Medical art in spiritual direction : Basil, Barsanuphios, and John on diagnosis and meaning in illness

This study examines literature of spiritual direction in context of recent scholarship on the conceptual role of medical knowledge and practice in early Christianity, to show: 1) spiritual direction constitutes a version of medical art defined by teleology of bodily and psychical health, which 2) relies on diagnostic skill in disease etiology to construct meaning for sufferers, and 3) for these very reasons can lead to the rejection of medical healing. The topic is framed by discussions of the cultural and hermeneutical aspects of modern medicine, which show that construction of meaning in illness is integral to clinical encounters and determinative of expectations of expertise. These points are made with regard to ancient medicine through study of Galen of Pergamon’s teleology and diagnostic advice. Thereafter the study focuses on Basil of Caesarea and the Old Men of Gaza. These treat medicine as divinely providential, within a narrative of sin and salvation that defines a teleology of bodily health as conducive to spiritual well-being. Accordingly, Basil develops etiologies of disease that distinguish between natural and unnatural origins to prescribe either recourse to or rejection of medical intervention. Barsanuphios and John of Gaza elaborate Basil’s etiologies according to their experience and demonology. Nevertheless, all three construct their authority over ascetic bodies in terms of medical expertise and suggest that spiritual direction dictates ambivalence toward, even rejection of medicine, insofar as its theological commitments dictate different conceptions of health and the range of meaning available in illness.