"The 'communion of saints' is a gift to pastoral practice"
Charlie Bell introduces his new book Light to Those in Darkness
I’m a psychiatrist and also ordained as a priest in the Diocese of Southwark. My first love – and, frankly, what I always thought I would do in my medical career, was oncology. The problem I found – if it is a problem – is that the more I talked to the dying, and those who cared for, nursed, and prayed alongside them, the more I realised that the thing that really interested me is how people think. It was a bit of a lightbulb moment – I still wanted to treat the cancer, and in many ways I still miss that part of medicine, but I really wanted to understand the existential questions people were facing, to think more carefully and fully about what this whole death thing – and the whole avoiding death thing – was about. It was amongst the dying that I found some of the truest, most honest, most searing and heart piercing narratives of human existence.
My first work experience was in a hospice, and it was there that I first heard of the idea of ‘total pain’ – something that was heavily influential on the palliative care teaching at the University of Cambridge and which also speaks very clearly to my other life as a priest. ‘Total pain’ is a serious attempt to recognise and to do something with the fact that when people come towards the end of their lives, things can sometimes become so overwhelming that it’s not as easy as simply giving analgesia and hoping for the best, but that one form of pain might manifest as another.
The concept came initially from Dame Cicely Saunders, surely one of the greats not only of palliative medicine but also of pastoral theology of the last century. Saunders was just a remarkable person – working in and then setting up hospices with an explicitly Christian but explicitly non-proselytising nature, and I think it’s fair to say that without her there would be nothing like the movement we have today. Saunders connected with her patients in a remarkable way and saw that the different forms of pain – physical, mental, psychological, social, spiritual – each of these became part of a complex and complicated mix in the dying person, and were far too frequently unaddressed, at the very least, and quite often simply ignored. She ‘got’ it, in a way that far too many doctors still don’t, and her concept of ‘total pain’ has a huge amount to offer clinicians to this day.
‘Total pain’ had infused much of my thinking whilst on a cancer ward, and it was during this time that I was training for ordination. Throughout my training and since, it has become clearer and clearer to me that we seem to have a bit of a problem with ‘doctrine’. That’s not because I think the doctrines of the church are somehow pointless or unnecessary, outdated or irrelevant – far from it – but because we so frequently think of them in the abstract without doing the hard work of linking our pastoral practice with our doctrinal commitments. I bring one particular example of such a doctrine into conversation with ‘total pain’ in Light to Those in Darkness, the doctrine of the ‘communion of saints’. I happen to think that this particular doctrine has much to learn from Saunders’ conception, and similarly, that ‘total pain’ can be sensibly and thoughtfully addressed through the lens of the communion of saints. This book is an attempt to show why that might be the case.
The idea of the ‘communion of saints’ sounds a little bit dry, not least if we only ever meet it when reciting the Apostles Creed, but it is actually one of the most radical, extraordinary things that Christians, of all different persuasions, profess – that we on earth are part of something much, much bigger than we are, that there is somehow a continuity with those who have lived, loved, and died years ago, and that this continuity is not some vague, vain imagining but a vibrant, genuine reality. When my father died in a hospice many years ago, the simple existence of this reality became more and more obvious to me – not something that I could easily explain, beyond a simple recognition that the communion of saints is. As Christians, we have this wonderful inheritance of the faith, this deep well of faithful resource we might draw on, and I wanted to do the theological work that linked our belief in this reality with what Cicely Saunders saw in her patients.
This is very much a two-way conversation. The communion of saints provides us, as Christians, with ways of thinking about death and dying, about existential dread, about pain, about how we are called to minister to the dying and about how they, too, might be ministering to us. There is a gift to our pastoral practice from our doctrine, if only we might look for it. Yet there is a complementary gift from conceptions of human experience that can broaden our doctrinal understandings and that call us to a continued process of questioning and deepening what has been revealed to us. It reminds us, too, of some fundamentals in our lives together as Christians, and in our lived-out anthropology – highlighting the ever-present need to recognise where we have our own part to play in our participation in the life of Christ, and reminding us of the mystery of the life of communion into which we are all called.
Light to Those in Darkness is a book that is grounded in theology and that refuses to make a neat division between that and pastoral practice. It is a book, too, that asks what the practical implications of our taking this seriously might be. It ultimately calls us to a recognition of the importance of hospitality and of sociality in our lives together, and of the importance of not ‘othering’ those on the edge, dying or otherwise. I hope it might be a small contribution to the revivifying of our doctrine and the recognition that real life really matters, too.
Dr Charlie Bell is John Marks Fellow, College Lecturer in Medicine and Praelector at Girton College, Cambridge.