Pursuing Health in an Anxious Age
Pursuing Health in an Anxious Age

Pursuing Health in an Anxious Age

Medical technology brings no peace like trusting in a God who is actively at work.

June 9 th 2016

Here's a sneak peak from Dr. Bob Cutillo's forthcoming book. As Comment's Summer issue reflects on the role that various technologies play in our social architecture, Dr. Cutillo reminds us that in the sphere of healthcare, technology and a robust theology need to go hand in hand. If you want to read more on health, you might consider our previous issue on Health Beyond the Hospital, and of course, stay tuned for the release of Pursuing Health in an Anxious Age.

[Content taken from Pursuing Health in an Anxious Age by Bob Cutillo, ©2016. Used by permission of Crossway, a publishing ministry of Good News Publishers, Wheaton, IL, 60187.]

Every uncertainty, every contingency that makes the world less predictable and more beyond our control, is a source of great dis-ease.

Life Outside the Garden

Our personal judgments of good and bad carry a heavy weight in life beyond the garden of Eden. In the garden, like the child learning to exercise autonomy within limits, we exercised our freedom under protected conditions. In choosing to reject those limits for a life based on our own assessments, we lost something essential for healthy existence—a sense of place. In moving out into a limitless world, as Romano Guardini writes in The End of the Modern World, "even as this new world view affirmed a freedom of space it denied human existence its own proper place. While gaining infinite scope for movement man lost his own position in the realm of being." In the garden, our human ancestors had a central place; outside it, we cease to experience a world that guarantees us a place in the total scheme of things. Not knowing where we belong, each one of us is forced to find our own way.

This places intense pressure on the reliability of our personal decisions, thus making us uniquely anxious in our choices. No wonder we plan incessantly in order to minimize chance and contingency. If we get it wrong, so we think, there is nothing in a hostile and impersonal universe that will rescue us. It certainly adds to the worry and anxiety with which most people pursue health and fear sickness today. Every uncertainty, every contingency that makes the world less predictable and more beyond our control, is a source of great dis-ease. So we reach for every new technique and technology that will enable us to regain control. Alone and unsure of our place in an uncaring universe, we rely on our knowledge of good and bad and the technical solutions that promise deliverance.

Armed only with these resources, we struggle with a common problem in medicine today: how far to go. It comes up in numerous scenarios, from cancer treatment to testing for a potential problem. In each case, the most common fear is not going far enough, and this is fueled by the anxiety that something bad is out there, and if we stop too soon, "it" will happen. The related assumption, of course, is that in stopping too soon, we have lost the chance to control "it." One example, in an age of medical imaging that reveals the minutest details, is seeing something we weren't looking for while looking for something else. The problem is that we often don't know what to do about the fearful "it" we have found.

The patient, an elderly woman visiting her family for an extended stay from another country, had been experiencing pain in her leg for several months. One night the pain was unbearable, so her family took her to the emergency room. The treating physician, wanting to investigate if compression of a nerve in her back was causing the pain in her leg, ordered a CAT scan. The powerful images that looked inside her body revealed nothing unusual in her back but saw something in a completely different place. Though the findings, called "incidentalomas," were small and nonspecific, the word abnormal appeared on the report. In these situations, the fear of something bad may be generated by the doctor, the patient, or both. In this case, the medical system reacted with fear, which ultimately led to three additional studies and a painful biopsy before all were assured that this was nothing bad.

It is hard to admit, but we are actors in a play who know only a small piece of the script, and we long for a director who knows what is next.

Besides the thousands of dollars spent to confirm "normal," one other casualty of "too much" in this case was the patient's actual concerns. In the pursuit of a normal test, the patient's ongoing pain was completely neglected. Her final reaction to high-tech medical care revealed her frustration: "I'm going back to my own country, where at least the doctors listen to the patient instead of looking at tests."

We can only be grateful for the powerful technology we have. Yet because the United States has more of it than any other country, we who have access to it are challenged to restrain our tendency to use it. But it will always be difficult to use wisely as long as the world is as bad as we fear. If only we could depend on something more than the power of our thinking and the tools we possess to stand between us and disaster.

Embracing Contingency

We are outside the garden now; we have eaten of the tree, and there is no going back. We know too much to return to its innocence and safety. The world is scary, accidental, and random, but the more we attempt to control the chaos, the more we fear what remains outside our control. Unfortunately, at one level the world of Genesis beyond chapter 3 confirms our fears. Outside the garden the human race faces a world of violence and pain; the soil is hard, the thorns are sharp, and from the moment Cain killed Abel, because Abel received a blessing that Cain did not, jealousy and envy have marked nearly every human story. Sarah envies Hagar, Jacob envies Esau, Laban envies Jacob, and Rachel envies Leah—over and over creating trouble, violence, and injustice.

The last third of Genesis is occupied by one final story, that of Joseph, whose envious older brothers sell him into slavery in Egypt. After selling Joseph, they assume they have solved their problem, but their view that having Joseph around was bad and selling him as a slave to Egypt was good created the problem of their father's grief, which was exceedingly bad. Though all his sons and daughters came to comfort him, "he refused to be comforted. 'No,' he said, 'in mourning will I go down to the grave of my son.' So his father wept for him" (Gen. 37:35). Jacob's sadness was slowly taking the life from him.

In the midst of unanticipated outcomes, failed attempts to make things better by our weak understanding of good and bad, and the ongoing presence of sickness and sadness, no matter what we do, we realize that despite our best efforts we truly do not know how it is going to be. It is hard to admit, but we are actors in a play who know only a small piece of the script, and we long for a director who knows what is next. As C. S. Lewis writes in "The World's Last Night":

We do not know the play. We do not even know whether we are in Act I or Act V. we do not know who are the major and who are the minor characters. The Author knows. . . . That it has a meaning we may be sure, but we cannot see it. When it is over, we may be told. We are led to expect that the Author will have something to say to each of us on the part that each of us has played. The playing it well is what matters infinitely.

And "playing it well" we would gladly do, if only we knew we were a part of a story where contingent events do not bother the director, uncertainty and unpredictability do not disturb the plot, and surprise is even embraced as essential to the story.

After the garden, one might suppose God would leave us to our own devices; after all, if this is what humanity wanted, we got precisely what we reached for. But God does not stop caring, as the stories of the imperfect people of Genesis show over and over. And the book of Genesis does not end with Joseph's slavery or a father's grief.

The brothers have come to Egypt, where Joseph has risen to second in power under Pharaoh. And the father, reunited with his son, has died in peace. Now those who sold him into slavery stand before their powerful brother, afraid of the "bad" he will do in revenge for what they did to him. But Joseph has a different worldview. He believes that the universe is not random. He sees that personal knowledge of good and bad is not as reliable as we think. And he knows that the play has a director who is not disturbed by contingency, is completely in control of the script, and even absorbs and makes use of the mistakes of the actors. As the book of Genesis closes, Joseph's words to his brothers give us good news for an anxious age: "Don't be afraid. Am I in in the place of God? You intended to harm me [plotted ra against me], but God intended it for good [tob] to accomplish what is now being done, the saving of many lives. So then, don't be afraid" (Gen. 50:19–21).

That God remains an active agent in the world and is able to incorporate even the things we assume bad into a greater plan that can be good has the possibility to drastically change the way we pursue health and face sickness. Every time our health is in danger or we become ill, naturally and appropriately we will pursue the good of keeping or regaining our health. But are there times and places when other goods are possible? The idea that God is good, that God seeks communion with us, and that God has power and intention to work out good no matter the bad leaves us open to a much wider range of hopes and expectations than the singular one of health at all costs and with any technique.

Bob Cutillo
Bob Cutillo

Bob Cutillo (M.D., Columbia University) is an Associate Faculty at Denver Seminary where he teaches on health and justice, a physician at Colorado Coalition for the Homeless, and an assistant clinical professor at the University of Colorado School of Medicine. He has worked for many years in faith-based health care for the uninsured and under-served, including several years in Kinshasa, Democratic Republic of Congo (formerly Zaire) as a medical missionary in urban primary health care. He is the author of Pursuing Health in an Anxious Age (Crossway, 2016).


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