Symptom as Symbol: A Contribution to the Medicine–Religion Dialogue

Introduction

Spiritual care evolves from the paradigm of humanity as created b’tzelem Elohim, from which devolves our responsibility to strive to act in God-like ways (imitatio Dei). The biological model of humanity outlines a trajectory from birth to death. The b’tzelem paradigm describes humans as beings that are always becoming because we participate in the “becoming” essence of God.¹ Medically, sickness and health are opposites, since sickness leads to the cessation of life. Spiritually, we see life and death as a mystery that might disclose itself to us if we assume that even those things that hurt us have meaning. They are not accidental but are a part of the order that governs us.²

If we have been taught to believe in a moral order, illness can be perceived as absurd, perhaps leading us to despair. Denial might provide a transient defense against this despair. Our task as spiritual healers is to assist in recovering hope by assigning meaning to the predicament of illness. The magical thinker would contend that one can believe or pray the illness away. Inevitably, we are confronted by both good and evil; the person of faith seeks to disclose the purpose of this evil. Evil, from the dynamic perspective of a becoming God, is potential for good. The spiritual task is to derive meaning or “blessing” from both the good and bad that we encounter in our lives.³

Spiritual care begins with the question “why.” Inevitably we engage the patient in a reflection on good and evil. How does the patient understand his or her experience of illness? For example, Job suffered most from the idea that his condition was no more than a cruel whim on God’s part. Hope can emerge, as we strive to perceive our lives in the context of a moral order. This became a central theme in Job’s ordeal. Like Job, we cannot avoid the subject of moral causality when patients ask what they have done to cause their illness, or when the bereaved ask why they have suffered painful loss. Our deeds impact upon our eco-system, just as we already know that our environment impacts upon us. In other words: if we look carefully, our tradition proclaims, we shall discover that the universe itself is governed by a moral order. As spiritual caregivers we are primarily proponents of faith in that order. Accordingly, we can no more sidestep theodicy than surgeons can bypass a tumor.

We have no “techniques” or devices other than presence and prayer. Our prayers, while acknowledging the patient’s suffering, must also offer the powerfully therapeutic ingredient of perspective. A study that was conducted of post-operative pain control illustrates this point. In the study, anesthesiologists spent time with patients in the experimental group explaining the procedure and the kind of anesthesia they were to receive. In addition, the anesthesiologist offered the suggestion that the patient would awake promptly after the procedure and feel little discomfort. And the study showed that these patients did, indeed, recover more rapidly and with fewer complications than those in the control group, who did not receive the benefit of these conversations.⁴

The spiritual objective is to help the patient renew a vital and dynamic faith. I would define faith as “the way in which we perceive reality.” The opposite of faith is not doubt; it is, rather, intellectual apathy. Without some measure of doubt, faith decomposes into magical or delusional thinking. Unwillingness to engage with the world and forge some meaning for ourselves is the absence of faith. We might then understand suggestion as the building material of perspective; it is an element of faith. Henry Beecher wrote about his observations of wounded soldiers on Anzio, who were lying quietly despite the fact that they had not yet been given morphine. He observed that wounds as severe as those he saw would have caused people, in his civilian practice, to cry out in agony. Yet, these men were quiet. Finally, he came to the realization that for these soldiers...