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Linus Geisler: Doctor and patient - a partnership through dialogue   © Pharma Verlag Frankfurt
Talking about God?
God in this day and age
The doctor as God?
The sick person seeking God
Questions and hopes
Ways and means
To hope for a miracle?
Eternal life?
 
God will wipe every tear from their eyes;
there shall be an end to death, and mourning
and crying and pain...
Revelation 21 v. 4
Talking about God?
Should the doctor talk to his patient about God in this day and age? Yes! Saving or lengthening somebody's life is only one side of the coin. The other side is just as necessary, and the doctor who only sees one side is either half-sighted or half-blind. Kierkegaard was of the same opinion, which he expressed in the saying which at first glance has a peculiar ring: "The fun of saving a person for a few years, is only fun. What really matters is dying in peace."
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God in this day and age
Pictures from the middle ages show us what the hospitals of the time looked like. The patients lay on stretchers in large rooms and were cared for by lay brothers. The priests moved around the hospital, moved towards those who were dying, prayed with them and gave them communion. The doctor only appeared occasionally, and prescribed appropriate medicaments, and when he reached the limits of his medical art, he moved respectfully aside. Such hospitals were like God's refuge, in which the priest presided, and the doctor only had a supplementary side-role.

Bearing in mind that hospitals are always a reflection of the system of society and the spiritual tendencies of the age, the hospital chaplain (although still there) today is only one of many nonmedical helpers and assistants. He is classified (if at all) along with the social worker, physiotherapist or hospital hairdresser. The chaplain is often regarded (especially by young doctors) as a "luxury" (H. Begemann). In any case, he will be delegated the role of psychologist if one is not available. The hospital chaplain as substitute psychologist, and the doctor as substitute priest?

A recent book described patient care in hospital, with details of the various responsibilities of nursing staff, midwives, laboratory technicians, physiotherapists, dieticians, clinical sociologists, occupational and speech therapists, social workers and even librarians. The hospital chaplain was not mentioned anywhere. This raises the question of whether sick people today even have a "need" to consider religious matters. Statistics suggest at first glance that this is not the case. Engelke found that only 5% of dying patients mention religious questions and that only about 5% request religious consolation. If other people are present in the room, the percentage drops to nil. Nevertheless 46% of dying patients ask about the meaning of their illness. Elisabeth Kübler-Ross describes how dying patients go through a phase of bargaining, in which most try to come to some agreement with God. This phase is usually very short, is normally kept very secret and only mentioned, if at all, to the priest or minister. In our day and age, it appears that God is considered less than ever before. Hans Schaefer writes: "We have become an agnostic society, in any case with regard to religious and church faith. We have become a society in which the awareness of increasing danger creates more and more anxiety, and less and less hope." According to Richter, at the end of the middle ages, man, who was no longer sure to have God, began wanting to be God instead. "After the removal of God's protection, the consciousness of the individual's ego is taken as a guarantee of the modern feeling of security." He continues: "The grandiose self-assurance of the ego has replaced trust and peace in God; the individual ego is made the effigy of God." This has brought with it a completely different approach to suffering. Richter calls it the "Concept of projected obliteration of suffering." This takes off from the premise that suffering is basically sent from some external source. It comes from witches, social dropouts, extremists, inferior races, parasites or poisons. This is associated with the illusion: "Suffering would disappear if all of the external causes could be eliminated. Avoidance of suffering is practiced in that suffering continues to be lied about or ignored, with repeated compensation mechanisms, with appeasement, with camouflaging by social techniques. The modern person practices hiding his suffering, a phenomenon which can be seen particularly in the U.S.A., where funeral parlous make up the dead to look as though they were slumbering youths in their bloom. In a fantastic illusion it is presumed that one can manage suffering, if one does not show it to oneself or to others."

Along with repression of suffering, the abolition of God, as well as efforts of man "to be himself God", coupled with a fixation on the dazzling possibilities raised by high-technology medicine, the approach of people to illness has also changed. An atmosphere in which people claim "their rights" will inevitably lead to bitter disappointment, as this is illusionary in many regards. It is propagated that man has the "Right to Health". However everybody knows that "Life is not a court where one can prosecute one's claim to health" (W. Stroh, hospital chaplain). This form of repression of suffering obviously succeeds only superficially, and is inhumane in the widest sense. pascal has already recognized: "Man's greatness lies in that he knows that he is wretched. The tree does not know about its wretchedness."

Suffering however can only be pushed under the surface, and cannot be exterminated by self-deceptive practices. Doctors are available for bodily suffering. But where should one go with problems of the soul, of suffering and dread, which are ignored by the auto-analyzer and electronic measuring devices? If one cannot go to God, why not perhaps substitute gods? Maybe fly to psychologists, psychotherapists, or psychiatrists? That almost everybody in America who can afford it has his own psychiatrist is probably less of an indication that Americans are particularly psychiatrically disturbed, but rather that the focus has changed from an inner to an outer search.
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The doctor as God?
The seed of temptation is laid in the nature of the medical profession, in that the doctor finds that he is regarded as god, or that he becomes like one. As more and more technical power is available to the doctor, he is in increasing danger of being regarded in the role of god, whether or not he is in agreement.

Brent describes this phenomenon in his letter headed "The stress of playing God". "Our unique role in the lives of our fellow human beings places us in one of the most privileged positions in the social order of the world. We save lives and help to bring them into the world.

Recently my life was saved by a lay person after a mountain-climbing accident. The whole event was over in a matter of just a few hours - about the same time that it would take me to resuscitate a patient with anaphylactic shock. I saw my rescuer as heroic - and felt towards him the sort of gratitude I have never before felt toward anyone. I was overcome with anxiety about the proper way to thank someone for this God-like gift. I realized that perhaps others may have been in the same position with regard to me.

Being on both sides of this sort of gratitude has given me insight into my behaviour as a physician in my practice of healing. How does one accept thanks from a patient whose life has been saved?

Some physicians cope with this stress by adopting an omnipotent, controlling directive stance with patients. The God-like approach sets us up to be rewarded for God-like actions or blamed for non-God-like failures. It is a defense mechanism that isolates us and that may prevent warm human interaction. How can we in our profession avoid absorbing these attitudes, when in fact we perform some incredibly helpful, dramatic, pain-relieving and life saving acts as part of our daily work? We are certainly fortunate to have the opportunity to be intimately involved in the lives of our fellow human beings, participating in life and in death. Perhaps the best way to accept thanks from patients whom we have helped is to thank them for giving us the opportunity to help - this may be their greatest gift to us."
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The sick person seeking God
A glimpse behind the facade shows that probably all those who are sick today (as always) are looking for and needing God. Today perhaps sickness is the only one of the very few situations in which a person dares to ask about God. Anxiety is at the root of their search for God. Anxiety is the major, overwhelming phenomenon of the present time, which can be described as the "Age of Anxiety".

In this "age of anxiety", illness, during which the person becomes convinced that his body is irreparably leaving him in the lurch and that life is inevitably drawing to a close, is a particularly profound source of anxiety. The doctor who is prepared to spend time listening is bound to hear the existential questions which lie behind this anxiety. What is the meaning of life and of suffering? Does prayer help? Does God exist? Is there really eternal life? Do miracles happen?

Superficial arguments can not remove discussion of these questions from the competence of the doctor. He should ask himself about the meaning of life, the possibility of miracles and think about life after death, whether or not he is a believer. This is not in order to take on the additional role of priest, but because "caring of the soul" of the patient is deeply embedded in the nature of a physician.
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Questions and hopes
Patients who are seriously ill often confront those around them with two questions, which are associated with both belief and non-belief: "Why does (a loving) God allow this suffering? Why does it have to be me?" 

There is absolutely no indication in either the Old or New Testament that God "wanted" either illness or wickedness in this world. Instead, the Gospels show a picture of Jesus of Nazareth, which is marked by rebellion and battle against illness. There is nowhere in the New Testament in which Jesus explains to a sick person that his disease comes from the depth of God's wisdom, or tells a sick person that he must patiently bear his suffering as God's will. On the contrary, He encouraged the sick to resist their disease. He presented illness, not as something coming from God, but rather as something which was against God's Will.

With regard to the question "Why does it have to be me?" Käunicke (chaplain in an oncology hospital) writes as follows: "Although this question is usually put to the chaplain, when one looks at it closely, it is not theological but rather a general anthropological one. I do not regard this as a typical religious question. It is a completely normal psychological defense mechanism as reaction to a terrible surprise. Obviously the "Why me?" question can raise all sorts of religious attires, in the same way that there are religious variations of it, such as that in the form of the primitive belief in scapegoats. This then becomes: "What have I done to deserve it?", occasionally accompanied by the presumptive picture of a tyrannical god, who storms, and showers the human race with disease. This picture of a furious God sending disease is completely disproves by Jesus of Nazareth in the New Testament. Here is clearly shown that fury causes disease, but that forgiveness releases the power of healing." Käunicke particularly stresses that the religious variant of: "Why does it have to happen to me?" as described above, especially by semi-secular "traditional" Christians with diffuse generalized beliefs is addressed to "an almighty Lord God", who not infrequently is endowed with authoritative traits.

It is permitted to ask: "Why does it have to be me?", but it should not be asked of God. Even Jesus of Nazareth pleaded with God about His fate in the garden of Gethsemane, knowing the horrors which would be inflicted on Him. There is no immediate acceptable answer to the question: "Why does it have to be me?", and it is therefore legitimate for the person of whom it is asked, not to answer it. And it is also important to make it clear that there is no reason to address this question to God and to start a useless bickering and railing against God. On the one hand Jesus tackled suffering with tremendous power. He had pleaded for the sick ("How blessed are the sorrowful, for they shall find consolation", Matthew 5 v. 4), but He accepted His own suffering and death in the name of God the Father ("Surely he took up our infirmities and carried our sorrows, yet we considered him stricken by God, smitten by him and afflicted." Jes. 53, v 4).

Käunicke wrote from his experience as a chaplain in an oncology hospital: "When I talk about this to patients, I occasionally sense how the dogmatic distance shrinks between God and Man, between Heaven and Earth. I, too, can once again pray to a God who knows what it is like to battle for one's life, and is frightened of death. This is somebody who is near me. The supposedly "all-powerful, loving Lord" God who is neither all-powerful nor loving nor, obviously, Lord in the face of real suffering - this God may rotate in his omnipotence wherever he may be. He is distant. However the God that Jesus personified in His Life and His Death; He, whom Jesus was allowed to implore: "Please not me!" in Gethsemane; He, now He, knows what it is like, when one comes to the end of one's life - He is then very close."

Hopefulness is created by this prayer and belief. When I believe that death "does not mean the end", that it does not have the last word, and that I can once again go to where I came from, then it is once more possible to hope. The promise: "Behold! I am making all things new" is the deepest source of all hope. Käunicke describes the sorts of hope of the terminally ill and dying: "One cannot live without hope - but also not die. Such hope can take various forms. Hope that something of me will live on in the children. Hope that I will see again those that have died before me. Hope that the doctors will have learnt from my case, and one day will be able to treat others more effectively. Hope that I will not be alone when I die. Hope that there is no death that can destroy the significance of my life; Hope, that I will be calm soon, and as well as hope that I will always be with God."
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Ways and means
It is usually sufficient just to listen. It may be that the patient only wants the opportunity to formulate questions that are besetting him, such as about the meaning of life, about God, or eternal life, instead of guiltily cloaking them in secrecy.

When nothing else appears to be helping, patients occasionally ask if prayer would help, or perhaps if somebody would pray for them. I answer such questions by saying that I personally am convinced of the power of prayer. I also tell them that we now have scientific proof for the help that prayer provides. The American cardiologist. Randy Bird, previously Professor at the University of California, used scientific methods to examine this question (1985). He studied the outcome of 192 patients in the Coronary Care Unit of the San Francisco General Hospital. This was a double-blind randomized study of prayer support. Throughout the State, intercessors of all denominations (Protestant, Catholic and Jews) were mobilized to pray for the health of patients whose name, diagnosis and condition were passed to them. There were about 5 to 7 who prayed (either individually or in groups) for each patient of the "Verum" group. The findings were astounding. Patients in the group receiving prayer needed significantly less antibiotics (3 as opposed to 16), suffered less pulmonary oedema (6 as opposed to 18), and none were intubated although 12 of the other group required it. Bird, who was also the medical director of the Fellowship for World Christians (FWC) described the results as "providing the scientific proof for that which Christians have always believed - that God listens to them."

Two other American cardiologists A. Kennel (Mayo Medical School) and J. Merriman (Doctors Medical Center, Tulsa) do not regard these findings as amazing. Both pray regularly for their patients and have the overwhelming conviction that prayer helps. Merriman's patients who have been prayed for, on average do better than those for whom nobody had interceded. Merriman quotes the Bible as the grounds for the power of prayer: "Pray for one another, and then you will be healed. A good man's prayer is powerful and effective (James 5, v. 16)." The results of such studies can not convince the non-believer, whereas a believer would expect them. In principle it does not depend on "proving" whether or not prayer helps. There is no doubt that prayer is an extremely effective instrument for hope.

"Hope is expressed in prayer, of course not in all cases, but in the majority." says H. Schaefer. Hope is the strongest counterweight to anxiety. This is because anxiety dreads change, whereas hope allows it willingly. It is probably not possible to live as a person without hope. Goethe wrote to Reinhardt in 1807: "It appears than human nature cannot bear complete resignation for very long." He expounded this further in a letter to Mrs von Stein: "Hope is with those who are alive, without it are only the dead." Nietzsche wrote: "Strong hope is a much greater stimulant to life than any single real piece of luck." Gabriel Marcel said that hope is "probably the very stuff that our souls are made of".

In principle every person is capable of hope. Whether or not he is able to reach the highest degree of hope, that is hope directed towards the beyond (transcendental), is a question of his belief. H. Schaefer: "Hope breaks into the deepest human despair from the certainty of a salvation from the transcendental world. Whosoever loses belief in the power of the divine has also lost the deepest source of hope. Whosoever destroys this belief is sowing hopelessness, and destroys the ability of the person to live." Hope is not something that one has but something that one is (E. Fromm). As one of the most important duties of the doctor is to maintain hope in his patient at all costs, he has to (even when he does not believe) concede his patient belief as a source of hope. This even applies when (for example in dying patients) it is the last form of hope, that is hope against all hope (spes contra spem).
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To hope for a miracle?
In the phases of despair occurring during an illness, a final anchor of being saved can be the thought of a "miracle". This saving anchor can only be grasped when belief in a miracle has not been destroyed. Therefore nobody has the right to disturb the belief of another, whatever he himself believes with regard to miracles.

The New Testament is a rich source of reports of healing which pass beyond the limits of "normal" healing. A report of the healing of a youth with epilepsy is found in Mark's gospel. Jesus answers the skeptical father: "Everything is possible to one who has faith." The father replied "I have faith; help me where faith draws short". (Mark 9, v. 23-24). The healing of the blind man of Jericho is related in Luke's Gospel. "Jesus stopped and ordered the man to be brought to him. When he came up, He asked him: 'What do you want me to do for you?' 'Sir, I want my sight back' he answered. Jesus said to him: 'Have back your sight; your faith has cured you', and he recovered his sight instantly." (Luke 18 v. 40-42).

Purely psychological factors have been shown to induce physical phenomena, proven scientifically. This is seen for example in experiments carried out under hypnosis. If it is suggested to a person under hypnosis that he is touching a red-hot iron with his hand, he will report great pain and show marked redness (sometimes even a blister) at the site of the contact, even if in fact this is made with a rod at room-temperature (G.L. Paul). It seems as if a physiological irritation, which cannot by itself produce a pathological reaction, leads to an abnormal skin reaction, where the perception of this stimulus is "altered" by a purely immaterial factor.

At Lourdes, all so-called "miraculous healings" are documented. This sort of miraculous healing is, as it were, only different from the burning experiment in hypnosis in its course. Whilst in the hypnosis experiment, pathological reactions are produced, there are factors at work in a miraculous healing which eliminate pathological findings, manifest as disease. F. Schleyer has scrutinized 232 cases of miraculous healing at Lourdes. He showed that the majority of the "miracles" could be explained on medical grounds. Nevertheless he discover 33 cases (14%) which could only be described as "unexplained by the usual medical criteria" under the strict conditions of the study. There must be healings which cannot be explained by anything other than psychic influences.

There is also evidence of the opposite phenomenon, in that death is induced purely by spiritual influence. There is a series of well-documented reports about the so-called Voodoo death in tribes. If for example, a tribesman is in disagreement with a medicine man, it can happen that he will be told that he will soon die, and when this will be. Shortly before this time, the tribesman will retire to his hut, and die at the appointed time. Nothing certain has been proven about the mechanism of this sort of "psychogenic death". It has been suggested that the overwhelming anxiety is the primary psychic cause of death (by an abnormal activation of the sympathetic system with ventricular fibrillation?).

The belief and hope of the true believer of course do not require this sort of phenomena as proof. However they can be used as points of discussion for those in a crisis, who perhaps would like to be able to believe once again, but are unable to do so.
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Eternal life?
Thoughts and discussions about last things often lead to questions such as: "What happens after death?" "Is there life after death?" "Does eternal life exist?" The patient can confront his doctor with any of these questions. Philosophers have given answers to these questions ranging from "wishful-thinking", "opium" or "illusion" passing through the "great Perhaps" of E. Bloch up to the unconditional "Yes!" of theology.

The extent of the intensity of the search for eternal life of people today can be seen, amongst other signs, from the fact that books such as that of the American psychiatrist R.A. Moody ("Life after Death") are top of the best seller lists through the world.

It is basically not possible to prove an after-life but as Hans Küng says "nevertheless justified". Küng has described the whole panorama of the historical, philosophical, medical and theological aspects of the question of life after death in his fascinating book "Ewiges Leben?". The most important passage in this book is as follows: "To believe in eternal life means that I must allow myself to trust sober-mindedly, in enlightened belief and in hope which has been tested, that I will actually, once and for ever, be completely understood, free of guilt and definitely accepted and can be myself without anxiety. If I believe in eternal life, then it is always possible to reestablish meaning in my life and in that of others. ... Eternal life: this means being freed, with no new slavery. My suffering, the suffering of humanity is lifted, the death of death has come about..."

At the end of the new testament, on the last page of Revelations, one finds this underlined in words full of promise and of hope, the vision of this other truly new world:

"Then I saw a new heaven and a new earth, for the first heaven and the first earth has vanished, and there was no longer any sea... God will wipe every tear from their eyes; there shall be an end to death and to mourning and crying and pain ... And He who sat on the throne said, "Behold I am making all things new!"

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Linus Geisler: Doctor and patient - a partnership through dialogue
© Pharma Verlag Frankfurt/Germany, 1991
URL of this page: http://www.linus-geisler.de/dp/dp32_god.html
 
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