Pain Seeking Understanding: 

Suffering, Medicine and Faith

This book’s twelve essays may comprise the first exercise in medical or clinical theodicy. They are certainly among the best. 

Like all theodicies, these essays ponder how the power and goodness of God might be reconciled with the pervasiveness of evil. They do so, however, with attention to the ways these questions erupt and may be addressed where people seek medical and pastoral care. As Richard Rice of Loma Linda University has observed, this book fills a gap between practical books on how to cope with suffering and theoretical volumes that explore the problem of evil. Its title, which makes effective use of the description of theology as "faith seeking understanding," signals the mood of a mutually supportive quest by professionals with different points of view who know how easily and deeply words can wound or heal.

The first portion of this book, titled "Clinical Perspectives," presents five essays. In the first of these, "Holding Fragments," Larry D. Bouchard, a professor of religious studies at the University of Virginia, introduces the distinction between theoretical and practical theodices and emphasizes the value of the second for clinical circumstances. He also holds that "one approach to practical theodicy will be the juxtaposing of partial meanings" that fosters a range of responses to suffering without trying to synthesize them into a single, permanent, comprehensive and coherent whole. 

Deborah E. Healy, a pediatrician at the University of Virginia, draws on her clinical experience in "Painful Stories, Moments of Grace." She recounts things her patients have said and done that enable her to know that "God is always there, even though I am not always ready to know God." Julia E. Connelly, a specialist in internal medicine at the University of Virginia who "is not a person of religious faith," draws on the resources of literature in "The Tragedy of ‘Why Me, Doctor?’" She writes that "the concept of tragedy is important to integrate into the physician’s professional world" because it cultivates an atmosphere in which "the emotions of the situation can be experienced and shared by both patient and physician" so that "movement toward surviving and healing, rather than explaining, can begin." 

In "When Truth is Mediated by a Life," Albert H. Keller, a pastor and medical ethicist in Charlottsville, Virginia, reflects on a series of conversations he enjoyed with a physicist. This scientist utilizes his academic skills in a business corporation and fathers two handicapped children, one of whom he and his wife adopted with knowledge of the youngster’s potential difficulties. Life is more like the world of business than a controlled scientific experiment, he observes, because it possesses more variables, movement and unpredictability. He contends that God does not exercise unilateral control over every occurrence. God fosters health and healing in every circumstance while leaving it up to others to co-operate with or frustrate this positive divine influence, he holds. 

Margaret E. Mohrmann, a pediatrician, theologian and medical ethicist at the University of Virginia, summarizes several points these essays make in "Someone Is Always Playing Job." Her chapter, which supplements her overview in the book’s introduction, contends that what this review calls clinical theodicy is "practical, experiential and paradoxical. It is less the abstract reconciliation of propositions about God, more the work of making things of form and beauty out of lived anxiety and pain."

The four essays in the book’s second section are clustered under the heading of "Theological Views." Daniel P. Sulmasy, a physician, Franciscan, and moral philosopher now serving in New York City, offers "Finitude, Freedom and Suffering." He defends the value of theoretical theodicies, criticizes those that attribute too much evil to misuses of freedom and contends that much suffering is an inevitable feature of the fact that we are finite beings. "To be human is to suffer," he writes. "It could not be otherwise." 

In "The Practice of Theodicy," Wendy Farley, a theologian at Emory University who explores these matters more fully in Tragic Vision and Divine Compassion:  A Contemporary Theodicy (Westminster John Knox Press, 1990),  urges that logical solutions are not enough. "Theory can provide some meaning to suffering," she asserts, "but it is in compassionate relationship that suffering discovers redemption." 

Elliot N. Dorff, who is the provost of the University of Judaism at Los Angeles, agrees in "Rabbi, Why Does God Make Me Suffer?" Observing that "Christian theologians often speak of the redemptive value of suffering," he claims that such thinking "has never been a part of the Jewish perspective." 

Per Anderson, a theologian at Concordia College in Minnesota, utilizes Reinhold Niebuhr’s "Serenity Prayer" to explore these issues. He holds that it is difficult in technological societies to discern the difference between courage to change things that can be changed and serenity to accept those that cannot. He holds that "to accept some suffering is to bear it in a way that may avoid unintended and future harms."

The third part of the book, "Implications and Directions," includes three essays that explore more particular matters. In "The Secular Problem of Evil and the Vocation of Medicine," James Lindemann Nelson, a philosopher at the University of Tennessee at Knoxville, asserts that "many of us who are nonbelievers in God but still believers in morality" also experience the problem of evil. This challenge is not to justify God, but to fortify moral agency in the face of undeserved and meaningless suffering. He holds that there are ways of life that embody a "golden mean" between destroying agency by exhausting oneself in service to others and eliminating moral agency by living with little or no regard for their needs. He holds that medicine is such a form of life, providing it is understood and practiced as a vocation. 

Ronald Cole-Turner, a professor of theology and ethics at Pittsburgh Theological Seminary, explores human responsibility in "God, Suffering and Genetic Decisions." He writes that "we are not responsible for what genes might do, but we are increasingly becoming responsible for what we can do to genes, and thus what altered genes will do." 

Mark J. Hanson, a theologian and ethicist at the Hastings Center in the state of New York, relates these considerations to recent developments in "Bioethics and the Challenge of Theodicy." He proposes that bioethics "help mediate between sufferers and the moral and theological resources necessary for them to find meaning in their suffering." He outlines six ways to accomplish this.

In her conclusion, Margaret E. Mohrmann considers how medical education might be improved so as to graduate physicians who respond more effective to the suffering of their patients. She also reflects on the book as a whole. She writes that "common factors in the queries of those who suffer include the elements of tragedy: the inescapable fact of suffering, the haunting awareness of choices made and demanded, the confusion of being enmeshed in a situation that surpasses comprehension." 

She also writes that "common aspects of the kind of responsiveness suggested for clinicians are expressed in recurring words and phrases: hearing, receiving, holding patient stories; respectful witnessing; being fully present, open to both disturbing inquiries and to the possibility of mediating consolation; accepting expressions of non-sense, honoring them as paradoxically meaningful; offering oneself, or someone else, as companion for the quest."

It appears to me that there are some forms of suffering that are inescapable features of finitude and many others that aren’t, much like Paul Tillich suggested with his distinction between existential and pathological anxiety in The Courage to Be (New Haven:  Yale University Press, 1976). The discomfort we sometimes feel because we cannot be two places at once is an example of suffering that is an inescapable feature of finitude. This kind of suffering is ontological and existential. We not need call it evil because we experience compensating benefits from being embodied creatures with such limits. 

Prematurely losing one’s health or life to trauma or disease is an example of evil that is actual but not necessary.  Because it is not an essential feature of finitude, such suffering is historical and pathological. In such cases, things could have been, and should have been, otherwise. There may be a sense in which both types of suffering are "tragic;" however, they seem sufficiently different to be distinguished.

If there is any philosophical theme that receives insufficient attention in these superb essays, it is the idea that some form and degree of self-determination characterizes all genuine actualities, no matter how microscopic. This lack of emphasis is surprising in view of the other ways several authors of these essays make good use of the contributions of process philosophers such as Alfred North Whitehead. 

The doctrine of "panexperientialism" is the other side of a conceptual coin the authors of these essays frequently polish. To suggest, as they frequently do, that God’s ability to accomplish things is limited by all those who are not God, is to imply that these other actualities, many of whom are human beings and many more who aren’t, also have some ability to influence the course of things. 

Monotheists do have good reasons to doubt the apparent conviction of a number of process philosophers that the "power-to-be" that all true actualities possess in some measure is a "given for God" rather than a "gift from God." Nevertheless, even if it is a "gift" rather than a "given," this widespread ability establishes that it is not merely human beings who can exercise some degree of self-determination with helpful or harmful results. Less complex forms of life can do so as well.

It is difficult to exaggerate the value of this book. It will benefit health-care providers, clergy and professors of religion, philosophy and bioethics.  It will also enrich the lives of many others who take the time to read it at a leisurely pace, preferably relishing one essay at a time. To Margaret E. Mohrmann and Mark J. Hanson who edited it, to the ten others who also wrote essays for it, and to those at Pilgrim Press in Cleveland, Ohio who published it, we owe much.  Thank you!