REVIEWED BY REY FRIEL
The Rebirth of the Clinic: An Introduction to Spirituality in Health Care
By Br. Daniel P. Sulmasy, OFM, MD
Georgetown University Press
Washington, DC
2006, 288 pp., $26.95
Don't be misled by this book's title. The Rebirth of the Clinic is about much more than the reinvention of the modern clinic or the advent of spiritual care. It is an insightful resource, obviously the product of intensive study, rigorous analysis, personal experience, and prayerful reflection. It represents the author's heartfelt attempt to answer core questions asked by many health care professionals: "Is there any serious, reflective basis for thinking about spirituality and health care? How might it affect our practices?"
Several of the book's chapters are based on essays that Br. Sulmasy has published elsewhere and on presentations before a variety of audiences. As a result, the chapters stand on their own and can be read in any order. Because of the breadth and rigor of Br. Sulmasy's analysis, the book will speak to health care professionals of all disciplines, particularly those who are searching in their practices for a way to care for the whole person.
The first line of the introduction is short and provocative: "Foucault's clinic is dead." Michel Foucault (1926-1984), a French philosopher known for his critical studies of social institutions, including medicine, celebrated a form of medicine he described as "liberated from the trappings of religion and based on science and reason." "Foucault's clinic," as Br. Sulmasy sees it, considers only the physical body of the person, ignoring the inner mystery of the person's spirituality. This scientific, pathology-based approach to medicine, which emerged between the Enlightenment and the establishment of university clinics in the 19th century, formed the basis for Western medicine and has persisted to the present day.
Although it brought the world technological advances and improvement in health, Br. Sulmasy writes, "Foucault's clinic harbored a fatal illness. And now it has breathed its last breath. Managed care is simply its coffin." The author sees hope in the death of Foucault's soulless "clinic," a harbinger of a spiritual awakening in health care today.
Br. Sulmasy is a Roman Catholic and a Franciscan friar — a practicing physician, philosopher, ethicist, researcher, and teacher. His perspective is grounded in his personal conviction that "what is most deeply human has been touched by the Divine." This is the basis for the author's hope that the "clinic" can and will be reborn. Many people of faith — as well as people of no faith — will find themselves heartened by Br. Sulmasy's view of the Transcendent actively engaged in human life, including the work of healing. For this reason, the book has the potential to appeal to a wide audience of readers who want to explore a vision of health care built on scientific scholarship and solid spirituality.
Br. Sulmasy's book is divided into three parts, each of which begins with a brief overview of its central theme. Part I ("Rebirth in the Clinic") explores the nature of illness and the nature of healing. It provides a rationale for establishing spirituality as the ground for the rebirth of the "clinic." Part II ("The Book of Numbers: Empirical Research on Spirituality and Healing") examines published research concerning spirituality in health care, and suggests a framework for conducting and evaluating such research in the future. Part III ("At the Threshold of Death") addresses spiritual issues — such as value, meaning, and relationship — that arise with special intensity at the end of life. The author cautions healers to remember that, partly because medicine has a sincere desire to serve the needs of dying patients, it can sterilize the spirit right out of dying.
For readers who have struggled to measure the effectiveness of spiritual care in health care, Part II is a "must read." It begins with Chapter 7 ("What the Data Cannot Mean"). Western medicine, enamored as it is with data and obsessed with measurable outcomes, is prone to pitfalls that occur when it tries to interpret data concerning the role in health care of spirituality and religion. The author's cautions in this area are helpful, particularly in regard to futile attempts to quantify the infinite and to justify spirituality in health care based solely on outcomes. Br. Sulmasy does offer data regarding the rightful place of religion and spirituality in medical research, teaching, and practice. However, he also points out the data's limitations, mincing no words as he does so. "Demanding this sort of [outcomes] evidence to justify spiritual or religious interventions is nonsense," he writes.
One by one, Br. Sulmasy examines objections that are often raised in discussions about the addressing of patients' spiritual concerns by health care professionals. Attending to patients' spiritual needs is not simply a moral option but a moral obligation, the author asserts. Step by step, he builds a case supporting his premise that the concerns of the healer are not just outcomes and efficiency; they also include repentance, reconciliation, wonder, awe, gratitude, worship, hope, dignity, meaning, and love.
There is no question that any health care professional would benefit greatly from reading The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. Chaplains and others familiar with Br. Sulmasy's writing will find this book particularly compelling. The Rebirth of the Clinic provides the theological and philosophical underpinnings substantiating clinical work predicated on body/soul integration.
I fear, however, that the book may not gain the wide audience it deserves. How will such a book find its way into the hands of other practitioners, particularly physicians, who believe that maintaining a strict separation between body and spirit is integral to the practice of good medicine? The title itself does not help. A reader unfamiliar with "Foucault's Clinic" will probably not be drawn to read about its rebirth. Emissaries will be needed to promote this book throughout the health care community.
One ironic problem with the book is the fact that, although the author sees a new model emerging from contemporary health care, he does not support his vision with empirical evidence. The reader is left wondering whether the mainstream, Western model of health care is indeed in the midst of transformation — or, on the other hand, Br. Sulmasy's envisioned "rebirth" is only wishful thinking. We who work in health care would probably argue that many (if not the majority) of our hospitals still operate according to the Foucault model, even as other healing modalities flourish all around them. Perhaps another book could more fully articulate the hopeful signs that point to the transformation of Western medicine.
Still, despite the lack of substantiating evidence, one can't help but be impressed by the collective power of Br. Sulmasy's reflections, analysis, and insights. My hunch is that most health care professionals would wholeheartedly welcome his invitation to help rebirth a "clinic" that acknowledges the Transcendent and embraces the patient, spirituality and all. This book is an invaluable resource for doing just that.
Rey Friel
Vice President, Mission Integration and Spiritual Care Services,
Catholic Healthcare West, San Francisco
Copyright © 2007 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.