“Do you want to be well?” Jesus asked the man by the pool of Bethesda. And still today this question is pressing to all of us, at all times, and in all circumstances. “Do you want to be becoming fully restored? To be becoming more like Jesus in all areas of life?” If you will pardon my stretching of the usual syntax of the English language, most of us would answer in the affirmative, yet I would caution against an overly rash answer. Full restoration brought with it consequences, for the man had to walk, had to carry his own bed, and maybe had to go back to work. Jesus later implied spiritual responsibility requesting that he “go and sin no more.” Indeed, when it comes to the topic of restoration to wholeness there is both important action to be taken on the part of both God and ourselves. There is a kind of enticing tension here that is throughout the Bible and, indeed, is at the heart of many of the decisions we make every day. On one hand, it is only in and through Christ that we have any hope for any Wellbeing at all, and at the same time he stops and asks me/you, “Do you want to be whole?” Then he does what only he can do, whether that is heal paralyzed limbs or minds, or reconcile our very souls and restore us to fellowship with God, which is followed by inviting us to follow him and sin no more, which we then get to choose to do. Then, as we read throughout the Scriptures, there are thousands of nuanced ways we live out the ever present tension of participating in what only God can do – a kind of Christo-centric life lived out in our marriages, in Medicine, in schools, and in families. At the same time, created in the image of God, we are free, we are creative, we make decisions, and we are captains of the body and life that he has given us, walking with him and working out the tensions of daily decisions.
What a joy and challenge it has been to contemplate a Biblical approach to Medicine that is aimed at God-designed Function. I am indebted to those who have joined our conversation with their well thought out and gracious words. The gamut ranged from Kevin Miller, a heart friend of the last 15 years, with a prominent podcast to Nick Besbeas, a new acquaintance with an influential business/tech background also inspired to get creative in our fight against chronic disease. Additionally, I read with interest the comments from Hin-Tai Ting from the perspective of one in the midst of a diagnosed dysfunction, and Dr. Karches, from the perspective of a fellow primary care physician with a desire to work within and improve the current healthcare system.
As with any complex problem there are so many different paths one can take towards a solution. All of my fellow contributors highlighted some of my points that resonated and then developed their own ideas even more deeply, or they took a different tack altogether. Our purpose ultimately is not to wax eloquent and chew on ideas together without any change, but we desire change, growth, and that to be towards conforming to the picture of Jesus we have in the Bible. The Greek word “metanoia”, often translated as “repent”, has a sense to it of “changing one’s mind”. I believe that part of our reason for existence at all is to be in this crucible of life, so that we get to learn (which is a kind of mind-change) and experience (which changes us) and grow in mind and body and soul towards God himself. I have landed on four conclusions from our discussion that are changing my mind.
Conclusion One
The Western Healthcare system is not and cannot become Christo-centric. Dr. Karches’ medical practice, and he, himself, is Christo-centric, but I do not have any hope that a third party payer system or governmental healthcare system would evolve toward this kind of Medicine. While we have always had the reality of human frailty and disease, and all of us are on the spectrum of dysfunction whether it be mental or physical, and all of us will die, the original question remains as to WHY we find so many of us in the chronic, degenerative consequences of disease. To highlight the plight of those who are less able to help themselves and the Christian invention of hospitals not only misses the point, but it devalues the self captaincy of those who are in fact crippled or lame in some way. Are those people utterly dependent on the system? I fear we have invited them to think so, but I would invite them to change that mindset and participate in a broader understanding of how they arrived in such a state and what they can do themselves to be becoming less unwell and more well.
I deeply appreciate the down to earth perspective of Wendell Berry, but to him I would also ask, “how did your brother wind up in such a state of severe atherosclerosis that he had a heart attack and needed this kind of surgery?” I do not know his brother, nor why he had this dysfunction, so we cannot judge his particular case, but we can assess the science that has proven what is the driving cause behind most of the cases of coronary heart disease (and stroke, and diabetes, and cancer, and dementia). The clear evidence is that 80% of the underlying cause is attributed to our daily life choices. Now, once you are having a heart attack, then I hope that the physician and medical team that you end up with will approach you from a Christo-centric perspective and provide help and care with grace and love. But I hope we can learn from the outcome, then go to our children and neighbors and invite them into a mind-change that will reduce the chances that they also are heading toward a heart attack.
Conclusion Two
As much as a great writer like Wendell Berry decries the industrialization of agriculture and healthcare, Nick Besbeas notes the wonders of another debatable side of modern economy – consumerization. Here, again, is the tension that we are trying to work out. Which is it?? Is consumerization a good thing or a bad thing?! Well…like most any other thing under the sun, it could be either. How are you as an individual going to engage with it to increase the likelihood that you are growing more Christlike?
Right now, for most people with the most common kinds of degenerative diseases (I am not referring to the crippled, blind, or lame), the system does not elevate them to the level of honored customer. Indeed the patient’s own definition of Wellbeing does not often enter into the discussion with one’s “provider” (that word itself may be representative of the over-consumerization of healthcare). In fact, from one perspective, we could say that the healthcare system is actually “consuming sickness”. It is primarily feeding off disease as opposed to primarily providing a path toward Wellbeing. So, on one hand, we have the negative “over-consumerization” of our healthcare system feeding off the disease of people. And on the other hand we have the “under-consumerization” of the actual customers, who are not invited into a service industry as their own captain, but almost as if they are there for the benefit of the system. They don’t feel like they are choosing to consume anything, thus there is a sense from Nick of a breath of fresh air with BFM. Finally, the customer gets to be right.
Conclusion Three
There is much to be honored regarding the Christo-centric medicine of the past. We will always have our sick and suffering among us (indeed this includes all of us in one way or another). The hospital was a Christian invention and it is a wonderful thing, but would it not be better to shift our focus towards pre-hospital care, so that we don’t need that kind of very expensive and inefficient care?
Currently, the government and insurance companies do offer a kind of financial “tip” for discussing lifestyle with a patient, but again… It is not working! The system is built on diagnosis codes for illness – not wellness. And even if there are a few conscientious doctors diligently discussing the foundational roots of disease with patients in the few moments at the beginning or end of an appointment, the vast majority of customers are NOT telling the story of their medical experience that reflects this. Most are telling the story of frustration. This almost goes double for those in the mental health arena, as Ting relates in his article.
When it comes to that chief cornerstone of Relationship within the BFM framework, there indeed are times (again, when the situation has grown dire or more acute) when quick and proper application of a diagnosis and a medication is desperately needed. But, where is the system when it comes to whatever is “PRE-depression” or “PRE-anxiety”? No customers even engage the healthcare system because they KNOW they are not quite sick enough, and they don’t want a medication. Yet, they know they are not full of Wellbeing. They are stuck in a kind of tension, so they just keep on doing what they have done, coping, until it gets worse.
We in the medical profession have taught our patients so poorly in this area over time, that so many in our churches also don’t have confidence in how to engage in this area of care. Jesus made it clear that one of the greatest commandments is based on our skill, our ability, our awareness, of how we love ourselves. I am hoping that a shift toward a BFM approach will help both patients (customers) and Doctors/PA/NP (and sometimes parents and friends and pastors!) build a framework for shoring up the chief cornerstone of our relationships with God, self, and others.
Conclusion Four
While there is much to be grateful for, and we will never lack for opportunities to serve those among us that have needs, it is nevertheless true that much unwellness in our culture is the very fruit of our culture! Kevin is right to highlight this in his piece, and he notes how a kind of deep complacency has seeped into our very church culture. O that we would wake up! O that we would be becoming more aware of the cultural water that we are swimming in and how it is producing a people burdened with unwellness. Systemized “healthcare” can be a very effective tool for acute treatment of a heart attack, but it has done very little to help our people be aware of where they are on the map of “pre heart attack”. And it is a catastrophic failure in treating matters of the heart – the soul.
While I agree with Dr. Karches that we do not likely need to revamp the entire healthcare system, I am confident the current system will not produce a product that a free and wise customer would want to consider when that person’s desire is Wellbeing. It is time for some of us in the medical community (which in the grand scheme includes families and the church!) to be compelled to produce a product that will serve individuals in their quest for improving their mind-body-soul. While there is no theological imperative, there is a Biblical basis for this approach. Jesus and the Kingdom of God is at hand. He asks all of us, “Do you want to be well?” How will I respond? There are some things that I know only he can do, and yet, our God that is with us invites me to choose to participate with him in this truly wonderful, messy, painful, tension-filled and awesome thing called – Life.