Singing the Lord’s Song in a Difficult Landscape
Dr James Hanvey, SJ
This is an edited version of a talk given by Fr James Hanvey, SJ at a Catholics in Healthcare Workshop.
Dr James Hanvey is a Jesuit working at Heythrop College, University of London. You can read more about his work and experience here
A Problematic, Politicised Landscape
The field of healthcare is an intensely politicised one. The danger is that the human face which is at the centre of all healthcare gets erased. While healthcare is a professional act requiring all our knowledge and skills it is also a personal encounter. Where it is politicised there is always the danger that the ‘professional’ is reduced to a purely instrumental relationship and the nature of the encounter is distorted. This ‘depersonalisation’ is a two way process: not only is the recipient ‘objectified’ but also the person administering the care is equality ‘objectified’ through a series of categories and statistics etc. Now, it is, of course, important that there are appropriate ways of measuring and tracking any system; also that there are high levels of accountability. But the process of politicisation here can turn these from means into ends. When this happens then there is also a fundamental transformation of the culture and its values. This can produce a displacement of the human person who, in this field, is one that is always encountered as vulnerable. What we miss is that those who care for them are also vulnerable in that such care, whatever the systems or levels of professionalism, is always an act of generosity – a response which always contains within it that desire to meet another person beyond the limits of the professional skills. In other words, healthcare is always ‘person care’ albeit within defined situations. At its heart is a human exchange.
Implicit or Explicit Theology
We are all operating with an implicit theology of the human person. We should make some of this, at least, explicit. While we all have a unique and irreducible essence, a sense of self or ‘me-ness’, this never occurs in isolation but is always within the context of relationships. In some important sense our ‘personhood’ and the expression of our individuality needs and requires these relationships and is generative of them. We become and express ourselves in and through our relationships with others.
A person who comes to you for healthcare comes with a narrative, and comes connected to other people and communities, as well as being connected body and soul. Indeed, these two are integrally bound up so that one expresses the other. The notion of the soul grounds the reality of the person so that they cannot be reduced to a mere body; the transcendental dynamic of our live – the way in which we live and shape our existence in love, freedom and understanding, cannot be reduced to chemical actions in the brain. Such reductionist strategies are not only deficient in their ability to comprehend the rich complexity of a human life but tend to a sort of determinism which ultimately undermines the moral nature of the human person i.e. that people do desire and are capable of doing good. On the other hand, a dualism which sees the ‘soul’ as the only really valuable thing about us is another sort of reductionism. It denies the very nature of our embodied existence and the way in which that defines us and is also the way in which we live in the world and understand ourselves. We are not disembodied subjects but women and men, have colour and shape, etc. Whatever conclusions we may come to about the way in which these physical dimensions are also socially constructed our bodies carry identity and meaning also. They literally locate us; in them and on them is the text of our lives
Yet, despite first appearances, I suggest that the Christian understanding of health and healthcare is not predicated upon a reductive dualism of body and soul. One place to start from to understand this is the extraordinary reality of the Resurrection. You will recall that the philosophers of Athens laughed at Paul when he spoke of this? The reaction may still be the same today, yet it is the scandalous core of our faith. It maintains that our embodiment is not accidental to us but is part of our eternal as well as natural destiny. So all healthcare that grounds itself in some sense of Christian anthropology that has a profound non-instrumental view of the embodied human person. It will value and respect the body because it too is ordained to glory. It too is the work of grace which is mediated not just sacramentally but in relationships of respect, care, and love. Yet, it is precisely because of this understanding of our embodied reality that for us Healthcare, working with the human being, is working with an occasion of transcendence.
In this sense, then, working in the healthcare arena is a deep and practical way of doing theology. That most beautiful sacrament of the sick points to this in its own way. It reminds us that no action of healing is ever just about the physical healing but about the restoration, in some way, of our sense of self, our integrity as a human being, our belonging, and, of course, our vocation to eternal life – which is not something that begins upon our death but is already present in our lives and is realised in each action of generosity, respect, care – each action which confers and recognises our value and our dignity.
Often this expressed just in those simple and routine ways: the thoughtfulness that attends to a person and just makes them that bit more comfortable, that takes just that little extra moment; the touch that consoles, etc. Also in the way in which people express gratitude and bonds of trust are built up. Now, this is not some idealised picture; it does not deny the complexity and the problematic nature of situations and relationships, but it somehow refuses to be bound by them. It always finds some way, no matter how small, of being unconstrained.
Witness and Resistance
This is why such an understanding of healthcare which never loses sight of the human reality is also an act of witness and resistance. We must resist both the depersonalising of the receiver of healthcare and the depersonalising of the giver of healthcare. We forget that the giver too can be regarded as purely instrumental: they’re simply to dispense whatever people believe themselves to be ‘entitled to’. In these situations the appeal is often made a receiver’s rights, they are a ‘client’ or ‘customer’. We forget that in this very human exchange of healthcare the ‘carer’ also has rights. They cannot be required to forfeit conscience and the sense of their own dignity and humanity. In other words, those who are professionally engaged are also humanly engaged and they cannot be treated as purely passive instruments either of the one receiving care or by the system within which they work.
Retaining a vision that is always greater than that expressed implicitly and explicitly by policies resists depersonalising. It also helps us prevent the ways in which we are “desensitised” to issues and questions because it allows us an alternative intellectual and linguistic ‘space’ – it allows us the possibility of understanding and interpreting ourselves, intuitions and actions in ways that are not completely absorbed by the language and concepts of the systems within which we have to work. I want to call this, Keeping of the Memory. The French sociologist of religion, Danièle Hervieu-Léger, in her book ‘The Chain of Memory’ argues that society has become ‘amnesic’. Her argument is that the structures and channels within society, which carries its ‘memory’ e.g., its traditions, customs, etc. has been eroded. It is not about staying in the past or about trying to stifle change; her point is that this sources of ‘memory’ are Utopian spaces i.e. they are the resources we have for envisaging a different sort of society. Far from being nostalgic, they are about the future for they keep alive and active the vision we have of something deeper, richer, better. Even though here analysis is of French society, I think it also has some validity for us. While reforms and changes are necessary, if they erode this sort of memory, they also diminish the creativity of the culture and that affects its values and the motivation of those who work in it. Often this exposes a paradox of the changes and reforms i.e. they erode the very values that the system depends upon in order to work and achieve its purpose. No system like the Healthcare system (and education, too) can work without the self-motivation and generosity of the staff. I would argue that, whether a person of faith or not, every person working within the system has some form of the values and the vision we have been exploring. That is why the whole thing works because it is that vision, however it is articulated, that inspires people to do what they do – often against the odds and at some personal cost. But if you disturb this, change it, or in some way diminish it, then you undermine the very culture or ethos on which the whole edifice depends. This culture is alike a living tissue, it can be destroyed as well as nourished. Keeping the memory, is keeping that unique tissue of human relationships, acts, understanding and vision alive by refusing to forget what is at its centre.
Keeping of the Memory is therefore a service we perform for everyone. We keep hold of the memory of the worth of the human being, and the importance of a healthcare system and process that affirms, remembers and embodies this.
The Community: It is interesting that in all his acts of healing – physical, psychological, spiritual, Christ doesn’t see health in purely personal or spiritual terms. Healing is also social: it is also a restoration to the community, and so we should see healthcare as being part of restoration of the person to the community. This is a holistic vision of reality that affirms we exist to be part of the dynamic of being connected and in relationship.
To be able to understand the fullness of Healthcare in these dimensions requires an attentiveness to the person in all their contexts and this requires not only a more complete vision of what care is, but the time to allow the person to unfold.
In conclusion: All this is, I believe, capable of translation into other less religious language. In so far as I am only reacting to what you have been saying, it is clear that everyone here has their language and understanding of all these realities and much more experience of them than I have. However, from a much more explicit Catholic theological point of view, I have been trying to express what I would call a sacramental vision of reality. This is a sense that all reality can carry grace but especially the human. It is in the ordinary as well as the extraordinary human exchanges at something of God’s presence and care is mediated. The ground of this vision is the Incarnation.
The Human is sacred and sacramental precisely because the incarnation is the guarantee that the human, by virtue of being human, is where God dwells. Part of that attentiveness to the human in all its richness – which should be the mark of authentic healthcare – is the attentiveness to the vision of God in God’s world. In this way we are all ministers of his grace to one another. Perhaps this is being this that we have the deepest level of resistance to all the ways in which the human is diminished. It may also be that in such acts we also have the deepest expressions of our freedom. It seems to me that to be touched by these acts and by those who live out of this vision is genuinely health giving.