Christopher SWIFT. Hospital Chaplaincy in the Twenty-first Century, The Crisis of Spiritual Care on the NHS  2nd edition. Farnham,  England:  Ashgate, 2014. Pp. 201. $31.46  ISBN-10: 1472410513; ISBN-13: 978-1472410511. Reviewed by NATHAN R. KOLLAR, St. John Fisher College, Rochester, NY 14618


Many times religious professionals forget where most religious sites are. They exist outside the parish buildings. It has always been that way but especially so during the Middle Ages when the houses of the monks and mendicants along with shrines dominated the landscape. In being reminded of what we may have forgotten we have an opportunity to see more of God’s presence among us. Chaplains, and in particular hospital chaplains, are walking reminders of important places and vital functions in our society where dedicated religious professionals speak the word of God through sound, silence, and action; bring Jesus’ real presence through the touch of that word and of their fingertips. When any of these religious professionals enter a parish church they reveal to all therein what many times those present do not want to see: God’s presence in suffering and death.

Christopher Swift offers us a glimpse of the multiple roles and identity challenges for those chaplains ministering in the hospitals of the English health care system. His diverse historical accounts enable us to see the development of the role of the chaplain from the beginning of hospitals.  It begins with an institution for poor-sick provided by the religious and bishops - an institution to care for their soul first and the body second. After all, it was generally accepted at that time that both sickness and poverty were born in sin. The hospital must care for both but especially the soul. The chaplain’s role was to nurture the patient’s soul through ritual, penance, and instruction.

The advent of the reformations of the 16th century resulted in a denigration of ritual, the advancement of government (royal) ownership of the hospital, and a new role for the chaplain who began to be seen  as an administrator of both the physical plant and the teacher of good morals.  As the practice of medicine became a profession, and better at healing the body, the hospital slowly became a place of physical healing with little attention to the soul: Managers cared for the institution; physicians and nurses cared for the body; chaplains cared for the soul. Scientific methods were used to assess the jobs of the first two but it was difficult to know if a chaplain did a good job.  

To gain relevancy some chaplains began to defend their role in psycho- somatic, psycho-social, and wholistic terms: they cared for the soul which impacted the mind, which benefited the body.  This argument demanded a wholistic perspective on health which, in those days, was seen to have little importance. But such arguments slowly gained ground especially as “spirituality” came forward as a replacement for religion in the 21st century.  The architecture of recent hospitals reflects this change as chapels were replaced with spiritual centers.  The spiritual was that mysterious inner, transcendent reality which was also impossible to quantify. The chaplain’s role was to deal with these unknowns, these unanswerable life and after life questions – questions on the edge of the hospital’s main concern.

If this is what the chaplain’s role has become, how does she or he play that role, on what stage, and to what audience?  The answers to these questions begin to be hinted at from some of Swift’s oft quoted statistics which strongly indicate, as he says, that most of those who play the role of chaplain are on the edge of mainline ecclesial society whether this be the Church of England or that of Rome. Many are gay or lesbian, married to a clergy person, and/or theologically liberal. The reason that being married to a clergy person is an issue:  in the Church of England only one of a married couple may practice their vocation and be paid for it; two cannot work for pay in the same parish. In the conservatively dominated churches, such as those of England and Rome, one’s sexual and/or political orientation may be very disturbing to a parish congregation – or the bishop for that matter.  The majority of hospital chaplains, therefore, are on the edge in both institutions (hospital and church) they serve. Yet on the edge of both institutions and serving the hospital staff and their patients (clients) they are found by those they serve to do a necessary and important job within the community of those who care and those cared for. No wonder the hospital chaplain’s identity is often challenged and seldom accepted on face value.  Many religious professionals also share their anxieties and seek opportunities for clarification. 

               Christopher Swift’s book is an excellent review of the history of hospitals in the UK, the impact of secularization and scientific assessment methods upon that hospital, as well the challenges to the vocation of hospital chaplaincy.