Forker, Thomas S.

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The Linacre QuarterlyVolume 37 | Number 1 Article 12February 1970The Mental Hospital Chaplain: A ReviewThomas S. ForkerFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationForker, Thomas S. (1970) "The Mental Hospital Chaplain: A Review," The Linacre Quarterly: Vol. 37 : No. 1 , Article 12.Available at: http://epublications.marquette.edu/lnq/vol37/iss1/12Rev. Thomas S. Forker was ordained in 1942, after studying in the Minor and Major Seminaries of the Diocese of Brooklyn. He took special courses. in Social Action at The Catholic Uni-versity, and in Basic Psychiatry at Brqoklyn State Hospital, New York. After being in parish work for 12 years he has now been the Catholic Chaplain at Pilgram State Hospital, Brentwood, New York, for the past fifteen years. He is at present the President of the A ssocia t ion of Mental Health Chaplains .. Father Forker is a member of the Executive Committee of the Nation, Guild of Catholic Psychi-atrists. so The Mental Hospital Chaplain - A Revio Rev. Thomas S. Forker The mental hospital chaplain i~ in unique position to take a cor hensive view of the care of the m( ly ill, in the past, the present, a· td projected in the future. In many i he is not directly involved, am take the position of an inte1 observer. He has a box seat OJ 1. fifty yard line. ment of popularity, and was re-ptaced by something new. The co~­vulsive therapies - Insulin , Metrazol, md Electric - and even pre-frontal lobotomy all enjoyed their day. With the discovery and introduction of the various synthetic and natural chemical agents , a whole new day of treatment possibilities dawned. Many patients who had been in the hospitals for years were either able to be re-Jeased, or at least no longer needed the hani_cal restraints and locked doors the past. And all the time there have been se who think of themselves as the al psychiatrists" - who would only psychotherapy. They frequently harshly of the "buttonpushers" "electricians" in the past, and now that the "pharmacists" really are curing people with their Chemo-' but have merely discovered a way to control them. Actually the of psychotherapy done in s has been minimal. The does not lend itself to the and is pro-expensive and time-As far as actual treatment war co&~~-ISUrnirltg cerned, for a long time there wa , little the psychiatrist could do f Jr patient in the institution. Cu. ~ care was the order of the day, a1 ,d patient was housed and fed, an~l tected from harming others or harmed himself. It was a frust period, and was probably best terized by the publicity in the atric Journals, which offered humanae restraints, safety win unbreakable feeding utensils , hydrotherapy tubs. Then about thirty years ago the was broken. One treatment anl•ther was discovered, enjoyed Linacre across the country there has dramatic reduction in the in-census. However, there still a big job to be done. Many of mental hygiene are pushing the idea of "Milieu ',and "Unitization." New York State Department of Hygiene has _been running a of interdisciplinary conferences "Maximizing a Therapeutic '. These bring together repre-of the various disciplines in hospital - not only the regularly · treatment services, but also the supportive services and ward personnel on every level. The aim is to spread the doctrine that every moment of a patient's stay in the hospital should be therapeutic . . Even in the absence of the doctors, the brightly painted walls and pleasant surroundings as well as the therapeutically-oriented night attendants, are "treating" the patient. This is a very interesting idea, even though it can hardly be called com-pletely new. Anyone who has been following the literature will remember that even 25 years a~o there were articles on the good results obtained by providing cheerfully painted and comfortably furnished day rooms and dormitories. And - it has long been known, among the lower echelons at least , that many · patients profited more from concerned and interested ward-employees, than from seldom seen doctors. Carried to its most extreme form, this milieu therapy is practiced · in so-called "Unitized Programs." This involves all who in any way treat a patient or provide for his needs not only in acting with the patient but also in diagnosing, planning treatment, and fmally evaluating the results and re-leasing the patient. The theory on which this new treat-ment is based is interesting. It assumes that by total involvement the strengths of all will be coordinated to help the patient. However, in practice there are many difficulties. It demands a great a .1ount of re-education on the part of e1. ·· ry person, and a willingness to " '\, ur roles" - that seems a bit un-re·:.listic. There is further a bit of fiction involved. While the doctor may sjt in the unit-meeting and be ou1-voted, nevertheJess by law he is the 51 . ' ~ ~ .. . ... ~. t ' . ·• i}·. .• . one respon'sible. I am sure. t~at, in case of problems , public opmwn w~uld take a very dim view of . any senous decisions being made by those who have no formal training or back-ground, and no license which waul~ make them responsible for theu actions. We shall have to see how these new theories work out in practice. Looking to the future we are told that the day of the large mental hospital is coming to an end. Th.e National Institute of Mental Health IS looking forward to the day in the near future when all patients will be car.ed for in Comprehensive Commumty Mental Health Clinics. The patient w~l never leave his neighborhood, but will be. cared for' part or full time' in Clinics, Day-Hospitals, arid various sheltered situations. Only in a very few cases will· a patient be committed to a full-time custodial institution. we will have to arrive at some r ew kinds of mental illnesses, ~t ich motivate patients to .seek help, If the . Comprehensive . Community Me· Lt~ Health Centers are to function. Looking out from his box sea in another direction the Chaplain 5ees that the acceptance of Religion, an~ its ministers in the Mental Has ,ita! picture has undergone m illY vicisitudes. In one of its first meetings, ba< k · the 1840's, the Association of Lu Asylum Superintendents, which. into the AP A, considered the des1 ity of having Chaphiins in asylums, and came to the decisior , it was most desirable indeed. that high point we find that th-gamut was run. With the popu· and even the ascendency . of the F r~ ian point of view, we find. ~ pc an tip a thy between Rehgi.on Psychiatry, and a correspondmgl f interested attitude toward l Chaplains in Mental Hospitals. II in some cases, there were even bitions against clergymen e institutions. In New York StaL~ , example , all of the older instit 1 have had Chaplains throughoui histories, usually supplied b ' various religious bodies. But 1n younger institutions sue~ was r: ot case. It was not until 1951· Chaplains were recognized as ·part the Staff, at which time the:· appointed as Resident Staff 0 ' away with the title and the position of Chaplain in its State Hospitals. And so the patients, deprived by their confine-ment in the State institution from freely satisfying their religious needs, will now be prepared from having such needs met by Chaplains. The State is redesignating the Chaplains as "Counselor", and has reworked the job description to reflect this change in emphasis. It is true that there have been many Chaplains who have thought of them-s principally in this light. How-, as far as the majority is con-' the Chaplaincy is occupied the full . exercise of the Priest-Counseling will have a place, but as part of the greater picture, centers principally around those which · bring men closer to God, God closer to men. is unfortunate that some of our young men, ·priests or seminari-who are preparing themselves to L-na.pian· 1s seem to have a mistaken as to just what their job will be. are anxious to take courses in , psychology or social work, that this will make them better . Of course all knowledge is , but they should be advised "blur the lines" as to what a is and does. If the young man . and skilled in counseling , gy or social work, and wishes in these fields that is fine. But will still need a Chaplain will take care . of those many that only a man of religion , as such, can do. Again, as an ideal it is mo~t inter~s~­ing. However' the very obvwus d~ff~­culties that arise make one wonder If It will ever be actualized. The almost insurmountable difficulty will ,be that of personnel. Right n~w the larg~ institutions use the available psyc~l­atrists, psychologists, and social workers in the most efficient way' and there are never enough to go aroun~. Every American Psychiatric _ Associ-ation convention sees the Departments of Mental Hygiene of various States bidding against one another for the always too few qualified ~eople. The new plan will use people m the mo~t ~he fficier~ t way' dispersing them m many ',.t: .all centers, leaving it u~ _to the p t,,~ nt to get himself to the climes for t ; ,,. 1ent. ~n view of the fact that most 1_ ~ nts never feel they need treatmen: , nyway, it would seem that It seems that the wheel has another turn to make. The wril er President of the Association of Health Chaplains - has been in that the current Church-State 'ght has caused at least one state - n the middle of the Bible Belt -- to Chaplain from his 50 yard box could also look at the changes come about in the staffing of s. Many, still active in the 52 field of institutional psychiatry, can remember when the general rule was . "underpay and -overwork." The jobs on the lower levels were taken fre-quently by those who could find work no place else. There were "Hospital Bums" who had worked across the country, floating from Job to job. Now . the upgrading of pay and the training which is given to new employees, has in many cases made the positions in the hospital more desirable, sought after, and held permanently. On the higher levels there have also been improvements made. There have always been dedicated mim who trained in psychiatry and then stayed in the mental hospitals instead of going into private practice. They fre-quently worked their way up in the system to positions of authority, and many of the overall improvements have come from such men. However, for a number of years, as the census figures were climbing in every hospital, anyone with an "M.D." could find a position in a mental hospital. Many were refugees from war and persecution. Some had been skilled and recognized in other special-ties abroad, but now with no license -they could practice only in an insti-tutional setting, they became "psychi-atrists bx Catastrophe". In this partic-ularly "verbal" specialty, they fre-quently had little or no English, and unfortunately little interest. The me-dical profession itself pushed ·"'cial examinations for the graduates (: foreign medical schools which \\ ;ded out many of the less able. At tl same time the increased ~::tlarie s ai.J higher professional regard seemed k · be encouraging more Well-qualified i' nerican mert to enter the field. 53 ,, ; .. I ' 'I Srch is the view from the 50 yard line . One of the ·problems about tracLig progress is thaf sometimes it might seem that one is findirig fault with the past. Sometimes in praising what has been done one may almost seem to be condemning the men who in the past worked with things as they were. When we speak of the 4ark painted wards, the heavy (unthrow-able) furniture , the restraints and the heavy duck strong-suits (untearable) we have to avoid the mistake of speaking as if the psychiatrists of the past continued these things by an almost callous purpose. We must recognize that men of good will were making do with what they had. Their dissatis-faction sparked the ·research that brought about some of the discoveries. It was the driving interest of those who worked with less that gave us the "more" we enjoy. Progress has been made. It has not always been a straight line. As in most other human undertakings there has 54 been a step backward now and tJ ,en but on the whole we can re; )Ort improvement. We · look forward to even greater progress in the future . The Chaplain can have a very f. re part to play in that progress. N :we discoveries and greater knowledgt: c of themselves never help an~ one These things have to be put into practice by men. The unstruck n at lights no frre , and the unused a lili~ will not help the patient. The Chaplain can help motiv2 :e concerned by the insight he can c bute. More perhaps by his at toward each patient as a child oi than by his words, he can mov, an overworked staff member tl trying. And on the side of the p he may, by treating him as oi cause him to feel valuable, · 1d worthy of being helped. As the sentative of a loving Father, he help this group of God's chik :en ·act and react with love. Family Psychiatry Dorothy Starr, M.D. . In medicine , I think , everyone hstens to his own music. Not only do we s~end most of our time reading our own JOUrnals; and listening to our own specialty, but I suspect .psychiatry may not be alone in listening mostly to its own school of thought . This Journal offe~s ~ot only the opportunity of shanng Ideas with other specialties but especi_ally ~ chance t o talk of "Family Psychi_atry for a group with a special comrrutment to the stability of the family. . I want first to review how family therapy differs from the better known analytic approach; . to offer some observations on family processes common in many families and voice my concern that the family therapist is headed out of medicine. Psychiatry entered the 1950's in this country , with. much enthusi~sm f or psychoanalysis but growing concern about . its limitations. Ex-t ,nsive training was required for the sulall numbers of qualified doctors v: i 0 could treat a relatively small nc ·1ber of cases. The fascinatina work b . Q t '~1g done With schizophrenic~ by a n ·.1:nber of gifted analysts was not i1 dely known, but even when recog-r ·J.ed , was cold comfort to the mental 55 

The Mental Hospital Chaplain: A Review

The Linacre QuarterlyVolume 37 | Number 1 Article 29February 1970The Mental Hospital Chaplain: A ReviewThomas S. ForkerFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationForker, Thomas S. (1970) "The Mental Hospital Chaplain: A Review," The Linacre Quarterly: Vol. 37 : No. 1 , Article 29.Available at: http://epublications.marquette.edu/lnq/vol37/iss1/29Rev. Thomas S. Forker was ordained in 1942, after studying in the Minor and Major Seminaries of the Diocese of Brooklyn. He took special courses. in Social Action at The Catholic Uni-versity, and in Basic Psychiatry at Brqoklyn State Hospital, New York. After being in parish work for 12 years he has now been the Catholic Chaplain at Pilgram State Hospital, Brentwood, New York, for the past fifteen years. He is at present the President of the A ssocia t ion of Mental Health Chaplains .. Father Forker is a member of the Executive Committee of the Nation, Guild of Catholic Psychi-atrists. so The Mental Hospital Chaplain - A Revio Rev. Thomas S. Forker The mental hospital chaplain i~ in unique position to take a cor hensive view of the care of the m( ly ill, in the past, the present, a· td projected in the future. In many i he is not directly involved, am take the position of an inte1 observer. He has a box seat OJ 1. fifty yard line. ment of popularity, and was re-ptaced by something new. The co~­vulsive therapies - Insulin , Metrazol, md Electric - and even pre-frontal lobotomy all enjoyed their day. With the discovery and introduction of the various synthetic and natural chemical agents , a whole new day of treatment possibilities dawned. Many patients who had been in the hospitals for years were either able to be re-Jeased, or at least no longer needed the hani_cal restraints and locked doors the past. And all the time there have been se who think of themselves as the al psychiatrists" - who would only psychotherapy. They frequently harshly of the "buttonpushers" "electricians" in the past, and now that the "pharmacists" really are curing people with their Chemo-' but have merely discovered a way to control them. Actually the of psychotherapy done in s has been minimal. The does not lend itself to the and is pro-expensive and time-As far as actual treatment war co&~~-ISUrnirltg cerned, for a long time there wa , little the psychiatrist could do f Jr patient in the institution. Cu. ~ care was the order of the day, a1 ,d patient was housed and fed, an~l tected from harming others or harmed himself. It was a frust period, and was probably best terized by the publicity in the atric Journals, which offered humanae restraints, safety win unbreakable feeding utensils , hydrotherapy tubs. Then about thirty years ago the was broken. One treatment anl•ther was discovered, enjoyed Linacre across the country there has dramatic reduction in the in-census. However, there still a big job to be done. Many of mental hygiene are pushing the idea of "Milieu ',and "Unitization." New York State Department of Hygiene has _been running a of interdisciplinary conferences "Maximizing a Therapeutic '. These bring together repre-of the various disciplines in hospital - not only the regularly · treatment services, but also the supportive services and ward personnel on every level. The aim is to spread the doctrine that every moment of a patient's stay in the hospital should be therapeutic . . Even in the absence of the doctors, the brightly painted walls and pleasant surroundings as well as the therapeutically-oriented night attendants, are "treating" the patient. This is a very interesting idea, even though it can hardly be called com-pletely new. Anyone who has been following the literature will remember that even 25 years a~o there were articles on the good results obtained by providing cheerfully painted and comfortably furnished day rooms and dormitories. And - it has long been known, among the lower echelons at least , that many · patients profited more from concerned and interested ward-employees, than from seldom seen doctors. Carried to its most extreme form, this milieu therapy is practiced · in so-called "Unitized Programs." This involves all who in any way treat a patient or provide for his needs not only in acting with the patient but also in diagnosing, planning treatment, and fmally evaluating the results and re-leasing the patient. The theory on which this new treat-ment is based is interesting. It assumes that by total involvement the strengths of all will be coordinated to help the patient. However, in practice there are many difficulties. It demands a great a .1ount of re-education on the part of e1. ·· ry person, and a willingness to " '\, ur roles" - that seems a bit un-re·:.listic. There is further a bit of fiction involved. While the doctor may sjt in the unit-meeting and be ou1-voted, nevertheJess by law he is the 51 . ' ~ ~ .. . ... ~. t ' . ·• i}·. .• . one respon'sible. I am sure. t~at, in case of problems , public opmwn w~uld take a very dim view of . any senous decisions being made by those who have no formal training or back-ground, and no license which waul~ make them responsible for theu actions. We shall have to see how these new theories work out in practice. Looking to the future we are told that the day of the large mental hospital is coming to an end. Th.e National Institute of Mental Health IS looking forward to the day in the near future when all patients will be car.ed for in Comprehensive Commumty Mental Health Clinics. The patient w~l never leave his neighborhood, but will be. cared for' part or full time' in Clinics, Day-Hospitals, arid various sheltered situations. Only in a very few cases will· a patient be committed to a full-time custodial institution. we will have to arrive at some r ew kinds of mental illnesses, ~t ich motivate patients to .seek help, If the . Comprehensive . Community Me· Lt~ Health Centers are to function. Looking out from his box sea in another direction the Chaplain 5ees that the acceptance of Religion, an~ its ministers in the Mental Has ,ita! picture has undergone m illY vicisitudes. In one of its first meetings, ba< k · the 1840's, the Association of Lu Asylum Superintendents, which. into the AP A, considered the des1 ity of having Chaphiins in asylums, and came to the decisior , it was most desirable indeed. that high point we find that th-gamut was run. With the popu· and even the ascendency . of the F r~ ian point of view, we find. ~ pc an tip a thy between Rehgi.on Psychiatry, and a correspondmgl f interested attitude toward l Chaplains in Mental Hospitals. II in some cases, there were even bitions against clergymen e institutions. In New York StaL~ , example , all of the older instit 1 have had Chaplains throughoui histories, usually supplied b ' various religious bodies. But 1n younger institutions sue~ was r: ot case. It was not until 1951· Chaplains were recognized as ·part the Staff, at which time the:· appointed as Resident Staff 0 ' away with the title and the position of Chaplain in its State Hospitals. And so the patients, deprived by their confine-ment in the State institution from freely satisfying their religious needs, will now be prepared from having such needs met by Chaplains. The State is redesignating the Chaplains as "Counselor", and has reworked the job description to reflect this change in emphasis. It is true that there have been many Chaplains who have thought of them-s principally in this light. How-, as far as the majority is con-' the Chaplaincy is occupied the full . exercise of the Priest-Counseling will have a place, but as part of the greater picture, centers principally around those which · bring men closer to God, God closer to men. is unfortunate that some of our young men, ·priests or seminari-who are preparing themselves to L-na.pian· 1s seem to have a mistaken as to just what their job will be. are anxious to take courses in , psychology or social work, that this will make them better . Of course all knowledge is , but they should be advised "blur the lines" as to what a is and does. If the young man . and skilled in counseling , gy or social work, and wishes in these fields that is fine. But will still need a Chaplain will take care . of those many that only a man of religion , as such, can do. Again, as an ideal it is mo~t inter~s~­ing. However' the very obvwus d~ff~­culties that arise make one wonder If It will ever be actualized. The almost insurmountable difficulty will ,be that of personnel. Right n~w the larg~ institutions use the available psyc~l­atrists, psychologists, and social workers in the most efficient way' and there are never enough to go aroun~. Every American Psychiatric _ Associ-ation convention sees the Departments of Mental Hygiene of various States bidding against one another for the always too few qualified ~eople. The new plan will use people m the mo~t ~he fficier~ t way' dispersing them m many ',.t: .all centers, leaving it u~ _to the p t,,~ nt to get himself to the climes for t ; ,,. 1ent. ~n view of the fact that most 1_ ~ nts never feel they need treatmen: , nyway, it would seem that It seems that the wheel has another turn to make. The wril er President of the Association of Health Chaplains - has been in that the current Church-State 'ght has caused at least one state - n the middle of the Bible Belt -- to Chaplain from his 50 yard box could also look at the changes come about in the staffing of s. Many, still active in the 52 field of institutional psychiatry, can remember when the general rule was . "underpay and -overwork." The jobs on the lower levels were taken fre-quently by those who could find work no place else. There were "Hospital Bums" who had worked across the country, floating from Job to job. Now . the upgrading of pay and the training which is given to new employees, has in many cases made the positions in the hospital more desirable, sought after, and held permanently. On the higher levels there have also been improvements made. There have always been dedicated mim who trained in psychiatry and then stayed in the mental hospitals instead of going into private practice. They fre-quently worked their way up in the system to positions of authority, and many of the overall improvements have come from such men. However, for a number of years, as the census figures were climbing in every hospital, anyone with an "M.D." could find a position in a mental hospital. Many were refugees from war and persecution. Some had been skilled and recognized in other special-ties abroad, but now with no license -they could practice only in an insti-tutional setting, they became "psychi-atrists bx Catastrophe". In this partic-ularly "verbal" specialty, they fre-quently had little or no English, and unfortunately little interest. The me-dical profession itself pushed ·"'cial examinations for the graduates (: foreign medical schools which \\ ;ded out many of the less able. At tl same time the increased ~::tlarie s ai.J higher professional regard seemed k · be encouraging more Well-qualified i' nerican mert to enter the field. 53 ,, ; .. I ' 'I Srch is the view from the 50 yard line . One of the ·problems about tracLig progress is thaf sometimes it might seem that one is findirig fault with the past. Sometimes in praising what has been done one may almost seem to be condemning the men who in the past worked with things as they were. When we speak of the 4ark painted wards, the heavy (unthrow-able) furniture , the restraints and the heavy duck strong-suits (untearable) we have to avoid the mistake of speaking as if the psychiatrists of the past continued these things by an almost callous purpose. We must recognize that men of good will were making do with what they had. Their dissatis-faction sparked the ·research that brought about some of the discoveries. It was the driving interest of those who worked with less that gave us the "more" we enjoy. Progress has been made. It has not always been a straight line. As in most other human undertakings there has 54 been a step backward now and tJ ,en but on the whole we can re; )Ort improvement. We · look forward to even greater progress in the future . The Chaplain can have a very f. re part to play in that progress. N :we discoveries and greater knowledgt: c of themselves never help an~ one These things have to be put into practice by men. The unstruck n at lights no frre , and the unused a lili~ will not help the patient. The Chaplain can help motiv2 :e concerned by the insight he can c bute. More perhaps by his at toward each patient as a child oi than by his words, he can mov, an overworked staff member tl trying. And on the side of the p he may, by treating him as oi cause him to feel valuable, · 1d worthy of being helped. As the sentative of a loving Father, he help this group of God's chik :en ·act and react with love. Family Psychiatry Dorothy Starr, M.D. . In medicine , I think , everyone hstens to his own music. Not only do we s~end most of our time reading our own JOUrnals; and listening to our own specialty, but I suspect .psychiatry may not be alone in listening mostly to its own school of thought . This Journal offe~s ~ot only the opportunity of shanng Ideas with other specialties but especi_ally ~ chance t o talk of "Family Psychi_atry for a group with a special comrrutment to the stability of the family. . I want first to review how family therapy differs from the better known analytic approach; . to offer some observations on family processes common in many families and voice my concern that the family therapist is headed out of medicine. Psychiatry entered the 1950's in this country , with. much enthusi~sm f or psychoanalysis but growing concern about . its limitations. Ex-t ,nsive training was required for the sulall numbers of qualified doctors v: i 0 could treat a relatively small nc ·1ber of cases. The fascinatina work b . Q t '~1g done With schizophrenic~ by a n ·.1:nber of gifted analysts was not i1 dely known, but even when recog-r ·J.ed , was cold comfort to the mental 55 

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The Mental Hospital Chaplain: A Review

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