A theology of healing for contemporary South Africa -a phenomenological and multidisciplinary...

P a g e | 1

A theology of healing for contemporary South Africa -a phenomenological and multidisciplinary approach

A Research Paper presented to St Augustine College of South Africa in partial fulfilment of the

requirements of the degree of Master of Philosophy in Theology (Specialisation in Fundamental

and Systematic Theology)

by Kerrigan McCarthy

Student No: 2008/036

8th July 2014

P a g e | 2

Declaration of originality I, Kerrigan McCarthy, hereby declare that the Research Paper I have submitted is:

a) my own unaided work;

b) no substance or any part of it has been submitted in the past or is being or is to be

submitted for a degree in any university;

c) none of the information used in the Research Paper has been obtained by me either

while employed by, or working under the aegis of, any person or organisation other than the

College.

Signature……………………………………… Date………………………

P a g e | 3

Dedication and acknowledgements

To Pam Durrant To Godfrey Henwood

‘And so long as you haven't experienced this: to die and so to grow,

you are only a troubled guest on the dark earth.’ ― Johann Wolfgang von Goethe

It is with pleasure that I dedicate this dissertation to Pam and Godfrey. In your attentive, dispassionate care for me, you have each observed my ‘death’ and growth, my transformation from ‘troubled guest’ to ‘Beloved Child of God’, as I have grappled to make sense of the mystery of my own healing journey. Thank you for living out your vocations. I hope that you will consider this work in part, a fruit of your vocation. Of course there are a number of persons to whom I owe gratitude for their direct input into this work: Thanks to Jennifer Charlton, Anne Wright, Rodney Moss, Jane Goudge, Natalie Simmons and David Spencer for reading earlier versions or parts thereof, and for making insightful comments and helpful suggestions. Thank you to Paul Germond for getting me started on the journey. Thank you to my supervisor, Stuart Bate for drawing my attention to the central role of sin and grace in healing. Your encouragement and discerning insights equally contributed to the transformation of this manuscript from an academic exercise to a work that speaks to my own healing journey. Thank you for your ecumenical spirit, willingness to share your time and passion for Jesus with me, and for your efficient, committed supervision. At a more general level, I owe a debt of gratitude to others - the lecturers at St Augustine College for truly educating me (MBBCh is merely a technical apprenticeship!) and Chrissie Thorn who has helped me to negotiate my way through the College administrative system; the Religious at Nazareth House and Sr Mura, who have taught me the meaning of generosity, sacrifice, and vocation; the staff and patients of the Nazareth House Hospice and Clinic who have allowed me to participate in their healing, in as much as they contribute to mine; the Anglican Church of Southern Africa, and the community of St Thomas, Linden for opening my life to the joy of sacramental worship, and liturgy; my medical colleagues and friends who have been ‘victims’ of my enthusiasm to share my new perspectives on Western medicine!; my parents Terence and Erna, and brothers Andrew and David - thank you for imparting a robust intellectual rigour, and for honing my powers of critical thought. Finally, thank you to my daughters Gemma and Carys who have given me up to books, papers and my laptop on too many occasions – thank you- it is for you that I have persevered on this healing journey. Kerrigan McCarthy Feast of St Thomas, 3rd July 2014

P a g e | 4

Abstract In our 21st century South African society influenced by Western medicine, African Religion and

Christianity, a multiplicity of meanings of illness, suffering and healing simultaneously co-exist.

This multiplicity of meaning can create confusion for Christian persons who become ill, or

Christian caregivers (doctor, nurse, minister or lay-person) alike. A clear theology of healing will

allow us to respond to illness and suffering with integrity of thought and praxis. In this

dissertation, I construct a theology of healing that draws from traditional sources of theology

(Scripture, Church Tradition and practice), and also from resources present within Western

medicine and African Religion. At the outset I define healing by situating it within a conceptual

framework that includes the ecosphere (representing health), anti-life forces (representing

illness), suffering (representing an aspect of illness) and healing – the transition between illness

and health. Using a phenomenological methodology, and including a detailed review of healing

from within the paradigms of Western medicine, African Religion and Christianity, I examine an

account of healing from each paradigm so as to describe the essential paradigmatic meanings of

healing as follows: 1)Western medicine provides technical proficiency in addressing disease, but

through objectivising of illness may leave persons with a sense of personal and interpersonal

‘disconnectedness’ related to the overall healing journey. 2) African Religion emphasises the

powerful role of relationships amongst persons (living and dead) to sustain or impair health and

healing and create meaning, but may leave persons without recourse and at the mercy of

Ancestor spirits. 3) Christian theology, tradition and praxis reveals God’s love for humankind to

be the source of healing – manifesting in the gift of life and human freedom through creation,

and the life, death and resurrection of Jesus Christ as a response to humankind’s misuse of

freedom. Acknowledging the multifaceted dimensions of suffering that are uncovered in the

phenomenological analysis, I revise the conceptual framework to situate suffering as a

component of the ecosphere, anti-life forces and healing. I identify those aspects of healing from

Western Medicine (powerful technology) and African Religion (powerful relationships and inter-

connectedness) that complement Christian Theology, Scripture and Church Traditional teaching

on healing and draw these together using the revised conceptual framework to delineate a

theology of healing for contemporary South Africa. Finally, I briefly illustrate how this theology

can be translated into praxis.

P a g e | 5

Table of Contents

Chapter 1: Introduction .................................................................................................................... 7

Background and Rationale ........................................................................................................... 7

Chapter 2: Methodology .................................................................................................................. 9

The research question .................................................................................................................. 9

Aims .............................................................................................................................................. 9

Conceptual framework ................................................................................................................. 9

A phenomenological approach .................................................................................................. 12

Chapter outline ........................................................................................................................... 14

Chapter 3: Health, illness and healing from the perspective of Western medicine ..................... 14

A phenomenon – coronary athosclerosis ................................................................................... 15

The immediate context of the phenomenon ............................................................................. 17

The broader context of the phenomenon - Western medicine ................................................. 18

Exploring Western medicine through phenomenological hermeneutics – a comprehensive

interpretation ............................................................................................................................. 25

Summary - Western medicine in relation to the contextual framework ................................... 26

Chapter 4: Health, illness and healing from the perspective of African Religion immersed in

Western-based culture ................................................................................................................... 27

A phenomenon – ‘Madumo and Mr Zondi’ ................................................................................ 27

The immediate context of the phenomenon ............................................................................. 29

The broader context of the phenomenon – African Religion immersed in Western culture .... 30

Exploring African Religion through phenomenological hermeneutics – a comprehensive

interpretation ............................................................................................................................. 38

Summary- African Religion in relation to the contextual framework ........................................ 39

Chapter 5: Health, illness and healing from the perspective of Christian Scriptures, Tradition and

Church teaching .............................................................................................................................. 39

A phenomenon – healing from HIV/AIDS ................................................................................... 40

The immediate context of the phenomenon – .......................................................................... 42

P a g e | 6

The broader context of the phenomenon – Healing in Christian Scripture, Tradition, Church

teaching and Ministry ................................................................................................................ 44

Exploring Christian healing through phenomenological hermeneutics – a comprehensive

interpretation ............................................................................................................................. 50

Summary – Christian healing in relation to the contextual framework .................................... 51

Chapter 6: Components of a theology of healing in contemporary South Africa ......................... 52

A review of the adequacy of the conceptual framework .......................................................... 52

Aspects of Western medicine and African Religion that can contribute to a theology of healing

................................................................................................................................................... 53

A theology of healing drawn from traditional Christian sources of theology, and contemporary

South Africa. ............................................................................................................................... 55

Conclusion .................................................................................................................................. 57

Chapter 7: A concluding note - taking a theology of healing into ministry ................................... 57

Bibliography ................................................................................................................................... 60

P a g e | 7

Chapter 1: Introduction In contemporary South Africa, Western medicine, African Religion, and Christianity offer a

diversity of perspectives, paradigms, and experiences regarding illness, suffering and healing.

These experiences and philosophies are based on different underlying understandings of the

reasons for illness and suffering and the mode or mechanisms of healing. Their different

approaches to healing call for responses and actions from individuals and communities that may

not be mutually compatible, and may even be destructive in combination. As such, they

represent a profound challenge to the integrity of our enacted faith - our ‘lived response’ to

illness, suffering and healing. Amongst persons in the healing and caring professions and those

with pastoral responsibilities amongst the Christian faithful, these challenges need to be

addressed, if we are to respond with integrity and love. Theology – understood as the

‘continuous process of disciplined and prayerful thought through which a community of faith

seeks to understand what it believes and thus to be guided in its living out of that belief’ (Hall,

2002, p.3) is an appropriate discipline in which to address these challenges. The material for this

disciplined and prayerful thought includes ‘the two sources of theology, namely the Christian

fact [Scripture and Tradition] and contemporary experience’ (Tracey, 1974, p14-16). In this

dissertation, I will construct a theology of healing that draws from traditional sources of

theology (Scripture, Church Tradition and practice), and also from resources present in our 21st

century South African society in which Western medicine and African Religion are practised, and

in which a multiplicity of understandings of the meaning of illness, suffering and healing

simultaneously co-exist

Background and Rationale

A personal interest in healing

For the last ten years, I have worked twice a week in a Catholic Hospice that provides HIV care

for inner city, medically uninsured and predominantly African persons in Johannesburg. As a

doctor, and specialist in laboratory diagnosis of infectious disease, my responsibilities have

included the diagnosis and management of HIV and AIDS, and treatment of opportunistic

infections, including tuberculosis. Through this avenue, I have been privileged to be a part of the

restoration of life and health of many, and to provide compassionate care for the dying. Over

the years, I have been mystified by my observation that persons’ underlying attitudes, in some

unmeasurable way contribute greatly to their achieving positive outcomes, and that the

Western medical paradigm in which I have been schooled does not fully address nor explain the

phenomenon of healing.

P a g e | 8

In the year 2000, I experienced a profound emotional wounding following the death of my

husband through suicide. I was diagnosed with depression during the year after his death. The

despair and hopelessness of that time was excruciating, and I desperately wanted to be well

again. Through medication, counselling, psychotherapy, participation in Christian community, a

supportive, loving family and personal spiritual discipline, a restoration to life and health has

taken place. I have observed that my experience of pain, which continues to be intermittently

present, has generated a deep empathy for those who suffer. I have discovered a vocation to

serve those who are hurting on account of life’s troubles. In a beautiful and unexpected way, my

professional training has converged with my personal experience.

Notwithstanding this personal and professional journey, the meaning of suffering and healing

has continued to elude me. While ultimately it is through God’s grace that I and many of my

patients have experienced, and continue to experience healing, yet, how does this happen?

What arrangement of medicine, prayer, self motivation and discipline, faith and miracle work to

bring about the productive and meaningful life I and many of my patients are privileged to lead?

This dissertation has offered an opportunity to examine and understand my own multifaceted

journey through Western medicine, African Religion and Christianity towards healing and

wholeness.

A theological rationale for an exploration of healing

Undergirding all Christian faith is the belief that ‘Christianity provides the authentic way to

understand our common human existence’ (Tracey, 1974, p.14). A theology of healing is

necessary if the Church is to show the adequacy of Christian faith in the context of illness and

suffering. Critically, it is not sufficient for this theology to remain an academic exercise. In as

much as the gospel of Jesus calls for a ‘metanoia’ or conversion (Mark 1:14-15), this theology

needs to be constructed and re-constructed in our own individual and cultural contexts.

Members of our contemporary South African society are familiar with many different

perspectives on healing, ranging from Western medicine, African Religion, Complementary and

Alternative Medicine, and a variety of different Christian faith traditions. Further, as care-givers,

our personal experiences of illness and healing form part of the context into which our theology

needs to be enacted. We need to own and acknowledge our woundedness and need for healing;

and be ‘converted’ to the healing presence of Christ in our lives. As persons with pastoral or

medical responsibility work through our own healing in this diverse context, we acquire the

P a g e | 9

vocabulary and experience of healing that can facilitate empathy for persons in our care.

Therefore, the process of constructing a theology involves a ‘translation’ of the gospel message

of the Kingdom of God into the metaphors, idioms, speech, motifs and life experiences of the

intersection of cultures in which it is being shared, owned and lived (Gener and Batuista, 2008,

p.891).

Chapter 2: Methodology

The research question What are the components of a theology of healing and how do these components inform our

understanding of healing, when healing is examined from within Christian faith that is immersed

in contemporary South African society?

Aims The aim of this dissertation is to construct a theology of healing that draws from traditional

sources of theology (Scripture, Church Tradition and practice), and also from resources present

in our 21st century South African society in which Western medicine and African Religion are

practised, and in which a multiplicity of understandings of the meaning of illness, suffering and

healing simultaneously co-exist.

Conceptual framework

Laying the foundation – the ‘poles’ of the healing continuum

Healing must be understood in its context. Csordas points out that ‘what counts as therapy

[healing] depends first on what is defined as a problem’ (1996, p.4). ‘Healing’ as an entity,

implicitly cannot exist outside of an initial state of well being, and a subsequent experience of

illness. If one is to situate each of these ‘poles’ of the healing continuum within a larger

conceptual framework and describe them dispassionately without reference to any paradigm, it

would be appropriate to describe an initial state of well-being as occurring in the ‘pole’ of the

ecosphere in its ideal state, wherein life with its proclivity towards abundance, takes place.

Illness, which diminishes the experience of life’s abundance occurs then, within the ‘pole’

represented by ‘anti-life forces’. Death is the ultimate ‘anti-life’ force, and precludes any return

to health, and healing. Healing then, occurs as a transition from health, within the living

abundance of the ecosphere, through the experience of illness (with or without concomitant

P a g e | 10

suffering) as a manifestation of anti-life forces, with a subsequent return to health. This is

represented in the figure below.

Figure 1. A conceptual framework illustrating the relationship between health, illness, suffering and healing.

The ecosphere and health

The ecosphere, represented in the diagram above by the labelled circle, encompasses the

natural world - the biosphere in which all forms of life including humans, live in

interdependence, form ecologies or communities, reproduce, and die. The ecosphere may or

may not encompass the spiritual world depending on one’s belief system or cosmology. Within

the ecosphere, and amongst persons, health arises through a complex interplay of biological,

psychological and social factors – termed the ‘bio-psycho-social’ model of health (Engel, 1977

p.129). This understanding of health entails a holistic vision that sees a person as an integrated

being with mind, body and relational contributions. Health is a state of physical, mental, social

and spiritual wellbeing brought about through the ability of persons to adapt and self-manage; it

is a composite of interdependent components and implies functioning as fully as possibly under

current circumstances (Huber, 2011, d1462). Health is therefore a manifestation of order,

wellbeing, and harmony within the constituent elements of the ecosphere.

Anti-life forces

Anti-life forces are represented in the diagram above by the labelled circle. Illness is

appropriately situated within the circle of anti-life forces because it arises through a complex

interplay of the negative individual and communal experiences of symptoms and disability -

shaped by organic disease, psychological considerations, social considerations, cultural

considerations and economic factors (Bate, 1999, p.261) which tend towards destruction and

death. Illness as a manifestation of anti-life forces may or may not have a transcendent or

spiritual dimension depending on one’s belief system or cosmology. Illness includes ‘a person’s

P a g e | 11

perceptions and experiences of [these] socially disvalued states’ (Young, 1982 p.257), and ‘how

the sick person and members of the family or wider social network perceive, live with and

respond to symptoms and disability’ (Kleinman, 1988, p.5). Illness may be socially constructed

from four sources as follows (Kleinman, 1988, p.10-55): 1) the significance of the symptom/s

that form part of the illness; 2) the cultural significance attributed to the illness; 3) the meanings

drawn from antecedent events in each individual’s life story which may influence person’s

response to certain symptoms; and 4) the moral or transcendent meaning or significance of

illness.

Suffering, is represented by the triangle within the circle and appears to be appropriately

situated within ‘anti-life forces’, as, when it arises, it is usually a component of illness or other

undesirable circumstances or outcomes. Suffering is more than the experience of illness,

symptoms and disability. It is intrinsically harder to define, perhaps because it has a ‘locus

beyond merely the body’ (Amato, 1990, p.5). Suffering can occur in relation to any aspect of our

experience of personhood, and is a unique experience for each individual. The human capacity

to imagine plays a role in the genesis of suffering. Persons who suffer remember or imagine a

life without suffering – and ask themselves ‘if only it was not like this….’ To the suffering person,

it seems that the physical, moral or emotional pain threatens their integrity (Cassell, 2004, p.34)

and is ‘unresolvable’ (Dyrness, 2008, p.57). The suffering person cannot conceive or create plans

to make a ‘way out’ of the pain. Thus, the amplified and projected consequences of pain,

morphing into perceived impending destruction, result in suffering (Schopenhauer, 2004, p.8). In

the presence of suffering, persons are often led to question the meaning of life. ‘Why me?’ is a

frequent response by persons experiencing intractable pain (Parker, 1997, p.206). Suffering

tends towards questions of theodicy and meaning. Skultans reports of Latvians struggling under

Soviet rule, that persons in suffering experience a ‘persistent struggle to construct a positive

meaning out of what is happening to them, and to reconstitute a proper sense of cultural

identity and social purpose under the brute force of events in which these are violated and

destroyed’ (Skultans, quoted in Wilkinson, 2004, p.40). Persons who suffer grapple with the

meaning of life, because suffering represents a fundamental challenge to their inherent notion

of how they expect, hope, and know things to be. Suffering is a universal experience of

humankind – ‘wherever humanity records its voice, then it always speaks of suffering’

(Wilkinson, 2005, p.1).

Healing

Healing is the process represented by the arrows from the circle labelled ‘Anti-life forces’,

through the circle named ‘Healing’, towards the circle labelled ‘Ecosphere’. Healing refers to the

P a g e | 12

trajectory of a person’s life, and all its encompassing health seeking behaviours and experiences

as a person moves from illness to health (Csordas, 1996, p.9). Healing can be understood

objectively as the unfolding of a specific treatment event, including diagnosis and administration

of therapeutic procedures, and experientially as the mental states, development of emotions,

attitudes, insights and attribution of meaning as therapy progresses. In addition, healing has a

socio-political dimension because illness is often a consequence of, or highlights particular

societal problems. Certain procedures may be a part of the healing process. Procedures are

understood as ‘who does what to whom with respect to medicines administered, physical

techniques or operations carried out, prayers recited, symbolic objects manipulated, altered

states of consciousness induced or invoked’ (Csordas, 1996, p.9). The outcome of the healing

process is ‘the disposition of participants at a designated end point of the therapeutic process,

with respect to both their expressed (high or low) satisfaction and to change (positive or

negative) in symptoms, pathology or functioning’ (Csordas, 1996, p.9). Because ‘health’ is a state

of physical, mental, social and spiritual wellbeing brought about through the ability of persons to

adapt and self-manage – a return to health (healing) requires an interplay of factors at many

levels – within the person at a physiological and psychological level, and at a relational,

community level, and at the level of meaning or spirituality. (Csordas, 1996, p.12)

A phenomenological approach An examination of healing presents an interpretive challenge in that the enquirer’s pre-

understanding, and discipline through which healing is examined affects the interpretation.

Different pre-understandings and disciplines may arrive at contradictory or mutually

incompatible explanations for healing. These may lead to a dismissal of the validity of claims

made about healing in the context of any specific paradigm or discipline. Bate describes this

problem as follows:

The question of healing in general and Christian healing in particular is one which is fraught with difficulties since there is so much disparity regarding the meaning of healing and the role of Christianity in healing people from their sicknesses. …. It is of the essence [to try] to get to the humanity of what is occurring [with regard to healing]: a humanity which often lies beyond the elemental and structural splitting which analysis and method in the modern human sciences prioritise. (Bate, 2001a, p.361-2)

To overcome the methodological problems identified by Bate above, this dissertation will

examine healing using a phenomenological approach. The Stanford Encyclopedia of Philosophy

defines phenomenology as

P a g e | 13

the study of ‘phenomena’: appearances of things, or things as they appear in our experience, or the ways we experience things, thus the meanings things have in our experience. Phenomenology studies conscious experience as experienced from the subjective or first person point of view.(Smith 2011)

Classical phenomenology was developed in the early 20th century by Husserl as a philosophical

reaction to positivism (Erlich, 2005:2), but has evolved to become a formal research

methodology. Phenomenological method entails collection of data through interview, group

discussions and observations with the intention of understanding an experience from the

perspective of the individual. Researchers’ pre-understandings, paradigms of knowledge and

assumptions are made explicit so as to allow an uncovering of individual perspectives in the

most unbiased way possible. A phenomenological approach is particularly helpful in the

examination of healing, as it allows exploration of the individual’s perspectives without initial

recourse to interpretive frameworks or assumptions. Phenomenology allows us to consider the

individual’s perspective, and only then bring various paradigms to bear on the enquiry. I have

elected to use a phenomenological method developed by Lindseth and Norberg (2004, p. 145),

who based on the theory of interpretation of Ricoeur, developed a methodology to research a

person’s lived experience so as to attain to its essential meaning. Lindseth and Norberg applied

their methodology to a number of situations pertaining to health (Sørlie, 2003, p.350; Talseth,

1999, p.1034). The intention is to understand the way in which the experience is related to the

‘being-in-the-world’ - the way the world reveals itself to our consciousness. A text or

phenomenon is subjected to a three-step process as follows: 1) an initial reading to obtain a

naïve understanding of the text to reveal our pre-understanding, 2) a thematic (structural)

analysis in which units of meaning are dissected to attain their thematic content. This step

allows for a value-free hermeneutical assessment of the text, in so far as we are able to suspend

our judgement; and, 3) a final comprehensive understanding, in which associations with

thematic content is made with relevant literature in order to arrive at a whole interpretation. In

my application of the methodology, I shall only present the results of step 2 – the structural

analysis; I shall not present the line-by-line dissection of the text that yields the thematic content

and understanding. Regarding step 3, the relevant literature will be reviewed in terms of the

conceptual framework, i.e. the poles of the healing continuum, namely ‘the ecosphere and

health’, ‘anti-life forces and suffering’ and healing.

Through this approach, I hope to uncover the essential meaning of healing as it appears to

persons in their lived experience, and not merely the meaning of healing as a social, psychic or

historical fact. The essential meaning of healing will reveal that which is invariable about healing,

P a g e | 14

despite all the variations in the experience of healing across religious context, time, and culture.

Within the South African context where Western Medical and African Religious perspectives on

healing prevail, the essential meaning of healing will inform our theological reflections, and

allow us to clarify what we believe about healing, and guide us in the living out of that belief.

Chapter outline After having outlined the rationale for a construction of a theology of healing in Chapter One,

and described the contextual framework and phenomenological method in this chapter, I will

proceed as follows:

In Chapters Three, Four and Five I will address healing from the perspectives of Western

medicine, African Religion and Christian Theology (inclusive of Biblical literature, Church

Tradition, and Christian experience) respectively. These chapters will follow the same outline: A

text that is illustrative of healing within the paradigm will be presented and evaluated using the

phenomenological method described above: Firstly, a naïve understanding and thematic

analysis will be presented. Secondly, the immediate context of the excerpt, the reasons for its

selection and a background literature review of that healing paradigm will be presented. Thirdly,

the essential meaning of healing within that paradigm will be drawn from the thematic analysis,

and these contextual insights. Finally, in each of Chapters Three, Four and Five, I will revisit the

contextual framework, so as to situate the essential meaning of healing within this framework.

In Chapter Six, in the light of the phenomenological enquiries in Chapters Three, Four and Five, I

will review the adequacy of the conceptual framework, and revise it appropriately. I will then

identify the components of a theology of healing which arise through the three

phenomenological enquiries into the meaning of healing (from the paradigms of Western

medicine, African Religion and Christian theology). Finally I will lay out a theology of healing,

using the revised conceptual framework.

In Chapter Seven, I will conclude with brief comments on how this theology of healing for

contemporary South Africa can inform praxis at the level of care-giver, person suffering from

illness, and society/institution.

Chapter 3: Health, illness and healing from the perspective of

Western medicine In this chapter, I present a description of a person’s experience in the recovery from coronary-

atherosclerosis, or cardio-vascular disease. Using the phenomenological method described

P a g e | 15

above, I extract the meaning of the experience for the person, and in so doing, attain to a fuller

understanding of health, illness and healing from the perspective of Western medicine. I then

return to the conceptual framework so as to review how well the framework fits the essential

meaning of Western medicine that we have arrived at. In Chapter Six, I will draw from this

chapter to construct a theology of healing.

A phenomenon – coronary athosclerosis Thomas Moore, in ‘Care of the Soul in Medicine’ (2010), describes his experience as a patient suffering from cardio-vascular disease –

When I saw Dr Dinesh Kalra, my first cardiologist , he did not make a good impression. I had just come out of the treadmill room, where I had had a bad experience – the technicians got so involved in a heated discussion that they didn’t see me nearly collapsing. The doctor was sitting at a screen, closely scrutinizing an ultrasound replay of my heart at work. He kept saying, ‘It’s abnormal. It’s abnormal’ – that word again. He showed me the scan. ‘Look, the whole heart is not pumping. There is a portion in the back that is inactive. This is a problem. Something is wrong.’ He told me to visit him in his office in three days. The technicians told me to go home and do virtually nothing. I couldn’t even walk or go to the store. ‘Can’t I play golf?’ I asked them. I had just played nine holes the day before. They looked at me as if I was crazy. ‘No walking at all,: they said, and they looked worried and concerned. Naturally, I caught their anxiety like a head cold and lived with it for three days. You can imagine my nervous anticipation. During the office visit though, Dr Kalra was more reassuring. ‘We can take care of it, whatever it is,’ he said. In later visits he became much more relaxed, and soon I was grateful to have him as my cardiologist. He smiled at my anxieties and my tendency toward hypochondria. He told me that I was like his father, who always worried about pains here and there that meant nothing. He told me to walk three miles a day and relax more. If I did indeed relax during this worrisome period when I had stents inserted into my heart, it was largely because of Dr Kalra’s attitude. He was competent but reassuring. My visits to him lasted only minutes, and yet he was fully present in those minutes as a positive, friendly human being as well as a skilled doctor. The combination, I’m sure, helped my healing. (Moore, 2010, p.26)

A naïve understanding

A first reading of the text allows for a basic understanding of the writer’s experience of illness,

and healing, and its meaning: For the writer, illness leads to an encounter with a bewildering

array of technologies (treadmills, ultrasound, stents), unsympathetic technologists (the

technicians, and the doctor), veiled meanings of test results (the meaning or significance of ‘it’s

abnormal’ is not explained), and contradictory advice (‘No walking at all’ vs ‘walk three miles a

day’). All this creates fear (‘I caught their anxiety like a head cold’). The technicians and doctor

objectivise the illness (the heart and its mechanics) in their appraisal of the problem, and their

response to it (‘we can take care of it’). The writer shares the same objectivity regarding his

P a g e | 16

condition, and reports being healed through a technological solution (stents inserted into my

heart), but allows that trust in the technical competence of the doctor (‘he was competent but

reassuring’) also played a role.

Thematic analysis

The power of technology

The story of the writer’s healing revolves largely around technology – the technicians do their

job on the treadmill, the doctor peers into the computer screen as if it were an oracle, the stents

perform the miracle of keeping the writer’s arteries patent1. Interestingly, how the stents got in

place, perhaps the greatest technological feat of all, is not part of this account2. All in all,

through the ‘god of technology’, the writer is alive to tell the tale.

An objectifying and deconstructing of persons

The writer speaks as if ‘he’ is a distinct entity from his heart – his body revealing an implicit

deconstructing of his personhood into separate entities – the thinking, sentient writer, and his

beating heart It is as if he is putting his body on the treadmill, subjecting it to an echocardiogram

and procedures such as stents placed in his coronary arteries while he himself remains a curious

onlooker, mystified at what all the procedures and tests mean. The doctor has a similar

approach. His problem is with the writer’s heart only, which is ‘abnormal’, and not with the

‘context’ of the heart –the fact that it is situated in a living, breathing, sentient being, who

himself has a broader context within a family and society. The doctor understands the problem

as an objective malfunctioning of an organ - ‘we can take care of it whatever it is’. Rather than

seen as a relational whole, the doctor implicitly deconstructs the writer as a person, objectifies

the problem part, and views it independently.

Fear and the need for human connection

The absence of human connection during his time of need, more than anything else, provokes a

profound fear in the writer. He reports that his near collapse which went unnoticed by the

technicians was a ‘bad experience’. The cardiologist focussing only on the screened image of his

abnormal heart – as opposed to addressing him directly was a ‘bad experience’. Only later on

during his therapeutic journey, when he reports that the cardiologist ‘smiled at him’, was his

1 A ‘stent’ is a firm piece of tubing that is inserted into a coronary artery (an artery that supplies the heart muscle with blood) in an area where the artery is narrowed. The stent dilates the narrowing of the artery, and ensures that the heart muscle receives an adequate blood and oxygen supply. 2 An incision is made in the femoral artery (in the groin), and a placement device fed through the vasculature, up to the heart. Once at the mouth of the aorta, the device is fed into the affected coronary artery, and the stent manoevered into position. The process is visualised by placing a radioactive isotope into the patient’s blood, allowing the progress of the device to be seen on a screen, as sequential or real-time X-rays are being performed.

P a g e | 17

anxiety partly assuaged. He reports at the end, that the feeling of closeness, of being a part of

the cardiologist’s family ‘He told me that I was like his father’ engendered a sense of security and

connection that made him feel reassured.

Confusion and the absence of meaning

In the description of his illness, the writer does not touch on the issue of meaning either at an

organic (pathological) level, or an existential level. At an organic level he is clearly bewildered,

does not understand the physiology of his heart, nor the pathology, nor the technology, the

tests, or the results. He is utterly alarmed therefore at the cardiologist’s expression - ‘it’s

abnormal’, which is put out there without explanation or reassurance. But equally, he makes no

attempt to relate the event to his broader context, and to understand what precipitated the

event, or what the event means for him, though clearly some consequences will impinge on his

life. ‘Can’t I play golf?’ – he asks. It is as if this meaningless event happened through a random

chance in a random person’s life. The more concerning significance of the omission of any

discussion of meaning in the writers account is that the condition described is a chronic one,

likely to recur, and potentially fatal. It is not as if the condition is addressed, the matter closed

and finalised with the placement of the stents. The single clue in this direction is given by the

opening introduction of the doctor as ‘my first cardiologist’. Surely questions about meaning in

life, of transcendence and of theodicy are raised in the writer’s mind as he grapples with this

new diagnosis?

At this point, before arriving at a comprehensive interpretation of the passage, it is helpful to

explore the immediate and broader contexts of this phenomenon - namely the author and his

book, and the paradigm of Western medicine.

The immediate context of the phenomenon

Thomas Moore and ‘Care of the Soul’

Thomas Moore is a North American psychotherapist, who has published widely in popular

literature on themes related to personhood, personality development and ‘soul’. Moore came

from an Irish Catholic background, and studied humanities, music and religion. He spent time in

a religious order and lectured at seminary before practicing psychotherapy for over 16 years,

until 1990. His first book, ‘Care of the Soul’ (1992), was widely acclaimed – in it he encourages

readers to embark on a self-knowledge quest that can encompass our shadows and

complexities, and embrace what he calls ‘soul’ – through nurturing of our imaginations,

embracing of paradox, and exploration of meaning behind everyday positive and negative

P a g e | 18

experiences. He draws extensively from Jungian psychology, and the work of James Hillman. In

‘Care of the Soul in Medicine’, Moore applies the same approach to the problem of illness and

healing, both from the perspective of patient and doctor. He critiques Western medicine for its

lack of ‘soul’ – beautifully captured in this quote from the epilogue- ‘I sometimes wish the doctor

who was treating me would see something of who I am and not just my malfunctioning body

parts’ (Moore 2010, p231). The excerpt presented as a ‘phenomenon’ above captures the

experience of many persons who encounter Western medicine in moments of crisis, and find the

experience deeply terrifying.

Why I selected this excerpt for phenomenological analysis

While the lifetime I have spent studying and practicing medicine makes Western medicine easily

accessible to me, I repeatedly encounter misunderstanding, misinformation, confusion, and in

times of crisis, bewilderment amongst non-medically trained family, friends and patients as they

encounter medical issues. Yet, Western medicine is in service of the very people whom it

bewilders. This paradox is highlighted beautifully in Moore’s description. As embodied creatures

in a world dominated by Western medicine, we will all encounter health issues at a personal

level, to varying degrees. The essence or meaning of the healing experience is not what I as a

doctor understand it to be, but what it means for persons within the paradigm. Moore’s

account, immersed as it is within Western culture and values, but from the perspective of a lay-

person, gives insight into the meaning of healing for persons within this culture.

The broader context of the phenomenon - Western medicine Recent work in the field of medical anthropology has proposed that Western biomedicine can be

understood as a ‘cultural system’ in that it has the ‘capacity to express the nature of the world

and to shape that world according to its dimensions’. (Rhodes, 1996, p.166). Within this and any

cultural system, order prevails through shared understandings of the nature of the way things

are (1996, p.166). Western medicine defines truth as empirically verifiable – such a robust,

measurable and objective definition that it is exceedingly difficult for persons schooled in

Western thought, including doctors and nurses, to appreciate that Western medicine is a

‘cultural system’, and that truth exists in other forms or is accessible by any other means. This

difficulty is compounded by the apparent superiority that Western medicine has over other

cultural systems in terms of technological success in dealing with disease. Because of this

definition of truth, Western medicine rejects the notion of a transcendent dimension to matters

of health and healing, as this dimension is not empirically verifiable.

P a g e | 19

Historically, one can trace the development of Western medicine to the scientific revolution of

the mid 17th century. With the application of the method of inductive reasoning (empiricism) to

the problem of illness, and human pathology, powerful scientific and technological advances in

the understanding of human physiology and pathology ensued, identifying certain problems

(disease) as amenable to technological solutions (medicines or procedures) (Lyons, 2008, p9 ). At

the same time, Descartes advanced his theories related to the mind body-split; the body was

understood as a material, objective entity, and the final common locus of human functioning,

while the mind was understood to be the non-material source of reasoning and emotions which

had control over the body (Engel 1977, p.196). Cartesian dualism and the application of the

scientific method to matters of health paved the way for the reduction of the concept of health

to become ‘the absence of disease’, while ‘healing’ faded into obscurity as a focus of study. The

goal to which medicine was orientated became the ‘removal of disease’.

We will identify the ‘poles’ of the healing continuum as understood from the cultural system of

Western medicine.


Western medicine has no commonly accepted definition of ‘health’ or healing (Egnew, 2005,

p.255). This is a curiosity, considering that the doctor’s role is to restore health and wellbeing.

Egnew explains that with an emphasis on pathology, and medicine as a technological

intervention, ‘cure, not care, became the primary purpose of medicine, and the physician’s role

became ‘curer of disease’ rather than ‘healer of the sick’ (Egnew, 2005, p.255). Health became

the ‘absence of disease’ and the work of healing faded into obscurity. This model of ‘health’

became known as the ‘biomedical model of disease causation’ (Engel 1977, p. 196).

In response to the aftermath of the Second World War, and the growing realisation that the

biomedical paradigm was insufficient to deal with the complexities of the human experience of

illness, this classical biomedical model was earnestly critiqued. It was criticised as being 1)

reductionist, because it ignored the complexity of factors involved in health; 2) mechanistic,

because it assumed that every disease has a primary biological cause; 3) dualistic, and therefore

neglected the social and psychological aspects of the person; 4) empirical because it assumed

that we can objectively identify biological agents of disease; 5) disease orientated and therefore

emphasising illness over health; and 6) interventionist – because it was overly intrusive and

controlling (Lyons, 2008, p.8-10).

In 1948, the World Health Organisation formulated a definition of health (WHO, 2006, p. 1), for

the first time within the Western medical paradigm. Health was defined as ‘a state of complete

P a g e | 20

physical, mental, and social well-being and not merely the absence of disease or infirmity’

(Lyons, 2008, p.9). At the time, this was a ground-breaking definition on account of its

broadness, and inclusion of non-physical causes for loss of health (Huber, 2011, p.1).

Drawing on this definition, and his own observations, in 1977, Engel proposed the

‘biopsychosocial’ model of illness (Engel, 1977 p.129). This model has become the prevailing

paradigm for understanding health and healing in Western medicine. It states that health and

illness arise from the interplay of biological, psychological and social factors. This definition of

health entails a holistic vision that sees a person as an integrated being:

The psychobiological unity of man requires that the physician accept the responsibility to evaluate whatever problems the patient presents and recommend a course of action… Hence the physicians’ basic professional knowledge and skills must span the social, psychological and biological, for his decision and actions on behalf of the patient involve all three (Engel, 1977, p.133).

Under this model, healing can be understood as a move towards health that is required in each

of the contributory areas of the illness – biological, social and psychological. This model is useful

within a Western paradigm, as it moves away from the splitting of health into a dualistic

perspective of ‘physical’ and ‘mental’ health. The determinants of health at a social and

psychological level can be identified, and promoted within communities. The World Health

Organisation has made this a focus of their work in recent years, over and above their specific

disease management programmes, recognising that ‘the structural determinants and conditions

of daily life constitute the social determinants of health and are responsible for a major part of

health inequities between and within countries’ (WHO, 2008, p.2).

Anti-life forces and suffering

In Western medicine, all of nature tends towards death - therefore ‘death and disease’ are the

chief anti-life forces, the mechanism by which life is overcome. In the Western medical

paradigm, death is a failure of skills or competence in addressing disease. Disease becomes the

major anti-life force precisely because it ultimately causes death. ‘Disease’ is the preferred term

over ‘illness’. Disease is the objective disturbance of the physiology of human functioning due to

an independently verifiable noxious agent, leading to a localisable pathology in the living

organism of the human body (Lyons, 2008 p.13). A disease is the named entity that is arrived at

when the practitioner recasts ‘the symptoms of illness in terms of theoretical disorders’

(Kleinman, 1988 p.5). By its nature, the term ‘disease’ is inherently reductionist, because it is

quite apparent that a ‘disturbance in human physiology leading to impaired functioning’ is

insufficient to explain all that happens and is experienced by a person in the presence of disease.

P a g e | 21

‘Disease’ is therefore a Western biomedical concept. While the agents of disease (hypertension,

bacterial causes of meningitis, the HIV virus etc.) exist within any culture, the concept of disease

exists within Western biomedicine only, and is contingent upon the definition of ‘truth as

objectively verifiable’ (Higgs, 2006, p.3).

Suffering which like health, has no definition, is perplexing to Western medicine, and has largely

been overlooked or ignored. Where suffering has been the subject of attention, it has been

understood as the experience of intractable pain (Cassell, 2004, p.31). The broadening of the

definition of health allows suffering to be understood beyond the experience of pain. So, in the

biopsychosocial model of health, suffering takes the form of specific injury to a person’s body, to

their self-understanding or to their social context. The injury which leads to suffering can follow

internal events such as the experience of pain, disease, psychological trauma or mental illness

(Cassell, 2004, p.42). When suffering occurs due to effects of the illness, it is the effects of

treatment, the social isolation concomitant with physical impairment, the psychological fears,

and loss of normal expectations for life, that may all contribute to a person’s suffering (Cassell,

2004, p.30). Injury can follow external events, such as flailing interpersonal interactions, natural

calamities, severe deprivation (poverty) or social injustice. The injuries that lead to suffering are

embedded in socio-cultural values. Kleinman’s work, summarised in Wilkinson ‘has sought to

highlight the extent to which the onset and response to chronic forms of mental and physical

illness are mediated by the cultural meanings through which people relate to their personal

social world. … Bodily feelings of pain and particularly those of chronic pain, are an idiom of

personal distress which arises more as a consequence of the social frustrations and cultural

contradictions in which people are made to live than as a result of psychological pathology,

physical injury or disease’ (Wilkinson, 2004 p.24). It is the cultural expectations that are brought

to bear on individual’s life circumstances that create the groundwork for the experience of

suffering.

Suffering that occurs from unanswered existential questions (such as ‘why me?’, or questions

related to meaning in life) are difficult to respond to from within the Western paradigm, because

the Western medical model does not admit a transcendent dimension. Nor does Western

medicine allow for the notion of personal evil forces, nor the possibility of sin as an offense

against a deity. What would be called ‘sin’ in other paradigms is understood in Western terms as

psychologising sickness, social deviance or competition for limited resources (Bate 2013, p.42).

Western medicine, situated as it is within a Western, post-Christian, philosophical tradition

appears to offer no explanation for meaning in life, beyond biochemical and ecological

P a g e | 22

perspectives related to Darwinian survival – as put by Richard Dawkins ‘Nature is not cruel, only

pitilessly indifferent…We cannot admit that things might be neither good nor evil, neither cruel

nor kind, but simply callous – indifferent to all suffering, lacking all purpose’ (Dawkins, 2008, p.

96). At this level, Western medicine appears particularly devoid of hope.

Healing

Continuing with the conceptual framework, healing in the Western schema, amounts to the

elimination of disease, and is better known as ‘curing’. Doctors – the ‘healers’ of society, are

technicians who understand the mechanics of disease, and apply technological solutions. While

the study of disease and disease management has become incredibly sophisticated, and

objectively successful in elimination or management of disease in the 20th and 21st centuries, the

science of caring has been neglected. Only recently has care of the suffering and dying gained

recognition. Dame Cicely Saunders founded the hospice movement only in the late 1960s and

only subsequently did Palliative Care achieve status as a sub-discipline of medicine (Faull, 2002).

Finally, only in the late 20th and early 21st century has Western medicine begun an earnest

exploration of the meaning of healing. In these developments, emerging Western thought has

new and insightful contributions to make regarding the meaning of health and healing.

Two complementary approaches have emerged to Engel’s bio-psycho-social model of health and

healing; the first proceeds along empirical grounds and provides evidence for the mind-body

connection, showing how the stress influences disease evolution in humans; the second

proposes an alternative basis for Western medicine, namely strengthened human relationships. I

will briefly review both approaches.

Scientific (empirical) evidence for the mind-body connection, illustrating how social and

relational well-being contribute to health

Within Western medicine, it is understood that cure of disease, while assisted by medical

procedures or medicines, is ultimately effected through the action of the immune system. The

importance of the immune system is easily understood when we appreciate that persons

suffering from AIDS may die, not from the human immunodeficiency virus (HIV) itself, but from

other ‘opportunistic infections’. These are diseases that in a person without HIV infection, would

be ‘mopped up’ by the immune system. Regarding the ordinary functioning of the immune

system, our experience of life would have us believe that stress predisposes us to disease or

illness – for example, being drenched in a rainstorm predisposes one to pneumonia, or a person

who is recently bereaved develops cancer. Molecular biological investigations have recently

provided evidence for this ‘mind-body’ connection (Leader, 2008, p.7) – showing how factors

P a g e | 23

that lead to ‘stress’ can impair the immune system and thus pave the way for development of

disease, and illness. This area of research is known as ‘psychoimmunoneurology’ or PNI

(Godbout, 2006, p.421). Robert Ader in 1975 (1975, p333) and later, Candace Pert (1985, p.820)

demonstrated that psychological stress disturbs normal interaction between the nervous and

immune systems. This altered balance between the immune and nervous systems may

subsequently impair cellular immune responses, which increase risk for development of cancer,

or increase susceptibility to infectious or lifestyle disease. The field of PNI is of interest in the

context of healing. Emotional well-being plays a role in preserving health, and the emotional

responses of persons to life events such as illness may facilitate or impair healing.

This evidence provides an explanation for healing that is congruent with the biological basis of

Western medicine and the biopsychosocial model of disease causation. In this model, the person

as an integrated being with biological, psychological and social contributions can experience

healing through maintaining well-being in each of these contributory areas. Referring back to

our conceptual framework, stressors brought about through psycho-social causes may be

understood as anti-life forces, along with disease.

An alternative paradigm for understanding Western medicine – the contribution of

human relationships to health and healing

As presented above, the science of Western medicine is built upon on empiricism. From this

perspective, healing becomes one of ‘curing of disease’ with all its attendant technological

interventions. However, Pellegrino and Thomasma propose that medicine is practised (as

opposed to the way new medical knowledge is created) from within a different paradigm.

Pellegrino and Thomasma propose that in medicine’s mode of practice, medicine is ‘a

relationship of mutual consent to effect individualised well-being by working in, with and

through the body’ (quoted in Scott, 2009, p.11). This shifts the emphasis in medicine from the

science of disease, including disease causation and management, to a relational approach. The

definition of healing (‘cure of disease’ in the biomedical model) thus becomes in their framework

‘a right and good decision for this particular patient’ (Pellegrino and Thomasma, quoted in Scott,

2009 p.11). Pellegrino points out that this framework does not deny the importance of medical

knowledge, and technical competence arising from such knowledge, nor does it negate ‘cure’ as

a goal of medicine, but rather, it engages these in service of a higher, more encompassing moral

goal, a ‘good and right decision’ (ibid). Pellegrino and Thomasma argue that

the practice of medicine does not consist primarily in the application of science, nor in a philosophical understanding of central concepts such as disease, or the social and political understanding of what it means to be ill. Primarily, medical practice exists in the

P a g e | 24

very humane actions of one human being towards another in order to provide comfort, relief and hopefully, cure. As such, medical practice differs from scientific or technological practices. This therapeutic relationship characterizes [the practice of medicine] as an essential part of the humanties (Van Leuuwen, 1997, p.99)

With this relational approach to medicine, three themes have emerged related to the meaning

of healing, which lie outside of the paradigm of empirical science.

Firstly, healing is the development of wholeness in relation to all aspects of self: within one’s

body, and in relation to significant others and to community/society/culture. Quinn (2000, p.19)

calls this ‘wholeness’ a pattern of coherence among aspects of self and other, and emphasises

that rather than being a ‘regaining of wholeness’ (one might not have had ‘wholeness’ to start

off with), healing is a move towards greater coherence with self and others. Healing can occur in

one area, or many areas together, but the overall effect is towards greater coherence.

Secondly, healing entails the construction of narrative around the re-interpretation of life. The

construction of narrative around an illness experience requires the ‘putting to words of one’s

experience of suffering’ and as such, delimits the boundaries of the experience of suffering –

bringing relief. Narrative is constructed around persons - this includes relationships with oneself,

with health care professionals, care-givers, family, friends and community, and is told to some-

one (Egnew, 2005, p.257). Wilkinson reports that illness narratives have the potential to

‘perform a work of healing at the level of personal meaning’ (2005, p.39).

Thirdly, the finding of meaning in suffering is observed to transform the suffering experience -

not that the agent of illness is removed, but that the illness acquires a new context that renders

it bearable. (Egnew, 2005 p.258). Meaning requires that an explanation for the source of

suffering be found within a coherent set of beliefs (Cassell, 2004, p.56). Along with the

development of meaning, persons who experience healing are often able to experience

reconciliation. Acquiring meaning in suffering facilitates transcending that suffering.

Certain key competencies in clinicians facilitate healing - namely self-confidence (the healer is

aware of and comfortable in his/her ability to facilitate healing), emotional self-management

(s/he is able to recognise and manage his/her own emotions), mindfulness (an ability to be fully

present, and attentive to internal, and external environment, and respond appropriately) and

knowledge (attentiveness to details of clinical care within his/her paradigm of knowledge) (Scott,

2008, p.319, Cassell, 2004 p.71). In addition, factors that promote healing are those that sustain

relationships between the sufferer, and healer – in Western medicine, the doctor. These include

P a g e | 25

valuing and creating a non-judgemental emotional bond, the conscious management of power

on the part of the healer in ways that would most benefit the patient and commitment to caring

for patients over time (Scott, 2008, p.315).

In this alternative paradigm for Western medicine, in which the practice of medicine is

understood as a relationship to effect the well-being of a patient the meaning of healing

transcends ‘cure of disease’. In this paradigm, healing includes the formation of narrative,

acquiring of meaning and transcending of suffering. It is immediately apparent that healing is

not something that can be brought about by an external agent or person, through his/her direct

action. Rather, healing is a deeply personal work at all levels, that can be facilitated through the

action of others, but which remains a subjective and particular experience - ‘the state of healing

or being healed is subjective, and must be evaluated by each individual for themselves’ (Jackson

2004 p.67). Nouwen refers to the healing ministry as one that ‘takes away the false illusion that

wholeness can be given by one to another’ (1974, p.94). When healing is understood in this way,

cure of disease is no longer the goal of medicine, nor is it absolutely integral to the healing

process. While decisions made by doctors and patients to embark on therapeutic processes that

may or may not result in cure, it is possible that healing – in the sense of acquiring meaning in

life, forming narrative in relationship with significant others or transcending suffering, may occur

with or without cure. ‘Healing is independent of illness, impairment, cure of disease or death’

(Egnew, 2005, p.257). Rather, ‘cure’ if it occurs, becomes a stage in the journey towards

meaning.

Exploring Western medicine through phenomenological hermeneutics –

a comprehensive interpretation I now to return to the phenomenon and relate Thomas Moore’s description of his experience of

healing from coronary atherosclerosis within a broader understanding of Western medicine. In

Moore’s description, I identified three themes – namely separation of mind-body and

objectivising of the body; fear and the need for human connection; and confusion and the

absence of meaning. I observe that these themes are indeed evidence of Western medicine’s

approach to health, illness and healing. The overriding picture one is left with, in so far as

Western medicine relates to Moore’s experience is one of technical proficiency or success in

addressing the objective problem, but a sense of ‘disconnectedness’ related to the overall

healing journey. The technological understanding of the workings of the body are not

understood by the patient. The patient himself is encouraged to disregard, or regard with

suspicion his bodily experiences. Caregivers and the patient are disconnected with each other at

P a g e | 26

a human relational level. The entire experience of illness is disconnected from its context in

community and within a broader, overarching cosmology. In current explorations of healing that

are taking place within Western medicine, there is a shift to a deeper, more holistic perspective.

However these moves are not able to situate the healing within a coherent broader framework

of meaning. The positive aspects of the healing process, and specifically those that deal with

transcending suffering, namely the construction of narrative, strengthening of human

relationships, reconciliation that may be achieved during healing, are not explained by the

dominant Western medical paradigm. For example, Western medicine itself is not able to

provide satisfactory meanings or motivations which are necessary if suffering is to be

transcended – rather individuals are supposed to make meaning for themselves, in a

philosophical context which provides little hope beyond survival of the fittest. In the traditional

biomedical model of Western medicine, even in the presence of cure, disease as it manifests in

ageing, and senescence is never eradicated, and reaches its ultimate triumph in death, as the

most profound and final anti-life force. Perhaps Western medicine discourages a patient’s

exploration of meaning in suffering and illness, because it is ultimately not able to address the

question satisfactorily. Meaning or the lack thereof becomes the Achilles’ heel of an approach to

healing based on Western medicine.

Summary - Western medicine in relation to the contextual framework Returning to my aim of constructing a theology of healing based on theological and

contemporary sources, I now review Western medicine in relation to my conceptual framework.

I observed that that Western medicine has struggled to define the concept of health. Western

medicine has contributed powerful tools to the management and elimination of disease as the

‘anti-life force’. I observe that Western medicine is perhaps effective in addressing suffering in

so far as it arises through disease (in the form of pain), but is limited in its response to suffering

that arises through lack of meaning. Recent explorations into healing in the field of psycho-

neuroimmunology have uncovered a biological basis for the biopsychosocial model. A novel

paradigmatic understanding of the practice of medicine proposes that medicine can be

understood as a relational transaction for the benefit of the patient. In this paradigm, the goal of

the practice of medicine transcends ‘cure of disease’. Healing includes the formation of

narrative, acquiring of meaning and transcending of suffering. However, in its traditional form,

and its revised conceptions, the Western medical paradigm does not fully address the anti-life

forces of death, and disease, and in this sense, there is not complete correspondence with the

conceptual framework. Equally, I observe that Western medicine is not able to incorporate into

its framework the ‘pro-life’ forces that arise when suffering is transcended. It may be that the

P a g e | 27

overarching cosmology of Western medicine does not correspond fully to the observed and

experienced natures of life, health, illness, suffering and healing.


African Religion immersed in Western-based culture In this chapter, I present a description of an interaction between a practitioner of African

Traditional healing and his client as observed by a westerner – an Australian anthropologist, and

apply the phenomenological hermeneutical method so as to elicit its essential meaning. In so

doing I attempt to reach a fuller understanding of health, illness and healing from the

perspective of African Religion immersed in Western-based culture. Then I return to our

conceptual framework so as to review how well the framework fits the essential meaning of the

experience of healing from within the paradigm of African Religion. In chapter Six, I will draw

from this chapter to construct a theology of healing.

A phenomenon – ‘Madumo and Mr Zondi’ Adam Ashforth, an anthropologist visiting Soweto in the 1990’s, in his book ‘Madumo, a man

bewitched’, describes the encounter with a traditional healer Mr Zondi and Adam’s friend

Madumo, who has consulted Mr Zondi for a particular problem.

When the financial discussions were complete and the conversation had lapsed, Mr. Zondi gazed at me across the table. The imphepho had burnt out and the air was clearing. Our eyes connected for a moment before I looked away. I coughed a little, awkwardly, to clear my throat. ‘So, Father,’ I said, ‘do you think you will be able to help this man?’, I looked over to Madumo. He seemed to be studying something in his notebook. I found myself smoothing the newspapers over the edges of the table. Mr Zondi was clearing his throat in readiness for reply. We were all choking from the smoke it seemed – when the phone rang. He reached for the handset, greeted the caller, listened and grunted ‘yes’ in Zulu half a dozen times, then hung up. ‘Ya’, he said, turning back to me. ‘I can cure him. His case is not so difficult. Not at all. Because his ancestors are still with him. Even in these troubles he is having, they have not left him. No, we can beat this thing.’ He turned to Madumo with an avuncular grin: ‘We’ll see this thing to finish, neh?’ I looked across to my friend, who was sitting forward on the couch, and caught the last traces of an attentive frown disappear in the face of a cheerful grin. ‘We will’, he said, ‘we will’. Though I had my doubts about the nature of Madumo’s afflictions and what to name them – psychological disturbance? Distemper of the spirit? Fraying of the soul? Witchcraft? I had no doubt that Mr. Zondi was sincere and skilled in whatever work it is that someone such as he does. He radiated confident authority. If I were Madumo and in search of a counsellor or confessor, I thought, a man like this Zondi would do. And Madumo seemed at ease in his presence; indeed, under Mr. Zondi’s influence, Madumo already seemed to be overcoming his morbid preoccupations. Whatever it was that the healer was proposing, I reasoned, it could hardly make matters worse for my friend. (2000, p.94)

P a g e | 28


In this passage, Ashforth is trying to make a judgement as to whether or not to offer his support

to Madumo entering into a healing relationship with Mr Zondi. The passage lends itself to two

understandings – the first is Ashforth’s personal judgement of the consultation, and the second

is how Ashforth understands the consultation in terms of its effect on Madumo.

Ashforth finds the whole experience bewildering, symbolised perhaps by the smoke of the

burning herbs obscuring his vision. His question ‘do you think you will beable to help this man?’

is more of an articulation of his inner doubt and sceptism, than a sincere enquiry. Besides, it is a

‘Western question’ – an ‘etic’ question, asked from someone operating outside the belief system

of African Religion. Ashforth tries without success to label Madumo’s illness in Western terms.

Yet something in Mr Zondi resonates with him, despite his inability to categorize the encounter.

He recognises an authority in Mr Zondi that engenders trust, and almost surprisingly to him, this

trust enables him to take the leap of ‘faith’ over his Western scepticism, and ‘release’ his friend

into Mr Zondi’s care.

Beyond his own bewilderment and disorientation, Ashforth observes that Madumo is deeply

reassured by the consultation with Mr Zondi. Madumo’s anxiety is assuaged and transformed

into ease. Ashforth describes the paternal and confident authority with which Mr Zondi engages

with Madumo, and his ‘taking on’ of Madumo’s troubles as if they are his own – ‘we will’ he says

- referring to ‘this thing’ which he promises to see to the end. Whatever the problem is, it clearly

is influenced by relationships with seen and unseen entities – as indicated by Mr Zondi’s

reference to Madumo’s ancestors. In Mr Zondi’s judgement, the situation is clearly salvageable,

and it is perhaps this pronouncement that Ashforth observes, gives Madumo what he needs

most – hope.

Thematic analysis

Western bewilderment and disorientation

The confusion the Westerner feels in observing this interaction is patent. Gone are the familiar

beacons of technology, professional distance, and objective categories of illness. Instead, smoke

from burning herbs, profound personal engagement with the healer and a general notion of the

affliction are the order of the day. Further, cure is related somehow to unseen elements, which

by their nature, are not amenable to empiric verification. All of these factors are deeply foreign

to the Westerner, who finds himself profoundly disorientated and unsure if anything like healing

by his understanding could ever emanate from within this paradigm.

P a g e | 29

The power of relationships

Undergirding both the illness and the cure, lie relationships which by their very nature, are

inestimably powerful – between persons (the healer and client), and between the living and the

dead (Madumo and his ancestors, Mr Zondi and the ancestors). These relationships have the

power to bring disaster or success, hope, or despair. Madumo’s fractured relationship with his

ancestors, who have all but departed, is the source of Madumo’s troubles, but their continued

presence in spite of neglect, according to Mr Zondi, is a reason to hope. Mr Zondi’s engagement

with Madumo’s plight, to the extent of taking on the problems as if they were his own (‘We will

see this thing to the finish’ he says), inspires trust, and confidence. That these relationships are

powerful is evidenced by the effect they have on the writer. In spite of his Western orientation

to healing, he is ‘sucked in’ – brought into a place of hope through the confidence, and authority

that Mr Zondi displays.

Meaning and Hope

Mr Zondi, in his capacity as healer, offers Madumo the opportunity make meaning of his

predicament by situating it in a broader context of spiritual realities. By interpreting events

within this context, with the help of Mr Zondi, Madumo is able to take action to restore the

disequilibrium that has ensued. All of this amounts to hope, that Madumo’s situation is not

irreversible, and that a way out exists. This hope is contingent on Madumo’s trust that Mr Zondi

has rightly appraised the situation, and that his guidance will indeed provide a way out.

At this point, before arriving at a comprehensive interpretation of the passage, it is helpful to

explore the immediate and broader contexts of this phenomenon - namely the author and his

book, and the paradigm of African Religion immersed in Western Culture.

The immediate context of the phenomenon

‘Madumo- a man bewitched’ and Ashforth’s search for understanding

Adam Ashforth is a social anthropologist, and visited South Africa in the 1990s intending to study

the politics of representation, and the reconstruction of the terms ‘ethnic’ and ‘racial’ over the

course of the transition to democracy. During his interactions with people in Soweto, he

befriended Madumo, and got caught up in understanding the world of urban blacks, permeated

as it was with violence that overwhelmed the justice system and what he termed ‘spiritual

insecurity’ – a general belief in and fear of witchcraft that permeated people’s consciousness.

Ashforth described these experiences in two books - ‘Madumo, a Man Bewitched’ – a

biographical tale of Madumo’s journey to find healing, and ‘Witchcraft, Violence, and Democracy

P a g e | 30

in South Africa, an anthropological treatise on the root causes and political consequences of

‘spiritual insecurity’. While Ashforth’s essential orientation is Western, he is able through his

anthropological training to suspend his judgement, and adopt an enquiring approach as he

earnestly seeks to understand how Sowetans, living as they do between two cultures, deal with

matters of life, death, injustice and socio-political organisation.


My medical training at a respected South African university has always and continues to teach

Western medicine as an absolute truth, and not as a cultural belief system with integral

strengths and weaknesses. Consequently it is difficult for doctors emerging from this system to

engage meaningfully with belief systems that have different foundational definitions of truth.

However, as I have practised medicine over the years under the influence of Christian faith that

encouraged me to respect persons’ freedom, my attitude to my patients who adhere to African

Religious beliefs has come into conflict with my educational paradigm. It became clear to me

that African Religion offers my patients something that Western medicine does not. Ashforth’s

books, amongst others, allowed me to reflect with more insight on the way urban persons who

adhere to African Religion approach illness and healing.

The broader context of the phenomenon – African Religion immersed in

Western culture African Religion is grounded in similar outlook and fundamental beliefs across the continent,

despite geographical and linguistic differences (Magesa, 1997, p.18-25). African Religion

fundamentally affects how adherents view themselves, and directs their life orientation, despite

substantial individual and societal changes in formal religious affiliation or prevailing societal

world-views. On this basis, it can be understood as a ‘world religion’ by the definition of Hans

Kung quoted in Magesa as follows:

[African Religion is] a believing view of life, approach to life, way of life, and therefore a fundamental pattern embracing the individual and society, man and the world, through which a person (though only partially conscious of this) sees and experiences, thinks and feels, acts and suffers, everything. It is a transcendentally grounded and immanently operative system of co-ordinates by which man orientates himself intellectually, emotionally and existentially’ (Kung 1993, p.xvii, quoted in Magesa, 1997, p.24).

Indeed, a number of scholars, summarised by Knox, having surveyed belief systems of South

African township residents from the late 1980s conclude that adherence to African religious

belief systems is ‘constitutive of mental and cultural landscape’, and is tied up with what it

means to be African (Knox 2008, p.94). Further, because ‘it is possible for us to live with

P a g e | 31

contradictions regarding epistemological truth’ (Bate, 2001, p.67) persons raised in African

contexts, and educated in Western paradigms are able to move freely between knowledge

paradigms, eclectically making use of knowledge systems that suit their purposes. This leads to

the observation that in many persons, African religious belief systems seem to be adhered to

synchronously with other cultural (e.g. Western modes of thought) or religious (Christian or

Islam) belief systems (Magesa 1997, p.9). Against this backdrop, I review African Religion using

the poles of the healing continuum presented in the contextual framework above. I present a

continental perspective on African Religion (Mbiti 1987, and Magesa 1997), and contextualise it

by illustrating pre-colonial traditions amongst southern African Bantu peoples as describe by the

anthropologist Hammond-Tooke (1993).


The ecosphere, as stated in Chapter One above, encompasses the natural world, with or without

the spiritual world, within which health arises through a complex interplay of biological,

psychological and social factors – termed the ‘bio-psycho-social’ model of health (Engel, 1977

p.129). In African Religion, the understanding of the ecosphere is fundamentally different to that

of the Western perspective. Because the meaning of health is contingent upon the

understanding of the ecosphere, it is helpful to explore the African Religious understanding of

the ecosphere in some detail. I will review the African understanding of time, Ancestor spirits,

community and relatedness in community, each of which are fundamental aspects of the

ecosphere when viewed from an African Religious perspective.

Foundational to African Religion is the concept of time, which unlike Western belief, is not

understood to be linear, stretching on to the infinite. Rather time is created as it is populated

with events. Time therefore stretches from the remote past, through the past that is within

reach of the memories of those still living, to the present (Mbiti 1989, p26). Extending into the

remotest past, is the primal ‘First Cause’ of all that has existed and exists in the present, - God -

the supreme life force, the ‘Great Ancestor, first Founder, and Power behind everything that is’

(Magesa, 1997, p 35). Amongst southern African Bantu groups, God, who bestows ‘life force’ on

all beings, was known as Dali or Qamatha (isiXhosa), Nkulunkulu (isiZulu), Raluvhimba

(Tshivenda) and Modimo (seSotho) (Hammond-Tooke, 1993, p150). Generally in African

Religion, but especially amongst the southern African Bantu peoples, God is often not directly

referred to, or attributed to have direct involvement with the living beyond being responsible for

the workings of nature. Rather, if God is to be approached, it is through intermediaries of the

ancestor spirits (Hammond-Tooke, 1993. p.150, Mbiti, 1987 p67). However, as the ‘Initiator of

P a g e | 32

people’s way of life or tradition’, God sets the ancestor spirits as keepers of tradition (Magesa

1997, p35).

According to Fortes, an ancestor spirit is

[a] named, dead forebear who has living descendants of a designated genealogical class representing his continued structural relevance. In ancestor worship such an ancestor receives ritual attention and service directed specifically to him by the proper class of his descendants. Being identified by name means that he is invested with attributes distinctive of a kind of person. (Fortes 1965, p.13)

The term ‘ancestors’ may be variably applied to the living-dead (those who have died but remain

within memory of the living), and the ancestor spirits – those ancestors who have passed

beyond the living memory into the distant past (Mbiti 1987, p84). Within this extended

community of living persons and ancestor spirit, and in the context of time, stretching from the

present, backwards, African Religion believes that one reaches fulfilment if one attains the

status of ancestor spirit, having progressed from life, through death, and the stage of the living

dead. This progression is desirable but not inevitable (Hammond-Tooke, 1993, p.153). The

progression is completed for each ‘living dead’ when there is no-one amongst the living who

knew that person while s/he was alive (Mbiti 1987, p83) . Therefore, not all deceased persons

became ancestral spirits; certain rituals were necessary after death (amongst the Nguni groups,

the ceremony ukubuyisa idlozi took place a year or two after death, and signified this change of

status (Hammond-Tooke, 1993, p.153)) but other persons, such as those who had not had

children, or children dying in infancy, could not reach ancestor status by definition (Knox 2008,

p98).

Progression towards becoming an ancestor spirit is aided through the veneration of the living-

dead, by the living. Indeed, the ancestors wish to be remembered and honoured by their

descendants, and may therefore intrude into the lives of their descendants from time to time to

express their pleasure or displeasure (Magesa, 1997 p79; Hammond-Tooke, 1993 p151). Most

commonly, the ancestor spirits appear in dreams, or by using animals, such as snakes,

caterpillars or hyenas, or may possess their descendants in a spiritual form. If the ancestors are

happy, order and peace reign in community so that the cycles of life – marriage, birth, long life

and peaceful death run their course unimpeded (Magesa 1997, p155). Most drastically,

however, and if displeased, they may bring about misfortune. Therefore, it is in the interests of

the living, who bridge the world of the seen and the unseen, to maintain good relationships

between themselves and the living dead of their familial cluster and clan (Mbiti 1987, p83).

P a g e | 33

African Religion recognizes that human wrong-doing, against the ancestors and God will sometimes bring times of adversity and suffering to the family, clan or community. Individuals at various levels of the community are expected to foresee these occasions and to manage the community’s goods and resources so that people are not caught unawares. (Magesa 1997, p.283)

Ensuring that the needs of the ancestors are met, has a further practical aspect of cementing

bonds of kinship in community. Amongst the southern Bantu tribes, the functional unit of

community was the agnatic cluster – a familial group related through descent from a common

great-grandfather (Hammond-Tooke, 1993 p110). The head of the cluster was the most senior

male of the descent group, and was responsible for overseeing and performing ritual offices

required for the ancestors by the cluster. Agnatic clusters were related at a broader level within

‘clans’ – defined as groups of clusters sharing a common clan name, and common ancestors,

though their genealogical relatedness had often faded into obscurity (Hammond-Tooke, 1993

p110). Amongst the southern Bantu, ancestors are known by the names of amadlozi or

amathongo (Zulu), amathongo or iminyanya (South Nguni/Xhosa), badimo (sotho) and midzimu

(Tshivenda) (Hammond-Tooke, 1993 p151). In these people groups, each clan venerated both

clan ancestors as a whole, and the living dead of their particular familial cluster. Amongst the

southern Bantu, social obligations including participation in rituals related to marriage, birth and

death, sharing of food and loans were primarily to the agnatic cluster, while duties of hospitality,

defence (in pre-colonial times) extended beyond the cluster to the clan (Hammond-Tooke 1993,

p.110). Beyond the agnatic cluster, the geographical neighbours were also people to whom the

duties of sociability and reciprocal help were owed.

This ‘bondedness’ in community amongst the living and living dead, and between the living is

evidence of the centrality of relationship in African Religion (Magesa 1997, p.52). Hospitality is

therefore seen as a prime virtue, as it strengthens community bonds. Indeed, Magesa says:

‘The realisation of sociability or relationships in daily living by the individual and the community

is the central moral and ethical imperative of African Religion’ (Magesa 1997, p.64). This

perspective is further made evident in the well known statement Umuntu ngumuntu ngabantu’

(Nguni) or ‘Motho ke motho ka batho babang’ (Sesotho) ‘A person is a person because of

persons (English) (Mbiti, 1987, p106). Persons are defined as such by their ‘being in community’

– in African Religious context, this includes the broader community of living dead and ancestral

spirits. In the traditional African worldview, health, and wealth, prosperity and peace are

evidence of strong, stable relationships within the community of persons comprising the living,

living-dead and ancestor spirits.

P a g e | 34


Anti-life forces, as in Chapter One above, are those negative individual and societal factors that

arise through organic disease, psychological, social, cultural and economic factors, and may or

may not have a transcendent or spiritual dimension. In African Religion, where kinship bonds

extend beyond the natural world, this latter transcendent, spiritual dimension is a significant

component of anti-life forces. Here I will review how in African Religion, the individual and

cultural significance of symptoms are shaped by the transcendent components of the ecosphere.

Most significantly, in African Religion, misfortune, including ill-health is understood to arise from

one of three sources, namely – 1) from the ancestors, as an indication of their displeasure, or 2)

from witchcraft – as a result of the malevolent wishes of living persons, or 3) pollution – that is

mystical contamination as a result of inadvertent exposure. (Hammond-Tooke, 1993 p178). To

this can be added ill-health or misfortune arising from non-ancestral spirits (originating from

persons who did not receive appropriate burial or spirits of non-initiated children), and nature

spirits, who simply bring disorder for no good reason (Magesa, 1997, p.176). In African Religion,

illness always has religious significance and there is no such thing as chance misfortune

(Hammond-Tooke, 1997, p.174). Therefore, in African Religion, anti-life forces are transcendent

in origin, and impact on the material world to bring about suffering and death.

The attitude towards the ancestors amongst different people groups is generally indicative of

the power that the ancestors brought to bear on the living: While they are generally benevolent,

if neglected by the living, through omission of honour due to them (for example, if appropriate

rituals during rites of passage or at other opportune moments are neglected), they can be

capricious, and jealous, and ‘send’ illness (Hammond-Took, 1993, p.153). Amongst southern

African Bantu, the South Sotho understood that their ancestors continually sought the death of

the living; amongst the Pedi, rituals were directed at preventing the ancestors from interfering

too much in the lives of their descendants; amongst the TsiTonga and Lovedu, the ancestors

were chastised and goaded for failing to protect their descendants when misfortune occurred,

while the Nguni displayed supreme reverence in their veneration of their ancestors (Hammond-

Tooke, 1993, p.154).

Witchcraft or sorcery (ubuthakathi in Nguni and boloyi in seSotho, Tshivenda)is the predominant

and serious cause of misfortune or illness in African Religion (Hammond-Tooke, 1997, p169).

Hammond-Tooke differentiates sorcery (normal humans who use medicines for malevolent

purposes) from witchcraft (evil acts instigated by persons who had mystical ability to harm

others) (1997 p.169). Witches have supernatural powers, and can inflict harm on others directly,

(though they may change shape, becoming invisible) or by sending agents to cause harm on their

P a g e | 35

behalf – such as animals (especially the hyena, and wild cat) or through mythical creatures (for

example, the thikoloshe amongst the isiZulu, the dead body of a departed spirit (a zombi) or the

impundulu, the lightning bird amongst the south Nguni) (Hammond-Tooke, 1997 p.170). Perhaps

the most feared attribute of witches is their hiddenness – a witch was unrecognisable, and could

be anyone – one’s neighbour, cousin, daughter-in-law. Such persons may not even know

themselves to be a witch – by day they are ordinary people, but by night, their spirits leaves

their bodies to work evil (Hammond-Tooke, 1997, p.170-3). Sorcerers on the other hand, use

medicines (ubuthi in isiZulu), such as poisons, or the altered body parts of their victims (such as

hair clippings or nail parings) to harm their victims. The medicine or poison need not be ingested

by the victim. Rather, the sorcerer bewitches their victim through incorporating the medicine

into incantations, and actions (Hammond-Tooke, 1993, p.172). For example, chewing the

medicines, spiting them out and calling the victim’s name, or roasting the medicines on the lid of

a pot of boiling water, dipping ones spear in the water, touching the medicines and then one’s

lips and saying the name of the victim while throwing the spear through a hole in the hut wall

were two ways of bewitching and bringing about illness (Hammond-Tooke, 1997, p172).

Pollution (umnyama amongst the isiZulu) is a relatively more benign cause of illness in that it is

brought about through no fault of a person, but rather through their being in a ‘specific

dangerous state’ (Hammond-Tooke 1997, p.178). These situations differed amongst southern

Bantu groups, but generally included women during their menstruation or after a miscarriage,

and all persons after death of their spouse or child (Hammond-Tooke, 1997, p179). Pollution is

described by Ngubane as

a happening associated with birth on the one hand, and death on the other…it is viewed as a marginal state between life and death. Umnyama is conceptualized as a mystical force which diminishes resistance to disease, and creates conditions of poor luck, misfortune, disagreeableness and repulsiveness whereby people round the patient take a dislike to him’ (Ngubane 1977:77)

In African Religion, witchcraft and sorcery is ‘the enemy of life’ (Magesa 1997, p.186) and ‘the

antithesis of harmony, order, good company, good neighbourliness, co-operation and sharing,

propriety and equitableness, honesty and transparency’ (Magesa 1997, p.186). Even in

contemporary times, amongst Sowetans in Johannesburg, Ashforth observed – ‘the repertoire

of available interpretations for misfortunes….includes concepts of witchcraft and understandings

of invisible agency that are substantially different from those of Western biomedicine’ (Ashforth

2005 p10). Magesa differs from Hammond-Tooke, and says that ‘in the African mentality,

everything wrong or bad in society and in the world, and most particularly, various afflictions,

P a g e | 36

originates in witchcraft. There is no kind of illness or hardship at all that may not ultimately be

attributed to witchcraft’ (1997, p182). Hammond-Tooke reports that the southern Bantu

peoples ascribed the source of witchcraft and sorcery as envy and jealousy, arising through

competition over limited resources (Hammond-Tooke, 1993, p175). Whether the root causes of

illness and suffering are witchcraft, ancestral displeasure or pollution, from an ontological point

of view in African Religion, the presence of ‘illness, poverty and other calamities point to a moral

disorder in relationships from the most elementary in the family, to the most complex in society’

(Magesa 1997, p.81). In African Religion, therefore, the primary anti-life force is represented by

broken relationships, which leads to objective misfortune of any and every kind. Beyond this

general explanation for the reason for suffering in the world, each episode of illness or suffering

can be attributed to specific actions or omissions of responsible persons, living or dead.

Healing

In African Religion, healing can be achieved through consulting a healer whose responsibility it is

to diagnose the cause of illness or suffering, and prescribe an appropriate course of action. The

cause may be one of ancestral displeasure, witchcraft-sorcery or pollution (Hammond-Tooke,

1997, p186). Therapeutic procedures may include the performance of appropriate rituals or

drinking certain medicines, with the purpose of appeasing the ancestors, or mitigating or

undoing the effects of evil.

African religious healers include diviners, herbalists, prophets/faith healers and traditional birth

attendants (Pretorius, 2002, p88). Hammond-Tooke reports that diviners are differentiated from

herbalists by their scope of practice, though amongst the Zulu only are they differentiated

terminologically as isangoma and inyanga respectively. In seSotho, Tshivenda and and Tsonga,

both diviners and herbalists are known as ngaka. Diviners diagnose the cause of illness through

direct communication with the ancestors – through trance, or psychic gifts (especially amongst

the Zulu isangoma) or through the throwing and interpreting of dice, made from carved ivory,

stones or ankle bones of goats or wild animals (Sotho, Venda and Tsonga ngaka). Diviners, who

could be male or female are called to their vocation by the ancestors through an illness known

as thwasa, (Hammond-Tooke, 1997, p193). Thwasa manifests as recurrent, troubling dreams in

which the ancestors appear, and physical symptoms such as stomach ache, nervousness, pains in

back, joints, shoulders and neck become pervasive. The person withdraws and keeps to

themselves. Typically, the afflicted person will seek an apprenticeship relationship with a

practicing isangoma, whereupon the symptoms of thwasa resolve. Herbalists however, were not

called to their role; rather, a person could elected to become an inyanga through learning the

P a g e | 37

trade. An inyanga has a vast knowledge of the medicinal uses of plants for the treatment of

common ailments, or as ingredients in potions to ward off evil (Pretorius, 2002 p.89).

As a therapeutic procedure, divination could take on various forms. Usually family members

would seek help on behalf of the afflicted person. Hammond-Tooke describes that ‘the

divination process among Nguni was essentially a co-operative one, a negotiation between

diviner and the patient’s support group (1997, p.190) as to the cause and who was responsible.

The diviner would make statements, to which the family remembers would respond

enthusiastically, or not, until the cause was worked out to everyone’s satisfaction. At that point

the family would respond ‘Phosa ngemva’ (‘put it behind you’). A specific form of healing ritual

held in common amongst Central and Southern African people groups goes by the general name

‘Ngoma’, meaning the ‘use of drums, singing, dancing and other constituent behaviour’ in

healing rituals (Janzen 1991, p.290). Amongst Nguni peoples, ngoma is done by isangoma’, the

diviner-healer. Ngoma opens with a prayer, utterance or declarative statement, and moves on

to call, and song, with participants responding with clapping, and singing en masse. It may go on

through the night. The content of the ngoma ritual may be determined by the participants, who

in a semi-liturgical fashion, will form their own song, replete with content from the burden of

their lives such as ‘articulation of common affliction, or consensus over the nature of the

problem, and the course of action to take’ (Janzen, 1991, p.290). The responses from

participants will often take the form of culturally standardised formulae invoking the spirit world

and calling the ancestors to help. Participation in ngoma rituals encourage the speaking out of

problems. The isangoma aims to understand the client and his or her troubles through knowing

them, their lives, their dreams and idioms. The isangoma facilitates the expression of these

within culturally accepted idioms (Janzen 1995, p.143), and identifies specific remedies (‘muthi’)

or actions (libations, family feasts during which prayers or invocations to ancestors can take

place) to take to ameliorate the condition, provide cure and prevent future troubles.

Hammond-Tooke describes how divination of the cause of the illness is an attempt to construct

a meaning and allocate responsibility (1994, p.197). When the cause is related to ancestral

displeasure, the victim is culpable of failing to honour his/her forebears, while if witchcraft or

sorcery is the cause, a breakdown in social relations lay at its heart (Hammond-Tooke 1994,

p.197). Magesa describes diviner/herbalists as persons with ‘trained minds and keen eyes for

breaches in the moral order’ (Magesa 1997, p194). The articulation of problems by the patient,

the focussed attention, time and effort that is directed towards understanding the patient and

P a g e | 38

his/her condition, the empathy between healer/therapist and patient and the healers’ ability to

assign meaning to illness all contribute to the immense power that healers bring to the healing

process (Mbiti 1989, p.165; Mkwanazi 1989, p.263).

Exploring African Religion through phenomenological hermeneutics – a

comprehensive interpretation Having reviewed African Religion, I now return to the phenomenon and relate Ashforth’s

description of his experience of interaction with an African traditional healer within a broader

understanding of African Religion. In Ashforth’s description, I identified three themes – namely

Western confusion and disorientation, the power of relationships, and hope and meaning. I have

highlighted the importance of relationship and community in the context of African Religion.

Illness is understood as evidence of disturbance in relationships within this broader community

of living, and living dead, which is occasioned through ancestral displeasure, witchcraft-sorcery

or pollution. It is clear that Mr Zondi understands the former as the cause of Madumo’s

predicament. Mr Zondi’s ‘taking on’ of Madumo’s problem as if it were his own, his references

to Madumo’s ancestors which have all but left Madumo, and his mastery in conducting human

relationships as evidenced by Ashforth’s confidence in him, all concur with the fact that

relationship and bondedness are the central moral and ethical imperative in African Religion.

Further, Mr Zondi is able to situate Madumo’s problem within the broader coherent belief

system of African Religion: Madumo has neglected to honour his ancestors (his mother in

particular, as described elsewhere in the book), and hence he is culpable. Through Mr Zondi’s

prescribed remedies, Madumo has potential to restore the damaged relationship, and achieve

healing. This renders Madumo’s suffering meaningful, and gives him hope. I have also shown

how the poles of the healing continuum in African Religion are different to those of Western

medicine. Ashforth’s disorientation and confusion is occasioned by the absence of familiar

Western characteristics of disease, namely objectivisation of the body and powerful technology.

While at a human level, Ashforth is drawn in by Mr Zondi’s relational skills, he does not identify

or value relationship or human bondedness, nor understand that it is integral to a system of

belief that provides meaning and hope. While the Achilles’ heel of Western medicine is the lack

of a coherent, system of meaning that is able to provide hope, African Religion abounds in hope

and meaning. In contrast, however, the technological power that characterises Western

medicine finds its corresponding power paralleled in personal relationships of African Religion.

P a g e | 39

Summary- African Religion in relation to the contextual framework Returning to our aim of constructing a theology of healing based on theological and

contemporary sources, I new review African Religion in relation to our conceptual framework. I

have observed that African Religion understands that the ecosphere comprises the seen and

unseen world of physical and spiritual beings, bound together in an essential relatedness. Health

is evidence of harmony within this extended community. The chief anti-life force, which

manifests as illness or misfortune is, ancestral displeasure, witchcraft-sorcery, or pollution. At

the heart of these lie distortion, or brokenness of the essential relatedness of beings at any level,

from individual to community. Magesa describes the phenomenon of latent witchcraft, present

in all persons, as the potential for evil, with active witchcraft representing failure to keep

universal destructive emotions in check (Magesa, 1997, p187). The healing process commences

with the development of relationship with a healer with attendant empathy, care and the

speaking out of problems in a ritualised manner. Healing procedures include ritualised singing,

dancing, occasionally with drums, the consumption of prescribed medicines, and other

ceremonies to ward off evil. Healing itself is understood as a restoration of the community and

relationship through actions, rituals, prayers of the living to appease disgruntled spirits and

restore protection. In relation to our contextual framework, however, illness or misfortune that

is brought about by the ancestor spirits, impel the living to right the imbalances of community

and restore relationships. In this sense, the suffering that is occasioned becomes a beacon,

directing persons to address wrong. Suffering and illness are therefore integrated ‘mixtures’ of

good, pro-life forces, and anti-life forces. In this sense, our conceptual framework shows

incomplete correspondence with African Religion.


Christian Scriptures, Tradition and Church teaching In this chapter, I present the story of the healing of a person suffering from HIV/AIDS, which

came about through her admission to a Christian Hospice. I apply the phenomenological

hermeneutical method so as to elicit the essential meaning of Christian healing. In so doing I

hope to reach a fuller understanding of health, illness and healing from a Christian perspective

that is inclusive of Biblical teaching, Christian Theology and praxis over the millennia. Then I

return to our conceptual framework so as to review how well the framework fits the essential

meaning of the experience of healing from within the paradigm of Christian healing. In chapter

6, I will draw from this chapter to construct a theology of healing.

P a g e | 40

A phenomenon – healing from HIV/AIDS During my work at Nazareth House hospice, a patient, Ms Patience X3, whose care I was involved

in, wrote her testimony and shared it at the opening of the new Hospice wing in 2008.

‘My name is Patience, from Eastern Cape. I am HIV positive. I am a proud mother to a 5 year old boy who is also affected by this disease. I started being sick in the year 2005, but I did not know what was wrong with me. I have been seen by many different doctors, but I couldn't get help until I met someone who told me to come to the clinic in Nazareth House. My mother brought me to the clinic and I got tested and I was diagnosed HIV positive. When my mom heard about my status, she got very angry with me and told me that she had nothing to do with me and my son again. That is when I started staying in Nazareth House with my boy. I was very ill, my CD4 count was 3, meaning that I was already fully blown. I couldn't do anything for myself, couldn't walk, I was on a wheel chair. I couldn't feed myself or bath myself and I had shingles all over my body. I was put in hospice where I was given my own room. I had to be fed at least twice every 30 minutes. I was being monitored carefully because I had bad sores all over my body. Being abandoned by my mom made me lose hope, and I was ready to die, but the love and support that I received from Nazareth House helped me to be the person I am today. I lost my job and my accommodation and I lost even the love and respect from my mom. The Sisters of Nazareth House made me feel at home. The care-workers were loving, caring and were so patient with me because they used to bath me at least three times a day. The doctor was calling almost every day to make sure that I was responding to my ARV's. Everyone in Nazareth House was caring and loving and they helped me fight my battle until won. Sister Mura was checking on me every moment. After my long stay at Nazareth house, she helped to arrange sponsorship for me to attend a call centre training course. I was able to find a job, and move into my own flat. I was able to take my son back to stay with me. I've learnt a bit from this amazing place, to love others, to respect and to give without anything in return. To people living with this virus, I would like to let them know that this is not a death sentence, they should not be afraid and to seek help in a place like Nazareth House.’ Patience X. 2012


Patience’s experience of illness was profound and affected every level of her person. She lost

control over her physical body to the extent that she could not work, she was not able to care

for herself, and could not even walk. The extent of her debility became public – as she lost her

job and her home. Her skin condition made her illness obvious – it was not concealable. At an

emotional level she was rejected by her own mother. The positive HIV test connected her illness

with the vast internal, and external stigma and shame that is part of the personal and societal

response to HIV/AIDS. The combined effect of this illness was that she lost hope, and in her

despair, was ready to die. However, her arrival at Nazareth House portended a profound

healing. The environment was full of love, manifesting as hospitality, care, attentiveness,

3 Not her real name.

P a g e | 41

physical, emotional and financial support, and provision of medicines. It is clear that this

experience of illness and subsequent healing was life changing for Patience. She shares how she

has learned about unconditional love, and how she has gained a new sense of meaning and

purpose for her life – in terms of encouraging people who are living with HIV to seek care.

Thematic analysis

Love

Patience mentions love a number of times – ‘I lost even the love and respect from my mom’;

‘love and support I received at Nazareth’, ‘loving’ careworkers, ‘everyone was caring and loving’,

‘I’ve learnt a bit – ‘to love others’. She attributes this love as the reason for her recovery (‘love

and support I received at Nazareth helped me to be the person I am today’). Love is at the centre

of the caring actions that address Patience’s needs at every level. Love is made visible through

relationships – which achieve their power for good or ill because of their ability to share or

withhold love. Patience refers to the relationships with her mother, herself, and her son, which

are all cast in a negative framework of disease, loss and disappointment. Then, she mentions

relationships with Sr Mura, the care givers and the doctor in the context of her healing. These

latter relationships are characterised by love, which is manifested as acceptance (Sr Mura’s

welcome of her, as contrasted with the rejection she experienced from her mother),

attentiveness to her physical needs, patience, and care (the care givers), competence with

regard to the medical skills (the doctor), and commitment over time (Patience became ill in

2005, and was still in contact with Sister Mura at the time of the opening of the new Hospice

facility in 2008).

Powerful medicine

The provision of medicines through which biological causes of Patience’s condition were treated

is an important aspect of Patience’s story. In her case, antibiotics, acting against bacterial causes

of her skin infections, and antiviral medications that inhibit the growth of HIV played an

important role in her healing. But critically, the role of these powerful medicines is subordinated

to a holistic perspective that addresses all aspects of Patience’s experience of illness. Primarily,

these medicines achieve their power because they are used in a context that abounds in love.

Hope, renewal and personal growth

Within this loving environment, Patience was able to find meaning in her illness experience. She

re-casts her illness as an experience that can provide hope for persons living with HIV. She is able

to integrate her experience of profound vulnerability and rejection into a system of meaning

that sees service of others as a way of providing hope. In this way, she is patterning her life story

P a g e | 42

on what has been modelled to her by the Sisters of Nazareth. Patience moves from a life that is

focussed on meeting her own needs and those of her immediate family, towards a more

inclusive, less self-orientated way of being.

The immediate context of the phenomenon –

Patience and the Sisters of Nazareth

The Sisters of Nazareth is a Catholic order of nuns, founded in London by Victoire Larmenier,

known as Mother St Basil. Victoire was born in France, in 1827, and at the age of 24, joined a

French Catholic order of nuns. In the mid 1800s, she left this order with a following of sisters, to

answer a call in London to care for the aged, poor, and later, homeless and abandoned children.

The core values of the movement were justice, patience, love, respect, compassion and

hospitality. In 1881, the Sisters arrived in South Africa at the invitation of the Bishop of Cape

Town. Their work in Johannesburg, Yeoville, began in 1894 when 6 religious sisters arrived in the

mining town to provide care for orphaned children, and the elderly. The vision and energy of

the Order grew to include provision of palliative care for adults and children dying from

HIV/AIDS in the late 1990s. Through their connection with various Catholic relief agencies,

Nazareth House in Yeoville, JHB gained access to antiretroviral therapy (ART) from 2004. They

opened a clinic for adults, a hospice for in-patient care for persons with opportunistic infections

including TB and provided ART for the HIV positive children in their home, and I was the first

doctor to work on the programme. In 2005 Sr Mura Doherty, and the Archbishop Buti Tlhagale

opened a dedicated ‘hospice’ facility for those with HIV/AIDS. Over the years, the name ‘hospice’

became a misnomer, as the vast majority of persons admitted for care were discharged, well.

The care at Nazareth house was different in quality to that obtained in public sector clinics and

hospitals, and the institution developed a good reputation with local residents and clinicians for

its excellent clinical care and supportive team of health care workers. In recent years, the

Nazareth House Order has come under severe criticism internationally for maltreatment and

cruelty to the children under its care in the early 1900’s (Historical Institutional Abuse Enquiry,

2014).

When I met her, Patience had advanced HIV disease, complicated by the presence of an

‘opportunistic infection’. In terms of the biology of her condition, she developed impaired

immunity and increased susceptibility to disease after infection with the human

immunodeficiency virus (HIV) some years prior. This occurs through infection of ‘CD4’ cells with

HIV. CD4 cells are white blood cells of the lymphocyte group that have the role of defending the

body from intracellular infections such as tuberculosis. At or prior to infection with HIV,

P a g e | 43

Patience’s CD4 count, like all persons newly infected with HIV, was between 500 to 1200

cells/mm3. Infection of these cells by HIV results in CD4 cells being subverted to produce HIV

particles. In the process, CD4 cells are progressively killed over 5-10 years. Ultimately, when her

CD4 cell count fell below 200 cells/mm3, Patience’s body lost its capacity to defend itself from

infection and she developed ‘Acquired Immune Deficiency Syndrome’ (‘AIDS’). Evidence has

shown that persons with a CD4 count below 200 cells/mm3 have an average life expectancy of 2

years (Spencer 2004 p.5)

When Patience was admitted to Nazareth House, she had AIDS, her CD4 count was three, and

she was seriously ill with a condition known as ‘weeping seborrheic dermatitis’ – the

dysregulation of skin cells and processes, which leads in severe cases to multiple infected sores

over the entire body. Her prognosis was dismal, firstly from the skin condition and secondly from

HIV-mediated immunosuppression. In caring for Patience, I recall she had a distinct will to

survive – motivated by her expressed wish to be available to mother her son. I prescribed

various antibiotics, and medicines to address the skin problems, and anti-viral medication (anti-

retroviral therapy or ART) to deal with the underlying and main problem of HIV. Through the

hospice care givers, Patience’s nutritional and emotional needs were met. Patience went on to

regain her health and be discharged. From a medical perspective her recovery was remarkable –

stories of recovery like hers are described by others as the ‘Lazarus effect’ (Zuger 1995 p. 5)

because of the return to near complete health in someone who was very close to death. The

story above was one she wrote at the request of the ‘mother of the house’, Sister Mura, who

had asked her to give an address at the official opening of a new Nazareth House Hospice facility

in 2008. What Patience does not mention in her story, is that her son, who was also infected

with HIV, acquired a complication that resulted in a visible deformity. Her journey with HIV will

be lifelong, not only because of her own need to take medicine and monitor her condition

closely, but also because of her need to support and nurture her son on his journey with HIV. In

this sense, her suffering although greatly helped by those factors she shared above, will be

ongoing.


Patience’s account of healing moved me greatly, because she is amongst the few of my patients

who have been able to articulate the meaning of their experience of illness and healing. While

Patience makes no specific mention of God as the agent of her healing, God, through the

medium of love, is implicitly present. The work of God, manifest through human institutions,

interpersonal love, and personal vocations of those who serve her is abundantly present in her

account.

P a g e | 44

The broader context of the phenomenon – Healing in Christian

Scripture, Tradition, Church teaching and Ministry Healing has been an expression of Christian faith across the millennia, within many varied and

different theological traditions and denominations. Healing in Christian tradition built on the

inheritance of the Jewish faith with regard to the understanding of illness, and suffering. Jesus

was known during his time to outsiders as a middle eastern miracle-worker/healer, and after his

death, Christians claimed Jesus to be the source of healing power. Healing was the predominant

sign of the Christian movement after Christ’s death and resurrection until the 5th century A.D

(Kelsey 1995, p.181). In recent times, healing as emerged as a feature of the ministries of the

Pentecostal movements and African Independent Churches, beginning in the late 19th century

and continuing to the present (Kelsey 1995, p.187) . Healing cannot be understood in isolation

from the Christian worldview. Therefore, the poles of the healing continuum provide a helpful

framework with which to set out the Christian cosmology, in so far as it applies to healing.


The Christian understanding of the ecosphere begins with the premise of the essential goodness

of the earth and created beings, created through God’s infinite love (Genesis 1:1-31). Christian

theologians have personified and anthropomorphised God’s purposes for human existence as a

participation in ‘God’s own life’. Life is a gratuitous gift of grace, which is God’s personal

communication of God’s self to all humankind, through love (Haight, 2012 p407). God’s gift of

creation includes human potential for goodness, and human freedom (Gilkey 1985 p. 51). Health

is integral to the message of the Christian gospel that promises ‘a sense of comprehensive well-

being’ (Nurnberger, 2002, quoted in Conradie, 2006, p.4). Health is in part, evidence of the

realisation of this freedom, as expressed in the goodness brought about in constructive,

harmonious human relationships amongst persons, society, in relation to the environment and

towards God. The Hebrew concept of ‘shalom’ (שלום) best expresses the meaning of health-

while the direct translation of ‘shalom’ is ‘peace’, the meaning encompasses more than this – it

implies a state of wholeness of individual and community – ‘it signifies welfare of every kind:

security, contentment, sound health, prosperity, friendship, peace of mind and heart’

(Bernbaum 1975 p. 601). Peace is understood to be the natural potentiality of humankind, and

has a present dimension, as well as an eschatological one – in the sense that the ultimate

fulfilment of humankind is anticipated to be a state of shalom (שלום) between God and

humankind, and amongst humankind (Greehy 1978 p577). God is the author of shalom (שלום),

and God’s purpose for humankind is shalom (שלום). Peace is found as a blessing, prayer and

promise in biblical literature. Peace is inclusive of health, and stable, constructive relationships.

P a g e | 45

‘I will give you your rains in their season, and the land shall yield its produce, and the trees of the field shall yield their fruit. Your threshing shall overtake the vintage, and the vintage shall overtake the sowing; you shall eat your bread to the full, and live securely in your land. And I will grant peace in the land, and you shall lie down, and no one shall make you afraid; I will remove dangerous animals from the land, and no sword shall go through your land. Leviticus 26:4-6

While this state of health, or shalom (שלום) can be attributed to a primal ‘garden of Eden’,

where communion and union with God was an integral state of being, the Garden of Eden story

is less of a temporal beginning, and more a reflection of human potential and projected longings

of humankind for fulfilment in union with our creator (Gilkey 1985 p.53).


In Christian theology, sin, leading to death is the primary anti-life force. The meaning of sin in the

Hebrew scriptures, and which was adopted by the early Church, was conveyed through a

number of Hebrew terms. These are instructive in revealing sin less as a ‘legal entity’, as follows:

1) Hattat (חטאה)–means ‘missing the mark, a breach of agreement, disloyalty to an agreement,

failure of an inferior to fulfil an obligation, or non-action’; 2) Awon (עוית) – means ‘a distortion, a

change in the nature of something for the worse, invoked by failure, or a corruption of person’;

3) Segagah ( השג) - means a ‘straying’; 4), Pasa, marad, marah (שע means a rebellion, the act– (פ

by which community is dissolved, a personal offense by which an insult arouses anger; 5), Ra

ע ) (means ‘evil, or that which lacks its proper form, which is crippled and distorted’; and 6 -(ר

Seker (קר means ‘a lie, a verbal denial of reality’ (Mackenzie 2002, p. 817). The New -(ש

Testament introduces the concept of sin being a power which may have dominion over persons,

sin being a single act, or a state or condition. Sin has a catechetical definition as follows:

Sin is an offense against reason, truth, and right conscience; it is failure in genuine love for God and neighbor caused by a perverse attachment to certain goods. It wounds the nature of man and injures human solidarity. It has been defined as ‘an utterance, a deed, or a desire contrary to the eternal law. (CCC, 1849)

In interpreting the meaning of sin through these biblical word studies, exegesis related to

creation narratives (not described here) and church tradition, it is possible to understand sin

through a theological anthropological approach. Sin can be understood in relation to God’s

loving intentions for humankind, as ‘resistance to God’s self communication, and enabling will to

actualise human potential’ (Haight, 2012, p394). Concupiscience becomes sin when humans

resolve the tension of being vs ‘non-being’ with attempts to secure our own selves, our future,

and our lives through our own efforts, on our own terms, rather than freely accepting God’s

infinite grace and love in trust. Underlying every personal sinful act, is a ‘measure of lack of

openness and surrender in self-actualization before God and according to God’s will – and more

P a g e | 46

aggressively, to a propensity against the designs of God and for the self’ (Haight, 2012 p.

397). Sin leads to a tainted actuality arising through the human propensity for evil, and the

temptations to freedom that lead to human religious and moral disobedience to God (Gilkey,

1985, p52). Sin has individual and societal dimensions - society is a complex of prior sin, in that

human social structures, which could potentially enhance human freedom to respond to grace,

become structures which entangle humankind in the mesh of sins of omission, evasion of

responsibility for society, and participation in structures that harm, and impair human potential.

In this sense, we are born and raised in sin.

Sin and illness are inter-related, at the level of human experience. While all illness, and all

components of illness within an individual are not directly consequential on individual sin (and

hence it is never possible to unequivocally blame the ill person from bringing illness upon

themselves), illness may often ensue as a result of the complex interplay of human freedom

used against God’s will for humankind at individual and societal levels (Conradie 2006, p.6). For

example, at this level we see illness occurring through air pollution, diseases of poverty such as

tuberculosis or malnutrition, or even illness where human culpability has played a larger, though

not singularly responsible role, such as motor vehicle accidents, or habitual smoking leading to

lung cancer. Illness and suffering may also ensue as part of the created order – the natural

world – and this can be understood as the suffering of becoming, or the actualising of our

potential good. Examples of this include the experience of human finitude, of ageing, or natural

illness through epidemics (Hall 1986, p. 49).

At a personal level, sin, the turning of one’s back on God, withdrawing from God or separating

from God, results in a loss of inner coherence, identity and truth. This leads to a conscious or

unconscious internal disharmony, which the study of psychoneuroimmunology has shown, can

affect the immunological system, and lead to disease (Beck, 2007, p. 83).

‘In a Christian perspective, God does not punish man. But he (sic) designed the world and its structures in such a way that man (sic) punishes himself if he fails to subject himself to these structures. This is already true for the motocycle driver who takes a curve at too high speed, and it is also true for psychological maturing phases that someone fails to navigate properly, as for the laws of the spirit, logic, reason and the recognition of truth, all of which must be observed. It is in particular the laws of the spirit insofar as these are oriented to the ultimate horizon of being, and in the Christian view of a personal God, which must be obeyed. To disobey these laws implies inner disorder and thus possibly also material disorder in the sense of disease’. (Beck 2007, p.84)

P a g e | 47

Healing

With this understanding of illness, the remedy for illness becomes synonymous with the remedy

for sin. Healing of illness and healing of sin are synonymous. This is corroborated by examination

of healing in the Hebrew and New Testament scriptures. The intertwining of literal (physical),

and ‘figurative’ healing (deliverance from moral evil and relief of pain) arises from the biblical

understanding of person as integrated body and soul (Lacoste, 2005, p667). This is beautifully

illustrated in the Biblical account of Jesus’ healing of the woman with persistent haemorrhaging

(Matt 9:18-26, Mk 5:21-43, Lk 8:40-56). The woman who touches the fringe of Jesus’ garment

without his knowledge and experiences healing, is told by Jesus ‘go, your faith has made you

well’. In all three accounts of this miracle in the synoptic gospels, the healing episode is

characterised by the woman’s hope that Jesus is able to heal, the verbal contact initiated by

Jesus in response to his perception that a healing has taken place and the use of the word ‘made

you well’ (sozo (σῴζω)), which means ‘save’ or ‘make blessed’ or ‘make whole’ (Schweizer 1970,

p.118; Maddocks 1995, p.32). The author in Mark’s account could have used other words for

healing that have no meaning other than ‘heal’ e.g. Iatros (ἰατρός). Therefore the use of this

word (sozo (σῴζω )‘save/heal’) is significant, and denotes that her healing at a physical level is

accompanied by newfound wholeness, and a ‘salvation’ if translated literally. We understand

from the account that the writer was intending to convey that not only was the woman’s

haemorrhaging healed, but also her shame, and ostracism from society – in other words, Jesus

healed her entire person. Her illness, arising through a composite interplay of organic structural

sin (the dynamics of which we are not aware of), societal disvalues, and internal psychological

states was healed through Jesus’ personal encounter with her.

From a Christian theological perspective, the remedy for sin is Jesus’ life, death and resurrection

which address sin at three levels (Conradie, 2006, p.7). Firstly, the resurrection of Christ

represents a decisive victory over sin and evil (Conradie, 2006, p.7) – it is an illustration of the

power of God to heal. It is a triumph over the anti-life forces of illness, suffering and death, and

makes way for the ultimate healing of humankind: John 3:16 explains that the suffering and

death of Jesus (the ‘giving’ of Jesus) accomplishes the absolute healing of humankind (‘that we

should not perish but have eternal life’). Kelsey describes how the Resurrection event

transformed the lives of the Disciples and subsequent generations of believers to become

sources of healing through the continuation of Christ’s life through the Church:

The apostles who had lived and suffered with Jesus were awed by what they met. They knew that something beyond the ordinary had occurred before their eyes. There was an unearthly wholeness and power in the one they saw as the messiah, the Christ. Through Jesus they were touched by the numinous, the transcendent - the same experience they

P a g e | 48

had had in their most profound religious encounters as good Jews. In the healing of the sick and demon-possessed, a degree of love and harmony and wholeness was manifested that left them thunderstruck. Then in the Resurrection came the confirmation of all their deepest intuitions about Jesus. The person they had followed was not conquered by the actions of unconscious human beings under the influence of the Evil One….what had touched them in dream and vision and myth they now saw actualised. With this experience they realised that the realm of the Spirit ruled over all reality, and that in the end there was nothing to fear. Through the Master who had led them until his death, and then returned, they could still find the same new quality of life which he had imparted as a living human being. (1995 p.285)

Secondly, the suffering and death of Christ simultaneously addresses the roots and

consequences of sin (Conradie, 2006, p.9). The grace of God to humankind is the giving of Christ,

a giving that resulted in his death, to humans ‘as they were’, and ‘as we are’. Grace then,

becomes forgiveness which is not an ‘undoing or negation of past sin’, but a profound,

revolutionary acceptance of human beings as we are – persons who have continually displayed a

‘lack of openness and surrender in self-actualization before God and according to God’s will –

and more aggressively, to a propensity against the designs of God and for the self’ (Haight, 2012

p. 397). This action of forgiveness can be better understood through the Hebrew Scriptural term

kapper (כפרים), meaning ‘atonement’ - a ritual act, meaning to remove an offence or cover an

offending object so that reconciliation can be achieved (MacKenzie, 2002, p.69). In Hebrew

worship, this was done ritually by covering with the blood of a sacrificial animal, but in the

suffering and death of Jesus Christ, it was done through the grace-filled giving over of God’s self

to the limitations and intrinsic suffering of the human condition, and over to death at the hands

of wilful, self-serving and evil persons. In the words of Gregory of Nazianzus ‘what is unassumed

is unhealed’(Epistle 101) – in other words, the taking on of human form in its entirety, allowed

for the redemption of humankind.

When confronted with this truth, if we have the courage to engage with it, our human

vulnerability is made plain. We realise ourselves to be fractured, disintegrated and broken (Kay-

Toombs, 2006, p.120; Dombeck, 1997, p.57). But simultaneously, we see our true selves, that is -

ourselves as our Creator made and sees us, as loved persons, radically accepted by God. Merton

refers to the results of this encounter in vulnerability with God as one in which we ‘cease to be

conscious of ourselves in separateness, and know nothing but the one God Who is above all

knowledge’ (Merton, 1961, p.122). A joining of selves, a mystical union with God and self, takes

place as the image of God in ourselves recognizes the origin of its person in God’s self. Merton

describes this mystical union as a simultaneous recognition of Godself and our true self as

follows:

P a g e | 49

The recognition of our true self, in the divine image, is then a recognition of the fact that we are known and loved by God. …. It is utterly different from any other kind of spiritual awakening, except perhaps the awakening of life that takes place within a man when he suddenly discovered that he is indeed loved by another human being. Yet this human awakening is only a faint analogue of the divine awakening that takes place when the ‘image’ in our spirit comes to itself and realises that it has been ‘seen and called by God and that its destiny is to be carried towards Him….it is quite usual, when a man comes into intimate spiritual contact with God, that he should feel himself entirely changed from within. Our spirit undergoes a conversion, a metanoia which reorientates our whole being. (Merton, 1961, p.124)

In the context of healing, Kelsey understands this re-orientation of our being following an

experience of God, in psycho-analytic terms. He describes the experience of healing through

faith in Jesus as one that results in the reconciliation of the unresolved tensions between the

conscious and unconscious minds, resulting in transformation of the ego (1995, p.227). The

resolution of tensions takes place because each part of our psyche is more closely aligned to our

true identity.

This experience is one of the most moving we can sustain…Those who enter this way are faced with ever greater consciousness and the task of integrating more and more of their own unconsciousness, which so often appears as destructive darkness. Each such experience brings new harmony of purpose, often with the sense of creative peace, as well as physical healing, because the conscious stress that produces so much disease is relieved. (Kelsey, 1995, p.288)

This grace-filled giving of Christ deals with the roots, and consequences of sin because it results

in ‘a mystical union in which the person of faith takes on and is recreated by the qualities of

Christ’ (Haight, 2012 p.410). Grace therefore works with human freedom to orientate our

human freedom towards God, and towards love of the other.

Thirdly, the incarnation of Jesus, and ongoing incarnation in the body of Christ addresses the

consequences of evil when it cannot be fully eradicated (Conradie, 2006, p. 14) - through the

ongoing sanctification of human life. At individual levels, Christians strive to mitigate the

consequences of sin in our own lives and the lives of those around us. Haight describes how the

social dimension of grace works its effects through creation of institutions, organisations,

policies and actions that are dedicated to the nurture and care of human life and thereby resist

the social dimension of sin (2012 p. 425)

From a theological perspective, the healing that is made possible through Christ’s death and

resurrection is inherently paradoxical – because it is the suffering and death of Christ that is

understood to lead to healing and life. It must be, therefore, that suffering plays some role in

P a g e | 50

the healing process. Pope John Paul II addressed this paradox in his papal letter ‘Salvifici

Doloris, - on the Christian Meaning Of Human Suffering’. He explains that not only is suffering

evidence of human distortion and sin, but suffering can be understood as the mystical

experience of participation in the sufferings of Christ. He describes that as the suffering person

identifies with Christ’s suffering, the significance of the individual’s sufferings in some sense

‘lose’ their own context, or become enlarged by the context of Christ’s suffering, which had

redemptive purpose and effect. In this new context, he shares how the meaninglessness of

suffering falls away.

Faith in sharing in the suffering of Christ brings with it the interior certainty that the suffering person ‘completes what is lacking in Christ's afflictions’; the certainty that in the spiritual dimension of the work of Redemption he is serving, like Christ, the salvation of his brothers and sisters. Therefore he is carrying out an irreplaceable service. In the Body of Christ, which is ceaselessly born of the Cross of the Redeemer, it is precisely suffering permeated by the spirit of Christ's sacrifice that is the irreplaceable mediator and author of the good things which are indispensable for the world's salvation. It is suffering, more than anything else, which clears the way for the grace which transforms human souls. (John Paul II. 1984, Salvifici Doloris p.26,27)

Furthermore, through Christ, suffering can be transfigured or transvalued into an aspect (rather

than a cause) of redemption (Gilkey, 1985 p.61). From this perspective, we see the inevitability

of suffering through conditions of human finitude, and through the consequences of evil, yet the

necessity of it for redemption and renewal. The ‘Atonement is the symbol of the divine

participation and sharing in the suffering conditions of existence, and so the divine redemption

of them in the New Being – hence is the suffering of evil transmuted, made bearable and so

conquered by the divine presence within it’. (Tillich, 1957 p.174). Gilkey reports that the inner

cure of suffering becomes an aspect of sanctification and the work of redemptive grace. Through

grace and new life, the inner person begins the healing journey from doubt, despair, anxiety,

meaninglessness, guilt, self-hatred, pride towards humble, repentant self-awareness, courage,

serenity, love and hope, while the outer cure of suffering is that through which evil/suffering is

mitigated or removed by creative political action (Gilkey, 1985 p.62).

Exploring Christian healing through phenomenological hermeneutics – a

comprehensive interpretation Having reviewed Christian Theology, Scripture and Church teaching regarding healing, I now

return to the phenomenon and relate Patience’s description of her healing within a broader

understanding of Christian healing. In Patience’s description, I identified three themes – namely

P a g e | 51

love, powerful medicine, and hope, renewal and personal growth. Having reviewed the

literature related to Christian healing, I show that love is integral to Christian cosmology and

hence, to healing. God created the world and persons in love. Through love, God wills persons

into relationship. Through love, manifested as the giving of Christ, God overcomes the

consequences of the misuse of human freedom. Through love, God transforms suffering into an

aspect of redemption. Powerful medicine, an important theme in Patience’s story, enters

Christian cosmology as a manifestation of God’s grace in its communitarian or social dimension.

Through the ongoing redemption of persons, and the discovering of their vocation, social

structures and institutions are created that mitigate the effects of sin. Nowhere could this be

more true than with the concerted efforts of patient advocates, HIV/AIDS activists, international

health organisations, clinicians, scientists and multinational pharmaceutical companies whose

efforts lead to the development and distribution at affordable prices of antiretroviral drugs.

Hope, renewal and personal growth as a theme in Patience’s story are consistent with Christian

cosmology, through the growing sanctification of persons as suffering is transcended, and

persons move towards increasing self-awareness, serenity and hope. In essence, Patience’s story

can be understood as an overcoming of suffering through love, leading to personal growth and

increasing wholeness.

Summary – Christian healing in relation to the contextual framework Returning to my aim of constructing a theology of healing based on theological and

contemporary sources, I have reviewed Christian healing in relation to the conceptual

framework. I have observed that Christian theology understands that the ecosphere is creation –

the world, inhabited by persons who are created with freewill and a potentiality for good. Health

is an intrinsic part of God’s will for humankind – expressed in Biblical terms as shalom (שלום).

The chief anti-life force is sin which leads to death, and which is made manifest at individual and

societal levels. Individually, sin arises through failure to trust in God, human self-assertion

against God, and active opposition to God. Illness is a consequence of sin – not necessarily

through direct actions, but through inhabiting a world of social sin – the collective and

cumulative consequences of sin expressed at societal level through the ages. Healing is

understood as synonymous with ‘salvation’, and is obtained through the life, suffering, death

and resurrection of Jesus Christ. Jesus’ resurrection represents the ultimate healing, but remains

an eschatological vision for humankind. Jesus’ suffering and death occasioned atonement of

human sin – the taking on of the human condition by the Divine Person, and his participation in

human suffering allowed human sin to be forgiven, and through appropriation by faith, redeems

humankind’s propensity to sin by radically healing human brokenness through the power of

P a g e | 52

love. Finally, even suffering, where it cannot be removed, is transformed when suffering persons

take on the redemptive vocation of sharing in Christ’s sufferings. In a final observation, it

appears that the Christian understanding of healing does not correspond fully with our

contextual framework, in that suffering is multifaceted, and can be simultaneously a

consequence of anti-life forces (sin) and an aspect of healing (redemptive suffering).

Chapter 6: Components of a theology of healing in contemporary

South Africa In this chapter, I will draw from Chapters Three, Four, and Five, commencing first with a review

of the adequacy of the conceptual framework. If necessary, and on account of any new insights

arising from the phenomenological enquiry into the meaning of healing within the paradigms of

Western medicine, African Religion and Christian Theology and Ministry, I will revise the

conceptual framework. Secondly I will identify aspects of the meaning of healing from the

contemporary South African context (Western medicine, and African Religion) that can

contribute to a theology of Christian healing. Finally I will list the components of a theology of

healing for contemporary South Africa. In Chapter Seven, I shall illustrate how this theology can

be translated into praxis for ministry in our South African context.

A review of the adequacy of the conceptual framework At first impression, because suffering arises through actions or situations that are destructive, it

would seem reasonable to conclude that suffering is unequivocally destructive. Therefore, in

setting the poles of the conceptual framework, in Chapter Two above, I noted of ‘suffering’, that

it ‘appears to be appropriately situated’ in the pole of anti-life forces’. However, as each of the

paradigms of Western medicine, African Religion and Christian theology were examined above, I

showed how there was not complete correspondence with the initial conceptual framework in

so far as this siting of suffering is concerned: A commonality amongst the three paradigms was

that suffering may have aspects that impel the victim or society towards a greater good. In this

sense, suffering is not unequivocally bad, and cannot be appropriately situated as an exclusive

‘subset’ of anti-life forces. In Western medicine, the conceptual framework failed to incorporate

the ‘pro-life’ forces that arise when suffering is transcended. These included the observations

that suffering entails the creation of meaning, the forming of narrative in relationships, and

forgiveness that may ensue when suffering is transcended. In African Religion, the conceptual

framework did not allow for the recognition that the suffering that is occasioned through illness

or misfortune brought about by the ancestor spirits becomes a beacon, impelling the living to

P a g e | 53

right the imbalances of community and restore relationships. In Christian theology, it is

understood that suffering is multifaceted, and can be simultaneously a consequence of anti-life

forces (sin) and an aspect of healing (redemptive suffering). In this sense, suffering and illness

must be understood rather as an integrated ‘mixture’ of anti-life and pro-life forces.

At this juncture, it is therefore appropriate that I revise the conceptual framework in a manner

presented in Figure 2 below. In this revised conceptual framework, the original poles are

rearranged so that suffering overlaps the poles ‘Ecosphere’, ‘Anti-life forces’ and ‘Healing’. As I

originally, depicted, suffering must be a part of the anti-life pole, because it arises as a

consequence of those forces that would seek to overcome life. However, suffering must also be

a part of the ‘Ecosphere pole’, in the sense that much suffering is the ‘suffering of becoming’

(Hall 1986, p. 49) – we reach our full potential as humans when we overcome the obstacles

intrinsic to our human condition. Suffering must also be a part of the ‘healing pole’, in that the

experience of healing includes an integration of suffering, and the making of meaning, leading to

a new level of integrity of wholeness (Cassell, 2004. p.56; Egnew, 2005, p.257; Wilkinson, 2005,

p.39). In this sense suffering is redemptive – it brings one to a new level of being, that in the

absence of the experience of suffering, one would not have achieved.

Figure 2. A revised conceptual framework illustrating the relationship between health, illness, suffering and healing.

Aspects of Western medicine and African Religion that can contribute to

a theology of healing Having examined the meaning of healing from the perspectives of Western medicine and African

Religion, it is helpful to review which aspects of healing within these paradigms can contribute to

a theology of healing for contemporary South Africa.

With regard to Western medicine, I identified that technological power in terms of effective

medicines and procedures which bring about cure, is a strength of this paradigm. However, I also

P a g e | 54

noted that technology within this paradigm in which persons are reduced to ‘carriers of

pathology’ leads to fear, bewilderment and hopelessness because of the absence of human

connection and the absence of meaning. In my phenomenological enquiry of healing in the

Christian paradigm, I showed how technological solutions to illness (antiretroviral drugs) were

taken up as part of a loving response of empathetic caregivers to the patient and not as a

‘solution’ in itself to the problem of illness. In the review of Christian theology, I observed that

the application of technology (effective drugs and procedures) to the problem of healing is a

manifestation of God’s grace at an individual and societal level towards the curtailment of the

effects of social sin (sanctification). It therefore seems appropriate that technological responses

to illness be included in a theology of healing as a manifestation of God’s grace, subordinated to

the imperative to love one’s neighbour.

Within the paradigm of African Religion, I showed how the power of relationships between and

amongst living, and living dead brings about or opposes healing. In a parallel vein, recent

developments in Western medicine, in the field of psychoneuroimmunology have shown how

stress (induced through disrupted social relationships) may impair immune responses and

indirectly bring about illness. Western enquiries into healing have highlighted that those factors

which promote healing are those that sustain relationships - valuing and creating a non-

judgemental emotional bond, the conscious management of power on the part of the healer in

ways that would most benefit the patient and commitment to caring for patients over time. In

Christian theology, the theme of relationship is implicit in every discussion of God’s interaction

with persons. I reviewed how relationship with Jesus is a means through which healing occurs –

through atonement, redemption and sanctification. However, Christian theology has not

thoroughly explored nor emphasised the importance of relationships within the community of

faith, and the role of these relationships in effecting healing. In the Christian paradigm, a

theology of healing can guide care-givers in the creation and sustaining of healing relationships.

A theology of healing can encourage the establishment and work of institutions that harness the

power of relationships to mitigate the effects of social sin. A theology of healing can encourage

appropriate community responses to the manifestations of social sin, and empathetic and

supportive attitudes towards ill persons.

P a g e | 55

A theology of healing drawn from traditional Christian sources of

theology, and contemporary South Africa. In Figure 3 below, the revised conceptual framework presented in Figure 2 above, is conceived in

Christian terms. This revised conceptual framework can assist us to describe a theology of

healing drawn from traditional Christian sources of theology, and contemporary South Africa.

Figure 3. A revised conceptual framework illustrating the relationship between health, illness, suffering and healing, conceived in Christian theological and biblical terms.

With regard to the ‘Creation’ pole,

• Harmonious relationships between God and persons are possible because of God’s

infinite love and grace towards us. Within this foundational, loving relationship with

God, persons are able to fully realise their true selves.

• The realisation of persons true selves is brought about equally through the generation

and sustenance of harmonious relationships among persons, and between persons and

the environment.

With regard to the ‘Sin and Evil’ pole

• Individual sin – in practice, human resistance to God’s loving intentions for us, - leads to

distorted relationships between persons and God, and among persons.

• Illness is the manifestation of social, societal and individual sin, for which all persons are

collectively and where appropriate, individually responsible.

With regard to the ‘Salvation and Redemption pole’,

• Healing is accessible through the redeeming love of Christ, which addresses individual

and social sin through forgiveness, redemption and sanctification.

P a g e | 56

• Christ’s forgiving love for all persons brings about healing at the individual level through

radical acceptance of persons, who simultaneously realise themselves to be fractured,

broken from the effects of sin, and inestimably loved by the Divine Creator.

• Christ’s redeeming love is manifested in many ways, including through technological

tools (drugs and procedures) which have become available to address the effects of sin.

Through the redeeming love of Christ, human intelligence has been directed to the

problem of illness in individual and collective ways.

o In the context of the redeeming love of Christ, technological tools are able to

reach their greatest good. Technological tools are used to greatest effect, when

those persons that apply the tools, and those that benefit from them are

orientated towards love of God and neighbour. Technological tools become a

vehicle through which God’s healing work allows persons to fully realise their

true selves.

• Christ’s sanctifying love which brings about healing, can be brought about for persons

when the communities of which persons are a part, are orientated towards the love of

Christ and neighbour.

o Love creates and sustains an environment in which a person can work towards

integrating their experience of illness into their lives to restore wholeness.

o In the context of the sanctifying love of Christ, sin is addressed through the

ability to harness the collective strength of community, society and institutions

to work for healing.

o Miracles may be understood as the expression of Christ’s sanctifying love, which

makes itself present directly (ie not mediated through Western medicine, or

sacrament) in physiological healing. These miracles are not explained through

faith, reward, works or other human agency. This is the mystical dimension of

salvation and of health.

With regard to suffering,

• Suffering, which arises through particular manifestations of sin and evil, also has

potential for good in so far as Christ’s suffering and death was transfigured into an

aspect of redemption.

• When persons are open to the love of God in the midst of their suffering, they may

understand their suffering to be taken up into the redemptive work of Christ. This allows

persons to situate their suffering in a framework of meaning, and reach a new level of

P a g e | 57

self awareness and self understanding. This experience leads to a new level of

wholeness and integrity, which in the absence of suffering, they would not have

achieved. In this sense, suffering is transformed, and can become redemptive.

Conclusion In this chapter, I revised the conceptual framework, by acknowledging that from all paradigms

(Western medicine, African Religion and Christian), suffering is best situated in the centre of the

overlapping poles of the ecosphere, anti-life forces and healing. I identified that technological

power to address illness, a strength of the Western medical paradigm, should be included in a

Christian theology of healing as a manifestation of God’s grace in mitigating the effects of sin at

a social, societal level. I made the caveat that technological power to address illness needs to be

subordinated to the imperative to love, and not as an end in itself. I identified that the African

Religious emphasis on harmonious relationships can be drawn into a Christian theology of

healing by a renewed emphasis on the role of relationships within the community of faith to

effect healing. Finally, using the revised conceptual framework, I delineated the components of a

theology of healing. Next, in Chapter Seven, I shall illustrate how this theology can be translated

into praxis for ministry in our South African context.

Chapter 7: A concluding note - taking a theology of healing into

ministry While it is beyond the scope of this dissertation to translate a theology of healing into praxis, it

may be helpful to provide some concluding remarks on how this theology of healing can assist

persons who are ill, or who suffer, and persons who are in the caring professions and pastoral

ministry.

At the outset it is essential to acknowledge that each person’s journey through illness and

suffering is uniquely their own. Equally, each person’s journey towards the Divine Creator will

take its own shape, regardless of his/her culture or religious orientation, on account of the

intrinsic freedom in which we are created. It is neither possible nor appropriate to persuade,

convince or subvert a person’s course of action towards any pre-determined outcome. Intrinsic

to the role of care-giver, be it familial, pastoral or professional, is a respect for person’s freedom.

This does not preclude the setting of boundaries on self-destructive or socially unacceptable

behaviour. The orientation of a person towards the Divine is an individual choice that cannot be

made by one person on behalf of another.

P a g e | 58

Central to all caring ministries, and at the heart of every person’s journey through illness is the

forgiving, redeeming, sanctifying love of Jesus Christ. Those involved in caring ministries can seek

to present this love of Christ to all who are ill, or who suffer. The presentation of the love of

Christ is pre-eminently through caregiver’s unspoken actions, attitudes and life-orientation

towards love of God, and less through the explanation in words of Christ’s love for us. Through

this love of God, which is made present in love for the patient, actions and attitudes that

facilitate healing can include:

• The fostering of an empathetic, non-judgemental care-giver-patient relationship.

• Ongoing commitment of care-givers to the patient over time.

• Emotional self-awareness and effective self-management of the care-giver, so that the

care-giver’s issues and background do not impact negatively on the patient.

• Technical proficiency with regard to the profession of the care-giver, which includes an

awareness of when the problem exceeds the care-givers professional competence.

• Engagement of the patient in the decision making process regarding the application of

medical technology, with respect for patient autonomy.

• The subordination of medical technology to the best interests of the patient –

recognising that some ‘cures’ create further suffering, which may not be desirable.

• Attentiveness to patient’s physiological, psychological and spiritual needs – spoken or

unspoken. This attentiveness is facilitated when caregiver understands him or herself to

be partnering actively with Christ in ministering to the patient. The prayer of the care-

giver for the patient, and the unconscious orientation of the care-giver towards love of

God and patient engender a receptivity to the needs of the patient that transcends

human insight or understanding. In this way, the care-giver acts as a conduit for the

expression of God’s love for the ill, and suffering.

On occasion, and when it is perceived to be helpful to the ill person, it is also possible to make

verbal reference to aspects of Jesus Christ’s love for us, while at the same time, being respectful

of person’s choice to integrate these words into their lives. It is helpful to be cognisant of the

patient’s religious or philosophical tradition, so as to address their vulnerabilities. So, for

example; in African Religion, Christ, the Great Ancestor, wards off the threat of malevolent

spirits; or, in the Western paradigm, the love of Christ reaches out to restore meaning. When

presented at the appropriate moment, Christ’s truth may be retained and used by the ill person

if they grow into a fuller understanding of Christian faith.

P a g e | 59

The forgiving, redeeming and sanctifying love of Christ is equally integral to negotiating the

journey through illness for us as suffering persons. An authentic engagement with God, through

faith, around the challenges of the illness can unlock new perspectives on our life situation, and

allow us to respond to these challenges in creative and constructive ways. We may need to ask

for guidance from others in the caring professions (Ministers, Religious, psychologists,

psychiatrists, Prophets). Scripture, particularly the Psalms of lament, is helpful. In these, the

Psalmist voices his/her complaint against God, giving vent to anger, disappointment. The

narratives of persons who have encountered illness and suffering as a transformative experience

towards greater sanctification are helpful in providing a template for us as we negotiate our own

journeys. Two constructive examples are those of Alexander Venter (2000, p.1-30), and Johan

Viljoen (2003, p.70-74). The acknowledgement that suffering is not unequivocally bad, can

encourage us to search for ways in which it can be transformed, and become redemptive. The

acceptance of medical technology as a means by which God shows his grace, can remind us that

humankind is loved by God. The importance of integration into community and the sharing of

one’s vulnerability on account of illness cannot be underestimated, as Christ’s forgiving,

redeeming and sanctifying love is often communicated through friends and family during time of

illness.

Finally, community, society and institutions play a role in mediating the forgiving, redeeming and

sanctifying love of Christ. Community attitudes to the sick are formed through collective

responses to illness. Rather than taking their cue from prejudice and fear, our collective

attitudes to illness need to be informed by the love of Christ. We do well as community when we

make it our goal to understand the experiences of the ill, so that we are able to respond

appropriately, and in love. Our response should not stop at individual actions, but in and through

love for those who suffer, we can harness the power of the collective through the creation of

institutions whose goal is to ameliorate suffering and challenge the underlying structural causes

of sin. Our participation in these institutions, whether they be overtly Christian or not, is an

expression of our willingness to serve God and our fellow humans towards the ultimate goal of

transforming and redeeming suffering.

In conclusion, in this dissertation, I have used a phenomenological methodology to explore the

meaning of healing from the perspective of Western medicine, African Religion and Christian

Theology. I identified aspects of healing in each of these two non-Christian paradigms that

contribute to a theology of healing. I described components of a theology of healing for

P a g e | 60

contemporary South Africa. Finally, I have briefly shared how care-givers, suffering persons and

communities may apply this theology.

Bibliography Ader, R., & Cohen, N. 1975. ‘Behaviorally conditioned immunosuppression’. Psychosomatic

Medicine 37(4), 333-340. Amato, J. 1990. Victims and Values. A History and a Theory of Suffering. New York: Greenwood

Press. Ashforth, A. 2005. Witchcraft, Violence and Democracy in South Africa. Chicago: University of

Chicago Press. Ashforth, A. 2000. Madumo – a man bewitched. Chicago: University of Chicago Press. Bate, SC. 1999a. Inculturation of the Christian Mission to Heal in the South African Context.

Lampeter: Edwin Mellen Press. Bate, SC. 2001a. ‘An interdisciplinary approach to understanding and assessing religious healing

in South African Christianity’. Missionalia 29(3),361-386. Bate, SC. 2001b. ‘Culture in Christian Praxis: Culturally mediated Christian responses to culturally

mediated human needs’. Journal of Theology for Southern Africa 109: 67-82. Bate, SC., 2013. ‘HIV prevention and the theology of sin: Inculturation in Urban Africa’. Grace

and Truth January, 36-64. Beck, M. 2007. ‘Illness, Disease and Sin: the connection between genetics and spirituality’

Christian Bioethics 13:67-89, Bernbaum, D. 1975. A book of Jewish Concepts. New York: Hebrew Publishing Company. Catechism of the Catholic Church. 1995. Nairobi: Paulines Publications Africa. Cassell, E., 2004. The nature of suffering and the goals of medicine. 2nd ed. Oxford: Oxford

University Press. Csordas, T.J. & Kleinman, A. 1996. ‘The therapeutic process’ in Johnson, T.M. & Sargent, C.S.

(eds) Medical Anthropology. Contemporary theory and method. New York: Praeger Publishers, 3-20

Conradie, E. 2006. ‘Healing in soteriological perspective’. Religion and Theology 13(1):3-22. Dawkins, R. 2008. A River out of Eden – a Darwinian view. United Kingdom: Basic books. Dombeck, M. 1997. ‘Healing the Fractured Self’ in Roach, M.F. (ed) Caring from the Heart. The

Convergence of Caring and Spirituality. New York: Paulist Press, 50-67. Dyrness, W.A. & Karkkainen, V.M. (eds) 2008. Global Dictionary of Theology. Illinois: Intervarsity

press. Egnew, T.R. 2005. ‘The Meaning of Healing: Transcending suffering’. Annals of Family Medicine

3, 255-262. Engel, G.L. 1977. ‘The need for a new medical model: a challenge for biomedicine’. Science 196,

129-136. Faull, C. & Woof, R. 2002. Palliative Care. Oxford: Oxford University Press. Fortes, M. 1965. ‘Some reflections on Ancestor Worship in Africa’ in Fortes, M. & Dieterlen, G.

(eds.) African systems of thought: studies presented and discussed at the Third International African Seminar in Salisbury, December 1960, London: Oxford University Press, 122-144.

Galvin, J. 2011. ‘Jesus Christ’ in Schussler Fiorenza, F. & Galvin, J (eds) Systematic Theology. Roman Catholic Perspectives. 2nd ed. Minneapolis: Fortress Press, 255-314.

Gener TD., Batuista L. 2008. ‘Theological Method’ in Dyrness W. & Karkkainen V. (Eds) 2008. Global Dictionary of Theology. Intervarsity Press. England.

Gilkey, L. 1985. ‘The Christian understanding of suffering’. Buddhist-Christian studies 5,49-65.

P a g e | 61

Godbout, J.P. & Glaser, R. 2006. ‘Stress-induced immune dysregulation: implications for wound healing, infectious disease and cancer’. J Neuroimmune Pharmacol Dec 1(4)421-7.

Greehy, J.J. 1978. ‘Shalom: The fullness of God’s Promise’. The Furrow 29 (9), pp 576-579. Haight, R.D. ‘Sin and Grace’ in: Schussler Fiorenza, F. & Galvin, J. (eds) Systematic Theology:

Roman Catholic Perspectives. 2011. 2nd ed. Minneapolis: Fortress Press, 3-79. Hall, D.J. 1986. God and Human Suffering. Minneapolis: Augsberg Fortress. Hammond-Tooke, D. 1993. The roots of black South Africa: an introduction to the traditional

culture of the black people of South Africa. Johannesburg: Jonathan Ball Higgs, P. & Smith, J. 2006. Rethinking truth. Cape Town: Juta. Historical Institutional Abuse Enquiry. 2014. Transcripts of proceedings on Day 9, 12th February

2014. Available at http://www.hiainquiry.org/index/day_9_without_hia_13_evidence.pdf [accessed on 1st June 2014]

Huber, M. et al. 2011. ‘How should we define Health?’. British Medical Journal 343, d4163. Jackson, C. 2004. ‘Healing Ourselves, Healing Others’. Holistic Nursing Practice 18(2), 67-81. Janzen, J. 1991. ‘Doing Ngoma: a dominant trope in African religion and healing’. Journal of

Religion in Africa 21 (4), 290-308. Janzen, J. 1995. ‘Self-presentation and Common Cultural structures in Ngoma Rituals of

Southern Africa’. Journal of Religion in Africa 25 (2), 141-162. John Paul II. 1984. Apostolic Letter Salvifici Doloris Of The Supreme Pontiff John Paul II To The

Bishops, To The Priests, To The Religious Families and to the Faithful of the Catholic Church on the Christian Meaning Of Human Suffering. Available at http://www.vatican.va/holy_father/john_paul_ii/apost_letters/documents/hf_jp-ii_apl_11021984_salvifici-doloris_en.html [Accessed 2 July 2012]

Kay-Toombs, S. 2006. ‘Vulnerability and the Meaning of Illness: Reflections on lived Experience’ in Talyor, C & Dell’oro, R. (eds) Health and Human Flourishing: Religion Medicine and Moral Anthropology. Washington DC: Georgetown University Press.

Kelsey, M, 1995. Healing and Christianity. Minneapolis: Augsberg Fortress. Kleinman, A. 1988. The Illness Narratives – suffering, healing and the human condition. USA:

Basic books. Knox, P. 2008. AIDS, Ancestors and Salvation. Local Beliefs in Christian Ministry to the sick.

Nairobi: Paulines Publications Africa. Kung, H. et al, 1993. Christianity and World Religions: Paths of Dialogue with Islam, Hinduism

and Buddhism. Maryknoll: Orbis Books. Lacoste, J.2005. Dictionary of Systematic Theology. New York: Routledge. Leader, D. & Corfield, D. 2008. Why People Get Sick. Exploring the Mind-Body Connection. New

York: Pegasus Books. Lindseth, A. & Norberg, A. 2004. ‘A phenomenological hermeneutical method for researching

lived experience’. Scan J Caring Sci 18:145-153. Lyons, A. & Chamberlain, K. (eds) 2006. Health Psychology – a critical introduction. London:

Cambridge University Press. Maddocks, M. 1995. The Christian Healing Ministry. London: SPCK. Magesa, L. 1997. African Religion – the moral traditions of abundant life. Maryknoll, NY: Orbis

Books. Mbiti, J. 1989. African Religions and Philosophy. 2nd ed. Johannesburg: Heinemann. McKenzie, J.L. 2002. Dictionary of the Bible. Bangalore: Asian Trading Corporation. Merton, T. 1961. The New Man. New York: Farrar, Strauss and Giroux. Mkwanazi, I. 1989. ‘The iSangoma as Psychotherapist’ in Oosthuizen, G. (ed) 1989. Afro-Christian

religion and healing in southern Africa. Lampeter: Edwin Mellen Press, 261-280. Moore, T. 1992. Care of the Soul. UK: Piatkus. Moore, T. 2010. Care of the Soul in Medicine. Healing Guidance for Patients, Families and People

who care for them. Johannesburg: Hay House.

http://www.hiainquiry.org/index/day_9_without_hia_13_evidence.pdf

http://www.vatican.va/holy_father/john_paul_ii/apost_letters/documents/hf_jp-ii_apl_11021984_salvifici-doloris_en.html

http://www.vatican.va/holy_father/john_paul_ii/apost_letters/documents/hf_jp-ii_apl_11021984_salvifici-doloris_en.html

P a g e | 62

Ngubane, H. 1977. Body and Mind in Zulu Medicine. London: Academic Press Nouwen, H. 1974. The wounded healer. UK: Bartman, Longman and Todd. Nurnberger, K. 2002. Theology of the Biblical Witness: An Evolutionary approach. Hamburg: LIT

Verlag. Parker, P. 1997. ‘Suffering, Prayer, and Miracles’. Journal of Religion and Health.36 (3), 205-219. Pellegrino, E.D. & Thomasma, D.C. (eds) 1981. A philosophical basis of medical practice: toward a

philosophy and ethic of the healing professions. Volume xvii. New York: Oxford University Press.

Pert, C.B. et al 1985. ‘Neuropeptides and their receptors: a psychosomatic network’. J Immunol. 135(2 Suppl), 820s-826s.

Pretorius, E. 2002. ‘Traditional Healers’ in Gilbert, L. et al (eds) Society Health and Disease – an introductory reader for Health Professionals. Johannesburg: Ravan

Quinn, J. 2000. ‘The Self as Healer. Reflections from a Nurse’s Journey.. AACN Clinical Issues 11 (1),17-28.

Rhodes, A.L. 1996. ‘Studying Biomedicine as a Cultural system’ in Johnson, T.M. & Sargent, C.F. eds. Medical Anthropology:Contemporary theory and method. New York: Praeger Publishers.

Schopenhauer, A. 2004. On the suffering of the world. Penguin. London. UK. Schweizer, E. 1970. The Good News According to Mark. London: SPCK. Scott, J.G. et al 2008. ‘Understanding healing relationships in primary care’. Ann Fam Med 6, 15-

322. Scott, J.G. et al 2009. ‘Healing relationships and the existential philosophy of Martin Buber’.

Philosophy, Ethics and Humanities in Medicine. 4, 11. Smith, D.W. Fall 2011. ‘Phenomenology’ in Zalta, E. (ed) The Stanford Encyclopedia of

Philosophy. Available online at http://plato.stanford.edu/archives/fall2011/entries/phenomenology/ . Accessed 7 May 2014]

Sørlie, V. et al 2003. ‘The meaning of being in ethically difficult care situations in pediatrics as narrated by male registered nurses’. J Pediatr Nurs Oct;18(5):350-7.

Spencer, D.C. 2005. The Clinical Practice of HIV medicine. A practical guide to the care of the HIV infected. Johannesburg: Goldstream books.

Talseth, A.G. et al 1999. ‘The meaning of suicidal psychiatric in-patients' experiences of being cared for by mental health nurses’. J Adv Nurs May 29(5):1034-41.

Tillich, P. 1957. Systematic Theology II. Chicago. University of Chicago Press. Tracey, D. 1994. On Naming the Present: God, Hermeneutics and Church. Orbis: Maryknoll New

York. Venter, A. 2000. Doing Healing. Cape Town: Vineyard International Press. Viljoen, J. 2003. ‘Responsibility and Caring for one another’ in Bate, S.C. (ed) Responsibility in a

time of AIDS. Pietermaritzburg: Cluster Publications, 70-74. Wilkinson, I. 2004. Suffering: A sociological Introduction. Cambridge: Polity. WHO. 2006. Constitution of the World Health Organization.

http://www.who.int/governance/eb/constitution/en/. Accessed 11 May 2014 WHO Commission on the social determinants of Health. 2008. Closing the gap in a generation:

health equity through action on the social determinants of health: The final report of the Commission on Social Determinants of Health. Geneva, World Health Organization,

Young, A. 1982. ‘The anthropologies of illness and sickness’. Annual Review of Anthropology 11,257-285

Zuger, A. 1995. Strong Shadows – scenes from an Inner City AIDS clinic. New York: W H Freeman & Co.

http://plato.stanford.edu/archives/fall2011/entries/phenomenology/

http://www.who.int/governance/eb/constitution/en/

A theology of healing for contemporary South Africa -a phenomenological and multidisciplinary...

Documents

Transcript of A theology of healing for contemporary South Africa -a phenomenological and multidisciplinary...