"If One Member Suffers...": Responding Faithfully to Persons in Pain in Light of the Opioid Crisis
Brett McCarty, ThD, St. Andrews Fellow in Theology and Science at Duke Divinity School; Joel Shuman, PhD, Professor of Theology at King's College; John Swinton, PhD, Chair in Divinity and Religious Studies at the University of Aberdeen
The opioid crisis is devastating people and communities across the United States, with nearly 50,000 people in America dying due to opiate overdoses in 2017 alone. Healthcare systems, elected officials, the criminal justice system, and others have been scrambling to respond. This panel explores the opioid crisis in light of Christian theological commitments, and it argues for modes of responding faithfully to persons in pain in light of the opioid crisis. In doing so, the panel seeks to display the deficiencies of treating pain and addiction as solely medical phenomena, and it argues for modes of response more attuned to human flourishing as understood by Christian practice and confession.
Drawing from interview work done in Appalachia, the first speaker will map the landscape of contemporary responses to the opioid crisis. In particular, this presentation will argue, perhaps counterintuitively, that a primary mode of response to the opioid crisis actually reproduces some of its underlying causes. Contemporary responses to the opioid crisis are dominated by discourses of medicalization. Today, the actions of an addict are understood to be the uncontrollable manifestations of someone gripped by a disease, whereas in the not so distant past the same actions were considered to be immoral or unlawful. While recognizing the vital role played by destigmatization in saving lives and the crucial role race has played in medicalizing opiate addiction, the paper examines other aspects of this wicked problem. In particular, it is important to recognize that both the practices of pain management that led to the opioid crisis and our responses to the crisis further the medicalization of life and so prevent substantive political responses. This claim requires some unpacking. By treating pain (“the 5th vital sign”) and addiction (daily doses of MAT) solely through symptom management, narcotics are used to mask wider questions about the good life and justice. Instead of pain and addiction serving as signs pointing to deeper disorders – e.g., economic devastation, broken relationships, corrupt government, and escapist theology – they become symptoms to be pharmacologically ameliorated. In this way, the medicalization of life prevents us from beginning hard and necessary economic, social, political, and theological work aimed towards communal flourishing. If, then, we take full account of the reality that many of the causes and responses to the opioid crisis participate in the medicalization of life, then how might we faithfully respond? This question will be explored at length by the other two panelists, but the first paper will conclude by describing how religious communities are uniquely positioned to resist the creep of medicalization by recognizing the pursuit of symptom relief as idolatrous if it is not situated within a broader account of justice and the good life.
The second panelist will argue for how Christian tradition offers particular, potentially helpful perspectives on how to rethink the typical, pharmaceutically-centered ways that clinical professionals have responded to pain and suffering over the past quarter century. The expanding reliance of clinicians on opioids to treat chronic pain since the early 1990s has been driven in large part by the broader phenomenon of medicalization; in a fragmented, individualized, rootless society, enamored by technology of all sorts, we turn to medicine for answers to problems traditionally addressed by extended families, friends, neighbors, and local institutions, including churches. Yet for all the real good it does, medicine alone cannot offer healing – or health – to persons suffering chronic pain. “Healing,” says the poet, essayist, and social critic Wendell Berry, “is impossible in loneliness. Conviviality is healing.” Berry’s claim is altogether consistent with one of the fundamental tenets of Christianity, which is that God’s redemptive work, mediated by the gathered community of God’s people – the ekklesía, or church – is to make of alienated, lonely individuals a community of mutual love and support. God’s work is to reclaim persons from isolation and re-member them into a community where “If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.” None of this happens magically, but rather through the hard work of friendship; one way of imagining the church is as a gathered society of friends, all of whom are broken in one way or another, each of whom is devoted to caring in concrete ways for the others. The paper concludes by describing how this work of reclamation offers a healing that is not dependent upon the complete relief of pain, but rather a place where we may serve one another in our weaknesses and truthfully lament the brokenness of our bodies as we await their promised redemption.
Finally, the third panelist explores how Christian communities might respond to addiction in light of the opioid crisis. The paper begins by describing how the presence of pain sits at the heart of opioid addiction issues. That pain can be physical and/or psychological, but it is always spiritual. The paper then goes on to argue that addictions are at heart misplaced desire, a way of substituting something physical for something spiritual; forgetting God and concentrating on creation. As such addiction is a mode of homelessness. Christians claim to have dual citizenship, with home being both here and in heaven. Christian homefulness - a sense of being at home in the world - is rooted in Jesus. If Christians shift their desires from Jesus to self they disenfranchise their souls and enter into a mode of homelessness from which it is difficult to escape. Addiction is an escape from pain. But pain is complicated. There is a thinning of pain that comes to us from overly medicalized understandings. A faithful response to addiction requires the creation of places of homefulness, the overcoming of self-desire and a thickening of our understandings of pain that reveals that our response to pain is not simply eradication, but understanding, healing and reconciliation, three perspectives that are rich for theological reflection and practical action.
**Panelists include a theologian conducting interview research in Appalachia, a theologian with experience as a physical therapist, and theologian with experience as a mental health nurse.
Drawing from interview work done in Appalachia, the first speaker will map the landscape of contemporary responses to the opioid crisis. In particular, this presentation will argue, perhaps counterintuitively, that a primary mode of response to the opioid crisis actually reproduces some of its underlying causes. Contemporary responses to the opioid crisis are dominated by discourses of medicalization. Today, the actions of an addict are understood to be the uncontrollable manifestations of someone gripped by a disease, whereas in the not so distant past the same actions were considered to be immoral or unlawful. While recognizing the vital role played by destigmatization in saving lives and the crucial role race has played in medicalizing opiate addiction, the paper examines other aspects of this wicked problem. In particular, it is important to recognize that both the practices of pain management that led to the opioid crisis and our responses to the crisis further the medicalization of life and so prevent substantive political responses. This claim requires some unpacking. By treating pain (“the 5th vital sign”) and addiction (daily doses of MAT) solely through symptom management, narcotics are used to mask wider questions about the good life and justice. Instead of pain and addiction serving as signs pointing to deeper disorders – e.g., economic devastation, broken relationships, corrupt government, and escapist theology – they become symptoms to be pharmacologically ameliorated. In this way, the medicalization of life prevents us from beginning hard and necessary economic, social, political, and theological work aimed towards communal flourishing. If, then, we take full account of the reality that many of the causes and responses to the opioid crisis participate in the medicalization of life, then how might we faithfully respond? This question will be explored at length by the other two panelists, but the first paper will conclude by describing how religious communities are uniquely positioned to resist the creep of medicalization by recognizing the pursuit of symptom relief as idolatrous if it is not situated within a broader account of justice and the good life.
The second panelist will argue for how Christian tradition offers particular, potentially helpful perspectives on how to rethink the typical, pharmaceutically-centered ways that clinical professionals have responded to pain and suffering over the past quarter century. The expanding reliance of clinicians on opioids to treat chronic pain since the early 1990s has been driven in large part by the broader phenomenon of medicalization; in a fragmented, individualized, rootless society, enamored by technology of all sorts, we turn to medicine for answers to problems traditionally addressed by extended families, friends, neighbors, and local institutions, including churches. Yet for all the real good it does, medicine alone cannot offer healing – or health – to persons suffering chronic pain. “Healing,” says the poet, essayist, and social critic Wendell Berry, “is impossible in loneliness. Conviviality is healing.” Berry’s claim is altogether consistent with one of the fundamental tenets of Christianity, which is that God’s redemptive work, mediated by the gathered community of God’s people – the ekklesía, or church – is to make of alienated, lonely individuals a community of mutual love and support. God’s work is to reclaim persons from isolation and re-member them into a community where “If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.” None of this happens magically, but rather through the hard work of friendship; one way of imagining the church is as a gathered society of friends, all of whom are broken in one way or another, each of whom is devoted to caring in concrete ways for the others. The paper concludes by describing how this work of reclamation offers a healing that is not dependent upon the complete relief of pain, but rather a place where we may serve one another in our weaknesses and truthfully lament the brokenness of our bodies as we await their promised redemption.
Finally, the third panelist explores how Christian communities might respond to addiction in light of the opioid crisis. The paper begins by describing how the presence of pain sits at the heart of opioid addiction issues. That pain can be physical and/or psychological, but it is always spiritual. The paper then goes on to argue that addictions are at heart misplaced desire, a way of substituting something physical for something spiritual; forgetting God and concentrating on creation. As such addiction is a mode of homelessness. Christians claim to have dual citizenship, with home being both here and in heaven. Christian homefulness - a sense of being at home in the world - is rooted in Jesus. If Christians shift their desires from Jesus to self they disenfranchise their souls and enter into a mode of homelessness from which it is difficult to escape. Addiction is an escape from pain. But pain is complicated. There is a thinning of pain that comes to us from overly medicalized understandings. A faithful response to addiction requires the creation of places of homefulness, the overcoming of self-desire and a thickening of our understandings of pain that reveals that our response to pain is not simply eradication, but understanding, healing and reconciliation, three perspectives that are rich for theological reflection and practical action.
**Panelists include a theologian conducting interview research in Appalachia, a theologian with experience as a physical therapist, and theologian with experience as a mental health nurse.