Posted by: dacalu | 30 December 2012

Dangerous Medicine

I want to start today’s post with a quote often attributed to St. Augustine of Hippo:

“A church is a hospital for sinners, not a museum for saints.”

It’s a lovely quote and I’ve heard it many times.  Alas, I cannot find it in the works of Augustine.  (If you can, please send me the citation.)  Rather, Abigail van Buren (a.k.a. the original Dear Abby) wrote this line.  Regardless, I think it summarizes neatly Augustine’s notion that we cannot definitively separate sinners from saints in this lifetime.  Even the church (pointedly, the church) contains both good and bad people, wheat and tares (weeds) that will not be separated until the end of days.  Further, it emphasizes that even the good face an internal struggle.  The church is a place for people struggling with illness.

It is a wonderful metaphor, but it opens us up to a number of questions that I think need to be addressed for us to take it seriously.

1) What is the sickness?

Sin, certainly, though sin has been constructed in a number of ways.  Let us say, with Augustine, that all suffer from an internal desire to do other than that which is best.  We need not commit to the essential character of Augustine’s “original sin.”  We do need to say that all of us are infected, no matter what place we hold in the church.  This, I think, holds the power of the sentiment.  We must never think of ourselves – whoever we may be: clergy, theologians, pious, … – as the doctors.  We must be fellow patients.

Augustine is actually pretty clear about this in his work, The City of God.  God is the doctor while humans are the patients.  No matter how aware we are of this basic idea, it becomes terribly easy to think of ourselves as physicians’ assistants or at least orderlies, and to some extent we must.  There is treatment going on, isn’t there?  Someone has to administer the treatment.  Here we find a challenge.

2) What is a hospital?

There’s a rather profound difference between what Augustine would have thought of and what Dear Abby would have thought of in terms of a hospital.  In Augustine’s day, a hospital was more likely to be a large facility, mostly filled with sick people who had been separated from the general public, for the good of those inside and outside.  Localizing the ill prevented mass infection and allowed fewer people to see to the needs of the many.  A hospital had many patients, far fewer servants, and perhaps only a a couple doctors with apprentices.  For most people, it was a place to maximize (minimal) comfort for the natural duration of an illness.  In the middle ages, pilgrims and the very poor might stay there as well.  This was the model for centuries.

By the 20th century, a hospital was something very different.  We think of a sterile place filled with medical professionals, whose goal is to cure patients as quickly as possible.  A modern hospital is a place of knowledge and power.  It is a place people go to get better – and then leave.

When we say that the church is a hospital for sinners, we must admit that none of us will be cured in this lifetime – a rather grim prospect.  It’s more like the medieval notion than the modern.  Are we to say that the church provides palliative care?  Are we to say that it provides comfort without cure?  I’m not sure I’m comfortable with that notion, but neither am I comfortable with the thought that the church (in this life) cures people of sin.

I fear that many people, faced with this metaphor, develop an amorphous belief that people in the church are healed of their sickness and move on to become healthy nurses – or even doctors.  To my mind, this notion defeats the central point of the metaphor.

3) What is the treatment?

Like hospitals, the notion of treatment has evolved over the centuries.  I think the Biblical answer, like Augustine’s, would be the “health-giving medicine of penitence,” the idea of regret for past action and the subsequent repentance, or turning away from the wrong path.  Augustine speaks of Justice (to each their due), Prudence (knowing the good from the bad), Temperance (ability to resist bad desire), and Fortitude (ability to keep doing good).  Medicine would have to strengthen one of these, allowing the patient to persist in turning.I can see three prominent treatments in Christian thought, historically:

A) Medicine given to the patient – the sacraments have been viewed, particularly from the Roman Catholic standpoint, as medicine given by God and administered by priests to the sinner.  The benefit of this perspective is that it’s concrete and makes grace both physical and visible.  The downside is that it can be viewed as magical or mechanical – compelling God’s forgiveness, rather than asking for it.  Mainline Protestants have flirted with the idea of sacraments, but without the idea that priests have a monopoly on them.

B) Cognitive therapy – doctrines have been viewed, particularly from the Protestant standpoint, as medicine given by God through scripture.  It’s meant to emphasize God’s primary role as doctor, but invariably is considered to be abused unless one uses it according to the prescription of particular pastors and theologians.  It allows for a very clear distinction to be made between those patients that are “on their meds” and those that are not.  Good for recruiting, bad in that it encourages people to be judgmental of one another – particularly bad in that it attaches correct belief to healing so that your own salvation must be in jeopardy if others do not believe the same way you do.  One of you must be using the meds off prescription.

C) Behavioral therapy – practices have been viewed, particularly from Anglican and Orthodox perspectives, as active treatment.  Much as a doctor might proscribe long walks, so a pastor might proscribe a pilgrimage.  It highlights the human role in healing, but runs the risk of confusing doctor and patient.  It can leave one open to “salvation by works,” which Paul and countless others have derided.  It appears, for good and ill, in Catholic Liberation Theology and Anglican Social Gospel movements.  I would venture it is central to the theology of most Baby Boomers.

I’m not entirely happy with any of these models, but I think we’re stuck with them.  The alternative would be to say that we are not sick.  That’s certainly inconsistent with the Christian message in Paul’s letters.  More to the point, I find it inconsistent with life.  We seek an answer to the unsatisfactory state we find ourselves in.  We want answers and religion attempts to discuss them.  Indeed, if we deny the problem, I think we deny any ability to help people.

Perhaps the greatest challenge faced by the church at the moment is a popular disagreement about how to apply the hospital metaphor to the church.  Many people, perhaps most, believe we really are sick, that the church has the treatment, but that we haven’t been taking our medicine properly.  They want to be more rigorous about trusting sacraments, adhering to doctrine, and doing our exercises.  I appreciate the concern, but the downside is that all three philosophies give the orderlies more power and importance.  Curiously, the authorities promoting each of the three treatments are most disdainful of those who promote the others.

The answer, I think, must be found in the concrete question of who’s getting better.  Which brings us back to the question of whether we’re all sick, and to what extent.  Are we to judge one another, or only ourselves?  I’m not a relativist.  I think there really is sickness and sin.  I am, however, a pragmatist, and I genuinely think that all three treatments help people – but in different doses and different times.

I trust the church.  I think we maintain the balance, because different things work for different people and – most scarily – only the patient can judge whether she is getting better.

Don’t get me wrong.  I must ask whether I want to be more like patient X or patient Y.  I must choose.  I can even give people my impressions on the state of their health, but it is not mine to choose their treatment.  Or is it?

That will be the existential question for the church.  If we are a hospital…

Are members people admitted as patients, or are they members of the staff?

The former has no requirements.  The latter has many.  When we ask questions about what we require for baptism and what we require before someone shares in communion, we are really asking this question.  Do they only need to be patients, or do we require them to be “good patients.”  Again, curiously, there are people on opposite sides.  The dominant position in Anglicanism and Catholicism for centuries has been to insist that Baptism is for everyone (patients) while communion should be restricted to the worthy (good patients).  Alternatively, Protestants have emphasized that only the worthy should be baptized.  For the last century, the liturgical movement has encouraged us to think anyone can take communion (patients), but only the worthy (good patients) should be baptized.  In all three cases, we’ve been refusing treatment to those who don’t promise to use it the way we want.  That sends a very clear message, a message of well doctors and sick patients, a message of monopoly and gatekeeping – and again, we find ourselves defeating the point of the central metaphor.

I’ll be meditating on the answer to this dilemma over the next year.  I think it will turn out the hospital is not the best metaphor to work with.  In any case, we will be forced to deal with the question of who to include.  We will have to figure out whether the church is the collection of people who want treatment, the collection of people on their meds, or the people delivering treatment.  All three I suppose, but the questions that vex us this century –

Who to baptize? With whom to break bread? Who to marry?  Who to ordain? –

These questions can only be answered when we deal squarely with the medicine metaphor.



  1. Lucas, I like the way you organize this idea around that classic line. While it may not be possible to find a full cure in this life, I do think we provide more than just marginal healing. There certainly are people I have met, who by participating in all the aspects of the church, and primarily through their loving relationships with God and others have found a degree of healing from the problem of sin that is truly amazing given the condition in which we find ourselves. The challenge, I believe for the church is to diagnose and prescribe the right medicine for the right people. Some people benefit so much from the sacraments, some from learning, some from actions of love towards others (charity work), some from learning to pray. It seems to me that these various medicines for our common illnesses fit best with certain circumstances but I honestly have very little idea in which cases they work best. That is something that God surely knows, and hopefully, if His church is faithful, we can discern with His guidance how best to treat everyone. Ecclesiologially, I would ask how can we best restructure the church so that people in need of these healing treatments are most likely to receive them in a loving manner?

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