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The Sacrament of Medication?

We Are All People Formed by Signs and Seals

Published on:
October 15, 2018
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9 min.
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I poured all forty pills out in my hand and stared into their small blue eyes. Was it possible that whatever was in them was all I lacked?” Virginia Heffernan, writing in Unholy Ghost: Writers on Depression, gives words to a question that is likely nascent and unsettled within the hearts of many who suffer. Eric Cassell, a physician who has written extensively about suffering, understands it to be the threat or actual harm to the integrity of one’s person: the body, roles, functions, and relationships that make up a person’s life. 

Medications become even more mystical since most people do not know how they work. Modern medicine can seem magical.

It’s no wonder Americans take a lot of medications—suffering is inherently bound up in loss or the threat of loss, and medicine promises to restore what has been lost (or protect what one has from being lost). And they take them for good reason too. Modern medicine has transformed once lethal diseases into manageable and chronic conditions. It has cured infections that would at one time obliterate entire communities. And it has assuaged pain when no cure was forthcoming. When suffering threatens to overwhelm, medicine offers a literal lifeline. Being a physician myself, I readily prescribe them. I believe they will be useful. 

Medications become even more mystical since most people do not know how they work. Modern medicine can seem magical. So much so that medications are powerful not only because a potent chemical acts on the human body. The positive effect of a placebo, an intervention with no active component, demonstrates that the meaning we infuse into medications has power as well.

The stark totality of Heffernan’s question begs a negative answer: we want to exclaim, “Of course those pills will not fill up in you what is lacking!” And yet by simply asking the question, she highlights the power medications can have for those who suffer. With that kind of mystique, perhaps these “small blue eyes” can restore what is lacking. 

Given their efficacy and ubiquity, the promises they make to us about a future of life and the possibility of flourishing, and the mysterious way in which they often work, medications seem to possess a power equal to the Lord’s Supper for symbolic authority. 

What significance can a sacrament have?

Looking on the Lord’s Supper as mere physical nourishment would lead us to believe that this is a paltry meal indeed. Stomachs may grumble even after partaking of the bread and wine or juice. But the Westminster Confession of Faith says sacraments function as “holy signs and seals of the covenant of grace.” Baptism and the Lord’s Supper signify the work of Christ, and also set apart—or set a seal upon—a people of his choosing. Even though we ingest morsels of food and drink, their power comes not from their physical constitution, but from the work of the Holy Spirit through them to declare what Christ has done and what kind of people he is calling out of the world. 

Medications seem to possess a power equal to the Lord’s Supper for symbolic authority.

By partaking together, the church demonstrates its communal strength and commitment to share the sufferings of Christ, to embrace those who are hurting, and to testify about who and whose it is. The church eating and drinking together holds in trust the hope of Christ’s coming reign through—not despite—his crucifixion and resurrection, even as it embraces those who feel hopeless. When our minds strain to remember why we approach the table and our bodies groan under the weight of their afflictions, we find ourselves embedded in a community that itself remembers and cries out—in praise, thanksgiving, entreaty, confession, and lamentation—to the God who saves.

It is not irrelevant that we actually eat the Lord’s Supper, rather than say, behold it sitting on a table, or only read about it. By eating, we are unified with what the bread and drink symbolize, and thereby participate in the body and blood of Christ. Remembrance through the Lord’s Supper is more than an intellectual exercise; it is an embodied activity communally shared across the church that tells God’s people who and whose they are. 

If the Lord’s Supper signifies a certain message, and sets upon us a seal as a certain kind of people, what are the other symbols in our lives that attempt to usurp what the Holy Spirit is doing through that precious meal? 

United With a Symbol That Can’t Show Us Our Salvation

In our modern world, medications—and indeed all medical interventions—compete with the sacraments of the church by means of imposing symbolic authority over how we conceive of our health, life, suffering, and dying. By ingesting a medication, we can be unified with what it symbolizes. Medications can act as both a sign of the working of this empty promise and as a seal, setting apart this person as one who faithfully awaits the fulfillment of this promise. There are at least two ways this occurs.

A common refrain heard in the clinic or hospital or even at a prayer meeting is, “Why do I have this sickness?” But perhaps there is a question that should be asked at least as often: Why do I have this health?

First, undue faith in medications can promote reliance upon the promise that modern medicine makes but cannot fulfill. Gerald McKenny, in To Relieve the Human Condition, argues that modern medicine promises to “eliminate suffering and to expand the realm of human choice—in short, to relieve the human condition of subjection to the whims of fortune or the bonds of natural necessity.” Do I feel I can finally be free from the “whims of fortune,” or, more accurately, the sovereignty of God, if I faithfully take this medication? Do I look into these “small blue eyes,” the pills in my hand, for salvation? Will I continually interpret my suffering through a biomedical lens that requires a biomedical response as if there is no other way to conceive of suffering? Not everyone who takes a medication will put faith in this promise. But many do so without even realizing what has happened. 

Trust in this promise does not stop at mere assent. Such trust is also formative. We may come to believe that, like yeast or rats in a pharmaceutical laboratory, we are mere biological systems that require biological restoration first and foremost to achieve wholeness. Allen Verhey speaking as a fictional patient in The Christian Art of Dying observed that even praying for a miracle can be a manifestation of one’s trust in the promises of medicine rather than the promises of God: 

I worry that praying for a miracle can be a form of the denial of death, as if when the technology does not deliver us from our mortality a prayer still might. . . . It is the same refusal to acknowledge the limits of our finitude, the same refusal to acknowledge our mortality and the mortality of those we love. It is the same tightfisted and avaricious hanging on to biological life, and it gestures the same anxiety that death may have the last word. . . . I worry that praying for a miracle may divert time from the task at hand, from the task, that is, of dying well and faithfully. . . . I worry that ‘praying for a miracle’ always seems to mean praying for a miraculous cure. It fails to recognize the other ways in which the good future of God comes upon us as we are dying. 

We may indeed need medication—to survive, to ease pain, to settle the mind. But we are not, first and foremost, our biology. Our direst problems are not constituted solely within the biological realm, and the greatest miracles are not biological.

Second, uncritical reliance on medications can foster idolatry of health. Illness and suffering are in this world because of the fall. Experiencing God’s creation without the burdens imposed by sick and disabled bodies is a blessing, and surely the way things were before creation was subjected to the curse. But health will not ultimately satisfy apart from God and the experience of his blessing. Health, both before the fall and in the new heavens and new earth, was and will be a means to something even better than itself. Health for health’s sake, health for sloth, health for envy, health for sin cannot be called “good health.” Christians can be lulled by the promises of medicine into that pursuit of health merely for health’s sake.

A common refrain heard in the clinic or hospital or even at a prayer meeting is, “Why do I have this sickness?” But perhaps there is a question that should be asked at least as often: Why do I have this health? The question begins to allow someone to see that health and illness are not mutually exclusive—indeed, one can find a taste of shalom even in the midst of illness and suffering. Asking the question can also help a person discern why they are taking this medication, and thus situate the medical story about their illness within God’s broader story informed by faith, scripture, and the church. 

There is power in a symbol of true hope and restoration. 

In our secular society, it would seem that the Lord’s Supper is vulnerable to being overthrown by the power of medication and all that it symbolizes. 

Suffering, at its root, is not a biological problem to be solved by the manipulation of chemistry, but a spiritual problem that can only be addressed through the power of the Holy Spirit. Seen in this context, the promise of medication is humbled—it is useful, but its use is limited.

For the Christian, however, the sacrament is not a meal of worldly power. This meal is a reminder that our savior was crucified, and his body broke and bled. Paul wrote that, “God chose what is foolish in the world to shame the wise; God chose what is weak in the world to shame the strong; God chose what is low and despised in the world, even things that are not, to bring to nothing things that are, so that no human being might boast in the presence of God.” If the God who invites us to his table is this same God, we can expect this will be a meal unlike any we have ever had. From a humble posture, the Lord’s Supper stands against the symbolic power of medications.

Although medication promises to eliminate suffering and free us from the bonds of our natural condition, meditating upon the Lord’s Supper can uncover the emptiness of that promise. Suffering, at its root, is not a biological problem to be solved by the manipulation of chemistry, but a spiritual problem that can only be addressed through the power of the Holy Spirit. Seen in this context, the promise of medication is humbled—it is useful, but its use is limited. It cannot always heal our bodies, and it can never meet our deepest needs. 

Furthermore, although medications are effective in many ways, the promise of that efficacy becomes increasingly hollow as life comes to an end. As aggressive attempts are made to stave off death and suffering, modern medicine not only fails to keep its own promises but ends up mimicking death itself by separating the one who suffers, according to Verhey, from her own body, her community, and her God. In contrast, the Lord’s Supper is a reminder that it is Christ who, through his death and resurrection, unites us with the hope of restoration of our bodies, our communities, and our relationship with God.

Not only that, but by actually eating the Lord’s Supper, we remember that even while we are broken in our frailties, Christ was also broken on our behalf. Christ shares in our brokenness even as we, by grace, share in his righteousness. Our savior is one who, rather than brushing suffering aside as if it never existed, enters into that suffering and transforms it through his resurrection. Therefore, the Lord’s Supper can act both as a sign of Christ’s paradoxical power that is found in weakness—the lion’s roar from the mouth of the slain lamb—and as a seal to set apart a people who are one with him who was crucified in weakness, but lives by the power of God. 

God’s people should not depend, in any ultimate way, on the promises of chemistry to comfort them, but rather on the hands that were pierced for their sake.

Neither Christ nor the practice of the Lord’s Supper demand we abandon modern medicine, but they do demand that we abandon reliance on modern medicine to help us use our health for sin. In partaking of the Lord’s Supper, we remember what we were saved from—that Christ’s body was broken for us, bearing the judgment due to us, and his blood was shed for us, washing away our sin. We also remember what we were saved for—adoption into the family of God, participation in community with our brothers and sisters in Christ, manifestation of the fruit of the Holy Spirit, glorification of God, and joy in God and his word even in the midst of suffering and tribulation. 

The Lord’s Supper is a reminder that if we are saved for something, we would do well to orient not only our time and money, but also our health, toward that for which we are saved. The Lord’s Supper can act as a sign of Christ’s restoration of all things to their proper ends, and can also act as a seal to set apart a people who are saved not only from sin, death, and judgment, but also for the wonderful things God has prepared for us. 

We can rely on Christ and embrace medication.

Symbols pervade our culture and they cannot be avoided. They are around us and we also take them into us. In that way, medications can have power that is not predicted by knowing chemical structures and their targets, and such power can subtly work against our growth in faith. Praise be to God, however, that he has given us the Lord’s Supper and baptism by which to remember his work and our own identity in him.

Without forsaking medication, let us come to the Lord’s table, pills in pockets, to remember who and whose we are.

I do not mean, in any way, to denigrate the utility and even goodness of medications used wisely and appropriately. But I am warning against putting our ultimate hope for release from suffering in modern medicine. Faith may strain and buckle under the weight of expecting God to fulfill the promises of medicine, rather than using medicine to embrace the promises of God. Illness and suffering may indeed present seemingly insurmountable obstacles between ourselves and God, and medications may help one who was once physically unable to read scripture, pray, or attend worship to do so. Thanks be to God that such medications exist. And yet, thanks be to God that our union with Christ is not finally dependent on our health or physical abilities, but on the work of the Holy Spirit in our lives.

There will be times when the experience of God’s presence is lacking, when hope has descended below a cold and dark horizon, when we are bereft of joy and perhaps even faith. Wandering among the shadows of that landscape, we will have medications, yes, but the Lord’s Supper is for those moments, too. 

There is no need to forsake our medications or our physicians. For clinicians, there is no need to forsake our work. Without forsaking those things, let us come to the Lord’s table, pills in pockets, to remember who and whose we are. Let us situate the use of medications within our understanding of why we have this health, whatever bits of it we have. And as we do so, let us praise God, “to him be glory in the church and in Christ Jesus throughout all generations, forever and ever. Amen.”

Joshua Briscoe
Joshua Briscoe worships with his wife and three children at Church of the Good Shepherd (Durham, NC; Presbyterian Church in America) where he is an elder. He is trained in hospice and palliative care and now works in the Duke University Health System as an internist and psychiatrist. He greatly appreciates commentary on a previous draft of this essay from elders Norman Acker and Raymond Toher, as well as Tricia Toher.

Cover photo by Jametlene Reskp.

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