As the title suggests, Frances Norwood characterizes hospital chaplains as "ambivalent" and "on the margins of modern-day hospital medicine," though the terms require some explanation. Her use of ambivalent is rooted in her observation that "the highly nuanced practice of modern-day chaplaincy includes a range of activities from the sacred to the profane that situates chaplains somewhat precariously between competing paradigms of science and religion" [p. 3] and that "the position of the modern-day chaplain within a world of medicine is a difficult one that is situated between structural differences that revere medical forms of power, hierarchy, and practice over religious ones" [p. 4]. In light of this, she perceives chaplains operating at times out of a medical paradigm and at times out of a religious one, resulting in a kind of ambivalence that may be professionally necessary "in order to survive" [p. 4]. Such survival, though, is located "on the margins of medical science, at the margins of medical power and hierarchies" [p. 15] --margins that are an "active, dynamic, and contested ground where agents negotiate for power and for place" [pp. 7 and 25].

The author focuses on the CPE interns in the pastoral care department of what appears to be a large teaching hospital (though the identity of the hospital, as well as the names of study participants, have been protected [--see note 1 on p. 26]), especially during their early acclimation to "the newness, the other-worldliness, of the hospital environment" [p. 7].

What tangled interns up the most in the beginning were: 1) the bureaucratic space of the hospital and some of the different rules for moving around the hospital and engaging others within that space, 2) figuring out how to approach patients in an environment that was not always set up to provide them with patients, and 3) becoming familiar and comfortable with medicine's view of the patient body. [p. 9]

Norwood seems to find chaplains consistently confronted with ideological and structural barriers (and often simply physical barriers to access to staff areas) as well as medical staff "gatekeepers" who may have "only a limited (or stereotypical) understanding of what chaplains do" [p. 18]. The author's depiction of chaplains is certainly not that of fully empowered and integrated members of a hospital staff, but she does point out their importance, noting that "medicine is not complete without the perspective and the orientation that chaplains bring" [p. 21].

What chaplains bring to the world of medicine is a different conception of the patient body. To the chaplain, the body is what I call a holy body, a (w)holy body that is not separated by organ, disease or skin; or by conceptions of sacred and profane. Nor is it separated from familial, societal, or Divine relationships. It is through the concept of the holy body that chaplains embrace their religious orientation to the world, bringing perspective, practice, and authority to the hospital setting that staff, patients, and families recognize. In the hospital setting chaplains embrace the religious structure, strategically distancing themselves from the dominant medical paradigm in at least three ways: 1) through their special kind of witnessing, 2) through touch, and 3) through serving as a stop-gap resource for patients who are suffering from issues deemed by staff to fall outside of medicalized versions of patient bodies and health. [pp. 21-22]

Chaplains are alive and well, if at the margins of medicine. By balancing paradigms of medicine and religion, the modern-day chaplain has been able to forge a strategic, ambivalent existence" [p. 26].

COMMENT: As a chaplain, and as part of a pastoral care department that has itself recently been the subject of an ethnographic study (as yet unpublished), I find value in the perspective on chaplaincy by anthropologists, who may have significant insights and who may raise up questions of how we appear to others and how we may need to interpret our activity and role to those who observe us. I appreciate that the present article has caused me to think specifically about ways that I may distance myself from--or embrace--a "religious orientation" in the course of my pastoral practice, and about what structural and ideological tensions and forces that I feel in the hospital may move me one way or the other. The article has also led me to muse about how my own experience of chaplaincy in a tertiary acute care hospital has tended to give me a very different sense of ministry in health crises than that of many congregational clergy. And, some of Norwood's anecdotes recall for me the feeling of being in a strange other world when I began CPE (though part of that was due to the strangeness of CPE as a learning process, over and above the strangeness of the hospital setting).

In regard to this latter point, I have serious concern about the claim that the article "introduces readers to the modern-day chaplain" [abstract, p. 1]. While elements of the picture of chaplains that the author draws may be accurate in some hospital settings at some times (e.g., during CPE internship cycles or during the first unit of CPE residency cycles), it does not well depict experienced staff chaplains. Norwood notes that there is "difference between the novice chaplain and the experienced one" [p. 14], but her use simply of the noun chaplain (or chaplains) throughout the article to offer an interpretation of an observation about the participants in the study--most often the CPE interns--strikes this reader as an inappropriate generalization. So, a statement like, "…chaplains had to stay on the move, walking up and down the floors, in and out of waiting rooms, cruising for something to do and attempting to mimic the air of purpose that flowed from the constant motion of the other staff, " I found entirely unrelated to my daily professional experience (or to that of colleagues I know) and therefore unacceptable, though I do accept that it may describe the action of some CPE students in their first days on the floors.

It is my hope that chaplain researchers will devote more effort to ethnographic studies and that pastoral care departments will work with anthropologists to bring a research-mindedness to what is often left to informal observations and assessments of the place, perspective, and activity of hospital chaplains. As Norwood herself comments, chaplains are "a group largely absent in ethnographic literature" [p. 4]. [Though see the article by Lee, under Related Items of Interest (below).]