Every now and then I read an article that sticks with me--that gets stuck in my mind and haunts me (in a good way). Recently I read on Comment’s website (which, it should be added, publishes consistently excellent content) an article called “Democratizing Healthcare,” written by a Baltimore physician named Matthew Loftus. The article, which describes the current landscape of medical care and offers some prescriptions for the future, is insightful in its own right regarding healthcare. But I couldn’t help thinking about all the ways it offers important analogies for soul care—the work of pastoring, the work of the church.
Early in his essay, Loftus shares an observation from his time as a primary care provider. Despite the vast amounts of money spent on health care (specifically urgent care from the emergency room) he says, “No one felt like they were $60,000 healthier.” Many patients—often those subjected to unnecessary over-treatment and testing—have spent a great deal of money but are left with the same symptoms. Patients get interviewed, scanned, medicated, and advised, frequently with a negligible impact on their overall health.
A similar critique can be levied against the church. The church (and particularly those charged with providing soul care) often use the same one-size-fits-all battery of spiritual tests on everyone, simply because that’s how the system is set up. Christian ministry often lacks attentiveness to the specific of each individual’s spiritual history and health. Here’s a fair question to ask about the spiritual care provided by faith communities: Is all the time and energy (and often money) people spend on spiritual stuff, making them any healthier? Do you see the vast quantities of money collected by the church and wonder how it’s being spent? Do people in these churches seem healthier? Do cities seem any healthier?
Discipleship in a Pill
A second important observation from Loftus’ article is that the healthcare system, while well-adapted to treat acute health issues, is not well-adapted to deal adequately with chronic disease. Many of the most prevalent and intractable diseases work slowly, over the long-term, and they can’t be addressed by another test or by a simple prescription. As Loftus writes, “You can’t put exercise in a pill and make a billion dollars.” The analogy to soul care is obvious. You can’t put discipleship in a pill and make a billion dollars, either (although a deluge of heavily marketed discipleship resources makes me think you can do pretty well by putting it in book form). While the church’s primary calling is to deal with the chronic disease called sin, its programs and structures aren’t well-adapted to address it.
Loftus continues: “The advice doctors toss out—eat healthier, exercise, quit smoking—is easy to agree to in the exam room, but much harder to live out back home,” and “Any smart doctor recognizes that the fifteen minutes a patient gets with them every three months is no match for the culture and environment a patient will return to.” Any smart pastor or ministry leader ought to have a similar recognition. The hour or so that people spend at church (or even the two hours they spend at a weekly small group) is no match for the prevailing environment to which they will return; be it a home where habits of addiction are reinforced; a university setting where fully secularized narratives hold sway; or a workplace that insists that identity is shaped by an upward mobile career trajectory. Just like patients who return to physically unhealthy environments after visits with their doctor, so people who engage in spiritually unhealthy behavior in daily life will be relatively unchanged even by frequent church visits.
A third parallel between health care and soul care has to do with alternative measures used by the sick to find temporary relief from their symptoms. Loftus writes, “As I try to treat obesity, respiratory diseases, and substance abuse in my work at a clinic for the homeless in Baltimore, it is impossible to ignore the fact that the stress, depression, and anxiety generated by a life stuck in poverty are powerfully (albeit temporarily) alleviated by unhealthy food, smoking, and drugs.” Local pastors spend hours of their weeks confronting similar realities in their parishioners. These are men and women who, in efforts to alleviate life’s burdens, seek fleeting solace in harmful addictions to alcohol, gossip, or pornography.
Writing about the healthcare system, Loftus could just as well be writing about our systems of soul care: “Any top-down solution (e.g., cigarette taxes or a vaccine mandate) is far easier than creating conditions under which bodies thrive.” The church’s job, then, is not to manage the chronic disease of sin through temporary relief of symptoms. Rather, it is to connect people to the life-giving power of Jesus Christ who has defanged sin and who opens eternal life—that is, the full realization of an integrated, thriving life. Put differently (and echoing Loftus), the church’s role is to create conditions under which bodies-cum-souls thrive, to create conditions of “life to the full”, as Jesus said. We have settled for too little, both in health care and soul care. Top-down spiritual solutions are no replacement for personal discipleship to the Living Christ.
Community Health Workers
Finally, in order to address the current failings of health care, Loftus suggests a greater commitment to community health workers. He advocates a shift in power from centralized institutions of healthcare to communities where the sick live. “The overall focus must and should always be in giving people more power over their own health, with the expectation that self-determining power—particularly when mediated through local institutions—is more effective at helping people take care of their bodies than being told what to do by larger and more distant institutions.”
Similarly, a shift in power must take place from the institution of the church (and its paid spiritual experts) to the communities where the spiritually sick reside. We need to shift our emphasis toward community soul health workers. And we must leverage the resources that already exist within communities. These are church members—small group leaders, elders, deacons, other lay leaders—unleashed into the geographical parish of the church. Homes and businesses and classrooms provide the setting for life: where we live out our spiritual sickness, but also where we can begin to be made spiritually well. More so than the distant institution of the church, it is faithful friends, fellow small group members, generous neighbors, who, because of their proximity and steadfastness, are best poised to help others take care of their souls.