Sound thinking
Medicine within in the immanent frame
by Ken Myers
“Jonathan Imber, the Glasscock Professor of Sociology at Wellesley College, has studied the decline of moral authority in contemporary medicine, at least for individual patients. . . . In his book Trusting Doctors: The Decline of Moral Authority in American Medicine, Imber shows that, at least in the United States, individuals tended to trust medicine because of its religious foundations. When those foundations became unstable in the 1970s, trust in the medical profession suffered a similar fate. Here is just one of several examples he cites in the book: during the 1960s the American Medical Association maintained a vibrant cooperative relationship between religion and health care, but by the end of that decade the effort ‘lost its force’ as the secularizing trends undermined that connection.
“Patients can no longer count on practitioners of medicine to incorporate trust-building spiritual or religious aspects in their care, so they look for it elsewhere, including from hospital chaplains. This is what a wife and husband research team at Harvard Medical School, Tracy and Michael Balboni, found. Their recent book, Hostility to Hospitality: Spirituality and Professional Socialization within Medicine, provides essential insights on a number of topics. But perhaps most importantly, it confirms the centrality of spirituality and religion for patients — especially when facing existential questions about their health care. Their findings show clearly that illness ‘is a spiritual event,’ especially when the ‘cultural camouflage’ around death and dying disappears. In some ways, the Balbonis’ marriage and work partnership (she’s a physician, he’s a theologian, and both are deeply committed Christians) exhibits the very thing they want to show: that those who want to provide patients the very best care can and should connect medicine and religion much more strongly.
“Unfortunately, their research also shows that, despite patients’ strong desire for this connection, they do not experience it in contemporary medicine — even in offices seemingly geared toward meeting this need, like hospital chaplaincies. Significantly, these conclusions are based on their pioneering qualitative sociological work at the Harvard Initiative on Health, Religion, and Spirituality. They probed beyond mere numbers into individual patients’ life stories. They also underline that the patients they consulted for their research came from a metro area (Boston) which is significantly more secular than other places in the United States. Unlike some research based on a biased sample size reflecting the views of the researchers, their results likely underreport the clear and unmet need for more spiritual care in US medicine.
“The Balbonis’ data show that both patients and providers clearly recognize the value of spiritual care. Furthermore, although physicians and nurses themselves are personally more religious than one might think, the data revealed a gap, an unmet need, facilitated by the culture of contemporary medicine. Specifically, they identify three interrelated facts about contemporary health care that currently make it ‘implausible’ for religion and medicine to connect in a way that would better serve patients and better reflect the views of providers:
“ • Hospitals are spaces set apart for advanced technological interventions and are largely understood to be places for curing, not for caring.
“ • As leaders of health-care teams, physicians have a derivative social authority to intervene in a person's life for their health which comes from the prior authority of the scientific method they employ.
“ • Contemporary medicine is often geared toward avoiding or forestalling death — which is at odds with a religious approach that emphasizes the reality of death and highlights the limitations of medicine to avoid or forestall it.
“Indeed, they note that in the cultural imagination of contemporary medicine, religion has a place only when the medical arsenal has been exhausted and death is imminent. In this context, religion becomes strongly identified with death — so if the cultural camouflage surrounding it is to remain effective, religion must be kept on the margins until no other outcome is possible.
“This explains, the Balbonis argue, why health-care providers do not offer spiritual care even when they personally understand its importance. Though this is often put down to a physician’s lack of expertise in the subject matter, something more subtle and even subconscious is going on: medical teams are structured to act for the good of ‘temporal salvation.’ Contemporary medicine has limited itself to an ‘immanent frame’ that focuses its attention completely on physical human flourishing. The social structures of contemporary medicine, after all, limit its authority to what the scientific method can support. In many medical contexts, explicit concern for the transcendent goods at stake, or even acknowledging the possibility that such goods should be engaged in a medical context, simply doesn’t fit secularized medicine’s understanding of itself.
“Physicians being robbed by their own secularized culture of the chance to engage their patients (and to engage the practice of medicine itself) with explicit attention to these transcendent human goods in turn reduces human beings to mere organic machines. And the move in this direction has been accelerated as medicine continues to redefine itself in terms of specialties and subspecialties that do not focus on the fullness of a human being’s reality, but on increasingly particular segments of a human being’s organic structure and functioning.”
— from Losing Our Dignity: How Secularized Medicine is Undermining Fundamental Human Equality (New City Press, 2021)
Charles A. Camosy was a guest on Volume 153 of the Journal.
