The Yale Journal for Humanities in Medicine

Spirituality, Religious Wisdom, and the Care of the Patient

Reflections on the Possibility of Gratitude as a Christian Virtue for Patients and Caregivers

Joel James Shuman, Ph.D.
jjshuman@kings.edu

Joel James Shuman graduated from the Medical College of Virginia with a B.S. in physical therapy. He practiced physical therapy for 10 years in West Virginia before enrolling in the Duke University Divinity School.  He obtained his Ph.D. in theological ethics from Duke where his dissertation advisor was the noted Protestant scholar and theologian Stanley Hauer was. His academic interests have focused on how Christian understandings of the significance of the human body might help us find ways to re-capture the sense of a common good. He currently serves as Assistant Professor of Theology at King's College in Wilkes-Barre, Pennsylvania. He is the author of The Body of Compassion: Ethics, Medicine and the Church and the forthcoming With Eager Longing:  Sickness, Devotion and Desire in Christian Theological Perspective.

When we've lost all we've had, we've had what we've lost.
Wendell Berry

To speak at the same time of gratitude and of illness is to risk absurdity, if not perversity. To the ears of the desperately ill, admonitions to "be thankful," or to "to count your blessings," are sure to be heard as platitudes - saccharine or offensively pious - even (or especially) when they come from the mouths of caregivers or family members who seem by all accounts to be feeling just fine. How can a woman suffering intractable pain see her life as a gift? How can a man with unremitting nausea and vomiting be thankful? How can parents standing at the bedside of a child gasping for air as she passes through the final stages of a fatal cancer regard their child's, or for that matter, their own lives with gratitude? And how can any of us - caregivers, family members, or friends of such people - rightly tell any of them to count their blessings?

How we can do it, I do not profess fully to know. Yet I am persuaded that speaking to one another of gratitude in such difficult cases is a risk that Christians, at least, must take. We must speak of gratitude, because of the central place occupied in the Christian theological tradition by the notion that is in some ways a prerequisite for gratitude, the notion of "gift." For the Christian story teaches us that our very existence as members of the "pied beauty" Gerard Manley Hopkins called this creation is purely a gift from God.[1] God's constant, loving outpouring of redemptive abundance toward the creation, which we call salvation, is a gift. Our every experience of beauty, joy, and love are all gifts, and, as such, are to be received with gratitude. Indeed, when Christians gather to worship, the entirety of their being together is directed toward the celebration of the great feast called Eucharist - a word which itself means, quite literally, thanksgiving.

Such theological abstractions are of course all well and good in their proper place, but what about those times in our life when we experience nothing of beauty or joy or love, times when we or someone we love are sick and suffering and facing a tortuous passage to the end of our (their) days? Clearly in such times, when the giftedness of life is so seriously in question, the dumb admonition to "be thankful" is inadequate. Words alone do not suffice. Rather, gratitude in the midst of sickness and suffering comes only as one of those difficult, complex graces that is received, cultivated and woven into the entire fabric of that common Christian witness which spans generations and cultures. Like so many graces, it is partly an art, and art, as Norman McLean reminds us, "does not come easy."[2] The hard work of Christian discipleship begins here, in the face of the difficult task of negotiating life as mortal and broken bodies in a finite and broken world, and to do so without losing hope, and perhaps, even, while offering thanks.

For Christians, the contemplation of these matters begins at the cross. The Christian cannot escape or ignore that even after the resurrection, in which he stands victorious over death, Jesus of Nazareth is the Lamb of God who appears always "as if it had been slaughtered."[3] And so it is in some sense from the cross, even as God destroys the power of the evil for which it stands - evil that includes among its effects pain and suffering from which there is no deliverance - that God rules the cosmos and comforts and delivers the afflicted. To realize this is to understand that within the horizon of this life, the course of Christian fidelity has a complex relationship to the course of our natural desire for relief from suffering: sometimes overlapping, sometimes diverging, sometimes intersecting, seldom predictably and always beyond easy control. When we are sick and suffering, or when the people we love are sick and suffering, that deliverance for which we gladly would and easily could give thanks may or may not be forthcoming. Moreover, we almost never know in advance and frequently will not know in retrospect the precise relationship of our prayers - however fervent, however righteous - to the way things turn out. But the absence of deliverance from sickness or suffering is neither a sign that God has withdrawn favor nor an occasion to abandon hope. The God on the cross remains present and powerful, even when things seem to go horribly wrong, even when consolation seems unavailable. To know this, however, to live as if it is so, is a difficult grace.

Just because it is so particular and so difficult to receive, the grace that is the Christian practice of thankfully receiving God's presence in and to our suffering demands the rejection of two rather simplistic extremes. On the one hand we must abandon the notion that God can or should be controlled by our behavior. God may not be domesticated within any variety of expectation that our devotion will be rewarded or responded to as an effect following a cause. The bluntly comedic belief that a life lived under the protection of God's grace necessarily includes the immediate or even eventual blessings that are health or deliverance from suffering in simple exchange for devotion has little to do with Christianity. It is instead a strange synthesis of capitalist ideology, modern self-help doctrine and a terrible caricature of the theology against which Jews and Christians, from the author of Job to Jesus to Paul, have so frequently argued.

We must also, on the other hand, avoid the tragic extreme of plunging into despair, believing that because relief from suffering is not immediately forthcoming God has abandoned us to our suffering, and we no longer have anything to be grateful for. It is and may always be unclear why the righteous suffer, the wicked often prosper, and, as the poet Michael Blumenthal says, "the wages of goodness are oblique and obscure, and not even assured."[4] Yet, at least for those who see the world as Christians, such apparent injustice should not leave us in despair.

As we reject despair and domestication, neither can we embrace as the Christian way a neatly tooled compromise that fits cleanly between these extremes. The "blessed hope" that constitutes the Christian promise is not simply an eschatological middle way between tragedy and comedy, not simply an abandonment of hope in this life in favor of a premature rush toward the better conditions of the next. Life in the world to come is certainly real, but it by no means entails a rejection of or hurrying through this life or this world. Because life in this complex, dense and fleshy world is God's good gift, the Christian hope for fullness of life is forever complex, dense and fleshy.

Seeing the shape this hope might take in unhappy times requires a narrative display. We must turn, that is, to the lives of people who have known and lived such hope and in whose life it is prominently displayed - in this case people who exist in the literary imagination. The novel A Place on Earth is the cornerstone of Wendell Berry's extended fictional account of the lives of the inhabitants of a rural Kentucky town to whom Berry refers as the "Port William membership." At the center of A Place on Earth is the household of Mat and Margaret Feltner, whose families have lived and worked, primarily as farmers, for generations in Port William. As the story begins, sometime in the early days of World War II, we learn that the Feltners' daughter-in-law, Hannah, is living with Mat and Margaret. Hannah is married to the Feltners' son Virgil, who is serving in the Army, and she is pregnant. From the book's opening scene we are shown clearly that the war represents an especially severe intrusion on the membership. It has disrupted their lives, and especially the life of the Feltner household. Yet we also see that the membership is a people devoted to living as best they can no matter what the circumstances, doing the same good work they and their forebears have been doing for years. It is their devotion to their work and their devotion to one another and their devotion to Port William, we sense, that sustains their anticipation that life will someday resume its normal rhythms; hard times come and go, and the members sustain one another in the midst of both. The Feltners' anticipation that their present hard times will soon pass is tested, however, when they receive a letter indicating that something awful has happened:

Mat goes to the table and holds the letter out to Hannah. There comes over him a great need to do this gently. But he can only do it bluntly, with a kind of shame as though there might be a polite way to do it but he does not know what it is.

She reaches out for the letter and takes it. Mat knows she is looking at him, but he does not look at her. And he knows when she looks away from him. She tears open the envelope and reads the letter, and lays it slowly and flatly down on the table, indicating that Mat should read it. And Mat reads it, and then, as though the duty falls to him, he reads aloud: "Virgil Feltner . missing in action."[5]

Uma Mysorekar, "Gratitude As Viewed in Hinduism"
Gratitude: Introduction
Table of Contents

Published: February 25, 2002