In this book, which I recommend, Gary Ferngren looks at early
Christian attitudes towards sickness and health care, and he compares and
contrasts such with the Greco-Roman environment. Ferngren doesn’t extend this
to comparisons with say, ancient India or China, as his project is to
understand early Christian attitudes in their context. So he looks at Greeks,
Romans, Jews and Christians in particular.
This is a timely book. The world faces ever more health crises,
and Christians have for centuries been one of the leading voices in
humanitarianism and health care. At the same time, some churches put so much
emphasis on prayer for healing that people risk omitting attention to
ordinarily medical help.
So what did the early Christians think? What did they do?
How were they different? Below, I want to summarise what leapt out at me when
reading Ferngren’s book. I’m not taking
it in the same order as the book. My order below is: Greeks, Romans, Jews,
Jesus and Christians.
The ancient Greeks
In the ancient world, centuries before Christ, Greek medical
tradition became divorced from pagan religion. In effect it became became religion-neutral.
This is of major significance to our story. Medical care became naturalistic and practical, based on
observation. If treatments consistently worked, then a Greek physician’s
reputation grew accordingly. Think Hippocratic tradition.
Physicians weren’t licensed. Such licenses had not been
invented. But with centuries of recording observations, Greek theoretical
medicine of various schools gradually became dominant over other approaches to
illness. (Ferngren, pages 19-22) At the same time, their secular medical
traditions continued to exist side-by-side with enduring “religious, folk, and
magical healing traditions”. And the paying public could pick and mix. They
could visit root or herb cutters, drug sellers, midwives, religious healers,
Hippocratic physicians, exorcists, diviners, priests, not to mention fitness
trainers. (37) People would choose according to their worldview, their
desperation, and how far their finances could stretch. They could go to the
apprenticed physicians or the educated layman, or await itinerant ones. There
were also self-help books (okay, scrolls!). Traditional methods were likely to
prevail where physicians were more difficult to access, especially for
peasants. (38) Whereas, if a sick person attributed their illness to demons,
they would approach a religious or magical healer, not a physician. (49)
What was the science? Ferngren says, “The relation of a
group of symptoms to a specific disease or disease agent is a recent medical
concept. Greek medical authors regarded diseases not as separate entities but
as groups of symptoms that affected individuals and could be described and
classified.” (14-15)
The Greeks had their educated scroll-reading physicians with
long apprenticeships. These schools were Dogmatism, Empiricism, and Methodism.
That is, treatment based on knowledge of inner anatomy, treatment based on
symptoms, and treatment according to common conditions. There were also
independent thinkers outside these schools, and there wasn’t unanimity. It was
person-centred anyway, an idea that a patient and a doctor should know each
other well. Doctors relied on what worked, and on the basis of what worked,
they sought trust and reputation. Their treatments could be hit-and-miss with
limited options, and so common sense prevailed over theory. Sometimes, the best
way to protect reputation was to avoid difficult or untreatable cases. All this
developed before Jesus’ era. (19-22) Hospitals had not yet been invented.
Charlatans did exist and could fool people, but good physicians’ healing reputations
prevailed. (37) Indeed, “medicine
enjoyed nearly universal recognition in the classical world as a humane art
that transcended local cultures and particular ideologies.” (41)
This was part of the background to the world the first
Christians lived in. More background now.
The ancient Romans
The Greek naturalistic way of doing medicine carried on into
the Roman era, as there wasn’t any distinctive Roman medical tradition. In this Greco-Roman
era, many physicians were either educated slaves or ex-slaves - that was the
Roman Empire for you. (But of course, a slave would never enjoy the status or
reputation of any free man or woman.) (17, 22)
Greco-Roman writers held to the famous “four humours” theory
of medicine as the “naturalistic” understanding, upon which a medical approach
was based. (18) The Hippocratic approach assumed for example that epilepsy had
a natural explanation, not a supernatural one. (19) When people were sick, they
looked for remedies, not models of thought. (59) So, on leprosy: “While social
ostracism and social terror accompanied the disease in Greco-Roman society, it
did not result in the ritual defilement and pollution that it produced in
Hebrew society.” (17) Contagion was not yet understood.
In Roman society, individual private alms-giving to the poor wasn’t
a thing. (98) Being benevolent was a public thing, done by the high and mighty in
order to receive public honour, and was expected to be a reciprocal
arrangement of some sort. The deep-rooted human sensitivity to being cheated
perhaps (of which social psychologist Jonathan Haidt writes so well).
Gods and rulers were the public's benefactors and were repaid with
sacrifices and status and honour. But in
their stories, the Roman gods showed little pity to the poor, and taking pity
on the poor wasn’t what Roman rulers were expected to do. Instead, benevolence
was towards society as a whole. If you took pity, then you took pity on the
unfortunate in your own social class, with the expectation of reciprocity if
you fell on hard times yourself. (86-87, 90) (Jesus comments on these customs
in the Sermon on the Mount as being insufficient for his disciples’ conduct.)
Benevolence was more like hospitality than social justice. (88) And so Roman
society did not owe medical treatment to the poor, the lame, etc. There was
philanthropy (a word that changed meaning over time, become broader) but it was
to rich and poor, not targeted at the poor. (90-92)
A Roman would be a physician for love of honour primarily,
more than for riches. Honour, social status, was of prime importance to the
Romans. An individual physician might be instinctively kind to a poor person
who needed treatment but couldn’t pay, just as an example of being kind to all,
of kindness to fellow members of mankind. They didn’t have a special mission
for the poor. But this kindness was taken as praiseworthy. In return, the
patient was to appreciate the physician’s art – honour again. Honour was the
one thing the penniless poor could give in return. (88-90)
Inequality was normal, which was bad news if you were sick
and poor. Don’t look to the Roman Stoics for too much hope. Inequality was seen
as natural and not problematic. There were no human rights ideologies demanding
that the poor sick be treated. Stoic ideas of universal brotherhood did not
mean universal human rights. (And their slaves had next to nothing resembling
human rights at all.) What was valued most by Romans was the honour of free
people, and Roman ideas of virtue (Roman virtue, not Christian virtue per se),
and the dignity that comes with good health, all fit into these values. The
valuable uniqueness of the individual was not a Roman idea, and Stoic pantheism
didn’t dream of it either. If anything Stoicism was somewhat insensitive to
individual suffering, and was only an elite indulgence anyway. They didn’t
think institutions much capable of improvement because they shared ancient
pessimism about human nature. (95-97)
There were “many healing cults throughout the Mediterranean
world. There were hundreds of pagan healing shrines in the second century, some
connected with local hero cults...” (69) However, claims of miracle cures were
two-a-penny, and people were canny and sceptical, especially educated Roman classes
who didn’t believe in exorcism either. (70) If stories of Jesus’ exorcisms
reached their ears, they would likely have dismissed them without further
thought, and stories of Jesus’ healings would have carried little weight. They
would have sounded unsophisticated and unconvincing to educated Romans.
Jews
The Hebrew idea that everyone is created in the image of the Creator God
is a sharp difference from the values of the Greco-Roman world. It helps
explain how concern for the welfare of the poor is a strong feature of both Old
and New Testaments. Individual private almsgiving for the poor, something of
little or no consideration by the Romans, was a Jewish thing that Christians
continued. (97-98)
As for treatments for the sick, the Old Testament shows that
the Hebrews were supposed to avoid pagan magical cures and were,
unsurprisingly, able to set broken bones and bind wounds. Epidemics were
sometimes associated with spirituality, and prayer and fasting for healing were
appropriate, but there was not a tradition of illness being demonic in origin.
The Hebrews did not have a systematic medical tradition of their own, and
emphasised Yahweh’s role as healer.
Once Hellenised in the centuries before Christ, Jews adopted
Greek traditions of medicine the same as anywhere else did (as well as keeping
up Jewish prayer). As Greek medicine was religiously neutral, adopting it is
hardly shocking. Although there were voices of caution about integrating
foreign expertise into the Jewish culture and a desire to maintain cultural
independence, which did actually carry over into early Christianity. (23-24) This
was the scene in Jesus’ day.
You don’t see exorcism involved in Jewish healings until
Tobit in the intertestamental period. You do find Jewish practices of exorcism
in descriptions of the Essenes and in the New Testament. (44)
Jesus
Unlike Jewish exorcists, Jesus simply spoke and exorcism
happened. Unlike them, he didn’t use amulets or other tools of magic. When some
Jews attempt to use Jesus’ name as a magical tool, it doesn’t work. (47)
Mostly when the stories of Jesus mention illness, it’s
nothing to do with demons. Diseases generally have different symptoms from
anything demonic in these stories. Diseases are described in ordinary language.
(60) The boy with epilepsy is a very rare exception. Otherwise, Jesus treats
disease by healing, not by exorcising: two different things. (45-47) For
instance, when Lazarus dies, it’s to do with illness, not demons. Nonetheless,
it’s a miracle that restores him to life. (60)
We see in the stories of Jesus a comfortableness with both
the secular physician and the miracle healer. Jesus is even described as a
“physician” of spiritual health, and the church remembered him as such, with
the emphasis on Jesus as healer of sinners. (30-31) However, Jesus did not
assume that misfortune was a result of personal spiritual sin. (60)
We know the story of the woman healed by Jesus after
bleeding for 12 years. What’s notable here is that she had been doing the
normal thing – paying to see physicians – and it hadn’t worked, and she had run
out of money. Such was the lot of many in the ancient world. Her turning to
Jesus who could heal by spiritual means is not an attack on physicians. It is a
pattern we might expect in antiquity. Go to reputable doctors first, but with a
back-up plan. (39-40, 47)
There are many miracle healings in the gospels, seen by the
gospel writers as “signs” rather than as everyday occurrences, signs that Jesus
was the Messiah who could defeat all the works of the devil, signs that
fulfilled scripture. (65) This pattern follows with his disciples at the
foundation of the church in the book of Acts. Signs and wonders announce that
salvation has come. (65-66)
Christians
Ferngren wants his readers to understand that ancient Christianity
was not really known as a “healing religion” although that idea is attractive
nowadays. (71) Yes, Paul mentions gifts of healing in the church, but does not
tell stories of healing, and does not give it great emphasis. Paul talks about
illness with quite natural descriptions, though not divorced from the work of
God. The letter of James is a bit of an outlier in the New Testament epistles,
with its process for anointing the sick and praying for them. This does not
preclude going to the doctors. (66-67)
The New Testament does not condemn non-religious physicians
and naturalistic medicine. (48) But it does think through questions about
illness through its theistic lens. In early Christianity, sickness was seen as
a consequence of the Fall. Disease and affliction were seen as part of the work
of Satan, even if Satan is not the immediate cause in this or that case. And
the bottom line is that healing still belongs to “the Lord who heals you,” as
was the case for the Jews before the Christians.
It would be mistaken to attribute to the early Christians a simplistic
belief that illness is explained by demonic causes. As with other people of
their time, they believed in natural causality of diseases – very much the
point that Gary Ferngren wants people to take from his book. Christians went to
doctors when they weren’t well, and they prayed. These two things were fine
together. When people are sick, they just want to get better. When physicians
and medicine failed, then they resorted to alternatives. There was no
specifically Christian approach to diagnosing disease or treating it.
Christians were part of a Greco-Roman world which had well established medical
methods and medical explanations would often do. (59-63) Religiously themed
healing was not very prominent. (65)
Unlike in the stories of Jesus confronting spiritual forces
of evil, Paul tells us no such demonic stories in his letters. Whereas Paul lists
healing as a spiritual gift, not exorcism. What was happening in the gospels
with Jesus – that is, stories both of illness and of demons - is not all
mirrored in Paul’s churches apparently. But illness was happening. In the lives
of early Christians, illness was not closely connected to demonology,
just as it wasn’t with Jesus. Sick people who could afford it simply went to
physicians, or used known remedies, and went to alternatives if that didn’t
work. (48)
So then, Christians in the first five centuries, although of
course predisposed to see miracles at times, “did not attribute most diseases
to demons, they did not ordinarily seek miraculous or religious cures, and they
employed natural means of healing, whether these means involved physicians or
home or traditional remedies.” (13) Exorcism was for dealing with demons, not
for healing illnesses, although these activities might be mentioned together.
(51-52) The idea of demons figures very little at all in discussion of illness.
Ferngren emphasises this, perhaps as an implied warning about some churches
today where illness is treated as spiritual warfare rather than natural. He
wants us to understand that over-spiritualising illness is not the way of Jesus
or of the first Christians.
In later centuries, exorcism-type wording became part of
baptism liturgy, and Christus Victor theology renewed interesting in discussing
demons in the context of Christ’s work. A religious order of exorcists first
appears in church structures in the 3rd century. (55-56) In the 4th
century, anointing the sick starts to have a formal liturgical setting. (67)
There were some healings in these centuries, and some voices of doubt about the
efficacy of physicians, but Ferngren wants us to get the point that in early
Christianity, if you were sick, you just wanted to get better, and you did what
people had done for centuries. You went the doctor.
It is an important lesson that we still need to hear in
modern times, whenever Christians postpone a trip to the doctor in the hope
that they should wait for a miracle first. That wasn’t the way of the early
Christians. And I’ve known people wait too long for a miracle who possibly
would have had better health had they been to a doctor sooner. Perhaps anyway.
Just as ancient doctors were sometimes unwilling to treat
the untreatable to avoid a reputation of personal ineffectiveness, pastors were
probably hesitant about recommending doctors for more or less the same reason:
to avoid damaging “don’t blame me” moments when medicine doesn’t work. Pastors
would have relied more on the common sense fact that people could make up their
own minds about visiting a doctor. If they heard bad stories about this or that
physician, they could choose to avoid the same.
Some Church Fathers were rather knowledgeable about
medicine. The Cappadocian fathers were familiar with the association of
contagion with leprosy. (26-28) Church Fathers were often keen to stress that
medical healing was knowable to anyone, and although it was sometimes
beneficial, it did not compare with healing as a superior gift of God enjoyed
by Christians who know spiritual things.
Of course, this is to speak of the attitudes of educated
literate Christians, and we can’t automatically carry that over from their
thought-world into that of the poorest Christians. Indeed, few Christians were
physicians until Christianity was legalised in the Roman Empire, and the first
Christian hospital only came along after that. Physicians tend to congregate in
cities. If lots of Christians were the rural poor, this counted against
becoming a trained physician, but they would know local healing traditions.
Being remote didn’t help with access to physicians, unless there were Roman
legions bringing their military physicians with them to keep them fighting fit (if access to them could even be bought).
(38)
To take an example of an early Christian text as a context,
the Didache’s users would likely have a religious view of sickness aligned with
the Old Testament, say, that leprosy brought impurity. Like most of the New Testament letters, a
text such as the Didache comments neither on natural nor supernatural healing,
but then a single text does not have to say everything! And a document for wide
use, remote rural or urban, among rich or poor, slave or free, couldn’t have a
one-size-fits-all solution to illness. (38) Some church members might
have some medical knowledge, and it wasn’t the role of church leaders to
counsel avoiding such acquaintances. (40) One would not generally expect an
early Christian text, e.g. the Didache, to read like an ancient treatise with
specific medical vocabulary.
Christian medical ministry
The Hebrew idea that everyone is created in the image of God
goes up another level thanks to Christian reflection on Jesus’ incarnation. Such
reflection had real world benefits for the sick and the poor. The Christian idea
of agape love comes to the fore. In light of the incarnation of God as
Jesus of Nazareth with his agape values, a sharp contrast to Roman
values comes into focus. In Christian thinking, human agape love
reflects divine love, an inspiring idea that Roman Stoicism never had. Jesus’
command to “Go and do likewise” is truly significant. Private Jewish
alms-giving carries on in Christianity because it reflects the agape
love of God (as seen in Jesus’ story of the Good Samaritan, for example). But private
charity is now a “go and do” command, visiting the sick, aiding the poor,
collecting alms on Sunday. You can reflect divine love by going to the poor.
This is not Roman! (98-100, 114)
On top of that, as well as everyone being made in the image
of God, everyone is now someone for whom Jesus died, with God in Jesus
reconciling the world to himself. Now everyone was of newly seen value. Consequently,
Christians began putting in writing their objections to abortion, infanticide,
suicide, gladiator games, because of the new emphasis on the value of everyone
made in God’s image. In contrast, Romans thought infanticide was reasonable and
not shocking. (100-101)
With the incarnation also comes a fresh endorsement of the
human body as made by God as a good thing to be cared for. Christ had two natures, human and divine, and
so human nature, exemplified by the human body, was imbued with value by Jesus’
life: the perfect man making good the image of God. The Christian idea of fully
integrated body-soul personhood, every soul and body having value, was a
contrast to values and stories of pagan Rome, where the Roman gods disregarded
the weak and the poor (and their gods favoured the powerful) because frankly
the weak didn’t really seem to matter to their gods. To Christians on the other
hand, the poor bore the face of Christ, and Christ was incarnated to save them body
and soul. Christ even identified with the poor, suffered, and expected his
followers to have solidarity with the poor. This is the social difference
brought about by reflection on the incarnation of Christ. (101-104)
Reflecting on Jesus led to a commitment to medical charity in
early Christianity. Ferngren goes on to write about early Christian physicians
and hospitals. Urban churches where were the poor and the sick could seek
assistance, and later hospitals added to that work. (113) What was the impulse
for this? Ferngren: “In contrast to the classical world, which had no religious
impulse for charity that took the form of personal concern for those in
distress, Christianity regarded charity as motivated by agape, a
self-giving love of one’s fellow human beings that reflected the incarnational
and redemptive love of god in Jesus Christ.” (114) Having such an ideology (leading
churches to such good works) is something that pagan temples and mystery religions
lacked. Therefore, Christian care for the marginalised was more effective and
organised. (139)
Christian hospitals appeared in the fourth century and were
available to the public, unlike Roman military infirmaries had been. One of the
strange ironies of the Roman world was that if you were a slave serving the
military, you may be given access to the military infirmaries, but if you were
a free citizen you were shut out. Slaves were property, an asset, and the
military looked after their assets. Some large landowners might do likewise
with their slaves. (124) Christian hospitals were therefore of a different, more open, ethos.
In summary, in the context of Greco-Roman society, early
Christians had broadly conventional views about sickness as a natural thing,
but very unconventional positive values towards the poor and the sick because
of the life and teachings of Jesus.
Ferngren goes in detail into practical developments in the
early church. If you want to know more about what early Christians thought and
did about sickness and healing and medical care, this is the book for you.
