A Question Of Ethics: LGBTQ+ Religion, Trauma, Spirituality, Resilience, Resistance Through the Lens of Narrative Ethics

Dr. Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each episode, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change, how you care for kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Kade Goepferd. Today’s segment, a Question of Ethics, recognizes that pediatric clinicians do ethics every day. And our guest host, Dr. Ian Wolfe, director of ethics, offers helpful guidance for pediatric clinicians navigating those everyday ethical issues.

Dr. Ian Wolfe: All right. Welcome to a Question of Ethics. This is Dr. Ian Wolfe, director of ethics here at Children’s Minnesota. On this episode of a question of Ethics, we’ll move into the space of narrative ethics. Stories are all around us and we often underestimate the power they hold and the way power influences whose stories are told and heard. All of us live within and create stories and narratives which shape how we live and how we interact with others. These narratives significantly affect our clinical encounters and are a large part of clinical ethics work.

My guest today is Dr. Cody Sanders. He is an ordained Baptist minister and associate professor of congregational and community care leadership at Luther Seminary here in Minnesota. He teaches in the areas of pastoral theology and spiritual care within congregational community contexts. Having taught on the adjunct faculties in this area and several other institutions, including Andover Newton Theological School and Chicago Theological Seminary, Sanders is a leader in the area of LGBTQIA plus spiritual care, writing and speaking frequently on the subject in churches and academic institutions. He is a practitioner of narrative theories of pastoral care and counseling, training clergy students and lay leaders in these skills of caregiving. His current research aims to build ministerial and congregational capacity to lead in cultivating caring communities amid climate collapse, political turmoil, technological acceleration, and the uncertainty of complex near future scenarios for our life in the world. Cody, thanks for joining us today.

Dr. Cody Sanders: Thanks so much for having me, Ian.

Dr. Ian Wolfe: I’ve asked Cody here today because I encountered a case some years ago, didn’t have any of the archetypal ethics questions, but led to significant distress. And this is unfortunately a case that I think if you asked many pediatric clinicians and pediatric ICUs is one they confront often these days. It was one of a queer youth who had attempted suicide, which would later become successful during their course in the ICU. The child had not been accepted by the religious family. In the ICU, the family continually discussed the situation as God’s punishment. ICU staff were shocked at the language around this used at the bedside by the family. Additionally, there was lots of anger from staff towards parents and towards their religiosity. There was also distress from staff who were of the same faith as the family were, who were also distressed at what they saw as an incorrect representation of their faith.

Cody, you wrote a book called Christianity, LGBTQ Suicide, and the Souls of Queer Folk based on your research you performed. You reference Arthur Frank’s work around narrative ethics. Well, I spent a lot of my time talking about ethics through the principles of bioethics. Arthur Frank’s work was foundational to my education and really in my current practice, we spend a lot of time on narratives and especially the ways narratives are created, taken, ignored, etc. Can you tell us about that work and how narratives play a role in caring for LGBTQ youth?

Dr. Cody Sanders: That research really dealt with the ways that narratives, particularly religious and spiritual narratives, can come to operate violently on a sense of soul. So I was looking beyond the typical purview of physical violence that we often think about in relation to LGBTQ people, things like bullying and family rejection and things of that nature to areas of sort of epistemological violence, the violence that intervenes in how we come to know ourselves as human beings and human beings in relation to others and community and as people in relation to some sense of ultimacy or God. And then how those narratives come to operate in a kind of ontologically violent way, telling us something about ourselves that becomes violent in the sense that it speaks to a constitutive level of our sense of self in the world. That we are condemned at a very core sense of our self or using the metaphor of soul.

So in that research, I think it’s important to name the ways that religious and spiritual narratives sit alongside many other types of narratives that can be violent, political, social narratives, but that religious and spiritual narratives have a sort of intensification effect on that violence because they purport to set life within an ultimate context, to set life in relation to God and many religious frameworks. And that kind of intensification can speak to us at our really core sense of who we are. And that was the type of violence that I was seeing taking place in the sense of self for queer and trans people leading up to suicide becoming a thinkable option.

Dr. Ian Wolfe: And so thinking about that research, applying that sort of what I would call a narrative ethics lens, thinking about this case, how would you see the narratives playing out in this case from getting to the point of the child contemplating suicide to then how that narrative spread out and almost caused more violence within the unit itself between fellow clinicians and colleagues?

Dr. Cody Sanders: Not knowing the specifics about the case, I can kind of see this case in relation to some of the themes that arose in my research with other people who had very similar experiences of suicidality in their youth and young adulthood. Some of the themes that I saw coming up in those narratives were the sense of constitutive condemnation, that they were condemned by these theological narratives in relation to their religious spiritual frameworks. One of my participants talked about the kind of chaos that produced for him trying to navigate between some really difficult conflicting messages like the message he received, that he was loved by God, and at the same time from those same sources, same texts, same preachers, that there was something about him that meant that he was hated by God as well. And it was that conflicting kind of spiritual narrative that became really difficult to hold because there were certain aspects of his religious spiritual tradition that he really loved and that were life-giving and that he wanted to hold onto, and certain aspects of that same tradition that were really violent and death-dealing to him.

And he had no one to work through that complexity with. And it wasn’t a situation where he could just sort of let go of all of these kinds of spiritual narratives because some of them were really important to him and he needed the help to disentangle them. And when there’s a family situation where that’s not possible to work through those things in conversation together, there’s a church community where it’s not possible to bring those things into conversation, life can come to seem really unlivable for people. Their sense of grounding, their sense of mooring begins to erode. People come to a place of narrative foreclosure where there is no longer a story of me to be told beyond that point. I saw that dynamic in a narrative framework being how suicide became a thinkable option for many of my participants.

In this case, that kind of narrative violence seems to have spread through the units that we’re caring for this patient and family. Likely some of the religious narratives that were operating violently in this family dynamic and against this patient were also theological narratives that were within the religious frameworks of some of the doctors and nurses and other clinicians who were working with these families. But they interpreted those narratives differently and they were coming from different perspectives on what they meant. I think there are a lot of dynamics that brings up that I’m really curious about, like for people who are within the same theological family, so to speak, what kind of sense of moral injury that might create when you also have a relationship to these narratives and the way that you’ve understood them isn’t violent toward LGBTQ people, but the ways you see them being used in this situation are quite violent toward LGBTQ people.

Dr. Ian Wolfe: That to me was something that resonated with me in this case. And why I bring it up is because we don’t, I think naturally in our day-to-day give much thought to the narratives that we create, and especially then to the power that they have, not only to cause violence between two people interacting, but then how that narrative can cause more violence towards others.

So in this case, you had staff members who were of the LGBTQ community and staff members who were also of particular faith perspective, and that sort of violence rippled out from that one narrative and that one violent act to really cause significant harm to many people. So you talked a little bit about the individual person grappling with the narratives that have led them to where they are that have constructed their life. Can you talk about how you think narratives in that context can affect health of queer youth?

Dr. Cody Sanders: Yeah, I think that’s a really complex picture, one that is really more complex than some of the literature in our fields have addressed at this point. One of the things that’s become more and more apparent to me is the way that the sort of temporality of narratives becomes important to attend to. And a colleague of mine, Keith Menhinick, and I have been working on sort of a theory of chronostress and temporal trauma. And the way I’m thinking about chronostress in this particular iteration is the way that there are often insufficient narrative materials to construct a sense of LGBTQ self in community or self in relation to God. For example, many LGBTQ people sort of come to our awareness of our LGBTQ identities in isolation. No one in our family reflects those identities. No one, perhaps in our wider circles reflects those identities. No one in our religious traditions that we know of reflect those identities.

And so we sort of come to this perspective of being isolated in this experience of our embodiment, which I think can be a really stressful situation for LGBTQ people. So one of the things I think is important to intervene in that situation of chronostress is to circulate the narratives of LGBTQ people that have become before us, the people who are our sort of queer and trans ancestors that we are related to in this narrative arc of queer history. So that when we begin to come to an awareness of our own sense of LGBTQ identity or embodiment, we are able to draw on the narratives of other people who have come before us, people whose stories we need in order to construct our own sense of self in relation to others.

And another piece of this narrative health, I think, is really looking at the lives of LGBTQ youth on at least four levels that I work on, the individual level, the person in front of us, their narrative, the ways that they’re making sense of their life in the world, the institutional narratives that shape their possibilities for being the ways schools, hospitals, churches are relating to LGBTQ concerns, socio-political and cultural levels, which is a really big one right now, and LGBTQ rights and protections are under attack across the country with about 480 plus laws being considered in state legislatures around the country that are targeting LGBTQ people at this point. And then the religious spiritual narrative level that set our life within a presumed context, which could operate in many different spiritual, religious, and ethical traditions.

So seeing our interventions taking place at all four of those levels, what we do at the institutional level to advocate for LGBTQ inclusivity affects what happens at the individual level. What we’re seeing at the individual level, for example, the Trevor project studied LGBTQ mental health in 2023 and found that 85% of the 28,000 plus LGBTQ youth that they surveyed said that they were paying attention to the political level of anti-LGBTQ legislation, and it was negatively affecting their mental health. So what we see at the individual level should prompt our intervention at the socio-political level, becoming involved in ways that are activistic and justice oriented outside of our individual clinical work or pastoral work.

Dr. Ian Wolfe: So pediatric clinicians encounter queer youth often. Thinking about this case, your work, kind of what you had just said, what things might clinicians consider in their practice to improve the lives of queer youth? Thinking about the ways that narratives have affected their life, what kind of things can the average pediatric clinician do, say on a clinic visit from a narrative stance?

Dr. Cody Sanders: A few things come to mind initially. One is to recognize the complexity of queer and trans narratives. I think for those of us who work in helping professions, whether it’s spiritual care or clinical ethics or pediatrics, we often encounter people who are experiencing problems. I mean like a case that you brought that was a really serious example of suffering and violence and trauma. But I think it’s important when we work in these professions that are treating problems that queer people face in their lives, that we also acknowledge that our lives are not totalized by suffering and violence and trauma, that there’s also goodness and beauty and joy to be lived and celebrated in queer and trans lives, and to ask questions in our conversations with people that bring out stories of strength and resilience and courage and love and joy to be lived in and trans lives.

I think another part is when we are experiencing a situation of helping someone in the midst of a really difficult situation of queer and trans stress or trauma, that we look at the area of social support because narratives are not individual. We don’t create our own narratives. The way we story our life in the world is always interacting with a larger community that surrounds us, and even larger sociocultural discourses that are swirling in the social consciousness and coming into our inner libraries, even unbidden. So anything we can do to strengthen the social support around LGBTQ young adults and youth who are experiencing stress and trauma in their family or religious tradition is really important. And one of the statistics that really struck me from Trevor Project’s 2019 study was that they found that having just one trusted, affirming adult in your life reduced the likelihood of suicidality by 40%.

So I talk to clinicians and spiritual care providers and folks in a variety of helping professions all the time who are not sure that the work they’re doing is making a big enough difference, and I think that statistic is so striking for those of us who have the opportunity to become a trusted, affirming adult in the lives of LGBTQ youth, that having just one person can reduce suicidality by 40%. And that’s incredible, and that is also a narrative intervention when our stories are coming up against the narratives of others and creating the possibility for flourishing in the midst of some really difficult circumstances.

Dr. Ian Wolfe: A great takeaway for clinicians is don’t underestimate the power of showing up, being willing to sit and listen to a youth’s story, and even then connecting them with other services or places that simply support them, or even a book that gives them a narrative of a queer leader that’s done great things. Providing a sort of counter narrative, I guess I would say, or narrative support. Is that something you would say?

Dr. Cody Sanders: Yeah, for sure. The other piece about this, and I think this is helpful for clergy, either parish clergy or chaplains, and probably for clinicians in hospital settings too, is that both churches and hospitals are often places where LGBTQ people are unsure if they’re going to be met with supportive and affirming care. So for clergy, chaplains, pastors, and for clinicians, I think anything we can do to even subtly signal to people that we are an affirming safe person who cares deeply about and trans people, genuinely, authentically affirming of their lives is a really critical step in beginning to build the trust that it takes to be a trusted adult in their lives. Any small signals, even like the wearing of rainbow pins and things, I think can be a signal to someone who isn’t sure that can trust the person who’s in front of them, that maybe that this is a person that really has their best interest and their care front of mind.

Dr. Ian Wolfe: Well, thank you so much, Cody, for being here today and these insights. I think it really exemplifies the power of narrative ethics and simply the power of narratives in healthcare, because I think, in our technologically advanced healthcare, we often deprioritize stories and so much of our world and our lives are made up by stories and affects significantly as you point out. Thank you for joining us today.

Dr. Cody Sanders: Yeah, thanks so much, Ian. It was a pleasure to be here.

Dr. Kade Goepferd: Thank you for listening to Talking Pediatrics. Come back next time for a new episode with our caregivers and experts in pediatric health. Our showrunner is Cora Nelson. Episodes are produced, engineered and edited by Jake Beaver and Patrick Bixler. Our marketing representatives are Amie Juba and Krithika Devanathan. For information and additional episodes, check us out on your favorite podcast platform or go to childrensmn.org/talkingpediatrics.