Created in God’s Image and Likeness
A reflection upon the contemporary and historical philosophical and theological understandings of health and disease.
Disclaimer: This paper was written as part of an undergraduate program and therefore does not meet formal academic standards. Although great care has been taken in the writing of this paper, errors might occur. The lecturing professor has reviewed this paper and scored it 99/100, corresponding to “Distinguished. Assignment is of sufficient substance and style to be submitted to a refereed journal for publication based on the critical thinking evidenced.” Reference to this paper in academic context should be done with caution.
Contents:
1 Introduction
1.1 Approaches: Teleology and Ontology
2 Health and disease: a philosophical perspective
2.1 The Naturalist-Normativist Dichotomy
2.2 A Linguistic Approach to Health
3 Health and Disease in Christianity
3.1 Health and Disease in the Scriptures
3.2 Health and Disease in Theology
3.2.1 The Relationship Between Disease and Original Sin
3.2.2 The Teleological Approach to Interpret Disease in the Early Church
3.3 Health and Disease in Monasticism
3.3.1 Self-Affliction as Ascetic Practice
3.4 Seeking Health: Christ the Physician and the Church as Hospital
3.4.1 The Practice of Prayer
3.4.2 The Practice of Anointing the Sick
3.4.3 The Practice of Confession
4 Conclusion
1 Introduction
In 2019 the world was hit by a severe health crisis. COVID-19, a contagious respiratory disease, rapidly spread across the globe. Many governments were quick to enforce mandatory societal lockdowns in attempts to control the pandemic, but as restrictions on individual liberty were prolonged, questions began to emerge as to what amount of mental, social, and economic malaise may justifiably be sacrificed to prevent the spread of physical disease. Any response to this question is preceded by the personal preconceived notions an individual has as to what ‘health’ and ‘disease’ are. Although these notions are personal on the level of the individual, they are informed by a common cultural heritage that is mediated through a large number of people in a society. In an effort to shed light on the origins of the aforementioned presuppositions, I will take a closer look at the cultural heritage of Western Europe in this paper through examining the contemporary and historical philosophical and theological understandings of the concepts of health and disease. I will first review the concepts of health and disease from a contemporary philosophical perspective. I will then consider the role of health and disease in the Christian tradition, starting with a preliminary review of the biblical perspective on these concepts. I will subsequently consider the historical perspective of the Early Church on health and disease, which will lead me to examine more closely the Byzantine and Eastern Orthodox approaches to these concepts. I will finally address the current practices of healing in the Eastern Orthodox tradition, and end with some closing remarks.
1.1 Approaches: Teleology and Ontology
In this paper I will frequently distinguish between an ontological and a teleological approach to health and disease. Ontology—Greek: onto, meaning ‘being’ or ‘that what is’—addresses health and disease as such; i.e. what they are and how they work.1 This descriptive approach has various useful applications (e.g. the medical field), but is less suitable for the domain of personal human experience. If a blood sample tests positive for a certain disease, for example, the patient—in contrast to the physician—will be less interested in what that disease looked like under the microscope than in how that disease will impact them personally. The latter falls under the domain of teleology—Greek: telos, meaning the ‘end’, ‘goal’, or ‘outcome’ towards which something is being directed—which addresses the meaning or purpose of health and disease.2
Ideally, ontology and teleology are two sides of the same coin: what something is, is simultaneously what it is for (e.g. a tin can that is supposed to preserve condiments is preserving condiments). In practice, however, this is not always the case (e.g. a tin can that is supposed to preserve condiments has been opened and no longer holds any condiments). Using these two perspectives alongside each other will therefore create a useful interpretive framework within which the concepts of health and disease can be reviewed.
2 Health and disease: a philosophical perspective
2.1 The Naturalist-Normativist Dichotomy
The World Health Organization (WHO) became a household name during the COVID-19 pandemic. Their definition of health provides a logical first step into the contemporary philosophical discourse on health and disease. It is as follows: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”3 Although widely criticized for its “breadth” and “vagueness,” this critique may be nuanced by the notion that there is no consensus on a narrow and concrete definition of health and disease among philosophers.4 According to philosopher Marc Ereshefsky, two main approaches may be identified in the contemporary discourse: the naturalist and the normativist approach. He writes:
“Naturalists (Kendell, 1975; Boorse, 1976, 1977, 1997; Scadding, 1990) desire definitions based on scientific theory. Their definitions attempt to highlight what is biologically natural and normal for humans. Normativists (Margolis, 1976; Goosens, 1980; Sedgewick, 1982; Engelhardt, 1986) believe that our uses of ‘health’ and ‘disease’ reflect value judgments. Healthy states are those states we desire, and diseased states are those states we want to avoid.”5
A personal opinion on health and disease is almost inevitably underpinned by one or both of these approaches. The key difference between them is the inclusion or exclusion of value judgements. The naturalist approach attempts to exclude value judgements, asserting that health is objectively based in empirical biological fact.6 It defines the success of a biological organism as ‘life’, whereas its failure is defined as ‘death’. Health and disease may thus be measured according to their contribution towards either prolonging the life or causing the death of an organism. Because the naturalist approach is primarily concerned with describing what disease is and how it operates, it may be considered an ontological approach. This approach is effective in, for example, the medical field; but runs the risk of becoming too rigid in its definitions, not allowing for the idiosyncrasies of an individual’s personal experience of health and disease.7
The normativist approach, on the other hand, embraces value judgements, asserting that health is relative to what has subjectively been determined as ‘desirable’ and ‘undesirable’.8 Being primarily concerned with the meaning of disease in terms of personal experience, the normativist approach may be considered a teleological approach. This approach is effective in terms of recognizing the idiosyncrasies of an individual’s personal experience of health and disease, but runs the risk of ending in arbitrariness due to its inclination towards relativism.9
Ereshefsky distinguishes a third, ‘hybrid’, approach that supposedly mediates between these positions. He writes:
“Hybrid theorists (Reznek, 1987; Caplan, 1992; Wakefield, 1992) define ‘health’ and ‘disease’ by combining aspects of naturalism and normativism. Their aim is to provide an account of health and disease that captures the virtues but not the vices of naturalism and normativism.”10
However, the description of this category is somewhat problematic. If hybrid theories are indeed first and foremost grounded in subjective value judgements (in this case: what are the virtues and vices of naturalism and normativism), they are not significantly different from normativist theories. I will therefore make no further distinction between these theories in this paper.
2.2 A Linguistic Approach to Health
Philosopher Roberto Mordacci has attempted to sidestep the naturalist-normativist dichotomy by proposing an analogical approach to defining health and disease. He argues that health may be characterized linguistically as an analogy of ‘plenitude’.11 Analogies of health exist in the domains of “body (physical health), self (mental health), relationship and morality (metaphorical uses of 'health' or analogies such as 'the society as a healthy organism' and 'salvation')”.12 Mordacci writes:
“Health regards all these dimensions, but with different analogical meanings and different kinds of normativeness at each level. The generalization here made speaks of health as the experience of life as a promise of good.
A way of expressing the good which is hoped-for, i.e., full life as the ultimate good, is the term 'plenitude'. Then, a first and very tentative general characterization of health (which is not a definition at all) might be: health is an analogy of plenitude. Health is not plenitude, but hints at it (and thus at happiness and salvation).
The whole family of the health-concepts could be interpreted as a hermeneutic of plenitude: the translation into language (and therefore the interpretation) of the indeterminate and vague meaning of 'plenitude', as it is found in the more concrete experiences of bodily integrity, well-functioning, well-being and so on.”13
Mordacci’s theory is profoundly teleological, because it proposes that something is perceived as ‘healthy’ if it hints at the perfect state of being that thing could be in if it would fully embody what it is supposed to be. Health is thus a unit of measurement that expresses the extent to which something reflects its telos. As this theory forms an understanding of health and disease based on how these concepts are used in language, one’s personal understanding of health and disease is likely to overlap with its findings simply by sharing this same language.
Circling back to the WHO definition of health, the analogical approach seems to provide the best framework for conceiving how “complete physical, mental, and social well-being” may be actualized. Whereas normativism runs the risk of getting caught up in relativism, and naturalism in absolutism, the analogical approach leaves room for both the subjective and objective dimensions of normativism and naturalism. This is accomplished through avoiding rigid definitions of health and disease as such, regarding them rather as principles that manifest themselves concretely in various areas. These concrete manifestations warrant being approached in ways that are most appropriate to their individual context, rather than being approached according to a general principle (i.e. naturalism or normativism).
3 Health and Disease in Christianity
3.1 Health and Disease in the Scriptures
One need only read the title of historian Tom Holland’s book Dominion: How the Christian Revolution Remade the World (London: Little, Brown Book Group, 2019) to get an inclination of the cultural impact the Christian faith has had on European societies. It is therefore inevitable that personal notions of health and disease are in one way or another influenced by the Christian tradition. A review of these notions must start with an analysis of the lexical definitions of biblical terms referring to them.
The most common lemmas related to healing are שָׁלוֹם ,רפא and אֲרוּכָה in Hebrew and θεραπεύω, ἰάομαι, σῴζω and ἐγείρω in Greek.14 Not taking words describing specific illnesses into account, the most common lemmas relating to disease are חלה in Hebrew and νόσος, ἀσθενέω and μάστιξ in Greek.15 The lexical definitions of these lemmas are given below.
Definitions of health- and disease-related lemmas in the Bible.16
Health-related lemmas:
רפא: Healer, one skilled in medicine; to become whole, healed; to be repaired. (HALOT, 1273)
שָׁלוֹם: Prosperity, success; intactness; personal safety, welfare, state of health; deliverance, salvation. (HALOT, 1507-1509)
אֲרוּכָה: Healing; repair. (HALOT, 85)
θεραπεύω: To render service or homage; heal, restore. (BDAG, 453)
ἰάομαι: To restore someone to health after a physical or spiritual malady; to deliver from sin. (BDAG, 465)
σῴζω: To preserve or rescue from natural or transcendental dangers and afflictions. (BDAG, 982)
ἐγείρω: To wake, rouse; to rise up (from a sitting position / into being / from the dead); to restore (to health / to previous good condition). (BDAG, 271)
Disease-related lemmas:
חלה: To grow weak, tired; to fall sick, be ill; feel pain. A by-form of חלא: to be empty, lack. (HALOT, 316)
νόσος: Moral or physical malady; disease, illness. (BDAG, 679)
ἀσθενέω: To suffer a debilitating illness, be sick; to experience some personal incapacity or limitation, be weak; to be in need. (BDAG, 142)
μάστιξ: A condition of great distress, torment, suffering. (BDAG, 620)
The lexical definitions show that the concepts of health and disease in the Bible are not confined to describing bodily conditions alone. Their semantic range extends to encompass a more general notion of a state of well-being that someone or something is in; has lost; or is being restored to, which is in fact similar to the range of meaning Mordacci encountered in his aforementioned analogical approach to health.
The semantic theme of health-disease-restoration also closely parallels the narrative arc of creation-fall-redemption in the Bible. In Genesis 1-2 God calls his creation and everything in it ‘good’ (corresponding to health or well-being); Genesis 3 relates how humanity fell away from that state of well-being through sin (corresponding to disease or degradation); and the Gospels testify of Christ’s healing ministry, which culminates in his bodily resurrection as the first fruits of an anticipated redemption of creation (corresponding to healing or restoration).17
3.2 Health and Disease in Theology
3.2.1 The Relationship Between Disease and Original Sin
This parallel between disease and the fall of mankind may sound over-simplified to Christians in the Western tradition, because in the Western tradition—following Saint Augustine’s interpretation of Genesis 3—original sin primarily refers to the status of guilt before God which Adam and Eve acquired after having sinned. Through inheritance this guilt has been transferred to all mankind, and therefore each individual stands condemned before God.18 In this view, there is no immediate connection between the fallen, sinful nature that is inherited, and the onset of disease—which is merely one of the many ways in which the general fallenness of creation manifests itself.
The Eastern Christian tradition, however, holds a different doctrine of original sin—following an interpretation of Genesis 3 that is found, for example, in the Apocalypse of Moses (or: Life of Adam and Eve). This first-century document—which is likely of Jewish origin—was widely read and very influential, and has various parallels with, for example, the Dead Sea Scrolls, 4 Ezra, Jubilees, 1 and 2 Enoch, the writings of the Apostle Paul, Hebrews 1:6, James 1:17, and Revelation 22:2.19 It presents an account of the life of Adam and Eve wherein Adam relates from his deathbed how the first sin resulted in the onset of disease. Theologians Marinus de Jonge and Johannes Tromp write:
“The first half of the document (esp. chs. 5–30) mainly deals with the necessity of death. Since the fall of Adam and Eve, people have no longer access to the tree of life (28.3). Instead, Adam was punished with every conceivable disease (some 70 diseases in total, 8.2), and thus irrevocably bound to death. The medical standards of the time should be remembered here. If, in ancient writings, someone is said to ‘fall ill’, the implication is practically always that he or she is about to die (so also in 5.2). Every disease is potentially fatal, and if humankind is punished with 70 diseases, it is clear that there is no escape from death.”20
The inheritance of mankind’s original sin is thus not a sinful nature, but mortality—and it is this mortality which prompts an individual to sin.21 Theologian John Meyendorff similarly writes:
“Mortality, or “corruption,” or simply death (understood in a personalized sense), has indeed been viewed, since Christian antiquity, as a cosmic disease which holds humanity under its sway, both spiritually and physically, and is controlled by the one who is “the murderer from the beginning” (Jn 8:44).”22
The Eastern and the Western interpretations of the causality between sin and mortality in Genesis 3 have thus resulted in different emphases in each tradition. Whereas the West interprets mortality as being a consequence of an innate, personal sinfulness, the East interprets the inclination towards personal sin as a consequence of innate mortality. Moreover, the West views disease primarily as being part of a more general fallen creation, whereas the East views disease as the process by which creation falls (Figure 1).23
The impact of these differences is most pronounced in the way in which the traditions attribute meaning to health and disease. The Western tradition tends to view bodily health and disease as ontological principles unto themselves, whereas the East would primarily view health and disease teleologically as soteriological principles participating in God’s overarching act of redemption. The Eastern Christian tradition has thus retained its close affinity to the biblical range of meaning that was present in the Early Church, whereas Western Christianity has grown more distant from it. This is not to say that the two traditions are inevitably at odds with each other; the differences in emphasis may have profound consequences in some areas, but on the whole the two approaches are often not mutually exclusive.
3.2.2 The Teleological Approach to Interpret Disease in the Early Church
It may be taken as anachronistic to speak of an Eastern and a Western tradition prior to the Great Schism of 1054 that divided the East and the West. The language of the Early Church was Greek, but around the second century Latin translations began to appear in the West.24 By the seventh century, one may speak of a Latin tradition existing distinct from but parallel to the Greek tradition.25 Therefore, although there were certainly two distinct traditions leading up to the Great Schism, it is perhaps more appropriate to refer to these as the Latin tradition (predominant in the West) and the Greek tradition (predominant in the East).
The Greek tendency to explain health and disease in teleological terms, rather than ontological terms, is precisely what historian Gary B. Ferngren encountered in his research for his book Medicine & Health Care in Early Christianity (Johns Hopkins University Press, 2009).26 Explaining his methods and approaches, he writes:
“While we possess a good deal of Christian literature from the first through the fifth centuries, we find little that speaks directly of Christian views of healing. … But there is a deeper problem. The New Testament does not yield unambiguous answers to the kinds of [ontological] questions we ask about sickness and healing … “Sickness and healing,” writes H. Roux, “are never approached in the Bible from the medical or scientific point of view, [i.e. ontologically] but always from the … viewpoint of the particular relationship which they create or make apparent between the sick person and God [i.e. teleologically]. It is not the nature of the sickness, its development or treatment, [i.e. ontology] which receives attention, but the fact itself envisaged as an event significant of man’s destiny [i.e. telos] or condition within the general perspective of the history of salvation.””27
The Early Church thus tended to adopt the Biblical framework when speaking about health and disease—i.e. explaining these phenomena teleologically in terms of their function within God’s redemptive plan.28 However, the Early Church is not completely silent on an ontology of health and disease. Ferngren writes that disease was generally attributed to natural causes—as opposed to divine punishment—and that treatment was generally looked for in the (secular) Greek medical tradition.29 Christians, however, were not to place their faith in the treatment itself, but in God, who would heal them by means of the physician’s treatment.30 Only under exceptional circumstances and within a monastic setting was it acceptable for some Christians to refuse to seek medical help.31
3.3 Health and Disease in Monasticism
Church historian Andrew Crislip describes how there is a noticeable tension regarding health and disease in monasticism. On the one hand, health can be a signifier of the spiritual virtue of a saint.32 The great virtue of Saint Antony, for example, was attested to by the fact that he remained free of injury in every way. Athanasius of Alexandria describes how “he lost none of his teeth—they simply had been worn to the gums because of the old man’s great age.”33 Crislip characterizes this type of extreme health as “a sort of paradisiacal existence in this world,” which brings to mind the aforementioned image of mankind being cast out of the Garden of Eden as being the primary cause of all disease (cf. §3.2.1).34 On the other hand, health can become a liability to the one who wishes to become holy. Eastern Orthodox theologian Jean-Claude Larchet writes:
“In fact it [health] is evil if it contributes to making a person indifferent to his salvation, keeps him away from God by giving him the false impression that he is self-sufficient, and bestows on him that strength of the flesh which actually weakens, rather than giving him that weakness in which God reveals himself, which constitutes true strength (2 Cor 12:9-10). Health is an even greater evil if it is used to give free rein to the passions, thereby becoming an instrument of iniquity (Rom 6:13).”35
Health is thus an asset only in as much as it contributes to the overall salvation of the individual.
The spiritual meaning of disease is equally ambiguous. Using the Scriptures as an interpretive guide, disease could be seen as one of the natural and unavoidable consequences of the fallen state of human nature (i.e. arbitrary); as a trial sent by God to test the righteous person’s faith; or as a divine punishment for committed sins.36 This means, writes Crislip, that illness could be taken as “both an unmistakable sign of the sufferer’s sin and as the mark of the sufferer’s special holiness and steadfastness in the eyes of god (and in between, the sufferer could just be unlucky).”37
Each of these different interpretations warrants a different response. Basil of Caesarea, for example, holds the art of medicine in high regard, and does not object to its use in instances of arbitrary disease.38 He simultaneously warns that God may withhold a cure if the disease was sent as a Divine trial or punishment—even discouraging medical aid in the latter case.39 His views on these topics are, according to Ferngren, representative of the majority opinion of the Church Fathers.40 It is important to note, however, that one is not required first to know the origin of an illness in order for it to then be spiritually beneficial. Larchet writes:
“… the Fathers stress the point that "it is not in vain, nor without reason, that we are subject to illnesses." This is why they encourage us to be vigilant when illness strikes, and not to trouble ourselves first of all with their natural causes and means to cure them. Rather, our first concern should be to discern their meaning within the framework of our relationship to God, and to throw light on the positive function they can have in furthering our salvation.”41
Every illness thus presents itself first and foremost as a spiritually significant event that may be beneficial to the process of salvation.
3.3.1 Self-Affliction as Ascetic Practice
Ancient ascetic literature lists numerous saints whose positive attitude towards disease had taken them to the extreme of avoiding treatment altogether or even of purposely harming themselves.42 This practice was controversial, and Saint Basil—among others—opposed it.43 According to Crislip—who devotes a significant part of his study to the phenomenon of self-chosen and self-inflicted injury—“Basil argued that the urge for (ascetic) sickness had to be moderated … [because] the pursuit of suffering is no better than the pursuit of luxury; both entail an excessive focus on the body.”44 Both Crislip and Ferngren observe that self-harm was not regarded as an appropriate ascetic exercise by the majority of the Church Fathers, and that avoiding treatment was only considered appropriate if the abbot had confirmed that the Monk’s illness was a form of divine chastisement.45 Larchet does not explicitly address the ascetic practice of self-harm, but writes in no uncertain terms:
“If sickness and suffering can and should be spiritually transcended and transfigured in Christ, and if they can constitute an ascetic pathway capable of leading the ill person for spiritual heights, nevertheless they should never be either desired or sought after. … It goes without saying that health ought to be preferred to sickness, on condition, nevertheless, that it is lived in God and for God.”46
From the Christian perspective, disease and self-harm are thus not desirable, nor should they be pursued by Christians.
3.4 Seeking Health: Christ the Physician and the Church as Hospital
In §3.1 and §3.2.1 I have discussed the relationship between health and the Garden of Eden, and disease and original sin. In so doing I have also touched upon the process of healing as being an expression of God’s redemptive act. In this paragraph I will elaborate on how this process of salvation is worked out within the Church.
From the way in which Christ presents himself as a physician in the Gospels, one can gather that healing is something to be desired by a Christian.47 But what is the kind of healing that Christ offers? This question is tied up with the ontology and teleology of mankind. God formed human beings using the dust from the ground and his own divine breath (Gen. 2:7), so that in mankind both the created and the uncreated are united—this is an ontological description of man.48 He blessed them, and gave them the task of filling the earth and subduing it (Gen. 1:28)—this is a teleological description of man. Instead of subduing the snake as it tempted them to disobey God’s commandment, however, Adam and Eve submitted to its will—which is a profound teleological lapse unworthy of their ontology.49 Because of their submission, “the "Prince of this world" replaced the "King of Creation"”, subjecting mankind to forces of ontological degradation, inevitably culminating in death.50 It is this fallen state of mental, physical, and spiritual corruption that Christ came to remedy.51
However, Christ did not exclusively perform healings by himself. He commissioned his apostles to “heal the sick” on his behalf (Matt. 10:9-14; Mark 6:7-13; Luke 9:1-5, 10:9). Relatively little is disclosed in the New Testament as to exactly what this healing ministry looked like within the Church. Whereas the Book of Acts records numerous instances of miraculous healing, the epistles do not mention any at all.52 In his first letter to the Corinthians, the apostle Paul mentions “gifts of healing” in a general sense (1 Cor. 12:9, 28, 30), and in his first letter to Timothy he advices Timothy to “Stop drinking only water, and use a little wine because of your stomach and your frequent illnesses” (1 Tim. 5:23). The only other time healing is specifically addressed, is in the letter of the apostle James:
“Is anyone among you sick? Let them call the elders of the church to pray over them and anoint them with oil in the name of the Lord. And the prayer offered in faith will make the sick person well; the Lord will raise them up. If they have sinned, they will be forgiven. Therefore confess your sins to each other and pray for each other so that you may be healed.” (James 5:14–16)
In these verses three practices are mentioned for the purpose of healing—prayer, unction, and confession—which are being performed in liturgical Churches to this day.
3.4.1 The Practice of Prayer
On the first practice, prayer, Larchet writes:
“Prayer is the first among all the religious healing arts because it is the foundation and a necessary element of all the others, and because it is uniquely efficacious in combating illness. … In order to grant him the desired healing, God asks of man only one thing: that he pray to him in faith.”53
Because prayer is an organic process of communication between an individual and God, there are many forms of prayer. Larchet outlines the three most common forms in which prayer for healing appears. The first form is that of prayer directed towards God for one’s own healing. This is an essential part of the healing process because it is God who gives healing through effectuating the treatment one has sought.54 The second form is that of prayer directed towards God for the healing of one’s neighbor. Because we are weak and slow to believe (Luke 24:25), Christians pray for each other, so that a brother or sister of weaker faith may be healed through the faith of others.55 The last form is that of prayer towards the Saints. Because the Saints have already been deified, they have become participants in the divine life and power, which allows them to heal the sick on God’s behalf.56 These three forms of prayer can all be practiced by individual believers, but due to the communal nature of the Church one commonly finds only the second and third forms in liturgical settings.
3.4.2 The Practice of Anointing the Sick
The second practice—healing by means of anointing—is mentioned in the Gospel of Mark as well: “They … anointed many sick people with oil and healed them” (Mark 6:13). This practice has continued to be performed within liturgical Churches, now referred to as the Sacrament of Holy Unction.57
In the Hebrew Scriptures, however, anointing has a different function. It is primarily used for consecrating an individual into the priesthood or kingship.58 The Hebrew verb for anointing is מָשַׁח (māšaḥ).59 Its participle, מַשִׁיַח (māšîaḥ)—from which the English Messiah is derived—is rendered Χριστός (Christos) in Greek, which is subsequently transposed into English as Christ. Our Lord Jesus is thus The Anointed One, i.e. the anticipated Davidic King whom God promised to adopt as his son in order for him to reign over an eternal kingdom (2 Sam. 7:9-16).
In the fall, mankind was dethroned from its royal vocation of uniting the created and the uncreated, resulting in mental, physical, and spiritual corruption.60 However, whereas human beings were created from the ground below reaching upwards in order to unite with the uncreated God, in Christ Jesus the uncreated God reached down in order to unite himself to the created mankind.61 By surrendering himself completely to the will of the Father—not even withholding his own life from him—Jesus became the first human being in whom mankind’s royal vocation was fulfilled. Christ offers participation in his restored human nature through faith, as Saint Paul writes: “If you declare with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you will be saved (Greek σῴζω: To preserve or rescue from natural or transcendental dangers and afflictions.62)” (Romans 10:9). The telos of the Sacrament of Anointing is thus the communal act of restoring an afflicted human being to the royal status they have in Christ. As Meyendorff writes:
“Whatever the outcome of the disease, the anointing symbolized divine pardon and liberation from the vicious cycle of sin, suffering, and death, in which fallen humanity is held captive. Compassionate to human suffering, assembled together to pray for its suffering member, the Church through its presbyters asks for relief, forgiveness, and eternal freedom.”63
3.4.3 The Practice of Confession
On the third practice—Confession—Larchet does not write anything at all. He notes that Saint James writes “if he has committed sins”, indicating that “there is no necessary link between the patient’s illness and the sins he might have committed.”64 Seemingly to the contrary, archimandrite Neacșu writes:
“As a rule, we can say that there is causal link between illness, suffering and sin, as sin brings spiritual sickness to the soul and then, it is causing suffering and bodily sickness. … Therefore, the Holy Anointing can only be understood in immediate connection with the Holy Sacrament of Repentance. Without this practical and sacramental unity, the Christian loses sight of both the meaning and the explanation of illness and suffering, and, consequently, of the meaning of his psycho-somatic recovery.”65
The views of Larchet and Neacșu seem to be contradictory. However, elsewhere Larchet does in fact recognize that personal sin and disease can be related. He writes:
“We can find in the Scriptures a few cases of afflictions that undoubtedly arise as direct consequences of personal sins. … They represent providential ways to salvation … [and are] a reminder to others—with the aim of calling them to repentance—of the fundamental, ontological link that unites illness, suffering and death to the sin of everyone.”66
Whereas Neacșu thus emphasizes the causal link between personal sin and disease, Larchet points out that this link need not be as strong. Rather than being causally linked to personal sin—and thus requiring confession and repentance—disease is, as a rule, caused by original sin, i.e. the inherited mortal nature of Adam and Eve. Meyendorff similarly writes:
“Byzantine theologians never succumbed to the temptation of reducing sin to the notion of a legal crime, which is to be sentenced, punished, or forgiven; yet they were aware that the sinner is primarily a prisoner of Satan and, as such, mortally sick. For this reason, confession and penance, at least ideally, preserved the character of liberation and healing rather than that of judgment.”67
This is not to say that confession and repentance are altogether redundant in the process of healing—quite the contrary. Larchet writes: “Orthodox spirituality … has included in its tradition of prayer … our collective responsibility in the face of misfortune …, of which illness is merely one expression.”68 Despite personal sin not being the primary cause of physical disease—and healing thus not requiring confession and repentance per se—these practices aimed at spiritual healing remain vital in “working out your salvation with fear and trembling” (Php. 2:12); i.e. preparing oneself for unison with God (deification). Therefore—assuming health in general is aimed at communion with God69—confession and repentance as practices of spiritual healing participate in the greater process of healing in terms of salvation alongside the practices of prayer and Holy Unction.
4 Conclusion
The aim of this paper has been examine from a philosophical and a theological perspective what presuppositions may have preceded one’s personal understanding of health and disease. Four dimensions have been presented: the natural or objective dimension, the normative or subjective dimension, the linguistic dimension, and the theological dimension.
The philosophical discourse revolves primary around the natural and normative dimensions of health and disease. Naturalism tends to operate within the ontological framework, whereas normativism tends to operate within the teleological framework. The domains can therefore present contradictory views on a given topic, but are generally complementary to each other. Both are likely to participate in one’s understanding of health and disease. (Cf. 2.1)
The linguistic domain concentrates on the shared understanding of health and disease related concepts in a given language. It discloses how health-related language appears in the domains of “body (physical health), self (mental health), relationship and morality (metaphorical uses of 'health' or analogies such as 'the society as a healthy organism' and 'salvation')”.70 (Cf. 2.2) A similar range of meaning may be found in the Biblical languages. It may be characterized as health-disease-restoration, which parallels the narrative arc of creation-fall-redemption in the Bible. (Cf. 3.1)
An examination of the theological domain unveils that this parallel is not coincidental. However, due to an interpretive difference in the explanation of original sin, Eastern Christianity has retained in its theology a close affinity to the biblical range of meaning that was present in the Early Church, whereas Western Christianity has grown more distant from it theologically. (Cf. 3.2.1) This implies that within Eastern Christendom, health and disease are tightly bound up with Christ’s redemptive act. Creation originally resided in a state of health that may be characterized as a state wherein ontology and teleology completely overlapped. Mankind failed to live up to its telos, however, when it lapsed into submission to the devil. Although through grace mankind continued to bear the image of God—albeit obscured in some instances—it had lost its likeness because it was no longer able to fulfill its purpose.71 This state of purposelessness, corruption, or disease may be characterized as the process by which creation falls into de-creation, or ‘evil’. By surrendering himself completely to the will of the Father—not even withholding his own life from him—Christ Jesus became the first human being in whom mankind’s royal vocation was fulfilled, thereby restoring human nature to its former dignity. Christ offers participation in his restored human nature to all mankind, so that all who believe may be fully healed and even glorified in the resurrection. (Cf. 3.4.2)
One may argue that this theological understanding of health and disease is alien to Western European thought, and that it therefore plays only a minor role in the process of forming an opinion on these concepts in the current day and age. It is not the theological doctrine itself, however, that has left deep traces in Western culture, but rather how it is reflected in Christian ethics. Ferngren writes:
“The Christian understanding of the imago Dei, viewed in the light of the doctrine of the Incarnation, was to have four important consequences for practical ethics that … represent a radical departure from the social ethics of classical paganism. The first was the impetus that the doctrine gave to Christian charity and philanthropy … A second consequence … was that it provided the basis for the belief that every human life has absolute intrinsic value … A third consequence … was in providing early Christians with a new perception of the body … Believers … formed a unified body in Christ and as such were members of one another … which created new boundaries that transcended traditional political and social divisions. A fourth consequence was that the doctrine of the imago Dei led to a redefinition of the poor.”72
This summary of the transformative influence Christian ethics had on pagan culture lists modern-day values—reflected in, for example, the WHO-definition of “complete physical, mental, and social well-being”—that are often entirely presupposed. They are, however, deeply rooted in Christian ethics. Ferngren writes, for example:
“The classical world had no religious or ethical impulse for individual charity. … There was no provision in Graeco-Roman society for public or private shelter or care of any kind for those who were destitute. Hence they were often forced to live on the streets, or in porches, tombs, or makeshift dwellings. … It was not uncommon for the chronically ill to be shunned, either because they posed too great an economic burden on a family whose very survival was threatened or because of the risk of contagion.”73
Questions as to what amount of mental, social, and economic malaise may justifiably be sacrificed in order to prevent the spread of physical disease would thus be answered—and were indeed answered (cf. e.g. the Alexandrian plague of 26374)—very differently without a Christian anthropology. I will therefore conclude that—even though one inevitably uses the natural, normative and linguistic interpretive frameworks as well—from the four dimensions within which health and disease can be understood, one’s theological presupposition is most likely to have had the most profound influence in shaping one’s personal understanding of health and disease.
William Arndt et al., A Greek-English Lexicon of the New Testament and Other Early Christian Literature (Chicago: University of Chicago Press, 2000), 282.
Ibid., 998.
International Health Conference, “Constitution of the World Health Organization. 1946.” In: Bulletin of the World Health Organization 80,12 (2002): 983.
Daniel Callahan, “The WHO definition of 'health'” in: Studies - Hastings Center 1,3 (1973), 77.--------Jerome Bickenback, “WHO’s Definition of Health: Philosophical Analysis” in: T. Schramme, S. Edwards (eds.), Handbook of the Philosophy of Medicine (Dordrecht: Springer Science+Business Media, 2017), 962.
Marc Ereshefsky, “Defining ‘health’ and ‘disease’” in: Studies in History and Philosophy of Biological and Biomedical Sciences 40 (2009), 221.
Robert M. Sade, “A Theory of Health and Disease: The Objectivist-Subjectivist Dichotomy” in: The Journal of Medicine and Philosophy 20 (1995), 518.
Ereshefsky, “Defining ‘health’ and ‘disease’,” 222.
Sade, “A Theory of Health and Disease,” 517.
Ereshefsky, “Defining ‘health’ and ‘disease’,” 223-224.
Ereshefsky, “Defining ‘health’ and ‘disease’,” 221.
Roberto Mordacci, “Health as an Analogical Concept” in: The Journal of Medicine and Philosophy 20 (1995), 475.
Ibid., 491.
Ibid.
Chris Byrley, “Healing,” ed. Douglas Mangum et al., Lexham Theological Wordbook, Lexham Bible Reference Series (Bellingham, WA: Lexham Press, 2014).
Ibid., “Sickness and Disability”
Hebrew definitions are taken from: Ludwig Koehler et al., The Hebrew and Aramaic Lexicon of the Old Testament (Leiden: E.J. Brill, 1994–2000); Greek definitions are taken from: William Arndt et al., Lexicon.
Jean-Claude Larchet, The Theology of Illness (New York: Saint Vladimir’s Seminary Press, 2002), 31-33.
John Meyendorff, Byzantine Theology: Historical Trends and Doctrinal Themes (New York: Fordham University Press, 1987), 143 (11.3 Original Sin) and further.
M. D. Johnson, “Life of Adam and Eve: A New Translation and Introduction,” in The Old Testament Pseudepigrapha and the New Testament: Expansions of the “Old Testament” and Legends, Wisdom, and Philosophical Literature, Prayers, Psalms and Odes, Fragments of Lost Judeo-Hellenistic Works, vol. 2 (New Haven; London: Yale University Press, 1985), 249, 254-255.
Marinus de Jonge and Johannes Tromp, The Life of Adam and Eve and Related Literature, Guides to Apocrypha and Pseudepigrapha (Sheffield, England: Sheffield Academic Press, 1997), 50.
Meyendorff, Byzantine Theology, 145.--------Larchet, The Theology of Illness, 34-36.
Meyendorff, Byzantine Theology, 144.
Ibid., 145.
Walter A. Elwell and Barry J. Beitzel, “Latin,” Baker Encyclopedia of the Bible (Grand Rapids, MI: Baker Book House, 1988), 1312.
Andrew Louth, Greek East and Latin West: The Church AD 681–1071, ed. Andrew Louth, vol. III, The Church in History (Crestwood, NY: St Vladimir’s Seminary Press, 2007), 3.
The magnitude and diligence of the study is attested to by the fact that a third of the book’s 246 pages is devoted to notes and bibliography. It has been well-received, although it has been critiqued for not including the sacraments of healing into its treatment of religious healing (Horden, 567; Daunton-Fear, 760); for overstating the positive impact of the Christian religion on medical practice (Riddle, 254); and for overstating the decline in miraculous or religious healings after the end of the apostolic era (Daunton-Fear, 760). Nevertheless, the book is a valuable resource in exploring the patristic mindset towards health and disease. Sources: Patricia Fosarelli, “Medicine and Health Care in Early Christianity,” The Linacre Quarterly, 78,2 (2011): 236.-------Peregrine Horden, “Review,” The Catholic Historical Review, 97,3 (2009), 567.-------Andrew Daunton-Fear, “Review,” The Journal of Theological Studies, 61,2 (2010), 760.-------John M. Riddle, “Review,” Journal of the History of Medicine and Allied Sciences, 65,2 (2010), 255.
Gary. B. Ferngren, Medicine and Health Care in Early Christianity (Baltimore, MD: Johns Hopkins University Press, 2009), 2.
Larchet, The Theology of Illness, 57-58.
Ferngren, Medicine and Health Care in Early Christianity, 140-141.
Ibid., 141.--------Larchet, The Theology of Illness, 114.
Ferngren, Medicine and Health Care in Early Christianity, 141.
Andrew Crislip, Thorns in the Flesh: Illness and Sanctity in Late Ancient Christianity (Philadelphia: University of Philadephia Press, 2013), 87.
Athanasius of Alexandria, Athanasius: The Life of Antony and the Letter to Marcellinus, ed. Richard J. Payne, trans. Robert C. Gregg, The Classics of Western Spirituality (Mahwah, NJ: Paulist Press, 1980), 98.
Crislip, Thorns in the Flesh, 82.
Larchet, The Theology of Illness, 55-56.
Crislip, Thorns in the Flesh, 33-34.-------- Larchet, The Theology of Illness, 58-59, 64.
Crislip, Thorns in the Flesh, 187.
“Just as we would have no need of the farmer’s labor and toil if we were living amid the delights of paradise, so also we would not require the medical art for relief if we were immune to disease, as was the case ... before the Fall. After our banishment to this place, however, … the medical art was given to us to relieve the sick, in some degree at least.” (Question 55, Long Rules) Basil of Caesarea, Saint Basil: Ascetical Works, ed. Roy Joseph Deferrari, trans. M. Monica Wagner, vol. 9, The Fathers of the Church (Washington, DC: The Catholic University of America Press, 1962), 331.
“[Christ] left some to struggle against their afflictions, rendering them more worthy of reward by trial. … [Yet] he sometimes cures us secretly and without visible means; … and again He wills that we use material remedies for our ills. (p. 332) … [But] to place the hope of one’s health in the hands of the doctor is the act of an irrational animal. … Yet, to reject entirely the benefits to be derived from this art is the sign of a pettish nature. (p. 333) … [Nevertheless,] illness is often a punishment for sin imposed for our conversion. … [In such cases] we should bear in silence and without recourse to medicine all the afflictions which come to us. (p. 334-335)” (Question 55, Long Rules) Ibid., 331-335.
Ferngren, Medicine and Health Care in Early Christianity, 140-141.
Larchet, The Theology of Illness, 58.
Crislip, Thorns in the Flesh, 85.
“The best rule and standard for a well-disciplined life is this: to be indifferent to the pleasure or pain of the flesh, but to avoid immoderation in either direction, so that the body may neither be disordered by obesity nor yet rendered sickly and so unable to execute commands. … (p. 212) With the body in such a condition (i.e. diseased), the soul is not free to raise its glance upward, weighed down as it is in companionship with the body’s malady, but is, perforce, wholly occupied with the sensation of pain and intent upon itself.” (Ascetical Discourse) Basil, Ascetical Works, 211–212.--------Cf. also Larchet, The Theology of Illness, 79-81.
Andrew Crislip, From Monastery to Hospital: Christian Monasticism and the Transformation of Health Care in Late Antiquity (Ann Arbor: University of Michigan Press, 2005), 97.
Ibid.--------Ferngren, Medicine and Health Care in Early Christianity, 151.
Larchet, The Theology of Illness, 79.
Ibid., 80.
Nathanael Neacșu, “Theological Premises and Practical Connotations regarding the Sacrament of the Anointing. Recourse to a Sacramental Theology of Ecclesial-Christian Life,” International Journal of Orthodox Theology, 11,1 (2020), 195.
Maximus the Confessor, Nicholas Constas (ed.), On the Difficulties in the Church Fathers. The Ambigua II (Cambridge: Harvard University Press, 2014), 109. (Ambiguum 41, 1308C)
Larchet, The Theology of Illness, 32.
Ibid., 83.
Acts 3:16; 4:9-30; 5:16; 8:7; 9:34; 14:9; 19:12; 28:8-9.
Larchet, The Theology of Illness, 85-86.
Ibid.
Ibid., 86-87.
Ibid., 88-89.
Ibid., 91.
Chris Kugler, “Messiah,” Lexham Theological Wordbook.
Ibid.
Neacșu, “Theological Premises,” 195.
Maximus the Confessor, On the Difficulties in the Church Fathers, 109-110. (Ambiguum 41, 1308C-D)
Arndt et al., A Greek-English Lexicon, 982.
Meyendorff, Byzantine Theology, 199.
Larchet, The Theology of Illness, 36.
Neacșu, “Theological Premises,” 202-203.
Larchet, The Theology of Illness, 51.
Meyendorff, Byzantine Theology, 196.
Larchet, The Theology of Illness, 38-39.
Ibid., 79.
Mordacci, “Health as an Analogical Concept,” 491.
Larchet, The Theology of Illness, 33.
Ferngren, Medicine and Health Care in Early Christianity, 98-103.
Ibid., 98, 132.
Bishop Dionysius of Alexandria writes in a letter preserved by Eusebius: “But the action of the pagans was entirely the opposite. They would thrust away those who were just beginning to fall sick, and they fled their dearest; they would cast them upon the roads half-dead, and would treat the unburied bodies as vile refuse, shunning the communication and contagion of the death, which it was not easy by many schemes to avoid.” Eusebius of Caesarea, Ecclesiastical History, Books 6–10, trans. Roy J. Deferrari, vol. 29, The Fathers of the Church (Washington, DC: The Catholic University of America Press, 1955), 126. (EH 9.22)