INTERVIEWER: CHARLES W. CHRISTIAN
Recently Grace & Peace (GP) sat down with Rev. Dr. John Swinton (JS), the Chair in Divinity and Religious Studies at King’s College, University of Aberdeen (Scotland). Dr. Swinton spent 16 years in the medical field, both as a mental health nurse and then as a chaplain, before completing formal studies in theology. Dr. Swinton is the author of numerous books and journal articles addressing subjects including end-of-life care and ministry to those suffering from dementia.
GP: YOU SPENT 16 YEARS IN THE MEDICAL FIELD AND THEN BECAME A THEOLOGIAN AND A PROFESSOR OF PASTORAL CARE. YOU’VE WRITTEN ABOUT MINISTERING TO THOSE AT THE END STAGES OF LIFE, AND YOU’VE TRAINED PASTORS IN THOSE AREAS. HOW HAS YOUR JOURNEY INFORMED YOUR WRITING AND TEACHING ABOUT END-OF-LIFE CARE?
- JS: There’s no real answer to it in the sense that I didn’t have an epiphany. I just had a journey. I nursed in the area of mental health for 16 years and thoroughly enjoyed that. But then, for no apparent reason in the late '80s early '90s, I decided—I think it’s stronger than that—I felt called to study theology. At that stage, I thought I would end up in hospital chaplaincy, and I did end up in hospital chaplaincy for a little while. But as soon as I started at my theological training, I knew I wanted to teach practical theology. This took me by surprise because I never really considered myself to be either practical or a teacher. So, I did my theology degree, and at the same I worked as a mental health chaplain in psychiatric institutions and in the community. I also spent some time working in end-of-life care as a hospice chaplain. Eventually all of that came to fruition when I ended up coming into an academic position full time.
- My nursing and chaplaincy work really have formed the bedrock for my theological reflection. My experiences have caused me to see the world slightly differently. I see theology slightly differently. I don’t mean that in an unorthodox way. It just means that I have a certain set of questions about theology that is guided by my experience with people with mental health problems or people who are dying. It is a perspective that is probably not available to a lot of theologians who haven’t had that same journey. And so, the strangeness of my journey turns out to be the blessing of my theological career.
GP: MINISTERS HAVE A GREAT DEAL OF FEAR AND TREPIDATION ABOUT MINISTRY AT THE END OF LIFE, INCLUDING FUNERALS AND DEALING WITH GRIEF. WHAT ADVICE CAN YOU GIVE IN THIS REGARD?
JS: There are probably many answers to that question. If I look at the students who come through the seminary where I teach, they’re all very enthusiastic. They’re all very much focused on the gospel and on mission and ministry in that sense. But, they’re very apprehensive when it comes to dealing with, for example, elderly people or end-of-life issues.
I think if pastors can view end-of-life care in the realm of discipleship, and not simply pastoral care, it can connect the mission of their calling more specifically with this ministry to the elderly and dying. The question must be, “What does it mean to be a disciple of the risen Lord and be dying?” More than that, how can we enable the dying to continue to understand that they have a vocation, a call from God, even in the midst of the difficulties that they have just now?
So, I think that part of the issue is that we place end-of-life care in the wrong category and therefore assume that these matters are somehow apart from the central things that we have to do. So, it’s not simply a matter of visiting the sick or visiting the dying. It’s actually about how do you visit vocationally? How do you visit with an eye on this person’s discipleship? If you shift that category a little bit, then there’s a whole range of new possibilities for innovation.
GP: SO, YOU REALLY SEEM TO BE DESCRIBING THE WHOLE IDEA OF LIVING WELL AND DYING, AS YOU HAVE WRITTEN ABOUT IN SEVERAL PLACES. DISCIPLESHIP AND GROWTH IN OUR FAITH DO NOT CEASE, EVEN WHEN ONE I S NEAR DEATH.
JS: That’s absolutely right, because end-of-life care begins in Sunday school. By that I mean that it’s a process of ongoing formation, so that when we come to that stage in life when we actually are encountering death and encountering the things that the gospel claims we shouldn’t be afraid of, we’re prepared for it.
If we think end-of-life care is simply a ministry for specialists reserved for when one is near death, we have misunderstood what Christian formation is all about.
GP: HOW CAN WE AS MINISTERS ADDRESS THE CHALLENGES OF END-OF-LIFE CARE IN A CULTURE THAT INCREASINGLY WISHES TO DENY THE REALITY OF DEATH? WE RARELY EVEN USE WORDS LIKE “FUNERAL” ANYMORE, FOR INSTANCE .
JS: Within general culture there is a denial of death, because people have lost the narratives that help us make sense of what death is. If you take a religious narrative out of your understanding of what life is and what death is, then you’re left with a very particular type of story, and that story is all about you.
So, it becomes all about your health, all about your well-being, all about your desire for the future—and so anything that threatens that threatens your very reason for existence. If our story is that death is the loss of all that we have, then death will terrify us. This is why it is very difficult to talk about getting old in this culture, because getting old reminds us that we are getting closer to death, and we don’t want to be reminded of the “loss of everything.” We can even pick
upon this kind of narrative in churches, since most churches (including the one in which I am ordained) tend to be very “happy” places: We like to sing happy songs and hear happy sermons, and there is nothing wrong with being happy.
However, if we forget that, as Dietrich Bonhoeffer reminds us, the songbook of the Bible, the Psalms, contains more psalms of lament than of any other kind, then we lose a balanced ability to face the realities of aging and death.
This is why Martin Luther focused upon the theology of the cross, for instance. Luther says to look at the cross, at the pain of Jesus, and then we will better understand the nature of sin and our own mortality. The lament psalms are there to remind of the pain and angst that we all face, but these lament psalms are also prayers. A death-denying culture seeps into the church sometimes, and that needs to be addressed by good spiritual practice at the end of life. Lament is one spiritual practice that can help us to do that.
GP: WHAT IS THE LINE BETWEEN LAMENT AND DESPERATION?
JS: A majority of the Psalms are laments. They are prayers that deal honestly with the situation we are in and confess those laments before God. Psalm 88, for instance, begins with, “Darkness is my only companion.” But, like most laments in the Psalms, there is a kind of resolution that occurs after this honest lament that reminds the psalmist and the readers that God is truly present: God is actively listening, even in our despair.
So, I think that one way we enable people— both within the culture and within the church—to develop the kind of story that helps us to flourish at the end of our lives, is by reclaiming the language of sadness through the practices of lament. This reminds us that we are not, for example, Buddhists whose ultimate goal is to escape reality. Rather, as Christians, we face even the saddest of realities with truth, and in those moments, we find that God is still there with us. The psalms of lament give us an example that helps us express the honest pain of the present, while recognizing the faithfulness of God and the hope of the resurrection.
GP: YOU HAVE DONE A GREAT DEAL OF CLINICAL WORK WITH, AND HAVE WRITTEN ABOUT, MINISTERING TO THOSE WHO DEVELOP DEMENTIA AND OTHER SERIOUS MEMORY-RELATED DISORDERS AT THE END OF LIFE. WHAT CAN YOU SHARE THAT COULD GUIDE US IN THOSE DIFFICULT SITUATIONS?
JS: People fear dementia more than they fear cancer because there is a sense of “losing one’s self” when the mental faculties begin to dissipate. In Western cultures, we believe the well-known Cartesian saying, “I think, therefore I am.” However, the Apostle Paul and the whole of the New Testament remind us that our true identity is found and kept in Christ.
Something profoundly important here is that if we are who we are in Christ, then it’s not what we remember ourselves to be, it’s not what we’ve done, it’s not the things of the past or even of the present that make us who we are. It’s Jesus that makes us who we are. So, the idea that I am who I remember myself to be is just a relational and theological mistake. We are who we are as God remembers us. When people lose their memory, they don’t stop being themselves because who they are was always held by God in Christ.
GP: FINALLY, HOW CAN THE PRESENCE OF MINISTERS ASSIST THE DYING?
- JS: A minister needs to think through his or her relationship with both the patient and with the clinical practitioners, since these days, most people spend their last days in a hospital or clinical care setting.
- Much of what goes on in end-of-life care is actually deeply spiritual, even though it looks as though it’s simply clinical.
- There is a sense in which the pastor sanctifies the situation and reminds people of the deep spirituality that is within that clinical context. You accompany a person or a family on that journey into the next phase of their lives.
- Whereas culture, and perhaps even the clinical context, are saying that this is a bad thing, this is the end of something, so let’s escape from it, the pastor says that this is a real thing, this is part of the narrative that we’ve always known about, and this is the last stage of a positive journey into something wonderful and something beautiful.
- So, our ministry is counter-cultural, but profoundly theological. You can be both hopeful and sad at precisely the same time. You can be broken and joyful at precisely the same time.
- The key thing is sustaining that story of discipleship that begins at birth in our practices and our presence at the end of life.