Sickness

Strangely enough, not everyone believes that sicknesses are real. The philosopher Peter Sedgwick comments that “outside the significance that man voluntarily attaches to certain conditions, there are not illnesses or diseases in nature” (quoted in Beauchamp and Walters, p. 74). H. T. Engelhardt Jr. similarly remarks, “One draws a line between innocent physiological or psychological findings and pathological findings because of particular human values in a particular circumstance, not because of the discovery of an essential distinction” (quoted in Engelhardt, pp. 173-74). So, it is thought, disease, illness or sickness are creations of one’s decision. This view has also been advocated by religious thinkers, notably by followers of Christian Science, although on entirely different grounds. They believe that God is the only reality and apart from God everything else, including sin, sickness and death, are mere appearances. Sickness is an illusion due to our forgetfulness of God. This produces fear, which is the true basis of all illnesses and is actually illness itself. “Take away fear, and at the same time you have also removed the soil on which sickness thrives” (quoted in Barth, p. 365). Jesus’ task consists in freeing humanity from the illusion of sin, sickness and death. This teaching does not stand up to the scrutiny of the Scriptures, which teaches that even though God is indeed the basis of all reality, God is not the only reality. Humankind is also a reality, a different one created by God and loved by him (Genesis 1-2).

Sin, evil, sickness and death are real consequences of our willful disobedience of our Creator, a disobedience that ushers in broken relationships with God, each other and nature. These are tragic realities and certainly are not illusions. We believe with Karl Barth that “sickness is real . . . as an encroachment on the life which God has created” (p. 366). Jesus Christ actually died on the cross to conquer the realities of sin, sickness and death.

Another school of philosophy holds that disease, illness and sickness are not merely mental or social constructions but refer to conditions objectively found in nature. In this view, there is a single unifying characteristic that underlies all diseases and sicknesses: an interference with one or more normal functions. A disease or sickness is a deviation from the normal operation of the human species. This deviation may be the result of congenital malformations (for example, cleft palate, heart defects) or of a hostile environment (for example, bacteria, accident, pollution).

The crux of the matter is to define what constitutes normal. In a relativistic culture, some want to deny an absolute standard of normalcy. Christopher Boorse, who holds an objective view of diseases and illnesses, cites C. Daly King as saying that “the normal is objectively, and properly, to be defined as that which functions in accordance with its design” (quoted in Beauchamp and Walters, p. 93). To Boorse, the human species (Homo sapiens) is designed to pursue a hierarchy of goals such as survival and reproduction; diseases and illnesses are malfunctions that do not conform to the designer’s specifications towards achieving these goals. This root idea of design in relation to disease and illness is consistent with the doctrine of the image of God, which teaches that human beings are created to be God’s image bearer with a definite purpose to glorify God (see Health). So with Barth we view sickness “as the forerunner and messenger of death” and therefore as “unnatural and disorderly”: “It is an element in the rebellion of chaos against God’s creation. It is an act and declaration of the devil and demons. . . . It is neither good nor is willed and created by God at all, . . . but is real, effective, powerful and menacing . . . to the man who has fallen from God and become his enemy” (p. 366).

Sickness as Disease and Illness

So far we have used the words disease, illness and sickness interchangeably. In fact, they are not fully identical. Illness and disease may be thought of as distinct, yet interrelated, aspects of that state of unhealth we may call sickness. We use the term disease to refer to the biological dimension of sickness that can be quantitatively measured through scientific laboratory tests or qualitatively observed through signs and manifestations. The term illness is reserved for the more subjective or psychological dimensions of sickness. In other words, disease is a malfunction or a maladaptation of biologic and psychophysiologic processes in the individual, whereas illness is a personal reaction to the experience of the disease. But this does not mean that they must coexist. Sometimes an individual may complain of feeling ill for which no anatomical, biochemical or physiological malfunction, that is, objective disease, can be identified, as, for example, with adjustment and aromatization disorders. Conversely, some diseases may also exist without the person feeling illness, for example, as with asymptomatic hypertension and atherosclerotic heart disease. Furthermore, an objective disease may, under certain circumstances, be induced by a subjective illness, for example, certain forms of peptic ulcer disease.

This distinction between the objective (disease) and subjective (illness) is particularly important in the treatment of sickness. Western physicians trained in a biomedical paradigm are better equipped to detect and treat diseases than to perceive and address the patient’s experience of illness. While they focus their attention on the cure of the disease, they tend to overlook the patient’s subjective needs entailed by the disease, thus not attending to the patient’s illness. In some cases, the disease may have been cured, but the patient remains ill, sometimes even more ill because of the physician’s failure to recognize the inner personal dimension of the sickness. When a person is afflicted by a disease, it involves more than the particular “diseased” part of the anatomy or physiology; rather, the whole person is affected.

The personal negative feelings may take the form of a sense of physical failure, mortality or despair due to loss of control over one’s destiny. Furthermore, sickness includes an interpersonal and social dimension ranging from assuming a sick role, thus being freed from certain routine duties and responsibilities, to becoming disconnected and isolated from the world in which one lives. A diminished self-esteem is often experienced by the patient. In short, a “diseased” person experiences a loss of both individual autonomy and social interaction. Consequently, a person’s disease may be cured, but unless these dimensions of life are regained, he or she may be unhealed and remain sick both at the personal and social level. It is for this reason we see in Jesus’ healing ministry that he was concerned, not with physical restoration alone, but with restoration of relationships, especially with God (see Healing).

Sickness and Suffering

The distinction between disease and illness also helps us to understand suffering when we fall sick. In becoming ill, we suffer our disease. In the modern Western culture we are profoundly influenced by a utilitarian philosophy committed to maximize personal happiness. As a result we tend to see any sense of “ill-being” or disease as an unqualified evil that must be removed at all cost. But illness is not always as negative as it sounds; becoming ill often serves good purposes. Feeling pain alerts us to the accidental disease of injury and reminds us to attend to it. Without the sensation of pain or the feeling of becoming ill, we would be harmed further. So the illness of pain serves the most useful and necessary protective function for our body. Likewise, guilt may be considered as a form of mental/emotional illness, which warns us that something is wrong and makes us pause in what we may be doing. For many, it is precisely the painful experience of guilt that often is instrumental in leading to spiritual conversion.

In the Bible sufferings, including those associated with sickness, are not something good in itself (Luke 13:1-5; John 5:14). But it falls short of saying that suffering is an absolute disvalue. Suffering becomes an occasion in which people grow in perseverance and maturity leading to wisdom and obedience to God (Hebrews 5:7-9; James 1:2-8). In suffering, people are given the opportunity to cultivate the virtue of contentment, which is independent of the circumstances of life; they experience a joy of victory over the ill feeling (Romans 8:35-37; Phil. 4:11-12). In our sickness we learn to trust and depend on God (2 Cor. 12:9) and renew our appreciation of God’s faithfulness. Often it is in our sickness that we are exposed to and overcome our own self-centeredness (Proverbs 3:11-12; Isaiah 48:10; Hebrews 12:5-11; Rev. 3:1) and gain the new capacity of “compassion” to comfort others (2 Cor. 1:3-5). Perhaps the greatest value of all is that our sickness reminds us of our creaturely limitation and finitude as a human reality, a reality not as an accident of evolution but a reality imposed by God. In our weakness and limitation we are forced to encounter God as our Creator, Lord and Judge, yet at the same time we are given the chance to experience a loving merciful Father, who has given up his Son as our healer. So our sickness is not only the “forerunner and messenger of death and judgment,” but with Karl Barth we may affirm that it is also “the forerunner and messenger of the eternal life” that God has promised to humankind (p. 373).

To see positive value in our sickness and the suffering that comes with it is not to justify them, only to point out the redemptive possibilities in an otherwise unqualified evil. Once we see them from God’s perspective, we may have an entirely different way to deal with our sickness and suffering. In fact, the real test of our commitment to a God-centered life is precisely in how we deal with suffering in our sickness. The supreme example is provided by Jesus in his obedience to God in dealing with life’s sufferings (Hebrews 5:8) and the suffering of the cross (Mark 14:34). As disciples of Christ, we are called to suffer with our Master. As a slave of Christ, Paul considers that his sickness and suffering (2 Cor. 11:23-25) are related to those of Christ (Col. 1:24-26). In the light of the redemptive possibilities of sickness, we are better able to evaluate our experience of disease and illness and should be less inclined to want to get rid of them at all cost.

» See also: Body

» See also: Healing

» See also: Health

References and Resources

K. Barth, Church Dogmatics 3/4 (Edinburgh: T & T Clark, 1961); T. L. Beauchamp and L. Walters, eds., Contemporary Issues in Bioethics (Belmont, Calif.: Wadsworth, 1989); C. Boorse, “Health as a Theoretical Concept,” Philosophy of Science 44 (1977) 542-73; H. T. Engelhardt Jr., The Foundations of Bioethics (New York: Oxford University Press, 1986); S. Hauerwas, Suffering Presence (Notre Dame, Ind.: University of Notre Dame Press, 1986); S. E. Lammers and A. Verhey, eds., On Moral Medicine (Grand Rapids: Eerdmans, 1987).

—Edwin Hui