These notes began as the David B. Larson Memorial Lecture, given at the Duke University School of Medicine March 3, 2016. I was not David’s close colleague as was Drs. Koenig and Levin, who sponsor the lecture series honoring him. But I knew David as a lively, brave intellect–an intellectual entrepreneur of a young field. It was an honor to speak in the light of his life.
The comments are appropriate today on the release of the 2016 County Health Rankings, which have become as powerful in public health as the US News and World Report rankings are for hospital management. It is helpful to know where one stands in comparison to others, even when the news is dismal–my home county of Forsyth dropped 14 places (!!!) to number 43 in the state of North Carolina. That is more depressing than our woefully short basketball team. The model behind the rankings (as with US News) can hide as much as it discloses, especially if one is trying to improve. In this piece I make offer two humble suggestions: include spirit as a driver of the health of populations, but not in a simplistic manner. So secondly, fully embrace complexity as the only way to understand the dynamics of human systems–and improve them.
I’ll include a few of the opening paragraphs of the paper below. For the full 18 page Monty, click here (Gunderson – Spirit and the health of complex human populations).
Since humans managed to walk on two feet there has never been a culture that did not include symbols, language, song and structures of meaning and hope. We painted on cave walls and surely told stories of creation, mapped the stars and found ways to bury those we loved in ways that honored hope as well as grief. That’s we find our way on the journey of life and health, especially at the scale of communities. So it is one of the curiosities of our time how often these most obvious characteristics of human culture are so often left out of important discussions as we once again try to find our way. You don’t have to know many humans very long to notice the odd and sometimes dangerous dimensions of faith. But surely there is an odd and sometimes dangerous effect of leaving it all out just because the typologies were fluid and the data messy. Excluding spirit from the discourse strips the human phenomenon of one of our most defining characteristics. It’s bad science.
The capacity of faith to warm and burn—sometimes burn the whole house down—can no longer be ignored. Spirit is an irrepressible dimension of the human way. We see this in the most intimate spaces where sexually transmitted diseases find safe harbor in the patterns of silence, in the ways that Ebola viruses take advantage of our burial practices and in the ever-intractable social determinants of race, poverty and place.
When Dr. David Larson died fourteen years ago it was possible to think of spirituality in medicine as a different kind of field as public health. The fields are now converging, which poses different questions to faith amid the intellectual ferment about population health, and its more clinical cousin, population medicine. This is not just a move toward “big”, but a move toward human complexity beyond what the field of faith and health normally engages.
I want to be clear that every single time I use the word “health,” I mean all four bio-psycho-social -Spirit dimensions. There is no broken bone that is only bone. There is no spirit detached from social, psychological and biological precursors and consequences. There is no social life that is not of biological consequence. That’s how we come; that’s how we go and that’s how we find our way in between. This is not how most medical researchers shape their hypotheses and choose methods even about such obviously complex issues like inequity, which is why most of the findings are thin gruel. Our partners in theology are more likely to talk of the complexity, as they have been working in the deep end of the mysterious pool for several millennia. Sociologists of religion know that religious identity hides as much as it reveals and that it changes during one’s life even if the vocabulary remains. But they usually stumble just where the health sciences are strong. We can do both better with some humility and courage.
Death may be complicated or simple. The opposite—life—is always complex; that’s why it proves resilient, expresses astonishing, surprising emergent vitality exactly where you’d least expect it. Both science and spirit ask us to be curious about its ever-surprising possibilities, to lend ourselves to the study and practice of those things that give it a chance.
Spirit makes new possibilities as real as the current realities.
(for the full text click: Gunderson – Spirit and the health of complex human populations)