O B B B C ?

Imagine folks sitting in a circle. Having a conversation about OBBBC. Or more precisely, about the OBBBC in one person's life. The circle could be around a fire in a primitive village; it could be around a small table in a modern hospital; it could be almost anywhere. That one person's OBBBC is the center of the conversation, and the purpose of the circle is to call forth all the wisdom available to understand the OBBBC.

OBBBC: One Big Buzzing Booming Confusion. Something has happened to this person's life that is out-of-the-ordinary. A sudden health crisis, onset of mental illness, addiction, or some other puzzling situation. A confusion that one person cannot unravel by themselves. So the circle is gathered, people with various kinds of wisdom, expertise and experience. The purpose is to develop a comprehensive understanding of the nature of this confusion and what may be done about it.

Paul Pruyser introduced me to OBBBC in Topeka, Kansas about 1980, where he practiced and taught at the world famous Menninger Clinic. Pruyser, a psychologist "wrote the book" on spiritual assessment: The Minister as Diagnostician. Pruyser and Karl Meninger (a psychiatrist and the clinic's founder), teaching a course by the same title, identified the value in including a chaplain in the circle of wisdom around the person with OBBBC. Every aspect of the person's life is important to understanding and planning a path toward recovery. The psychiatrist could use his specialized knowledge, experience and language system to diagnose the OBBBC and recommend helpful action. The psychologist's perspective adds more to the picture, as does that of the medical doctor, the nurse and the social worker. Each has a distinctive perspective, a wealth of experience and a language system to enhance understanding of the person's needs. Each specialist is able to identify resources that could be helpful. The interesting discovery, made by Pruyser, was that this was also true of the chaplain on their team. Pruyser was surprised to discover that the recommendations of the chaplain often closely paralleled those of the psychaitrist. In response he began to study the spiritual dimension of life, seeing that it was more than something completely mysterious.

Pruyser's challenge to us is twofold: To people with OBBBC and to treatment teams working with such people, his challenge is to make sure there is someone on that team trained to bring the specialized knowledge of the spiritual dimension of life to the table. Then he challenged clergy to learn to use their language and observational skills systematically so they could bring something significant and helpful to that conversation. Every person with OBBBC deserves to have someone at the table who can help them (and the others at the table) understand both the spiritual problems involved and the spiritual resources that will help in the person's journey toward wholeness.

Basic Needs

We all have certain basic needs, demanded by our mind/body/spirit vehicle. The body needs water, food, and sometimes shelter. The mind needs information, stimulation, expression and feedback.

What does the spirit need? Consider this a spiritual “basic food group” list. Regardless of religious affiliation (or lack thereof) we all need:
- Love and belonging
- Meaning and purpose
- Freedom from guilt and shame
Looking at your own experience, you may remember times when you had all these in abundance. What filled your cup? Where did the supply come from? How did you get what you needed? What resources (individuals, groups, systems, organizations, belief systems, world views, habits/disciplines) helped feed these things to you? Have there been other times when one or more of these were in scarce supply? What emptied your cup? What blocked your access to, or appreciation of, what you needed? Or what experience accentuated one of these needs? With these questions you are doing a spiritual self-assessment.

Listening to another person’s story, keeping these questions in mind, you can explore their experience to discover where their needs are greatest at the moment. Then you can compare the needs with the resources they know about. Are there gaps? What additional resources are needed to return to a state of spiritual well-being?

I adapted this three need list from Nurses Christian Fellowship. I like it because it’s easy to remember and to teach. I also use several other lists, some more complex, some even simpler. Each is a map, a simplified representation of reality, the spiritual territory of a person’s life experience. Like exploring outdoors, a map can be quite helpful in finding one’s way around unknown territory.

Perhaps!

"How fortunate you are; now you are wealthy" said a Chinese farmer's friends after a strong young horse wandered into his farm. Having a horse made all the difference between being a poor farmer and a wealthy farmer; the horse allowed one to till more land, to grow more food than the family could consume, enough to take to market.

"Perhaps!" was the wise farmer's reply, much to the puzzlement of friends.

Next day, as the farmer's son was working to train the horse, he was thrown so hard he broke his leg. "How unfortunate you are; your horse is no good and now even your son cannot help with the crops."

"Perhaps!" was the wise farmer's reply, again to the puzzlement of friends.

Next day the army came through the village, conscripting all the healthy young men, taking them off to war. "How fortunate you are; your son's broken leg kept him from being conscripted..."

"Perhaps!" was the wise farmer's reply, again to the puzzlement of friends...
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The human is the meaning making animal. Making meaning is a distinguishing characteristic of the human being. In "The Meaning Makers" (Chapter 1 in The Life of Meaning) Bob Abernathy and William Bole trace the understanding of what distinguishes humans from other animals. Aristotle identified our social nature, but we share that with some other animals. Benjamin Franklin identified us as "the tool makers;" since then we've discovered that chimpanzees make tools, too. Our distinction, they conclude, is that we are the meaning making animal: "We manufacture meaning out of the rawest of materials -- out of sickness, war, death, as well as routine events."

Observing this meaning making process is part of Spiritual Assessment. Jerry Davis, one of my early mentors told us chaplain interns: "Chaplains aren't often here to treat the illness; we are here to treat the meaning of the illness." Patients and clients often benefit when someone carefully observes and reflects on the meaning they give to their experience. Some helpful curiosity may consider these questions:

• What meaning does this person give to this experience?


• How does he make this meaning rather than some other possible meaning?


• Is the expressed meaning congruent with the context or does it depend on convoluted thinking, such as denial of the obvious, to work?


• Are there patterns to meaning making like "awfulizing," minimizing, seeing a conspiracy in everything or a "devil behind every bush?"


• Does this meaning come from early life conditioning, religious or cultural conditioning? (Think of the farmer's friends) Or is it fresh and dynamic, open to more possibilities? (The farmer's response comes to mind)


• How well does this chosen meaning work for her? Does it lead to closed or open doors?


• Does this meaning promote "lessness" or "fulness" (helplessness, hopelessness or resourcefulness and hopefulness)


• How aware is she of her meaning making process? Is she a victim of meaning making patterns beyond her awareness ? Or does she have mastery of the process, to observe, evaluate and improve it?


• If given the opportunity, can this person reframe this experience in other possible meanings? If not, can he consider another meaning someone else might offer?

I'm reminded of this ancient statement of Epictetus: "When anything external distresses us, it is not the event which causes us pain, rather,our response to it... ... and this we have the power to revoke at every given moment."

How's Your Courage?

If you saw my Dad in the busy San Diego area emergency room where he worked, his opening line was likely "How's your courage?"

If you were on the "knife & gun club"/accident/trauma side he wasn't there to treat you, but to help you deal with what had happened. It was shorthand for "How resilient and resourceful are you, and what spiritual/social/family resources do you have that could help you now?" If you were on the mental health/OD/alcohol side, he was there to assess your needs and resources and help determine whether you would be treated/released or need to be admitted for further care.

On the surface "How's your courage?" was timely and disarmingly engaging. Beneath the surface, it's a spiritual assessment question without being even slightly religious; the first spiritual assessment question I ever learned, in fact, without knowing it. My Dad was a hospital chaplain who specialized in mental health care. Like most acute care hospital chaplains, he also had his share of trauma duty. So he spent a lot of time in the ER, meeting people for the first time at some of their worst moments. Moments when they might benefit from remembering what had helped them get through tough times before.

Here's why "How's your courage?" is such a good spiritual assessment question:

• It is an open-ended question that usually elicits more than a one word answer.
• It is beyond religious boundaries, expressing no bias, preference or exclusivity;
• It acknowledges a difficulty without focusing in it.
• In acknowledging difficulty, it's more realistic than some forms of religious "helpfulness" which tend to provide religious answers that aren't connected with life's real questions. Remember Scott Peck's opening line in the phenomenal best selling book The Road Less Traveled? "Life is difficult." Any useful spirituality must at least acknowledge this reality; ideally it will even deal effectively with it. And perhaps one will discover, as Peck indicated further down page 1, once the difficulty is acknowledged, life isn't nearly as difficult as it is when pretending it should be easy.
• In acknowledging the difficulty without focusing on it, it implies hope, looking forward, beyond the moment and the situation. "How's your courage?" is a question in line with the Appreciative Inquiry model of consulting. Building on research at Case Western Reserve University AI practitioners have discovered that consultants get more lasting results when they ask "What's right here?" questions than "What's wrong here? questions. "What's wrong...?" questions lead to local identification with the problem, lack of identification with external suggestions, increased helplessness, and result in short lived follow up. "What's right...?" questions lead to local identification with resources and strategies that have been used and been helpful, decreasing helplessness and resulting in enduring change and resourcefulness that is owned by the participants. It's more solution focused than problem focused.

The greatest limitation of "How's your courage?" is that it isn't appropriate where a difficulty isn't obvious and acknowledged. "How are your spirits today?" fits better in this case.

So, how's your courage today?