In writing this book, Professor Ferngren has undertaken a Herculean task, one that would ordinarily require an everlasting afterlife (or a few extra incarnations, depending upon your point of reference).  In the space of 200 pages, he covers 3,000 years and four continents. He forewarns us that he omits non-Western and pre-literate religions from his study, more because of lack of information than because of lack of appreciation.

This book deliberately sidesteps the thorny relationship  between psychiatry (and neurology) and religion. The author concedes that it demands a separate study. Yet it offers salient information pertaining to psychiatry and religion and so it should interest readers of Metapsychology.net.

Ferngren discusses differences in attitudes toward illness, as influenced by religion. He begins with the ancient world. He explains that the Mesopotamian civilizations (which include Babylonians, Assyrians, and many more) lived in a state of perpetual anxiety, because they believed that divinities invoke illness as punishment, yet never knew exactly how to propitiate those angry deities who bring sickness (or famine, drought, pestilence, and other horrors of the ancient agrarian world).

The Hebrew tribes also arrived in Mesopotamia, where they appropriated many ideas of their new neighbors but introduced many more innovative ideas and belief systems. The Hebrews also linked disease to divine intervention. Rather than regarding illness as a punishment for offending the gods, per se, the Hebrews saw disease as chastisement and a corrective measure that can bring the sufferer closer to Yahweh. The Hebrew Bible’s Book of Leviticus details expiatory Temple-based rituals. The Book of Deuteronomy (aka the Book of the Law) catalogues literally hundreds of “Thou Shalt Not’s” (along with “Thou Shalt’s”). The later appearing Book of Job attempts to explain the irrationality of illness.  

The ancient Egyptians had an easier lot in life because they regarded their royalty as gods, in contrast to Mesopotamian civilizations.  Therefore, decrees by their kings were deemed direct communication with the divine. Obeying orders of the kings supposedly conferred protection against illness or epidemics.

The Greeks sanctified Asclepius as physician and healer, and the Romans appropriated Aesculapius from the Greeks. Hygieia and Serapis also spawned their own healing cults.  Whole families made pilgrimages to Aesclepian temples, in hopes of dreaming of the deity and achieving health through “incubation”.  Ferngren assures us that “incubation” was practiced by many cultures and not restricted to Greeks.  

The author emphasizes that pre-Christian pagans viewed illness as punishment from on high, and so citizens of ancient Greece or Rome felt no duty to heal the transgressors or to care for the ill with compassion. Paradoxically, Greek culture produced impressive advances in medicine, which we quote to this day. In yet another paradox, the Hebrews viewed healing and tending to the sick as their duty, even though Deuteronomy threatens miscreants with “madness, blindness and ‘astonishment of heart.'”

Professor Ferngren is at his best when comparing pre-Christian pagans with early Christians. He devotes his first book, Medicine and Health Care in Early Christianity (Baltimore: Johns Hopkins Press, 2009) to this topic. Even those who do not believe in miracles, and even those who do not believe at all (and at least 20% of contemporary Americans are unaffiliated with any religious group or belief system), cannot help but be impressed by the importance accorded to Jesus’ healing as described in the Gospels. The role of suffering in Christianity is equally important, partly because enduring such suffering supposedly makes the sufferer more G-d-like. Christian asceticism and Muslim reverence for the physical form are contrasted in a single chapter devoted to Islamic medicine. Clinicians engaged in the active practice of medicine, psychiatry or palliative care would find these distinctions particularly thought provoking.

The discussion of the Middle Ages, and the emergence of healing shrines and cults of the saints  is parsimonious, as required by a short book with big aspirations. Eventually, he travels to the 19^th and 20^th centuries, to discuss religious healing, Pietists and Pentecostals, Christian Science, Holy Rollers, tent services, televangelism and faith healers. By then, Professor Ferngren has prepared readers to view these practices and practitioners as part of a continuum rather than as iconoclastic schisms or  personality cults. His approach is historical rather than anthropological and so he sidesteps the colorful descriptions found in cultural studies.

Readers who are familiar with religion-by-religion or region-by-region approaches taken by Henry Sigerist, MD or Oswei Tempkin, MD (both physicians and one-time heads of Johns Hopkins History of Medicine section) will be taken by surprise by Ferngren’s chronological approach. His co-authored chapter on Islamic medicine is an exception, because it focuses on a single religion in different regions and elaborates on religious reasons why Muslims prioritized medicine and care for the body.    

His topics are rich, and many beg  for amplification. I can easily envision an expansion of this introductory text, perhaps approaching Mircea Eliade’s 16-volume Encyclopedia of Religion (1987). For instance, the link between specific religions and early hospitals (or hospices) deserves a volume of its own. Tracing the trajectory of Catholic hospitals to the present day, when few Western women enter nursing orders of nuns who provide low or no-cost hospital care, is essential to understanding the forces behind the closing of certain Catholic hospitals in the U.S. It is also worth noting that one of six hospitals was Catholic in 1950. These trends in turn impact contemporary health care and health policy overall.

In the past twenty plus years, hospital stays have shortened dramatically. (Psychiatric hospitalization reached its peak in 1950.) Considering that 21^st century health care has convulsed under the yoke of managed care, and its refusal to cover “medically unnecessary” confinement to acute care hospital wards, it may be reassuring to look backwards and learn that anyone who could afford home-based care avoided hospitals altogether. Only the impoverished—that had no choice—chose to die in hospitals. Practitioners of palliative care will appreciate these historical insights, although it is unclear how well they will receive information about the “religious epiphany” that inspired the hospice  movement.

Professor Ferngren notes that Jews were vastly overrepresented in 19^th and 20^th century medicine. This concise statement recollects (but does not reference) John Efron’s comprehensive study of Medicine and the German Jews (New Haven: Yale UP, 2001), where Efron reports that 50% of Berlin’s doctors were Jewish in 1933 (at the start of the Third Reich), while 60% of Viennese doctors were Jews. Apparently, Viennese Jewish doctors were not limited to Sigmund Freud and his psychoanalytic circle.

Recall that Professor Ferngren expressly excludes psychiatry from this introduction to medicine and religion. Therefore, he justifiably avoids comments on the Reich’s condemnation of psychoanalysis as the “Jewish science,” or on the ramifications of that decision, on Germany, Jews, Carl Jung, and more.  

Some readers may expect a book on “religion and medicine” to focus on court-ordered blood transfusions for Jehovah’s Witnesses or the unending debates about abortion rights (and wrongs) and the beginnings and ends of life. Some may recall less obvious examples of the collision between medicine and religion, such as the imposition of Western medicine on an epileptic Asian immigrant, as described in Anne Fadiman’s The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (New York: Farrar, Straus and Giroux, 1997). Those readers will soon realize that this is a vast, vast topic, and one that is endlessly fascinating for some.  

This book is highly recommended to anyone who is interested in the intersection of religion and medicine. It is equally important to health care professionals who are otherwise secular, and who may be unaware of the extent of religious influence on seemingly psychological attitudes.  I expect this book to become required reading for many clinical health care and bioethics classes (as well as history classes). It is also a perfect choice for leisurely reading for those who pursue this subject with a passion.

 

© 2014 Sharon Packer

 

Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books includeDreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at drpacker@hotmail.com .