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Roman Catholic Views of Personal and Social Health
(For background information and photographs, click
here.)
By Aaron K. Ketchell
Introduction Physical Health Mental Health Social Health Spiritual Health References
Introduction
Catholicism,
from the Greek word katholikos ("general" or "universal")
is a name applied to two strands of Christianity. The term has been used since
the first centuries of the Common Era (C.E.) to describe the original movement
founded by Christ and the Apostles. Thus, many groups utilize "catholic"
in the general sense to denote their relationship to the early church (e.g.
the Roman Catholic Church, Orthodox Christian churches, and the Anglican churches).
In a narrower sense, the word refers to the "One Holy Catholic and
Apostolic Church" governed by the pope and Vatican, which is the largest
Christian denomination in the world. In casual usage, "Catholicism"
usually suggests adherents of the Latin or Roman Catholic Church (Bahr, 2004).
The roots of Roman Catholicism
(a title that was not in common parlance until the sixteenth century) can be
traced to the earliest decades of Christianity. Numerous developments
in the first four decades of the Common Era codified the church that would eventually
dominate Medieval Europe. Essential for the identity of Roman Catholicism
among these early developments was the formulation of the Apostles' Creed and
the Nicene Creed. The Apostles' Creed was so named because it is a summary
of essential Christian beliefs as held at the time of the Apostles. Although
parts of this statement can be traced to the first or second centuries, its
current form probably dates from the seventh century. The creed affirms
doctrines such as the existence of a Trinity, Jesus' virgin birth and resurrection,
and a future time when Christ will return to judge the living and the dead.
The Nicene Creed, originally drafted in 325 C.E., elaborated upon these
principles and has become (in various forms) the profession of Christian faith
for all Catholic and Orthodox churches and most Protestant denominations.
Despite these similarities,
essential differences that separate Roman Catholicism from its Christian brethren
include: the church as official agent and mediator between the people and God;
the respect of tradition (or authoritative beliefs such as the writings of Church
Fathers, the decisions of Church councils, and the pronouncements of popes,
that are not found in Scripture); the recognition of the seven sacraments; belief
in the real transformation of the bread and wine of the Eucharist as the presence
of Jesus' body and blood (transubstantiation); veneration of the Virgin Mary
and other saints; and salvation through good works, rather than by faith alone.
That which most thoroughly distinguishes
Roman Catholicism from related Christian traditions is the authority of the
papacy. The pope, or the Bishop of Rome, is the institutional head of
the church while Christ is the spiritual leader. As a direct successor
of the apostle Peter, by the fifth century the pope claimed authority over secular
rulers while at the same time holding that his teachings were representative
of Christ. According to Roman Catholic belief, he possesses ultimate authority
over all issues of "faith and morals" and may declare official dogmas. Additionally,
he oversees a vast administrative structure (the largest human organization
in the world) that is headquartered at the Vatican in Italy. Throughout
the past two millennia, the pope has had varying degrees of political power,
with his authority over secular issues reaching a zenith under Innocent III,
who led the church in the early thirteenth century. Although Roman Catholics
continue to recognize the pope's influence, it is not accepted by Orthodox Christians
or Protestants, and it has even been rejected by some smaller Catholic groups.
The first Christian communities
were founded in large Mediterranean towns. However, when the Roman emperor
Constantine converted to Christianity in the fourth century, he claimed divinely
ordained authority and made his new faith the official belief of all those governed
by Rome. By the early seventh century, the papacy proclaimed its jurisdiction
over all Christendom and its responsibility for ordering every aspect of society
in the Middle Ages. From approximately 600-1000, Western Europe was troubled
by political unrest, poverty, famine, plague, and disorder. Partial stability
was provided by monasteries and local parishes. From 1000-1300, Europe
underwent rapid urbanization and witnessed significant population growth. Theology
of this period was influenced by theologians such as Thomas Aquinas (1225-1274)
who developed Catholic canon law into a systematic code of belief. From
1300-1600, papal control of secular life began to diminish with the rise of
strong national monarchies. The dawn of Renaissance thinking called into
question existing social, economic, political, and religious structures, and
the pope's ultimate authority became suspect. The most thorough reevaluation
of his power occurred during the Protestant Reformation, when vast numbers of
Catholics left the church for schismatic bodies instituted by Martin Luther,
John Calvin, and others (Amundsen, 1986, pp. 65-68).
The Roman Catholic Church convened
the Council of Trent (1545-1563) in response to the Protestant Reformation.
This council was meant to refute doctrinal innovations put forth by reformers
such as salvation by faith alone, the unnecessary nature of the priesthood,
and the deemphasizing of the sacraments. Moreover, it meant to eliminate
financial, administrative, and other abuses that had led to much corruption
among the clergy. Trent implemented a conservative and strict theology,
created a more centralized power structure, retooled the liturgy, and instigated
a monitoring system for popular religious expressions such as the veneration
of saints. This "Tridentine" Catholicism would be the model
for the Church as it expanded its influence into Africa, Asia, and the Americas
(O'Connell, 1986, pp. 108-110).
The Tridentine model guided
Roman Catholicism until its boundaries were once again reformulated at the Second
Vatican Council (1962-1965). Among many innovations, this council: changed
and modernized earlier Catholic teaching by declaring that masses (liturgies
for worship) should be conducted in vernacular languages instead of Latin; promoted
greater ecumenism with other Christians and inter-religious dialogue; affirmed
the separation of church and state; and asserted that obedience to church hierarchy
should be softened via clergy who serve, rather than lead, congregations. Modern
day Roman Catholicism continues to grapple with issues such as a priest shortage,
the place of women within its polity, dissenting opinions among members concerning
social issues like abortion, contraception, and homosexuality, and charges of
clerical sexual abuse. Yet despite these travails, the Church remains the largest
Christian organization in the world and currently boasts over one billion members.
Physical
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Medieval Christians sought physical
healing through a variety of temporal means. The miracle working power
of saints was primary among these initiatives and was employed most thoroughly
during outbreaks of the plague in the sixth through eight centuries and amidst
the devastation of the Black Death in 1348-1349. With demonic causality
accepted as the explanation for most disease in the Middle Ages, appeal to saints
who may facilitate cures became a way for believers to effect change in the
physical realm while still demonstrating their conviction that the divine was
the source of these remedies (Amundsen, 1986, 68-72).
Although insuring the spiritual
health of their flock was of utmost importance for clergy, many did study medicine
and subsequently functioned as physicians. However, the Second Lateran
Council of 1139 specifically forbade monks from practicing medicine "for
the sake of temporal gain" because in doing so, they were making themselves
"physicians of human bodies" and thus neglecting "the care of
souls" (Schroeder, 1957, pp. 201-202). Throughout the High Middle
Ages, papal decrees continued to emphasize that medical practice should not
lead to the neglect of spirituality. Nevertheless, individuals continued
to consult doctors and to partake of folk or natural remedies that, according
to church doctrine, could verge on spiritually harmful superstition.
The papacy did implement various
material measures to battle the Black Death, which was the most atrocious pestilence
ever to afflict Europe. God was viewed as the ultimate cause of this outbreak,
but Pope Clement VI attempted to hinder the disease and hired doctors to care
for the afflicted. In the end, most medieval Christians sought cures for
maladies that united the temporal with the spiritual. As Ronald Finucane, a
leading authority on the late Middle Ages, has asserted, "It is clear that
in practice most sick people called upon the power of saints and of trained
physicians. This was as true at the very top of the social ladder as at the
bottom; as true for laymen as for clerics" (1977, p. 67).
While medieval theology emphasized
the primacy of the supernatural realm, it also continued a historical focus
upon good works as a means to salvation. For example, Vincent de Paul
(1580-1660) established the Sisters of Charity to care for the sick and dying
in Paris. Since the seventeenth century, this model has been emulated
by scores of other similar organizations. Elizabeth Ann Seton introduced the
Sisters of Charity into the United States in the early 1790s. The Dominican
Sisters of the Sick-Poor were founded in the 1840s. In 1886, Dr. Charles
H. Mayo and a group of Franciscan nuns opened St. Mary's Hospital in Rochester,
Minnesota. And by the early 1960s, there were 950 Catholic hospitals in
operation in the United States alone (O'Connell, 1986, pp. 135-136).
Although Catholic hospitals
are now mostly dependent on medical insurance and public monies and are hardly
distinguishable from their Protestant counterparts, the Roman Catholic Church
has continued to be a leader in the field of health care. According to
Jesuit ethicist Richard A. McCormick, the mission of any such institution should
be to "give sensitive care to the whole person" that supports "loving
care and respect for personal dignity" (1987, pp. 8-9). Focused upon
the needs of the underserved and equitable distribution of health care resources,
oversight organizations such as the Catholic Health Association support more
than two thousand health care sponsors, facilities, health plans, and related
initiatives throughout the United States. Addressing the Catholic physician
in a 2000 prayer, Pope John Paul II respected the work of a long-suspect medical
profession when he prayed, "You who are the Way, provide us with the gift
of knowing how to imitate you every day as medical doctors not only of the body
but of the whole person, helping those who are sick tread with trust their own
earthly path until the moment of their encounter with You" (2000). Thus,
like many Protestant denominations, the Catholic Church promotes hospital chaplaincy
and professional pastoral counseling to help people dealing with physical and
other challenges to draw upon their spirituality for strength.
Mental
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Although mental illnesses, like
physical ailments, were often construed as products of demonic influence during
the Middle Ages, they were also given partial material explanation. As
psychiatrist Jerome Kroll has suggested, "Mental . . . illnesses were attributed
as much to overwork, overeating, and overindulgence in sexual activity as to
climactic conditions, magic spells, and demonic possession" (1973, p. 281).
However, such illnesses were still viewed as products of sin; counsel
provided by priests, repentance, and even exorcism were considered the most
efficacious remedies. Penitential literature, voluminously produced during
this period, played a large role in mental healing. These works discussed
a wide variety of indiscretions and prescribed specific acts of penance.
Sacramental practices also facilitated
a sense of mental wellness. Extreme unction (called "anointing of
the sick" in antiquity and renamed this after the Second Vatican Council),
was often administered to those deemed at the end of their lives and was meant
to allay anxieties and to help to prepare for death. Although on rare
occasions this sacrament was said to restore physical health, according to the
Council of Trent its primary impetus was to strengthen "the soul of the
sick person by exciting in him great confidence in divine mercy." It
aided the person to more easily bear "the miseries and pains of his illnesses"
and to resist "the temptations of the devil" (O'Connell, 1986, pp.
114-115). Thus, as with physical wellness, medieval mental health was
subsumed under a more vital notion of spiritual well-being.
A willingness to adopt modern
stances toward and categories of mental illness did not occur until the end
of the Tridentine era. Although the parish priest had always served as
counselor as well as spiritual guide, only in the 1950s did a faith-informed
variant of psychology permeate the clerical profession. The papacy issued
a statement in recognition of the International Year of Disabled Persons (1981)
that called for greater emphasis upon the "dignity, welfare, and total
development of the handicapped person, in all his or her dimensions and physical,
moral, and spiritual faculties that must be primarily considered, protected,
and promoted" (McCormick, 1987, p. 149).
Thus, as McCormick has stated,
Catholics now reject the notion that all mental illnesses "are consequences
of sin and manifestations of evil." Instead, the goal should be the
building of "a network of support among us through which decisions can
be made in faithful response to a loving God" (1987, p. 150). Actualizing
this charge are groups such Catholic
Charities USA, who seek to support individuals, families, and communities
via a faith-based psycho-social approach. Although Catholic Charities' social
service agencies may incorporate religious beliefs and practices of clients
if they wish, there is no requirement. Often agency staff and clients
are not Catholic, so agencies must be open to clients' diversity and their goals
for service. In addition, many parishes and dioceses have implemented
mental health ministry plans that offer practical and pastoral support to those
affected by mental health issues. Through these and myriad other programs,
the Roman Catholic Church has furthered a contemporary emphasis upon holistic
health informed by modern science while continuing its emphasis on spirituality
as most crucial for achieving all facets of wellness.
Social
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Throughout the Middle Ages,
Christianity included a communal perspective emphasizing the corporate body
of Christ, i.e. the church and community of believers. Care for the poor
was the responsibility of bishops who erected xenodochia (later termed hospitalia)
adjacent to churches. These institutions provided shelter, food, and other
amenities for the impoverished. Monasteries were also places of refuge for the
indigent and monks were required to provide various types of care for which
they would have to "render account for all these on the Day of Judgment"
(Amundsen, 1986, p. 83).
During the late Middle Ages,
the social nature of sexual morality became a paramount concern of the Church.
Prohibitions against adultery, masturbation, homosexuality, contraception, and
abortion permeated confessional manuals. Much of this sentiment arose
from Thomas Aquinas' elaborations upon natural law. Discussions of sexual
ethics have a long history within the Church and possibly originate with Augustine's
understanding of sexual pleasure and desire as spiritually disobedient impulses.
For Aquinas, sex was within the order of nature but individuals had to
maintain focus upon procreation as its ultimate end (McCormick, 1987, pp. 88-89).
As Thomas Tentler summarized, "Medieval churchmen were devoted to
the idea of the moral goodness of procreation and mistrustful of doing anything
for pleasure" (1977, p. 207). The Church's stance toward sexual ethics
within marriage was softened a bit by the Council of Trent. The procreative
element remained central, but the council did acknowledged that love and pleasure
could be inspirations for sexual activity. These thoughts, however, did
not sanction birth control-which remains prohibited by the Vatican. With
high rates of infant mortality and the need for children to assist with agricultural
work, childbearing had great social import (O'Connell, 1986). Aside from
this practical issue, the church views all human life from the moment of conception
to be sacred.
Beginning in the sixteenth century,
the Roman Catholic Church engaged in intense global missionary efforts. Clerics
accompanying European explorers established a variety of social services abroad,
including orphanages, homes for the aged, and poor houses. But as with
all other domains of health, the social was constantly consigned secondary status
to spiritual welfare. Reflecting upon these efforts, Pope Pius XII stated
in 1951, "Such works of charity are undoubtedly of the highest efficacy
in preparing the souls of non-Christians and in drawing them to the faith and
to the practice of Christianity" (Carlen, 1981, p. 197).
Modern Catholicism has placed
an ever-increasing emphasis upon issues of justice. For example, in Latin
America liberation theology entails "a Biblical reflection concerning the
poor and a practical . . . discovering [of] steps to implement a plan of action
to overcome oppression" (Ortiz & Smith, 1999, p. 314). By rooting this
ideology in praxis and empowering local communities to determine courses of
theologically-based action, liberation theology integrally links spirituality
and everyday experience. Catholicism has developed numerous and extensive
social justice movements from the Catholic
Worker Movement to Catholic social services, and lobbying governments against
the prevalence of poverty, war, capital punishment, and abortion. In addition,
social ethics are promulgated through parochial schools and hundreds of Catholic
institutions of higher education in the United States. And, since Vatican
II, the Catholic laity has been granted a greater responsibility for the shaping
of social ethics.
In the American context, the
United States Conference of Catholic Bishops (USCCB)
addresses the gamut of social health concerns. This organization includes
departments that address faithful citizenship, migration and refugee services,
pro-life activities, and a host of other concerns. The Department of Social
Development and World Peace is the national public policy agency of the USCCB.
This department frequently issues statements on topics such as nuclear
disarmament, fair trade, human rights, welfare reform, and environmental justice.
According to their website, these initiatives are all subsumed under four
core principles: to "share the social teachings of the Church"; to
"apply Catholic social teaching to major contemporary domestic and international
issues which have significant moral and human dimensions"; to "advocate
effectively for the poor and vulnerable and for genuine justice and peace in
the public policy arena"; and to "build the capacity of the Church
(national and diocesan) to act effectively in defense of human life, human dignity,
human rights and the pursuit of justice and peace."
Spiritual
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Upon attempting to convert Europeans
to Christianity during the Middle Ages, promises of spiritual health became
paramount for missionary efforts. Whereas indigenous European religions
offered responses to concerns such as poverty or disease and harmony with nature
(as in shamanism), Christianity emphasized a relationship with God, salvation
through Christ, and the mediation of faith through ecclesiastical structures.
According to the Christian theology, there would be no worldly suffering
if not for original sin, and individuals' sinfulness was often the explanation
for sicknesses. Thus, the goal of missionary work was, according to professor
of classics Darrel Amundsen, to "wean the flock from the temporal to the
eternal, and from the material to the spiritual." In doing so, spiritual
health became "the very essence of Christianity" and notions of well-being
were realigned "from a present horizontal to a future vertical orientation"
(1986, p. 78).
The church promoted the development
of medicine and hospitals during the Medieval period. In addition, physical
and mental wellness could be partially facilitated via devotion to saints, veneration
of relics, or pilgrimages to sacred shrines. However, cure of the soul
trumped cure of the body. As described by Fulbert of Chartres, an eleventh
century bishop, Christ was the true "author of good health" and therefore,
prayer and penance should be the primary means of achieving this-worldly happiness
and other-worldly salvation (Behrends, 1976, p. 47). Despite the prevalence
of folk remedies and the dawn of rudimentary scientific medicine, this vantage
continued to be accentuated throughout the medieval period. When the Fourth
Lateran Council convened in the early thirteenth century, it took great strides
to emphasize the spiritual (i.e. Catholic) responsibilities of ostensibly secular
physicians by restricting medical care for Christians to doctors of the same
religious persuasion. This measure not only assured that Christian patients
would not be able to obtain Islamic or Jewish treatment but also allowed clergy
to check the practices of the medical profession from within the church confessional.
Little was said about illness
at the Council of Trent. Extreme unction (an anointing usually at the time of
death) was addressed, but the council insisted that the spiritual, rather than
physical, well-being of individuals was the purpose of this sacrament. In
fact, one of Trent's principal foci was to reassert the importance of sacramental
practices whose significance were being questioned by reformers. By adopting
this course of action, the Church not only avowed the necessity of clerical
guidance, but also reasserted the necessity of a sacramental theology that posited
the existence of outward and physical expressions of inward and spiritual graces.
Although such an understanding recognized the supernatural as immanent
in the lives of devotees (in contradistinction to the more transcendent God
of Reformed Protestantism), it nevertheless upheld the primary importance of
otherworldly concerns (O'Connell, 1986, pp. 108-131).
Even prior to the watershed
changes of the Second Vatican Council, the Catholic Church began envisioning
health in a more holistic fashion while yet maintaining the primacy of the spiritual
realm. This "principle of totality" was first outlined by Pius
XII when he referred to "the good of [a person's] being as a whole"
(1952, 779-789). At Vatican II, attendees spoke of the preservation of
the human person "whole and entire, body and soul, heart and conscience,
mind and will." It was imperative for humanity to uphold this totality,
which at its root required an acknowledgement of God as the source of "harmony
with themselves, with others, and with all created things" (Abbott, 1966,
pp. 201, 211). Thus, while the church has partially remade its wellness
principles through more broad and holistic insights, spiritual health for Catholics
is still predicated upon an individual's acceptance of Christ's healing redemptive
love mediated by clerical authority and religious doctrine. Yet the Catholic
Church recognizes spiritual insights that occur in other Christian denominations
and other religions. Since the Second Vatican Council, the Catholic
Church has engaged in various ecumenical rapproachements and interreligious
dialogues (e.g. Griffiths, 1982; Johnston, 1978; Pannikkar, 1978).
The Catholic Church has developed
elaborate systems of mystical theology and spiritual practices, such as retreats
and meditation or contemplative prayer practices, as well as spiritual growth
counseling. In modern times, these have been made available widely to
the laity (Keating, 2002; Johnston, 1995; Merton, 1961). These practices
may supplement and deepen experience of the liturgy, the sacraments, reading
of scripture, and other devotional activities. For many Catholics, the
sacrament of the Eucharist provides the most intimate experience of spiritual
communion with Christ. Within mystical theology (i.e. theology about the
development of spirituality), spiritual health matures through a process dedicated
to deeper and deeper cultivation of a relationship with God, immersion in divine
love, expressions of this relationship in daily life, and the cultivation of
holistic well-being.
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