For much of the past century, the relationship between American Jewry and Israel mirrored that of a prosperous cousin magnanimously supporting the country cousin, providing primarily financial support to the fledgling country. The practical assistance went one way from the diaspora to Israel, with Israel providing intangible benefits like pride and identity. Jews worldwide were welcome to visit and go home inspired, or even cast their lot with the young state or pre-state by making aliyah, but ki miTsiyon tetsei Torah applied only to very specific areas of Jewish culture.
The twentieth-century thinker Simon Rawidowicz preferred a different model, proposing that Israel and the diaspora are two sides of an ellipse: “equal and critical gravitational centers that shape and define the Jewish people.”1 Even though this model has since been eclipsed by more nuanced approaches, this brief article leans on the dual center model of shared learning.2 It outlines the evolution of spiritual care (livui ruḥani) in Israel, acknowledging the indispensable assistance American chaplaincy had in seeding the Israeli field, and points out differences as well as similarities between the professions as they have developed in Israel and the United States. It suggests how chaplaincy in North America can learn from some elements of the Israeli experience as well, particularly as religious life in the United States changes, as outlined by Wendy Cadge and Shelly Rambo; the Israeli approach of “spiritual, not religious” may become more relevant to American chaplaincy settings, as it already has in Canada, which uses “spiritual care” exclusively instead of the previous term “chaplaincy.”3
A Short History of Chaplaincy in the United States and Israel
Several books and articles have outlined the history of chaplaincy in the United States and/or the roots of spiritual care in Israel.4 This section distills the basic elements of that history in order to make sense for a first-time reader.5 In the United States, chaplaincy began as a subset of ministry. That trend is shifting slowly.
In addition to a more humanized profession, the field of chaplaincy and its certification bodies are opening up more to people who want to be chaplains yet do not come from the traditional educational backgrounds that chaplaincy has historically drawn from. Due to the nature of professional chaplaincy and the developmental process that goes into becoming a chaplain, educational barriers continue to keep talented individuals out. Opportunities are increasing, however, for those holding a more diverse group of master’s degrees. The profession is now seeking ways to include more people with master’s degrees in philosophy, psychology, and social work. This is making way for more people to enter the field and incorporate more diverse skill sets and research, as well as use more evidence-based skills and interventions to enhance practice.6
In Israel, the field started bottom-up with several training courses that trained caregivers in theoretical and on-site practical work; graduates then sought work and tried to develop professional opportunities as caregivers, although there were two liberal rabbis who functioned as chaplains under the radar years before: Rabbi Philip, leader of the liberal Emet Veʾemunah congregation, who visited patients at Hadassah hospital in the first half of the 1900s, and Rabbi Pesach Krauss, a Conservative rabbi, therapist, mediator and certified chaplain who volunteered at Hadassah Ein Kerem’s small hospice department in the early 2000s. These two functioned as de facto chaplains in Israel when no one else in the country of any stream or background or training did, although without official recognition as rabbis. Krauss had been a pioneer of Jewish chaplaincy in the US before moving to Israel in 1991, and he helped inspire Rabbi Chaplain Jonathan Rudnick to found Beruach, the spiritual care training course at Shaare Tzedek Hospital, with the support of Dr. Nathan Charney (also spelled Cherny). (Chani Kroizer took over later as director of the program, in English called “By Spirit”).7
After a fact-finding mission and conference in 2005, the New York UJA (United Jewish Appeal) Federation began supporting training programs in Israel. UJA helped seed fledgling Israeli organizations, and NAJC (formerly National, now Neshama: Association of Jewish Chaplains), under the leadership of CEO Cecile Askeoff, provided early stage professional guidance, courses (in Israel, in the United States, and online), training for supervisor-educators, and establishment of criteria for the certification process. In the initial years, US Clinical Pastoral Education (CPE) supervisor Rabbi Zahara Davidowitz-Farkas came to Israel to teach CPE over several summers; a group of Israelis joined on-line interfaith clergy CPE with Rabbi Mychal Springer of the Jewish Theological Seminary (JTS); and Kashouvot brought a group of Israelis to learn with Reverend Mary Martha Thiel at Hebrew SeniorLife in Boston. Since then, individual Israelis have traveled to the United States to complete or continue their learning beyond the minimum two units required for certification in Israel.
Even now that the Israeli institutions have established their independence, students and certified caregivers continue to learn in formal and informal ways from their colleagues and mentors in the United States (and Europe), including attendance at conferences, as well as in-person and online learning with leaders in the US chaplaincy scene.
Israeli spiritual care provision is taking place in hospitals and nursing homes, as part of government-provided services such as those for bereaved families, and in private clinics and home visits. Certified caregivers work in over fifteen hospitals, in elder care, and in bereavement support. Hospitals, nursing homes, some day centers for the elderly and other sites benefit from the student interns who do approximately four hundred hours of field work, spread over two years. Often the work site’s positive experience with student interns opens the staff’s eyes to the benefits of spiritual care, which hopefully will encourage the sites to request professional caregivers, or a blend of professional and students, in future.
There are two hundred certified spiritual caregivers in Israel, of whom ten are Arab (one Druze, two Christian, and seven Muslim). Several more Muslim students are currently learning in Kashouvot’s program at Poriyah Hospital in Tiberias and under Rabbi Mike Schultz’s supervision at Rambam Hospital in Haifa. Caregivers come from a range of backgrounds. Some are educators, physical therapists, nurses, social workers, yoga teachers, while others hail from nonrelated fields such as tour guiding, translation, high tech, or law. (See Non-Clergy Spiritual Care below for more details.) The average age is between fifty and sixty, about 80 percent female. As of publication, there are five accredited training programs, each with its own flavor. The programs have a wide geographical reach and more applicants than available spots. Other programs are in the accreditation process.
One reason there are not more students is that it is hard to find work after one’s training is complete; most work one day a week and retain their previous employment or, if they are retired, do other activities on the other days.
One positive development during the Covid-19 pandemic was that Kashouvot’s caregivers received a grant from Bituaḥ Leʾumi (Social Security) to work with staff so that they would become stronger and learn to avoid burnout during this especially stressful time. Staff raised questions like: “How can I say goodbye? If a person dies, is it a failure on my part? How should we mark the passing of patients or residents? How do my beliefs affect my work and relationships with colleagues?” Spiritual caregiver educators created workshops to help staff process these themes individually and in groups.8
Other encouraging developments include the inclusion of spiritual care in the array of therapies from which relatives of people who died from violent death (murder, car accidents or suicide) are able to choose, under the auspices of the Ministry of Welfare and Merkaz Elah. Despite this impressive activity, caregivers and students are present in only a fraction of departments and hospitals. They not represented at all in prisons, the army, and many other community or medical/elderly settings.
Diversity in Israeli Spiritual Care
In large part because the Israeli field grew out of the efforts of American Jewish chaplaincy and American Jewish philanthropy, and because the early leadership teams did not include any Israeli Arabs, the field did not initially take root in Israeli Arab society. Significant efforts in recent years have begun to rectify that oversight, but the gap is still substantial. Medical settings in the Palestinian Authority are completely separate, and to the authors’ knowledge, no cooperation has yet been initiated except a day-long training co-led by Rabbi Mike Schultz and Kashouvot staff at Augusta Victoria Hospital in East Jerusalem, a Lutheran hospital that serves many residents of Gaza and East Jerusalem and has recently initiated a specialty in palliative care.
Jewish melavim ruḥani’im still do not reflect the demographics of the Jewish population of Israel. People who come to study tend to come from middle or upper economic classes, because they have to pay for studies (approximately 8,500 NIS for each of two years) and invest the time for classes, fieldwork, reading, and assignments without any guarantee of work at the end. There are also more Ashkenazim than their proportion of the population, as well as more kibutznikim. There are some Russian speakers, but the number is not proportionate to their percentage in society. Minority groups such as Ethiopians are poorly represented. Many of the Jews identify as secular or traditional, with some open-minded religious and a handful of ultra-Orthodox. Many have an eclectic spiritual life and find some inspiration in Jewish Renewal, Buddhism, and/or anthroposophic philosophy, following spiritual practices like meditation but not religious rituals.
Rambam has been able to attract some Arab speakers to the program in Haifa, a mixed city with good interfaith relations and many Arab towns surrounding it. Kashouvot now has its first two Muslim students in the Poriyah Hospital program near Tiberias and is making it a priority to attract Arabic speakers for future training by experimenting with an introduction to spiritual care mini-course in Arabic (if funding permits) and by integrating students, with scholarships, in the regular courses in order to enrich the experience for all and provide more tools for intercultural care.
Similarities with Pastoral Care/Chaplaincy in the United States
The basic function of a chaplain is to convey: “I’m here, I’m listening, I care.”9 What Israel and the United states have in common is more significant than what divides us. Both countries share the basic approach to spiritual care, which entails a commitment to supporting people during life transitions, illness, loss, or the end of life; respect for each care seeker’s system of beliefs, culture, personality and life story with no agenda to influence, convert or pressure the care-seeker to adopt the caregiver’s world view; genuine interest in other cultures and faiths, and in each individual’s understanding of their life’s purpose, gift, challenges, and meaning; and finely-honed skills in listening, reflection, and interpersonal relationships, as well as other tools useful for a chaplain/spiritual caregiver, such as prayer, poetry, music, art, nature or writing.
Differences from the United States
Yet, because of the diversity of Israeli culture, with the richness of Jewish life and learning across the religious spectrum, and specific challenges and opportunities in the structure of the medical and religious establishment, spiritual care in Israel has developed on a different path than its American chaplaincy sibling. The main differences between the two involve entrance requirements for students seeking to study spiritual care (higher and more academic in the United States), the need for theological background/degrees or ordination as a prerequisite (in United States until recently), the length of training (most certification bodies in the United States require four units compared with two in Israel), the self-definition of caregivers as neutral/spiritual/religiously motivated (more in Israel), the extensive presence of caregivers in medical and other settings and awareness among patients that pastoral visits are an option (accepted and even mandated in the United States but less well known and less pervasive in Israel), presence at end of life (de rigueur in the United States but not part of the protocol in Israel), and inclusion in interdisciplinary care plan meetings, holiday events, and events of national import (a US very important parts of the chaplain’s role in the United States but rarely in Israel, where the main role is individual support for patients, families, or staff and some workshops for staff). Most important for this article, spiritual care in Israel is disconnected from religion. Study is open to anyone who has a Bachelor’s degree in any subject at all, and at times this requirement is even waived for people who can prove “significant, relevant life experience” such as nonacademic or therapeutic training.
Challenges in Israel
The vast majority of the population in Israel is unacquainted with the profession, and efforts to explain it often founder due to the lack of a clear and apt title for it. The word “spiritual” is problematic. For some it can raise curiosity and interest, give a feeling of openness and possibility, and set the field apart from religion, which is often perceived as monolithic, serious, imposing its rules on the individual, or irrelevant to matters of the human spirit. Yet, for others, it raises concerns that this profession is new-age, flaky, and detached from reality, or that it involves religious coercion or sudden changes in lifestyle.10
The Association for Spiritual Care in Israel (known as “the Amuta”) is the primary professional body that oversees the standards for care provision, works to develop service provision in the field, and brings professionals together for peer learning and support. The Association has taken a key role in regulating the field, establishing standards for certification of caregivers and accreditation of training programs and, more recently, for training educators. All training and service provision organizations partner with the Association to advance these goals, but success depends on many external factors. It would take a vote by the Knesset and buy-in from the Ministry of Health to turn it into an official health care profession, with governmental supervision and potentially funding. Yet there is no wellspring of pressure on the Knesset, and the Ministry of Health does not want to take on additional expenses. These factors, combined with lack of political power, instability of governments, and other more pressing items on the national agenda, mean that the process of establishing the profession is unlikely to proceed very quickly in the coming decade.
Furthermore, spiritual care is still not accepted by all medical and therapeutic staff, although there is greater awareness and appreciation than a decade ago. Organizations of psychologists and social workers have expressed caution and even hostility about the inclusion of spiritual care as an official role. The original hopes of the Association that “within 10 years we will become part of the mainstream healthcare system” have thus not been fully fulfilled, although much progress has been made, and it is not clear when and how this transformation will (or could) proceed exponentially without a significant change in the underlying factors.
In Israel, caregivers usually begin work at a hospital in a single department. The arrangement for an institution to offer spiritual care for the first time is usually initiated by a personal connection between the caregiver or external nonprofit or training center rather than on an institutional basis.11 It usually takes place in one department rather than an entire hospital. Even students who provide “free labor” are therefore present in only a small range of medical settings. Encouragingly, while most earlier courses took place off-site with each student doing practical training in a different center (with the exception of Beruach which was based in Shaare Tzedek and the training course at Ramban Hospital in Haifa), more new courses are hospital-based, such as Kashouvot’s courses at Poriyah, Barzilai, and Ichilov Hospitals. A training cohort of ten might therefore be spread across up to ten hospital departments, exposing a larger number of staff to their work. As for professional chaplains, they are often paid by small external nonprofits, and their continued presence is dependent on fundraising efforts despite the hope that hospitals will eventually adopt spiritual care as part of their own budgets. The Ministry of Health did issue a paper mandating that hospitals and elder care centers introduce some palliative care and include some spiritual element as part of it.12 Yet, according to the World Health Organization definition, this paper has no teeth, the word “spiritual” is not defined, and most settings that are introducing palliative care focus mainly on the medical aspects and rely on social workers and psychologists for the emotional (not necessarily spiritual) aspects of care.13 Unless major macro changes are made, such as the requirement in the United States that hospitals provide spiritual care in order to receive accreditation, it is hard to see how the field will grow quickly.
Non-Clergy Spiritual Care
From its founding, the field of Israeli spiritual care decided to take a “spiritual but not religious” approach and to accept aspiring professionals who were not clergy.14 Fewer than twenty altogether (10 percent of all the certified caregivers), are clergy, all of them Jewish, from different movements: Conservative, Reform, and Orthodox, including female rabbis, who are still a novelty in Israel. Indeed, according to the Association’s standards, caregivers are forbidden to introduce themselves as clergy unless they are in a private clinic or specifically religious or parochial setting.15 Even then, they are allowed to share this background only in response to the patient’s questioning, and only if it would contribute to providing the best possible spiritual care for that patient. Even if they do not have a clergy background, applicants to Israeli spiritual care training programs still have to be a good match for the work in a number of ways; they must, for example, have a strong enough foundation for their personal spirituality to nurture them through this sometimes challenging work, even if they do not come with the kind of theological training expected in the United States. Instead, the training programs themselves must incorporate substantial study of how various cultures and religions, and the students themselves, relate to elements of life such as suffering and death.
According to Schultz,
There are at least three reasons why the Israeli field did not base itself on a clergy model. First and arguably foremost, doing so would have excluded women to a dramatic extent. Outside of the Masorti and other progressive Jewish denominations, which are relatively smaller in Israel, the other Jewish, Muslim, Christian, and Druze clergy are almost entirely male. Secondly, there are such substantial religious-secular tensions in Israel, and so many non-religious Jews carry the scars of being forced to follow the Orthodox establishment approach at key moments in their lives, that we worried that Jewish clergy would have a hard time making a healing connection with them. Finally, as the American field of chaplaincy is increasingly realizing, spirituality is truly broad, encompassing religion but not limited to it, and as such we should not exclude talented potential professionals who are not coming out of a religious framework.16
This approach reaches a similar conclusion to Western spiritual care, though for different reasons.17
There are positives and negative aspects of both the clergy and the non-clergy approaches, which can be illustrated in my own personal story. I did my CPE training in the United States, at Lenox Hill Hospital in New York and Hebrew SeniorLife [sic] in Boston, and in Israel, including two summers at the Schechter Institute and three years of JTS’s extended clergy unit online, with fieldwork at the French Hospital and Beit Alicia Russian-speaking nursing home. Since Lenox Hill was my first and formative experience, and since I generally value academic degrees and rigorous training, authority, hierarchy and hard work, I readily accepted the model of chaplains being clergy or people with advanced degrees in theology. Even though few of my patient visits centered around God, theology, theodicy, or even ritual, I feel it is important to be grounded in the texts, prayers, and rituals of my faith and knowledgeable enough to facilitate similar experiences for and with people of other faiths.
I thought that the originally Protestant CPE centers had made significant efforts to expand the discourse in order to make it relevant to people of other faiths, and that the inclusion of master’s degrees in theology alongside clergy opened chaplaincy to women who were not willing or able to become clergy, such as Orthodox female Jews, Catholic lay leaders who did not want to take vows, or others who for a variety of practical, financial, spiritual, emotional, or other reasons did not want to become clergy.
I understood the fear that, if CPE were presented as a religious-only profession, the Orthodox rabbinate might want to regulate it and close it to all others. I also understood the fear that liberal clergy or Jews were not considered “authentic” in Israel and more religious patients would not open up to them if they presented their official credentials. Yet my experience in the field taught me that patients were very open to talking to whatever chaplain appeared, however he or she was dressed and whichever social group he or she appeared to belong to—including ultra-Orthodox men and women patients, who welcomed the visits, conversation, and prayer of Conservative female rabbi spiritual caregivers (of whom there are at least four, three of whom are on the staff of Kashouvot). Amazing interpersonal meetings took place, which had such potential to break stereotypes and show the power of liberal Judaism as an authentic alternative. I think that forbidding chaplains from mentioning that they were clergy is missing an opportunity to legitimize liberal clergy and earn them respect in the important roles of bridge-builders and healers; it also tacitly reinforces the status quo in Israel that only Orthodox Judaism is legitimate.18
I also thought that the spiritual but non-religious approach missed out on a key component of chaplaincy, expressed eloquently and succinctly by Rabbi Gary (Tuvia) Lavit:
When the Chaplain listens and tries to understand the person, there is an implication that God is paying attention and listening. When the patient relates his/her life story and struggle and fears to the Chaplain it somehow feels more like God is paying attention, than when the very same conversation takes place with a secular practitioner such as a Social Worker.19
A psychologist can give highly valuable emotional help to persons. It is different, however, when the Chaplain, despite—and because of—his known religious values, listens and validates the patient’s personhood. For the patient, this is not only emotionally helpful; it can be an existential and spiritual experience—because it is someone, who represents the attention of God, that is validating and respecting the patient. In summary of this point, even when a Chaplain or a Social Worker might do the exact same thing with a patient, the identity of the Chaplain gives his/her intervention a different, spiritual and existential meaning.20
It also seemed to me that Israeli caregivers relied too much on tools such as cards with pictures that the patients could choose to talk about, guided meditation, or breathing and were too scared to ask whether the patient wanted a prayer or blessing (traditional or extemporaneous), thus missing out on a central tool of chaplaincy.21 As Lavit expresses: “Another way in which the Chaplain has something to add professionally, which just isn’t part of the professional role of the Social Worker, is prayer.”22 Fixed prayer and ritual may be meaningful:
- For the person who prays regularly, standard liturgical recitation and ritual may give a sense of being grounded in the familiar—even while everything else in life is falling apart.
- For the person who doesn’t pray regularly, but who has memories of prayer and ritual, the standard recitation, with familiar melody, may be associated with events and significant persons from the past, which can arouse memories, and emotions of identity with those persons and events. Secondary to the emotions is the valuable spiritual experience of “being connected” to one’s own past self.23
Lavit also discusses the benefits of extemporaneous prayer, which the chaplain can create or co-create with the care recipient, in response to the recipient’s hopes and concerns.24
I agree with this heartily, and the parts about spontaneous prayer are even more moving coming from a personally traditional, Orthodox-ordained rabbi.
Of course I agreed with the Amuta’s mission of offering spiritual care to people of all faiths and backgrounds and the ethical imperative not to impose one’s own world view on the care recipient, but I did and still do not see this as problematic for clergy people who are strongly rooted in their own faiths. Indeed, it is a basic element of chaplaincy in most countries.
Over the years, my attitudes have softened somewhat. First, I see the personal qualities of kindness, presence, patience, empathy, artistic creativity, song, human touch, and willingness to learn and grow that many of the caregivers bring to their work. I see that there is a great need for hundreds, even thousands, of spiritual caregivers in all manner of settings, from Kiryat Shmona to Eilat, and I applaud the people who are willing to study at their own expense for two years and volunteer or work for symbolic salaries (40–100 NIS per hour, with an average 70) in public settings. I think the need for practitioners is immense, and we need all the qualified people we can in order to spread the profession and eventually advocate for its inclusion as a recognized profession and part of the array of care options.
I understand the wish to carve out a profession beyond the oversight of the chief rabbinate. And I understand the cultural sensitivities that might make a Jewish patient in Israel initially cautious about receiving pastoral care from a Christian or Muslim or clergy figure, or even a Jewish one from a different stream, especially if they are not familiar with the concept of spiritual care. I see that just accepting an M.A. in theology instead of ordination or changing some Christian language are not sufficient to invite and welcome previously marginalized groups to training and professional roles.
I see that Israeli caregivers might offer a blessing or ask the patient “what would you wish for yourself?,” which is a step toward prayer, albeit a hesitant one, that might suit circumstances in which the care recipient has made it clear that prayer would not suit him or her. Furthermore, I do not fully accept Cadge and Rambo’s assertion that, despite limitations and accessibility, “[t]heological institutions are the best prepared to offer this training, we argue, even as they have struggled to keep up with rapid changes in American religious demographics, because they remain the primary educators of religious professionals.”25 I think CPE centers based in hospitals or university-based programs such as Scotland’s chaplaincy certificate offered through Nursing Schools can transmit the necessary tools, although I do think that chaplains should supplement their learning to make sure they are familiar with the main tenets, prayers, and rituals that are likely to be important to their care recipients.
As a middle ground or synthesis, I can say that I fully accept non-clergy tracks for spiritual caregivers as long as students gain significant exposure to the rituals, beliefs, texts, and traditions of their own and other world religions; awareness of the nuances within each faith group; and humble curiosity to ask about the individual’s world view, even when they think they know the patient based on the official identification. I also think that chaplains who are clergy should not have to hide this fact, especially because the powerful interpersonal connections they make and the trust they build in pastoral encounters can shatter stereotypes and lead to long term societal change. As a general rule, I believe in taking the best of both worlds: bridging the styles of the United States and Israel and responding to each patient or care recipient as appropriate and helpful to the specific circumstances.
As spiritual care in the United States evolves to be less hierarchical; more racially, culturally and religiously diverse; less focused on hospitals; more inclusive of caregivers from different backgrounds, and more focused on “spiritual, not religious” approaches and care recipients, we could even argue that Israel was prescient in skipping the clergy stage and going straight to the postmodern 2020s model that will continue to gain ground in the United States and western Europe, where secularism is almost a religion in itself. As Cadge and Rambo note:
We extend this invitation to think about the work and educational preparation for chaplains because we believe there is a growing role for chaplains in North American religious leadership given shifting religious demographics. While many people historically sought counsel from leaders in places of worship that reflected shared beliefs, shifts in religious life suggest that this kind of support—if it continues—will be provided differently.26
Thus there is certainly room for multiple approaches, just as we embrace multiple sources of wisdom and loci of influence.
Mutual Learning
North America and Europe were the sites of many innovations that trickled into Israel several decades later.27 Israel has a great deal to learn from developments in these other places. The connection between chaplains and other medical staff will be a critical part of building trust, team relationships, and a culture of dialogue. I especially hope that Israel can learn to see a chaplain as an integral part of an interdisciplinary team and not a threat to other professions. As Lavit writes regarding the United States, but with the intention that this idea be universal:
Each has an indispensable role to fulfill. All of the clinical professionals help patients and their families or loved-ones get through the physical and emotional challenges of very hard times. The Chaplain has the unique role of making a positive difference to suffering persons in a spiritual and existential way. The tools and methods used are different for each of the professions. All taken together, in a collaborative approach to care, can make for the best, integrated, and comprehensive care of suffering people, when they need us most.28
The learning is not unidirectional. The United States also has something to learn from Israel in light of increasing secularization, diversity, and democratization of access to spirituality in the United States. One thing Israel has to offer is a slightly different toolkit, which is more likely to include poetry, guided meditation, breathing, artistic prayer cards, and creative new rituals perhaps more suited to “spiritual not religious” patients in all countries or to interfaith work.29 Another important lesson is the power of non-clergy spiritual caregivers and the need to reevaluate the traditional track of theological backgrounds, advanced degrees, and clergy training as a prerequisite for most chaplains in the United States. Lessons can also be drawn from Canada and Europe as well as other countries where chaplaincy is emerging in numerous grassroots models.
Much remains to be done in terms of having the profession in Israel recognized and funded, as well as including caregivers in medical and other settings such as disaster relief, prisons, army, schools, shelter; diversifying the populations served; and widening access to students of more backgrounds. B. M. Kinzbrunner and B. D. Kinzbrunner insist that (extensive, medically based) research is an essential component in advancing the profession.30 I agree that convincing hospitals and health insurance companies that it is worthwhile to them economically (because of reduced interventions, increased compliance, and improved well-being) is the main way to hasten the profession’s official recognition and incorporation into the health system. Yet this article provided an occasion to look back over the past decade and a half and celebrate the labor of love that launched spiritual care in Israel and has continued to tend and grow it, year by year. Valerie Stessin offers an optimistic assessment that the startup nation will use its resourcefulness to advance this field and find ways to negotiate the question of funding. She even suggests that spiritual care has the potential to heal not only individuals’ hearts and souls but the heart and soul of the country itself.31 I and my colleagues hope that, by the time the next article is written, spiritual care will be more integrated into medical facilities and will have made inroads into prisons, schools, army, rehab, shelters and other settings, as well as more popular in private visits for in-home aging and end of life support for individuals and their caregivers and families.
Rabbi Miriam (Carey Knight) Berkowitz was certified in the first cohort of Israeli spiritual caregivers in 2014 and is one of the few Israelis to be certified also by the NAJC. She founded Kashouvot: Advancing Pastoral Care in Israel in 2010 with Rabbi Valerie Stessin and co-directed it until 2019. Berkowitz has provided pastoral care, mentored chaplains worldwide, offered training for synagogue bikkur holim groups, and taught as an adjunct professor of chaplaincy. She currently performs boutique lifecycle events for visitors to Israel (www.ravmiriam.com; www.israelbatmitzvahs.com) and is completing the Israeli tour guide course.
1The author wishes to thank Rabbi Mike Schultz and Rabbi Valerie Stessin for contributing their historical knowledge and helpful comments to this article.
1 Justus Baird, “Israel and the Diaspora: Two Foci of a Single Ellipse,” Shalom Hartman Institute (May 6, 2014), https://www.hartman.org.il/israel-and-the-diaspora-two-foci-of-a-single-ellipse/, originally published by eJewishPhilanthropy.com.
2 On the history of the question, see Yehezkel Dror, “Diaspora-Israel Relations: A Long-Term Perspective,” Israel Studies 17, no. 2 (2012): 86–91, here 88.
3 See, e.g., the Canadian Association for Spiritual Care, https://spiritualcare.ca/.
4 Einat Ramon, “The Development of Professional Chaplaincy in Western Countries and in Israel,” in Meeting in the Midst: Spiritual Care in Israel, ed. Netta Bentur and Michael Schultz (Jerusalem: JDC-Eshel, 2017), 47–59 (Hebrew) traces the development of spiritual care in the United States and Europe, the entry of Jewish chaplains into the military and then hospital chaplaincy in the United States, the beginnings of spiritual care in Israel, and the training tracks and approaches of the various countries. See also Valerie Stessin, “Spiritual Care in Israel: A Decade of Quiet Revolution,” Israeli Journal of Nursing Care 28, no. 3 (2015) (Hebrew) and B. M. Kinzbrunner and B. D. Kinzbrunner, “Spiritual Care in Israel: The Future is Now,” Israel Journal of Health Policy Research 3, no. 32 (2014).
5 For more in-depth information, see “The History of Spiritual Care,” Kashouvot: The Center for Spiritual Care in Israel, https://www.kashouvot.org/en/birth-of-clinical-pastoral-care/ and “The History of Spiritual Care,” Kashouvot: The Center for Spiritual Care in Israel, https://www.kashouvot.org/en/history-of-spiritual-care-in-the-jewish-world/. See also N. Bentur, S. Reznitzky, and A. Sterne, “Attitudes of Stakeholders and Policymakers in the Healthcare System towards the Provision of Spiritual Care in Israel,” Health Policy 96 (2010): 13–19; A.T. Boisen, The Exploration of the Inner World: A Story of Mental Disorder and Religious Experience (New York: Harper & Brothers, 1936); and E. Brooks Holifield, A History of Pastoral Care in America: From Salvation to Realization (Eugene, OR: Wipf & Stock, 1983).
6 Wendy Cadge and Shelly Rambo, Chaplaincy and Spiritual Care in the Twenty-First Century (Chapel Hill: University of North Carolina Press, 2022), 265–66. See also W. Cadge, J. Freeze, and N. Christakis, “The Provision of Hospital Chaplaincy in the United States: A National Overview,” Southern Medical Journal 101, no. 6 (2008): 626–30.
7 Ramon, “Development,” 54 and Einat Ramon, “The Patients’ Rabbi,” Makor Rishon, May 29, 2019 (Hebrew).
8 Stessin, “Spiritual Care,” 32.
9 Russell Stagg, “Jewish Chaplaincy: Prescription for Change” (MA thesis, Gratz College, 2008), 1.
10 Stessin, “Spiritual Care,” 30.
11 Stessin, “Spiritual Care,” 38.
12 “Guidelines of Palliative Care and End of Life Situations,” State of Israel Ministry of Health, https://www.health.gov.il/English/Topics/SeniorHealth/Pages/palliative_care_code.aspx.
13 Livia Kislev and Yakov Bachner, “Where is the Spirit Blowing? Attitudes of Nurses toward Spiritual Care for their Patients at End of Life—The Gap between Law and Reality,” Israeli Journal of Nursing Care 29, no. 3, (2017): 17–27.
14 This difference is reflected by the widespread term livui ruḥani (“spiritual accompaniment”) instead of chaplaincy or even the more active “spiritual support.”
15 Ramon, “Development,” 55.
16 Personal correspondence with Rabbi Mike Schultz in preparation for this article, March, 2023.
17 T. Bard, “Reshaping the Chaplain and Spiritual Counsellor for the Twenty-First Century,” in Thriving on the Edge: Integrating Spiritual Practice, Theory and Research, ed. A. Schmidt, T. O’Connor, M. Chow, and P. Berendsen, (Canadian Association for Spiritual Care, 2016), 15–25.
18 When I directed Kashouvot, three of the staff were Conservative rabbis ordained in Israel, one was an open-minded orthodox rabbi ordained at Yeshiva University, one was an ultra-Orthodox woman, and two others were educated Modern Orthodox women with academic backgrounds. There were many moving encounters. A Muslim Arab taxi driver in the neurology department at Hadassah hospital asked to learn Talmud with his spiritual caregiver, who was a Belgian, female Conservative rabbi, and a Haredi man in the same department looked forward to praying during regular visits with the same caregiver. A fiercely secular Argentinian man at the French Hospital asked for the priestly blessing from his spiritual caregiver, who was a French, female Conservative rabbi; after he asked how she had come to this work, she was “allowed” to reply that it was a natural outgrowth of her work as a rabbi. At this, he exclaimed, “Now it is beginning to get interesting!” A secular woman with advanced cancer at Asaf Harofeh Hospital asked to pray with this same rabbi as her spiritual caregiver and was thrilled with the rabbi’s suggestion that the patient write an ethical will for her young daughter.
19 Gary Tuvia Lavit, “The Difference between Chaplain, Social Worker and Rabbi” (unpublished manuscript), 2.
20 Lavit, “Difference,” 3.
21 George Fitchett et al., “Development of the PC-7, a Quantifiable Assessment of Spiritual Concerns of Patients Receiving Palliative Care Near the End of Life,” Journal of Palliative Medicine 23, no.2 (2020): 248–53, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987727/, identify a list of concerns that are the most common and most relevant for chaplaincy interventions (in the United States). These include the need for meaning in the face of suffering; the need for integrity, a legacy, a generativity; concerns about relationships with family or significant others; concern or fear about dying or death; and issues related to making decisions about about treatment, religious/spiritual struggles and other religious/spiritual dimensions (Table 1, 250). Many of these concerns can be addressed by a “spiritual but not religious” chaplain, but the chaplain must be unafraid to face issues such as “the patient wonders whether he/she is being abandoned or punished by God…is concerned about God’s judgment, forgiveness and/or love…questions God’s love for him or her… feels God is not answering prayers, expresses anger with God, is alienated from formerly meaningful connections with religious institutions or leaders, identifies a need for assistance to perform important rituals, and has other spiritual concerns” (250).
22 Lavit, “Difference,” 3.
23 Lavit, “Difference,” 3.
24 Lavit, “Difference,” 3-4.
25 Cadge and Rambo, Chaplaincy and Spiritual Care, 13–14.
26 Cadge and Rambo, Chaplaincy and Spiritual Care, 14.
27 These include (but are not limited to) holistic medicine, medical clowning, and palliative care.
28 Lavit, “Difference,” 4.
29 Based on Stessin, “Spiritual Care,” 33.
30 Kinzbrunner and Kinzbrunner, “Spiritual Care,” 3.
31 Stessin, “Spiritual Care,” 38.
