Sts. Cosmas and Damian
The following is the text of a speech I gave to a very diverse group of pastors from the Boise area during a conference on Posttraumatic Stress Disorder. Although I was treated with great kindness, consideration and deference by the audience, it was not as well received as I had hoped it would be. I think that it challenged the closely held views of some of the participants; others had difficulty placing it into the context of their educations and/or frames of reverence. Others were apparently bored by the autobiographical content; since my life is admittedly relatively boring, it would be disingenuous to take umbrage. Nevertheless the lecture contains the philosophical elements of humanology and anthropiatry and the process by which I came to understand them. Since the reader is not condemned to an hour of listening to a possible doofus in a lecture hall, and can extract from it what he or she desires, I have posted it in the form of a blog.
Keynote Speech: Conference on Ministry to Veterans
November 9, 2011
It is indeed an honor to address this audience. It’s an honor for a number of reasons, but
one of them is that I have always felt drawn to the ministry.
See, when I was a lad age 7 we moved to a tiny village in
coastal North Carolina. I met this kid
my age named Kevin Roughton and we became best friends. Now even though North Carolina was then the least
Catholic state in the US, Kevin just happened to be Catholic (his mom grew up
in a Catholic orphanage in Pennsylvania).
“You should come to mass with me,” he declared, “you’re Catholic after
all.”
“Am not,” I retorted.
“Are, too,” he countered.
So I went home and asked my Dad. “Are we Catholic?”
“I guess so,” said my Dad.
Crestfallen, I started going to mass with Kevin and his mother.
Being Catholic in
North Carolina at that time was not easy.
I got invited to a lot of church picnics just to get harangued, but it
was more than worth it for southern fried chicken and potato salad. Kevin and I went to mass in Edenton NC 30
miles away but eventually we reopened a tiny mission church in our home town of
Columbia.
By the way Kevin and I
are still friends. He plays music
professionally in the beach communities of the Northern North Carolina coast,
around Nag’s Head.
In high school I was rather studious, a fact which all but
eliminated any possibility of a youthful romance. Superimposed on that problem was the fact
that I had never been incarcerated, and to be popular in the rural south in
those days you had to have “fought the law,” and I had not so girls were pretty
much out of the picture. To be fair, I
had very little relationship with my mother, and I think a boy’s relationship
with his mom contains certain elements that prepare him for the complex system
of emotional barter between a young man and a young woman. I was devoted to my church, and as I had been
sitting on the bench in the game of romance, I began to think that perhaps I
was meant for the clergy .
I mentioned to Father Parker, our priest, that I was
interested in the priesthood and he gave me information on several seminaries I
could apply to, and he walked me through the initial phase of the applications
process. But Father Parker was nothing
if not wise, and later he counseled me to wait until after I finished college
to apply to the priesthood. “I had had a
bit of life experience before I became a priest,” he advised; “I was in World War Two and I got to travel, and
I think that’s what you should do. Go to
college, and if you still want to be a priest after that, apply again.” So I went off to Georgetown University,
discovered college girls and thought little about the priesthood for a long
time thereafter. After a while in
college I reverted to my feral agnosticism.
Years later I married a Southern Baptist girl from Rocky
Mount, NC and we immediately ran into the problem of what church to
attend. We elected to become Anglicans,
splitting the difference so to speak and so we went to All Souls’ Anglican
Church in the evocatively named town of Ivy, just outside Charlottesville,
Va. The denomination was one of the
schismatic branches off of the Episcopal Church and they were aggressively
recruiting priests; I felt a resurgence in that old attraction to the clergy
and thought that perhaps their choosiness line was on the other side of
me. Although I was still in residency I
enrolled in training to become a deacon in that church. Eventually our bishop, who had recruited me into
the ministry and who was our instructor in the classes we were taking for the
diaconate, left our parish under something of a cloud so I abandoned my trek
toward the Anglican diaconate. Besides,
their standards seemed a little low.
When we moved to Roanoke, Va., we found an Anglican church
that did not suit us because there were almost no couples our age there. I called my wife’s cousin, an Anglican priest
who had been our priest in Ivy and who had baptized our firstborn, and asked
him what we should do; he suggested we try an Orthodox church. He said he had gone to liturgy at an Orthodox
Church, and quoting the emissaries of St. Vladimir, he said “I did not know if
I was in heaven or on earth.” Intrigued,
we went to the only such church in Roanoke: Holy Trinity Greek Orthodox. The priest, Fr. Bacalis, was one of those
spiritually luminous people and despite the uniformly cool reception we got
from the laos (the people in the
pews), he inspired us to join their congregation. Some years later in Charleston SC I became
interested in being a perpetual deacon in the Greek Orthodox church, and with
my wife’s somewhat reluctant blessing I formally applied to the Atlanta
Metropolis to begin training. For
reasons I can only speculate about, my application was the beginning of a long
period of non-communication from the Atlanta Metropolis. I concluded that since the Chancellor of the
Metropolis had been my parish priest and since he had heard my confessions,
there may have been specific reasons why my application had been put “on
terminal hold.”
My point is that I’m the only person I have ever heard of,
possibly the only person who ever lived, who has applied to the ministry in all
three major branches of Christianity without it resulting in any kind of
ordination. Sometimes I suppose God
sends us messages that are both quite clear but also somewhat embarrassing.
But it is not that I have not been given a vocation and
through this business I believe I have discerned the voice of God saying to
me: “Being a doctor is not enough for
you?” And the truth is, Medicine has
brought great meaning and challenge to my life.
In retrospect, perhaps God saw that my desire to get involved in some
aspect of the ministry was in some ways a lack of gratitude for the meaning he
had given my life through Medicine. It
is also possible that he foresaw some untoward outcome of putting me in a
pulpit somewhere. There can be no doubt,
however, that the calling to the ministry and the calling to medicine sound
very similar, for they are both a calling to service to mankind.
One of my many motivations for studying Medicine, in
retrospect, must have been some psychological need I had to understand what a
human being is. I did a combined
residency in Internal Medicine and Psychiatry so I could understand the
diseases of the body and the mind and how they interact with each other. The model of the human being I was using at
that time was the same one used by René Descartes in his six essays called Meditationes. In
the model of Cartesian Dualism, a
human has a body (“corpus”) and a mind (“mens”). In the John Veitch English translation (1901),
mind and soul are used interchangeably.
For example in one sentence where Descartes uses the word “mens,” Veitch
translates “mind and soul.” This is evidence that as the East and the West grew
apart, the model in the West became that a human being had two parts: A physical part or corpus, and an intangible part or spiritus, into which mind and
soul have been condensed.
I learned through my own experience and external
observations, however, that humans are not quite that simple. I’ll return to this issue a little later.
Now I mentioned that we became Orthodox Christians on the
advice of my wife’s first cousin, an Anglican priest. But as with any sort of metamorphosis one
undergoes, it was not an instantaneous process.
Allison and I had to do a great deal of reading, and we had to attend
liturgy frequently and at the end of about a year, we were quite literally anointed
or chrismated into the Orthodox
Church. During the process of reading
about Orthodoxy I learned a great deal about history and philosophy and one of
the things I learned that surprised me the most was that Orthodoxy was in fact
my ancestral house of worship. The name
“Albanese” means Albanian, and it was a name applied by Italians to Orthodox
and Catholic Albanian (and also Greek) refugees from the Ottoman conquest of
the Albanian homeland. A number of my
family members in New York have made this same journey back to their ancestral Christianity.
Of the most compelling things I learned during our journey
to Orthodoxy was that there once existed a magnificent Christian empire in the
eastern Mediterranean. I knew very
little about it, but learned that it lasted for a thousand years almost to the
day. They called themselves the Roméos, and they
called their empire Romanía. It is the
historical spiritual homeland of all Eastern Orthodox Christians, much as
Palestine was for so many centuries that of the Jews.
How could it be that one of the most important empires in
history is little more than empty space on the map of historical consciousness
of Westerners, especially Americans? One
reason is that Edward Gibbon, the British historian whose magnum opus was The
Decline and Fall of the Roman Empire, the traditional lens through which we
perceive ancient Europe, felt that one of the worst events in world history was
the Christianization of Rome. I will
quote E.J. Oliver [1958]: “Although
Gibbon judges events in the history of Rome with the serenity, detachment, and
seeming objectivity of an English scholar, it is important to note that as the
author of his History, he feels as a Roman, thinks as a Roman, and writes as a
Roman. His Rome is neither Italian nor Christian, but simply Roman, or more
precisely, Republican Roman. It is specifically for this reason that he
expresses the strongest opposition to Christianity and the Byzantine Empire (I
believe he called them a race of degenerate princes), since he considers the
morals and manners of both institutions to be debilitating in nature, and
therefore in exact opposition to those of Republican Rome.” Julius Norwich is another historian who
blames the Western lack of interest in Byzantium on the scorn directed at the
empire by Gibbon.
Another reason for the rather startling ignorance of the
Eastern Roman Empire in the West is that Byzantium was Orthodox, and for the last
five hundred years the religious consciousness of the West has been almost
exclusively Protestant and Catholic. Orthodoxy
could only be perceived dimly behind the turbans and keffiyehs of the Muslims
of Asia and North Africa, having been engulfed by an Islamic tide. A hard example of this phenomenon is the book
by one of our greatest contemporary historians, Paul Johnson, called “A History
of Christianity.” He makes virtually no mention of the Orthodox East in this
book.
The Byzantine Empire’s first ruler was named Constantine the
First and it’s last was Constantine the Second.
During most of its existence, it remained one of the most powerful
economic, cultural and military forces in Europe. It was the most stable power of the Medieval
period and for much of its history the wealthiest place on earth. Their culture was a blend of Roman, Greek and
Arabic but their language was Greek. It
has also been said that the Byzantine Empire had a Roman body, a Greek mind and
an Eastern, mystical soul.
Come with me back there on the Orient Express to Istanbul,
formerly called Constantinople (even by the Ottomans) and before that called
Byzantium. We will dial back the time
gauge to approximately 1000 AD, the time of Basil the Second. The extent of the Empire at that time was
Asia Minor (Turkey), all of the Balkans and southern Italy and Sicily. On this journey we will open the doors of the
Hagia Sophia and look upon Orthodox
Christianity; we have a strong ethic in Orthodoxy against proselytism but we
are always eager to share the riches of our faith and traditions with others. We view ourselves as the keepers of an
ancient version of Christianity, and although for a lot of reasons we do not
encourage conversion from other Trinitarian communities, we believe all have
something to gain from knowledge of our way.
Perhaps an analogy would be that in your seminaries, most of you study
Greek to enhance your understanding of the Scriptures. You may have seen the Idaho Statesman Sunday,
where there was a front page article about an Orthodox iconographer here in
Boise. While he is devout, as are all
iconographers, he sees no conflict with sharing his gift with the non-Orthodox,
and he paints these sacred images for churches of all kinds.
Now the Byzantines had universal literacy when in England,
France and Germany it was only the monks who could read and write. They had female physicians, and a tolerance
for Catholics, Muslims and Jews that was unusual in the Medieval period. While it would be unfair to say that the Jews
fared as well under the Byzantines as they do in America today, their lot
worsened terribly when the Crusaders and the Latin Kings invaded Byzantine
territory. Byzantine citizens practiced
good hygiene when people in France and England smelled like barnyard animals. Much
to the dismay of the Franks and Germans who visited there, they drizzled olive
oil over their food. Barbarity!
The West owes a tremendous debt to the Byzantine
Empire. First, for many centuries the
Byzantines formed a strategic buffer between the West and the surge of
Islam. The continuity of Western
European Civilization exists because of the valiant warfare of the Byzantine
cataphract; had they not prevailed for so long this might well be a meeting of
imams and mullahs as opposed to Christian ministers. Second, Byzantine scholars brought the embers
of classical thought with them to Italy as the hour approached of the final
Turkish assault on Constantinople. Lars
Brownworth, contemporary historian and author of the book Lost to the West: The Forgotten
Byzantine Empire that Rescued Western Civilization, has noted that of the some 50,000 original
manuscripts we have from the Classical Age, 40,000 were brought to the West by
these Byzantine scholars. This was
precisely the spark, argues Brownworth, that ignited the flame of the
Renaissance.
The Byzantines had a huge advantage over other civilizations
that came before and those that came after.
They spoke and read and wrote in Greek, the language of Plato and
Aristotle, but also the language of the Septuagint and the New Testament. Therefore they understood the Scriptures with
the discernment of classical wisdom, patterns of thought that have never been
improved upon. In the West, mind you,
classical Greek thought had been largely discarded, for it was pagan and
therefore unlikely to be of any value.
In Byzantium the writings of the Greek Fathers were on the bookshelf
next to the Holy Bible.
This is important because not only did the knowledge of the
classics affect the way the Byzantines saw their faith, it also had an
influence on the way they viewed the world around them. Medicine, for example, was secular and
essentially pagan (Hippocratic). This
fact had significant implications for the way mental illnesses were
treated. For Hippocrates wrote one of
the most important essays in the history of Medicine, perhaps of civilization
itself: “On Spiritual Illness.” In this
essay he says “I know you Greeks out there all think that when someone develops
insanity, it was done to them by the Gods (here he articulates the concept
portrayed in the story of Hercules). But
I tell you that insanity represents diseases of the brain.” Hippocrates had
skipped ahead many centuries of medical understanding. Now in the West during the Middle Ages, as
noted by Andrew White in his classic book “A History of the Warfare of Science
with Theology in Christendom,” all too often were the mentally ill tortured to
death because of the confusion between the mental and the spiritual. In the Malleus
Maleficarum, the infamous treatise on witchcraft, the authors say that one
of the ways witches cause harm to mankind is to “deprive them of reason,” in
other words, mental illness is evidence of demonic influence.
The confusion between the mental and the spiritual is found
in many places and it always has terrible consequences. One example is this. When I was in Charleston SC I was part of the
chaplain’s corps of the Citadel (The Military College of South Carolina—you may
be familiar with it from Pat Conroy’s The
Lords of Discipline). I was the
leader of the Orthodox Christian Fellowship, and once a week I met with the
cadets and we would study the Scriptures and the writings of the Holy Fathers
of the Church. When the Commandant of
the Chaplain’s Corps, learned that I was a psychiatrist, he puffed out his
chest and proclaimed “Doc, I believe that all psychiatric illnesses are
basically spiritual.” He was professing
the belief, like the authors of the Malleus
Maleficarum, that the signs of mental illness are evidence of a spiritual
defect. The implication is that if someone with autism or schizophrenia were to
make a heartfelt conversion to Christianity, his or her mental illness would
resolve. This error in thinking is what
I call the spiritualization of mental
illness. As I said it was specifically
refuted by Hippocrates 2400 years ago.
This ran directly against my experience. I said earlier that the body/sprit model of
the human being started to run counter to what I was seeing in my professional
life. I knew many severely mentally ill
people who were basically kind and while you can’t read hearts or minds, many
of them appeared to have very deep faith.
They seemed to be taking in their faiths the only refuge they could find
against a lifetime of isolation and torment.
Let’s do a thought experiment. We are going to go looking for a spiritual
disease. Could diabetes and sleep apnea
be spiritual diseases? Well, they are
both the products of the two of the “seven deadly sins:” Gluttony and
sloth. If the symptoms of mental illness
are due to a spiritual defect, why does God supposedly have such an easy time
healing depression but a difficult time healing diabetes?
In the ivory towers of academia, a similar problem
exists. Here, however, because atheism
is so firmly rooted in the culture of academics, we see the reciprocal of the
problem of people like the chaplain at the Citadel. The university professor
perceives concepts like good and evil, spirituality and religion as
fundamentally superstitious, and moral issues (for want of a better term)
becomes subjugated to psychiatry.
Monstrous behavior is attributed to mental illness alone, and mental
illness always predisposes to monstrous behavior. This is what I call the psychologization of evil, and it is why many psychiatrists resent
having to be custodians of pedophiles in psychiatric hospitals when in the
opinion of many mental health professionals, they are not mentally ill. In
my experience, mentally ill individuals are rarely dangerous, and those who are
usually have chemical addictions. Many
dangerous people who are not mentally ill also have chemical addictions.
Scientology has very few adherents, but it has a
disproportionate impact because it aggressively recruits from within the
Brahman class of entertainers. Its views,
dimly perceived in much of the elements popular culture, that the symptoms of
mental illness are caused by inhabitation from evil entities, is just as
harmful to the mentally ill as the Malleus
Malleficarum.
Is it any wonder, since the mentally ill have to contend
with some ignorant people within Christianity, academics and Scientologists
that we have closed the Mental Hospitals and turned the patients out into the
streets? This society, which perceives
itself to be the most compassionate in history, has, I would argue, some very
17th Century ideas about how we should treat the mentally ill. Patients with major mental illness have a
reduction in life expectancy of approximately 10-25 years, most of the mortality
coming from cardiovascular disease.
Available data also suggest that there is a significant reduction in
life expectancy from PTSD as well; PTSD is not usually included in these data
indexed above but in an article by Op Den Velde et al (2011) in Psychological
Reports, PTSD among Dutch survivors of World War II led directly to decreased
quality of life and a 42% increase in mortality. Were this another category of
illness, the CDC would have declared a state of emergency I think.
St. Paul, who although a Jew was schooled in Greek, writes
in I Thessalonians chapter 5: “Now may the God of Peace himself sanctify
you completely; and may your whole spirit (psyche), soul (pneuma) and (soma)
body be preserved blameless at the coming of our Lord and Savior Jesus
Christ.” He makes unmistakable use of
the classic Greek model of the human being.
When I was a young man I had the
unparalleled opportunity to study for a year in France. I call it studying; it was mostly chasing
girls. The most durable part of that
experience is the memories of all the people I met there: French people, international students from
almost every country, and a number of expatriate Americans of all descriptions. One guy was quite a bit older than the rest
of us students, he was a Presbyterian missionary. He told me about his conversion. Under the guidance of what we Orthodox would
call his “spiritual father,” he accepted Christ as his savior. “I don’t feel any different,” he protested to
his mentor. “It’s not in your feelings,”
he replied, “it’s in your faith.” He was saying, the way I interpreted it, that
faith is not a psychological experience.
For Trinitarian Christians, the
tripartite model of the human being has a certain significance. Here are a couple of concepts from Oriented
Leadership, a book written by Ben Williams and Mike McKibben as a kind of a
guidebook based in Orthodox Theology for lay parish leaders. “The understanding of God as Trinity was the
direct result of experience, of
revelation—that God is somehow Three-in-One and One-in-Three. We human beings have this same image and
likeness.” Also: “The Church Fathers affirm a Trinitarian
nature in our mind, word and breath.” Mind, word and breath correspond closely to
mind, body and soul.
So there is this view in Orthodoxy
that in some sense Man is a kind of a Metaphor for God, and that we are made in
God’s image in that we are trinities like Him.
It is important to recognize the limitations of any metaphor; if Christ
is fully Human and fully Divine (Chalcedon 451), for example, is his Human
Nature also Trinitarian like ours? The
concept of Man being made in the Image of God in this manner is a hypostasis (in mathematics, a hypostatic
union is like honey has sweetness as
opposed to honey is sweet) like the
doctrine of the Trinity. In other words,
you believe it to a point but recognize that it is a concept limited by
language and human cognition.
The three systems of mind, body and
soul are distinct from one another but they have hazy frontiers, and each can
influence the other two. Let us examine
how the pneumopsychosomatic model of
the human being might improve our understanding of various sorts of diseases
and how to manage them. We will do so by
examining the relationships between the three systems.
1. Psychosomatics. This is the study of the relationship between
mind and body. I am board certified in
psychosomatic medicine, so it must exist.
The perfect example of psychosomatics is the cycle between depression
and myocardial infarction, as demonstrated by Frasure-Smith. We know that if someone has a heart attack,
he is four times as likely to develop depression as he would if he had never
had a heart attack. And if a person who
has had a heart attack develops depression, he is four times as likely to die
of a heart attack during the next year as someone who has a heart attack and
does not develop depression. We already
saw how major mental illness yields a reduction in life expectancy, in that
case the imaginary arrow goes from the mind to the body. In the reciprocal of that, a patient with
liver failure develops confusion and disorientation, a case of the body
affecting the mind.
2. Pneumosomatics. This is the relationship between soul and
body. This relationship can be
illustrated by the fact that those who go to church regularly live longer than
those who do not. Scientific articles in
scholarly journals have demonstrated the health effects of various religious
practices; one study demonstrated significant benefit from being an
Adventist. Of course that study was done
at Loma Linda University, but it only proved what we already know. Moreover Viktor Frankl, the Viennese
psychiatrist who spent World War II in the concentration camps, concluded that
it was those who had faith who were able to survive the horror, because it gave
meaning to their suffering. But how does
the body affect spirituality? Perhaps
the most important way is the manner in which various biological imperatives,
like the cravings for food and sex and sleep create distractions for us, and
this is why so many traditions (especially perhaps the Orthodox) make use of asceticism as a way to open the nous, the eye of the soul, which we will again look at a bit further on. Ascetic
disciplines in the form of fasting and vigils make the body healthier as
well. As Chrysostom said, “The body
tolerates hunger much better than it does gluttony.” There is an ethic in Orthodoxy that one way
to evaluate an ascetic practice is whether or not it is helpful or
harmful. The Orthodox Church disapproves
of flagellation, for example, because although it serves the purpose of
subjugating the body to the soul by conquering pain in a sense, ultimately it
is harmful to the body.
3. Psychopneumatics. This is the relationship between mind and
soul. This one is in some ways the
hardest to characterize, because it is a relationship between two immaterial
entities. We know, however, that
although faith does not prevent or treat mental
illness, it can be an important part of recovery and it can have a mitigating
effect. There are data that show that
religious experience decreases the effects of depression, anxiety and substance
use on populations who participate (Wink et al., Research on Aging 2005). In the other direction, when one is striving
to improve the health of the soul, one turns one’s mind to the sacred, by
reading Holy Books, meditating on holy things and so on. The mind, when exposed to or turned toward
the horrific, can have an impact on spiritual health. Posttraumatic Stress Disorder is adumbrated
by St. John Chrysostom thus: “…there are
those who are under an inner compulsion to sin:
their hearts and minds have become so twisted and distorted, possibly
through bitter experiences in the past, so that they can barely prevent
themselves from sinning. This type of
sin is really a spiritual disease; we
must try to heal such sinners with the same combination of compassion and
determination which we apply to bodily diseases.” Of the six mature ego defense mechanisms
described by George Vaillant, five are experienced by most people in a
spiritual context including, get this,
asceticism.
Now let us examine the way in
which all three systems work together.
We will look at two patients, patient A and patient B.
Patient A has depression and diabetes. She is taking an antidepressant and a
medication to lower her blood sugar. She
feels like her health is slipping away.
She struggles to balance a 50 hour a week job and managing her
relationships with her husband and her children. She responds to stress by overeating and her
blood sugar control is not satisfactory.
She feels she is too busy to go to Church.
She struggles to fill an
emptiness. An Orthodox Christian, she
talks to her priest, who recommends reading the Bible and the Philokalia, he
recommends prayer and meditation, observance of the fasts, frequent attendance
at liturgy and taking communion.
Now we return to the concept of
the nous, the eye of the soul. In Orthodox
tradition, the nous is normally closed because of the distracting cares and
activities of this world. By reading the
holy books, meditating, fasting, consulting with a spiritual mentor, going to
church and to communion the eye of the soul gradually opens and the divine
light can enter, cleansing and healing mind, body and soul.
While she had improved
significantly on her antidepressant medication, her residual depression
eventually subsided. She gained control
of her appetite and her blood sugars decreased.
She felt a calming and an inner peace she had not had in many
years. Patient A has experienced what is
properly called noetic healing. She also evidences what is called metanoia, a recognizable transformation
in thought and behavior as caused by faith.
Patient B is a Viet Nam combat
veteran. While in theater, he
participated in the killings of numbers of civilians; he was acting under
orders but was deeply conflicted about it, and he wondered for many years later
if he could have prevented it. This is the
spiritual injury mentioned by
Chaplain Holt a moment ago. Gory images
filled his mind without his consent, and he was plagued by nightmares of these
events. The spiritual conflict over
killing affects his mind, such that he is debilitated by Posttraumatic Stress
Disorder. He cannot tolerate going to
church because his hypervigilance makes it impossible for him to focus on the
service. He begins abusing drugs and
alcohol, including intravenous heroin in an effort to find some kind of
peaceful state. He accidently inoculates
himself with hepatitis C, goes on to develop cirrhosis and liver failure, and
from there dementia and delirium. So a
spiritual conflict leads to a psychiatric disorder and from there to a
substance use disorder and then disease of the body, affecting the function of
the mind. The challenge here may be to
find a spiritual way to approach this patient, for the original lesion was a
spiritual one, and it is difficult to imagine a durable recovery without
spiritual intervention. As St. John
Chrysostom wrote: “But only when we
truly open our souls to the transforming grace of God will the symptoms of
spiritual disease begin to disappear.”
To me, these cases are compelling
evidence for the reality of the pneumopsychosomatic
(anthropiatry or humanology) approach to disease. One of the greatest problems with it is that
not everyone perceives in him- or herself a spiritual dimension. Once I had a chronic pain patient who was
referred to me for psychotherapy, perhaps medication. He spent the hour talking about how great was
his suffering, and the only thing that would help would be escalating doses of
opioid narcotics. His provider, alas,
was unwilling to increase the dose of the oxycodone, so the patient felt that
life was not worth living. I had just
read Man’s Search for Meaning, so I
shared with the patient that faith can give perspective to one’s suffering and
perhaps he should explore the possibility of a spiritual answer to his
dilemma. Even though I took care not to
recommend any specific spiritual pathway, I later learned that the patient had
complained about me to the Patient Representative, noting that I had been
“pushing religion” on him. Physicians
have to be very careful about the manner in which they make contact with their
patients’ spirituality and in that case I must not have been careful
enough. I for one do not know how to
address spiritual issues in such patients.
Another problem if you want to
look at it that way is that we live in a diverse and secular society. When I was visiting Russia a few years ago,
my hosts took me on a tour of a psychiatric hospital. The hospital was full of Orthodox icons for
the patients to venerate. Presumably the
patients were all Orthodox. The benefits
of living in a diverse, secular society are many but among the disadvantages is
that you have to tread carefully on spiritual matters and it’s difficult to
meet the needs of a large number of patients in one approach. Nevertheless the Department of Veterans
Affairs, even though we a part of a secular organization, recognizes the role
of spirituality in the health of the veteran.
Once some years ago I heard an
anecdote about a woman who complained to her gynecologist about being
depressed. She had every reason to
consult her gynecologist about depression because most gynecologists are pretty
good with depression psychopharmacology.
He surprised her though, by telling her that if she were to accept Christ
as her personal savior, she would no longer be depressed. The gynecologist had violated a Hippocratic
principle: sacerdotalism. Hippocrates warned that physicians should not
get too deeply involved in the spiritual lives of their patients; there are
professionals whose job that is and that is not what the patient is paying you
for. There are exceptions to this rule;
when I was a student at Georgetown I met physicians who were Jesuits, but you
knew right away they were trained priests by the way they dressed. Most of us, however, know better than to do
any more than facilitate interaction between our patients and their
professional clergy.
That’s why at the Boise VA the
Chaplains are so important. I know their
value from personal experience. Last
January I was diagnosed with cancer, and the person who was the most important
support to me through that terrible ordeal was Chaplain Bramhall. There were important spiritual elements in my
journey to feeling well again and Chaplain Bramhall, and I cannot forget my
priest Father Nektarios, made it possible for me to get through that
experience. I had three great
catastrophes going on in my life at the same time, and the only way I could
rest was to believe that God was taking me apart, destroying me utterly so he
could take my component parts and put them together into something more useful
than me. Father Nektarios asked me to
read Job, which seemed too obvious. But
I read it with new eyes, closed my Bible and said, “Blessed be the name of the
Lord.”
As Chaplain Holt said in the video,
there is a complex interaction between the biology, psychology and spirituality
of the patient, and at our VA Hospital we recognize every element of the care
of the Veteran. The role of the minister
or priest or rabbi is viewed with great importance on inpatient mental health,
medical surgical wards, in Hospice and Palliative Care. The challenge for me is to figure out how
best to integrate the Chaplain’s Service into our activities in Medicine
Service; our frontline providers are residents and they are focused on
acquiring the knowledge and skills necessary to manage the biological needs of
their patients. But at the Boise VA, we recognize our patients not just as pancreases or dopamine receptors, but as human beings with biological, psychological and spiritual dimensions and we bring healing to them in all three systems. In my opinion, that's how you care for a human being.
Sources:
1. The
Byzantine Empire, by Julius Norwich.
2. Lost
to the West, by Lars Brownworth.
3. Decline
and Fall of the Roman Empire, by Edward Gibbon.
4. Man’s
Search for Meaning, by Viktor Frankl.
5. The
Orthodox Study Bible.
6. The
Encyclopedia Albanica (theencyclopediaalbanica.blogspot.com).
7. Greek
Orthodox Archdiocese (goarch.org).
8. On
Living Simply, by St. John Chrysostom.
9. On
Wealth and Poverty, by St. John Chrysostom.
(c) Copyright 2011 Robert Albanese
