Augustine Institute - MA Theology - 3rd Course, "Light to the Nations" - 2nd Writing Assignment

William T. Ward

A Hospital Chaplain’s Companion

Chapter 1: The Origins of Illness

In Judaism, the commandment to visit and care for the sick is known as Bikur Cholim (Wikipedia 2025). In Christianity, Jesus says, “I was sick, and you visited me … as you did it to one of the least of these my brethren, you did it to me” (Mt 25:36,40 RSV-2CE). The Prophet Muhammad said, "Whoever visits a sick person or visits a brother for the sake of Allah, a caller calls out to him: 'You have done well, and may your walk be blessed, and may you occupy a place in Paradise'" (Jami` at-Tirmidhi 2008: Vol. 4, Book 1, Hadith 2008).

Hospital chaplains encounter an endless array of illness scenarios as they walk into a patient’s room to provide spiritual and emotional support to patients and their families, regardless of a patient’s religious beliefs, if any. A thorough understanding of the origins of illness from a biblical perspective will provide a practical framework for hospital chaplains to address such situations involving patients of a Judeo-Christian and, arguably, a Muslim background.

Primary sources for this study will be the first section of French philosopher and Orthodox convert Dr. Jean-Claude Larchet’s book, “The Theology of Illness,” entitled “The Origins of Illness,” and the writings of St. Francis de Sales. Of the forty-three saints cited in Dr. Larchet’s book, published in 1991, there is not one mention of St. Francis de Sales, who thrived four centuries earlier, wrote extensively on sickness and death, is a fellow native of France, a doctor of the church, and venerated in both the Catholic and Orthodox churches. This seems perplexing. Dr. Larchet is still alive but has no publicly available contact information. A request for comment via his publisher has been made, but no response has been received to date. In the meantime, this essay will argue that Dr. Larchet would have benefited from citing St. Francis de Sales’ writings in his research on this subject, thereby enriching his theology of illness. Above and beyond this, where applicable, contemporary examples pertinent to the subject matter will be included that will also enrich this theology. Together, they will possibly call for a second edition of the text.

“The Origins of Illness” section of Dr. Larchet’s book “The Theology of Illness” is divided into seven chapters:

·       The Original “Perfection”

·       The Initial Cause of Illness: Original Sin

·       Are People Responsible for the Illnesses That Afflict Them?

·       The Healing of Human Nature by the Incarnate Word

·       Why Does Illness Persist?

·       Illnesses of the Body and Illnesses of the Soul

·       The Precariousness of Health

Each will be explored in this sequence and enhanced by de Sales’ views on the chapter’s subject matter, if any.

By “The Original ‘Perfection’,” Larchet is referring to the state of perfection that existed prior to The Fall, the moment Adam and Eve disobeyed God. So, we commence with biblical roots. It seems there is no end to the implications of a single bite of a piece of fruit. “And the LORD God commanded the man, saying, ‘You may freely eat of every tree of the garden; but of the tree of the knowledge of good and evil you shall not eat, for in the day that you eat of it you shall die’” (Gen 2:16-17). Does this imply that illness and physical death were not part of the original plan for mankind, that is, prior to The Fall? “God created man in his own image, in the image of God he created him; male and female he created them” (Gen 1:27) might support such a theory, assuming God himself is eternal. Was there a difference in the constitution of the human body before The Fall, versus what we have had since? Or is the reference strictly to an eternal human soul? Perhaps Adam and Eve were initially more spiritual than physical. That might explain why they suddenly felt embarrassed by their nakedness after The Fall: maybe there were no physical bodies beforehand. Such questions will be addressed along the way.

Larchet begins with several quotes from saints; a few follow. “We are to believe that in Paradise our first parents begat offspring without blushing. In Paradise, then, man lived as he desired so long as he desired what God had commanded. He … had it in his power so to live eternally. … There was in his body no corruption, ... He feared no inward disease, no outward accident” (St. Augustine, City of God, XIV 26, quoted in Larchet, 19); “If you wish to know the state of our body as it left the hands of God, return to paradise, and behold the man whom God had just placed there. His body was not subject to corruption. … he experienced none of the infirmities that we know in our day" (St. John Chrysostom, Homilies on the Statutes, XI, quoted in Larchet, 19); and "Neither illness nor deformity existed in the beginning with our original nature” (St. Gregory of Nyssa, Letters, III, quoted in Larchet, 19). Larchet posits that the nature of man was possibly immortal before The Fall, though he goes on to address some nuances based on “God formed man of dust from the ground, and breathed into his nostrils the breath of life; and man became a living soul” (Gen 2:7). Some of these same saints point out that the “human body at its creation and according to its very nature was unstable, corruptible and mortal” (Larchet, The Theology of Illness, 20). There apparently is patristic disagreement over whether immortality originally existed for both the body and the soul, or perhaps only for the soul, and that such a distinction needs to be made. It may be that because man was formed from dust from the ground, his body was mortal, and because his soul was formed from God’s breath of life, his soul was immortal. There is no way of knowing for sure. What is clear is that because man was given free will, it was up to him to maintain his original state as long as he abided by God’s wishes. We know that did not happen.

St. Francis de Sales did not write focusing on the state of being prior to The Fall, but rather focused more on the effects of Original Sin. Perhaps this is where de Sales went off the radar for Dr. Larchet. However, Larchet had no trouble later referring to other heretofore unmentioned saints, such as St. Gregory of Nazianzus, St. Irenaeus, and St. Cyril of Alexandria, each venerated in both the Catholic and Orthodox churches.

Larchet then moves on to a second topic, “The Initial Cause of Illness: Original Sin.” Once again, Larchet makes his case with multiple quotes from saints. "The misuse of his freedom of choice introduced into Adam susceptibility to punishment, corruptibility, and mortality" (St. Maximus the Confessor, To Thalassios, 42, quoted in Larchet, 26); "For the first creature, disobedience procured exclusion from Paradise; ... in his disobedience, man acquired fatigue, suffering, and distress, and finally he fell into the power of death" (St. Theophilus of Antioch, To Autolyclls, II.25, quoted in Larchet, 26); and "It is because of the sin of disobedience that illnesses torment mankind" (St. Irenaeus, Against Heresies, V, quoted in Larchet, 27). This fall from grace, due to a simple disobedience, led to a loss of Adam and Eve’s original state and even to their banishment from the Garden. Whatever state they were in prior to The Fall led to “the LORD God made for Adam and for his wife garments of skins” (Gen 3:21). Thought-provoking insights into this come from the many people who have survived near-death experiences that included temporary out-of-body experiences and have been brought back to life, often as a result of the advances of modern medicine. This topic can get cringy, with a lot of New-Agey psychobabble. However, a recent book has been published from a Catholic point of view, “Near-Death Experiences” by Scott L. Smith, Jr., that covers near-death experience stories from the bible, of saints, and of priests and laypeople. Such “experiencers,” as they are called (Wikipedia 2025), provide a glimpse into the distinction between existence solely as spiritual forms versus our normal day-to-day existence within the confines of a physical body. They often refer to the return to their bodies as a depressing return to a fallible, diseased, or injured “meat sack” or some other derogatory term for the physical body (IANDS 2025). They then face a lengthy and often complex process of “reintegration.” They report that, in spirit form, it all felt familiar, as if they had been there before, and more like their natural selves than what we all take for granted as our normal day-to-day existence in our physical forms, and often an indescribable sense of love (IANDS 2025). None of us will truly know until we have permanently passed on from this world. However, such experiences seem to be a brief glimpse into what it may have been like before Original Sin, followed by an unfortunate return to the post-Original Sin state.

Free will can be thought of as God’s gift to mankind that acts as a linchpin, holding us together on a proper path to the degree that we conform our will to God. St. Francis de Sales emphasizes a weakening of the will as a main effect of Original Sin. To a large degree, he focuses on concupiscence, meaning excessive lust or sexual desire. He states there are twelve movements of concupiscence which go in pairs of opposites, all perfectly natural, though the will can direct them toward good or evil: love and hatred; desire and aversion; hope and despair; courage and fear; joy and sadness; anger and calmness (De Sales, Treatise on the Love of God, 20). Such a weakening of the will makes us more likely to be swayed toward evil, which, in turn, can lead to illness, whether physical, mental, or spiritual. Realigning our will with God can promote the healing of illness. As an example, alcoholism is classified as a disease by the American Medical Association (AMA 1956), affecting its victims physically, mentally, and spiritually, and yet millions have recovered due to the predominantly spiritual basis of the Twelve Steps of Alcoholics Anonymous (Kaskutas L. A. (2009). Alcoholics anonymous effectiveness: faith meets science. Journal of addictive diseases, 28(2), 145–157. https://doi.org/10.1080/10550880902772464). Step Three states, “Made a decision to turn our will and our lives over to the care of God as we understood Him,” and Step Eleven, “Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out” (The Twelve Steps | Alcoholics Anonymous).

Dr. Larchet then moves to a third chapter, which addresses the question, “Are People Responsible for the Illnesses That Afflict Them?” Larchet states directly, “Illness … is a direct consequence of the personal sin of Adam and Eve. Furthermore, the Fathers often depict illness, together with the other evils that result from the original sin, as a punishment” (Larchet, 33). But he then immediately points out that such punishment is not carried out by an angry God, but is rather self-inflicted. "It is as if human creatures who in the beginning by their transgression welcomed sin and ushered in illness” (St. Gregory of Nyssa, Homilies on the Beatitudes, VI, quoted in Larchet, 35). It seems unfair that such a fate should be hereditary, passed down to all descendants. St. Cyril of Alexandria expresses this idea as, "Nature fell ill from sin through the disobedience of a single man, Adam. Thereby, the multitude of human beings was made sinful: not because they shared Adam's sin – they did not even exist yet – but because they shared his nature, which had fallen under the law of sin" (St. Cyril of Alexandria, Commentary on Romans, PG 74.789, quoted in Larchet, 36).

St. Francis de Sales acknowledges much the same, but prefers to focus on illness as an opportunity for spiritual growth. “The true patient does not complain of his sickness, or desire to be pitied; he speaks of it sincerely, truthfully, and simply, without bewailing himself, without being angry, without making his malady appear worse than it is” (De Sales, Consoling Thoughts on Sickness and Death, 33). This may sound like martyrdom, but de Sales reminds us that He who has all power has also provided us with remedies, in the form of medical professionals and the treatments they may prescribe. “There is no harm in desiring a remedy; on the contrary, we should carefully endeavor to procure it; for God, who sends you sickness, is also the author of remedies” (De Sales, Consoling Thoughts on Sickness and Death, 33). De Sales likens the burden of occasional illness to the cross we all carry through life, as did Jesus, and to do so with love, knowing the reward that lies beyond. “The bed of the sick is an altar of sacrifice” (De Sales, Consoling Thoughts on Sickness and Death, 39). An anecdotal example would be the testimony of a hospital patient reflecting on his three hospitalizations over the course of his lifetime. The reasons for admittance were varied – an accidental poisoning, alcoholism, and a cardiac arrest – but each discharge had commonalities. “I have consistently experienced a sense of rebirth, an increased appreciation for life, and a renewed sense of purpose after each hospitalization” (anonymous source due to HIPAA compliance).

Larchet’s fourth topic is “The Healing of Human Nature by the Incarnate Word.” Here, Larchet quotes Romans: "Thus, as one man's trespass led to condemnation for all men, so one man's act of righteousness leads to acquittal and life for all men. For as by one man's disobedience many were made sinners, so by one man's obedience many will be made righteous" (Rom 5:18-19). And adding the words of St. Cyril of Alexandria, ''As in Adam man's nature fell ill from corruption, so in Christ it has recovered health" (St. Cyril of Alexandria, Commentary on Romans, 789, quoted in Larchet, 40).

St. Francis de Sales illustrates what is referred to as the hypostatic union – the doctrine that Jesus Christ is one person with two distinct natures: fully divine and fully human – by quoting the Song of Solomon, “O that you would kiss me with the kisses of your mouth!” (Song 1:2), thus describing a metaphorical spiritual union between human nature and God.

Dr. Larchet then poses the question, “Why Does Illness Persist?” All may sound well as of the previous topic, but we must bear in mind that free will still has free rein. “This work of Christ, however, does not in any way infringe on human freedom. His saving work is imposed neither upon mankind nor upon other created beings. Rather, its accomplishment is offered to man's free will and presupposes man's acceptance and free collaboration” (Larchet, 41). Gregory of Nyssa adds, "He who holds sovereignty over all things, respecting human freedom to the very limit, allowed us to have as well our own domain of sovereignty, over which each of us would be the unique master” (St. Gregory of Nyssa, Catechetical Discourse, XXX, quoted in Larchet, 42). Larchet goes on to stress that a successful use of our free will is accomplished with the Church, through the sacraments. Of course, many refuse to do so, leaving them vulnerable to other forces. Moreover, he points out that no matter how aligned individuals may be with the Church and its sacraments, “all human beings, by virtue of their common nature, are to a certain extent mutually affected by their sinfulness, and thereby share together in the evil consequences of their sins, so they share together as well in the blessings promised to them” (Larchet, 43). Once again, we can be adversely affected by others' actions.

Here, St. Francis de Sales, ever the optimist, continues with his embrace of the benefits of illness, as we saw previously in the third chapter, “Are People Responsible for the Illnesses That Afflict Them?” If we are at least partly responsible for our own illnesses, and they can be beneficial to us, spiritually, physically, and mentally, it stands to reason that a persistent nature of illness can serve as a periodic reminder of the work that remains. De Sales thinks of illness as a worthy penance. “Evils often happen to us in order that, not having done much penance voluntarily for our sins, we do some unavoidably” (De Sales, Consoling Thoughts on Sickness and Death, 27). Note that “patient,” as in a hospital “patient,” and “patience” come from the same Latin root word, “patiens,” meaning suffering or enduring. “The true patient does not complain of his sickness, or desire to be pitied; he speaks of it sincerely, truthfully, and simply, without bewailing himself, without being angry, without making his malady appear worse than it is” (De Sales, Consoling Thoughts on Sickness and Death, 33). If only all hospital patients would have such an attitude.

Larchet addresses the topic of “Illnesses of the Body and Illnesses of the Soul.” “When the soul participates in divine peace and in the power of divine grace, it communicates this peace and this grace to the functions of the body” (Larchet, 52). Undoubtedly not true for all holy people, such as the many saints we know of who suffered significant challenges of illness culminating in short lives, but many do “attain a ripe old age and preserve even at the bodily level a remarkable vigor and surprising youthfulness” (Larchet, 52). St. Antony of the Desert immediately comes to mind. He quotes St. John Climacus, who takes it to another level by touching on the subject of incorruptible bodies. “I believe that the bodies of those persons who have become incorruptible are not as susceptible to illness as others are, for, having been purified by the all-pure flame of divine love, they are no longer subject to any form of corruption” (St. John Climacus, The Ladder of Divine Ascent, XXX, as quoted by Larchet, 53).

De Sales devotes a chapter of Introduction to the Devout Life to “Anxiety of Mind,” in which he connects illnesses of the body to illnesses of the soul. Trouble can set into the soul, whether from external sources, such as poverty or sickness, or from internal sources, such as depression (De Sales, Introduction to the Devout Life, IV XI). In our attempts to resolve such situations, we can make matters worse if our objective is self-love, thereby complicating the problem. Instead, de Sales suggests, “strive above all else to keep a calm, restful spirit, steady your judgment and will, and then go quietly and easily after your object, taking all fitting means to attain thereto. By easily, I do not mean carelessly, but without eagerness, disquietude, or anxiety” (De Sales, Introduction to the Devout Life, 200). He also devotes a chapter to “Of Sadness and Sorrow.” He says sadness weakens us and makes us vulnerable to evil forces. “The ‘sorrow of the world’ disturbs the heart, plunges it into anxiety, stirs up unreasonable fears, disgusts it with prayer, overwhelms and stupefies the brain, deprives the soul of wisdom, judgment, resolution, and courage, weakening all its powers” (De Sales, Introduction to the Devout Life, 201-202). Even if we do not develop physical illness, we are already on a path to mental afflictions.

Dr. Larchet’s final topic is “The Precariousness of Health.” By this, he means that no one is ever perfectly healthy; that good health is more “a matter of a lesser illness” (Larchet, 53); that ideal health is beyond our comprehension, since it is nothing we have ever experienced; and that what we call health is illness so insignificant that we do not bother to identify it as such.

St. Francis de Sales has us focus on the cross, no matter what is going on in our lives. “May God help us to regard little the nature of the way that we tread, but to keep our eyes fixed on Him who leads us, and on the blessed country to which He leads us!” (De Sales, Consoling Thoughts on Sickness and Death, 60). In other words, try to avoid even thinking about what may be going wrong in your life, whether physically or on some other level. It is a given that such things will happen, but it is best to keep your eyes on the prize. “What matters, whether we pass through deserts or through fields, provided God is with us, and we go to Heaven. I beg of you to elude the remembrance of your malady as much as you can, and though you feel it, you need not consider or look upon it; for the sight of it will give you more apprehension than the thought of it would give you grief. Thus, we bandage the eyes of those on whom the sword or the lance has to be used. It seems to me that you dwell a little too long on the consideration of your ailment” (De Sales, Consoling Thoughts on Sickness and Death, 60-61).

As can be seen, drawing on both the writings of St. Francis de Sales and contemporary sources, Dr. Larchet could flesh out the first section of his book, “The Theology of Illness,” entitled “The Origins of Illness,” if he were inclined to publish a second edition. Chapter 2 of this writing will do a similar treatment of Larchet’s second section, “The Spiritual Meaning of Illness.” The same can be expected for section 3, “Christian Paths Toward Healing.” In its totality, a hospital chaplain who studies all of this will be better equipped to do what they do best: provide spiritual and emotional support to patients and their families, regardless of patients’ religious backgrounds, if any. This will lead to a more holistic path toward recovery and a better understanding, for both patient and chaplain, of why we experience illness and the benefits of it.