a lucky person, being a single mother, even when everything has also a tragic aspect. (Transcript, anonym, thirty something, 14 month following the death of her spouse. Taken from the San Francisco Study on spousal bereavement, quoted in Znoj, 2006).

In the 20th century, several clinicians and scientists (e. g., Frankl, 1972; Maslow, 1970), writing in the general domain addressed the ways in which critical life crises offered possibilities for positive personal change. Posttraumatic Growth is manifested in a variety of ways (Dimensions of Posttraumatic Growth), including: 1. 2. 3. 4. 5. 6. 7.

An increased appreciation for life in general Radically changed sense of priorities Closer, more intimate, and more meaningful relationships The experience of an increased sense of compassion A general sense of increased personal strength Identification of new possibilities for one’s life Growth in the domain of spiritual and existential matters

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Calhoun and Tedeschi (1998) emphasize that by rethinking the event over and over (rumination), people manage to cope with the emotional impact and start having new perspectives. They even may develop a completely new frame of reference or world-view incorporating the traumatic event and therefore become a more fully developed person. However, according to Linville (1987) these changes do come not cheap: In order to be capable of integrating nonnormative events, the self has to adapt to a more complex representation of the world and the “old” feeling of security may vanish forever. Linville reported that in the sequence of life-threatening life crises, not only will people get stronger in the sense of a cognitively buffered self, they become more resistant to depression. On the other hand, their mood may become lower and more moderate (see also Janoff-Bulman, 1989). Linville explained this paradoxical effect through the mechanism of a lower self-esteem while representing a more complex world. A child represents the world in a simple way but the sense of self is undisturbed and when a child wants something, it is not hampered by a self-consciousness representing the world as often frustrating one’s needs. However, during the process of growing up, many frustrations have to be integrated: the needs have to be negotiated and as a consequence, the sense of oneself becomes less narcissistic and more adapted to environmental demands. On the other hand, there is evidence that highly narcissistic people are more resistant to stress (Bonanno, 2004), although this might only be the case as long as the environment fits into the represented world. High selfesteemers would then be better protected from depression and they may be better able to rebuild their cognitive system without loosing a positive outlook. Taken together, the changes following the aftermath of a serious lifeevent suggest a non-linearity of different possible outcomes. Non-linearity was also observed by William James when interrogating the varieties of religious experiences. Especially he was drawn to the experience of sudden turning to religion after a serious life-event. He even proposed a kind of mechanism he called “schema” working like a mysterious filter turning bad into good or evil into blessings. It may evolve following extreme life-events. He wrote: In this state of mind, what we most dreaded has become the habitation of our safety, and the hour of our moral death has turned into our spiritual birthday. The time for tension in our soul is over, and that of happy relaxation, of calm deep breathing, of an eternal present, with no discordant future to be anxious about, has arrived. Fear is not held in abeyance as it is by mere morality, it is positively expunged and washed away. (W. James, lecture 2, 1902).

Spirituality has the power to overcome insurmountable obstacles that a more critical mind and more “down to earth” stance would recognize as too gigantic a task. Human history is full of example where heroes and saints overcome huge enemies single-handedly and without the slightest chance. For instance, the famous [Saint] Joan of Arc was reported to win an already lost battle

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against the British emperor. The important point here is that spiritual power or a belief in supernatural power overcomes the most disturbing realities. Following the death of a beloved child, many parents see themselves as mutilated and severely harmed. Still, they often do not suffer for themselves but see a promising life cut short. In many cases, spirituality may help to locate the dead child in heaven [or an afterlife] but grief remains. Growth following bereavement – especially parental bereavement – is probably different both in process and outcome (Yalom & Lieberman, 1991). Most people are biased in their own judgments in favor of themselves. That is, they perceive themselves as better lovers, car drivers, or healthier than average – in fact, most healthy adults are positively biased in their selfperceptions (e. g. Taylor & Brown, 1988). Unrealistic optimism seems to be a good predictor of health: As reported by Scheier und Carver (1985), unrealistic optimism makes people feel better and is associated with positive relationships and higher motivation. In addition, unrealistic optimism is associated with successful coping and better recovery from health-related stressors (Scheier et al., 1989). However, this perspective has gained widespread criticism (e. g. Colvin & Block 1994). Do positive illusions foster mental health? An examination of the Taylor and Brown (1988) formulation suggests that positive illusions are only beneficial when there is enough realism left enabling the individual to adapt to a specific environment. This truism may help researchers investigate personal growth (PG) more realistically. What we should not expect is that people who report personal growth are completely well and psychologically healthy. Znoj (1999) proposed a model of PG where reported personal growth was dependent on psychological impact: Following this model, personal growth is both a coping strategy and an outcome following a major life-event. It is related to symptoms, because following a life event, usually people get distressed and more symptomatic. But it is a nonlinear, reciprocal association. Highly distressed participants should experience a low level of personal growth, and people who had experienced high distress following the event but do not later when reporting on it should report high levels of personal growth. On the other hand, people who had experienced a major life-event without suffering from symptoms should report no stress – related growth. A cluster analysis with the bereaved parents of the Bern study on parental bereavement (Znoj & Keller, 2002) supported this hypothesis. In this study N = 176 bereaved parents (male 59, female 117) were investigated. The mean age was 42 years, the time since child loss averaged five years, and the mean age of the dead child was around three years (0 to 48 years). The cause of death varied: 47 % died either from chronic or acute disease while accident (15 %), suicide (14 %), newborn or early deliverance (17 %), and sudden infant death (7 %) were the other causes. As measures we used the Beck Depression Inventory (BDI, Beck, Steer, & Brown, 1996) and Impact of Events Scale-Revised symptom scales (IES-R, Creamer, Bell, &

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Falilla, 2002), a measure of social support, the sense of coherence (SOC, Antonovsky, 1993) as a measure of resilience, and stress related growth (SRGS: Park, Cohen & Murch, 1997). In addition we used the DSM-IV criteria as a measure for posttraumatic stress reactions. Thirty-seven percent of all bereaved parents had elevated BDI-scores (23 % between 11 and 17; 14 % scored above 17). The bereaved mothers reported higher depression scores than the bereaved fathers (t (158) = 3.54, p < .01) with a mean score of M = 11.14 (SD = 8.53) compared to M = 7.38 (SD = 5.24). The depression scores were correlated with age (rp = .29, p < .01) when controlled for time since loss. Time since loss was negatively correlated with depression in bereaved mothers when controlled for age (rp = -.29, p < .01) but not in bereaved fathers (p > .90). The correlations of post-traumatic growth however showed no linear relationship with depression but could be clustered in three groups. Figure 1 summarizes the results.

Figure 1. The bereaved parents could be separated by cluster-analysis into three groups: “benefit-finders”, “vulnerables”, and “resilient”. Total N = 170 (missing = 6)

The data show that the participants of the high depression group (the cluster center in this group was 21 on the BDI) did not report personal growth. But low symptoms are not indicative of PG either. There are obviously many nondepressed parents who do not claim such a personal development. This finding is in line with the resilience hypothesis (Bonanno, 2004). Persons who were not affected by the loss to a degree impacting their functions may continue life without further changes, even when they are badly hurt. But what

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predicts personal growth in bereaved parents? A systematic approach using hierarchical regression analysis revealed that the affective quality in the remaining family, being able to find new friends, a rather strong sense of coherence, especially being able to find meaning in adverse situations and stress – related intrusions were predictors of personal growth. Together, these variables explained 20 % of the variance of PG measured with the Stress Related Personal Growth scale (SRGS: Park, Cohen & Murch, 1997) in the mentioned Bernese study of bereavement. The low symptoms, low personal growth group had the lowest level of stress – related intrusions, the difference was highly significant against the highly symptomatic group (p < .001, multiple comparisons, Bonferroni corrrected). The high PG-group reported lower levels of stress-related intrusions than the high symptom group (p < .001) and there was a trend to have more intrusions than the low symptoms, low PG group (p < .10). The finding is in line with Calhoun’s and Tedeschi’s (1998) theory that rumination in the sense of rethinking and building a new frame of reference is a necessary condition for PG. On the basis of these findings one may conclude that PG is not necessarily a good predictor of health and well-being. Indeed, correlations with health indicators such as depressive mood did not reveal any statistically significant relationship for the bereaved parents. Within the same study a subgroup of the bereaved parents agreed to be asked especially about their religious experiences and religious coping activities. As is indicated in Table 1, religious coping activities such as praying or visiting church services were not found to be related to constructive thinking (Epstein & Meier, 1989). The Constructive Thinking Inventory (CTI, Epstein & Meier, 1989) was designed to assess experiential information processing. The experiential system (as contrasted with the rational system) is pre-conscious, emotional, fast, and emphasizes imagery. Good constructive thinkers are reported to experience less stress and to be able to carry a heavier productive load. Religious coping activities were also not found to be related to personal growth or depression. In contrast, the way God is perceived as response to the evil (Theodicy) was highly predictive in the parents who lost a child. Znoj & Morgenthaler (2004) distinguished three ways of perceiving God under the stresses of child loss: namely plan, punishment, and compassion. Punishment and plan both related to depression as the main measure for emotional load. Whereas bereaved parents who perceived their fate as part of a higher plan were less depressed, those who saw themselves as punished showed high an extremely high correlation with depression. To embrace a compassionate Deity however, was positively related to personal growth. For details see Table 1. In a different study, two of my students compared parents who lost a child with a group of matched parents who’s children survived the treatment of cancer (Lannen-Meier & Zwahlen, 2004). In total, N = 125 parents completed the battery of standardized questionnaires and open questions, 45 % were male, 55 % female parents.

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Table 1. Correlations between religious schemata – Theodicees – and Religious Coping with Constructive Thinking, Personal Growth, and Depression in bereaved parents – loss of a child (Znoj & Morgenthaler, 2004). N = 54 ** p < .01; * p < .05 (Pearson Correlation) Constructive Thinking Personal Growth Depression Punishment

–.49**

–.02

.47**

Plan

.07

.14

–.30*

Compassion

.01

.30*

–.17

Religious Coping

–.13

.23

.10

Twenty-five parents experienced the death of their child; thus 80 % of the parents experienced the distress of having a child diagnosed with cancer and its medical and social consequences, but in the end their child survived the illness. The best predictors for personal growth were adaptive emotion regulation, spiritual coping, and denial. In sum, 25 % of the variance could be explained by these variables. Denial as a coping strategy related positively to personal growth (b = .07, p < .05). The parents reported higher levels of adaptive emotion regulation than the general population and lower levels of maladaptive emotion regulation. In terms of gender distribution and other demographic variables, there was no difference between the two groups. Mean age was 42.7 years, the male participants being somewhat older than the female participants. The mean time since the death of the child was 3.5 years in the bereaved group, the time since diagnosis averaged 7.6 years for the bereaved group and four years for the group with the surviving children. The response rate was higher for parents whose child survived the treatment (39 % vs. 21 %). The most important result was an interaction between emotional regulation strategies and personal growth as an outcome. The figures 2a and 2b depict the interaction effect between the two parent groups – the bereaved parents and the parents whose children survived. The dependent variable is psychological growth and the moderating variable is coping in three different perspectives. The first two perspectives involve maladaptive emotion-focused coping (avoidance and distortion in the EMOREG (Znoj, 2008) and venting of emotion in the COPE study from Carver, Scheier & Weintraub, 1989). The third perspective is acceptance. Only for bereaved parents did these coping strategies have a significant effect on psychological growth.

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Figure 2 a. The outcome of maladaptive emotion regulation in bereaved parents vs. parents who’s child survived in terms of personal growth

Figure 2 b The outcome of the coping strategy acceptance in bereaved parents vs. parents who’s child survived in terms of personal growth

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Further Evidence for Loss Triggering Religious Experience In a longitudinal study focusing on an elderly population that was part of The National Centre of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability : Life Course Perspectives,” Perrig-Chiello and coworkers focused on the processes of overcoming vulnerabilizing factors in close relationships and paths of adaptation to major stressors in middle- and oldaged adults. In this longitudinal questionnaire study (2012, 2014, 2016), more than 1800 participants were included (774 married, registered partnership; 638 separated, divorced; 419 widowed). The age ranged from 39 to 95, and all participants were living in Switzerland. Among many other questions, the following questions related to religion and religious coping were included: From the Duke University Religion Index (Koenig & Büssing, 2010) three dimensions were investigated: Organizational religious activity (ORA), Nonorganizational religious activity (NORA), and Intrinsic/subjective religiosity (IR). In the whole sample, all three dimensions were negatively correlated with loneliness and positively with life satisfaction. In the spousally bereaved subsample, all three dimensions were strongly related with personal growth, a greater understanding of religious and spiritual matters and stronger religious and spiritual beliefs (see Table 2). Table 2. Correlations of the Duke University Religion Index with dimensions of religious experience in the widowed subgroup (N = 419). LIVES IP212 longitudinal study. N = 419 (widowed) ** p < .01 ORA = Organizational religious activity NORA = Non-organizational religious activity IR = Intrinsic/subjective religiosity Growth Total

Greater understanding of religious and Stronger religious and spiritual matters spiritual beliefs

ORA

.22**

.45**

.53**

NORA

.17**

.48**

.53**

IR

.18**

.45**

.52**

These results may indeed indicate that personal loss has a deep impact on the way we perceive ourselves and the world. Coping strategies that usually work well under “normal” circumstances may get amplified in times of prolonged distress, especially following personal loss. The results of the LIVES study show also limitations. There were no relations of religious coping strategies

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found with better outcome in terms of depression or life-satisfaction, but only a strong correlation of religion-related coping activities and personal growth or spiritual beliefs. These associations have still to be investigated more thoroughly and within different settings. The experience of personal loss is in some cases devastating and leaves no room for growth or spiritual development. Recent epidemiological studies reveal that approximately two to five percent of bereaved persons suffer from chronic loss. In the last part of this paper, I will give an overview of the loss related research.

Disordered Grief Emotional and behavioral consequences include intensive sadness, anxiety, aggression towards the deceased or persons related to the loss, and sometimes, dissociative states where the emotional system seems to be blocked. The reaction to loss is structurally similar to traumatic events and often results in emotional dysregulation. In many cases grief intensity weakens to a manageable degree in most people within a period of several months. Grief after the most intensive time is still present but the loss becomes gradually integrated and no longer stands in the way of ongoing life. Similarly, most immediate stress reactions following life-threatening events recede over time. Horowitz had previously pointed to similarities in terms of content shared by Post-Traumatic Stress Disorder (PTSD) and grief patients (Horowitz, 1986). Horowitz and colleagues (Horowitz, Bonanno & Holen, 1993) called this family of failure – to – adapt – disorders the “stress-response syndromes.” This concept is becoming increasingly recognized and may appear as a new area of disorders in the ICD-11. In the 5th edition of the DSM (Diagnostic Statistical Manual of the American Psychiatric Association) the “persistent complex bereavement disorder” is perceived as a possible diagnostic category. It has been repeatedly shown that the most commonly assigned classifications for these cases are PTSD, Depressive Disorders, Anxiety Disorder, Adjustment Disorders, and Personality Disorders (Enright & Marwit, 2002). The clinical utility of these labels, however, has to be called into question (Maercker et al., 2008). The debate centers around the extent to which complicated or prolonged grief represents a truly unique pathological entity when contrasted with normal grief, but also with posttraumatic stress disorder or major depression. However, consensus is that grief can be complicated, much as wound healing can be complicated (Shear et al., 2011). One readily accessible indicator is to listen to clients or patients. Self-statements like “I fear I would go crazy if I fully realized the death of my loved one” is very specific to complicated grief (CG) but not to depression.

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Table 3. DSM 5: Persistent Complex Bereavement Disorder 1. Intense yearning or longing for the person who has died 2. Frequent intense loneliness or that life is empty and meaningless without the deceased 3. Recurrent thoughts that it is unfair, meaningless or unbearable to remain alive when the loved one has died or a recurrent urge to die in order to join the deceased 4. Frequent preoccupying thoughts or visions of the loved one 5. Frequent troubling rumination about the cause, circumstances or consequences of the loved one’s death 6. Recurrent disbelief or inability to accept that the loved one is dead 7. Persistent feelings of being shocked, dazed, stunned or emotionally numb 8. Recurrent feelings of anger or bitterness related to the death 9. Persistent difficulty trusting or caring for others or envy of those who are not bereaved 10. Frequently experiencing symptoms that the loved one had, or seeing or hearing the voice of the deceased 11. Intense emotional or physiological reactivity to memories of the deceased or reminders of the loss 12. Changes in behavior due to excessive avoidance of reminders of the loss, or excessive seeking after reminders of the deceased (or both). The above-listed symptom disturbances must last at least 12 months for clinical classification to apply. Depression is no longer excluded in the case of death of a close person.

Note: Individuals with persistent complex bereavement disorder, or complex or prolonged grief disorder, are incapacitated by grief and focused on the loss to the exclusion of other interests and concerns. There is rumination about the death and longing for reunion with the deceased, identity confusion, inability to accept the loss, anhedonia, bitterness, difficulty trusting others and a feeling of being “stuck” in the grieving process. Numbers 5–12 are cognitive symptoms

Treatment of Complicated (Prolonged) Grief Disorder (CGD) In the following, current treatment approaches to CGD will be outlined. Katherine Shear’s approach to treating CGD has become widely recognized (Shear, Frank, Houck & Reynolds, 2005). This approach was informed by the imaginal and in–vivo exposure techniques used for PTSD, including the confrontational technique of “revisiting” the deceased loved one. Distress related to the loss (eg, yearning, longing, reveries, and fears of losing the

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deceased forever) is targeted using techniques to promote a sense of connection to the deceased. These include an imaginal conversation with the deceased that is conducted with the patient’s eyes closed. This technique is complemented by a preceding psychoeducation and subsequent “restoration of life goals” phase. Shear et al. (2005) compared this newly developed treatment to standard interpersonal psychotherapy (Weissman, Markowitz & Klerman, 2009). The results were much in favor of Shear’s complicated grief treatment, such that this treatment approach is now being disseminated around the world. This exposure-based treatment was studied in a modified form by Boelen et al. (2007). They examine different sequences of exposure and cognitive restructuring. Exposure began with the writing of distressing memories and included in-sensu exposure during the sessions. Cognitive restructuring (CR) focused on individual dysfunctional thoughts (e. g. guilt, anger). The evaluation was made halfway through therapy. The exposure phase that followed brought more improvement than the CR phase. Doing exposure first, followed by CR, yielded the best results. In the approach of Wagner, Knaevelsrud & Maercker (2006) a web-based intervention was investigated. The treatment also begins with a technique of self-confrontation similar to that used for PTSD (Lange et al., 2003) consisting of a written assignment. Patients are asked to write four texts where they describe the circumstances of their bereavement and their thoughts and feelings at the time. The therapist facilitates the non-avoidance of fear related to these memories. The cognitive restructuring is then based of these accounts. Most of the time what is dealt with are feelings of guilt or a sense of responsibility in the death of the loved one. Patients are then asked to write a supportive letter to a friend who finds him or herself in exactly the same situation as them. A further intervention consists in establishing rituals or activities to commemorate the deceased. The aim is to give the deceased a place in everyday life, to reorganize priorities, and to see how the patient can consider re-connecting with friends and social life. Within 10 weeks, patients write a total of 10 written assignments, to which they receive individual feedback from their therapist via e-mail within one workday. Being a web-based intervention, the group of patients was a highly selective one. In a randomized-controlled trial (RCT) with a wait-list control condition, the effect sizes were in the range of ES = 1.2 to 1.5, and ES = 1.2 to 1.6 for pre-treatment to 3-month follow-up. Follow-up measures at 18 months confirmed the stability of these effect sizes (Wagner & Maercker, 2007). At post-treatment, 81 % were healthy (i. e. below the clinical threshold), against 33 % in the control group. Further, 73 % said they had not missed face-to-face contact with their therapist (missed: 20 %, don’t know : 8 %). Wagner et al. (2007) examined other outcomes besides CGD, in particular post-traumatic growth and naive optimism. The goal was to establish the fact that therapy did lead to positive functional change and not dysfunctional change (operationalized as naive optimism). Results confirmed this hypothesis. Functional change in the five domains of posttraumatic

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growth (new possibilities, relating to others, appreciation of life, personal strength, spiritual change) did take place, but no significant increase in optimism was observed. This result can be summarized in the following common saying: patients got sadder but wiser through the process of grief and its treatment.All the studies reported here show that in an individual setting (of one patient, one therapist) good therapeutic success can be achieved with exposure and cognitive restructuring. The sharing of pain with others in an appropriate way, so that close relationships do not become dysfunctional, seems to be an important issue. Social sharing as a treatment goal may also be specifically suited for group treatments of CGD.

Outlook A good fit can be found between the dual process model (Stroebe and Shut, 1999) and deepened investigation of risk factors, as has been shown for cognitive-emotional changes after bereavement (Znoj, 2016). One example is that loss-oriented processes are typically cognitive-emotional reactions accompanied by feelings of injustice or anger associated with loss and which may vary in degree from moderate to exaggerated. Anger about the circumstances of the death of a loved one could lead to more severe grief, specifically when the death is perceived as unjust, such as in the case of the death of a child. Znoj and coworkers (Znoj, Morgenthaler, & Zwingmann, 2004) investigated bereaved parents and found high correlations of the feeling that fate is unjust with increasing psychopathology. A failure to adapt following a major loss of an attachment figure may not only lead to a complicated or prolonged grief disorder but also to other forms of psychopathology such as depression or panic disorder. It is probably critically important to look not only at grief-specific symptoms but also at the individual processes of coping. Just recently, Coifman and Bonanno (2010) were able to show that context sensitivity for negative emotions at 4 months post – bereavement predicted fewer depression symptoms at 18 months. In addition, our own work (e. g. Znoj, 2008; Znoj & Keller, 2002) has shown that processes of emotional regulation may lead to completely different outcomes after the loss of a loved one. Also, the important roles of cognition as well as beliefs have to be taken into consideration for predicting clinical outcomes. Because grief is not a disease and the experience of loss and death is part of the human condition, social and cultural aspects shape the individual’s response. The question of whether we perceive a grief reaction as part of social life or whether we focus on individual suffering and therefore individual treatment remains open for future developments.

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