Handbook on Religion and Health – garygunderson Blog

Torrent

Videos and photo from the River Wharfe.

I was supposed to be in India two weeks ago to participate in the Christian Medical College of Vellore’s strategic conclave and to attend the astonishing Sikh Sathya Sai Grama in Bangalore. Instead my visa got caught in the US government’s sabotage of international relations. You can imagine how badly I felt to not be in these sacred places at this time so pregnant with possibility and, yes, danger.

The Sikh One World One Family Foundation supports the Sri Madhusudan Sai Global Humanitarian Mission that provides essential services in 5 world regions, to over 100 countries, and maintains 12 Centers for Human Development (one is coming up in Los Gatos, CA). One of our Leading Causes of Life Fellows, Dr. Sunny Anand is deeply involved.

CMC asked me to speak about the theological clues from the Leading Causes of Life relevant to strategic planning. They take theology more seriously than any Christian hospital in the world—at least that I know about. So I leaned in and spoke frankly. (find the full text here)

CMC expected my remarks to be framed by the new book that came from the Leading Causes of Initiative, Taking Responsibility for the Life of Complex Human Ecosystems—Deep Accountability. And also in the context of my 18 years in hospital leadership roles. That title sounds preposterous but that’s exactly what CMC is trying to do in India in the most complex human ecosystem imaginable. The challenge is especially, dangerously, vexingly hard for a massive academic medical center trying to be Christian in a wildly interfaith context. Especially at a time in India when the god of the medical market is rising in power every week. CMC is among the most eminent medical schools and clinical systems in a nation with more middle class and wealthy people than in the United States.

I based my theological comments on the passage from Ezekiel 47 that Larry Pray told me about one day. “Gary, grab the Bible on your desk and turn to Ezekiel 47! I asked my secretary to go find one, then quickly read about the trickle of living water escaping the temple, running down the street, growing into a torrent downstream over his head. “Man do you not see it?” “See what?” I asked with the man in the water. “That you are being carried by a torrent of life, surrounded by even more life on the banks.” That is what we must build strategy on–that torrent.

Our new book addresses this in the chapter called “Storm” which is inspired by Ivan Illich’s 1970 book, Medical Nemesis. It was audacious to jam Illich in a chapter, even worse in a blog but even a teaspoon makes for hot and uncomfortable reading. Every faith-based hospital and academic medical center I know about long ago became comfortable with the ugly complicities and intellectual capitulations he predicted a half century ago.

In the USA Mr Kennedy may finish off the last remaining scraps of thoughtful mission as the trillion-dollar array of organizations betray their founders, patients, staff and communities by joining in the whitewashing of their complex human ecology. Illich is sadly prescient, but not just sad. Nemesis is the Greek God who brings justice to those enjoying privileges they do not deserve because they betrayed their gifts. Illich focused on the medical science—obvious even a half century ago—as these institutions tuned their financial logic to the most profitable sciences, mostly cardiology, cancer and, as the public aged, orthopedics. That’s what drives the financial engine, builds the massive buildings and pays the ridiculous salaries. And that’s part of what calls forth the certain storm Illich predicted.

These organizations also betray the moral intentions of the thousands of people who give their lives to these organizations. Illich didn’t address that, but I was one of them and I know many more hugely decent people involved. So our book not only grieves for the waste of moral intention but asks us all to focus on being deeply accountable – from wherever we are in the span of our lives.

It is never a convenient time to face the complexity of the human ecology, especially when one is making vast sums patching up the damage that comes from ignoring it. Hospital executives and Board members have nearly unanimously decided to take giant steps backward as quietly as they can terrified that the MAGA or MAHA people will notice the estimated trillion dollars in financial reserves held by non-profit healthcare organizations. So the earlier chest thumping commitments to a diverse community—what we call complex human ecosystems—evaporated as quietly and totally as morning dew in a southern summer day. Shameless; but what attracts Nemesis is their pride in these business decisions that betray both faith and science.

Promotional poster for a double book launch at the University of Cambridge, featuring two books: 'Taking Responsibility for the Life of Complex Human Ecosystems' and 'Handbook on Religion and Health'. The event includes details such as date, time, location, and speakers. — *Follow the link to register for the event by Zoom.*

The most obvious action of Nemesis is likely be the taking away these organizations’ non-profit tax benefits. MAHA cares as little about their mission as do their Boards, viewing them realistically as just part of the corporate healthcare industry which they believe should be in the hands of the most efficient capitalists—Google, Microsoft, Amazon, whoever. Without well-funded Medicaid, Medicare and public health these organizations are forced toward the high-margin services and they will supplicate before these deep wells of capital. Of course, the health-tech firms know that Artificial Intelligence will decimate physician-driven hospitals and allow for precision cherry-picking of paying patients. They will let somebody else feed medical scraps to the poorly insured middle class and the poor. Faith-based hospitals could have invested this past half century arguing for policies building deep accountability to the science of prevention, chronic condition management and truly effective care. Instead they invested in self-serving revenue-oriented policies. This eroded any possibility that the public they were supposed to serve would now protect them when Nemesis comes to call with all its profoundly bad news.

The good news is clarity that it didn’t have to be this way; and it doesn’t need to be this way in the future.

Every part of this book is about deep accountability, and only one chapter deals with healthcare. Those of us who do care about the health organizations – public, private and faith-based – will need the other chapters to think with, to break the deadly intellectual dead-end the health sciences have trapped themselves in. We need clarity about how much capacity we have to act, invent, choose and imagine. We need to join economist Mariana Mazzucato’s fundamental new thinking about what and who produces value in our current world, unmasking, like Illich, those who are satisfied with mere cost and acritical profit-taking. We need mycologist Merlin Sheldrake’s whole new way of seeing how we humans move toward each other to make new social and political possibilities real. And we need the dramatic insights about social meshworks that are so much smarter than the dumb computer networks we’ve long tried to emulate with such meager swill.

A serene landscape featuring a river reflecting trees with autumn foliage, surrounded by lush green hills and a blue sky.

We can reclaim the light we have to live by, the joy that is the natural fruit of taking responsibility for the full life of the complex human and natural ecology where we live. We are not leaves before the harsh winter wind.

It is Spring time. It is always Spring time. Even in the dark and cold of January life is finding its way all day and night, never resting, always emerging, never quitting. Joy! Life works.

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Good start

Five hundred and six pages. Thirty-three authors. A big book. So, a warning, this is sort of a big blog.

It’s about the Handbook on Religion and Health: Pathways toward a Turbulent Future (Edward Elgar, UK), which focuses on the complex way that faith at social scale, for better or worse, shapes health and well-being … so that we can make the choices that lead toward life for the people and places that are ours to love. That itself is a big sentence which hints at the need of a big book. The Handbook dares to mark a pivot toward a whole new phase in the intellectual understanding of faith and health. All of its authors, many well known in their fields, were asked to step away from what they already knew and look forward. They did that.

There have really only been three eras before now defining that relationship. The first lasted three billion years when the dimensions of what humans eventually called faith, which eventually evolved into religion and even more eventually science, were simply and utterly part of the whole.

That first era was capped by a flurry of thinking once we humans accumulated enough frontal matter that we could name ourselves boldly homo sapiens sapiens (the human that knows it knows). For all this time religion, including faeries, YHWH, Jesus and all the saints and scientists were in one intellectual stewpot for better—and often for worse in the hands of the powerful.

The first phase lasted roughly up till the “Enlightenment” in the 1700s, during which pretty much everything thought to that point was unthought. It became obvious to every rational intellectual that we didn’t really need religion at all to map what was known and knowable. Religion was intellectual detritus that obstructed clear thinking or, at best, needed to be shown to be reasonable.

The Enlightenment glow went out in the middle of the last century, seared by murderous gas ovens, nuclear blasts and, now, 129-degree summers. We’ve been in an intellectual wilderness of post-modern, post-industrial, post-constitution, post-language, post, post, post, post everything. The boundaries have evaporated including, to the dismay of the left-over Enlightenment thinkers, the rise of religion entirely untethered to any social or political norms, logic or facts.

A friend sent me this picture from National Geographic that so vividly indicates there is way more going on then we ever thought.

The echo-chamber world of academic health research with its pristine peer-reviewing world of double-blind control trials ignored all the dismal wilderness outside (making it triple-blind). But late in the day, this era acknowledged minor claims that religion was a variable in human health. Each of these footnotes squeezed through a tortuous process that fundamentally considered any signs of religiosity to be a false signal, better explained by a bio-chemistry or abnormal psychiatric phenomena. In fact, the American Psychiatric Association had disease codes for religion until the 1970s.

It is important to remember that the simplifying secularists had a point; much of what is attributed to religion—by both believers and those who scoff—is a false signal, often harnessed for tribal, parochial interests that can be stupid and dangerous, especially at political scale. And it’s important to not trash the traditional research models that were superb at knowing what they considered knowable partly by rigorously excluding things not.

Still, the end of this era was marked by the article in Journal of the American Medical Association two years ago (Balboni, VanderWelle, Doan-Soares, et al., 2022). The Harvard team laboriously sorted through thousands of articles that claimed findings of spirituality in health for the few meeting the very highest standards of peer-reviewed studies. Only a thin gruel could pass through the thin intellectual mesh, but even those findings came as a shock to the field. It is also important to note that one of the problems in associating spirituality as a variable is that nobody agrees on what it is, which suggests that maybe it doesn’t exist at all.

That study would not have happened without the four pillars that begin with the earlier Handbook by Larson and Koenig, followed by the basic texts of Oman and Idler. This is why the JAMA article marks the end of the era, making possible a new beginning.

This brings us to the 506-page start of the fourth era, the Handbook on [Formerly Known as] Religion and [Formerly Known as] Health: Pathways for a Turbulent Future. I add ‘formerly known as’ deliberately. The new era lives in the science of complexity, and multi-variant phenomenological study of complex phenomena that begins with the assumption that humans are in our every facet biological, psychological, social and spirted. Most of the traditional gatekeepers do not think that way and remain especially uncomfortable with taking the phenomena “formerly known as religion” seriously. Dr. Paul Laurienti addresses this in his chapter in the Handbook, noting that those fields are busy “harmonizing” research methodology based on the old accepted processes that methodologically exclude any surprises. “Who needs a new era?” they would ask.

The Handbook is disruptive in another whole way because it grows from the Leading Causes of Life. Even the spiritual part of the last era was driven a great deal by the spirituality interested in death, dying and the closely linked clinical chaplaincy. The era has more to work with. The Handbook (Ch. 28, pp. 456-57) argues that

“Looking at humanity as a living system invites us toward an integrative generative practice that does not collapse in the simplicities of upstream-downstream instrumental intervention. To be deeply accountable for the whole of the social watershed invites the immediacy of picking up one’s own trash before it can contaminate the lives of those to whom it would otherwise flow. And it invites humility before all that we have received for good or ill. This posture of always being both recipients of blessings we did not create and stewards of the blessings that will flow through us is what the Leading Causes of Life call intergenerativity, or simply blessing. When we are conscious of being in this right relationship–recipient and steward—we feel something like awe, gratitude and being in the right place.”

This is not good news to all the traditional researchers who have based their careers and methodology on the previous models. Even those intellectuals talking about complexity do not quite honor the complex generativity of the psycho-social-spirited phenomena. We are not an interplay of calories or protein but consciousness of the whole becoming more vital and prosilient. This is part of how “what was known as religion” functions in synergy with the thing “formerly known as health”—the vital phenomena, not just biochemical or material, but consciously alive on all levels.

While the traditional researchers will perhaps not be happy to find that their academic cheese has moved, this Handbook is a three-pound thrill for the next generations of hard thinkers. And it is happy not to conclude anything:

“Perhaps we have only begun. Neither religion or the health sciences quite thinks this way about its work or way. This is not how we collect or analyse data and thus not the way we regard the possibilities of what we might learn from research (maybe we say, formerly known as research). But even asking whether we could learn more and thus be more accountable for possibilities and cannier about risks shifts us just a bit. As is evident in other chapters in this handbook, new methodologies, new norms of transdisciplinary dialogue and analysis will emerge, just as new shared language does in El Paso, Texas, and other borderlands—objective and subjective—around the world.” (Ch. 28, p. 457)

This may not be the last 506 pages needed. But it’s a good start ….

// The Handbook on Religion and Health: Pathways for a Turbulent Future is available in hardback immediately (priced for academic libraries!), with an eBook coming in a week or two (~$48) and, we hope (not yet confirmed), a paperback to follow later. Most of my friends will wait for the paperback or eBook! I’ll let you know when they are available.

Pathway

There are times when, amid what seems like chaos, clarity comes, is named and made visible. People respond, turn around, and make choices that lead to life. The closing months of 2024 are likely this kind of time.

When the times comes—some call it Kairos—one hopes the intellectual muscles are trained and ready. It takes time to think hard, and not possible to do alone staring at tiny screens. (To get anywhere intellectually is just like hiking: “to go fast, go alone; to go far, go together”).

Friday morning, we learned that Handbook on Religion and Health: Pathways for a Turbulent Future was published. Only 1,155 days ago Jim Cochrane was asked to consider editing a volume on religion and health. TC encouraged him: “Yes! Do this and blow the field wide open!” Eventually, 33 authors from around the world typed 502 pages of very hard and explosive thinking that none of us could have done alone.

TC and I celebrated the publication at a Glasgow pub. “What’s it about?”, asked a bewildered friend, trying to be respectful. The question has come about everything I’ve ever written. The answer makes it worse, especially in a loud pub: “It’s about the intersection of faith (no, not that dumb kind!) and health (no, not the pills and machines!).” The real answer is almost too audacious to say out loud, even in a pub after more than one pint.

It’s about the leading causes of life, here, now.

“The first step in such fundamental research,” we wrote in our concluding chapter of the Handbook, “would be to understand the nature of the living system in question.In a nitty-gritty practical kind of way, confronting an ugly and terrifying contagion of polio, Jonas Salk of polio vaccine fame, knew he had to learn how to think like a virus or, as he put it, follow ‘the biological way of thought’ (Salk, 1972, pp. 7-15), before focusing on all the symptoms and damage the virus inflicts. A virus may not think in the way a human does, but in its own way it makes choices, indeed patterns of choices, as it adapts, moves as an organism inside and around the human creature that is also making choices and patterns of choices to create the ecology in which the virus finds its way. Something like this nesting of living systems is happening in every component of every living system. Part of what a virus must “consider” or “think” about is how it understands its relationship to the larger ecology of systems including the human one.

Maybe the virus has a more accurate view of what constitutes the human living system than do most humans; perhaps even those thinking about the health of the human public. A virus “sees” any one human as an inseparable part of a meshwork of other bodies offering a rich array of slightly different bio-psycho-chemistries linked in a connected social network that allows the virus to move around the entire living system as a single, if differentiated and variable, whole” (p. 453, Ch. 28: The Watershed of Life: A River Runs Through It).

The implications are profoundly hopeful for us humans. We have the intellectual leverage to break out of our doom loop of compounding stupidities. We are alive. And life has found its (our!) way for roughly three and a half billion years.

And even more hopefully, we have more to work with than any other part of the living system. We are capable of knowing ourselves (sapiens sapiens), but even more since spirit gives us the capacity to see dynamic emergent complexity that is us, in the spirited cosmos that is built for life.

“Public health science and public religion,” we also write (p. 456), “are best understood as co-creating components of a kind of consciousness of the planetary human phenomenon. The first immunizes humanity from the disease of premature certainty, the second from hubris and heart-heartedness. Science animates the religious ethical imagination by clarifying the boundaries and possibilities of mercy, while religion holds science accountable to serve all, not just whoever paid for the research or technical gizmo. Science protects religion from simply making things up, while religion protects science from overlooking the most obvious things—we are children of one family.”

The Handbook is published, but as an invitation to the hard thinking we need, it is just beginning. The official release is in Washington DC on September 27^th and 28^th, with other events planned in Minneapolis, La Crosse, Winston-Salem, Houston, Cape Town and elsewhere. The baobabs on the cover, on the website of the Leading Causes of Life Initiative , and for the preceding African Religious Health Assets Programme, are not just pretty. At every intellectual step we have figuratively gathered in the African way under the shelter of the ‘tree of life’ where we can talk deeply with each other about what matters most.

I’ve been thinking of the many people who have carried me on this spirited intellectual current, such as Reverend Larry Pray who came into my life as part of the CDC funded Institute of Public Health and Faith. The Handbook ends with the story of when he called me at the hospital in Memphis, urging me to grab the Bible he assumed (wrongly) I had on my desk. Liz Dover had one, so I was able to follow Larry to Ezekiel: “And on the banks, on both sides of the river, there will grow all kinds of trees for food. Their leaves will not wither, nor their fruit fail, but they will bear fresh fruit every month, because the water for them flows from the sanctuary. Their fruit will be for food, and their leaves for healing” (English Standard Version Bible, 2006, Exekiel 47:12).

*Double rainbow over the University of Glasgow*

Easily overlooked is the humbling chiding for us humans as the vital flow rises over our heads: “Hey, do you see the flow?” (47:6). How could we miss it? It is life itself.”

/// The Handbook on Religion and Health: Pathways for a Turbulent Future is available in hardback immediately (priced for academic libraries!) with an eBook coming in a week or two ($48), and, we anticipate (not yet confirmed), with a paperback to follow later. Most of my friends will wait for the paperback or eBook! I’ll let you know when they are available.