Disease, Community, and Grief in a COVID-19 World

by Susan R. Holman | ελληνικά

Some years ago, I was on a high-speed Acela to New York one morning when, in Connecticut, a woman in her early 60s apparently fainted while waiting at the crossing barriers. Recently discharged from the hospital, she was the primary caregiver for her grandchildren, ages 4 and 2, and was now, with great caution and love, driving them to preschool. Gently, uncontrolled—inexplicable to those watching—the nose of her car bounced under the barriers and rolled onto the track—at the very moment when our train barreled through. The woman and her grandson died instantly; his tiny sister died several days later. After a long wait, a half-mile past the impact, our train still enmeshed with the mangled car, we, the shocked passengers, were eventually disgorged at the closest station to wait for a new train. When reporters began trawling the crowded platform, microphones in hand, I could not speak. Silence seemed the only respectful response to such a violent and deadly serendipity.

These days, in the global grief of the current pandemic and its economic and political fallout, I feel much as I did that morning on the platform: overtaken by silence. An inner sentinel calls me to attend with respect the widespread “shell shock” of emerging losses for which there are no adequate words. Such silence is for me a solidarity of spirit, a way, as it were, to weep with those who weep. And yet—precisely because this crisis also directly relates to my academic engagement in global health and the history of faith-based responses to illness and need, I wrestle within such silence with an equally complex sense of responsibility to find language that might shape (if only my own) choices and actions in the midst of a media firehose of verbiage. This essay is a partial response to these inner sensors. But perhaps it might encourage others wrestling with a similar struggle as we listen, hope, and begin to craft useful, tempered conversations with depth and integrity.

Orthodox Christians have many resources to turn to in thinking about the religious history of tragedies that connect health with economic and social distress. The coronavirus-19 crisis makes clear two truths that those in the ancient world knew all too well. First: disease is no respecter of persons; mortal life and health are time-bound; are we ready for death? Second, of equal or greater concern in our relationships with one another: suffering in such crises is often preventable; it happens because the worst victims are too often those most vulnerable to governmental systems that fail in their mandate to rightly serve the public with justice, respect, and economic, social, and cultural rights. In the United States, this has meant that African Americans, other minority groups, poor workers in the “essential” service sector, those with inadequate health insurance, and those forced to live in crowded or substandard housing are and remain at significantly higher risk of illness, viral transmission, and death. These are the same individuals who may also lack clean or sufficient water, time and personal safety for self-care, and related tools they need to help their families survive. Their children face even greater long-term risks and challenges, not only in family dynamics but in learning and economic potential. Online education, for instance, expects them to have simple tools—web access, space, an organizing adult, quiet for home study—that are often utterly unrealistic. Yet childhood education directly correlates with both health and earning power in adulthood. The social determinants responsible for these problems reflect chronic social wrongs that dedicated persons of faith and ethics—including Orthodox Christians—have worked tirelessly to address anew with each generation. While I write this in days when the news focus is on the Gordian knot of keeping both the economy and its citizens alive, the long-term consequences and social effects are, as we all know, just beginning.

Disease and poverty meet along social borderlines. These borderlines start at our skin and extend into the air we breathe, the resource and environmental costs of our needs and wants, and the intersecting political, developmental, and system dynamics that support human flourishing as well as profit and greed. Global borders, like human skin, are porous. A virus is not like a terrorist; it is more like an invisible breath of wind. It has no agency; it just is. It is not man-made, though its effects trigger cellular action by its human host. It does not resolve with war, though it may resolve with science. Over the years, I have come to find it helpful to think of disease—including cancers—not, as many do, as an enemy to “battle” or “fight,” but as yet one more hapless created entity in the natural world over which I am called to be a wise steward, perhaps even to pity it in its mutating madness. Like the inappropriately disturbed dark creatures of the deep in the stories of J.R.R. Tolkien and C.S. Lewis, disease agents cause terror not because they are evil but because they are heartrendingly out of place. Yes, certainly we must do everything possible to disarm their harmful capacities—wash our hands, wear PPE, scrub surfaces with counter-toxic cleansers, avoid transmission risks in eucharistic and other gatherings, and work ceaselessly to find and create effective vaccines and prevention. But even practicing such strong medicine, there is no place for human hatred, blame, or xenophobia. “Safe distancing” is safe only when it opens possibilities of effective research, cure, and economic hope at a global level.

We might in this context take time to read and study the patristic texts that touch on such concerns. Cyprian of Carthage, the Cappadocians, John Chrysostom, Ambrose of Milan, Augustine, John of Ephesus, Jacob of Sarug, and others offer thoughts readily available in English translations that address illness, health, and connections with social economics. Directly relevant to pandemic destabilizations, Cyprian’s third-century treatise “On the Mortality,” for instance, speaks to those in a pathogenic crisis (says historian Kyle Harper) possibly similar to Ebola. And John of Ephesus, describing the Justinianic plague of the sixth century, highlights not only its bodily markers but also, as Susan Ashbrook Harvey has detailed, the mental and emotional agonies caused by its economic and social aberrations. As we struggle to rethink our current context mindful of world history, Orthodox Christians may pair such sources with thoughtful reflections on other related narratives, for instance Martin Luther’s famous letter asking whether one ought to flee in time of plague (yes and no, he said; it depends), and similar sermons preached in the weeks and months when infected fleas were hopping about 17^th century London.

In the writings of the early desert monks, we sometimes find praise for a spiritual value in illness. Other beloved patristic characters, like Basil and John Chrysostom, seem to prefer health as they constantly complain about bodily ailments and inconveniences. Yet a common theme across most of these narratives is a shared dedication to nurturing the common good of the broader community in both well-being and economic justice. Chrysostom knew, after all, that often it was not disease that most scared the economically comfortable but the specter of need itself. “I laugh,” he said, “for this is a childish fear…Can you not see that we are all in need of each other?” (Hom. 17 on 2 Cor. 8.15). His preaching practiced what scholar Wendy Mayer has called “medico-philosophic psychic therapy,” essentially a type of logotherapy that expected literally curative effects to follow when one opened one’s mind to the moral lessons of a sermon. When such preaching addressed an audience simply sick in body, most writers affirmed combining logotherapy with the use of physicians and “ordinary” medicine, including non-miraculous material substances that may or may not be combined with healing shrines, prayers, and eating paint off icons.

Public health depends on economic balance. Basil and Ambrose both condemned as toxic the economic profiteering of high-interest loans, describing the devastating losses they caused for those afflicted with unemployment and need. For Basil usury was a fatal, chronically self-devouring disease like a wild animal; its metastasizing growth, he implied, feeds on itself and its host to the destruction of differentiation, a disordered body, family, and property undermining civic stability. (Hom. Ps. 14b). If you are the financier, better to forgive the interest at least—or, best, write off the entire loan as a gift. The godly capitalism of right material practices was, he said, at core about thanksgiving. Addressing grain-hoarders during a famine, he wrote: “As costly capital, preserve thanksgiving in your soul….Cling twice as tenaciously to thanksgiving as you do to luxury.” (Hom. 8.6)

Economics are so bound to illness that the sick poor are “twice poor,” say Gregory of Nazianzus’ and Gregory of Nyssa’s respective sermons titled “On the love of the poor.” A Christian’s right response to their plight demands direct identification of them with the body of Christ, modeling aid action on God’s liberal and indiscriminate generosity for creation. Such “love” is not simply mercy but righteousness. These texts speak directly to many of our own chronic worries: homelessness, disability, beggars in the street, and the agonizing tensions and sorrows between family members for whom physical distancing is a stigmatizing rejection.

The Gregories also point to our fixation with contagion, both the transmission and the common terror.  “Certain illnesses,” said Gregory of Nyssa, “do have an external cause and can be traced to pestilence in the air…” with the result that “the illness develops, invading the blood by putrid humors.” (Paup. 2)  And Gregory of Nazianzus admitted that even in the church “the reality is frightening and moves us to take precautions.” (Or. 14.27) While neither Gregory knew of aerosolized viral transmission, both here echo a striking common touchpoint with the present that is also found in one of the oldest and most enduring Hippocratic texts, Airs, Waters, Places. Included in the core medical curriculum across Christian antiquity, this treatise affirmed that health depends on certain characteristics of these same three aspects of climate and environment that shape our worry and responses today. While the Gregories’ beliefs about how contagion worked were pre-modern and frankly in error, they are more concerned with the timeless mandate of community in the call to view the suffering sick other as “part of your own body.” (Or. 14.25, 28) Nyssen points further to the human body’s own repair system, one in which “all the healthy parts act together to resorb the place of infection.” (Paup. 2) Indeed, as these texts remind us, perhaps the most “unhealthy” response—one that risks fatal long-term spiritual and economic pathology—is not physical distancing but social “othering.”

When my train collided with that beloved grandmother and her tiny charges, I was, in a grim ironic twist, at that very moment in my Quiet Car seat reading a father’s memoir about the accidental death and loss of his own young child, and the place of his Catholic faith in the grieving process. Suddenly, in an instant, such loss entered my own reality. Health and economic conjunctions tend to be like that: they actualize what we thought we understood in ways that force us to new perspectives.

The interpretive intersections between illness, the economic health of a well-functioning moral community, and religious practice, have always been complex. Disease is invisible, impersonal, internal, often implacable, often crossing those porous borders as an unexpected guest into our most personal spaces, where it proceeds to change the very fiber of the house. These patristic writers and others remind us that this house belongs to all, and in our hope for good order we need each other. As we face new pandemic and loss in a digital era, may such enduring complexities challenge us to glimpse anew the sacred body in our efforts for global health.

Susan R. Holman is the John R. Eckrich Chair and Professor of Religion and the Healing Arts at Valparaiso University. Her publications include The Hungry are Dying: Beggars and Bishops in Roman Cappadocia (Oxford 2001) and Beholden: Religion, Global Health, and Human Rights (Oxford 2015), which won the 2016 Grawemeyer Award in Religion.