Chapter 28: Parish Clergymen and Mental Health: The Kokomo and La Grange Projects by Granger E. Westberg
Over a period of four years two groups of clergymen, in two separate cities, were given intensive, brief courses on how to deal with people under stress. The pattern for the approximately twenty clergy from Kokomo, Indiana, consisted of one intensive week at the University of Chicago, followed by six monthly meetings after which the men returned for a second intensive week of instruction at the University. This was to have been the end of the project, hut the clergymen continued to meet on a monthly basis, often with key groups of doctors, lawyers, nurses, and others in the town of Kokomo.
The clergy of the second community, La Grange, Illinois, following their one-week intensive program at the University, agreed to meet once each week for case conferences based on their own parish problems. After three months they returned to the University for a second intensive week and then continued to meet in La Grange on a weekly basis at the community hospital with one or more doctors present. Usually, the case presented was the patient of one of the doctors in attendance.
Both the Kokomo and La Grange projects grew out of one of the University of Chicago’s regular two-week seminars for parish pastors on the subject of pastoral counseling and the relation of ministers and doctors in their cooperative ministry to the sick. These seminars had been conducted each summer since 1945. Normally they drew clergymen from a variety of denominations who live in cities and towns in widely separate parts of the country.
At the conclusion of each seminar the students would attend an evaluation session where they were asked to comment on the course and offer ways to improve it. During the evaluation session in the summer of 1957, one of the students, a pastor from Kokomo, said, "This seminar has been tremendously helpful to me. I believe it will significantly change my perception of my responsibilities and opportunities of service to my people. But if I am to follow through on some of these necessary changes in myself, I will need the daily encouragement of fellow pastors who also feel as I do. As long as I have been surrounded by these men in the seminar, I have been doing quite well in my resolution to change. But when I get back to Kokomo, my enthusiasm will probably be dampened by the fact that I will have no one to talk to about these matters." He concluded by saying, "I wish that all you fellows were from Kokomo."
The pastor from Kokomo touched off an animated discussion. Every man present said approximately the same thing. Courses like this would have cumulative value if the students were all from the same community, for they could work together in implementing these newer concepts of clinical theology. During the next few months, we at the University did a good deal of thinking and planning of the possible development of such a project. With the help of the Lilly Endowment we finally decided to go to Kokomo and invite all full-time clergymen to attend such a seminar. We gave it the general title of "The Role of the Clergymen in Mental Health." Through the help of various groups in Kokomo, and particularly the Kokomo Tribune, we were able to explain the nature of the project to this community of some forty thousand people. There were approximately thirty-five full-time clergymen in Kokomo and surrounding Howard County. Of this number twenty-three responded to the invitation.
The Kokomo project was jointly sponsored by the Department of Religion and Health of the University of Chicago with the assistance of the Department of Psychiatry. Dr. Edgar Draper, a psychiatrist, gave full time to the project during each of the one-week sessions. The late Chaplain Carl E. Wenner, of the University of Chicago Clinics, and I acted as directors of the project.
It was not long after the arrival on our campus of the twenty-three Kokomo pastors that we were convinced of the value of inviting all the clergymen of a particular community to study the force of joint clergy action in the area of pastoral care and mental health. The Kokomo group consisted of a cross section of the major Protestant denominations as well as some less known denominations like Bible Baptist, Independent, and Mennonite. A Roman Catholic priest was in the group but there was no rabbi, for Kokomo had no resident rabbi at the time. We were fortunate that Dr. John Hoigt, a newly arrived psychiatrist in Kokomo, was able to participate in the entire project. He lived with the clergymen in the dormitory on the campus. This was his first experience in such a setting, and he said it afforded him an unusual opportunity to get to know the men informally.
By the end of about the third day, many of the clergymen began talking freely about their reactions to this experiment. Some of them admitted that they had not wanted to come to this seminar, but were practically forced to attend by members of their churches who, upon reading the newspaper articles, had insisted they take advantage of this unusual opportunity. These men had tried to beg off, pleading too much work, but their parishioners won out. They admitted that during the first day they had resisted becoming involved in the small group discussions of actual case situations. They said that as they gradually realized that the teachers held parish pastors in high regard they had found themselves more willing to enter into the discussions.
Then these pastors described bull sessions lasting far into the night in which they began to explore possible ways they might utilize some of the new insights for the good of Howard County. As they learned to appreciate one another in the neutral setting of the University campus, away from the arena of competition, they vowed no longer to compete against one another. These men were kept very busy from early morning until late at night, in large groups, in small groups, and in individual consultation. An attempt was made to cover certain areas and subjects which they could use as background for their clinical work in Kokomo during the six months before they would return to the campus for the second week of intensive study. Each pastor spent approximately two hours a day on the wards of the hospital seeing patients and writing up one of the interviews. These case write-ups became the meat of the seminars and forced each man to open himself up to his colleagues concerning his ways of dealing with people under stress.
In the teaching sessions considerable time was spent in describing the process of personality development and how pastors might detect early signs of mental illness. Also discussed were the family and ways in which the clergyman might assist in getting families off to a good start, particularly since he assumes this responsibility in agreeing to marry couples. The importance of the pastor’s conversation with his people was stressed. In the Kokomo group, as in previous groups, it was found that pastors felt very ineffective as counselors. All of them said that although increasing numbers of people were coming to them with their problems they felt there was little they could do for them. One of the aims of the first week of the course was to give these students a new appreciation of how helpful a pastor can be to people by carefully listening to them.
After one year the Kokomo project was technically over, except for the results of the psychological tests which over a period of two years sought to determine whether any changes were observable in the pastors who participated in this project. The results of testing seventeen out of twenty-three men from Kokomo caused the psychologist on the project, Dr. Andrew Mathis, to describe his findings in this way:
The Kokomo project seems to have accomplished something significant. . . . The sense of isolation from which many of them seem to have moved should begin to show in their parish contacts. . . . From pre- to post-testing there was an increased tendency to be more accepting of emotionality. In terms of behavior it would indicate that these men have moved toward being more capable of accepting an emotional stimulus for what it is without having to alter it immediately to suit their own terms. . . . There was along with this increased acceptance of emotionality a decrease in the introduction of fight and flight. This is an impressive change. It suggests a greater tolerance for a broad range of emotional relatedness and a decreasing tendency to alter defensively the emotional climate of an interaction either by directly opposing it or withdrawing from it. The extent to which these responses reflect a real change in their behavior should contribute toward increased effectiveness with a wider group of people.
Before the year was over the ministers of Kokomo began an interesting experiment in education for marriage. Most of them asked couples who wished to be married by them to
participate in a course conducted several times each year on an all-county inter-church basis. Church bulletins carried an announcement that couples desiring to be married in the church were expected to get in touch with the pastor at least one month prior to the date of the wedding, so that he might get to know each couple personally. As a result of this tightening up of standards for Christian marriages, couples began calling the pastor as much as six months prior to the date of the ceremony to arrange for counseling and instruction.
The Kokomo project continued with some enthusiasm for a year or so, and then gradually the interest declined as men who were leaders in the project moved from Kokomo to other cities.
The La Grange project was similar to the Kokomo project except that the pastors came from a suburban community made up primarily of executives and junior executives. Several of the pastors in the group were now serving top churches in their denomination and had therefore reached the pinnacle of their professional mobility.
One of the most significant differences between the two projects was that a serious attempt was made to incorporate physicians, especially psychiatrists, into the La Grange project. It was one of the concerns of the leaders to get professional level conversations started between doctors and ministers. It was felt that some frame of reference needed to be developed so that each discipline could speak to and be understood by the other — a need for a common language to bring about meaningful communication.
When the La Grange area pastors met for the first week at the University of Chicago, they had opportunities to meet perhaps a dozen different doctors in a variety of situations including lectures, ward rounds, and small discussion groups. Every effort was made to encourage the clergymen to talk with as many physicians as they could while they were there, so that they might learn to discuss constructively common problems concerning patients. While most of the pastors were reluctant to "bother" the doctors a few said they had more professional level conversations with doctors during that week than they had experienced in their entire ministry.
When the clergymen from La Grange completed their first week at the university and returned home to their local churches, they had some glowing hopes of more effective professional interchange with their local doctors on the staff of Community Memorial Hospital in La Grange. It was not long, however, before they discovered that these physicians were not prepared for this kind of conversation with clergy. This difficulty in communication showed up one of the weaknesses in the planning of the La Grange project. While a few doctors in the La Grange area were aware of the purpose of this special study of the role of the clergymen in community health, the majority of doctors had not been brought in on the early planning in any real way, and as a result they hesitated to enter into a project which to them had dubious value. In an attempt to explain to these doctors just what the La Grange project was, a committee of pastors sent the following letter to approximately one hundred physicians who were on the staff.
As you probably know, clergymen of the various denominations who serve churches in the west suburban area have been providing chaplaincy services for the patients of Community Memorial Hospital. In our desire to improve our care of the increasing number of patients who ask to speak to a minister, a number of us have taken a post-graduate course at the University of Chicago in ministering to the sick.
We have now been meeting once a week for about two months to discuss actual cases of parishioners who are ill or on the brink of illness. We feel we could be much more helpful to these parishioners, who in some cases are your patients, if the physicians in the community would join us from time to time with these weekly discussions. We think that there is no better time than the present for us to try to discover ways in which our two professions might together better serve the patient.
As a result of this invitation to physicians about a dozen different doctors sat in on two or more meetings over the two year period, four doctors sat in on more than ten meetings and two on more than twenty. In addition to the physicians, two clinical psychologists attended eight meetings each, a psychiatric social worker who is director of the Southwest Suburban Mental Health Clinic in La Grange attended many sessions, and a lawyer who participated in both weeks with the clergymen at the university attended faithfully.
The theme which perhaps recurred more often than any other was that of the difficulty of communication between ministers and doctors. This came out in many different ways. The following is an excerpt from a tape recording of one of the sessions. (All sessions were taped.)
Pastor A: "Oh I don’t have any trouble talking to the nurses about patients. Most of them belong to my church. It’s the doctors I don’t feel comfortable with because they haven’t asked for us as the nurses have."
Physician: "We don’t ask for you because we don’t know yet what you do. That’s why I’m coming to these meetings so that I can find out. But if, as Pastor B says, you ministers don’t know what it is you are trying to accomplish with a sick person, then I think probably you’ll want to back up and begin to define for yourselves what you think you can do for people."
We found then that modern clergy are generally uncertain of their ministry with respect to sickness. It was also clear that in their own theological education they had seldom been forced to relate their theological stance to a particular clinical situation. The method of these weekly seminars was to start with a clinical situation confronting the pastor. He would usually take fifteen to thirty minutes to make his presentation. Then for the next hour the group dealt with why this pastor responded in the particular ways he did to this person’s needs. His response was usually predicated on his particular religious stance, so his colleagues, and particularly the physicians and psychiatrists present, would ask him to spell out how this was related to his theological position. The case study method meant coming at the minister’s task in quite the reverse order from that to which he had been accustomed in his theological preparation.
This reverse approach to the examination of one’s doctrinal position was upsetting to some of the men, and one or two clergymen dropped out of the weekly seminars shortly after presenting cases on which they were questioned about their work with people. But those of us who led the group and who are accustomed to this clinical approach felt that there was more than the usual amount of kindness and charity demonstrated among the participants throughout the two years of weekly sessions. In fact we felt that there was never quite enough open criticism of one another. They treated each other with gloves on, perhaps, in part, because their own theological training had been conducted in dignified classroom settings. Most of them had never before had their own clinical work examined with any degree of candor and criticism.
The La Grange clergymen were quite open to frank criticism, provided it did not take the form of personal attack. While there was a good deal more self-searching than any of them had ever been subjected to before it did not go as deep as it might have.
As we worked with the men of these two projects we found ourselves listing ten goals toward which we were striving. We had to a degree —
1. Introduced parish clergy to the idea that they can take brief one- or two-week seminars which deal with subjects immediately applicable to their parish situation.
2. Succeeded in getting a medical school to offer a course for clergy in what might be called "clinical theology."
3. Helped clarify the minister’s role and responsibility in the search for underlying causes of mental illness.
4. Helped prepare parish clergy to recognize emotional problems which had their roots in religious conflict.
5. Demonstrated the importance of a cooperative attack on mental illness by fellowship and exchange among all the members of the clergy in a particular community.
6. Introduced clergymen to other professional people working in the area of health.
7. Encouraged pastors to promote an ongoing educational program in their own churches related to mental and spiritual health.
8. Gave impetus to an organized program of continuing postgraduate education for the parish pastor in a variety of subjects.
9. Discovered how a cross section of American clergy with traditional courses in theology would respond to a radically different manner of teaching.
10. Helped ministers obtain new insights for their own personal mental health.