Presidential address from Prof. Jim McManus

Resourcing for Mission, Witness and Dialogue

A reflection on the Charism of the Guild of Health and St Raphael

 

Jim McManus

Jim McManus is President of the Guild of Health and St Raphael, and this is an extended write up of his first presidential address to the Guild AGM on October 16th 2017

 

Crossing disciplines to grow God’s people

It’s a great honour and privilege for me to be asked to become the President of the Guild, and a greater honour to be invited to address you at your AGM, and share fellowship and worship with you. I hope to be of service to you as the Guild continues its important work. This has prompted me to reflect on the Guild, and the issues facing it.

As you’re aware, I’m a Catholic, working in Public Health for my day job and working across disciplines of psychology and public health. So there will naturally be something interdisciplinary about what I have to say, and also some of this will be quite Catholic.  I say this not because I think what Roman Catholicism has to bring is better than any other Christian denomination, I want to say that I think it is different, and complementary to what others bring.  It is my hope that the Guild will continue to be a place which offers Christian insights “from all our best traditions” as the hymn goes, to a world which needs it and to a church – institutions and peoples – which more than ever needs to rediscover the importance of its Mission here. The reflections I share in a dialogical “this is how it is with me, how is it with you?” spirit, rather than a purely confessional one. Equally, if my perspective seems very Catholic at times, it is done in the intention of bringing a contribution from my tradition to the enormously valuable contribution of the other traditions already engaged in the Guild.

My reflections suggest to me that the task, and opportunities, facing the Guild also cross disciplines, and are neither purely theological nor purely policy nor purely scientific. They are multi-disciplinary. There is a theological, pastoral and biblical dimension to the opportunities. There is a public advocacy task. There is a scientific task. And there is an organisational and leadership task.  I believe this is a Kairos time, a moment of opportunity for the Guild to identify its Charism and work to this. And I want to suggest to you what those might be. It will become apparent that I take as implicit the need for the Guild to be a place which crosses disciplines and helps others to do so. As a recent editorial in Nature[1] identified:

The best interdisciplinary science comes from the realization that there are pressing questions or problems that cannot be adequately addressed by people from just one discipline. Witness the gathering of the scientific tribes — and the merging of approaches — for the Manhattan Project to work on the atomic bomb. More recently, Nature has reported on ‘implementation science’, which combines medical expertise with local knowledge on how best to carry out programmes to improve public health.

An interdisciplinary approach should drive people to ask questions and solve problems that have never come up before. But it can also address old problems, especially those that have proved unwilling to yield to conventional approaches

To give away my whole point, the summing up of my reflections is that through the use of different methods and dialoguing of different disciplines, the Guild is well placed to help rediscover and discover for the first time a Biblically and Scientifically informed vision of health, resource a praxis which helps us achieve this, and thus equips church and world to grow the Kingdom. And this is its Charism. That Charism breaks down into various elements.

But first I need to explain what I mean by Charism, and the background to why this Charism is needed.

The nature of Charism

Mary Healy subtitles her book on Healing[2] as bringing the Gift of God’s Mercy to the World.  I believe this is a good summary of what the Christian calling on health and health care is – participating in bringing the vision of being healthy and fully human into reality for as many people as possible, precisely because it is the gift and desire of a God who loved us, made manifest in the person and work of Christ.

This book rewards close reading, not least because it has an entire chapter on the Charism of healing. Some Christians talk about Charism as being the gift of the Holy  (1 Cor 12) Spirit given to someone for building up the Church.  Catholics talk about Charism in an organisational sense also, the particular Charism or unique focus or gift of an organisation or a religious order or agency, for example, in its work of building up the Church and, importantly, the world. Charisms of organisations in Catholic senses serve not only Church but world as an important contribution to the Mission of Christ.

Charisms are particular gifts, says Healy, reflecting on St Paul (1 Cor 12), and are “manifestations of the Spirit” (p114.) She also reminds us that if we seriously want the Charism of Healing we also need to ask for the Charism of Humility.

Coming to the work of health and healing, I think the Catholic dual understanding of Charism has much to offer us. First, at an individual level, there are those who will have the Charism of bringing healing, and others who have different charisms, like insight, administration and so on. These are all important for the life of the Church and the Mission of the Guild. But I don’t intend to dwell on them here in detail, even though as Christians we really need to develop a clearer and more nuanced appreciation of the Charism of Healing and the whole issue of praying for and seeking Healing which we can celebrate.

I want here to focus on the organisational sense of Charism. While the words “unique selling point” capture some of it, the dimension of “what specifically does this organisation, as opposed to that one, have to offer”, that isn’t enough. By organiational charism of the Guild I mean where in the ethos, self-understanding, gifts, witness, tradition, insight and mission of this organisation can we discern the specific work of service God has equipped and invited us to perform, here and now, in this context?  What are we here for?  And what does that mean here and now?

A specific Catholic organisational understanding of Charism repeatedly asks and re-discerns this question in changed circumstances. The Benedictine Charism, for example, is not about having monasteries. It is about Balance, balancing work with prayer (Ora et Labora).  The Charism of the orders founded to heal are about care, healing and care for those who can be cured as well as those who cannot.

So the Guild, I believe, has a Charism.  And I believe also that this is a particular time when the Charism of the Guild is needed in our British context as never before. Before I get there I need to set the context of a Christian contribution to Health and Health Care.

 

The Nature of health and health care: A Christian take

I think we are, once again, in a time of crisis in Health Care, which needs the insights which Christians can bring.  We see continuing fragmentation in provision of health care, and there remains a stubborn social gradient in that those most vulnerable and poor have worst life expectancy and health experience, and those best off are best placed to benefit from the public services established for them. The ongoing work of the Institute of Health Equity under Sir Michael Marmot’s direction is just the most recent demonstration of a stubborn reality[3].

The imperative for healthcare and the access to the means of healthcare have been argued cogently by John Coggan[4] as an important moral and philosophical issue, as a public good. His nuanced arguments and conclusions deserve more thorough coverage, but among them he makes the point that health and healthcare is a moral concern, precisely because it concerns our public good. But this has been argued theologically in many places too[5]. And seeing health as a public good need not mean we take a utilitarian approach, as some francophone theological work on this has pointed out.  Virtue ethics, a focus on the person in social context and a focus on our shared duties and responsibilities to each other in solidarity have promise which a purely utilitarian model of health ethics and policy does not[6].

At the same time, the increasing instrumentalisation of health and healthcare is being challenged both in practice and in scientific discourse as leaving out the integral nature of the human person[7]. Health is not about curing bodies. The human being cannot be compartmentalised. Even though our British model of the National Health Service sometimes sees significant benefit from this in terms of dealing with the problem, too often we are still not good enough at working with the person.  At the same time, the World Health Organisation’s oft-stated vision of a state of complete and total wellbeing – physical, emotional, psychological and spiritual – is recognised by Christians as eschataological and aspirational rather than reality. All the more reason for us to engage in our efforts on this.

We need a better discourse on what Health and being healthy means. And for my money we as Christians have much to offer here.  Health involves the flourishing of the whole person, including spiritual aspects. That much is well recognised by the scientific work on the biopsychosocial model of health[8]. The theological insight which leads to this conclusion is being increasingly restated[9],[10].  Much of this recent discourse leads us to the conclusion that Health is found in a satisfactory response to the realities of life that help us live, as much as possible, in balance, in other words, to flourish despite our limitations and challenges. Wellbeing is as much about flourishing interpersonally, psychologically, spiritually and emotionally as it is coping with the inevitable physical issues which befall our bodies.

The benefit of this type of insight – health as response to reality which enables us to function as well as we can –  is that it can put paid to the damaging anthropologies and theologies which see disabled people or people with mental health issues as broken or less than human.  Yet we have to often put the person in the “sick role”, famously identified by Parsons[11] and the term “sick” remains too often applied in Church discourse and theology.

Despite the fact it uses the term “sick”, the Catholic insight that “ the Church not only welcomes the sick as recipients of loving care but also recognizes that they are called to live their human and Christian vocation and to participate in the growth of the kingdom of God[12]” is a call to remember the Christian vocation to flourish ourselves, and help others to do so. Far from putting others or ourselves into the “sick role”[13] the Christian insight is they have a special closeness to God and are a gift to us – the gift of challenge and opportunity to live our commitment to human flourishing.

Accepting our humanity has limitations and learning to live within that in its dimensions is a different conceptualisation of wellbeing than the view that to be healthy everything must be perfect.  Those of us who have lived through serious or life-threatening illness (I speak here from experience) may have a glimpse of this. And for me, certainly, my experience of a Stage IV cancer brought as much gift as it did challenge and pain.

Luigi Maria Epicoco in his short but profound work Only the sick recover, has much to tell us about what he terms the call to authenticity , one dimension of flourishing – and this needs to be spiritual and interpersonal as well as physical[14].  

In this context, Jonathan Pennington’s recent book The Sermon on the Mount and Human Flourishing[15] deserves close reading and prayerful reflection. I believe it is a book which has come just as we need it. Pennington (pp 289-310) shares six key insights with us on. I quote these (with his capitalisation), and my summary/paraphrase of what he says, below:

  1. The Bible is About Human Flourishing. I take this to mean as Christians we need to be about Human Flourishing and this is public as much as internal
  2. The Bible’s Vision for this is God-Centred and Eschatological – for a Christian full flourishing can only come about in relationship with God
  3. The Moral View of the Bible is a Revelatory Virtue Ethic – I take this as saying God reveals to us what we should be like, and Christian Tradition is an attempt to embody that. Being humans, we need to constantly be recalled to that because we fall away
  4. Salvation is Intexricably Entailed with Discipleship/Virtuous Transformation – transformation of heart, faith in Christ and service to God’s creation are all inextricably linked
  5. Virtue and Grace are Compatible, Not Opposites – grace and human ability must work together for good
  6. Biblical Human Flourishing Provides Crucial Insight into the Meaning and Shape of God’s Saving Work – reflecting on this shapes our engagement with the Bible, God and God’s world.

So, we need to rediscover and refocus the Christian lens of flourishing to look at health and our healthcare system.

Let me say here that as a Christian, we have a right and an obligation to develop a Christian reading of the Health System. Our right comes from being citizens who use and pay for the system. Our obligation comes from the fact our calling and faith is by definition a calling and faith to and for God’s world, a public faith. A Christian reading of our health systems, and our social systems, need to be geared not only for physical cure and recovery where possible – and supportive care where not – but to help people retain and recover their whole person authenticity in the face of their experience, to flourish as much as possible including and beyond the physical. It is a commonplace that – for serious matters at least – care must be multidimensional if it is to be effective, the experience of working in end of life care alone confirms this.  Pennington’s six-fold thesis on flourishing should cause us to read the Church and the Health system in the Biblical light of flourishing.

The Church and its mission: ecclesiology meets health policy

Modern health care needs the enduring Christian witness that the person is more than body, that health care is more than physical or dealing with merely the organic aspects of mental ill-health and that health is about adjustment and authenticity, finding and living in a balance which contributes to our flourishing, and that of others. Health is public and social, it is interpersonal as much as it is personal and private. A detailed reflection on the work of Jesus in the scriptures make clear that this is so[16].

So the Church needs to recover what it means to be a place of healing, fostering authenticity and living in reality in a way that we flourish and find balance as much as possible.  This is a serious calling for the Church, and it should be a calling we expect our health systems to work to.

The Church has a lot of work to do to put its house in order for doing this. Hans Zolner writes of the need to address the tremendous spiritual and physical violence done by sexual abuse in church settings if we are to live our vocation to care, love, include and heal[17]. In this 500th anniversary of Martin Luther writing his theses, the call to be always reforming is a call to remind ourselves that we need to always work to be places of healing, refreshment and safety. As the famous attribution to John Henry Newman goes, “there is nothing on this earth as ugly as the Catholic Church, and nothing so beautiful’.

The ecclesiology of many theologians including Barth and Balthasar that the Church is both called to redemption and sinful and wronging at the same time should inform our Christian witness in health and health care and make us focus strongly on genuinely making Christian communities safe and healing places where people can find the authenticity of which Epicoco speaks.

That has several profound implications. First, we need to acknowledge our own imperfections and need to work to achieve being healthy. Second, we need to rediscover the fact that this call is part of our call to discipleship, and requires us to work at this.  Third, we need to focus ever more on Christ the source of our mission. When Pope Francis said the Church is a field hospital not a community of the perfect he was issuing a deep call for us to acknowledge our limitations and work with and through them. Fourth, we need all the help we can get – every possible source of grace from sacrament to mutual service and correction.

All of this might drive us to the conclusion that we have no right to speak, since we are not perfect. I reject that entirely. We should speak into the public sphere on health, health care and access to it because it is a public good, and the Christian faith is a public faith, not a private one. Jesus himself called us to share in his ministry of bringing life and healing to all.  We have every right to speak publicly to this issue because we have insight which can serve others.  We have every duty to speak publicly into this issue because we have insight which can help and heal. We have every duty to speak into this because we were here first – much health care and arguably much social care came about as part of the ministry of the church historically[18].

And there is another reason, the health system itself is in the same place Newman placed the Church – beautiful and ugly, functional and broken, healing and harming. Any serious organisational study of health policy makes that eminently clear[19]. This means we can speak from a similar place as a Church system, into a health system in the same boat.

 

Confidently discerning our Charism

As a Catholic, I have just emerged with the Church from observing a year of Mercy, which has recalled the Church to its mission of service to humankind. There is no coincidence that one strand of what is termed the movement for New Evangelisation in the church explicitly sees this in terms of service to humanity, showing our values by living them out in service to others, coming from two fundamental insights: human beings are precious to God, they have great dignity, and it is a participation in the ministry of Christ to serve their health and flourishing.  This much is recognised officially by the Church in the re-issue early in 2017 a new Charter for Healthcare Workers[20] , originally issues in 1995, which explicitly sets out the vocation of Christians to engage in healthcare as a direct participation in the Mission of the Church and in turn this is part of the Church’s participation in the Mission of Christ.

Sadly this new Charter is only available in Italian. As a Catholic I come from a rich heritage of religious orders founded to provide healthcare, and at the same time it often feels like there is a limited understanding of the theology of health and healthcare around in the Church. But it prompts us to recover the riches of Catholic traditions: the saints who were agents of care, the saints and founders of religious orders of nurses, doctors, carers and healers; the care institutions of Catholic foundation, and the orientation which a fundamental recognition of human dignity brings: everyone has a right to the means to life and health, and we also have a responsibility to ourselves to seek that.  For Catholics, the thing we call the Sacrament of the Sick is rendered utterly pointless if we are not living out what that Sacrament offers in service, witness and discipleship. Moreover, the Sacrament of the Sick was never intended to be for the individual, and the rebasing of extreme unction after Vatican II brought us back to the Catholic insight that it is intended to be for the person and their loved ones and church family[21]. It is a communal celebration, not an individual one[22]. Health is communal as much as individual[23]. Rediscovering what we have forgotten about liturgy and health remains a key task for us[24].

The Charism of the Guild today

So, given what I have said about the task Christians are called to being i) re-claiming healing and health as being multi-dimensional, ii) of reclaiming health as being about adjustment to reality, iii) living as wounded healers seeking balance, iv) speaking into a world which forgets this and v) calling and needling a Church which forgets or sometimes even betrays this, what can we say are the specific Charisms of the Guild?

I believe the Guild is called to a threefold Charism to help Church and Society recall what it has compartmentalised or forgotten. And I believe that falls into three dimensions:

  • Mission and Witness
  • Dialoguing
  • Resourcing

Each of the three dimensions I believe has three constitutive elements, at least. They will, necessarily, overlap. But let me tabulate them here:

Dimension

 

Elements Explanation
Mission and Witness Evidencing – creating, collating and sharing the evidence for our insights from all relevant sources Evidencing the links between faith and health, and the need to avoid compartmentalising the human. Evidencing the nature of the person
  Discussing – discussing evidence and insight with a range of partners inside and outside the church and health systems Discussing through various media (events, publications, social media and so on) the insights of the Guild with as many dialogue partners as possible
  Healing – exemplifying and encouraging a Christian understanding and praxis of healing in all its forms, true to Scripture and Tradition, guided by the Spirit

 

And providing that space of refreshment and healing to members too

Evidencing and exemplifying healing and its various dimensions to Church and world. In particular, exemplifying the nature of the wounded healer –we are in the same boat as those we serve
     
Dialoguing Faith and Health: Faith and Health are compatible, not competing, dimensions of human existence A place for dialogue at scientific, practical and theological levels between Faith and Health in all its dimensions
  Faith and Science : Faith and science are compatible and complementary

 

A place for similar dialogue between Faith and Science,
  Scripture, Tradition and Science: Working between and across these disciplines and insights to elucidate each other and build insights Fostering work which helps people across all disciplines, and especially the Church and Christians working in health,
     
Resourcing Practice and Praxis[25] – encouraging a genuinely theologically and scientifically informed praxis

 

Resourcing people through a range of methods from training to informal learning, publishing and hosting discussion, dialogue and encounter

 

  Theology – facing Church, academy and world Constructing a theologically rigorous reflection on health, healing and flourishing which can be taken and used by others, supporting theologians at all level of living and doing theology whether as practice or academic exercise.

 

  Science – facing Church, academy, world and health systems Encouraging and fostering scientific rigour and resourcing scientists at all levels to enter meaningfully into exploration and elucidation of faith and health

 

It is I hope clear that an essential outlook and methodological dimension to all of this is the interdisciplinarityof which I spoke earlier. Human experience and human flourishing, if it encompasses physical, spiritual, interpersonal, emotional and other dimensions, cannot be encapsulated or elucidated fully by just one discipline.  In fact, the more we reduce health to one discipline, the more we lose practically and scientifically and the more impoverished our anthropology – our understanding of the human – becomes. More than one recent criqitue of our intellectual life has pointed out the need to combine disciplines to gain better insight[26]. Prof Ken Robinson says, ‘Creativity depends on interactions between feeling and thinking, and across different disciplinary boundaries and fields of ideas’

I said above that the summing up of all this is that through the use of different methods and dialoguing of different disciplines, the Guild is well placed to help rediscover and discover for the first time a Biblically and Scientifically informed vision of health, resource a praxis which helps us achieve this, and thus equips church and world to grow the Kingdom.

I believe living out this Charism is much needed. I believe that God is calling us to live this Charism because the Church, the world, and most importantly, God’s people, are in need of it. It will contribute to the growth of the Kingdom. I would welcome your take on our Charism, and what you feel my role should be, over the next three years, in helping us get there.

 

 

 

 

[1] Mind Meld, Nature 525, 289–290 (17 September 2015)

[2] Healy, M (2015) Healing: Bringing the gift of God’s Mercy to the World. Hungtington, Indiana: Our Sunday Visitor Press

[3] http://www.instituteofhealthequity.org/

[4] Coggan, J (2012) What makes Health Public? Cambridge: Cambridge University Press

[5] Benestad, J B (2017) “Foundations of Authentic Medical Care” in Travaline, J.M. and Mitchell, L. A (Eds) Catholic Witness in Health Care: Practicing Medicine in Truth and Love . Washington DC: Catholic University of America Press pp 3-30

[6][6] Muller, D (2006) “La sante. Emtre bien public et bien prive” in Boitte.P  and Cobbaut, J Bien commun et systemes de sante. Paris: Editions du cerf pp145-159

[7] Thiel, M-J (2006) “Le movement de medicalisation de l’existence humain” in Boitte.P  and Cobbaut, J Bien commun et systemes de sante. Paris: Editions du cerf pp87-118

[8] Havelka M, Lucanin JD, Lucanin D.(2009) Biopsychosocial model–the integrated approach to health and disease. Coll Antropol. 2009 Mar;33(1):303-10.

[9] Philibert, P J (1998) “Transitions in the meaning of health and health care: A first world perspective” in  Illness and Healing :Concilium 1998/5 . London: SCM Press. Pp1-7

[10] Colosi, P (2017) “A Catholic Anthropology and Medical Ethics” in Travaline, J.M. and Mitchell, L. A (Eds) Catholic Witness in Health Care: Practicing Medicine in Truth and Love . Washington DC: Catholic University of America Press pp 31-69

[11] Parsons, T. (1952) The Social System. Glencoe, IL: The Free Press

[12] Congregation for the Doctrine of the Faith (2000) Instruction on Prayer for Healing . Rome: Libreria Editrice Vaticana

[13] Mitchell, E (2013) The Sick Role. NHS England Blog https://www.england.nhs.uk/blog/ed-mitchell-2/ Last Accessed 1 November 2017

[14] Epicoco, L. M. (2016) Soli I malati guariscono Milano: San Paolo

[15] Pennington, J. A (2017) The Sermon on the Mount and Human Flourishing. Grand Rapids: Baker Academic

[16] Henriksen, J O and Sandnes, K O (2017) Jesus as Healer: A Gospel for the Body. Grand Rapids: Eerdmans

[17] Zolner, H (2017) “Le ferrite spirituali causate dagli abusi sessuali”  La Civilita Cattolica, 40/17, pp244-254

[18] Avalos, H (1999) Health Care and the Rise of Christianity. Peabody, Mass. Hendrickson

[19] Reisman, D (2016) Health Policy: Choice, Equity and Cost : Cheltenham: Edward Elgar Publishing

[20] Pontificio Consiglio per gli operatori sanitari (2017) Nuova carta per gli operatori sanitari. Rome: Libreria Editrice Vaticana.

[21] Larson-Miller, L (2005)  The Sacrament of the Anointing of the Sick.  (Lex Orandi Series) Collegeville, Minnesota: Liturgical Press

[22] Kendiza, M. C (2012) Catholic Update Guide to the Sacraments of Healing; New York: St Anthony Messenger Press

[23] Baudasse, P (2008) Maladie: un autre regard. Paris: Editions du Jubilee

[24] Morrill, B. T (2013) Divine Worship and Human Healing: Liturgical Theology at the Margins of Life and Death. Collegeville, Minnesota: Pueblo Books/Liturgical Press

[25] Trokan, J (2013) “Models of Theological Reflection: Theory and Praxis” Catholic Education: A Journal of Inquiry and Practice Accessible at http://digitalcommons.lmu.edu/cgi/viewcontent.cgi?article=1032&context=ce Accessed 2 November 2017

[26]Robinson, Ken. 2011; Out of Our Minds; Capstone.