Nons, Nunyas, Appreciative Inquiry and the Aged

by Reeve Robert Brenner

Judaism gave us Christianity.  Christianity gave us Pastoral Care.  Pastoral Care gave us spirituality – as understood, developed and expanded in various forms and configurations in relatively recent times by chaplains, ministers and rabbis.  Had Judaism produced Pastoral Care, perhaps it would have given us Appreciative Inquiry(AI). And Identity – life history, autobiography and personal self-understanding - rather than Spirituality would today be the chaplain’s primary focus.  Identity – as in your personal story-line - relates to who you are and your own interpretation and evaluation of life’s experiences; spirituality relates primarily to what you believe or what you are thinking.  They are not identical.  In many ways, they profess two different emphasis and objectives.  But in truth the word “spirituality”, for most purposes, may be ambiguous enough to cover both meanings. (It may therefore be perhaps far too ambiguous to identify with any certainty just what is its intended usage in any given instance.)  

It will be argued that in supportive counseling, AI looks to what “deeds” have been performed and achievements realized, taking stock of one’s self-inventory. Spirituality, as conventionally understood, is about the ineffable and the immersion in the improvable, not about the detached physical world of concrete evidence and demonstrable reality.  Identity is more focused on the facts of one’s life, spirituality on “the twilight zone” of the religious awareness of another dimension of meaning and judgment.    It is of some significance to take note that there is no word for “spirituality” in Hebrew scripture; “ruchaniut” is a rather recently coined, albeit quite appropriate, term. It derives from “ruach,” translated as spirit or wind and first encountered in the second verse of Genesis (note 1).  

From a contemporary Jewish perspective, spirituality may be best understood as realizing shleimut (from shalom), wholeness of identity, arriving at fulfillment, being complete, the integration of the elements of one’s soul, akin to integratsia dushi, the pulling together of disparate fragments of a person(ality). For both Judaism and Christianity - and doubtlessly for other faiths – spirituality refers to the various ways humanity goes about its self imposed tasks devoted to accessing and reaching beyond the transient for the transcendent and for disciplines – such as those indoctrinated and inculcated in Clinical Pastoral Education, U. S. Military Chaplaincy schools, rabbinical and other seminaries - offering guidance in our quest to discern and internalize the transcendental.  
 
A rabbi of any Jewish movement might hasten to add at this juncture the observation – rephrased and annotated elsewhere in this analysis -  of Rabbi David Ellenson, president of the Hebrew Union College – Jewish Institute of Religion, the Reform Rabbinical Seminary: “Judaism asserts that the ‘spiritual urge’ inherent in each of us can only authentically be realized through ‘deeds.’ Judaism requires ‘a leap of action.’ As Buber phrased it, ‘Genuine religiosity is doing.’”

There is no reason to make the case for Appreciative Inquiry emerging from the Judaic Christian tradition.  There is no direct AI line parallel to Christianity, or to the pastoral and spiritual (Protestant) traditions, or to CPE.  “Clinical Pastoral Education,” David C. Duncombe does well to observe, is also “indebted to the pragmatism of John Dewey and the empiricism of William James” (2).  AI emerged from the Organizational Development “tradition” advanced as “A Positive Revolution in Change” (3).  A chevron representation resembling a sergeant’s stripes might be more suitably suggestive of the Judaic Christian tradition and discipline functioning alongside the AI discipline and tradition.  Discipline, a system of preparation and training, also conveys the sense of cultivating “disciples”, that is, followers and practitioners to carry on the tradition and to build upon it. The reader might take note of AI’s self-referentially but quite justifiably applied language of “Revolution” and “Change.”    
                                                                       
     It is difficult not to take note of the dialectical element of Appreciative Inquiry as applied in the context of supportive-counseling-interventional-interaction and observe how very much in common AI has with the Talmudic dialectical and the relational Buberian I-Thou traditions.  After all, relationships are established in Appreciative Inquiry as in all interpersonal disciplines and religious fellowships.  Inquiry entails the dialectic and the establishment of a kind of friendship, if not intimacy. Nor is it “chesed” (for which there is no English translations; chesed is deeper and more abiding than fidelity, faithfulness, loyalty) because it is not long-term in building to that level of closeness and familiarity. But it surely strides beyond the subject-professional interaction; it has already gone well beyond I-It by virtue of engaging in soul-searching and deep reflection with another in dialogue.  Although Appreciative Inquiry may surely provide therapeutic, beneficial outcomes, it is not intended to be Freudian or psychoanalytic.  Nevertheless, the “talking cure” upon which various other disciplines and philosophical orientations rests is clearly in evidence in Appreciative Inquiry.

(1) “NONS” and AI

Appreciative Inquiry, is referred to as AI, not as in Artificial Intelligence – an altogether other claimant for the AI copyrights and trademarks. Besides, although certainly, “intelligent,” Appreciative Inquiry is hardly “artificial”. The purpose or point of this article is to suggest the relevancy of Appreciative Inquiry to Human Services Professionals, hospital chaplains working with the aged in the twilight of their lives and with others facing a more proximate and pressing mortality. AI as a professional human services conception may be considered by ministers, chaplains, pastors, rabbis and relationship counselors of every stripe as well as by students of Clinical Pastoral Education (CPE) and other professional programs as a judicious theoretical and practical supportive counseling approach to working with those in need. We will explore one of at least two ways AI applies: one is oriented to organizational development, the other which is explored here, to the dialogical interaction, whether in clinical units in interventions with patients, in homes, hospitals and hospices and homes for the aged and the like. There are likely other models for AI application.

The patient listing at the Shady Grove Adventist Hospital in Rockville, Maryland, identifies patients by their self-declared religious denominational affiliation: “BAP” for Baptists, “CAT” for Catholics, “SDA” for Seventh Day Adventist, “JWS” for Jewish, etc. and “NON” for the non-religious, non-denominational, secularists, atheists, agnostics, ignostics, etc. On average, of the approximately 200 to 250 patients cared for daily 135 declare for a faith; some 75 do not and are classified as “NONs.” At intake, for various reasons, misclassifications frequently occur. Even after I reclassify some 20-25 of the 75 denominationally by religious affiliation, as determined during the course of my rounds of visitations, the NONs present the largest composition of patients at the hospital. I have found that occasionally the NONs outnumber all other religious classifications combined.

AI relationship counselors are not making the case for a generic chaplaincy.  One size does not fit all.  Jewish patients in a hospital setting will not be best served by a non-denominational AI practioner but by rabbi’s practicing AI “on top of” rabbinic ministrations which include, for example, the misheh berach (“He who blesses…”) and refuah shleima (“…full recovery…”) liturgy recited in Hebrew they have come to expect given their circumstances.

In other counseling settings as well, it is still preferred that Roman Catholic priests minister to “CATs”, Protestant ministers to “BAPs”and so forth. The NONs are the exception to the rule in that they might be benefited by AI counseling from any skilled professional practioner – assuming they genuinely have no religious preferences.  That point must be explored early on in counseling to determine early religious upbringing and current faith or faithless professions.  

Two hospital verbatims melding traditional Jewish with AI practices are attached to this writing not so much as models of AI-Jewish chaplaincy practices as this writer’s first feeble attempts at learning how I might go about acquiring the skills best suited for the combined rabbinic-AI practice and trying it out to experience the feel of it.
 
It is useful to be reminded that there are no shortages of appropriate ways by which a minister or chaplain might relate to a self-declared irreligious or non-denominational patient – classified as a “NON” – just as indeed there are various valid ways human services professionals relate to the NON-nons, the religiously affiliated and spiritually inclined patients, during their stay at a clinic, hospice or a hospital. One way – Appreciative Inquiry - appears particularly applicable and well suited for dialogue with self declared “NONs” and especially fitting, age-appropriately applied, when end-of-life issues and realities obtain.
    The Appreciative Inquiry approach raised in this article is not intended to wean a professional away from the spiritual/pastoral ministry assessments, interventions and procedures – or from various other forms of intimate conversation, deep religiously faith-filled dialogue, inspirational readings and prayer – but to have them consider enlarging their repertoire by making use of the kinds of methodology reflected in the AI assessments, interventions and procedures categorized on the list tendered and placed at one’s disposal further along in this article and others which have been in development elsewhere.

 Here’s where organizational development may contribute to making the case for striking a greater balance in the ministry between an approach focusing on the appreciation and validation of a person’s life (aspects of Identity) on the one side and, on the other, the reach for spiritual transcendence in the religious sense (aspects of Spirituality).  Glenn Calkins would require that the question concerning “the appreciation and validation of a person’s life,” be posed in this way: is the pastoral visitor offering validation of a person’s life or is the patient/person self discovering?  Anecdotal experience (not grounded in research) would have us believe that the pastoral professional visitor, or the relationship counselor, initiates the process and gets-it-going and then the person, the elderly especially, fills in and takes over, recounting, self appreciating and reinforcing his/her life for meaning validation.  Marcus Valerius Martial wrote: “To look back upon one’s past life with satisfaction is to live twice.”

Clearly - a disciple of the rabbinic tradition would avouch - the reach for identity as the reach for spirituality, the reach for theology as the reach for social action, for deed and creed, for behaving and believing - all apparent polarities (with frequent convergences) - have in various ways, and in different degrees, important applications in the matter of an individual’s make-up and well-being.  The rabbis of the Talmud – and to this day – teach that we try to achieve balance between intellect and instinct, faith and acts, belief and behavior, mystery and morality. Similarly, we might characterize our objective or goal as that of striking a balance between Appreciative Inquiry validating a person’s accomplishments and achievements in life (“doings”, mitvot) and traditional “religious” approaches whose intention is to achieve spirituality, transcendence, however understood.

(2) AI ASSESSMENTS

Relevant to the convergence of AI and Pastoral Assessment for meaning validation, Steven S. Ivy writes, “Pastoral assessment is an important step in pastoral care-giving.  Indeed, pastoral interventions must flow from the assessment if assessment is to have more than intellectual value.  How does this model contribute to pastoral practice?  What suggestions and insights into persons are crucial to this diagnostic perspective which generates accurate empathy and clear directions for care?

“First, the emphasis of this assessment model is on the inner perspective of the person.  The open, semi-structured method gives persons an opportunity to put their pilgrimage into words.  While the inner experience of the person is of primary interest, other aspects (such as behavior, affect, relationships, and environment) are considered within the model.  This encourages the pastor to listen for the inner meaning of the person’s story and pilgrimage.” (4)
Ivy, in a comment by Glenn Calkins to this writing, “is seen as a member of a sub-group of therapists, theologians, pastoral types called ‘the meaning-makers’.” 

Accordingly, in an AI interview, the probing for meaning, purpose and achievement, is gentle, the inquiry is unthreatening but there is a serious effort to walk through, with the patient, the memories and reflections of a life thus far.  Its approach is rather more proactive than reactive as will be explored further along; there is less mirroring patients’ lead than in spiritual ministry.  Age is an important factor (see, for example, verbatim #1) but even young people have lifetime reflections defining important moments of achievement and accomplishment which are often put out of mind, not fully appreciated, sadly neglected and rarely reinforced before AI begins to elucidate and bring them forward to the forefront of reflection. There are likely many “doings” performed by the person – whether parishioner, congregant, hospice resident or  hospital patient - which deserve appreciation and recognition; which lead to affirming life, its value and values and which in turn, at times, conduce to more positive attitudes and dispositions – actions, the acknowledgement and recollection of which, may advance the recovery rate and restoration to health, particularly when mind-over-matter matters.  

One of several typical AI dialogues might roughly begin with “tell me about your family,”  “who are your loved ones and those closest to you?” and end with “you certainly were a successful parent-father-brother-sister or what have you…you accomplished a lot in your relationships with them and you strengthened their character and built upon their abilities in an admirable way”.  

An AI practitioner should not expect a patient to say of him or herself, “I certainly was /have been/am a great parent/friend/sibling/benefactor.  But when the AI practitioner intuits and “knows” the patient or counselee is, or may be, or has been skillfully brought to, thinking this, will: Say It! In Words! The AI chaplain might elicit concrete illustrations of character-defining incidents or anecdotes of good will to cite, acknowledging that that or another particular act of kindness or consideration or triumph is precisely what you are looking for and talking about, the two of you: “the time you took such and such to such and such place and did such and such was a marvelous paradigm as an example for your children, a model of behavior and will likely affect others for the good for a long time to come.” And if you are a rabbi with an avuncular twinkle in your eye, you might add “and it may just tip the scales and merit your being ushered into the right place in the world-to-come in long past your 120th year.”

A dedicated Christian pastor might say, “Appreciative Inquiry may serve as an initial approach to dialogue but a pastor/chaplain dialectic interaction should lead to spirituality”. Some I have known would add, “and to traditional or liturgical rites and prayer.” This view must be unpacked and examined.  It suggests that no life could be considered fulfilled without “religious” spirituality. This view requires a rather narrow and limited understanding of spirituality as restricted to religious spirituality which excludes the genuine “NONs” as defined above. We are also acknowledging that there are boundaries to spirituality and we are granting that if spirituality is everything it is nothing at all. Affirming Identity and respecting expressions touching upon matters of Identity, esteeming actions, achievements and accomplishments in the various realms of a person’s life, reaching objectives and personal goals – these may not be seen as “religious” spirituality in the narrow sense of the concept but may also be valued for NONs and others as perhaps a kind of secular spirituality.

Moreover, when identifying moments of invoking and realizing it, the meaning of spirituality must be clarified to be certain that a common understanding – or at least a common denominator - has been reached on the subject just as when the use of the word “God” is called forth, at some point it is necessary to disclose who (or “what?) is meant.  But, surely, certain understandings of spirituality and certain understandings of Appreciative Inquiry may converge and overlap in the service of those with whom the human services professionals – rabbis, ministers, chaplains - interact.  To what extent the convergence is subject to definitions and careful scrutiny – and research.  In this regard, the AI Identity assessment and intervention draft outlined in the chart below has been compiled not to replace but to augment and supplement the traditional list of pastoral assessments and interventions.

     (Not to be overlooked in religious spirituality dialogue is the importance of distinguishing between beliefs in a personal god as opposed to affirmations of an impersonal god (6).  And it is also necessary to make distinctions among the secularist, the theist, the atheist, the agnostic and the ignostic (7) when we are examining or exploring spirituality.)
                

(3) AI DERIVED FROM ORGANIZATIONAL DEVELOPMENT

     For this next observation, let us define or re-define spirituality in such a way as it may converge with Appreciative Inquiry (granted that faith in a supreme being is not a defining element as to where the two converge), seeing that they each seek to establish a level of consciousness, or said differently, moments of the achievement of a higher level of consciousness. We have maintained that Spirituality is about the ineffable and improvable, not about the physical world of demonstrable fact.  Spirituality could be understood also as the religious awareness of another dimension of meaning and judgment. Identity as self-understanding and self-declaration is more closely connected to, and appears more “like,” the realities of one’s life.  Reinhold Neibuhr said, “The role of religion should be to inculcate a sense not of infallibility but of humility” and humanity (and a self-consciousness leading to the performance of acts, mitzvot, commissioned in real time - a rabbi might very well append.)

     Appreciative Inquiry derives from Organizational Development theory as an alternative to the “identify the problem and correct it” orientation of other community organization procedures. Focusing on the deed, the action, AI may also be connected to the Mitzvah System which Jews recognize as “other than” the believing and faith requirements of Christianity. After all, Christianity offers truth and salvation.  Judaism offers “merely” culture and continuity.  The Aged NONs of the world, perhaps no less than others, may be interested in neither.  But they are interested in the effects of their deeds, the good doings in fact that they performed in their lives which they understand as accomplishments, achievements, and which are brought to the forefront by inquiring appreciatively, whether in a hospital setting, or elsewhere, particularly among the Aged NONs.

 (4) On AI INTERVENTIONS

The Shady Grove Adventist hospital chaplain’s record of intervention and interaction with patients in their rounds of pastoral – understood here as “spiritual” - visitations are listed, in part as follows:
  1. Minister’s pastoral presence
  2. Worship/Prayer
  3. Meditation
  4. Ceremonials
  5. Scripture Reading
  6. Spiritual Assessment
  7. Theological Discernment
  8. Sacramental Celebration
  9. Special Worship Services
  10. Other Devotional & Religious Matters
(Several others may be more readily subsumed not so much among the “spiritual” as within the pastoral interventions category, such as “reflective listening,” “referral” and “crises intervention.”)

These pastoral “interventions” and “assessments” are unquestionably important and have proven to be effective by skilled professionals at Shady Grove Adventist Hospital in Rockville, MD.  But the hospital sought to provide for the spiritual needs of all patients.  The hospital sought to cast a wider net which would encompass, not neglect the none-of-the-above NONs.  Enter AI.    
 
An Appreciative Inquiry approach/intervention, for every stripe of NONs and non-nons as well, would not object to have the practitioner/pastor/chaplain appropriate and incorporate where appropriate, spiritual interventions.  He/she would likely build AI upon these and determine with enthusiastic approval and acclaim the successes and achievements the individual has had/is having:
  1. With his/her family, as a parent, grandparent, sibling, friend, care person
  2. In the community
  3. In work for noble causes
  4. In one’s professional line of work as boss, as support person, etc
  5. In political realms and in social undertakings and movements bettering society; in paying attention to issues of the day
  6. In various noble activities helping others: disaster victims, troubled individuals, etc
  7. In other good deeds performed for the welfare of particular and identified others
  8. In good influences upon others; in charitable givings  
  9. In other elevated realms of the conduct of a life
  10. In creative acts and activities however understood
Among several outcomes and/or objectives realized, might be that by taking note with appreciation of the achievements of the person/patient,  a meaningful and substantial reinforcement of the good that they have accomplished will result. It may likely translate into an encouragement of future efforts and undertakings of good for others. This process of calling to mind achievements and accomplishments may yet even deepen the successes the individual has already realized and reinforce the person’s will and resolve to resume life in an ever increasing good will giving, mitzvah/deed performing, frame of mind for whatever years of relative health and well-being remain.  Perhaps too the morally strengthening point will be made that the absence of public acclaim and not having been elected to the hall of fame does not necessarily mean lack of achievements in avenues of elevated endeavor, or an absence of doings in “real time” that have helped to ennoble people and improve the lives that the individuals have touched over a - however long or however short - period of a lifetime.

It may be said that the Judaic-Christian tradition addresses wrongs, sins, errors and seeks ways to correct them and realizing wholeness (shalom and shlaimut) in that way.  Appreciative Inquiry does not conform to those priorities.  AI does not seek to present itself as a restorative, compensatory, remedially palliative discipline. AI presents itself not so much as an exercise in self-evaluation as in self-appreciation.  AI is not Yom Kippur. Particularly when the discipline’s focus turns to Organizational Development issues, AI veers away from rectification, making right, mending and correcting and prefers to proceed towards the reinforcement of, and the strengthening of, the positives, the successes and the affirmatives. It would rather build upon these than reconstruct and repair the negatives and the disagreeable especially the bitterness and errors of one’s life.  This stands in sharp contrast to the motivation for checking into a hospital in the first place, of course, which is precisely to correct the physical ailments and the negatives impacting on one’s wellbeing. Nevertheless, within virtually any setting AI has application in strengthening the will to carry on performing appreciated conduct of life. It can be seen that the place where AI and Pastoral/Rabbinical/Spiritual Care converge may be developed into a grace-full habitation accommodating certain human services professionals, supportive counselors, hospital and hospice chaplains, CPE programs, and perhaps certain others in the congregational ministry in the general as well.
      

(5) ON AI AND THE NUNYAS

In an open AI list discussion, Rob Voyle writes:

Most AI is oriented to having people explore their core values and what gives them life, so even in secular settings exploring these questions at some depth will result in the conversation that is of a “spiritual” nature (though not necessarily religious).  Most people find love life giving and hate life destroying, so asking about what is life giving is going to take you into the realm of positive qualities such as love, respect, honor, acceptance etc.                                      
     
Let us assume that the interactive ‘talking cure” is effective, to a certain degree, in relieving anxiety and cathartically expressing deeply held feelings.  Let us also agree that dialogue as in Martin Buber’s “I- thou” relationships-of-depth, has important meaning for both parties as participants. If that is the case then the question, “how does this dialogue and AI process get to convey the desired sense of reaching out in wholeness (shleimut) and, in certain instances, friendship - and not as in a probing, inquisitional or professionally pro-forma manner, employing rote techniques and making another person into an object –an It - precisely in contrast to the desired effect?  How does one go about the interview in this or that specific case of application of AI?  And how does a practitioner of spiritual/AI address the nunyas?  The nunyas are those patients who will look with annoyance and often with the arched eyes of astonishment and disdain at any personal questions they reasonably and readily (mis?)identify as intrusions into sensitive emotional inner terrains by a stranger - the professional. And say “none your business” or “nunya” for short!  

I learned about “nunyas” from an especially charming, elderly woman who taught me the term, its importance, and its power as well as the clear challenge that emerges from the “nunya” syndrome.  In many instances, the nunyas are genuine.  They do not want to expand their horizons with new-comers probing into their lives. Not in this stage of their lives. They may be saying or thinking: “Who are you to be interested in my life story?” “What are you doing poking into my personal business or why are you probing for my achievements and for my accomplishments, for how I’ve been with family, friends, and co-workers, and what I have ‘given back to the community’”?  And perhaps, “chaplain, why the intrusion? Why don’t you get on with it or shut up and pray…do your thing and get lost.”

But it is also quite clear that once the nunyas have gotten past - or even have expressed - “It’s none of your business” clearly, if not always entirely convincingly - the likelihood looms large that the individual who might be at first justifiably categorized as a nunya, before too long begins to interact openly and self-reflectively - within the AI dialectic. Often, the nunya patient turns out to be a better AI “subject” than one would expect of others – beware! Don’t always place your trust in first impressions! They might welcome being brought into the AI process:  participation in discussions touching upon the deepest meanings and interpretations of life experienced. It may be true that a nunya might very well have so strong a family and friendship circle consisting of individuals who knew/know so well of the accomplishments and achievements of the person/patient that there is no genuine need for affirmative action from a stranger, however well-meaning, interested in underscoring a life of accomplishments.  But these nunyas are few.  Some nunyas may have their emotional guards up as a coping method to avoid perceived hurt, when in fact, AI was being practiced to authenticate and affirm a life. Nons and nunyas are likely the very persons/patients/subjects for whom AI interventions are most appropriate.  

It appears that some nunyas were born; others are made – made by chaplains, clergy and other relationship professionals more often than we care to admit.  This may also be an illustration or proof that chaplains “who don’t know what they are doing make it difficult for those of us who do.” Any one of the questions on the assessment questionnaire below might drive an otherwise extrovert loquacious patient – especially the Jewish patients I see at my rounds at the NIH and at Shady Grove Hospital – to turn private and withdrawn, uncommunicative, closed-off, reclusive, reticent and distant as well.  All of the above. It also creates the clenched teeth grimace of a newly formed unsociably standoffish and suddenly taciturn nunya.    

Should anyone ever care to create a coterie of nunyas, the following “standard” interview questions will do it.  The following questions could very well turn anyone into a reticent, inhibited nunya.
  1. Do you feel peaceful? 
  2. Do you have a reason for living? 
  3. Do you have trouble feeling peace of mind? 
  4. Does you life lack meaning and purpose? 
  5. Do you feel connected to a higher power (or God)? 
  6. Do you feel connected to other people? 
  7. Are you able to forgive others for any harm they have ever caused you? 
  8. Do you feel forgiven for any harm you may have caused? 
  9. Do you feel a sense of appreciation for the beauty of nature?
Roy Voyle,  previously mentioned, appreciates Appreciative Inquiry and writes “I think there are several reasons for the affinity for spirituality and AI.  

The first is the way most questions are framed.  What you focus on becomes your reality.  From my understanding David Cooperrider was influenced by Albert Schweitzer’s ideas of reverence for life, so the types of questions he began with had that reverential quality, which in turn elicits ideas and lived experiences of spirituality.  So when you ask people their best experience of a time when they were creative, inspired, working cooperatively with others, etc. you are going to get responses that border on the realm of the spirit.  On the other hand imagine what would happen if we inquired into people’s worst.

However you frame the idea of God, or Source of our existence, every time you ask the question:  tell me a story of a time when you were at your best, you are asking the question about a time when they most closely approximated the Source’s intention behind their existence.  When people are at their best, they often report ideas of existence.  When people are at their best, they often report ideas of being in a flow state that had them connected to something that was far greater than themselves, and often in ways that were beyond simple words and explanations.

To put it in Judeo-Christian terms, asking about my best is asking me about those times that I most closely approximated the image of God that God created me to be.  Whether the experience was in a secular or religious setting you are asking about those times when I was “one with God”  

It is of some value to take note that part of the physician’s job description is to keep hope alive.  Dr. Paul E. Alexander, a clinical associate professor of psychiatry and human behavior, Brown Medical School, writes, “Patients who have hope are more likely to recover from their illnesses.  Studies have shown that the immune response is compromised by depression and hopelessness.  It is vital that physicians speak honestly with patients about their illnesses, and keeping hope alive needs to be part of that discussion.  Communicating hopelessness may be a self-fulfilling prophecy” (5).

Physicians provide hope. Relationship Professionals – ministers, rabbis, priests, chaplains -provide “inspiration” - from the same root as spirituality.  They also may provide an authentication and validation of a person’s life – a kind of inspiration that motivates and energizes the person to reflect upon, and wherever possible, return to a lifetime agenda of doing good and to build upon it.  Appreciative Inquiry which zeros in on Identity - understood in part as self understanding, validation of good deeds (mitzvot) and accomplishments - could very well become an important and powerful professional application providing for another’s self-discovery of meaning and purpose to a person’s life; it is also quite practical, versatile and distinctively useful for the purpose of assessment and intervention, validation and valuation, particularly for the aged, NONs, NUNYAs, and for all.

(5) AI VALIDATION

A.Chief Chaplain:  “Chaplain, go and visit Hilda Jones who is terminal; she knows it. Why don’t you dialogue her on Spiritual Care for the Aged Terminally Ill like you were trained to do
B.Staff Chaplain:  “what should I do Chief?
A.Cheer her up.
B.How am I to do that?
A.You’re the Chaplain, you’ve been trained, do something.
B.I didn’t learn cheering up of the dying in any of my CPE or seminary classes.
A.Make something up.  When General Patton told the Chaplain to pray for the weather to clear and the Chaplain asked him how, Patton said “write a persuasive prayer.”
B.So I’m to write a prayer?
A.Wouldn’t hurt.  What else do you have in your inventory?
B.You mean to cheer up the dying?
A.Exactly. Go to work.  That’s why we pay you the big bucks.  Go out there to the ICU and earn it.
B.Anything you say, chief.
A.And you know what? You could tell her we all die sooner or later.
B.…and now it’s simply her turn? That will cheer her up.
A.It certainly will. Also tell her she looks good dying. Women like to hear that.
B.Good idea chief. Sexism, even sexism, when situationally appropriate. Any other ideas?
A.How about telling her our buried bodies nourish the earth?
B.…as a fallen leaf replenishes the soil? Didn’t think of that. Perfect ice-breaker,
A.How about telling her god told you she’s heading for heaven…
B.Lying is permitted for the dying? Must have some scriptural authority somewhere.
A.Exactly
B.How about I help her appreciate her best attributes and all the good she did and all the good fortune she had in her life?
A.  If you think it’ll work. Give it a try.

Bahya ibn Pekudah, in his Hovot haLevavot (Duties of the Heart), told of talmidim (scholars) passing a dead animal. “How awful its smell,” said the disciples. “How white its teeth,” said the rabbi (master).
        
In recent experiments, as written up in the New York Times, “psychologists have shown that, when reminded that they will one day die, people fixate on attributes they consider central to their self-worth.  Those who value strength squeeze a hand grip with more force; those who prize driving ability, cooking skills or physical appearance intensify their focus.  ‘Given this awareness of our mortality’ said Jeffrey Greenberg, a  psychologist at the University of Arizona, ‘to function securely, we need to feel somehow protected from this existential predicament, to feel like we are more than just material animals fated only to obliteration upon death.  We accomplish that by trying to view ourselves as enduringly valuable contributors to a meaningful world.  And the more others validate our value, the more special and therefore secure we can feel.”

 For the Nons, Nunyas and the Aged, and for us all, Appreciative Inquiry may be just the right way to go about validating their value – and our own.  

Footnotes

Footnotes: (a) In tribute to Glenn Calkins consummate CPE supervisor.
1.ruach elohim, in The Torah: A Modern Commentary published for Reform Jews by the Union of American Hebrew Congregations, is translated “Wind of God.”  The reader is informed in a footnote that ruach can mean both “wind” and “spirit.” The note goes on to say that, “Wind, however, provides a closer parallel to Babylonian texts than the traditional translation, ‘spirit of God.”
2. The Journal of Pastoral Care, Spring 1988, vol. xlii, no. 1, p. 46.
3.  David L. Cooperrider and Diana Whitney, Appreciative Inquiry, Stripes Publishing, 2000.
4.  Dr. Steven S. Ivy, Chief, Chaplain Service, Nashville, VA, Medical          Center, Nashville, TN 37262 The Journal of Pastoral Care, December, 1987, Vol. XLI. No. 4, p. 338
5.  Dr. Paul E. Alexander, New York Times, December 29, 2005, letter to the editor, p. A26.   
6. Reeve Robert Brenner: The Faith & Doubt of Holocaust Survivors, Free Press 1981; Jason Aronson Inc. 1997, p. 86.
7. Reeve Robert Brenner: Jewish, Christian, Chewish, Eschewish:       Interfaith Marriage Pathways for the New Millennium (to be published-2007; electronically available).

Appendix - Two Verbatims (Descriptions of chaplaincy encounters)

Verbatim #1

Rabbi Dr. Reeve Robert Brenner, Chaplain SGAH
Verbatim #1
October 15, 2005
Presented at Shady Grove Adventist Hospital 11/15/05

The clock read that it was 1:30 and my stomach agreed.  I’d been visiting patients in various units for most of the day from early on and had been conscious in all my interactions of my hidden agenda.  That agenda could best be identified as an attempt to apply Appreciative Inquiry theory and practice by affirmation of the positives evoked from the interaction and dialogue of my visits with patients. I was determined to check out the ways AI might be applicable and of benefit to a patient.

I was walking along briskly but in a moderate pace when a young man in his late 20’s caught up with me. I turned to acknowledge his presence.

Chaplain: Hi, how are ya doing?  What’s up?
(He looked at me with a smile.  He was in a bit of a daze)
Morrie:  I’ve just become a father.
C:  How great is this news!  Wow!  How is your wife?  Doing well, I hope.
M: Yes she is.  She delivered a wonderfully beautiful, huge baby boy.  Over 10 lbs., well over 10 lbs.
C:  Phfew, wow, that’s a big baby!  Lotta work for your wife, no?
M:  Yes, she’s really taking it well.  We’re just overjoyed.
C:  Is this your first?
M:  Yes it is.
C:  The warmest congratulations!  What great news!  What’s your child’s name?
M:  Isaac!
C:  Isaac?  I haven’t heard Isaac as a name bestowed upon a child in quite a long time but it’s coming back as I understand it, along with Max and Sam.
M:  Exactly.  We didn’t want a name that appeared in the top 20 names… we don’t want to look at that – the really popular current names.  We went to the popular names on a list from the internet and started at about number 30 and on and about the 50th name we hit on Isaac and we both loved it.
C:  …which means in Hebrew - “laughter”! or ‘will bring on laughter and joy.’
M:  Yes, I know!  That’s one of the reasons why we liked it so much.

By now we, together, reached the cafeteria.  I went to my right and picked up a tray and for a few moments lost sight of Morrie altogether.  I picked up a bit of lunch, went to the register and brought my food tray to the table and sat down.  And actually I’d already begun to eat. Presently, I see a figure over my right shoulder and immediately recognized it was Morrie coming with his tray and actually seeking me out.  

C:  Why don’t you grab a seat?
M:  Yes, I’d like that.

He sits down across from me, sets down his tray rather deliberately and smiles again as though we are sharing a happy confidence. He appears grateful for the opportunity of expressing gratitude and for him to be able to speak to somebody and express the great exuberance that has filled his life now that he has a son, now that he is a father.

C:  By the way, Morrie, do you know how his name goes in the original Hebrew?
(Just as I am about to say it myself aloud, we say it together, simultaneously.
Both of us say:  YITZHAK!
M: (Ani midaber b’ivrit…) I speak Hebrew.
C:  Oh, we could speak Hebrew together then.
M:  Yes, I’d like that very much.  The only thing I don’t like about the name is …I love the fact that it means “laughter” but that he was to be sacrificed.  That God was going to have Abraham kill his kid and that troubles me.  I was always taught that Isaac was a sacrifice.  That’s what Isaac seems to be all about in the bible.  That made me uneasy.  That makes me uneasy.
C:  Hold on a moment.  Hold on a moment.  With respect, my friend and new daddy, I believe you have misunderstood the intent of the biblical storyteller.  Allow me to put it differently, to give you another view or interpretation.
Child sacrifice was rampant; it was the standard operational procedure of Abraham’s time.  That’s what fathers did.  They sacrificed their first son and, yes, if you read many theologians who follow Kierkegaard and other existentialists who look upon Abraham as a knight of faith then Isaac was a proto-Jesus, a willing sacrifice.  But that’s merely one rather unfortunate interpretation.  That view really has no validity in Judaism because in truth Judaism was born with a rejection of human sacrifice to the gods.  The fact is that Abraham and Isaac walked back down the mountain together, father and son, hand in hand, alive and well.  There was no sacrifice.  A revolution began.  Judaism began.  Human sacrifice was rejected.  Here was a group of people, a tribe that would not follow the routine of the surrounding peoples sacrificing their first born and burying the son in the cornerstone of the building and killing virginal maidens and other human beings as was the habit during that and other periods of time.  
Think of this: Isaac was, with Abraham, the instrument of the birth of Judaism.  No walking down the mountain alive, Isaac and Abraham, no Judaism and no Christianity and no civilization as we know it today.  Keep something else in mind.  He’s the one who takes on the duty of the strong supporter and transition figure.  He’s the one who takes hold of the legacy and tradition.  Without him passing it on to Jacob, there is no Israel.  So, he’s the man who was the transmission.  He’s the one who embodies continuity.  Furthermore, he represents continuity.  You have an Abraham, but if you don’t have an Isaac, you don’t have continuity.  So, Isaac is a great name and there is not only nothing to be ashamed of, man, it’s a proud patriarchal name.  That’s power!  That’s status!
M:  I can’t begin to thank you enough.  I can’t bless the stars enough for bumping into you.  You’ve made my day and my Shabbat.  I appreciate so much this insight you’ve provided.  I’ve gotten a whole different handle on it.  A different understanding, thanks to you.  I bless the day my son was born on.  I bless the day that I walked into your presence.  I think God sent my son to me and for all I know he may have sent you to me because, like Elijah, you came out of the blue, we caught up with each other and our steps….it was amazing.
C:  Yeah, you were also in quite a daze.  You’d become a father, you’ve changed your status so emphatically.
(We chuckled)
C: Yeah, you still are in quite a daze, you’ve become a father, you’ve changed your status so emphatically and forever, no going back daddy, abba!
(We continue to chuckle)
C: You’re an open guy now, you’re very open.  Emotions raw, no? I tell you this, that child of yours is lucky to have you as a father and I’ll bet you, he’s lucky to have your wife as a mother.  That’s the truth.  He’s a lucky young man and you’re each fortunate to have each other.

M: Where are you rabbi, and what are you doing here today?  
C: I’ll answer that if you’ll also answer for me what it is that you do where you are not being a father and talking to rabbis?  How do you waste your time all day?
M: I’m into Cryptology.  I work for the government and I do encryptions.
C: You do what?!  You’ll have to explain that to me.  The only thing I know about is Enigma because a couple of friends and members of my NIH congregation are gung-ho in this field and in voting machines and how information is controlled.
M: Fair enough, but how did you get here?
C: I serve as rabbi of a congregation in Bethesda and I also spend a lot of time as the rabbi of the NIH and I’m here today at Shady Grove Adventist Hospital, believe it or not, making connections with the non-theists, the humanists, the Jumanists, the trans-denominationalists, the atheists, agnostics and ignostics and the secularists, we classify these individuals as “NONS” and I speak to them, not so much about spirituality as identity, accomplishments, achievements and appreciation of what they’ve done, just like I expressed a moment ago appreciation for what you do and what you’ve done and what kind of a decent and fine man you’ve become and now experiencing such an event as becoming a father and naming your son Isaac and carrying on the traditions.  You’ve got a lot to be proud of-yourself and your family.  You’re bedrock of the community.  On your shoulders a community grows and continues.  So you are, at a very young age, you’re a pillar, a column, a buttress upholding the community and a symbol of what quality could be like when you contribute so much to civilization and society.
I’m proud to get to meet you and to get to know you.
M: As am I rabbi, as am I.
       

This verbatim documents my first uninformed try at AI without having exemplifications, specimens, or prototypes of others at hand to guide my verbatim and without having designed my own experimental instrumentalities of AI Intervention.

But one important lesson I learned, among others to be sure, is that age need not be the
sole determining factor in applying AI dynamics. Granted that an elderly person will likely boast of more if not greater achievements than a middle aged individual or a young person! Nevertheless parenthood, siblinghood, friendships at every age are all grist for the appreciation mill, potentially churning out support, reinforcement, and the strengthening of inner peace and resolve. I wonder also how in this matter (my interaction with Morrie) spirituality, as practiced by other pastors, clergy, rabbis and chaplains might have taken a different line of approach.

Verbatim #2

Rabbi Dr. Reeve Robert Brenner, Chaplain SGAH
Name: David Amron (fictitious name)
Age: 79
Diagnosis at Admission: degenerative disorder
Length of Stay: several days
Visit: first
Date of Interview:  Dec. 5, 2005

David Amron is a man of 79 years old, afflicted with a degenerative disorder which loses feeling at the extremities and continues slowly throughout his body.  He is quick to tell you he is not only resigned to the affliction; he has made his peace with his entire life.  He has three lovely children, eight grand-children, he’s very proud of what he’s done in his life.  He is a remarkably cheerful and a man with a positive outlook and grateful for all his life.  He is without bitterness concerning his affliction and greets everybody warmly and with good cheer.  I felt fortunate to find myself in dialogue with him.  

Verbatim

C: Hi.  I’m Chaplain Brenner.  My job is to inflict myself upon patients who do not declare for a particular faith or denomination.  Sometimes, information gets mangled.  Are you a NON or do you have a religious denomination? (He looks up as though to take me in or size me up…) May I intrude on your space at this time?  Later?  Tomorrow?  Never?  
P: Come right in but in my life I have nothing to complain about so I don’t know if I really need a chaplain.
C: Tell me about it and what makes you so cheerful so I can learn to bottle it and exploit it for others and make a few bucks.  (He smiles)
P: I’ve had a good life, a meaningful life.  I’ve accomplished a great deal and I can’t complain.  Let me tell you what I mean by “I can’t complain”.  I have a son-a lawyer, a daughter-a doctor, another son of mine is an engineer.  They all have their own wives and husbands and they are raising wonderful grand-children.  They are loving and appreciative of all that has transpired in their lives which makes me, through them, and because of their happiness, also a fulfilled man.  And they all love their Zayde.
C: Zayde, huh?  Voos Makht Ah Yid En Golis.  (Literally, “what’s a Jew like you doing living in exile” “Or how are you making out in exile?” an expression of Yiddish irony and bonding.) I wonder how come you got on my “NON” list?  But it does happen.  

(I thought I’d get that out of the way as not very relevant and that’s not where I wished to take this dialogue.  By my intuition and his body language and the words he uttered, I said to myself:  He’s a likely candidate for combining AI and spiritual ministry at once, the kind of blending or melding of the two disciplines to capture and validate the life experiences of a real winner, affirming a life and at the same time opening the door of the mansion of spirituality an inch or two wider in the wake of my visit.)  

It’s so important to take note of one’s blessings and to focus on the positives of life without denying the negatives, of course.

P: Take, for example, my tennis game, which I had to give up finally because the racket would fly out of my hands.  I had increasingly less and less control of what my fingers were doing and I had to give up tennis but I love and still love tennis and I played it a great deal and it’s kept me slim and kept me probably healthy for longer than I deserved to be judging from my parents’ early deaths.  So I can’t even complain about the loss of my tennis ability because I had so much of the good of the game all my life.
C: You’ll miss it though, of course, just like I miss playing basketball when I don’t get to play basketball.
P: Yes, of course I’ll miss it but I cannot say to myself I didn’t get a great deal out of it.  And, although it’s not the same as playing, I like watching the game and I imagine myself and think of myself often playing tennis with friends and my kids.  And so my memories and those old happy feelings still stay with me even when I’m off the tennis court.
C: Not everybody would feel that way.  How come you feel that way and how did you manage to come to that kind of positive attitude in life?
(Was I warming up to AI dialectical thinking?)
P: It may’ve come from the Second World War.  I was drafted and was in the Navy and thought many times that I wouldn’t come back.  I even wrote a letter to my wife, which was essentially a good-bye letter thinking I wouldn’t come home but I did.  So I think it may have been partly because I was one of the lucky ones to survive the war – the Second World War - when I was young and it’s carried over, perhaps, till now.  
C: A sunny disposition? That’s been a credit to this world. What were you doing in the military?
P: I was an engineer. Believe me, there weren’t too many Jewish engineers in the Navy at that time which was really very interesting.
C: How so?  In what way was it interesting for you that you would bring it up that way?
P: Well, I always felt that I had to represent my people…”inzereh yidn”.  I had to be a better soldier and more courageous and stronger and more going after it and all that, precisely because I was a member of a minority group and that motivated me to be the best kind of soldier I could be.  I even may have taken a few extra chances and risks that were unnecessary but which I wanted to do which may have been connected to my being a Jewish person in an all-non-Jewish setting in the military.  
(I thought then of the risks that pious Jews and other religious people took trying to keep their religious practices and behavior intact in the concentration camps of World War II.  After all, I wrote a book on the subject.)
C: You feel you did a good job in that as well, is that it?
P: No question about it.  I did some reading, later I served as an assistant to the chaplain especially when the military Rabbi was elsewhere and all in all I felt that I had performed some extra duty beyond what the military required of me by being a better Jew than even I would’ve thought  I could’ve been.
C: Can’t top that.  May I, before I leave, pronounce the Aaronite priestly blessing of the Kohanim and then I’ll go and chase down a number of other patients who declare themselves to be Nons but may in fact be Non-Nons?  You know this hospital cares about the spiritual well-being of all patients.  Not only the religious patients.    
P: Yes, I see that.  It’s a good thing that you do go visit all patients regardless.  Everybody needs attention.  And yes, please do recite the blessing.
C: (I say in Hebrew and then in English) Yivarechacha…
May the Lord bless thee and keep thee.
May the Lord let his countenance shine upon thee and be gracious unto thee.
May the Lord lift up his countenance upon you, David Amron, and bring you long life, health restored and happiness as well as his most precious gift of inner shalom, inner peace and inner harmony, Refuot Haguf, soundness of body, hardiness, freedom from ailment, renewed in strength and vitality; may the Eternal grant you vigor and wholeness and healthful well-being, venomar Amen.
P: Amen

Assessments & Evaluations

1.Questions arising from the AI dialectic include, who expresses the words of appreciation, the chaplain or patient?  Answer:  both.  Modesty, genuine or false, would likely restrain a patient’s self evaluations of praise and self-acclaim.  Patients might be helped to overcome their unwillingness to toot their own horn.  Contrast cultural distinctions among different religious and faith communities such as the Jewish (e.g. Humorists and comedians like Jerry Seinfeld, Woody Allen, Mel Brooks, Gene Wilder) and the Calvinists.  All patients “undergoing” Appreciative Inquiry, regardless of their faith communities, may be helped to appreciate the importance of, and the application of, the ancient dictum and famous maxim which I created decades ago in another connection (concerning my own sermons and pulpit addresses) namely, “He who tooteth not his own horn, said horn tooteth not.”
2.Concerning the application of AI, this patient was an easy shot, perhaps too easy a setup but of some value nevertheless in the matter of relating to subjects providing maximum potential for the application of the AI process.  It’s useful to start off with easier subjects and then to address the more complicated and difficult patients who may be less open and amenable to the process.  This patient was easy but no less important.  He is an optimist and even beat me to the appreciation or “good-fortunes-of-life punch.”    
3.Future objectives requiring further investigation and reflection deal with how AI is to be applied for patients with cloudy dispositions and those who are unmistakably depressed (some with good reason, e.g. illness).  
4.Future visits with patient might focus on 1) filial relationships 2) community and worthy causes to which patient contributed 3) Other areas of life worthy of appreciation.