Theology Today - Vol 38, No. 1 - April 1981 - EDITORIAL

1 - Religion and Pain

DISCUSSIONS about the relationship between religion and pain are usually focused in one of two directions. One is the endless and frustrating speculation of theodicy: the attempt to reconcile the prevalence of suffering with the providence of God. Centuriesof reflective imagination by theological and ascetical writers have hardly produced a better response than the story of Job. The other line of discussion about religion and pain results in moral treatises, textbooks, and seminary lectures on medical ethics. What does religion say about informed consent, tubal ligations, and the right to die with dignity? The Hastings Institute, among others, is paying sophisticated and detailed attention to these ethical problems.

The perspective of this issue of THEOLOGY TODAY is neither on theodicy nor on ethics.* Rather, several of the authors are behavioral scientists who look at the psychological and sociological approaches to the "handling of pain."

There have always been people who recognized a connection between religion and medicine and who brought the consolations of religion to

The guest editorial for this special issue of' THEOLOGY TODAY has been prepared by Joseph H. Fichter, S.J., Professor and former Chairman of the Department of Sociology at Loyola University, New Orleans. He is widely known for his work in the sociology of religion, and his books include Religion as an Occupation (1961), Priest and People (1965), America's Forgotten Priests (1968), Organization Man in the Church (1974), and Catholic Cult of the Paraclete (1975). He is currently completing a book on religion and pain, to be published by Seabury Press.
* Three of the articles for this issue were originally presented as papers at a session of the annual meeting of the Society for the Scientific Study of Religion. Father Fichler chaired the panel, and papers were delivered by Barbara Payne, Paul W. Pruyser, and Bernard Spilka, John D. Spangler, and M. Priscilla Rea.

2 - Religion and Pain

the sick and suffering. Even in antiquity, provisions were made under religious auspices for sick people in Greece, Egypt, Babylonia, and India. The first hospitals in Western Christianity were established by groups of highly motivated religious women who cared for the indigent sick in the name of the Lord. Mother Teresa of Calcutta is a dramatic contemporary exemplar of this ancient ministry.

This issue of THEOLOGY TODAY asks what people do, and how they do it, when they care for the sick in the name of religion. What is the spiritual dimension of health care? How are the consolations of religion brought to the sick and suffering? As Dominican theologian Thomas O'Meara says, "In the health ministry, we go beyond what Christianity says" about illness and death, and we face the question: "What does Christianity do about illness?" How do ministers of religion assist in the control of pain? How does the pastor, or the nurse, or the physician, express loving spiritual care for the sick, the elderly, the dying?

As inevitably happens in research projects, the questions we ask give rise to other questions. We ask here whether Kübler-Ross widely accepted scheme of five stages of dying is a genuine Christian interpretation of the experience of terminal illness. We raise the question of hospital chaplains whose ministry to the sick tends to be less pastoral than psychological. Clergy who are theologically "liberal" seem to water down the religious content of the counselling role. Lay people who tend the elderly sick find that religion helps them to be compassionate and loving to those in distress. In more specific psychological terms, there are various modalities by which religion may effectively relieve pain: prayer and miracles, hope and denial.

Every Christian probably knows that Jesus himself was never sick, and certainly knows that Jesus had a record of healing many sick people. He wanted his followers to have compassion for the suffering. Luke says that he sent them out to preach the Kingdom of God and to heal the sick. In the young Christian communities, special attention was paid to those who needed help: the sick, the widowed, the orphaned. The followers of Christ heeded the Pauline counsel that "if one member suffer anything, all the members suffer with it, or if one member glories, all the members rejoice with it."

The corporal works of mercy, which include the care of the sick, were incumbent on all believers. Historically, however, there soon developed a more direct and specialized care of the sick in the ministrations by deacons and deaconesses. It appears that the role of deaconess included, among other duties, the ministry of nursing service to sick women at whose homes she regularly visited. What happened then was the development of a nursing ministry among Christians who felt that they had a special vocation to care for the sick. The point of emphasis here is that historically the primary motivation for taking care of people in pain was religious motivation. It was for spiritual reasons, for the love of God

3 - Religion and Pain

and in imitation of Christ, that the early Christians organized their nursing ministry. Thomas Szasz suggests that the functions of medicine and religion "have a common origin in the ancient role of the healer (for example, Jesus Christ)."

The development of the monastic system in Western society was conducive to the successful establishment of hospitals under religious auspices. The Hebrew and the Muslim religions also taught the high value of human life and held that care for the sick and the poor is a spiritual obligation. Christianity, however, writes William Glaser, "provided the doctrinal and organizational basis for hospital staffs." It is a historical fact that "for many centuries, European hospitals were run by the church or by associations of laity affiliated with the church, and they were staffed by nuns. For much of their history, they were custodial institutions where sick and dying people were maintained and given religious guidance."

Like other social roles and occupational programs, the corporal works of mercy have become specialized and professionalized in modern technological society. Even the terminology has changed. What had obviously been sick care over the centuries is now generally called health care, or even medical care, although in many instances the patient needs the nurse more than the medical doctor. The large modern hospital obviously centers its attention on sick patients, but this attention is in many instances a means to two other objectives: maintenance of a medical research laboratory and a clinical training ground for students from medical schools.

The hospital has undergone a complete metamorphosis. What Illich called "dormitories for travelers, vagrants, and derelicts," that is, the poor and despised sick people of late antiquity, has now become a citadel of scientific medicine. "It was originally not an institution for diagnosis, treatment, and nursing, but rather a place in which works of mercy and compassion could be performed." There is no doubt that the care of the sick poor, which had been done on a voluntary, spiritual, and personal basis in earlier centuries, now tended to become impersonal, rational, and routinized. Nowadays we are told that "the challenge of witnessing Christian values is primarily a fight against the trend toward impersonal mechanization and depersonalized programming in health care."

All of the public hospitals, as well as the voluntary, non-profit facilities, are now seen as the normal locus for sick people. What was once a moral precept, obeyed by religious believers, has now become an accepted moral duty of the larger community. Health care and social welfare have become institutionalized as a collective obligation. Most citizens in advanced liberal society realize that the right to health care is a basic human right and that the larger society has a corresponding duty. Americans have generally accepted the need for Medicaid and Medicare but seem reluctant to accept an all-embracing national system of health care.

4 - Religion and Pain

From the perspective of the spiritual dimensions of health care, several trends are worth noting. Although the population is growing and church membership remains relatively high, the number of church-related hospitals is declining. There is also a decrease of nursing schools under religious auspices as well as medical schools that had once been affiliated with church colleges. On the other hand, the professionalization of hospital chaplaincy has involved churches and seminaries in clinical pastoral education. Young ministers and seminarians are being trained in the corporal works of mercy as an integral part of their education. Lay people from church congregations are giving volunteer service to hospital patients and in the ministry of home health care and hospices.

It appears that religious people are getting more involved with medical and health questions while medical people are getting less interested in religion and spirituality. Presbyterian Hospital chaplain Dennis Savior remarks that "in modern times medicine has divorced itself from religion completely." This is in contrast to earlier periods of Western society when health care was motivated by religion. "The modern medical center has a large laboratory and a small chapel." What had once been a kind of "natural affinity" between medicine and religion has turned into a Strained and artificial relationship, and in most cases it is because the medical practitioner recognizes little, if any, healing competence in the religious practitioner.

There is no question that medicine has successfully alleviated most of the physical pain associated with surgery and serious illness. The Christian believer is grateful for this measurable alleviation of suffering but still recognizes that sickness and suffering are a condition of the whole human being. There still remains a significance in pain which relates in some manner to the Way of the Cross, to the "Man of Sorrows." This is the mystery of pain no one can completely avoid. The holistic approach to healing includes the spiritual, as well as the social, physical, and emotional aspects of the patient, and it is in this human totality that the medical person and the religious person combine in a caring relationship for the sick patient.