In this article, the authors propose that late antique medicine is a rich and versatile subject to teach in undergraduate courses, despite a seeming lack of sources and teaching resources. Following an introduction, authors Crislip, Langford, Llewellyn Ihssen, and Marx offer contributions describing their experiences teaching courses that offer some coverage of medicine in Late Antiquity. The contributions show that late antique medicine fits in easily as part of courses on magic and science, and that it lends itself to comparative or world-historical approaches. Late antique medicine likewise provides opportunities to explore the relationship of religion to science and of medicine to the humanities. The authors show that a range of approaches to late antique medicine, including disability studies and medical anthropology, can inspire productive and thoughtful responses from students, and serve as a helpful introduction to the medical humanities for aspiring healthcare professionals.
The history of medicine in Late Antiquity faces many of the same problems that the period itself once had in teaching and research. It used to be normal for Late Antiquity to be marginalized and for coverage of it to be cursory—in the last week or two of a course on Roman History, or in the first week of a course on Medieval Europe. This has changed. There is much more emphasis on teaching Late Antiquity now, with an abundance of courses and no shortage of textbooks, readers, and source-books. But late antique medicine has not been quite so lucky. It is still caught in an awkward position, trapped between what has long seemed like the end of Greco-Roman medicine and the beginning of medieval, Byzantine, and Islamic medicine. Some of this awkwardness results from a major gap in medical literature in the period from Galen's death in 216 CE to the middle of the fourth century.1 There is also a lingering feeling that medicine in Late Antiquity was merely a diluted form of the system developed by Galen or an increasingly irrational outlook on health and healing colored by the influence of Christianity.2 Skepticism about the value of medicine in Late Antiquity is reflected in a lack of teaching materials devoted especially to this subject.3 Scholars wishing to teach courses on the history of medicine in Late Antiquity, therefore, face some real challenges.
But developing and teaching a course on late antique medicine also represents a major opportunity. Focusing on the history of medicine in Late Antiquity invites teachers and students to consider a world with broader horizons than a course that focuses more narrowly on the Greek and/or Roman worlds.4 Late Antiquity allows for direct engagement with Christian, Islamic, and Jewish traditions of health and healing and consideration of the impact of religion on medicine. A course that addresses medicine in Late Antiquity consequently provides a chance for teachers to probe issues of continuing relevance in medicine, such as alternative or integrative approaches to healing, boundaries between what are often termed rational and irrational medicine, and Eastern vs. Western traditions. Clearly, there is much potential for scholars to incorporate late antique medicine into courses with a wide range of different approaches.
This article introduces four approaches to teaching medicine in Late Antiquity. The contributions draw from a workshop co-organized by the authors of this introduction and Kristi Upson-Saia (Occidental College) at the 2017 meeting of the North American Patristics Society in Chicago. The authors of the four contributions that follow were panelists at the workshop and have written up more formal versions of their remarks.5
This format preserves some of the original features of the workshop, which was structured around a set of pre-circulated questions. These concerned some basic issues for teaching ancient medicine, including the theoretical perspectives that were employed and introduced to students and how the course anticipated dismissive responses that would judge ancient medicine primarily in terms of modern biomedicine. We likewise asked panelists to discuss the readings and assignments that they offered to students along with any persisting issues that they encountered.
Our goal with this format was to offer attendees of the workshop and readers of this journal some sense of the range of ways in which late antique medicine is being taught at different institutions. The panelists teach at both public and private institutions in Canada and the United States. They draw from training in Classics, History, and Religious Studies, while also employing a range of different theoretical perspectives in their courses. Their approaches demonstrate how late antique medicine can be presented as part of courses treating disability studies, the history of science, and magic with more or less emphasis on Christianity and Europe alongside other religions and regions of the world. Late antique medicine consequently emerges as anything but marginal in how it is being taught to students.
APPROACHES AND STUDENT AUDIENCES
Though the four contributors to this article offer different approaches and emphases in their courses, some common themes nonetheless emerge. These speak to larger trends across student populations in higher education, and the increasing emphasis on medicine as a field with deep connections to the humanities.6 Linking the subjects of medicine and religion provides a way to challenge the assumptions of many students that medicine is simply a science. It likewise speaks to the deep – and often personal – interests that many students now have in mental health, an area that is a major strategic priority for many universities.
Central to the project of teaching medicine and religion in Late Antiquity is the defamiliarization of Western biomedicine as a normative framework and a standard for efficacy. The sub-field offers ample room for challenging students to examine norms and normativization, the hyper-valuation of positivism, and cultural imperialism. Steps toward this goal include the social and historical contextualization of medical texts, therapeutic practices, and narratives of sickness and healing as well as analysis of their ideological character and their entanglement of theological and scientific questions and meanings. By tapping into contemporary debates about the science and ethics of healthcare in cross-cultural contexts, the contributors to this article highlight the relevance of ancient and late antique history for students whose participation in the course may be motivated more by professional interest (for example, nursing students), scientific leanings, or personal experience than by historical engagement.7 This especially comes out in the course of Brenda Llewellyn Ihssen, which is directed largely towards students who are training to be healthcare professionals.
Different disciplinary perspectives can be effectively deployed toward activating the contemporary relevance of the late antique sources and challenging the epistemological hegemony of the biomedical paradigm. Most central to the contributions here are the perspectives of medical anthropology and sociology. As Andrew Crislip writes, these disciplines provide the resources for students to “engage various types of texts on equal footing,” and to identify the “social and political influences on Biomedicine.” Central to their usefulness is, in the words of Heidi Marx, “the idea that science is culture and has a culture and a history.”
Anthropological and sociological perspectives already have a strong foothold in the field of Late Antiquity and in the study of religion more broadly; this perhaps goes some way toward explaining their popularity in classes dedicated to medicine and religion in Late Antiquity. Another theoretical approach that can be fruitfully incorporated is disability studies. Accessible historical studies that deploy disability studies as a lens are in abundance—especially in relation to the Hebrew and Christian scriptures (for a brief discussion of these sources, see the contribution by Andrew Langford). Whereas medical anthropology and sociology highlight the cultural and historical contingency of medicine, disability studies draws attention to the ways in which disability itself is socially produced. Disability studies encourages students to reflect upon the political salience of the material that the class focalizes and provides tools for analyzing how late antique rhetoric shaped contemporary Western understandings of disability and its alternatives. Using the tools of disability studies, students are better placed to analyze “the power dynamics and ideologies of disease and disability,” as Andrew Langford writes below.
Philosophy of science is not discussed by any of the contributors to this article. Yet, students in STEM fields can be fascinated (and provoked) by work that problematizes the epistemological regime of contemporary Western science. Work by authors such as Donna Haraway, Barbara Duden, and Bruno Latour challenges students to examine the contingency and moral weight of scientific authority.
This emphasis on a humanities approach to medicine speaks to the close experiences that many students have with healthcare and ill-health. Andrew Crislip remarks that most students at his institution have had some encounter with mental health services. The 2014 National Survey of College Counseling Centers showed that severe psychological problems are an increasing issue on college campuses: more students are presenting with psychological conditions, such as anxiety disorders, clinical depression, and self-harm. Over a quarter of students are on psychiatric medicine, up from 9% in 1994.8 We believe that there is a growing need for humanities-based courses that deal with themes of healthcare, illness, religion, and spirituality, where students can develop historically- and theoretically-grounded perspectives on healthcare and personal well-being.
Another growing constituency is the body of students who plan to enter healing professions: pre-nursing and pre-med students, pastors-in-training, future counselors, etc. Medical/health humanities programs, in particular, are spreading. While medical humanities programs began in medical schools in the 1970s as a way of incorporating “applied humanities” into training for physicians, they are rapidly becoming a fixture in undergraduate education.9 The number of baccalaureate health humanities programs has more than quadrupled to about 70 in the United States and Canada since 2000 with more in development.10 Essential to this burgeoning, interdisciplinary field, is the work of training students to attend to “the complex cultural landscape of patients across race, class, ability, and gender identity.”11 We might add to that list the category of religion.
A central challenge to scholars of Late Antiquity who are also instructors of students who intend to pursue healthcare careers is this: how can we best position our students to approach their chosen profession and industry with a historically-grounded appreciation for the role of religion in modern attitudes toward sickness, mental and physical well-being, and medical intervention? A similar question applies for students pursuing different programs of study and careers but whose lives will nonetheless require them to grapple with issues of illness, mortality, and well-being and to see that religion still colors how people respond to these situations and circumstances.
The four contributions that follow all pose questions of this sort to students. They draw on Late Antiquity as a period that offers the potential to consider major changes in the history of the world, approaching the growth and development of major faith traditions alongside the history of medicine. In the process, they challenge Eurocentric assumptions about this topic, encouraging students to consider how medicine was, and remains to be, not only a matter of science.
Healing in Antiquity
Approaches to Teaching Ancient Medicine with Magic, Miracles, and Medical Anthropology
I have never taught “Ancient Medicine” as a standalone course, or “Medicine in Late Antiquity” for that matter. Instead, I have taught ancient medicine as a component of courses on “Healing in Antiquity” or “Studies in Ancient History: Magic, Medicine, and Miracles.”1 Regardless of the catalog title, I approach the course in the same format: following two weeks of methodological and historical orientation, I devote approximately 40% of the remaining weeks to medical literature and approximately 40% to ancient “magic.” For the final few weeks we apply knowledge about the healing traditions and professional debates among doctors and other non-medical healers to reading miracle and healing narratives, including selections from the Gospels, non-Christian miracle accounts, and Apuleius’ Golden Ass, which touches on a number of important themes in the course, e.g., magic, gender, embodiment, healing, and the divine.2
The introductory weeks set the stage for the approaches and themes that recur throughout the course. First, I introduce the students to the main theoretical models that I draw from, that is, medical anthropology and sociology. Second, I introduce students to basic elements of ancient Greek and Mediterranean society. I continue to incorporate lectures on important parts of ancient history and religion throughout the course, since most students enroll in my courses without any previous Classics or Religious Studies coursework.
I always begin with a reading in medical anthropology. I generally assign the first chapter from Robert A. Hahn, Sickness and Healing: An Anthropological Perspective.3 There are many other useful introductions to anthropological approaches to healing and illness, but I have found Hahn's chapter especially helpful in introducing concepts that I return to throughout the units on ancient medicine, magic, and miracle narrative.4 In this chapter, “The Universe of Sickness,” Hahn first compares three nosologies, or taxonomies of illness—those of the Subanun of Mindanao in the Philippines, the Ndembu of Zambia, and modern Biomedicine, the dominant nosology of “Western medicine.” Hahn sets the three systems on equal terms, such as the Subanun's overlapping diagnostic categories based on symptoms, causal agents, preceding symptoms, and “personal etiology,” or the Ndembu's classification of sickness as but one member in the broader category of “misfortune,” along with their specific diagnostic categories within sickness. Hahn then turns the same analytical lens onto modern Biomedicine, which “is most often assumed (by Westerners) to be rational and systematic, based on empirical evidence and inductive and/or deductive logic.”5 He quickly dismisses any presumption of rationality by examining the International Classification of Diseases, which (following the then current ICD-9) divides all diseases into 999 categories, the logic of which he drolly summarizes: “There is no apparent reason, other than coincidence or numerological fancy, why the number of sicknesses allotted in the universe should accord so closely with the decimal system 103-1.”6
Hahn also discusses the nosology of diagnostic psychology, now the DSM-5, as another case study in the arbitrariness and non-rationality of Biomedicine. The DSM, like the ICD, is a nosology based on a non-rational numerical system, driven primarily not by scientific observation of the natural world, but by a professional imperative to bill services to insurance companies.7 It is also the nosology most familiar to students, given that Psychology is the most popular major at VCU (as at many other institutions), and that significant numbers of undergraduate students are now (or have been) under clinical psychological care. The DSM in its various editions provides a useful case study in the social and political influences on Biomedicine, examples of which students have been able to witness in their own lifetimes, or at least the lifetimes of their teachers or parents, such as the invention and disestablishment of homosexuality as a disease, or the creation and elimination of the familiar Asperger syndrome.8 All of this encourages students to think about healing in a comparative and anthropological way from the beginning of the course.9
Hahn also introduces “dimensions of sickness,” which are themes that I am able to return to throughout the course: illness narratives, the experience and social realities of being ill, and competing explanatory models or etiologies of illness.10 Illness narratives offer accounts of suffering within the body, within society, and within the cosmos; frequently in antiquity accounts of suffering engage more than one level of experience. Hahn also notes the importance of attending to the roles or behaviors expected of the sick, of the healthy, and of healers, as well as the ways that different cultures explain the causes of sickness.11 The latter concerns about social roles and competing etiologies are of special focus in my classes, since they are topics that feature prominently in my own work on illness in Late Antiquity. Disease etiology, individual experience, and conceptions of the body as part of the cosmos, thus, become consistent objects of analysis throughout the course.
This approach encourages students—and provides them with the necessary vocabulary and concepts—to engage various types of texts on equal footing, whether it be the Hippocratic Corpus, the magical papyri, literary accounts of magic, or miracle narratives. I suspect that these disparate sorts of readings would not fit together as neatly if I approached the course from a history of science and medicine perspective. Or perhaps, to take it from the other direction, my choice to orient my course around healing in antiquity (rather than medicine) has necessitated such a comparative approach.
Another important component in defamiliarizing the “western” medical and scientific tradition is to place ancient healing traditions within Greek culture more broadly and in contrast with other medical/scientific traditions. After establishing a general anthropological viewpoint, I then assign readings from non-Hippocratic Greek literature, Hesiod's Works and Days (ll. 1–201) and selections from the Presocratics, among the latter including selections from Alcmaeon and Diogenes of Apollonia due to their interest in medicine and anatomy.12 The reading from Hesiod has proved to be a touchstone for the entire course. It is a reading that students readily come back to on their own, as it relates so memorably to the meaning of suffering on several planes—the individual body, society, and cosmos—and engages themes of gender, embodiment, and the relations between humans and gods, themes which carry through the Hippocratic Corpus, Soranus’ Gynaecology, magical literature, the Gospels, and Apuleius’ Golden Ass.13
I have also included readings that set Greek science and medicine against ancient Chinese medicine—not because of my own disciplinary expertise, but because there are rich and accessible resources for comparing the two systems. In contrasting the fundamentals of Greek science with ancient Chinese science, I have followed the presentation in Geoffrey Lloyd and Nathan Sivin, The Way and the Word: Science and Medicine in Early China and Greece, and have assigned students a portion of the book.14 In teaching Galen I also draw on historian of medicine Shigehisa Kuriyama's analysis in The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine, of which I have also assigned portions for students.15 Instructors in the Religious Studies Program at VCU have at times taught Chinese and Tibetan medicine, so my hope has been to complement those interests, as well as to underscore the relevance of ancient healing traditions to contemporary debates about “alternative” and non-biomedical treatments.
The class has varied from seminar sized, to 25 students, once exceeding 40 students, depending on factors that have little to do with the class itself and more to do with university-wide curricular and registration issues. Whatever the size, I tend to balance the class evenly between lecture and discussion. Given that students have almost no background in Classics, ancient history, or early Christianity, I provide considerable structure for class discussions. I have developed detailed reading and discussion guides for various topics, such as Galen's On the Passions of the Soul, literary representations of magic, ancient demonology, the Hippocratic Oath, and the Epidemics. In these cases I distribute the discussion guides and divide students into groups to work through select questions, for which they submit written responses to me; we reconvene as a class, and each group is responsible for presenting their answers to the class. Sometimes these discussions have the goal of modelling for undergraduates how historians analyze primary sources, other times they engage contemporary debates about healing and ethics.
Three class exercises in ancient medicine stand out as especially successful, at least as far as encouraging students to be engaged creatively and collaboratively with the primary sources. Early in the semester, students compare and contrast the ancient Hippocratic Oath with the modern Hippocratic oath administered at VCU School of Medicine and elsewhere. Students use the two short documents as evidence for the broader “health care systems” of classical Greece and western Biomedicine, including issues of competition between types of healers, codes of professional ethics, the role of the patient in the healing process, and the interrelations between science and religion.16 Next, after having read a core selection of Hippocratic texts,17 students read the Epidemics, book I, a collection of a doctor's case notes. Along the lines of the New York Times Magazine's “Diagnosis” feature (or TV's House M.D. if they want to be dramatic), students are assigned patient case histories and tasked with determining the patient's disease etiology and underlying pathology, along with assessing how and why the prescribed treatment was effective or not, by applying concepts and terminology from Hippocratic medicine.18 A third exercise that I always look forward to is based on Galen's On the Passions and Errors of the Soul, a sort of imperial Roman self-help manual.19 Students use this text (I assign only the Passions portion due to Galen's usual prolixity) to tease out the differences in society and the role of the doctor between classical Greece and imperial Rome, to compare how ancients and moderns understand the “emotions,” and to reflect on the varying discourses of self-help, self-control, and self-improvement in Rome and in U.S. consumer culture. The basic orientation and the structure and focus of such in-class assignments fit well with the units on ancient magic and miracle narratives, both of which have well-developed resources for approaching the materials from anthropological and cross-cultural perspectives.20
While I am fortunate to have studied ancient medicine within a traditional Classical Studies paradigm (with Ann Hanson, who also introduced me to the world of medical papyri as one of my teachers of papyrology), my research as a historian of healing and medicine in Late Antiquity has always been influenced by medical sociology and anthropology, surely because of my disciplinary grounding in Religious Studies. Anthropology, and sociology before it, have been important components of the study of Christianity in Late Antiquity as well as of New Testament studies and have been important inspirations for my own work.21 It is through the anthropology and sociology of medicine that I found a “way in” to making sense of the discussions of sickness and healing in the monastic and ascetic sources I have drawn on in my published work.22 It is natural that it is these perspectives that I have found so helpful in organizing my classes. I have found that by grounding questions of healing in Late Antiquity in the anthropology and sociology of medicine I can structure the course to be inclusive of different types of evidence, whether that is the Hippocratic Corpus or Galen, the magical papyri and literary accounts of magic, or healing narratives like the Gospels. It also helps a course like “Healing in Antiquity” or “Magic, Medicine, and Miracles” to complement other areas of the curricula in my departments and beyond, as well as to draw students who might not otherwise be inclined to sign up for the course. In teaching at universities without classical studies faculties or that are facing the seemingly continual threats to humanities programs (especially traditional liberal arts disciplines), and in my specific case having taught in universities with strengths in Asian studies or health sciences, I have found that an anthropological and sociological approach has helped in keeping the courses enrolled and popular, very frequently with excellent and engaged students, who bring valuable disciplinary and work knowledge to the class, such as through training and work in nursing, pre-medicine, mental health, and Asian medicine. For whatever they may be worth, my courses in healing in Late Antiquity have garnered my highest student evaluations over the years. I find it a shame that we are under pressure now to make sure our curricula are “relevant,” whether to align with workforce development priorities or to address the latest political controversy in our classrooms. While medicine in Late Antiquity might seem to some to be a prime example of academic obscurantism, I have found this course to be one that is unusually engaging and relevant to the lives and academic careers of my students.
Teaching Disease and Disability in the Bible and Late Antiquity
In 2017, I taught “Disease and Disability in the Bible” as an intensive, three-week short course for graduate students at McCormick Theological Seminary, an ecumenical seminary in Chicago. This Bible elective fulfilled either the Hebrew Bible or the New Testament upper level credit requirements that all Master of Divinity and MA students at the seminary must complete. In addition to discussing the various depictions of disease and disability in biblical and cognate literatures, I introduced students to ancient disease etiology, social and physical locations of healing, and modes of therapy and health care in antiquity. We studied these phenomena with constant reference to the ancient Near East and the Mediterranean world of Late Antiquity.
My main goals for the course were to analyze biblical texts with a critical eye toward the power dynamics and ideologies of disease and disability, to contextualize biblical discourses about disease and disability with reference to the practices of Greco-Roman medicine, to articulate the social and theological significance of modern conceptions of disease and disability, and to distinguish these modern conceptions from their ancient counterparts. Above all, I aimed to investigate the ways in which impairments of mind and body were described, categorized, labeled, legislated, suppressed, celebrated, feared, and revered in biblical literature.
The intensive nature of the course required pedagogical modifications. Instead of following a strictly historical progression, marching through analysis of evidence from the earliest biblical texts to Late Antiquity, each class session included a consideration of evidence from both the Hebrew Bible and the New Testament according to a given theme, such as sensory and mobility disabilities, mental illness and epilepsy, or the role of disease imagery in polemic and heresiology. Arranging the course thematically addressed not only the immediate, practical need of students to begin research for papers due at the end of the third week, but also resulted in the juxtaposition of texts from different periods and milieus. This in turn facilitated synthetic, comparative discussions. In each session, we compared ancient biblical materials with non-biblical evidence and identified and explained differences or similarities. Students enjoyed this comparative approach but had to be guided in and convinced of the importance of the painstaking work of contextualizing each passage as part of a certain literary and historical context. Students learned to identify generic and historical differences among the biblical texts by comparing biblical passages with ancient literature and realia that are chronologically similar yet generically different or representative of a divergent perspective.
For example, I used texts like Deuteronomy 28 to discuss ancient associations between sin and divine punishment, but also nosological treatises like that of Anonymus Londinensis, a first century C.E. doxography of medical theories and some of their major practitioners, in order to emphasize the variety of ancient theories of disease and its remedy.1 The contrast of genres and time periods helped students appreciate the diversity of the ancient evidence, but also introduced them to a key question that we returned to throughout the course: what is the bearing of time, place, and literary form on narrative constructions of sickness and healing? We pursued this question through comparison of similar texts. For instance, we read the story in Numbers 12 where Miriam is punished with a skin condition in conjunction with an Old Babylonian physiognomic omen that explains that if a man has a skin disease called pūşu (white spots) with “points” that “man is rejected by his god; he is rejected by mankind.” He is forbidden to “tread in the square of his city.”2
I compared these older texts from the ancient Near East with each other and with later texts from the New Testament, since at times the New Testament documents invoke earlier traditions about dermatological problems and their treatment. For instance, I set the miraculous healing narratives from Mark 1:39–45—about a man who, described as a lepros, is touched and healed by Jesus and then told to show himself to the priests—alongside biblical passages like Leviticus 13–14, which includes priestly prescriptions for the skin, and which is traditionally called on by scholars to help interpret New Testament texts discussing the various skin conditions identified as leprosy. Lastly, I also compared New Testament depictions of “leprosy” with roughly contemporaneous texts. For instance, we read Aretaeus of Cappadocia's discussion of “elephantiasis,” a condition later identified with leprosy but with different symptoms and a different name.3 This allowed for fresh comparisons, and led to the insight that not all conditions dubbed “leprosy” were (or are) marked by the same symptoms or even the same stigmas, and that each must first be carefully located in their own historical and ideological context before the work of comparative analysis can begin.
The core of the primary source readings for the course were texts from the Hebrew Bible, the biblical Apocrypha, and the New Testament. Interleaved with these readings were medical and magical texts from the ancient Near East and Greco-Roman antiquity—some that are accessible in source books but many that are not.4 In addition to textual sources, I discussed the architectural layouts of temples, as well as artefacts from sites such as healing shrines, temples, and baths, during the unit on healing spaces. I introduced students to sites in the ancient Near East, Asia Minor, and Greece, including the temple of Gula in Mesopotamia, the Jerusalem temple, the pool of Bethesda,5 and the Asclepieia and other healing shrines of Lerna, Cos, Athens, Corinth, and Epidauros.6 In light of the centrality of the household in ancient healing and therapy, domestic layouts were also a central focus.7 I discussed the terracotta votive offerings of body parts in relationship to the Asclepieion in Epidauros in order to emphasize the intersection of medical therapy and religious rites.8 The class also examined Greek magical papyri and amulets in order to discuss the variety of treatment options as well as modes of healing available in the medical marketplace.9 I highlighted the findings from various instrumentaria in order to help students better envision the ancient physician's tool kit.10 Lastly, I used photographs of ancient figurines, one in particular that is said to depict a man with Pott's Disease (British Museum no. 1814,0704.277), in order to reflect on the role of realia in ancient ideas about disease, especially the apotropaic effects ascribed to such figurines. Grotesques such as this one provided an excellent opportunity to discuss the tenuous nature of retrospective diagnosis and to expand our interpretation of the figurines to include their social function and the social aspects of labeling diagnosis.11
In terms of secondary readings, a few classroom-friendly publications of collected essays exist for disability and biblical studies.12 Hector Avalos, Sarah J. Melcher, and Jeremy Schipper, eds., This Abled Body: Rethinking Disabilities in Biblical Studies, contains essays accessible to advanced undergraduates, mostly pertaining to the Hebrew Bible.13 The volume edited by Candida Moss and Jeremy Schipper, Disability Studies and Biblical Literature will be cost-prohibitive for many (it is currently listed at more than $100), but provides essays on pertinent topics in both Hebrew Bible and New Testament.14 Amos Yong's The Bible, Disability, and the Church: A New Vision of the People of God is especially useful for seminarians for its attempt to integrate biblical disability studies and contemporary biblical theology and church practice.15 The commentary released recently by Sarah J. Melcher, Mikeal C. Parsons, and Amos Yong (eds.), The Bible and Disability: A Commentary, provides an entry point into the broader contours of disability in the Bible, and follows major canonical groupings rather than intensive, granular discussions of chapter and verse.16
RELEVANCE AND HERMENEUTICS
In historically-oriented courses, the problem of relevance inevitably arises. Students may wonder: why read these texts? What do they have to do with me? The fact that biblical stories touching upon disease or disability arise frequently in Christian lectionaries (from which many of my students preach regularly) tends to drive home the relevance and importance of the problems presented by such texts. The challenge was not so much to convince students that ancient disease ideologies continue to merit study, since healing texts from the Bible continue to be read, taught, and preached about in many Christian traditions. Rather, the real challenge was to help them negotiate the ongoing role of such healing narratives and their attendant ideologies in modern religion and society.
One class session that emphasized that point was the unit on dermatological diseases, in which students grappled directly with the way that religious texts and traditions sometimes enable the stubborn persistence of stigma around particular bodily conditions, while at other times they valorize suffering and particular diseases. My colleague Mark Lambert, who has expertise in leprosy in medieval Christianity, offered a guest lecture on leprosaria, discussing medieval leprophobia and leprophilia, the work of Father Damien on the Hawaiian island of Molokai, and the Carville National Leprosarium that operated in Louisiana for more than a century, closing only in 1999. By examining the cultural valuation of leprosy in several historical periods, students were able to appreciate stark changes in how different historical settings and their prevailing ideologies enabled vastly different reactions to this condition, including revulsion, reverence, exile, and institutionalization.
Because most students taking this course were preparing for religious ministry of one kind or another, they had a consistent interest in discussing hermeneutical questions in addition to exegetical ones. That is to say, they were keen not only to discern the historical meaning of ancient and sometimes alien attitudes toward disease etiology and remedy (the exegetical task), but also to discuss the kinds of interpretive options available to modern readers of ancient evidence (the hermeneutical task). For instance, modern readers need to assess not only why ancient readers attributed manic or febrile pathologies to demonic, non-human agents, but also in what terms we can interpret such phenomena for modern readers. To facilitate reflection on how we interpret disabilities in particular, I began the course with several essays on issues of method in biblical and disability studies.17 I assigned essays that, among other things, directly address the problem of how to interpret narrative episodes recounting demonic possession, especially when the non-scientific documentation of deviant behaviors seems to match modern diagnoses.18
The approach I have described here is transferrable to other course formats. Though the intensive nature of the short-course format gave the initial impetus for the combination of chronological and thematic approaches reflected in the structure of the course as I have described it, adaptations could easily be made to accommodate a ten or fifteen-week term. A brief glance at the full range of primary and secondary texts referenced will demonstrate that what was organized as a single day of intensive study could easily be made into a week's worth of readings and discussions.19 One advantage of retaining the hybrid approach to the material is that historically earlier texts are not forgotten by the end of the course simply because, often, they happen to come first in chronologically oriented course schedules.
One of my major concerns in this course was to help students develop new critical tools for thinking about our complicated inheritance of conceptions of disease and disability in the Bible and Late Antiquity. Juxtaposing ancient texts about disease and disability with modern critical insights provides a pragmatic way to engage the important task of analyzing and critiquing the long and varied history of ideas about health and disease. Critical interpretation of these ideas was especially relevant for students preparing for ministry to communities that may still ascribe to some ancient notions of disease etiology and remedy. However, the task of observing and critiquing the ideologies of health and disease that operate in society is shared by all.
Using Late Antique and Medieval Sources to Challenge How Students Think About Healthcare
For the past fifteen years I have been teaching the history of Christianity and Islam largely to undergraduate students in the Pacific Northwest corner of Washington State. My institution, Pacific Lutheran University (PLU), is a small, liberal arts college with a large professional school of nursing. Because the University has a two-course religion requirement, a sizable percentage of students in any given religion class are a combination of majors and minors in nursing, biology, pre-professional health, or kinesiology. My professional judgement about content and methods of assessment appropriate to my students’ focus on healthcare plays no small role in how I teach. In addition to general Christian history courses—which are, on their own, interdisciplinary—I teach a course specifically designed for science students titled: “Health and Healing in Christian History.” In a post-Boyer, “New American College” world, courses that are intentionally inter-disciplinary are possible and welcome within institutions that support the purposeful integration of a liberal arts program with professional schools and civic engagement.1
The mid-twentieth century saw a shift around the education of medical personnel, primarily with respect to the teaching location from that of an exclusively professional to a liberal arts setting. While this provided medical students with an opportunity for a more holistic education, saturated schedules of science classes and off-campus clinical experiences coupled with general-education requirements generated a frenzied approach towards any class that fell beyond perceived medical training.2 As coherence between theoretical and applied elements of education is central to the success of professional students in a liberal arts setting, medical students noticeably benefit from classes that meet general education requirements at the same time that they are transparent in their applicability and benefit to students in their future role as health-care practitioners.3 More than one institution in the past decade has responded with the creation of majors, minors, and Master's programs in the “Medical Humanities,” and faculty across disciplinary boundaries have been surprised to find the immediate applicability of their field to this theme.
Excited by the possibilities that linked classes might offer for students, my colleague Dr. Suzanne Crawford O'Brien—whose expertise is in Native American healing practices—and I were inspired to create two linked religion courses with a focus on health and healing. We sought to create an alternative path to satisfy PLU's religion requirements specifically for nursing, pre-professional health, pre-med, and science students in ways that emphasized interdisciplinary learning and on days and at times that were structured around nursing students’ schedules. Dr. Crawford O'Brien, who teaches courses that fall under the category of “Religion and Culture,” arranges her course in such a way that it “compares a wide variety of religious and cultural traditions, exploring the various ways in which people understand healing and employ religious and cultural traditions to promote wellness.”4 My course, “Health and Healing in Christian History,” is the second half of this two-course, year-long study, and it is organized specifically around the way in which the Christian religion influenced, supported and contributed to the development of the medical profession, including: theological formation of a defense of the healthy body and a defense of the body in pain, construction of sites of care (e.g., xenodocheia), organization of divisions of care, systematic defense of the study of medicine, pharmacology, women as healthcare practitioners and scientists, and dialogue among Muslim and Christian physicians.
The course goals and learning objectives for this class emphasize particularities of the study of religion and history that are consistent with university-level learning: students engage in critical analysis of primary source materials, they encounter distinct viewpoints, they develop discussion skills, and they refine their writing. In addition to the goals and objectives clearly stated on the syllabus, I have sub rosa goals that are equally as important. One goal that I have is to introduce nuance to the sometimes-simple definitions of complex ideas that students bring into the classroom. Characteristic to the Pacific Northwest, most of my students approach the study of religion from a place of deep suspicion, hostility, or ambivalence. Through no fault of their own, students rarely enter the classroom with a nuanced understanding of concepts such as, for example, “suffering” or “health,” the distinctions between “illness” and “sickness,” and the role that the religious realm plays in patient identity. Further, many enter the semester with the belief that religion and science are enemies, a historically inaccurate claim, but one highly prevalent within North American conservative Christianity. Having not had sufficient time to critically reflect on what those terms mean or how they overlap, students who enter into the field of medicine without having spent time in deliberation on these conceptions are seriously disadvantaged when facing a patient for whom “suffering” means something different than what they would assume otherwise. Through study of texts that demonstrate spiritual and medical authority of both physicians and bishops, ideally, students learn that religion and science have had a long and healthy relationship, that both disciplines are largely asking the same questions about wellness and healing, and that both have similar goals in mind in that they mutually seek to alleviate or radically transform suffering.
My second sub rosa goal is that my medically-focused students might begin to cultivate a spirit of empathy towards patients whose religious views might shape their approach to health, well-being, or even dying. As the students move through their education into clinical care, it is helpful for them to learn that all religious traditions address the physical body, as well as physical, mental, and spiritual health in some fashion; the degree to which students are aware and mindful of this can make them more sensitive medical professionals, and so I begin to nurture this in the classroom. Two examples should suffice: in one case, students are introduced to various monastic responses to the question “Should I seek medical help?” On one end of the spectrum one finds that the response should only be prayer, as Christ is the eternal physician; however, this is placed alongside the much more frequently-quoted view that Christians should seek medical care because God, as the author of all things, is also the author of medicine.5 Knowledge about and awareness of these distinct views towards medicine and medical intervention can be useful when students encounter a patient who interprets their own disease and the role of their health care provider—whose religious identity is irrelevant—as part of what they view as God's plan for them.
A second way in which religion contributes to future patient care and sensitivity is through the introduction to the concept of “asceticism,” which is a monastic discipline that can seem, from the outside, to be a form of self-harm. The subject of religious asceticism is indistinguishable from conversations about the body, health, and healthcare. Monastic texts consequently provide the richest source for teaching and learning. In my particular course, Christian asceticism is included in the classroom as part of the historical continuum of asceticism in general. Students are introduced to asceticism through primary sources to Stoic and Cynic philosophies that highlight the interconnection of bodily health and virtue. Through reading and discussion, students learn about the development of preferential treatment of the soul at the expense of the body and bodily health in the most extreme cases, or indifference to the body in the most moderate cases.6 With this historical and philosophical background in mind, students read select Christian sources (identified below) that highlight the training of the individual soul alongside historic development of Christianity within its public, social setting, as a religion that responded pragmatically to public health concerns. As noted above, there is a natural link that students make between religiously ascetic behaviors and psychological disorders that result in self-harming actions. Students are not necessarily correct in how they make that link because they most often focus first on the activity that they deem to be self-harming. But the fact that the students make this link at all allows us the opportunity to think about, ask questions about, and discuss the various motivations behind behaviors that are rational and fulfilling to one person but harmful and frightening for another. In time, students develop a deeper consciousness around the multiple motivations that drive people to seek transcendent pain, and over the course of the semester they begin to reflect with greater empathy and nuance on the challenges that face both medical professionals who work with those who self-harm and the patients themselves. Learning about the various types of religiously ascetic activities, the theologies and philosophies that support them, and the distinction between asceticism and self-harm encourages students to examine the assumptions they might have about a patient (or friend) who self-harms.
Whether encountering a new philosophy or a new patient, we all must face our assumptions about beliefs and bodies. The significant medical advances of the past few years and the rapidity of technological developments make it easy for anyone below the age of 20 to assume that life before cell phones and hand sanitizer was inconvenient and unsafe. Relevancy is one avenue by which students might explore the significance of the past and, in doing so, move beyond a surface notion that history merely exists to teach us moral lessons. I offer visible historical relevancy in my “Health and Healing” course through the analytical essay assignment. In this assessment, students are provided with five topics related to our readings, each of which has a contemporary correlation. For example, they might read selections from The Life of Catherine of Siena7 as a study in anorexia, The Life of Christina of Markyate8 through the lens of mental health, or Cyprian of Carthage's Treatise 79 as a study in public health. In this way students are invited to link religion and healthcare together in both historic and modern ways for the benefit of future patients.
An additional method of assessment that emerged quite accidentally cultivates classroom discussion around these topics. With each reading assignment students must ask a question of the text that will promote discussion; a successful question will reveal that a student has not only read carefully but has moved beyond content-based questions to posit implications of knowledge. Given the nature of the material, these questions can be emotive. Indeed, a student once cautioned in response to one such question: “We should not even try to address that, it will just open up a can of worms.” Because I believe that the classroom is the right place to open up a can of worms, and because I believe that students entering the medical field will need to practice the ability to handle moments of heightened emotions, I now read aloud the more provocative questions (anonymously, of course) to the class, and we discuss them. Known as the “Can O’ Worms” questions, the students greatly enjoy this exercise, and—in time—compete to see who can write the most challenging query. Some examples of “Can O’ Worms” questions that students compose include the following:
After reading Gregory of Nyssa's sermon On the Love of the Poor, one student wrote: “Gregory lays out a worldview that allows the reader—any reader—to put aside their fear of illness and accept the sick people they interact with as part of their community…his philosophy seems simple and reasonable. Nevertheless, is including or accepting the diseased into a healthy community, medically, as realistic or simple as Gregory suggests?”
After reading some selections from texts that address depression, acedia or other forms of mental health issues,10 one student wrote: “Where do you draw the line between what mental illnesses can be tolerated within society and which ones cannot?”
After reading passages about patients brought to holy persons for healing in the “Life of St. Theodore of Sykeon”11 and in John Moschos’ Partum Spiritual,12 students wrote: “Does it matter how someone is made well? Or does it only matter if such treatment is effective?” And, quite importantly: “Is it ethical to let someone administer medical care if that form of care contradicts a person's religious teachings?”
No matter the reading or question, the students always engage vigorously in the conversations; sometimes the most valuable thing that they learn in the process is that there are rarely clear answers. More challenging to negotiate in the classroom than the “Can O’ Worms” questions is when students encounter approaches towards healthcare that seem to stand in direct contradiction to their view of health; more specifically, an approach to the body that encourages or cultivates the “sick” role. Nursing students—individuals whose instincts are to relieve pain—are often alarmed to learn that sometimes suffering is a choice, that not all who suffer seek relief, and that sometimes death is a cure. Indeed, these are provocative ideas for anyone raised in a culture that promotes peak health and bodily comfort at all times. If someone in the past was experiencing pain, students often think that person was in pain because “people did not know better,” not because that person consciously chose pain. They encounter this most intimately and in alarmingly direct language in selections that I assign from Pseudo-Athanasius’ Life and Activity of the Holy and Blessed Teacher Syncletica.13 Religious texts that describe in great detail the bodily mortification of saints, martyrs, or monastics are not abnormal; what is unique in this text is that the extent of her physical suffering causes those around her to be bothered as well: “…putrefaction and the heaviest stench governed her whole body so that the ones who served her suffered more than she did. Most of the time they withdrew, not bearing the inhuman odor; but when need called, the multitude approached, kindling incense, and again withdrew because of the inhuman stench.”14 My students are always bothered by graphic descriptions of Amma Syncletica's disease as much as by her willing acceptance of suffering and pain, and the text provides learning on multiple levels, including empathy in healthcare and questions over right-to-die issues.
There is no shortage of possible texts for this type of course, and any time a source deals with bodies it is instantly more accessible, popular and interesting for students. To my surprise, the most popular reading is neither the graphic Amma Syncletica nor the atmospheric gynecological health tract of Hildegard of Bingen;15 rather, Gregory of Nyssa's sermon, On the Love of the Poor has endured as the top read.16 Aided no doubt by a beautiful and accessible translation provided by Susan Holman, students are encouraged in this reading to consider implications of public perceptions of illness and disease in Late Antiquity, emotions that diseases arouse and how a community is altered by the presence of the diseased person. This is due, in part, to my own particular student population; my very earnest, justice-minded students are naturally drawn to recognize and appreciate Gregory's confrontation of structural inequalities and systemic violence against the marginalized ill. This text resonates deeply with them and leads to productive discussions about religion and social ethics.
Ultimately, I aspire to teach my students that “religion” is not a category set apart from all other forms of life experience. Beyond the classroom, the greater goal is that when my students, as healthcare practitioners, encounter patients whose religious identity shapes their health narrative, the study of these texts will have enhanced their medical education—and patient care—in significant ways.
Teaching Ancient Medicine in a Religious Studies Department
I started teaching the history of medicine during my time as a history graduate student at the University of California, Santa Barbara. I was given the opportunity to teach a course that was cross-listed between History and Environmental Studies. It was a course on the history of science from antiquity to the scientific revolution. I so enjoyed teaching the material that I decided to make ancient medicine a new research focus when I completed my degree, and I have continued to teach it whenever I can.
Although I am trained in philosophy and history, my job is in a religious studies department, so it is not possible for me to teach an entire course dedicated to ancient medicine. However, I include substantial sections on the history of medicine in a number of my courses including in a seminar entitled “The Pre-Modern Cosmos” and a third-year course entitled “Theory of Nature.” Both of these courses focus on the intersections between philosophy, science, religion, and medicine in the pre-modern world (500 B.C.E. to 1500 C.E.). I also include a two-week section on Religion and Healing in my “Religion in the Hellenistic and Roman World” course, and I address ancient medical notions relating to sex and gender in my course on “Gender, Sexuality, and the Body in Early Christianity.” The main objective I have for the first two courses is to immerse students in a different cosmos from the one they inhabit, a cosmos which I tend to present as relatively stable from Plato's Timaeus until the Copernican revolution (i.e., from about the fourth century B.C.E. to the fifteenth century C.E.).
In other words, while paying attention to change over time as we proceed chronologically, I tend to emphasize the persistence of certain scientific assumptions over the span of these 2000 years. One of these stable frameworks is the humoral system based on rational medicine, a hybrid of Hippocratic and Galenic ideas eventually filtered through the great Arabic medical writers of the early Middle Ages. Based on ideas discussed at the NAPS 2017 ReMeDHe pedagogy workshop, I have recently proposed a new course for my department entitled “Medicine, Magic, and Miracle in the Ancient World.” I have tried to introduce a number of novel assignments in this course, which I refer to as an Experiential Learning Lab. The assignments associated with this portion of the students’ grades require them to engage in activities such as participating in a modern healing ritual, concocting an ancient healing remedy based on either a folk or pharmacological recipe, adopting an ancient form of dietetics for a couple of days, or creating a healing/apotropaic amulet for a modern medical condition. Additionally, I am working with colleagues in Health Sciences at the University of Manitoba to launch a team-taught “Health and Humanities” course for pre-medicine students that will include an important historical dimension. This course aims to expose pre-med and health sciences students to the ways in which humanities disciplines approach topics related to medicine, health, and healing. The objectives of the course include building awareness about the history of medicine and health care, fostering the ability to listen with empathy to patient narratives and experiences of illness through exposure to literature, challenging students to re-think their definitions of health and normalcy through exposure to theoretical interventions from disability studies, and increasing students’ capacity for critical thinking about bioethical/biomedical issues.
I tend to take an anthropological approach with my students by introducing them early on to the idea that science is culture and has a culture and a history—an idea first impressed on me by the work of Emily Martin and Sharon Traweek, two important anthropologists of science.1 This is one way I attempt to deal with the tendency of some, albeit few, students to be dismissive of pre-modern scientific theories and understandings. I emphasize that like Ptolemaic astronomy, the humoural system of ancient medicine was the explanatory model for two thousand years (and even more) and worked well enough to satisfy both doctors and their patients. When discussing certain readings that raise theoretical issues, I also draw on work in gender studies to approach topics such as Aristotle's discussions on reproduction. For instance, we read Judith Butler or Joan Scott to establish a framework for discussing the ways in which both gender and biological sex are constructed differently in the ancient world, and I encourage students to think about this in the context of modern gender/sex differences.2
That being said, I am generally very encouraged to find that most students aren't dismissive of ancient medicine at the outset. Instead, they tend to be rather fascinated – a phenomenon I understand completely but still find very gratifying. Nonetheless, I pursue a number of strategies to “unsettle” and “disorient” students. First, I take every opportunity to highlight the superiority of our ancient predecessors’ skills in dealing with the natural world on matters of basic survival (food production, navigation, etc.). Second, I regularly challenge them to think about the depth of their knowledge of modern scientific paradigms such as genes, the immune system, and so forth. My aim here is to highlight that for most of us, our knowledge of the current scientific consensus in a variety of domains is cursory at best and often functions at the level of belief and not knowledge (to invoke Plato). I also take every opportunity to highlight the moments when pre-modern scientists and ordinary people got things right, and I further emphasize that they did so without the help of our instrumentation and other scientific advances. For instance, I talk about the way in which Aristotle discovered various marine species whose existence has only recently been confirmed.
When it comes to executing the above-mentioned goals and objectives, I have discovered a number of primary source readings that tend to work well in my classes. Although it is tough slogging, I usually read through much of Plato's Timaeus with students carefully at some point because it demonstrates so clearly the ways in which the ancient cosmos was structured and also discusses human biology in great detail.3 In terms of introducing students to rational medicine, I find that the Isagoge of Hunain Ibn Ishaq (ninth century) is a great place to start.4 Although it is an early medieval text, it contains a clear and excellent digest of the basic principles of Galenic medicine. I also love to teach Hildegard of Bingen's scientific works because they so beautifully demonstrate what happens when one puts together the Timaean cosmos with Christian theological concepts. It provides gender balance not just in terms of authorship but also because many of her positions on the role of women in bringing balance to cosmic systems strike a refreshing counterpoint to Aristotelian explanations of biological difference.5
When it comes to discussing the professionalization of medicine in antiquity, I have students read a number of works in tandem. I ask them to read a chapter from Vivian Nutton's Ancient Medicine in which he makes the point that the cult of Asclepius was not in competition with professional medicine, but both were working toward a similar goal—namely that of marginalizing more ad hoc healing practitioners.6 We read Nutton's chapter in tandem with the Epidaurian miracle inscriptions, which serve to highlight the way in which many of the miracles mirror medical procedures.7 I also teach excerpts from Aelius Aristides’ Sacred Tales to make the same point, because we see that Asclepius functions as the supreme physician to whom Aristides’ human doctors defer.8 Finally, the Hippocratic work, On the Sacred Disease is very helpful for highlighting the fact that ancient doctors were not involved in discrediting traditional Greek religion. They were not involved in juxtaposing religion and science, but were involved in discrediting a class of ad hoc healers who would have been their main competition in the ancient Greek polis.9 The author, I argue, is making a theological argument more than a medical one. These texts all work very well together to highlight Nutton's important point.
Material culture also plays an important role in these classes. I have so many personal images related to ancient healing from museums and at various archaeological sites. I was trying to figure out how I could use these in my classes. I realized that I have never had a formal art history or archaeology course, but I spent a lot of time reading museum placards and site maps, and it dawned on me that I could reproduce that kind of learning experience in my classroom by constructing a kind of virtual museum of healing-related objects for my students. I do this by devoting two lectures just to looking at and discussing images from my photo collection. I then have students find an image themselves, research it, and write about it in relation to a theme from the course. This is an exercise I “stole” from Christine Thomas at UCSB who taught me Greco-Roman religions.
In general, I find teaching ancient medicine in a religious studies context thoroughly engaging and gratifying. Students respond with curiosity and interest, and a number of my honours students have so enjoyed the subject matter at the undergraduate level, that they have chosen to continue in Master's level studies on topics related to religion and medicine both here at the University of Manitoba and at other institutions.