Customer Reviews

The Minister as Diagnostician: Personal Problems in Pastoral Perspective

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Paul Pruyser, in "The Minister as Diagnostician" gives an insightful view into the challenges, struggles and questions of ultimate meaning that hospital patients face. The purpose of the book is not a biblical exegesis exercise, but rather to help pastors and chaplains draw on the disciplines of spirituality and psychology to gain a deeper understanding of what patients, familiy members and hospital staff go through. Pruyser's book is a pioneering effort in this respect, because next to Anton Boisen's work in the 1940's and 50's, this book is one of the few that adopts an interpretive rather than prescriptive approach toward pastoral care. In a nutshell, Pruyser seems to be saying that if we are to be effective in our pastoral care, we must first have a grasp on what situation the patient and his or her family are in- what are their resources for support? where do they locate ultimate meaning and hope? what are their challenges? What pastoral resources can be mobilized to address these needs?

Pruyser provides an extremely helpful model and template for understanding the spirutal needs of the patients to whom we minister. For those of us who make pastoral care visits, particularly in the hospital, on a regular basis- this book is tremendously helpful food for thought. If you are looking for a book of proof texts on the basis for pastoral care, however- that is not what this book is all about. Remember, Pruyser's approach is descriptive, rather than prescriptive. This book is an excellent pastoral care resource for chaplains, pastors and pastoral care visitors. I have used it in my work as a hospital chaplain and I would highly recommend it.

Pruyser's small, easily read book is packed with both a conceptual framework and a distinct seven-dimension scheme for diagnosing spiritual issues. It is particularly useful for ministers working with people whose lives are complicated by illness, injury, addiction, or traumatic memories, or whose spiritual journeys don't follow an expected path. A second group to benefit from this book would be healthcare providers who want to learn how to engage more helpfully with patients for whom spirituality is a significant factor affecting their well-being.

Pruyser explores several important distinctions:
* Example: The distinction between "diagnosis" and "labeling," contrasting Karl Meninger's enlightening concept of co-diagnosis, in which the patient and professional come to a shared understanding of the patient's situation, with the often demeaning experience of labeling, where the patient/parishioner is given a label by a doctor or clergy member.
* Example: The distinction between "religious judgment" and "spiritual diagnosis." Religious judgment typically focuses on how a person's beliefs and behavior compare to a religion's expectations; it may be expressed about someone within or outside the group. Spiritual diagnosis focuses on the quality of the person's spiritual experience and its interaction with their physical, emotional and social well-being. Spiritual diagnosis will identify one's spiritual strengths and resources as well as areas of difficulty and vulnerability that need attention.
* Example: The distinction between spiritual and psychological authority and language. Pruyser, a psychologist, wrote at a time when ministers were developing a new appreciation for the insights of psychology; some were adopting psychological language and abandoning religious language. He challenges ministers to be clear about their base of authority and to reclaim their own language in exploring and describing the human condition. The seven dimensions of spirituality he identifies are described in spiritual and experiential language.

The Minister as Diagnostician is a thought provoking guide for those who want to sharpen their ability to diagnose spiritual issues in people for whom they care. It is especially useful for those who work in multi-faith environments and who need both a clear and non-parochial language to communicate their understandings.

The Minister as Diagnostician is not a biblical treatise, nor does it claim to be. Pruyser's base of authority is that of a psychologist and educator who learned to appreciate the contribution of an excellent chaplain to the interdisciplinary care team in the mental hospital where he worked. Pruyser's inclusion of ministers in his list of professionals was intended as a compliment to the professionalism of that chaplain and others in an environment where ministers were generally marginalized.

My bias as a reviewer is that of a chaplain who has used Pruyser's work as the foundation for spiritual diagnosis with thousands of patients over 25 years in medical hospital, addiction and mental health treatment settings. Patients, many who considered themselves to be non-religious, have often described this exploration to be the most helpful spiritual encounter of their lives. Pruyser's diagnostic scheme and language opened the door for them to affirm their spirituality and to choose a path of intentional progress. Though Pruyser issues the caveat that he writes from a Christian perspective, and has tested his seven-dimensional model only within that environment, I can attest that it has also been quite effective in the multi-faith, multi-cultural environment of Hawaii. I include The Minister as Diagnostician in my "top ten" list of books most influential in shaping my ministry.

A classic and must-read if one is to work in an institutional setting.

Some people maybe put-off buy the jargon but it does help to solidify basic principles of chaplain visits. With this said, I think many parish pastors may not appreciate the more clinical nature and style.

However, there is the common ground of continuing to listen beyond one's "words". We servants are to listen to the heart, as well as the words, and this book attempts the reader to create more meaningful and clearer encounters when paying visits.

This book by Pruyser turned out to be a big disappointment. While I could list a number of reasons why I did not care for the book, I will limit my remarks to two areas which I found to be especially disappointing. To state it quite simply: the overall tenor of the book is secular. For example, he repeatedly refers to the pastor as a "professional" who is counseling "clients". While both of these terms may be technically acceptable to some people, I find them both to be offensive. In the true sense of the term, the pastor is not a "professional" (according to Pruyser, the pastor is viewed as one professional among many others such as psychiatrists, doctors, social workers, and others who perform what he sees as similar "services"). In light of the Biblical qualifications and duties of a pastor, it is hardly appropriate to refer to him as a "professional" in this sense. To do so takes a man who is called and gifted by God to perform a sacred duty and secularize him and the ministry he has been given. To be sure, the ox is not to be muzzled when he threshes the floor, but to take the fact that pastors are compensated for their efforts and thus lump them in with those whose callings are of an entirely different order and label them all "professionals" does not resonate well.
Also, over the course of the 134 pages, there is only one Biblical passage which is referenced (Jn. 8:3-11, p. 117)! This was tremendously disturbing. As a book which is targeted to ministers (remember the title of the book), it was quite a let down to read page after page and chapter after chapter only to find no attempt to deal with pastoral counseling from a Biblical standpoint. If Pruyser is not first and foremost interested in what God has to say, then what is the use of writing a book that is expected to be used as a resource for those men who have given their lives to serving God based on the revelation which He has given in His Word, the Bible?
Some of the chapters were not a total loss, though. However, even in the chapters that contained some decent material, (Chapter 4- Why Do People Turn to Pastors?; Chapter 5- Guidelines for Pastoral Diagnosis; Chapter 7- Language in the Pastoral Relationship; Chapter 9- The Agapic Community) the framework from which Pruyser proceeded to write had a very secular tone to it. Maybe that word "secular" has been overused and doesn't seem to fit in a critique of a book which is designed to be read by pastors, but there was little if any spiritual vibrancy on these pages.
An interesting bit of irony is found when one compares the actual content of the book to the authorial biography on the back cover. In that brief paragraph, we are told that one of Dr. Pruyser's "unusual qualifications to write this book" include the fact that he is in possession of "considerable theological insights." In my estimation, nothing could be further from the truth. This book contains virtually no theological insight (explicit or implicit) and never makes any attempt to deal with the issue of pastoral counseling from a Biblical/theological perspective.
Having said all of this, the main point of the importance of a pastoral diagnosis in cases of counseling has not been lost. There are points at which I can agree with Pruyser and appreciate what he is trying to communicate, yet the detached feel of the book was something I was constantly having to fight against.