Seeing the Spark of the Holy
My Grandfather's Blessings: Stories of Strength, Refuge, and Belonging.
Rachel Naomi Remen.
New York: Riverhead Books, 2000.
382 pp. $24.95 (Hardcover).

Rachel Naomi Remen's first book for mass publication, Kitchen Table Wisdom, inspired such affectionate loyalty that many of its readers will undoubtedly have read her present book long before this review is published. Remen is formerly a pediatrician at Stanford and cofounder (with Michael Lerner) of the Commonweal Cancer Help Program in Bolinas, California. She is one of the most respected—even revered—speakers and writers concerned with the humanistic reshaping of medical practice, the recognition of spiritual dimensions of illness and care, and, in the Commonweal program, the healing power of listening. In her current work she listens both to people with cancer and to physicians whose work has left them needing reorientation. I am sure that, like anyone so prominent, she elicits cynicism in some corners. On my reading she has used years of personal and clinical experience to create a spirituality that is inclusively nondenominational while still honoring religion, and she applies this spirituality to practical problems of being ill and of doctoring. She's a pragmatic utopian who provides some of the clearest ideals in health care.

Can her new book, My Grandfather's Blessings, possibly sustain the expectations such a reputation creates? Remen and her publisher follow the format of the earlier book in design, tone, and format. The book consists of short stories, two to five pages each, readable independently of each other but cumulative in their effect. There are six sections. Read out of context the titles sound like California softcore pop spirituality: "Receiving Your Blessings," "Becoming a Blessing," and so forth. A few stories set off my alarm for New Age gee-whiz, but the collection as a whole worked for me, literally, like a charm. Remen drew me into her world, and as I continued reading, I began to believe myself capable of making my world a brighter, better place.

Kitchen Table Wisdom seemed held together by Remen's progress from medical school, through her own illnesses, and finally to Commonweal—from aggressive scientific medicine to healing through attention to patients' voices and souls. My Grandfather's Blessings, on the other hand, is held together by continuing stories about Remen's grandfather, an Orthodox rabbi and scholar of the Kabbalah. Though he died when she was a child, his effect on her spiritual awareness was profound; it took Remen years to recover that effect. This book is testimony to that recovery. Thus the "blessings" come both from Remen's family history—this magical grandfather who seems to spring from a later film of Ingmar Bergman but remains original to Remen's writing—and from the teachings of the Kabbalah, interpreted in Remen's inclusive version. "My grandfather was a man of many blessings," she writes. "These blessings were prescribed generations ago by the great teaching rabbis, and each is considered a moment of mindfulness—an acknowledgment that holiness has been met in the midst of ordinary life."

Each story in this book is a meeting with holiness in ordinary life. Again, the stories have a cumulative effect. To stay with them long enough to begin to see the order in their apparently random scrapbook arrangement is to experience one's relation to the world differently. "A blessing," Remen writes, "is about our relationship to the spark of God in one another." In giving and receiving blessings, "we can repair the world." In a brief review, such words can sound like feel-good wish fulfillment. In the accumulation of these highly concrete stories of encounters with suffering and dying, readers can see the world being repaired, and they can experience Remen's grandfather's blessings. The idea that medicine could be a practice of seeing the spark of the holy in everyone is sure to bring out cynics. I myself am simply grateful.

Guiding the Caregiver
Spiritual Care: A Guide for Caregivers.
Judith Allen Shelly.
Downers Grove, Ill.: Intervarsity Press, 2000.
180 pp. $11.99 (Softcover).

This text on spiritual caregiving will be well received in many, but not all, circles. It offers help in preparing students in the health field—nurses, physicians, allied health professionals—as well as seminarians and lay persons who spend their time and talent in offering spiritual care. The book is divided into three sections: defining terms, rendering care, and providing self care for the caregiver.

Yet Shelly is explicit in her intention to appeal to those who want to offer Christian spiritual care and asserts that "we should not be looking for spiritual techniques or healing practices from other belief systems." The author also greatly laments the postmodern deconstructionist world view and its accompanying tolerance for incorporating any spiritual practice that brings comfort into health care. The real consideration for Shelly is what the Bible says about health and healing. Shelly views spirituality as "the whole person in dynamic personal relationship with God." The biblical concept of health, she says, is closely related to the concepts of salvation and shalom.

The most remarkable feature of this guidebook is the myriad of credible examples drawn from the author's nursing experience both in the hospital and in her congregation. Parish nurses will certainly identify with many of these situations. The chapter on assessing spiritual needs includes experiencing reciprocal love and forgiveness as well as finding meaning and purpose in life and hope for the future. It has helpful and specific suggestions to enhance skills of observation and interpretation. Shelly includes several quite practical spiritual assessment guides, both for self and others.

Barriers to rendering spiritual care—hidden needs, fear of treading on private territory, lack of time, and feeling unprepared or ill-equipped—and methods to overcome these are discussed in detail. Shelly wisely counsels that spiritual care be carried out with gentleness and respect: give the option of saying no, evangelize rather than proselytize, offer compassionate presence by listening carefully. Always the good teacher, this nurse author suggests strategies for providing effective spiritual care more easily. These suggestions include pairing up with a friend to do some of the suggested assessments, starting a small support group of like-minded individuals, identifying a mentor, journaling, and praying.

The section "Doing Spiritual Care" begins with a look at the worship community. It provides an excellent methodology for assessing the needs and resources of a congregation and offers tips for the congregation to become a more caring community. Chapters in this section also address compassionate presence (being with rather than doing for), prayer (when and how to pray, with an emphasis on those who are especially isolated due to illness, and praying with in addition to praying for), and the Bible. Shelly acknowledges both the use and misuse of the Bible and urges the reader to become "familiar with a wide variety of Scripture to choose appropriate passages." She provides a listing of helpful biblical passages that might be appropriate in given situations (guilt, loneliness, abandonment, suffering, fear of unknown, fear of death, and chronic illness) and suggests that the spiritual caregiver keep a log for future reference.

Also in this section is a chapter "The Power of Touch." Here after discussing the dynamics of touch, providing very practical guidelines for appropriate touch, and citing biblical references to the use of touch by Jesus, Shelly gives what this reviewer would consider undue attention and too many footnotes to therapeutic touch. Certainly there is controversy around this alternative/complementary therapy, but her condemnation of this energy-based practice and the theory behind it appears premature and overdone. She rightly questions the research studies claiming effectiveness, but also views this practice as "dabbling in the occult" and "mysticism gone awry." She warns that "in many ways it is idolatry." Given all the recent discoveries in physics, it could be pointed out that God created energy fields. One might want to be open to what this could mean in terms of facilitating all kinds of healing processes, of making things whole again.

In the final section "Caring for the Caregiver," a chapter on the family caregiver urges the faith community to take concrete actions to show family caregivers love, with a caveat that "all of them call for a high level of compassion and commitment." Insightful recommendations include providing respite care, offering friendship and support so as to avoid caregiver isolation, assisting caregivers to recognize their own needs as well as those of the person in their care, and becoming knowledgeable about the resources in the congregation and the community to meet identified needs.

In the chapter "Caring for Yourself," Shelly offers several recommendations that she links to scripture references: joining/forming a support group, finding a mentor who models rather than meddles, and looking after one's own physical, emotional, and intellectual needs. The author also discusses the maintenance of a healthy spiritual life that is nurtured with quiet time for daily devotions, reading, meditation, and prayer and suggests periodic time for more extended retreats. I was disappointed that this chapter was not more comprehensive in its content and did not provide an extensive bibliography of other resources.

The book concludes by emphasizing the need to identify others who can assist in rendering spiritual care. Shelly points out that although this process is initially time-consuming and somewhat frustrating, organizing a team of volunteers will assist in avoiding compassion fatigue. She identifies steps to take in developing a volunteer program within a congregation and also provides a detailed outline for the orientation of volunteers.

If used as a primary resource to assist caregivers in rendering authentic spiritual care, this text needs to be supplemented by other readings and resources that Shelly suggests. In addition a teacher would want to select resources to insure a more balanced approach to spiritual caregiving, one congruent with their own and their students' faith traditions. As the author reminds us, "Caring for the spiritual needs of others allows us to tread on holy ground….This work is a wonderful and eternal investment." Judith Shelly's work helps us tread a bit more gently and to make that investment.

Family as Domestic Church
Family: A Christian Social Perspective.
Lisa Sowle Cahill.
Minneapolis: Augsburg Fortress, 2000.
176 pp. $17.00 (Softcover).

In this follow-up to her fine study Sex, Gender, and Christian Ethics, Lisa Sowle Cahill more fully develops the metaphor of the family as "domestic church." In her earlier work she briefly adumbrated the patristic origins and recent resurgence of this metaphor in Roman Catholic family theology. The domestic church suggests a "vision of the family's transformative commitment to society, and its presupposition that the family as a community of social service can by virtue of that very function be a locus of its members' happiness and fulfillment," according to Cahill's earlier writing. It is particularly significant, given Cahill's renown as a bioethicist as well as a theologian of sex, gender, and family, that in this new work she points out how the family must exist as a social and cultural force, rather than a merely natural and biological entity, within the larger society.

In her new book an initial discussion of the role of the family in civil society challenges the argument that problems plaguing the modern family are purely the result of individualism run amok. Cahill sketches the contours of her argument for a critical familism capable of exposing what theologian Reinhold Niebuhr would call "collective egotism," defined here to include an excessive emphasis on kinship, to the exclusion of the common good, that becomes a sort of family idolatry. Cahill defends a rich notion of the Catholic doctrine of subsidiarity as a two-way street in which the state not merely leaves families alone, but also engenders a relationship in which families give back to society through social service and good example.

The argument for family as a social unit continues in chapters surveying the social nature of the family in early Christian thought, and in the theologies of John Chrysostom, Martin Luther, and the Puritans. The early Christian sections cover some of the same ground that Cahill explored in earlier writings on the family. The section on the Greek church theologian John Chrysostom effectively presents his theologies of marriage and sexuality as a more positive alternative to the Augustinian tradition. The chapters on Luther and the Puritans bolster Cahill's argument for the role of the family in civil society. Therein Cahill effectively highlights the social nature of Luther's thought against those who would view Lutheranism as a pietistic tradition, though she ultimately finds him less than fully critical of the social order in some key ways. The sections on the Puritan tradition are based largely on secondary sources, tend to conflate British and American social contexts, and are rather harsh on the tradition as a whole.

Cahill is once again in her element when she shifts into analysis of the Catholic tradition. Her treatment of papal pronouncements on the family, like her discussion of early Christianity, does not cover entirely new ground. The Catholic section is supplemented and updated with a discussion of the effects of recent welfare reforms on the American scene. The primary effect of Cahill's Catholic chapter is to set the stage for a novel turn in her work in family theology—a discussion of the African American family as, in many ways, a more authentic embodiment of the domestic church ideal with many lessons for those from other segments of American society.

Consideration of the African American family is a new venture for Cahill and may prove to be the most controversial part of the book. Cahill draws largely on the work of sociologists Andrew Billingsley, William Julius Wilson, and Donna L. Franklin, and of theologians Toinette Eugene, Robert Franklin, and Cornel West, to highlight the resources African American families draw upon to survive in a culture that has been remarkably and regrettably hostile. Primary among these are the extended family, the black church, and the African American community. That African American families have used these resources profitably is meant to support Cahill's larger argument for the social nature and transformative potential of the family as domestic church.

Yet in her treatment of the African American family Cahill makes weaker use of the critical realism that she brings to so much of her work elsewhere. While Cahill draws on the work of leading African American scholars in her analysis, African American studies is now a flourishing field, entailing diversity and contestation. Wilson's work in particular, which Cahill interprets as recommending primarily structural rather than cultural solutions for problems plaguing African American families, has been challenged by other African American scholars of equal stature—most notably Orlando Patterson, who in his recent Rituals of Blood, which paints a much less optimistic portrait of African American gender and family relations. The most valuable part of Cahill's African American family discussion may be her willingness to test norms against diverse contexts in her ongoing project of critically articulating universal norms that are responsive to the variety of real and embodied human needs.

Envisioning Communal Justice through a Judaic Lens
Health Care and the Ethics of Encounter: A Jewish Discussion of Social Justice.
Laurie Zoloth.
Chapel Hill: University of North Carolina Press, 1999.
343 pp. $19.95 (Softcover).

Laurie Zoloth's arguments for a Jewish perspective on social justice are compelling to me for reasons that transcend her text. Although she speaks as an orthodox Jewish feminist and I speak also as a feminist but from the reform tradition, we speak the same tongue—the mama loshen I learned as a child—which says that relationships are central to our being in the world and that we must walk in others' shoes to know and to respond to their pain. The notion of chosenness is also a call to act, to heal our broken world. Says Zoloth, "At the heart of Judaism is this nagging mandate. Do not be satisfied with the unredeemed world…act to change it, to criticize it, show up the injustice of your society, expose the falsity that Jeremiah knows and the pretension that Isaiah sees." Our membership in the community is not voluntary; we cannot avert our glance from vulnerabilities that compel a response. While we cannot be singularly responsible for all, we are not excused from organizing, from raising our voices, from resisting complacency. I read Zoloth's book through these lenses.

The first part of the book analyzes the Oregon experiment with priority-setting as a reference point for discussions about community justice. She then discusses classic liberal theory and calls for an alternative language of justice that focuses on community rather than on the autonomous, self-legislating individual. I focus on this call.

In a departure from generalized critiques of autonomy and individualism, Zoloth starts with a particular tradition. Jewish sources, essentially invisible in discussions about health care reform, have both substantive and procedural contributions to make to any revived debate about justice and health care. First, Judaism affirms the centrality of community, not as a choice made by autonomous agents, but as an ontological and practical necessity. The priority of community gives each of us the responsibility of sustaining it even at a substantial cost to ourselves. Judaism cannot envision freedom without covenantal responsibility. A rights-based ethics, in contrast, renders the good of the collective as a contingency at best and, therefore, a good of limited moral relevance. Yet Jewish history is testimony that without communal responsibility there would be no survival. Today the moral language that supports such a vision of human good, speaking directly to the relationship of individual to community, is rarely articulated. Second, Judaism offers a method of disputation, a tradition of argumentation. Zoloth thus finds in Judaism "method, text, and history" that lead to the "recovery of a language of public values of community and the possibility of reconsidering the centrality of collective responsibility."

With Zoloth I believe language is an essential starting place for new visions, words are the source of a renewed consciousness, and dialogue is the optimal method for arriving at an ethical truth. Bioethicist and Jewish scholar Rabbi Elliot Dorff reminds us in Matters of Life and Death: A Jewish Approach to Modern Medical Ethics: "The best we humans can do is to engage in serious discussions with others in order to refine our own thinking and practice." Because the centrality of halakha (law) differs among the branches of Judaism, Dorff also cautions us that the interpretation of texts "requires intelligent application, with careful attention to differences between principles and policies, the nuances of specific cases, the historical development of legal texts, and the impact of the reader in discovering their meaning and applicability…always with constant awareness of Judaism's moral and religious purposes."

Zoloth's work is an impassioned reinterpretation of historic texts, in particular the Book of Ruth, and it probes modern theological reflections, especially the work of Emmanual Levinas, for a new language to ground claims of social justice. Levinas's ethics of encounter offers a key link to the new language Zoloth seeks. "My very uniqueness," writes Levinas, "lay in my responsibility for the other; nobody could relieve me of this...." To Levinas, the major ethical event is "hospitality"—a "call to the other to share your whole world, to be responsible not only for the other but for his or her responsibilities as well."

The Book of Ruth advances Zoloth's argument. Can the private commitment of Ruth to Naomi, in time of great scarcity, "have meaning in the wider world of social policy amidst a city of faces?" Indeed it can. The two women reenter Naomi's community from exile and reenact the intensity of the private in the public realm. "What Ruth teaches us is that citizenship is solidarity, that meaningful discourse starts with the recognition of the other, and that justice is prior to any human freedom."

The Ruth story, with relationship at its core, provides a framing language for a discussion about health care justice. As Ruth joined her fate to Naomi's, she acknowledged the power of relationship. That too is the task of community, especially when it is faced with scarcity. Scarcity can unite as well as divide; communal acknowledgment that relationships and connection are primary can alleviate scarcity's threat to communal survival. Scarcity can be dangerous, forcing a confrontation between the self and the other; in the extreme situation of Auschwitz, for example, where starvation was an omnipresent threat, Primo Levi's insistence on the humane gesture, the regard for the whole, did not save him from thinking obsessively many years later of the slice of bread he might have shared. The moral demands Levi experienced and never forgot seem lost in America's contemporary attitude toward health care.

How then do we reinvigorate and transform the language of justice so that we experience scarcity as our collective problem? It must start, as Zoloth notes, with new and radical moral choices. The Jewish tradition is an important but usually untapped resource for that new consciousness. Theologians of different persuasions can speak a new language and tell a new story to counter today's prevalent competitive, marketplace mentality.

Zoloth ends with fundamental suggestions for advancing a discussion of justice in health care. She returns us to the very notion of neighbor—"Only when the other is understood as myself is it licit to speak about limits on his or her life." If we acted upon Levinas's concept of hospitality or the recognition that exile and disempowerment affect us all, would we allow 44 million Americans to be without health insurance? Could we support what has become, in many places, assembly-line medicine, where there is no time for an authentic encounter between patient and physician? But there is danger in seeing ourselves in others. And there is little in our public utterances to suggest that we are ready to face that danger.

Economics: The Human Face
Development as Freedom.
Amartya Sen.
New York: Knopf, 2000. 366 pp. $15.00 (Softcover).

During fall 1996 and November 1997 Nobel economist Amartya Sen came to the World Bank as a presidential fellow and delivered six lectures aimed at enriching public discussion on matters of economic and social development. The bound lectures, Development as Freedom, address complex issues of democracy, economics, and social justice in clear, nontechnical language. Among Sen's topics are culture and human rights, women's agency and social change, and the relationship between markets and states in securing social opportunities.

In all his arguments Sen makes clear: economic matters are never merely economic, but reflect decisions—at best democratic—about individual freedoms, social values, and public priorities. With this in view, Sen calls ultimately for a global public discussion about the global resources (e.g., financial, technological, ecological, social, scientific) we share as human beings. For Sen, where organizations like the international financial institutions (e.g., the World Bank, the International Monetary Fund) and the United Nations put their resources is a reflection of how they measure human need. Sen calls for measures of human need and human life that go beyond economic terms to consider the social and cultural factors. Rejecting the language of "human capital," Sen has given development economics a new face by thinking instead in terms of "human capabilities." What, he asks, is a given human being capable of doing and being? In light of this question, wealth is not an end in itself but enables human beings to live lives they have reason to value. Likewise, true global inclusion of the world's poorest and hungriest nations will involve more than mere market inclusion, more than merely bringing free trade to the country at risk.

After declaring himself to be nonreligious, Sen takes up what he sees to be a potentially religious question: how can a compassionate world order contain so much affliction and hunger? For religious and nonreligious people alike this is a call to human responsibility. "As competent human beings we cannot shirk the task of judging how things are and what needs to be done." Whatever the forum of our participation—be it local, national, or multilateral—Sen challenges us to bring an experience of our common humanity to the questions of social justice, inequality, and exclusions.

That no famine has ever occurred in a functioning democracy bespeaks the usefulness of democratic conversation. For in famines, as Sen argues, what is needed first of all is not food but a democratic community's reasoning about social priorities. Sen's logic is as follows. Famines are not caused by an overall lack of food (indeed food may be a lively export during famine) but by the loss of individuals' buying power in gaining access to food. Moreover, contrary to popular assumption, famines never devastate a whole population, but only small portions of one—rarely more than 5 or 10 percent. Sen avers that true democracies can together strategize preventative measures to preclude the starvation of portions of a population during economic or agricultural slumps. Likewise, insofar as a free media is part and parcel of democracy, it can publicize policy missteps and pressure for reform.

In the midst of clichés about global economic growth "lifting all boats," Sen's book speaks intelligently to a truth we know: we live in a world of unprecedented contrasts between opulence and deprivation. Global inequalities in education, health care, and even food distribution call each of us to come together as human beings to try to understand the causes for extreme poverty and to take responsibility, seeking solutions for a more just world order. For those inclined to answer this call, Development as Freedom is a primer for a humane economics.