Awaking to Mutual, Reciprocal Need in Plague and Epidemic Disease: The Origins of Early Christian Health Care

Abstract

While the early Christian Church demonstrates a deep desire to relieve physical suffering, the Greco-Roman world in which it developed lacked the same impetus to respond to human need, especially in the context of epidemic or communicable disease. Christianity’s dedication to health care, and its belief that assisting the sick constituted an absolute obligation, distinguished early Christianity from its contemporary cultural milieu which regularly ignored and excluded the sick. The novelty of the Christian approach to healing can be traced to the early church’s unique recognition of human need. This vision of human need, which ultimately replaced the secular Greco-Roman emphasis on reciprocal philanthropy and providing assistance only to the worthy, is clearly exemplified in the life of Christ, in responses to plague and in the writings of John Chrysostom and the Cappadocian Fathers Basil the Great, Gregory of Nyssa, and Gregory of Nazianzus. An analysis of these sources demonstrates that the early Christian Church viewed the sick not only as persons to be assisted insofar as they shared a common human nature but also individuals necessary for the salvation of the broader community as a whole. The early church’s emphasis on reciprocal interdependence between healthy and sick eliminated the boundaries traditionally established between these two groups and transformed long-standing notions of contagious disease. Ultimately, the development of these attitudes toward the sick originates in a deeper truth which underlies the Christian healthcare tradition both in the ancient world and in the modern era: humanity’s profound and mutual need of God, before whom all are spiritually ill.

In an age of pandemic disease such as COVID-19, both secular and religious institutions readily embrace the obligation to prevent and relieve sickness. Worldwide, healthcare professionals risk their own health for the physical well-being of others daily. Though today these expressions of courage and sacrifice are widespread and even expected, they would have been utterly novel in the pagan, Greco-Roman world in which the early Christian Church developed. Early Christians, unlike their contemporaries, were unquestioningly impelled toward the relief of suffering; this difference is reflected in the writings of John Chrysostom and the three Cappadocian fathers. Christianity’s radically unique and novel attitude toward human need is the source of the early church’s belief in the obligation to heal. Chrysostom and the Cappadocians viewed the poor—and especially the sick, whom they characterize as experiencing an intensified form of poverty—not as external to the Christian community but instead as performing a unique and integral role in its journey toward salvation. Their understanding of human need as not merely a motivation for philanthropy, but ultimately as the essential and defining feature of every human person, motivated the early church’s conviction that engaging in healing activities was a central, nonnegotiable mark of a genuine Christian life.

An examination of any number of historical periods might shed light on the development of the Christian attitude toward healing. This exploration aims to investigate the early Christian Church’s original motives for engaging in healing practices. A wide variety of early Christian texts shed light on the topic, but the fourth-century writings of John Chrysostom and the three Cappadocian fathers—Basil the Great, his brother Gregory of Nazianzus, and their friend Gregory of Nyssa (Elpidophoros 2020)—are particularly important. Inhabiting “a shared context” (Holman 2017, 148), these bishops and leaders of the early Christian Church displayed a marked concern for philanthropy by together advocating for and establishing a novel system of social welfare in the ancient world (Hanawalt and Lindberg 1994, 2; Rhee 2017, xxxvii). Basil, Gregory of Nyssa, Gregory of Nazianzus, and John Chrysostom are each considered to be Eastern Church Fathers, and they write as individuals deeply familiar with Hellenistic thought. Basil and Gregory of Nazianzus both received a classical education at Athens and Gregory of Nazianzus studied with the future Roman emperor Julius (Sundberg 2017, 2–27). In Presence and Thought: An Essay on the Religious Philosophy of Gregory of Nyssa, von Balthasar describes Gregory of Nyssa’s familiarity with the Greco-Roman milieu: “(H)e knew better than anyone how to transpose ideas inwardly from the spiritual heritage of ancient Greece into a Christian mode. And he accomplishes this in that fundamentally Hellenistic spirit that allows him to translate religious experience seamlessly into its conceptual expression” (Sundberg 2017, 28–29). Thus, their attitudes toward social assistance can be juxtaposed against those of the prevailing pagan Greco-Roman culture in the West.

The writings of Chrysostom and the Cappadocians offer a valuable insight into early Christian thought about health care insofar as they not only preached extensively but also ensured that their words were accompanied by actions. In 312 AD, the Edict of Milan legalized Christianity in the Roman Empire and allowed for public philanthropy on the part of bishops (Bortness and Hägg 2006, 9; Cardman 2008, 942). This newfound freedom not only enabled them to establish a system of institutionalized Christian philanthropy on an unprecedented level but, more importantly, permitted them to express their views openly and without fear of retaliation (Brandsen and Vliem 2007, 422; Crislip 2005, 101). Thus, these writings of Chrystostom and the Cappadocians reveal how the Church taught in a relatively unrestricted environment.

All four were bishops from wealthy backgrounds (Meredith 1999, 11) and thus wrote from the perspectives of the clergy and of the rich. Nevertheless, their writings were also influenced by their own familiarity with the sacrifice of wealth and with the experience of need. Basil, for example, distributed his family’s riches and embraced voluntary poverty (Sundberg 2017, 25), and each preached about poverty in the wake of a severe famine that ravaged Cappadocia between 368 and 369 AD (Holman 1999, 284). These unique and shared experiences shaped their understanding of human need not merely as a motivation for philanthropy but as the essential and defining feature of every human person, a concept that ultimately motivated the early church’s conviction that engaging in healing activities was a central, nonnegotiable mark of a genuine Christian life.

The early Christian world was one of widespread poverty (Rhee 2012, 10), yet the poor did not constitute a distinct class in the Greco-Roman world (Humfress 2006, 183). Human need in and of itself did not attract significant attention, for the poor were unnecessary to the continuation of society, or the Populus, as a whole. The poor never formed a distinct class in the Greco-Roman world and thus as a whole were never an object of particular concern insofar as individuals were not classified as rich or poor but instead as citizens or noncitizens (Ziegler 2018, 45). Thus, the poor existed “wholly outside the traditional urban social hierarchy” of the pagan Greco-Roman society and “simply…d[id] not appear in the conceptual topography that better-off citizens ha[d] of their city” (De Vinne 1995, 5). Without widespread recognition and considered unnecessary to the continuation of the broader society, the poor were essentially excluded from the community. For this reason, “the rich elite had no expressed concern, sympathy, or aid for the needs of the poor per se, as opposed to those of the populus” (Rhee 2012, 21). Charitable assistance, when extended, was never offered with the intention of meeting the bodily, spiritual, or relational poverty of another human being. Instead, philanthropy was an act of self-promotion and thus was designed to remedy some lack within the giver. This desire “to display wealth, to express respect for the dead, and to exercise political responsibilities” (Rhee 2012, 21) motivated philanthropy in the form of highly visible, public displays which failed to offer the poor what they really needed: food, shelter, clean water, and medicine (Ferngren 2011, 7). With an emphasis on satisfying the giver’s personal agenda rather than the recipient’s want, “no distinction was made between the destitute and others,” and communal initiatives were likely to leave the poor just as badly off as before (Ferngren 2009, 90). For the pagan Greco-Roman society, the ultimate fate of the poor was of no concern, however, for “poverty was regarded as amongst the evils that should be most carefully avoided; and it was considered as a disgrace that could only be endured by the low and bad man. The poor man was held to be incapable of wisdom and honesty” (Schmidt 1889, 67). Unable to evoke either respect or pity, the poor were abandoned by a Greco-Roman world that failed even to recognize their needs.

Not only was Greco-Roman philanthropy blind to—or, perhaps, ignorant of—the objective needs of the poor, but insofar as the prevailing social hierarchy was based upon relationships of a reciprocal nature, such as family relationships (Ferngren 2009, 95), a strong emphasis was placed on extending charity only to the “worthy” (Rhee 2012, 22). The impetus to concern oneself only with “the dignity of the virtuous person” rather than with any needy person at all (Ferngren 2009, 95) meant, as scholar Helen Rhee (2017) writes, that

The recipients’ needs were not considered favorable factors in distribution. Justice meant that each should receive proportionally to one’s status, not one’s need; therefore the (working) poor, though ubiquitous, received gifts as “justice” demanded only if they were part of and participated in the civic community, and the destitute and beggars were excluded from the civic community. Thus, the poor were ever-present but largely remained invisible. (pp. xii–xiii)

Throughout the Hellenistic period, any concept of altruism or charity remained distinctly absent in favor of “a condescending benevolence” without “private charity or…a personal concern for those in need” (Ferngren 2009, 87). Even Cicero, considered an outlier on the subject of poverty insofar as his view towards the poor, was relatively liberal for his cultural milieu and argued that aid should only be extended to the man who deserved to be helped (Schmidt 1889, 71). Cicero (1887) advised “that in beneficence regard should be had to merit, in which matter we should take the character of the candidate for our favor, his disposition toward us, the degree of his familiarity and intimacy with us, and the good offices which he may have previously rendered for our benefit” (p. 1.14), and similarly, Dionysius Cato reflects this attitude toward social assistance when he exhorts “show[ing] favor to the good” (Cato 1922, 15).

The requirement that one be worthy of assistance also applied to the diseased and ill for, where the sick were concerned, the widespread understanding of health as a personal, earned virtue created a society which rendered physical wellness equivalent to goodness (Aquilinia 2017, 9). Ultimately, this made the sick objects of disdain (Ziegler 2018, 38) rather than subjects worthy of compassion or pity (Ferngren 2011, 9) such that many afflicted with the scourge of illness were abandoned without assistance. As Schmidt (1889) writes, “the artisan who was not rich, the poor man who was not a slave, could find no refuge; it would have been contrary to the ancient spirit to care for them” (p. 70). Pagan physicians, then, had no obligation to care for the sick man simply because he was sick, but only because he was both sick and characterized as a valuable member of society.

In contrast to these pagan Greco-Roman attitudes, the Eastern Church Fathers demonstrated a profound recognition of and concern for human sickness wherever it was present. Chrysostom and the Cappadocians display concern for the poor in general and they particularly attend to sickness as an especially intense form of human need. Gregory of Nazianzus (2003) declares that disease is “the most abhorrent and oppressive evil of all” (Oration 14.9) and Gregory of Nyssa writes that “the sick who is poor is doubly poor” (Gregory of Nyssa 2001, 1.490). Their special concern for the ill is not unlike Christ’s own concern for those afflicted by sickness, insofar as the overwhelming majority of Christ’s miracles were acts of healing (Love 2008, 229) and many of his acts gestured toward the unquestionable goodness of health (Kelsey 1995, 91). The Eastern Church Fathers’ concern for the provision of medical care is part of a longer Christian tradition of esteeming healing activities (Heyne 2019, 9), something that Gregory of Nyssa (2007) echoes when he writes to a physician-friend that “the one who preferred your science [of healing] to all pursuits of this life would hit upon the proper judgment and not miss the mark” (p. 83).

Early Christian communities included disproportionately high numbers of physicians (Aquilina 2017, 51), but the provision of health care in the early Christian Church not limited to professionals. Ministering to the sick was deeply entrenched in the life of the entire Christian community, with deacons expected to advocate for the needs of the sick within the church’s official administration (Rhee 2012, 128) and catechumens required to participate in healing activities prior to entering the church (Barrett-Lennard 2005, 144). Just as Christ asked his followers to heal physical suffering before commanding them to preach the Gospel (Aquilina 2017, 38), the early Christian Church first demanded that unbelievers share in the ministry of healing before publicly affiliating themselves with the followers of the Gospel.¹

The early church’s concern for the sick did not arise merely from the imposition of a novel set of social or religious demands, however, but instead from an entirely novel framework of social assistance. In radical contrast to the prevailing Greco-Roman conception of aid based on social relationships, the church declared that the simple, objective existence of need in another was enough to justify assistance. Chrysostom decries worth-based approaches to aid by declaring that “[W]e show mercy [on another] not because of his virtue but because of his misfortune” (Chrysostom 1984b, 57). He references the Good Samaritan when exhorting his fellow Christians not to allow anything to distract them from the undeniable poverty in another: “[I]t matters not whether the sick one is Christian, Jew or Gentile, it is his need that calls out to you” (Jonson 1992, 39). Just as Christ expanded the notion of community beyond the “inward” Jewish ideal (Ferngren 2014, 77), the early Christian Church refused to practice charity with respect to human divisions. Chrysostom (1984b), too, prohibits his congregation from asking questions before extending aid:

If you wish to show kindness, you must not require an accounting of a person’s life, but merely correct his poverty and fill his need. The poor man has one plea, his want and his standing in need: do not require anything else from him; but even if he is the most wicked of all men and is at a loss for his necessary sustenance, let us free him from hunger. (p. 52)

Similarly, Gregory of Nazianzus (2003) exhorts his congregation to disregard the source of another’s need, writing that Christians must “open [their] hearts to all the poor and to all those who are victims of disasters from whatever cause” (Oration 14.6). Where the needs of the sick are particularly concerned, Gregory of Nyssa mirrors Christ’s refusal to use sickness as an indication of someone’s sinfulness or holiness (Pilch 2000, 13; Aquilina 2017, 9) by declaring that it is not “the sick person’s fault if the frail fabric of his sickly nature exposes itself in these unfortunate ways” (Gregory of Nyssa 2001, 2.483). Throughout the New Testament, Christ similarly granted requests for healing without exception, overturning the framework underlying the conversation about whether “worth” should precede assistance (Temkin 1991, 104). Just as any person who asked Christ for bodily wholeness received the fulfillment of his plea (Dawson 2008, 73), the Church Fathers also proclaim Christ’s unambiguous teaching about the goodness of healing (Temkin 1991, 104) and revise the pagan Greco-Roman conception of philanthropy² by establishing “misfortune,” not worth, as the sole criterion for the reception of aid (Chrysostom 1984b, 53). As a result, “the meaning of charity itself changed. For the classical world charity had been a way of being rich…[but] for Christian society, it was a way of being Christian, without giving primary regard to a pre-existing relationship” and “defined by the concrete needs of individuals: food, clothing, shelter, and care for the sick” (Hanawalt and Lindberg 1994, 44). Rejecting worth-based conceptions of philanthropy, the Eastern Fathers of the early Christian Church instead turned to a charity motivated by objective human need.

The Church Fathers not only established need as the basis for philanthropy but declared that the needs of others imposed obligations of an absolute nature. Basil (2009a) taught that Christians were responsible for failing to assist their neighbors, writing that “[Y]ou are thus guilty of injustice towards as many as you might have aided, and did not” (p. 7). Elsewhere, Basil (2009b) intensifies the severity of this obligation, declaring that anyone who ignores the needs of another forfeited his humanity and “should…be reckoned with the savagery of the beasts, accursed, and a homicide” (p. 7.321C). Ultimately, Basil believed so strongly in the obligation to assist one’s neighbors that when commenting upon public health emergencies, he attributes responsibility for these disasters not to the sin of the afflicted—as the pagan Greco-Roman society might have—but instead to a communal moral failing (Wessel 2016, 138). Blaming social evils on “the multitude of [his community’s] sins,” Basil (2009b) suggests that ensuring the well-being of the society was an obligation shared by all (p. 1.308C).

The Church Fathers not only demanded that Christians respond to human need, but that they do so in an utterly selfless manner. In the pagan Greco-Roman world, assistance was extended only when it improved the giver’s own welfare and certainly never if it would damage his personal well-being (Schmidt 1889, 69). According to the Eastern Church Fathers, however, human need constituted such an absolute demand that the Christian must ignore even his personal financial situation. Gregory writes to the poor man, “[Y]ou will say, “I am poor; me too!’ So it is! Nevertheless, give. Give what you have” (Gregory of Nyssa 2001, 1.460). Basil also instructs his listeners to exercise charity regardless of their own capacity to give when he asks, “[A]re you poor? There is someone much poorer than you. You have enough bread for ten days; another has enough for one…do not shirk from giving of the little you have” (Basil 2009b, 6.302A). The absolute nature of the demands placed upon the entire Christian community—rich and poor—stood in radical contrast to anything required by the prevalent cultural attitude toward social assistance. Yet the early church’s belief in the obligation to care for the needy was not just a lofty ideal but a lived reality. Basil, for example, underwent medical training, personally cared for lepers (Miller 1985, 115), partnered with local governments to create a network of healthcare institutions (Schmidt 1889, 267), and earned the praise of pagans for his willingness to embrace close contact with the sick (Nazianzus 1894, Oration 43.6). Unsurprisingly, working in Basil’s healthcare complex was a mandatory duty for anyone living in his monastery (Crislip 2005, 116). In Antioch, Chrysostom extended social services through hospitals, hostels, and orphanages affiliated with the church (Ferngren 2009, 116).

The radical nature of the early church’s concern for the sick further manifested itself in her response to various plagues. Although no official public health institutions prevented or controlled epidemic disease in the Greco-Roman world (Ferngren 2009, 116), the pagan priority during any large-scale public health crisis was to preserve community’s overall well-being. Thus, during a plague, sick and healthy were divided to the point of destroying the most intimate human bonds; even family members rejected one another (Schmidt 1889, 264). According to Eusebius’s description of the Decian plague in 250 AD (Ferngren 2009, 115), eliminating personal contact was a hallmark of the pagan response, for “those who were beginning to fall sick [the pagans] thrust away, and their dearest they fled from, or cast them half dead into the roads: unburied bodies they treated as vile refuse; for they tried to avoid the spreading and communication of the fatal disease” (Eusebius 2011, 2). This response was not unprecedented; Galen himself fled from to Asia Minor from Rome in 166 AD to avoid plague (Mattern 2008, 85). The Christian response was drastically different, for it did not alleviate the epidemic in impersonal ways such as calling upon the gods as the pagans did (Rhee 2012, 129) but instead embraced profoundly human, intimate responses that eradicated all divisions between healthy and sick:

Most of the brethren through their love and brotherly affection for us spared not themselves nor abandoned one another, but without regard to their own peril visited those who fell sick, diligently looking after and ministering to them and cheerfully shared their fate with them, being infected with the disease from them and willingly involving in their troubles…at all events, the very pick of our brethren lost their lives in this way, both priests and deacons and some highly praised ones from among the laity, so that this manner of dying does not seem far removed from martyrdom, being the outcome of much piety and stalwart faith. (Eusebius 2011, 2)

The radical nature of the church’s deeds did not escape the notice of others. Pagan observers interpreted the Christian response to the plague as attributable to their religious faith: “and all men glorified the God of the Christians and owned that they alone were pious and truly religious: did not their actions speak for themselves?” (Eusebius 2011, 117). Emperor Julian (2017) similarly praised the attractiveness of Christian philanthropy:

The Hellenic [pagan] religion does not yet prosper as I desire, and it is the fault of those who profess it…why, then, do we think that this is enough, why do we not observe that it is their benevolence to strangers, their care for the graves of the dead and the pretended holiness of their lives that have done most to increase atheism [i.e. Christianity]? I believe that we ought really and truly to practice every one of these virtues. (p. 129)

Later in the letter, Julian (2017) expressed his desire that the Romans replicate this charity by

In every city establish[ing] frequent hostels in order that strangers may profit by our benevolence; I do not mean for our own people only, but for others who are also in need of money…for it is disgraceful that, when no Jew ever has to beg, and the impious Galileans support not only their own poor but ours as well, all men see that our people lack aid from us. (p. 130)

The Christian response to epidemic disease defied pagan social ideals of inwardness, reciprocity, and ensuring one’s personal benefit. The novelty of their philanthropic framework, however, was not just conspicuous³ but also beneficial. Maintaining close contact with individuals plagued by communicable disease strengthened the Christian Church, for according to Helen Rhee, “the Christians’ organized care of the sick (however rudimentary it might have been), motivated by higher love, was a factor in a greater survival rate of Christians than pagans during the time of epidemics and other crises and ultimately in the growth of Christianity” (Rhee 2012, 130). Scholars believe basic human care might have “cut the mortality rate by two-thirds or even more” (Stark 1996, 89). As the sick recovered, their newly acquired immunity also allowed them to serve others without the risk of death, which further improved survival rates (Stark 1996, 90–91). Ironically, the refusal to ignore the needs of others, motivated by the desire to respond in personal and sacrificial ways even at the risk of one’s own life, ultimately benefited rather than impoverished the early Christian community.

Yet the uniquely obligatory and personal nature of the Christian response to suffering—acknowledged by both Christians and non-Christians alike—cannot be attributed merely to the addition of novel philanthropic demands not previously imposed by the pagan Greco-Roman milieu or even to a deeper recognition of human need. Instead, it arose from a fundamentally novel conception of the relationship between each individual and the broader community. The Greco-Roman world prioritized society above the individual, and thus the individual only possessed a place within society insofar as he contributed to it. For this reason,

No activity was undertaken by individuals, philanthropic organizations, or temples to ameliorate the conditions of the sick during epidemics; they and their families were left to fend for themselves, often with wholly inadequate resources.…It was the Christian belief in personal and corporate philanthropy as an outworking of Christian concepts of agape and the inherent worth of individuals that introduced the concept of social responsibility in treating epidemic disease. (Amundsen and Ferngren 1982, 86)

Without attention to the individual needy person, viewed as useless to the broader society, the Greco-Roman world had no reason to establish communal obligations toward the suffering. It “failed to create a system of social welfare” (Hanawalt and Lindberg 1994, 2), causing the sick not only to be ignored but also destined to a life of profound isolation. Gregory of Nazianzus writes that the ill

[a]re driven away from cities, they are driven away from homes, from the market-place, from public gatherings, from the streets, from festivities, from drinking parties, even—how they suffer!—from water itself…[with the community] denying them shelter and failing to provide them with basic sustenance, treatment for their wounds, and dressing for their sores. (Chrysostom, 1984a, 47)

The fear of contagion barred the sick from acquiring basic physical necessities. More importantly, it excluded them from belonging to and participating in the broader community. Gregory of Nazianzus (2003) declares that allowing the fear of contagion to inform one’s actions was irrational, cowardly, and unbefiting of a Christian:

You will not demean yourself in the process; you will not catch their malady even if the squeamish deceive themselves into believing such nonsense; or rather, this is how they justify their, call it over-cautious or sacrilegious, behavior; in point of fact, they are taking refuge in cowardice as though it were a truly worthwhile and wise course of action. On this score accept the evidence of science as well as of the doctors and nurses who look after these people. Not one of them has ever yet endangered his health through contact with these patients. (Oration 14.27I)

While his statements about the transmission of epidemic illnesses are inaccurate, Gregory of Nazianzus’s primary objective was to eradicate not what he judged were false beliefs, but instead the individualistic notion that meaningful boundaries existed between the healthy and sick. For the Eastern Church Fathers, excluding another human being through active ostracization, as performed by the pagans during the plagues, or through a refusal to provide care, which Gregory of Nazianzus alludes to in his own congregation, was not passive self-preservation but active hatred. Chrysostom (1984a), too, declares that ignoring a needy individual day after day is “the worst kind of wickedness; it is an inhumanity without rival” (pp. 21–22), in that the poor man’s distress is not just overlooked but actually magnified by “people [who] are present but unwilling to stretch out a hand” (Chrysostom 1984a, 30). Gregory of Nyssa extends these teachings, rebuking those who might meet the objective needs of the sick but withhold human presence. For the Church Fathers, genuine charity demanded not just meeting physical suffering but also relational pain, and thus Gregory of Nyssa rebukes those who “say that it is sufficient to provide food to those who have been removed to the farthest border lands, distant from our lives” (Gregory of Nyssa 2014, 180). In order to promote genuine unity among healthy and sick, Chrysostom calls his congregation to overcome feelings of innate revulsion when he writes that “most people cannot stand to be near them, or even look at them, but avoid them, are nauseated by them, and regard them as abominations, so to speak. It is this that preys on them even more than their ailment: they sense that they are actually hated for their misfortune” (Gregory of Nazianzus 2003, Oration 14.10). Even natural, visceral human responses were expressions of selfishness for Chrysostom. In stark contrast to the prevailing cultural attitudes toward the sick, the Church Fathers demonstrate a deep concern for the isolation experienced by the diseased while refusing to permit any exclusion motivated by the fear of contagion or discomfort.

To promote the inclusion of the sick into the larger community, the early Christian Church not only eliminated the distance between healthy and diseased but repersonalized those afflicted by illness. Exclusion was worthy of being reprimanded because it left the needs of others unresolved and constituted hatred, but also because it was an act of dehumanization, and thus unbefitting of the Christian. Recognizing that certain diseases such as leprosy disfigured their victims in profound ways, Gregory of Nyssa nevertheless chastises anyone who would not recognize a sick man’s underlying humanity even if “he neither bears clearly on his person the distinct marks of a man nor those distinguishing marks of some other animal” (Gregory of Nyssa 2014, 117). He is particularly concerned about how exclusion affects the sick, whom he describes as “human beings…who are ashamed to answer to this common name, and who fear dishonoring the common nature by carrying the title” and thus declares that they could not be viewed as dissimilar to the rest of the community (Gregory of Nyssa 2001, 2.480). Despite appearances which might suggest otherwise, external distinctions could not negate something more essential: “the same nature” (Gregory of Nyssa 2014, 177). Insofar as the sick shared the same nature as the healthy, they were indelibly and irrevocably incorporated into the human community at the level of their most fundamental identity and thus could not be excluded.⁴ The implications of a shared human nature were profound, for in a community based on something more fundamental than external health, ignoring a suffering brother was no longer merely an act of violence against another. Rather, it became an act of self-hatred, or, according to Gregory of Nyssa, equivalent to proposing “a charge of cruelty against yourself” (Gregory of Nyssa 2014, 180). Thus, he declares that refusing “the means by which to fulfill the whole law” by ignoring the sick would be an act of “seek[ing our] own destruction” (Gregory of Nyssa 2001, 2.484). The ideal of unity proposed by the Eastern Church Fathers, while it certainly intensified the necessity of extending aid also reduced the sense of loss that might accompany the provision of social assistance. Basil (2009a), for example, declares that charity does not diminish one’s goods in any way but instead preserves them: “if you want storehouses, you have them in the stomachs of the poor” (p. 7). In this way, Basil transforms the concept of philanthropy by suggesting that it was not an act in which one lost something irrevocably but instead an act in which one shared with another so closely united to himself that it was a storing—rather than a depletion—of his own belongings. Challenging typical assumptions about social assistance, the Church Fathers eradicated the boundaries between healthy and sick by gesturing to a shared human nature.

The Church Fathers extended the novelty of their framework even further by declaring that just as the sick needed the healthy to be restored into the broader social community, the healthy also required the sick to be restored into full communion with God. On the most basic level, assisting the sick drew the healthy toward God through the exercise of charity. Gregory of Nyssa particularly praises almsgiving and declares that charity does not impoverish but instead enriches the giver insofar as the poor are “treasurers” and “keepers of the gates” who judge whether the rich were compassionate and thus control the distribution of heavenly rewards (Gregory of Nyssa 1984, 132). According to Susan Holman, the Church Fathers made “the recipients of alms…essentially symbols, their bodies representing holy containers by which the donor may be lifted up to God. The poor are thus rendered with a profound, if inert, liturgical identity” (Holman 2017, 54). Viewed this way, and in light of the entire framework of social assistance established by the Church Fathers, the poor were not just reincorporated into the earthly community of the early church as equals but also included in its spiritual community with an elevated status. As Brandsen and Vliem (2007) write, “[A]s citizens of a heavenly kingdom, the poor now h[e]ld even greater power than did the poor in the gift economy system” (p. 427). Yet the poor were not merely occasions for exercising charity and attaining spiritual goods. They also possessed a priestly character which enabled them to mediate between God and man:

The Cappadocians regarded care for the poor as essential in theosis, the ideal attainment of participation through Christ in the sanctity and sanctifying power of the deity, sometimes called ‘deification.’ Often (but not always) the poor are assigned the role of jurors before God to attest to good deeds (or lack thereof)…they represent a kinetic ground for redemptive almsgiving, effecting heavenly favour merely by standing between wealth and heaven. Like pilgrim tokens, the poor are tangible representations imbued with the power of the sacred they represent, power available for blessing only to those who dare tactile engagement with them. (Holman 2006, 449)

As both living witnesses of good deeds and sacramentals capable of transmitting a deifying power to those who cared for them, the poor enabled the rich to encounter the divine. Thus, they were necessary for the physically healthy and rich—yet spiritually ill and poor—man who, by associating with the sick, was no longer abandoned to the consequences of his own sin or excluded from heaven. Through contact with society’s untouchables, he was drawn from his misery into healing and communion with Christ: “the physical leper becomes the essential means by which the spiritual leper may find a mediator to wipe away his own polluting spots of greed and passion. Here the leper, once set apart for his pollution, becomes a symbol of all that is now ‘set apart’ for God” (Holman 1999, 298). Under this framework, the physically healthy man was obligated not to avoid, exclude, or even eliminate the sick not just because the early Christian Church demanded it, but because close contact with disease, previously viewed as a death sentence, was the pathway to spiritual restoration (Aquilina 2017, 97). Commenting on the transformation which contact with the sick achieved for the healthy man, Susan Holman (1999) argues that it is not a coincidence that “the Greek verb that [Gregory of] Nyss[a] used for contagion, μεταδίδωμι, was commonly employed as a positive expression implying sharing or distribution. It is precisely this capacity for sharing that both Gregories describe as the leper’s greatest gift to their audience” (p. 302). The divinization mediated by the sick was so valuable that the poor, beyond merely controlling the distribution of heavenly treasures, were themselves treasure; Gregory of Nyssa declares that Christians must “embrace the wretched as gold” (Gregory of Nyssa 2001, 2.457). Recognizing that the physically healthy man, just like his sick brother, also required a deep, urgent reincorporation into a broader community, the Church Fathers entirely invert the nature of contagious disease. Intimacy with the sick did cause the healthy man’s demise but led to salvific healing by drawing him toward union with God. Under this framework, the needy and the one capable of satisfying that need could not exist independently. Instead, the welfare of both were so intimately united that, as Gregory of Nazianzus (2003) writes, the church would be “so derelict in our obligations to look after our fellow man [if] we actually believe[d] that avoiding these people assures the well-being of our own persons” (Oration 14.10). Insofar as both healthy and sick were plagued by needs which they could not satisfy without the help of the other, the achievement of individual well-being in the early Christian community necessitated a context of interdependence and unity.

This vision of mutual need in which the sick manifested the divine to the healthy in a unique way not only acted as an equalizing force among members of the Christian community. On a more fundamental level, it equalized the entire community relative to God, before whom all were similarly impoverished regardless of their physical circumstances. On the most basic plane of man’s existence—where the relationship between the human and the divine was concerned—“the social divide between the needy and the self-sufficient, dishonoring the former and honoring the latter, [wa]s relocated to place men side by side before God” (Finn 2009, 135). As Gregory of Nazianzus (2003) writes, “[W]e are all poor and needy where divine grace is concerned, even though, measured by our paltry standards one man may seem to have more than another” (Oration 14.1). For the Church Fathers, the sharing of both healthy and sick in a profound and essential poverty before God “foreshorten[ed] social distances” to the point of the eventual elimination of these distances, for in light of each man’s profound neediness, the boundaries which otherwise might have created divisions between citizens and noncitizen, the rich and the poor, the healthy and the sick, or the worthy and the unworthy were irrelevant (Finn 2009, 137). Gregory of Nazianzus (2003) echoes the uselessness of human distinctions by reflecting upon the truth that God does not demand anything from men when they are in need: “all alike deserve our pity and look to our hands just as we look to the hands of God whenever we are in need of something” (Oration 14.6). By encountering others’ needs, the Christian recognized his own dependency; this new self-knowledge enabled him to view all in the community, as Gregory of Nazianzus (2003) does in his most famous sermon on poverty, as “brothers and fellow paupers” (Oration 14.1). The early Christian vision of human need, then, functioned not just to include the needy and sick into the community of the rich and healthy but, on a deeper level, to reincorporate all into a single community in need before God. For this reason, Gregory of Nazianzus (2003) writes that, “confronted with the suffering of others, [he]…dwel[t] on the infirmity of [his] own flesh” (Oration 14.8). Not only would the healthy and rich be obliged to view the needy as sharing in their own human nature, and thus as not “other” to them, but because that shared human nature was characterized at its most basic level as impoverished and sick before the divine, they would be obliged to recognize their own fundamental, undeniable neediness. As Augustine (2009) suggests, no person could honestly recognize this need in himself and refuse charity toward his brother: “that man is in want; you, too, are in want; he is wanting something of you, and you are wanting something of God. When you despise the person who wants something of yours, will not God despise you for wanting something of his? Supply, then, what the needy person lacks, so that God may fill your inner being” (p. 34). For the early Christian Church, to engage in an act of healing was not just to acknowledge another’s need but also to peer beyond human distinctions of poverty and sickness and discover something more essential about the human person: his ultimate and total need before God.

The early church distinguished itself from the prevailing culture, and the Church has continued to prioritize activities because of her belief that caring for the sick is a foundational, nonnegotiable part of the Christian life. This is a belief only expressed by the early church as well as frequently noted by modern Scripture scholars.

From the whole of the Gospel’s healing narratives, these scholars draw a bold and overarching conclusion: Jesus’s actions and words demonstrated that a Christian should never question the value of healing another human being, for “healing, per se, was good. There is no other sense that can be made of the Gospel narrative” (Kelsey 1995, 91). This interpretation has been advanced even further, however, with some scholars proposing that healing, in light of Christ’s public ministry, can be understood neither as an objectively good activity nor as a mere component of his work. Instead, healing is an absolutely intrinsic part of Christ’s message (Thelen 2017, 13), and “in memory of Jesus it could hardly have been otherwise” (Verhey 2003, 1). Throughout the development of Christianity, the lived expression of this belief has taken different forms, beginning with Chrysostom and the Cappadocians’ founding of a social welfare system that never existed in Rome (Hamawalt and Lindberg 1994, 2). This continued through the early years of Christianity through the organizing orphanages, hostels, and hospitals (Rhee 2017, xxxvii), the establishment of what is today “considered [to be] the first hospital in Western civilization” (Caspary 2012, 33), and the close relationship between the provision of health care and the development of monastic institutions, which viewed “their health care system as a given, as an integral part of monastic life from its inception” (Crislip 2005, 40). By the fourth century, for example, Benedictine rule reveals its prioritization of providing health care and “state[d] that ‘the care of the sick [was] to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them’” (Porter 1997, 111). Christians continued the healing tradition through the medieval (Ziegler 2018, 62) and early modern periods and beyond (Kusukawa 2004, 19). Today, the Christian Church remains active in the provision of healthcare services worldwide, with the Catholic Church alone, for example, overseeing 5,000 hospitals and 16,000 health clinics (Patton 2017). An analysis of Christian writings traces the source of these healing activities to the early church’s novel belief in the absolute and deeply spiritual obligation to care for the sick. This vision of health care established definitive, ultimate obligations to respond to human need and thus entirely revised the prevailing framework worth- and reciprocity-based philanthropy held by the pagan Greco-Roman world. When Christian and pagan responses to outbreaks of epidemic disease are compared, the novelty of this alternate vision becomes starkly apparent. No longer did the burden rest upon the poor or sick, who in the pagan Greco-Roman society would be required to justify the worth of their existence and the value of meeting their needs. Instead, any Christian who encountered need in the form of sickness—regardless of his own circumstances or means—was obligated to assist his neighbor in a radically selfless way, even at the cost of his own health or life. By validating human need and rehumanizing those who experienced it, the early Christian Church definitively shifted the burden of proof to the rich and healthy man, who would one day be required to justify, before God, his response to the innate worth of his neighbor which he was obliged to offer on the basis of a shared human nature. The newfound Christian emphasis on the needs of the individual sufferer demanded a correspondingly novel vision of community insofar as healing was not oriented only to the rehabilitation of the sick but also their reincorporation into the broader community. As Christians acknowledged a shared humanity which transcended distinctions between rich and poor or healthy and sick, a more fundamental, shared identity emerged: that of each man’s utter and total neediness before God. In this way, healing did not only function to reveal a Christian’s identity on a horizontal plane as he discovered a shared humanity that demanded mutual interdependence among men, but ultimately oriented him on a vertical plane by determining his rightful posture before God. Thus, the early Christian Church developed a tradition of necessary, obligatory healing because it not only produced a recognition of the shared humanity between persons, but a more profound and consequential recognition of what it meant to be human in the face of the divine—and that was nothing other than existing in a state of utter need: poor and yearning for eternal riches, and sick and desperate for spiritual healing.

Biographical Note

Sarah E. Becker, BS, graduated from Hillsdale College with a Bachelor of Science in biochemistry and philosophy in May 2020 and is currently a first-year medical student at the Oakland University William Beaumont School of Medicine in Michigan. In the future, she aspires to pursue clinical ethics and women’s health or hospice and palliative care.