Toward An Adventist Theology Of Health (4) - On Therapy

To be healed and be whole is a deeply rooted human aspiration. It is so pervasive that, while it affirms itself in our minds, it really starts in our bodies. And takes the form of a pre-rational, immediate experience that reason only later reworks into explicit decisions. The term “Resilience” articulates the psychological and ethical capacity of particularly strong individuals to recover from difficulties through specific and clear choices. But philosopher Baruch Spinoza's idea of “Conatus” (“Conatus Essendi”) identifies a more primordial and universal drive. Conatus – “the effort or the persistence to live” – is the innate inclination of a being to continue to exist and enhance itself. It is present not only in every human being but in every human body. Thus healing can't be reduced to “fixing” or “repairing”. And, even when “fixing” the body is impossible or only partially possible, this “drive to live”, an unquenchable thirst for wholeness, doesn't disappear but takes paradoxical and creative forms.

And this healing process is internal – it comes from within our body. A mysterious and endogenous force is the precondition for whatever external therapeutic strategy is pursued. A mechanical perception of the body and its twin sister, a technical understanding of medicine, tend to overlook this. They converge toward reducing the body to be a failing machine, unable to generate and trigger its own healing process. In contrast, a more holistic way to healing requires discernment, listening, wisdom and love – not just mechanistic medical capabilities.

But a healing process isn't only affirmative toward life. It's also unavoidably paradoxical – for two reasons:

- First, it inevitably presupposes its counterpart: disease. Disease always contests healing by preceding, resisting and sometimes surviving it. Healing doesn't always overcome disease. Thus healing is a vulnerable process which is unable to completely eliminate surprises.

- Second, healing itself sometimes creates more disease. Diseases that follow healing are not always residuals of previous dysfunctions. Sometimes they are simply by-products of the healing process. Iatrogenic episodes (i.e. induced inadvertently by medical treatment) are unfortunately not exceptions but a constant reality even in today's progressive medicine.

This double characteristic of healing as affirmative yet paradoxical exists in every medicine and in all cultures, ours included. The affirmative characteristic of healing in Western medicine results from the enormous pragmatism and efficiency reached at almost every level of the therapeutic intervention. But the other indicator, that of the intrinsic paradoxical character of today's medicine, results from numberless diseases that have increased and radicalized through medico-technical progress itself. Today's medicine is efficient but unfortunately not always resolutive. Let's consider now this paradoxical profile by examining three typical trends of today's medical strategies.

1. Medicalization of healing

Technical medicine is having an increasingly powerful impact people's lives through a dual mechanism. First is a measure of de-humanization within the clinical process. Our humanness, with its asymmetries, paradoxes, discontinuities, exceptionality and opacity certainly slows management of the strictly clinical process. In order to streamline and make it more manageable the clinic has been coupled with the laboratory. And the laboratory mentality, with its important quantitative but also unilateral data, has impacted the clinics, hospitals and the understanding of patients themselves. This method has imposed a new metaphysics, that of the immanent cause. Bodies are viewed as machines and the technical instruments which support a body's life functions are also machines. Both work based on the same principle: absolute supremacy of the mechanical model. Success is assessed in terms of mechanical metrics. Contemporary medicine is thus based on technological innovation where the body is supported by other machines such as cardiac defibrillators, ventilators, artificial hearts, or artificial organs. Even modern pharmacology operates according to the same mechanical principles. The archetype of this kind of medicine is the ICU (Intensive Care Unit) – spearhead of today's medicine.

Additionally, medicalization can end up treating as diseases a variety of negative but formerly-considered normal experiences of human existence. For example, various types of sadness, dissatisfaction or sub-clinical depression. Modern medicine is asked to provide absolute satisfaction of requests that are not strictly necessary in order to adequately fulfill life's common experience. Today's medicine doesn't aim merely to relieve suffering, but also to optimize people's endeavors. The border between normal and pathological, for a medicine constantly unsatisfied with its conquests, moves constantly in search of ever higher standards. And the perceived promise of optimizing the quality and duration of life are goals that will push medicine to transform our desires into needs and produce unattainable, utopian targets.

2. De-socialization of healing

Healing has always been a relational experience. The therapeutic alliance included a long chain of actors. Beyond physician and/or priest the healing mechanism typically included family and friends who intervened as therapeutic agents. Today all these actors are considered peripheral and are just present as accessories or anonymous, interchangeable witnesses of a process from which they have been divested. And even when they are involved in the healing process they tend to do it in mechanical terms or on a contractual basis – for short, and physician-directed interventions. All the social support, lauded as essential for the healing process, is nevertheless understood and implemented without correcting the mechanical-contractual model. The therapeutic social bond has almost disappeared from the healing process and all the compensating mechanisms and substitutive strategies hardly hide its absence.

3. De-personalization of healing

The mechanization of the healing process has also unavoidably touched the patients directly. A model aimed at absolute efficiency as the end result could not do otherwise. They are the irregularity – the “wild card”. The patients, of course, have not disappeared. They are an important component of the medical process. But with what status? Patient present unique, objective, failing bodies, and thus are quantitatively included. But the qualitative aspect has simply disappeared. And the evident sign is the dictatorship of numbers. Quant covers over qual. All the initiatives and strategies invented to personalize patients hardly hide structural failures. The therapeutic setting more and more moves toward depersonalization.

The reintroduction of human centricity in today's technical and impersonal medicine will never succeed if it is done peripherally. It will not succeed if the mechanical and analytical model is not reduced and essentially revisited. Certainly the true inclusion of the human dimension will necessarily impact the mechanistic model, but what the resulting fusion loses in quantitative precision it will gain in qualitative meaning.

We rightfully recognize that Adventism considers the person holistically. But there is a strange symmetry between the mechanical and depersonalizing trend of Western medicine and the schematic, linear and pragmatic Adventist anthropology. This probably derives from inadequately taking into account the various complex levels of existence (body, spiritual, behavioral, etc.) and an oversimplified way of understanding them. Until we seriously consider humanness, with all of its asymmetries, paradoxes, exceptionality, opacity and alternatives, our person-centered medicine and anthropology will remain superficial.


This is a companion discussion topic for the original entry at http://spectrummagazine.org/node/7319

I share the somewhat pessimistic view of modern medicine the author unfolds for us. And yet, in all fairness, … just having been in hospital and having experienced surgery for a painful ailment that drove me round the bend for half a year (quite holistically - not just physically) … I am grateful for modern medicine. Never before has medicine been so successful and contributed to longevity. That doesn’t negate the drawbacks described in the essay by a qualified physician.

Perhaps a theology of health is one of caring. At Waldfriede Hospital (the only Adventist acute care hospital in Europe…) I experienced the difference in care - and it was eagerly confirmed by my secular roommates. But having known this hospital for many years, I don’t only have a comparison to other hospitals, but to its own development over time… If medicine is just big business for the Adventist world, we are losing our “Ministry of Healing” - in exactly the way Hanz described.

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Precisely because we do NOT practice health care as we know we should, is the reason our “person-centered medicine and anthropology will remain superficial“ at best.

Toward An Adventist Theology Of Health (4) - On Therapy 11 February 2016 Hanz Gutierrez said: “Until we seriously consider humanness, with all of its asymmetries, paradoxes, exceptionality, opacity and alternatives, our person-centered medicine and anthropology will remain superficial.”

In response Andreas Bochmann said “… If medicine is just big business for the Adventist world, we are losing our “Ministry of Healing” - in exactly the way Hanz described.”

Many societies believe that illness is the result of supernatural phenomena and promote prayer or other spiritual interventions that counter the presumed disfavor of powerful forces. Spiritual values and religious issues play a major role in patient compliance. Human beings bring their individuality to health care. They have systems of health beliefs to explain what causes illness, how it can be cured or treated, and who should be involved in the process. The extent to which patients perceive patient education as having cultural relevance for them can have a profound effect on their reception to information provided and their willingness to use it. Western industrialized societies such as the United States, which see disease as a result of natural scientific phenomena, advocate medical treatments that combat microorganisms or use sophisticated technology to diagnose and treat disease.

Having ministered in and out of Adventist health care settings most of my adult life as a Chaplain and Chaplain Educator in the United States, Central, and South America, I will cite a few examples of how we have not met the needs of several minorities.

Some patients have extended family that wield significant influence, and the oldest male in the family is often the decision maker and spokesperson. The interests and honor of the family are more important than those of individual family members. Older family members are respected, and their authority is often unquestioned. Among Asian cultures, maintaining harmony is an important value; therefore, there is a strong emphasis on avoiding conflict and direct confrontation. Due to respect for authority, disagreement with the recommendations of health care professionals is avoided. However, lack of disagreement does not indicate that the patient and family agree with or will follow treatment recommendations. Among Chinese patients, because the behavior of the individual reflects on the family, mental illness or any behavior that indicates lack of self-control may produce shame and guilt. As a result, Chinese patients may be reluctant to discuss symptoms of mental illness or depression. Chinese patients seeking care in Adventist facilities in several Adventist facilities, by and large have not been given this consideration.

Some sub-populations, such as those from India and Pakistan, are reluctant to accept a diagnosis of severe emotional illness or mental retardation because it severely reduces the chances of other members of the family getting married. In Vietnamese culture, mystical beliefs explain physical and mental illness. Health is viewed as the result of a harmonious balance between the poles of hot and cold that govern bodily functions. Vietnamese don’t readily accept Western mental health counseling and interventions, particularly when self-disclosure is expected. However, it is possible to accept assistance if trust has been gained. I am not aware of that level of sensitivity being taught to our Adventist medical staff.

Aspects common to Native Americans usually include being oriented in the present and valuing cooperation. Native Americans also place great value on family and spiritual beliefs. They believe that a state of health exists when a person lives in total harmony with nature. Illness is viewed not as an alteration in a person’s physiological state, but as an imbalance between the ill person and natural or supernatural forces. Native Americans may use a medicine man or woman, known as a shaman. This practice is shunned in many clinics and programs that the Adventist sponsor in health care.

Although Hispanics share a strong heritage that includes family and religion, each subgroup of the Hispanic population has distinct beliefs and customs. Older family members and other relatives are respected and are often consulted on important matters involving health and illness. Fatalistic views are shared by many Hispanic patients who view illness as God’s will or divine punishment brought about by previous or current sinful behavior. Hispanic patients may prefer to use home remedies and may consult a folk healer, known as a curandero. This practice and many home remedies are not considered in Adventist facilities when treating Hispanic patients.

Many African-Americans participate in a human experience that centers on the importance of family and church. There are extended kinship bonds with grandparents, aunts, uncles, cousins, or individuals who are not biologically related but who play an important role in the family system. Usually, a key family member is consulted for important health-related decisions. The church should be an important support system for many African-Americans.

As can be seen, each ethnic group brings its own perspectives and values to the health care system, and many health care beliefs and health practices differ from those of the traditional American health care culture. Unfortunately, the expectation of many Adventist health care professionals has been that patients will conform to mainstream values. Such expectations have frequently created barriers to care that have been compounded by differences in language and education between patients and providers from different backgrounds.

Differences in our humanness affect patients’ attitudes about medical care and their ability to understand, manage, and cope with the course of an illness, the meaning of a diagnosis, and the consequences of medical treatment. Provison and priority has to be given in our health care at all levels to encourage better understanding of the needs of all our patients. All patients and their families bring their humanity and individual specific ideas and values related to concepts of health and illness, reporting of symptoms, expectations for how health care will be delivered, and beliefs concerning medication and treatments. In addition, specific values influence patient roles and expectations, how much information about illness and treatment is desired, how death and dying will be managed, bereavement patterns, gender and family roles, and processes for decision making.

Until we start doing what we know we need to do in health care–to make man whole—will remain just—big business.

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The gospel of the kingdom which was established by Christ himself in his life and ministry was demonstrated well as He freed each individual from the chains of the oppression that the Kingdom of darkness had bound them in. Christ thus established beach-heads for the extension of his kingdom in the lives of thousands of these liberated individuals. Christ has given to His saints today the work of continuing that same ministry.

I lay on the operating theatre of a small bush hospital in far away Korea awaiting my Christian surgeon and my anethetist who would give me my spinal before repairing my broken left tibia and fibula and dealing with my dislocated ankle. Several hours before this I has disabled myself when I fell on a dewy disabled ramp at the University where I was lecturing. My family were all about 8,000 kms away.

5 days into my 15 day stay in hospital my wonderful surgeon invited me to dine with him at a restaurant of my choice. I arrived in style - in the back of the hospital ambulance. Unfortunately, on our arrival there it was discovered that there was no elevator to the first floor of the building. So, I was treated to the honour of having the rather short ambo carry my lanky form up the steep stairs right into the restaurant, to be met by my surgeon and a whole delegation from my university.

What western surgeon would think to do that for one of their patients? Yet, this is exactly what Jesus would do! In addition, my surgeon came for an unhurried visit every morning of my hospital stay.

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Here at Loma Linda Univ Medical Center and School of Medicine, recognized as the bastion of SDA healthcare training, a movement has been going on to address true whole person care. Started by Drs Alexander and Elder decades ago, it is now really coming to the forefront. A movie was made about this, and is making the film festival rounds now. Will soon be available online and in DVD. You can see the trailer here:

Watch this and I believe you’ll be amazed at how modern western healthcare is truly becoming wholistic.