{Medicine, health, psychiatry, faith, death… issues
discussed by Dr.Daniel and his wife Dr.Jane Hinshaw, through an Orthodox, scientific
and spiritual perspective, in a meeting with the community that took place in
the dining room of our monastery of Saint
John the Baptist, on Saturday 3 February 2018.
A special blessing that we would like to share
with our readers.
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One of the extraordinary things about the Orthodox Christianity’s
understanding of reality is Orthodox Anthropology: how do we understand the
nature of the human person.
The Eastern fathers of the Church have emphasized how there is a
unity of the body and soul and this occurs from the very point of conception, and so as human persons we acquire our
personhood because God has called us to be persons, God makes us persons.
The image of the Trinity is impressed upon each of us as Christians, by our Chrismation and baptism, so the Holy Spirit is there and hopefully will dwell with us as we draw toward the Kingdom. And so God has done everything possible to make us His children. And yet we have this tendency, because of the fall, to continually wander away. In the Church’s use of the Greek language, there has been this term called amartia to describe what sin is, but in classical Greek before the Christian era, amartia in its most basic form meant: not being the way things should be. The classical example was the athlete, the one who would be throwing the javelin and he missed the target. Another extraordinary thing about the Orthodox Church compared to the Western branch of Christianity is, there is a recognition because of the fall of Adam and Eve, that not only do we have sins that we consciously choose to do, but there is also sins that we don’t consciously choose, that this is not the way that should be, where we are not meeting the mark, we are not hitting the target.
So before Communion, in the prayer of Saint John Chrysostom, we say: “Forgive us our sins voluntary, and involuntary, known and unknown”. And with the fall of human nature there is also a direct consequence of the fall as an effect on the entire cosmos, from which all the nature suffered. The Greek word Pathos which is typically defined in English with suffering also refers to the Passions.
As Christians we are not dualists, evil is not an independent entity, it is not something that has an independent existence, it is a parasite of the good, is a distortion of the good. When persons are affected by sin, whether it is something that they consciously chose to do or it is part of what they inherited through their fallen human nature, they are experiencing suffering, and the earliest meaning of suffering in classical Greek, was that something happened to a person. By the time of Christ, in the Hellenistic period, the meaning became more precisely something bad that happens. Probably one of our really great early saints from this era, Saint Ignatius of Antioch, more than anyone in the early Christian literature used the term pathos, pathimata, to explore and to transcend that meaning to refer to the suffering of Christ, the passion of Christ.
In essence when we experience sin, or we experience the effects of
sin, we are experiencing suffering, and what is extraordinary in the church’s
tradition, in the Nicene Creed that we recited today in the Eucharist, “Christ…suffered
and was buried…”, but there is no specific statement that He died, but clearly
His suffering implies death. So, we enter this world already affected by the
brokenness, and we suffer, and in our suffering we are dying even from our
birth.This is the situation; we are thrown in this world in a sense, we don’t chose our parents… and as Christians though we acquire our parents, we acquire God the Father , we acquire the Holy Trinity, the Holy Mother of God, all the saints within us through the baptism, Eucharist, and all the mysteries of the church. But this broken state we have, is essentially mirrored because of the union of body and soul, we see it expressed in physical illness. In some sense, the physical illnesses that we struggle with, are sin, not sincerely sin that we voluntary chose but they are not the way things should be. And the extraordinary thing, which is really just incomprehensible, is that the very God, Who is the source of all beings, the source of existence, Who is beyond anything we can comprehend, chooses to become part of this broken creation, to transform it fundamentally from within.
Hence, in the incarnation, the human dilemma is addressed in such a profound way, that we are confronted with a phenomenon of the uncontainable God, becoming a human being and through this process, in his letter to the Philippians, Saint Paul speaks of Kenosis, Jesus emptied Himself. And the extraordinary thing is that God, the second person of the Holy Trinity voluntarily chooses kenosis, to save His creation, but each one of us is confronted with the fact that we experience an involuntary kenosis.
It is interesting just as a brief aside, to mention that there is a major change in the world’s health situation. By the year 2020 which is rapidly approaching, even sub-Saharan in Africa, where the infectious diseases have been the dominant cause of death, and masses’ suffering, this is being replaced by the diseases of aging, or the so called non-communicable diseases. So apart from war, apart from massive epidemics, the mass majority of human beings now, die as a result of diseases related to the aging process.
This represents a huge challenge, people are living longer and they become weaker to this involuntary kenosis, so we see this in each other, we see our youth fades away, and we lose the kind of strength we might have had ten years before. We are now not that energetic, maybe we may acquire heart disease, diabetes, cancer… these are some of the major causes of death, and the other one that is also rapidly catching up is progressive dementia.
Jane and I had the privilege of visiting Saint James the Persian monastery, few days ago and we witnessed the incredible loving care that the sisters were providing to one of the very much older nuns, who has advanced dementia.
This is the rock upon which our faith in this world rests. This issue of involuntary kenosis of aging, the aging related diseases, is the very point upon which our relationship with this secular world can make a connection.
In my Western culture, and as I see this in Lebanon as well, there is an enormous fear and denial of death; we will do anything, pay any price to doctor…save me… keep me from dying… and yet it will come, it will definitely come. I can feel it in me now! My own death is coming. This is the issue: what will modern man do with this knowledge?...
First of all if he is willing to confront it, he has to say: yes it is coming. For the Orthodox Christians, very simply they have already died, we should not fear our physical death, we have been immersed in the waters of baptism, and we received the living God in us.
If God knows us, like the
wise virgins we will never die!
The Orthodox fathers and mothers always talk about remembering death. When I was young before I became Orthodox, I used to operate a lot as a surgeon, I remembered talking to a colleague, and after an operation we said: “how would you like to die?”… we were just talking loosely as young people would. I said: “I would want to die in my sleep, not suddenly”, but not anymore! Now, I hope I have a long linear illness because I know I have a lot of work to do; I need lots of time to repent. When we encountered this as becoming Orthodox, Jane and I, both as physicians, we had to rethink our whole perspective of medicine.
There is nothing more beautiful than sometimes to be in the presence of someone who is dying, especially if he was dying in faith or peace, real peace. Of course, we are whole persons and for us we wanted to offer what kind of skills or knowledge we had as physicians to try to help address the suffering of the person who was dying, so that he would be able to be prepared.
We work within a holistic model of the person. The person is in the image of Christ, from a holistic medical perspective, we talk about the tripartite, the Trinitarian image: soul, body and spirit, there is the physical aspect of the person, psychological, social, and spiritual. We tried to help even our secular patients who don’t have faith, to understand that they can experience some level of healing even thought they die. The most classical example of this in the Gospel is the ten lepers, who cried to Christ “heal us”, He said: “go off, and be checked by the priests”, they all were healed on the way, or cured of the leprosy, but one came back and actually gave thanks to God, and he was the one who was also healed, not just cured. It is interesting that in the Byzantine times, hospitals were called Ksenodokia, which in the Greek word kseno means stranger; everyone who is sick is foreigner, isolated, separated…
Dr. Jane: Ι want to mention that I have spent 30 years working with our military mental health with mental illness. I think the point Daniel brought up about people who are ill being foreigners or strangers is especially seen with the mental illnesses, they become like the lepers of our society. I really feel privileged being able to work with the mentally ill, and I think they are really God’s special children. What we stressed to our students is that serious mental illness usually needs to be treated with medication, which thank God He gives it to us, and then once they get their mind back in reality then they will be able to grow as people and grow spiritually in their faith. My joy was in taking care of a group of schizophrenic men for 20 years, for medicines, but we would also meet as a group for some months and they would talk about their joys and sorrows.
In every single visit they would talk about their faith and how that helped sustain them. Even with medications some of them still struggle with hearing voices talking to them all the time, but they would pray to God and say help me to discern what the real voices are?. Here are people who really felt their need, and felt God’s presence in every moment of every day. And I even had one man when he heard the voices, he knew some of them were evil but he would test them, saying: do you know the name of Christ, and after a while of testing, evil voices went away so when he would come in to my office, I would ask: "just the good spiritual voices today?". He would answer: "yes", and we knew we were doing well.
So I thank God that I have had the privilege, and the blessing of working with some people that few people know but I think they are the real spiritual heroes that I have met in my life. And my most moment of humility was when at the end of group meeting they would get up, grab everyone’s hands and say a prayer, and they would thank God for bringing them their doctor!...
Glory be to God for everything.
Dr. Daniel
and Dr.Jane Hinshaw.
Dr.Daniel B.
Hinshaw is a professor of surgery at the University of
Michigan School of Medicine. The founding director of the Palliative Care
Consultation Service at the Veterans Administration Medical Center (VAMC) in
Ann Arbor, Michigan, he formerly served as chief of surgery then as chief of
the medical staff at the VAMC. His clinical research interests are focused on
care at the end of life, spiritual distress in advanced illness, and the use of
complementary medicine in the relief of pain. Basic research interests have
included the toxicology of mustard gas and the role of the microfilament system
in coordinating the events of programmed cell death (apoptosis).
Dr. Jane (Carnahan) Hinshaw is
a Clinical Instructor of Psychiatry at the University of Michigan Health
System, and Staff Psychiatrist at the Mental Health Clinic at Ann Arbor
Veterans Administration Medical Center. Her area of special interest involves
psychiatric issues in palliative care.
Drs.
Daniel and Jane Hinshaw have committed their lives to studying and offering
palliative and hospice care not only in the United States, but also in Romania,
Serbia, Uganda, and in Ethiopia.