Visions of Human Health
Healing Body and Soul In the Jewish Tradition- The Role of the Physician
Peter Kahn, MD(c), MPH(c), ThM(c), Harvard University
The practice of modern medicine has become increasingly dualistic and increasingly focused on the treatment of a patient within a computer screen. This patient is more often than not composed of vital signs, lab values, and perhaps other monitoring parameters that the awesome cadre of modern healthcare machinery produces. Indeed, the vocabulary of medicine makes no attempt to conceal this dualism and focus on bodily healing alone; patients are discharged from the hospital and surgical fields are specifically known as sterile, with no aspect of the true patient himself showing in either case. The tradition of healing and the role of the physician in Judaism is diametrically opposed to such dualistic thinking and instead mandates deep concern for the entire humanity of the patient, ranging from his bodily infirmities, to those of his mind and spirit. The role of the physician as elaborated by Jewish theology is that of a covenantal partner with the patient. If the physician is to function as a true healer, he must accept the cry of the convalescent and allow his fate to mingle with that of his patient, and in so doing, join the patient in the raw experience of his suffering, however challenging this may be. Yet, although this sort of theology may seem overly demanding, approaching patients through this lens can provide a rich, fulfilling, and motivating set of beliefs to medical practitioners of all faiths and practices.
This paper will explore many of the foundational Jewish texts surrounding the role of the healer with a focus on the commandment of visiting the sick (bikur cholim). It will begin with Biblical texts and range through Talmudic texts, ultimately culminating with present day authorities and commentators. In each generation, we will find a refinement of the duty of the physician and a deeper understanding of his role in the Divine profession of healing.
A Process Approach to Medicine in a Post-Modern World
Nick Zehner, MDiv(c), Harvard Divinity School
While science undoubtedly stands as the cornerstone of modern medicine, there is a growing awareness within the field that some of the most critical and vexing problems facing patients and healthcare providers alike will not have scientific solutions which is to say that they are meta-technological. Medical research is progressing at such rates that the capacity to intervene is outstripping integration into any sort of comprehensive ethical framework. By emphasizing non-contextualized scientific aptitude, medical colleges and nursing schools unintentionally produce healthcare workers ill-equipped to help their patients cope with the psychological and sociological fall-out of injury and disease. Possibly most troubling of all, intentionally or not, healthcare systems the world over often treat those in their care as if their ailments were singularly mechanical, problems for the engineer not the compassionate physician or nurse healing a human person.
It is within this context and with an honorific admission of the incredible scientific gains of modern medicine in human longevity and quality of life that it is asserted that the current philosophical model modern medicine employs relies on problematic metaphysical assumptions that have led directly to the aforementioned problems and many more. If the perennial problems of access, cost, bias and quality of care are to be truly remedied and not simply masked for a time, a post-modern model of medicine is required. Such a model can be developed using the process theologies and philosophies of Alfred North Whitehead, Charles Hartshorne, and other process philosophers.
This post-modern model of medicine is characterized by the rejection of objectivism, by the acknowledgment that science is not a value-neutral endeavor, and by the rejection of interdisciplinary boundaries. In this new model, the individual is understood in terms of his or her relation to the totality of what Whitehead calls Actual Occurrences, namely the whole of reality and existence. Individuals are a result of their relationships to what already exists, has existed, and is becoming. This principle of interrelatedness and connectivity is the foundation of this post-modern model and informs every aspect of its application. Within this new model, the entirety of the patient’s physical, psychological, spiritual, and emotional dimensions are first, recognized as inextricably tied to one another, second, considered essential to medicinal treatment in restoring wellness and equilibrium in the patient, and third provide the basis for the development of healthcare systems that are able to equitably provide holistic care for everyone in their communities.
Health and the Human Good
Patrick Daly, MD, Boston College
In this paper, I derive an explanatory model for the multiple dimensions of health from Bernard Lonergan’s “structure of the human good.” This is part of an ongoing project to work out a transdisciplinary approach to health science and the healing arts based on his generalized empirical method. This approach or method relates directly to two questions posed for this year’s conference: first, it offers a rigorous alternative to secular ideology in finding a common, open-ended source of human and natural science in the structured operations of human inquiry and practice; and second, it relies on openness to all questions – including those related to ultimate meaning – that may arise in any given situation in order to understand what is really going on and to decide what is truly best to do. I begin by comparing Lonergan’s schematic representation of the human good, a 3-row by 4-column table of terms, to several well-known models of health: George Engel’s biopsychosocial model, Daniel Sulmasy’s biopsychosocial-spiritual model, and Cicely Saunders’ four components of “total pain.” I then work out the significance of the terms in Lonergan’s model and their mutual relations in order to indicate its explanatory power.
Regarding the structured operations of human inquiry and practice, Lonergan marks off four levels – experiencing, understanding, judging and deciding – based on the key operation at each level. The first three levels unfold in a cognitive cycle when we ask and seek to answer questions about what is going on, setting the conditions for judgments of fact. The fourth level unfolds in an existential cycle when we ask further questions about what to do, recapitulating the first three levels in setting the conditions for judgments of value, which in turn set the conditions for deciding upon a course of action. These cognitive and existential cycles combine to form a self-correcting cycle of learning. Lonergan defines the “good” heuristically as what we intend in questions for deliberation, which occur at the fourth level of “intentional consciousness.” In the collective history of human choice and action, the tripartite structure of experience-understanding-judging unfolds once again as layers or levels in the good that we intend: particular goods, goods of order, and terminal values.
While deeply indebted to Aristotle and Aquinas, Lonergan puts more emphasis on the historical unfolding of world process and less on the nature of things as predetermined; that is, more emphasis on phusis (potency) than telos (end). Lonergan describes two vectors moving through these activities – one creative from below in which new understanding emerges, the other healing from above in which wisdom makes it possible to reverse situations that are not going well. In an earlier article I defined health – a subset of the human good - as what we intend in asking what will make us better. Here I correlate the clinical, social and religious dimensions of health to the structured levels of the human good, concluding with examples from the recent Ebola outbreak and the current debate about aid-in-dying.
Illness, Healing and Spiritual Practices: Theological Perspectives & Ethical Priorities
Joshua Snyder, PhD(c), Boston College
In responding to this year’s theme of “Spiritual Dimensions of Illness and Healing” this paper will argue against the Western trend of bifurcating care of the soul from care of the body. Specifically, I will address how illness, health and healing are religious experiences requiring analysis through a theological-ethical paradigm. This implies that in additional to curative therapies aimed at restoring the health of the body, there is a need for spiritual practices that respond to the needs of the embodied spirit. As such, this paper will highlight the importance of establishing ethical priorities for Christian practices aimed at restoring holistic wellbeing to those suffering from chronic illness.
First the paper will offer a theological analysis of illness, health, and healing from a Christian perspective. I will argue that illness is both a threat to the wellbeing (shalom) God intended humanity to experience as well as an opportunity to radically encounter God’s transformative love. Similarly, I will examine health in terms of the Hebrew idea of shalom. In this way, health is wholeness; it includes physical, emotional, mental and communal wellbeing. Shalom stands in protest against illness and necessitates theological reflection on healing. I will argue that the healing ministry of Jesus and the early Christian community brought together care of the body and care of the soul. This section concludes by arguing that recovering the ancient Christian tradition of “cure for souls,” offers complimentary spiritual practices needed to address the religious nature of illness.
As an embodied spirit, those suffering from chronic illness are vulnerable to existential despair, psychological depression, and spiritual apathy. The second part of the paper will examine the role of Christian communities in developing practices aimed at care of both body and soul. In using the term practices, I am building on the work of Alasdair MacIntyre whereby practices are coherent and complex forms of established cooperative human activity directed toward the goods internal to that form of activity. Spiritual practices formed and informed by the Christian community seek to make present God’s transformative healing within the world. Membership in this community of care brings with it the gift of wellbeing; to the extent that it is attainable in this world. But the question remains, what about the majority who live with debilitating illnesses and lack access to medical and spiritual care? The paper will conclude by addressing this dilemma and establishing several ethical priorities for practices that bring together care of body and soul at promote holistic wellbeing (shalom).
Peter Kahn, MD(c), MPH(c), ThM(c), Harvard University
The practice of modern medicine has become increasingly dualistic and increasingly focused on the treatment of a patient within a computer screen. This patient is more often than not composed of vital signs, lab values, and perhaps other monitoring parameters that the awesome cadre of modern healthcare machinery produces. Indeed, the vocabulary of medicine makes no attempt to conceal this dualism and focus on bodily healing alone; patients are discharged from the hospital and surgical fields are specifically known as sterile, with no aspect of the true patient himself showing in either case. The tradition of healing and the role of the physician in Judaism is diametrically opposed to such dualistic thinking and instead mandates deep concern for the entire humanity of the patient, ranging from his bodily infirmities, to those of his mind and spirit. The role of the physician as elaborated by Jewish theology is that of a covenantal partner with the patient. If the physician is to function as a true healer, he must accept the cry of the convalescent and allow his fate to mingle with that of his patient, and in so doing, join the patient in the raw experience of his suffering, however challenging this may be. Yet, although this sort of theology may seem overly demanding, approaching patients through this lens can provide a rich, fulfilling, and motivating set of beliefs to medical practitioners of all faiths and practices.
This paper will explore many of the foundational Jewish texts surrounding the role of the healer with a focus on the commandment of visiting the sick (bikur cholim). It will begin with Biblical texts and range through Talmudic texts, ultimately culminating with present day authorities and commentators. In each generation, we will find a refinement of the duty of the physician and a deeper understanding of his role in the Divine profession of healing.
A Process Approach to Medicine in a Post-Modern World
Nick Zehner, MDiv(c), Harvard Divinity School
While science undoubtedly stands as the cornerstone of modern medicine, there is a growing awareness within the field that some of the most critical and vexing problems facing patients and healthcare providers alike will not have scientific solutions which is to say that they are meta-technological. Medical research is progressing at such rates that the capacity to intervene is outstripping integration into any sort of comprehensive ethical framework. By emphasizing non-contextualized scientific aptitude, medical colleges and nursing schools unintentionally produce healthcare workers ill-equipped to help their patients cope with the psychological and sociological fall-out of injury and disease. Possibly most troubling of all, intentionally or not, healthcare systems the world over often treat those in their care as if their ailments were singularly mechanical, problems for the engineer not the compassionate physician or nurse healing a human person.
It is within this context and with an honorific admission of the incredible scientific gains of modern medicine in human longevity and quality of life that it is asserted that the current philosophical model modern medicine employs relies on problematic metaphysical assumptions that have led directly to the aforementioned problems and many more. If the perennial problems of access, cost, bias and quality of care are to be truly remedied and not simply masked for a time, a post-modern model of medicine is required. Such a model can be developed using the process theologies and philosophies of Alfred North Whitehead, Charles Hartshorne, and other process philosophers.
This post-modern model of medicine is characterized by the rejection of objectivism, by the acknowledgment that science is not a value-neutral endeavor, and by the rejection of interdisciplinary boundaries. In this new model, the individual is understood in terms of his or her relation to the totality of what Whitehead calls Actual Occurrences, namely the whole of reality and existence. Individuals are a result of their relationships to what already exists, has existed, and is becoming. This principle of interrelatedness and connectivity is the foundation of this post-modern model and informs every aspect of its application. Within this new model, the entirety of the patient’s physical, psychological, spiritual, and emotional dimensions are first, recognized as inextricably tied to one another, second, considered essential to medicinal treatment in restoring wellness and equilibrium in the patient, and third provide the basis for the development of healthcare systems that are able to equitably provide holistic care for everyone in their communities.
Health and the Human Good
Patrick Daly, MD, Boston College
In this paper, I derive an explanatory model for the multiple dimensions of health from Bernard Lonergan’s “structure of the human good.” This is part of an ongoing project to work out a transdisciplinary approach to health science and the healing arts based on his generalized empirical method. This approach or method relates directly to two questions posed for this year’s conference: first, it offers a rigorous alternative to secular ideology in finding a common, open-ended source of human and natural science in the structured operations of human inquiry and practice; and second, it relies on openness to all questions – including those related to ultimate meaning – that may arise in any given situation in order to understand what is really going on and to decide what is truly best to do. I begin by comparing Lonergan’s schematic representation of the human good, a 3-row by 4-column table of terms, to several well-known models of health: George Engel’s biopsychosocial model, Daniel Sulmasy’s biopsychosocial-spiritual model, and Cicely Saunders’ four components of “total pain.” I then work out the significance of the terms in Lonergan’s model and their mutual relations in order to indicate its explanatory power.
Regarding the structured operations of human inquiry and practice, Lonergan marks off four levels – experiencing, understanding, judging and deciding – based on the key operation at each level. The first three levels unfold in a cognitive cycle when we ask and seek to answer questions about what is going on, setting the conditions for judgments of fact. The fourth level unfolds in an existential cycle when we ask further questions about what to do, recapitulating the first three levels in setting the conditions for judgments of value, which in turn set the conditions for deciding upon a course of action. These cognitive and existential cycles combine to form a self-correcting cycle of learning. Lonergan defines the “good” heuristically as what we intend in questions for deliberation, which occur at the fourth level of “intentional consciousness.” In the collective history of human choice and action, the tripartite structure of experience-understanding-judging unfolds once again as layers or levels in the good that we intend: particular goods, goods of order, and terminal values.
While deeply indebted to Aristotle and Aquinas, Lonergan puts more emphasis on the historical unfolding of world process and less on the nature of things as predetermined; that is, more emphasis on phusis (potency) than telos (end). Lonergan describes two vectors moving through these activities – one creative from below in which new understanding emerges, the other healing from above in which wisdom makes it possible to reverse situations that are not going well. In an earlier article I defined health – a subset of the human good - as what we intend in asking what will make us better. Here I correlate the clinical, social and religious dimensions of health to the structured levels of the human good, concluding with examples from the recent Ebola outbreak and the current debate about aid-in-dying.
Illness, Healing and Spiritual Practices: Theological Perspectives & Ethical Priorities
Joshua Snyder, PhD(c), Boston College
In responding to this year’s theme of “Spiritual Dimensions of Illness and Healing” this paper will argue against the Western trend of bifurcating care of the soul from care of the body. Specifically, I will address how illness, health and healing are religious experiences requiring analysis through a theological-ethical paradigm. This implies that in additional to curative therapies aimed at restoring the health of the body, there is a need for spiritual practices that respond to the needs of the embodied spirit. As such, this paper will highlight the importance of establishing ethical priorities for Christian practices aimed at restoring holistic wellbeing to those suffering from chronic illness.
First the paper will offer a theological analysis of illness, health, and healing from a Christian perspective. I will argue that illness is both a threat to the wellbeing (shalom) God intended humanity to experience as well as an opportunity to radically encounter God’s transformative love. Similarly, I will examine health in terms of the Hebrew idea of shalom. In this way, health is wholeness; it includes physical, emotional, mental and communal wellbeing. Shalom stands in protest against illness and necessitates theological reflection on healing. I will argue that the healing ministry of Jesus and the early Christian community brought together care of the body and care of the soul. This section concludes by arguing that recovering the ancient Christian tradition of “cure for souls,” offers complimentary spiritual practices needed to address the religious nature of illness.
As an embodied spirit, those suffering from chronic illness are vulnerable to existential despair, psychological depression, and spiritual apathy. The second part of the paper will examine the role of Christian communities in developing practices aimed at care of both body and soul. In using the term practices, I am building on the work of Alasdair MacIntyre whereby practices are coherent and complex forms of established cooperative human activity directed toward the goods internal to that form of activity. Spiritual practices formed and informed by the Christian community seek to make present God’s transformative healing within the world. Membership in this community of care brings with it the gift of wellbeing; to the extent that it is attainable in this world. But the question remains, what about the majority who live with debilitating illnesses and lack access to medical and spiritual care? The paper will conclude by addressing this dilemma and establishing several ethical priorities for practices that bring together care of body and soul at promote holistic wellbeing (shalom).