I believe I am following your point. Still, the idea of “wellness” is a wider idea that applies to psychology “in general”. Your way is not the way of every therapist/patient. I commend you for your approach as it seems to rise above these facts.

My wife is a physitrist, and so her practice is more medically oriented. The culture has affected her, where recently for example (you and I discussed this briefly) a patient “advocate” had one idea of wellness, and she and the patient another (this was situation centered around what was the best way for the patient to die). It was probably about $money$ in the end, but the cultures ideas of “death with dignity” etc. certainly had a part to play.

Christopher,

Don’t put your words in my mouth. Subjective report that the original symptoms that brought them into treatment are dissipated or manageable: “My appetite has improved” – reports gained weight (Original Notes: patient reports loss of desire and interest to eat usual 3x per day; estimates weight loss >5%” [My observation] Patient appears thin & pale).” “I am going to bed and getting up at my normal times, and I feel rested” Patient is alert, normal eye-contact, initiating discussion) (Original Notes: patient reports falling asleep immediately upon arriving home from work, often in work clothes, and sleeping until morning alarm. Reports not feeling “rested,” despite length of time slept. [My observation] Patient appears listless, tired, somewhat inattentive, yawning).” Some patients no longer hear voices, some hear them less often, some continue to hear them, but realize they do not have to obey or believe them. For some truly refractory patients, the best outcome – their form of “wellness” – is, with medication and a supportive therapy group, to simply have reduction in the volume of voices, and they learn to ignore them. Get the idea, Christopher? Where do you see “morality” or the “religion of the age” in what I am doing? For the most part, the people I deal with are not going to ever get “well” in the way you are framing “wellness.” Perhaps that makes it easier, perhaps that makes it more difficult.

I just took a part-time job in a local clinic – to reduce my traveling – and one of the questions they asked me in the interview was, “Tell us about an ethical conflict you have had with a patient.” I told them, “I have never in my career had an ethical conflict with a patient, probably because from the initial contact, I am very clear about my boundaries. But I have had several ethical conflicts with colleagues, and I will quit before I will compromise my values.” No comment, and we moved on. But then again, I’m an OG (old-school gangsta)! “I am a companion of all them that fear you, and of them that keep your laws!” (Ps. 118) and “the law is my delight,” (v.77) Christopher, but culture has not affected my practice. I don’t know your wife’s specialty practice, but she is welcome to write me.

“Wellness” is a combination of the patient’ s subjective report that the original symptoms that brought them into treatment are dissipated or manageable to the point that they can return to functioning as well as previous to the onset of symptoms and it is the clinicians observation that there is congruence with the patient’s report and their actions.

Exactly – it’s subjective, based on subjective principles and “morality”, the good, etc. It’s all based on the religion of the age. As far as the limits of your imagination, perhaps your too close? My wife is a physician, and is capable of lamenting the fact that the culture has affected her practice and what it means for “wellness”, etc. (I could cite many examples – but then HIPAA is always a problem)…

It is only impossible if you assert human freedom does not exist — which Calvin did and MacArthur does.

A response to your comment above that you cannot accept that “a benevolent God sees this world as the best of all possible options,” Archibald MacLeish won the Pulitzer Prize for drama in 1959 and the Tony Award for best play, J.B.: A Play in Verse. Its most memorable mantra: “If god is good, he is not god. If god is god, he is not good.” J.B., of course, is Job. There is nothing new under the sun, Mr. Bradshaw. Although, some instances win you both a Pulitzer and a Tony. Funny the things you remember from a Jesuit education.

Unfortunately, M Stankovich, it is impossible to uphold the notion of a sovereign God while simultaneously asserting that suffering isn’t also somehow part of His “plan”.

As John MacArthur so crudely and simply put it: “God exists. Evil exists. God is sovereign. Therefore, God wills evil to exist.”

Personally, I can’t accept the idea that a benevolent God sees this world as the best of all possible options. As such, I’ve become a bit of a heretic open Theist

I am reasonably certain I was arguing against any empirical measurement. It seems to me you introduced this criterion of “state of mind” by indicating prayer during suffering “has great power in its effects.” Now you seem to be satisfied with the single criterion of St. James, that it simply be “fervent.” No argument from me.

Returning to the question posed to me, your colleague above indicates that my original statement is the “furthest thing from Orthodox teaching,” and, apparently was so shocked and resolute mine was in opposition to “Orthodox teaching” that he did not bother to articulate what, exactly, he believes that teaching might be. Nevertheless, the frankness of his statement suggests mine is diametrically in opposition to the Church, meaning there must be some objective virtue – perhaps paralleled in the natural law? – to human suffering. Except for the fact that it does not appear until Gen. 3:16-24 in the narrative of the expulsion from Paradise: destined to labour the earth, the ground is cursed, “and in pain shall you eat of it all the days of your life. [τὰς ἡμέρας τῆς ζωῆς σου]” (Gen. 3:17), it literally does not exist “from the beginning.” Now, lest anyone imagine God “inflicted” this punishment, recall that all parties were informed this was the consequence of disobedience, and thus the consequence was earned. Human suffering was the consequence of arrogance, lust, desire, and foremost, prideful disobedience. And apart from Jn. 16:1-4, where the Lord predicts the suffering that is to come, He certainly devotes considerably more time consoling His disciples with the promise of the Comforter and that, “Whatever you shall ask the Father in my name, he will give it you.” (Jn. 16:23). Now, if there is someone who has actually experienced or witnessed great suffering in another human being – with all deference and thanks to Fr. John Breck who assured me the greater the suffering, the greater proximity of God – and believes there is actual virtue, or that Fr. Schmemann’s description of “disease as cleansing” and a “teacher of humility” were actually personal pieties and not, in fact, a “blessing” from God but rather an unintended, unattributable horror of our fallen humanity in the context of this broken world, I would love to hear it.

Put the empirical aside. One does not measure the effect of prayer on scales.

Think instead in these terms:

Confess your faults one to another, and pray one for another, that you may be healed. The effectual fervent prayer of a righteous man avails much (James 5:16).

As the Paschal address of St. Chrysostom would suggest, and so do those uttered in the moments of ecstatic triumph and victory. It would seem that any attempt to measure the qualitative or quantitative benefits, one against another, of “effect,” is quite ridiculous, knowing that on that “Day without evening,” when our God will be “all in all,” there will no longer be any suffering!

Prayer for others uttered in the depths of private suffering has great power in its effects.

Christopher,

Really? I have yet to find an insurance company willing to reimburse any clinician pursuant to any “value value” system. You might look into ICD 9/10, DRG’s, DCM’s, and obviously the DSM IV/V to appreciate how “wellness” is achieved: once a disorder is diagnosed by a determination of its symptoms, a treatment plan is drawn up and implemented pursuant to an evidence- base. This may include the use of education, medication, psychotherapy (and a meta-analysis of 40-years of combined clinical data published this Spring, nothing has proven more effective than Cognitive Behavioural Therapy), family Therapy, marital therapy, and so on. “Wellness” is a combination of the patient’ s subjective report that the original symptoms that brought them into treatment are dissipated or manageable to the point that they can return to functioning as well as previous to the onset of symptoms and it is the clinicians observation that there is congruence with the patient’s report and their actions.

I attended a very traditional graduate school of psychology, a very traditional medical school, and a very traditional graduate school of social work. I cannot imagine from where you all have derived these ideas! I was never taught about the “systems of values” relative to the practice of psychology or psychiatry (with the obvious exceptions of codes of ethics); and I was a resident in a large Roman Catholic medical center in NYC with nuns, daily advertised mass, & a crucifix in every room, but I was never asked my specific faith, and expected only to uphold the professional & professional standards of the facility. Rent the chickens already.

Michael Bauman,

I believe there is a distinct difference between the inescapable suffering the Lord predicted will come and has come to those whom He specifically entrusted the Truth and His Bride the Church, and his weeping at the tomb of Lazarus at the state of what His creation had become. He wept for what was not His desire nor His intention, “as it was in the beginning.”

For man is by nature [ κατὰ φύσιν] mor­tal, inas­much as he is made out of what is not; but by rea­son of his like­ness [τὸν ὄντα ὁμοιότητα] to Him that is (and if he still pre­served this like­ness by keep­ing Him in his knowl­edge) he would stay his nat­ural cor­rup­tion, and remain incor­rupt; as Wis­dom 6:18 says: “The tak­ing heed to His laws is the assur­ance of immor­tal­ity;” but being incor­rupt, he would live hence­forth as God, to which I sup­pose the divine Scrip­ture refers, when it says: “I have said you are gods, and you are all sons of the most High­est; but you die like men, and fall as one of the princes.” (ref. Ps. 82:7)

Neither corruption, nor disease, nor suffering are attributable to the desire or wish of the Creator, nor are they natural or “as it was in the beginning.” Simply put, God did not create us to suffer, nor will there be suffering in the Kingdom which is to come. Recall the Burial Service: “Grant rest to your servant in a place in brightness, of rest, and of repose, where all sickness, and sorrow, and suffering have fled away.”

Secondly, as to the idea of the “materialistic notion of avoiding all pain.” I was my mother’s power of attorney for healthcare decisions. She and I drew up her DNR previous to her last hospital admission, which included her desire to have no extraordinary measures taken to prolong her life, including resuscitation, but she did authorize medications to relieve pain, and to be provided adequate hydration. When she had experienced her third heart attack, two cardiologist came in and said “There are some things we could do to help you. Would you like to talk about them?” She smiled and nodded her head, “No.” They looked at me and I smiled. They asked if there was anything they could do for her. She quietly said, “Increase the pain medication. I’m having chest pains.” Should I have intervened and said “This is purely a materialistic, pain-avoidance, solely physical/psychological request?” I’m sure you would say no. Likewise, I interact with a class of patients whose lives are pain avoidance in an entirely different context. It’s difficult for me to be cognizant – and so stimulated – by this as many here.

Finally, how many times did you hear during Holy Week, “The Lord, who is on His way to His voluntary passion for us and our salvation…” “He Who voluntarily endured scourging and spitting for us and our salvation…” “He Who voluntarily endured being nailed to the Cross, bitter crucifixion, and death for us and our salvation…?” And the emphasis is on “voluntarily” and “for us and for our salvation.” Our human suffering was not enough – it was a consequence of our fallen humanity, an evil interaction with the broken world for which we were responsible – nor would it ever be enough to reconcile us back to Paradise. It could only be accomplished by the Son of God Himself on the Cross.

Fr. Alexander Schmemann said in his final sermon, “Thank You, O Lord, for the sufferings You bestowed upon us, for they are purifying us from selfishness and reminding us of the “one thing needed;” Your eternal Kingdom.” There is the old Russian saying that illness is a “visitation” from God. Obviously there are the example of the Holy Martyrs. But I think it is much more significant to consider why, suddenly, after the whole of Great Lent we have been reading Genesis, it concludes on the Friday before Palm Sunday. And with the beginning of Holy Week, we begin the Book of Job – the long, detailed, tedious account of the sufferings of the Lord’s Servant, which amazingly concludes – with everything restored to Job – at the Vespers of Great and Holy Friday. And likewise, the Lamentations of the Matins of Holy Saturday is Psalm 118, in its entirety, the song of him who loves the Law: “Your law is my delight!” “Your statutes give me life.” So what is the point? The same Fr. Schmemann said what we celebrate in Job and in the lover of the Law is the “One Who endured, the One who was faithful until the end for us and our salvation.” The only thing I could ever say about tragedy & suffering was from Job:

Then Job replied to the Lord:
“I know that you can do all things;
no purpose of yours can be thwarted.
You asked, ‘Who is this that obscures my plans without knowledge?’
Surely I spoke of things I did not understand,
things too wonderful for me to know.
“You said, ‘Listen now, and I will speak;
I will question you,
and you shall answer me.’
My ears had heard of you
but now my eyes have seen you.
Therefore I despise myself
and repent in dust and ashes.”

From 2012.

Personally, I found no virtue, no nobility, no positive lesson to be learned from suffering. None. It was pointless, unintended by God, and lacking in any reward or crown. It was the real evil.

This is the furthest thing from Orthodox teaching I have ever heard Michael Stankovich say, and I’m shocked to hear him say it.

Michael S., If suffering is the real evil, how do you distinguish between that kind of suffering and the suffering of the Cross?

How do you answer the clearly materialist premise that life is all about avoiding pain and seeking pleasure–pleasure being defined in solely physical/psychological terms?

M Stankovich: In terms of whether “pathological evil” belongs in the DSM, it does raise an interesting question: how does psychiatry define “wellness” absent some sort of objective value system that acknowledges the existence of evil?

Good question. The answer is I think found in what is happening in psychology today – it defines it exactly as however the dominate religion in the culture defines it. For us, that means modernism – so study of homosexualism from any point of view that does not explicitly affirm it is out…