«They that are well have no need of a physician, but they that are sick. For I came not to call the just, but sinners.»

— Mk 2:17 (DRV)

Since Jesus Christ in the above Gospel quote, sickness has been used as an analogy for sin. We recognize that sickness happens when something is not well with our body. Likewise, sin happens when something is not well with our soul.

Now, this metaphor can be pushed too far. There is a modern tendency to pathologize sin, just like there was an ancient tendency to ascribe a sinful root to all illnesses (and this ancient tendency can also be seen nowadays, for example, in debates about healthcare reform, where sometimes all diseases are blamed on poor life choices, as if reality weren’t more complex than that.)

However, if we do not force the meaning of one concept into the other, and just read this comparison as an analogy, then we can gain some pretty good insights about the nature of sin.

In this regard, a physician is in an excellent position to acquire those insights, if he sets his mind to it. I know this to be true for me, at least. I have lost count of all the times when, confronted with something that happens in my professional practice, I get an epiphany and proclaim “Oh, now I see why this is so in Catholicism.

Maybe this is my bias as an oncologist talking… but I think that, if we are going to use sickness as a metaphor for sin, then cancer is the best disease to use for this effect.

Cancer is not acute, it doesn’t come in a flash and in a flash goes away. Cancer is chronic. We must fight it, day in, day out. Even when we eradicate it, we must remain vigilant, lest it comes back.

Cancer is not a disease of external agents, like infections are. I mean, sure: cancer may be caused by external agents… cancer may be influenced by external agents… but ultimately, it is a disease of our own body. Cancer cells originate from normal cells of the host that have gone haywire. This explains why it is so difficult to treat cancer: it is so inextricably attached to our organism in a “wheat-and-tare” kind of way, that it is difficult to impact one without impacting the other.

Finally, cancer is not merely a malfunction of our organs and tissues. It is much more than that. The cancerous tissue is not merely causing harm by not doing what it is supposed to do. Rather, cancer is actively and persistently working against the normal functioning of the whole organism, trying to get advantage over it for “selfish” reasons, eventually inducing death.

For all these reasons, I think that cancer is a pretty decent analogy for sin. Of course, it is an imperfect analogy, just like any other analogy. Push the analogy too far and it will break. For example, many cancers are incurable, while there is no sin that is not redeemable through the grace of Our Lord. However, I posit that we would not be incorrect in stating that sin is a “cancer of the soul.

If this is so, then maybe an oncologist may offer a good perspective in how to deal with sin. After all, the oncologist’s purpose is to treat cancer and sin is a “cancer of the soul.” So, I would like to share seven loose reflections I’ve made in this regard through my years of medical school and medical practice. These were, in fact, very important for me to understand several of Pope Francis’ remarks that seem to scandalize many fellow Catholics, which just makes my sharing of them even the more important.

1. Focus on the person, not on the sickness

Nowadays, medicine is highly compartmentalized. This is a necessity, given the wide body of knowledge that keeps expanding at such a great pace, that it is not possible for a single human being to keep up to date with all recent discoveries. So a cardiologist will focus on the heart, a pneumologist on the lung, a neurologist on the nervous system and so on…

However, this may lead to serious gaps in our medical approach, since a sickness may impact various systems at once. We may feel sick, not because an organ is malfunctioning, but because the whole net of organs is malfunctioning.

Oncologists seem to evade this by focusing not on a system of organs, but on a systemic disease: a disease that may appear in any part of the body and affect any part of the body.

But there is still a grave danger. Just like a cardiologist may risk isolating the heart from the rest of the body, an oncologist may risk isolating the body from the person to whom it belongs.

When I was in medical school, I was told there were two models for exercising medicine: The biomedical model was obsolete, and tended to concentrate only on the sickness, with the sick person as a mere background where all the action took place. According to this model, the disease was just a list of symptoms and findings which the physician would compute into the adequate treatment, as if he was solving an equation on a drawing board. On the other hand, the more recent and more appropriate biopsychosocial model tended to have a more holistic approach. Here, disease is not merely a biological entity, but is modeled by the totality of the person, which involves psychological, social and even spiritual factors.

Regarding all the Church polemics with Pope Francis’ pastoral approach, what I see is that many of my fellow Catholics’ misunderstandings stem from what appears to be a spiritual version of the biomedical model. Sainthood is viewed as a check-list that a Catholic must satisfyingly clear irrespectively of that Catholic’s life circumstances. Rigorists will frequently pay some kind of lip-service to how hard it is to clear the check-list, and how sorry they are about it, but eventually the clearing of the check-list takes prominence, regardless of everything else and as if that alone would suffice.

Pope Francis’ approach is more akin to the biopsychosocial model. It is not that he thinks that sin is not wrong. Rather, he’s pointing to more effective ways to combat sin. And we do this, by reading sin not as a check-list that must be cleared, but as something much more profound, that must never be dealt with apart from the concrete sinner we come to meet on the road. In other words, this concrete sinner should be our main focus. Why is he sinning? What is the best way to lead him away from his sins? What can I do at any given time to help him? Is mere preaching sufficient? Can it be counterproductive in this given situation? If so, what else can I do?

Dealing with sin is important not in itself, but because it is vital for the individual sinner’s well-being and salvation. Were it not for the sinner, then sin wouldn’t matter: it would be a mere abstraction. God wishes the salvation of the sinner more than the crushing of the sin. The latter is important only because of the former. This truth must be understood and integrated into our praxis. It can’t be mere lip-service. And one way to recognize if this is mere lip-service, is if this truth really models our apologetics or if it simply is used as a preamble to justify whatever arguments we were going to use in the first place, irrespectively of how they would be received by the sinner we have in front of us.

2. Practice takes precedence over theory

One of the greatest shocks a medical student gets when he becomes a practicing doctor is the gap between what he has learned and what he sees in his office every day. This person has spent years and years studying books and notes, training his ability to fit symptoms into diagnoses as if they were pieces of a puzzle… and the first patient that he gets doesn’t seem to fit anything he read! It is indescribably frustrating! I can’t begin to explain the sense of lostness, of having the rug swept beneath your feet, the feeling of betrayal…

It is also a crisis… every… single… medical professional must confront and overcome.

I think it would do a lot of good if orthodox Catholics did experience and overcome a similar crisis. Many Catholics come to the faith with a sense of everything falling neatly into place after years studying the doctrine and theology. Then they come out to the real world and see a mess and think it’s their duty to start cleaning things up.

Thing is, it’s not. Or rather, it is, but not the way they think it is. Cleaning things up means acknowledging that theory flows from reality, not the other way around. The medical book was written to describe the sickness. The sickness does not exist to fulfill the medical book.

But if you are the kind of person that likes to steer your course by using theoretical guidelines (as I am) I say: Don’t lose hope. This crisis is a passing thing. Eventually, with practice comes a sense of what the theory was all about to begin with. The disagreement between theory and practice is a mere illusion, an illusion that vanishes once you acquire practice. But you’ve got to have practice. You have to spend months or even years rolling up your sleeves and getting dirty on the field. I can’t explain it any better, because otherwise I would be explaining a theory to you. I may only pass onto you what you must do. And that is: get your head out of the books and start doing things!

3. Stay humble

Another obligatory crisis every physician experiences when he finishes medical school is the downgrading of the conception of his self-worth when confronted with reality. Only high-achieving students enter the medical faculty, so it is very common to have this kind of “I’m gonna be Doctor House when I grow up” mentality.

Time and time again, our teachers tell us: “You’ll not be able to cure everyone. You will make mistakes. You will not be perfect. You gotta stay humble.” But we’ll always brush them aside, like: “Pffff, yeah whatever. Maybe that’s true for you and all the other guys. Not me.” Ah, the folly of youth…

But it won’t be long until you find that your teachers’ prophecies will inevitably be fulfilled. Not the least because you are human and humans, by definition, make mistakes. You are not godly, so you won’t be able to miraculously cure everyone you touch.

In the field of oncology, this strikes us as even more true. Nowadays, we are able to cure many cancers, especially those diagnosed in early stages. But for many others, we still don’t have the knowledge and technology available to attain a cure. Merely prolonging survival with quality of life for some months… or even having a person die without major discomfort… all these can be viewed as victories, according to the case at hand. Sometimes, this is what’s asked of us, mere mortals. Oncology forces us to take joy in the small victories: a person that reconciled with his family members before dying, a person that was able to survive to attend his grandson’s baptism, a person that suffered a lot of pain and later died comfortably, with a smile on his lips.

Now, here the analogy breaks, for we can never find a victory in having a person’s soul die in his sins. But in this point 3., I wish to focus the analogy, not on the disease, not on the patient, but on the practitioner.

You see, I had to experience a similar crisis in my apologetics. When I converted, I thought: “Hey, I know some pretty good arguments. Their logic is bullet-proof. I bet that as soon as I present these arguments to all these uncatechized folk, they’ll notice that I have a point and rethink their erroneous ways.” Ah, the folly of youth…

Yup, being right is not enough. In fact, if you’re too right, there is a real danger that you’ll turn the other person hostile, depending on how much that person has invested in that particular error. This, if you’re lucky. Other folk will just shrug you aside and say: “Well, OK. That’s your belief. Just don’t impose it on me” and then go their merry way.

This is probably happening right now, as people are reading this. Some are probably here not to read what I wrote, but to find faults in order to refute me. As soon as they discover that I’m defending Pope Francis, their mind will be made up about me and the worthiness of this text. In fact, no matter how much I try to explain and substantiate my assertions, it’s likely that there will be comments filled with distortions, if not complete insults toward me.

And that’s fine. I learned to live with that.

But since having a person re-assessing his own preconceptions is so rare, maybe we should find a victory in that too. There are so many people out there that will never give the Church a chance because of their prejudice… that having someone just perusing the Church with interest and respect should fill us with joy. So, maybe kicking those people out of the Church for not meeting the standards we think are acceptable is not the proper way to go. Maybe lauding every small step that these converts make toward the fullness of Truth is more productive. Maybe having a gradual process is better than an All-or-Nothing toss of the coin where “nothing” is more likely than “all.” Maybe we should find comfort in the small victories and not despair. Maybe someday we’ll find out that that person effectively has crossed the threshold and come into full communion with the Church! But, to achieve this, we got to do something physicians are accustomed to do and that Francis dissenters hate: we got to accompany the sinner.

4. Continually reevaluate your treatment plan

 Cancer is a very “smart” disease. Cancer cells are very adaptable, much more than normal cells. They will use anything at their disposal to disseminate themselves into the whole body. Any normal physiological process occurring in our body to maintain our life and health can be hijacked by the cancer cells to stimulate them.

Likewise, sex, property, politics, all these are good things unto themselves. But sin can find a way to distort them, so that the good they produce gets diverted to produce wickedness.

It can be graver, still. For example, one of our immune system’s job is to fight cancer cells. However, cancer cells may find ways to have the immune system do their bidding. When they do that, the immune system doesn’t inhibit the cancer, rather it stimulates it.

So it happens with sin too. Sin is, in fact, even “cleverer” than cancer. The Catholic religion, the Scriptures, the liturgy, the saints’ lives and private revelations, theology, the sacraments… all these are wonderful remedies against the ills of sin. However, they can be exploited by sin to produce more sin, if we become so overconfident that we don’t understand that it is not sainthood that is growing in us, but pride. They become idols and, therefore, occasions of sin.

An oncologist knows that cancer is highly adaptable. He will constantly monitor the efficacy of his treatment plan. Sooner or later, cancer may evade our efforts and find new, unexpected ways, to survive. It would be great if those that deal with sin were as vigilant as that, especially regarding their own sins.

5. Team work is key

If there is a word oncologists love, it is multidisciplinarity! It is considered standard procedure that any given patient must, whenever possible, be discussed on a multidisciplinary group at the outset. By doing this, we ensure that every therapeutic specialty will be able to give their imput regarding the best treatment plan: surgery, radiotherapy or chemotherapy, according to surgeons, radioncologists and medical oncologists, respectively. Sometimes, the treatment plan must dovetail all these areas, which must work together in an articulated and synchronized fashion.

Ultimately, the success of this enterprise lies in the cooperation between physician and the patient himself, since every treatment is doomed to fail if the patient doesn’t collaborate. Likewise, any plan to convert a sinner that doesn’t integrate the sinner in the process will have disastrous consequences.

Many of Francis’ critics have been scandalized because of His Holiness’ changes to the Pontifical Institute for Studies on Marriage and Family, when all he did was integrate some of the other fields of knowledge into it, like psychology and sociology, and not just theology and doctrine.

The Pope’s true intentions can be read in his own words from Amoris Laetitia # 203-204:

«Seminarians should receive a more exten­sive interdisciplinary, and not merely doctrinal, formation in the areas of engagement and mar­riage. Their training does not always allow them to explore their own psychological and affective background and experiences. (…) The response to the consultation also insisted on the need for training lay leaders who can assist in the pastoral care of families, with the help of teachers and counsellors, family and community physicians, social workers, juvenile and family advocates, and drawing upon the contributions of psychology, sociology, marital therapy and counselling. Professionals, especially those with practical experience, help keep pastoral initiatives grounded in the real situations and concrete concerns of families.»

As an oncologist I am delighted by this! It is about time that clerics advising and discerning with concrete people would have some formation in the fields of psychology and sociology! Isn’t it true that a biological sickness may cause psychological and social harm? Isn’t it true that psychological and social ills may cause biological sickness? So why don’t we understand that biological, psychological and social ills may impair our spiritual health? The person is a unit, where every factor is indissociable. Dissecting a person into biological, psychological, social and spiritual components and addressing them separately is artificial, not organic and, therefore, a mere abstract exercise with no practical effects.

Now, this doesn’t mean that the priest shall be replaced by a psychologist. Just like you’ll never see an oncologist taking the scalpel and performing a surgery. They have different ministries and fields of expertise. This only means that, if they are to effectively tackle the problem of sin on a real person, they will have to work together. Acknowledging each other’s role and understanding the basics of each other’s work is key to allow this team work to run smoothly.

6. Treatment should be tailored

Occasionally, you’ll hear people complain: “When will you guys find the cure for cancer?” Sometimes, the media will triumphantly report about some scientist finding the cure for cancer, only to forget him the next week. There will be conspiracy theories about the cure having already been found, but Big Pharma not selling it in order to capitalize on a chronic disease.

All these stem from a profound misconception: that there is something called “The Cancer” for which we will find “The Cure”.

Thing is, there is not one cancer, but a multiplicity of them. A gastric cancer behaves very differently than a bladder cancer. A lung cancer contained within the lung will not be approached the same way as a lung cancer that has spread to other organs. A breast cancer with hormonal receptors will respond to hormonal therapies, whereas a breast cancer without hormonal receptors will not.

In fact, the same cancer in the same stage will behave differently from person to person.

Each cancer in each person is its *own* disease. Therefore, treating cancer is not about treating a disease, but about treating a group of different diseases, as numerous as there are patients. Finding a magical bullet that will kill them all is not consistent with what we know today.

Therefore, our research specialists are now dwelling on a very fascinating field: tailored therapy! In the future, every single cancer will be analyzed for mutations that will predict its response to a particular drug. And every single patient will be analyzed for characteristics that will predict his tolerability to that same drug. Physicians will be able to mix cocktails of drugs which will be the most appropriate for Jack, but in turn would not work for Jill.

Another thing a physician must take into consideration when he tailors his treatment plan is the fitness of the patient. Is he a strong, vigorous, person? Or is he a weak, frail person? Surely you can’t administer the most powerful and violent chemotherapy in your arsenal to a bedridden patient!

I think this is exactly what Pope Francis wants to do regarding sinners. We must tailor our approach to what will be more effective to that particular sinner at that particular time. However, if you believe his critics, then I would be pressed to admit the absurd proposition that, just because I am in favor of a tailored treatment, where some patients don’t get aggressive chemotherapies, then it must be because I don’t regard cancer as a disease. Or because I don’t take cancer seriously. Or that I believe any quackery is a legitimate treatment. Foolish, right?

The same goes with the accompaniment of the sinner. It must be tailored. Sometimes you need to target your approach and not be too aggressive. That doesn’t mean that sin isn’t wrong. It doesn’t mean that we don’t take sin seriously. Or that any spiritual path is equivalent to that of the Church. It simply means that sin is bad and we need to find the best way to help that sinner achieve salvation.

7. To be frail is to be human and to be human is to be frail

These were the lessons I took from my work in oncology that helped me better understand where Pope Francis is coming from. I am honored to have been given the privilege of performing this beautiful profession. During the few years I’ve practiced it, I was able to glimpse at the lives of my patients and respective families. I’ve shared with them moments of joy, sadness and frustration. More importantly, I learned that it is in its frailty that the human condition is manifested in all of its splendor. It is in the bleakest moments that people may surprise us for better or worse. It is only in the darkest caves that heroism shines. And, more significantly, we find true humanity when we acknowledge our weakness and allow God to mold us from there.

This is also one of the most impressive lessons of our religion. God was present not in the power of the earthquake or of the fire, but in the soft breeze. God was present on a little unborn child, on a jewish refugee baby, on a humble carpenter, on a crucified criminal.

Pope Francis has made clear that he takes this sickness-sin analogy seriously, by proposing as the overarching project of his pontificate that the Church be a “field hospital” for sinners. Those that come into our fold must be treated as sick people in need of our attention and care. No matter the military ranks of the patients in this hospital, and how ugly the war outside rages, the field hospital is not the place to start shooting at each other. It is a place where wounds are tended, including those of the most valiant of soldiers. These should, therefore, owe respect to their doctors and collaborate on their efforts, instead of setting up courts martial all over the hospital, hindering its proper functioning.

If we are to properly engage the epidemic of “cancers of the soul”, we need to seriously readjust our attitudes and focus. Ultimately, our victory in this war rests on that. May the Supreme Physician heal all of our wounds and sicknesses, in the Church as in every single one of us. Amen.

[Photo credit: “Seven Sacraments Altarpiece: Anointing of the Sick”, van der Weyden, 1445-1450]

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Pedro Gabriel, MD, is a Catholic layman and physician, born and residing in Portugal. He is a medical oncologist, currently employed in a Portuguese public hospital. A published writer of Catholic novels with a Tolkienite flavor, he is also a parish reader and a former catechist. He seeks to better understand the relationship of God and Man by putting the lens on the frailty of the human condition, be it physical and spiritual. He also wishes to provide a fresh perspective of current Church and World affairs from the point of view of a small western European country, highly secularized but also highly Catholic by tradition.

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