From Monastery to Hospital: Christian Monasticism and the Transformation of Health Care in Late Antiquity (review)

In this important book, Andrew T. Crislip draws on a wide range of documentary and narrative sources to explore the ways in which health care was an integral component of monastic life. He argues that the monastic innovation of a “structured health care system was not only important for the growth of the early monastic movement, it was fundamentally transformative of Late Ancient health care as a whole” (8). Acknowledging the varieties of monasticism that characterize this early period, Crislip focuses his own inquiry on the Egyptian desert. He concludes that the recognizable infirmaries of an early monastic frame were “the template for the late antique hospital, which emerged in the 370s” (8). Health care practice within these desert communities served as the model for the Cappadocian Basileias, “the first hospital for which any significant evidence survives” (103).

Crislip divides his consideration of monastic health care into four chapters. In the first chapter, Crislip “documents the health care system of early monasticism, focusing on communities of the fourth and fifth centuries” (8). Organizing his consideration comparatively, he provides a general overview of the institutions and methods that characterize monastic health care (9). Initially, Crislip explores the delivery of inpatient and outpatient care in both a cenobitic context and in the less structured settings of lavra monasticism. However, as the volume progresses, it is the cenobitic locus that increasingly becomes the focal point of Crislip’s investigation. Crislip identifies an impressive range of medical personnel involved in caring for sick monks. He provides an overview of the level of care available from doctors, nurses, elders and stewards, lay caregivers, and self-care (14–18) and considers the types of diagnostic and therapeutic treatments dispensed (18–28).

In the second chapter, Crislip frames the Late Ancient monastic health care system as an extension of the caregiving functions of the family. He suggests that monastic health care evolved as a necessary consequence of the monk’s renunciation of traditional social bonds. “The monastery was not a supplement to the traditional bonds of society but a wholesale replacement of them” (56). As individuals renounced familial commodities and services like clothing, shelter, food, emotional support, and health care, it was incumbent upon the monasteries to supply these needs through alternate means (55–67). Crislip suggests that, in essence, the monastery functioned as a “surrogate family,” the infirmary duplicating the care more fortunate ancient individuals would have received at home. For those without family, monastic health care far exceeded what would have been available through patronage, philanthropy, or ecclesiastical charities.

In his third chapter, Crislip “examines the social functionality of the monastic health care system from the perspective of medical sociology” (8). In particular, he scrutinizes the ways in which the familial model of health care was shaped and re-shaped by the particularities of early monastic life. Describing a phenomenon that he terms “the emergence of the monastic sick role” (68), Crislip argues that for the first time in history, monastic care for the sick did away with the ancient stigmatization of illness. Through shifting the responsibility for sickness away from the person, conceptualization of the “sick role” was radically altered. In its enactment, the “sick role” was significant in socially de-stigmatizing exemption from behavioral obligations, work, worship, and diet (70–86). Crislip notes, however, that sympathetic treatment of the sick was not without its challenges. Resistance to the “sick role” manifested itself both among caregivers and those receiving care. Monastic narratives and regulations legislate the abusive treatment of the sick by others (86–90) and abuse of the “sick role” by the sick themselves (91–99).

In his final chapter, Crislip argues for the broad influence that the monastic health care system exerted on Late Ancient Mediterranean society. Citing development of the Late Antique hospital (8) as a logical extension of the monastic infirmary, Crislip presents the Cappadocian basileias...