The Meaning of Illness

It’s actually somewhat odd to speak of the meaning of illness as if we were talking about the meaning of some inescapable necessity—such as the meaning of compulsory education, which everyone is obliged to accept, like it or not. For those with a worldview, everything in life has meaning. Paul is no exception when he says in the Epistle to the Ephesians that there is “one Lord, one Father, one faith”: The meaning of all things certainly finds its place within this unity. We can understand nothing outside of this unity. It’s a unity that, for us, is ultimately always meaningful, because it comprehends everything. A person who talks about the “meaning of illness” ought to be able to provide some definition of the latter. Illness is a negative, inasmuch as being sick in the usual sense is a deficit, even when that deficit involves a sort of plus in terms of mass. A cancerous tumor, for example, represents an increase in bulk, but it remains a deficit, because it ties up energies otherwise necessary for health. If, on the other hand, one were to attempt a definition of health, one would also run into difficulties from a medical point of view. For if we had a definition of health we would really know who is healthy and who is sick; we would really possess tools for distinguishing the two things. When a patient turns up saying, amidst half-concealed embarrassment, “I’m just coming to see whether I’m healthy,” his embarrassment often gets communicated to the doctor as well. The physician can do a quick check and ask a few questions: “Do you hurt anywhere? Have you noticed any changes? What is the reason for your visit?” Most of the time, though, this sort of patient comes for deeper reasons having nothing to do with illness. He has no symptoms. The physician asks questions, takes blood samples, x-rays, and, if the patient can afford it, runs a whole series of other tests—only in order to tell him at the end of the process: “You’re healthy.”

A declaration of health, however, is the sort of diagnosis you make when you don’t know what else to say. True, you have not detected any illness, but illness is impossible to rule out with absolute certainty. It follows that health isn’t to be defined in terms of illness. A healthy person is one who can pursue his occupation, who is not hindered by his physical condition, who has a certain normal capacity for work, who doesn’t noticeably diverge from this norm, who sees neither an increase nor a decrease in capacity over a certain period of time. Obviously, seventy-year-olds perform less well than twenty-year-olds, but this doesn’t mean they’re ill, because performance normally falls off with age. So there are degrees and levels of health based on age and sex. Nevertheless, the statement “you’re healthy” is bound up with a certain negative insight for the doctor, even when he is speaking to the best of his knowledge and in good faith. Even if I, as a physician, have conducted a very painstaking examination, I can’t draw an absolutely clear boundary around what I’m calling “health.”

Illness in itself is no abstraction. It goes without saying that one can develop theories, or even build entire theoretical edifices, far from the sickbed. A physician can sacrifice his whole life—small sacrifice!—to investigate some disease or theory thereof without ever coming into contact with patients or knowing anything about actual sick people. The doctor can remove real illness out of sight. Nevertheless, we always associate the idea of sickness with human beings. There’s a unity of illness, which everyone expresses according to his own character. For example, there are diseases with striking symptoms, diseases that look threatening and really are. In some cases, a patient may fall into a prolonged faint—fainting can be an escape mechanism—and his respiration slow to a standstill; those around him, including the doctor, do everything they can to revive him, but their efforts are in vain. And yet he wakes up again after a while and says this is a habitual occurrence. On the other hand, an illness can look harmless: a mild headache, a low fever—a few initial, inconclusive symptoms. It might be the flu, but it also might be indications of a malignant brain tumor. Normally, though, a mild headache and a low fever don’t lead to anything serious, so there is no need to be concerned about the possibility of a brain tumor for the first 9,999 patients. It’s just that we mustn’t therefore discount the 10,000th case. We must be ready to downplay symptoms for the sake of the many while remaining aware of the rare possibility for the sake of the one.

When a person is sick, when he has a real illness that prevents him from exercising his profession, that isolates him from others, and requires special, time-consuming care, he is never sick by himself. He affects his environment—not by making those around him sick, but by obliging them to deal with his illness. This means that, in speaking of the “meaning of illness,” we also need to talk about the meaning of illness for those who are part of the sick person’s life or are otherwise involved in his situation. This meaning is in a certain sense inexhaustible.

We can look at some examples of illness from the New Testament. Take the case of the man paralyzed for 38 years, who waits for someone to bring him down into the pool—until the Lord comes and heals him. Or take the blind man who wants to be brought to Jesus: He hears the Lord is nearby, but the disciples try to stop him. The Lord comes, speaks with him, and he is healed. We see Lazarus. The Lord lets him fall ill. Martha and Mary have asked him to come look after their brother who is in distress. The Lord hears the news but chooses to delay until it is too late and Lazarus has already died and lain in the grave for three days. And then, after all this, Lazarus is healed. Here we see that the encounter with the Lord means healing.

The Gospels, however, contain a lot of very different things pertinent to illness. Consider the episode of the cursing of the fig tree. The Lord is hungry and sees a fig tree, but there are only leaves on it. It’s not an insignificant detail that the Lord has already predicted his Passion three times, that we already see the outlines of his Passion, since we’re just a few days away from Good Friday. And the Lord goes to the fig tree, looks for figs, and doesn’t find any, though he is hungry. And despite the fact that he knows it isn’t the season for figs, he expects fruit and curses the tree for not providing him any. Thus, when the Lord passes by the next day, Peter points out that the tree he cursed has withered to the roots.

When we think of people who are gravely ill, who suffer intensely, who are so engrossed by their illness that they’re no longer capable of any activity, we’re inclined to think: Yes, now is the time of no fruit, a time when—whatever else may be true about it—neither we, nor others, nor the Lord, nor the Church can expect anything from these sufferers. But when we think about the fig tree, we remember that the Lord demands fruit, that the Lord can demand more of our time and our nature than they’re capable of rendering, so that in the laws of supernature he bursts open every law of nature. We thus realize that, if we don’t want to become cursed fig trees, we must bear fruit even in sickness; we must bear the exact fruit the Lord demands of us. This fruit will most likely be found in the way in which we bear the illness itself. A father who has to support a family already finds it difficult enough that he can no longer live by what he earns, that he no longer receives a salary, that some illness prevents him from making a living. The sacrifice is one of time, and it’s often intensified by pain, by the look of a world seen through the lens of sickness, by the progress of the disease itself.

The foregoing raises a question: What can we—as doctors, carers, family members, fellow patients, visiting friends, and members of the Church—do to help the sick bear the fruit that is asked of them? Is there something we can do to help the sick man himself get to the point of bearing fruit? Or is there something we must do in order to produce a fruit ourselves through the patient’s illness? We see in may cases that patients may be willing to put up with their sickness, to bear it as a required sacrifice, but, when it comes to their family, they can help produce a fruit only by their commitment to suffering in patience. Everyone sees how they act, everyone is called to stop and think about the meaning of what’s happening, which he feels concerns him personally. It’s as if illness itself had become a call, a call to think about meaning, a call to discover this meaning and remain within it.

Now, the two greatest fruits of illness undoubtedly consist in the fact that everyday life gets burst open, that all the relations that have grown more or less stale acquire a new keenness, inasmuch as they become the object of a reflective search for meaning. They present themselves with new force: The sick person is suddenly a new gift, people are concerned about him because they realize what he means to them. He gets a new value. New only because we reflect more deeply on the meaning of things, because we refresh our relations, because we see that something is happening that touches the very core of our being.

At this point, a question arises as to the role the doctor is called to play in the whole business: How large should it be? In the past, there were fewer scientific techniques available for treating the sick. Physicians had an entire system for assessing various symptoms. They could read these familiar symptoms by looking at the face, the hands, and so forth. The procedure is quite different today. When someone is really sick, he is examined scientifically. He, or else parts of him—blood, water, and so forth—go through the lab. He may be repeatedly x-rayed or imaged. The doctors reconstruct an entire clinical history. And the result is a case file with so-and-so many blood tests, measurements, reactions, and so forth. Everything gets read together in a single narrative, but it’s as if the patient himself were a secondary character in the resulting assessment. The symptoms of the disease, or what the doctors can grasp of it, has taken center stage.

Is it possible to bring the two things into some kind of unity? Can we unite direct observation of the patient himself with the procedure of extracting diagnoses from dead material? Up to a certain point, yes. But the doctor has less time today than in the past, even as he needs more time in order to stay up-to-date scientifically and to make scientific use of laboratory results. This is time that, in the end, is taken from the patient. There’s a growing tendency today to delegate all the lab work to a staff of trained non-physicians; once the preliminary work is done, the doctor can quickly read over the results and so spend more time at the actual sick bed. I believe that this tendency to spend more time with the patient, as opposed to treating his illness as something independent of him, though without neglecting the scientific side, will continue to establish itself more firmly.

Let’s say I’m looking at two x-rays of intestinal TB on the same day. I see the same ulcers and the same blood sedimentation rates. My inclination will be to speak of two similar cases, and I’ll be reinforced in this opinion if I find out that both patients have been sick for two months. But even though I see the same symptoms in the images today, I’ll be looking at two completely different cases in two months’ time. I’ve happened to capture the cases when they’re at the same point, but this point doesn’t yet tell me anything about their development, or about which patient will die and which will live. For that I need more than average values on a given day. I need observation of the whole person.

In America it’s become customary to send people to ten or twelve laboratories before they even see the doctor. This can be taken to absurd lengths. It can get to the point where the human being is cut up into pieces, where he no longer has anything to do with the process at all. And yet every measurable reaction belongs to an actual human being. An optimist gets over the flu much quicker than a pessimist because he doesn’t let it get him down.

The word “reaction” is the second word of medicine. How does the patient react, how does he respond? We typically think here in terms of medicines and techniques, but we have to ask: How does the patient respond to the illness as an invasion of his personal life, how does he answer the call of sickness? As Christians we’re convinced that every illness implies a call and imposes a decision—not in the sense of an attempted cure, but in the sense of deeper choices. For many people, illness represents the first opportunity for deeper thought about meaning, or the first encounter with faith, or the first chance to glean some meaning from their life. The reason isn’t just that they have been called, or that they have gained insight into the fragility of life, or that they’ve entered a season of deeper reflection. It’s also that their illness has introduced them into the community of the sick. I’m not speaking here primarily of the community formed in the hospital ward, or of a common life based on shared illness, or of a doctor’s community of patients. I’m thinking instead of the essential community of the sick, which is a community within the Church. The Church prays for the sick, remembers her sick members, and embeds them in the treasury of prayers. And when a patient has experienced this in his own life, when he knows that he is not alone even in the greatest solitude, he feels called to answer, not just by recognizing the existence of the community of the sick, but also by becoming a member of it. When you talk to patients about this—as you always do when they’re seriously or chronically ill—you’re repeatedly moved to see how struck they are when they realize that they’re not forgotten, that the Church provides a space for them, that their illness may be a stimulus to prayer, that someone unknown to them may like to pray for people suffering from lack of health, and, thanks to this joy, this unknown person becomes grateful for his own health and feels drawn to the community of the suffering.

No believer who talks about suffering can simply leave it at that. He knows that every life is bound up with the Lord’s suffering, that every suffering gives the other a chance to help shoulder the burden, that every experience of deprivation brings the occasion for a new gift of surrender. When God takes health from you, when he withdraws a certain possibility of action, when he uproots you from everyday life, he doesn’t do so simply in order to take. He also wants to give. So let us give as well—give what he expects, even if it’s not something he plans to take away.

The foregoing has touched on a few main points. Be aware that there is a whole range of questions here, none of which we have treated exhaustively. We’ve merely tried to suggest some perspectives, a few possibilities for gratitude, ways of getting involved and helping in a personal way—directly as a doctor or nurse and indirectly through prayer. And when you are active in the profession, even more: when you live your whole day with sick people, you get used to giving your thoughts a personal turn. Doctors all speak differently, even when they believe the same thing.