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ss nucleus - winter 1997,  Spiritual Schizophrenia

Spiritual Schizophrenia

The Oxford English Dictionary defines schizophrenia as "a mental disease marked by disconnection between thoughts, feelings and actions, frequently with delusions and retreat from social life".

Everyone agrees that schizophrenia is very serious disorder. Splitting one's thoughts, emotions and actions is bad for you. The end result can be confusion, emotional blunting and apathy. Yet the world encourages us to show spiritual schizophrenia. It's fine to be a Christian as long as you keep it in its place. It's okay in the church or the privacy of your own home but certainly not at work.

Often we try to maintain this separation - being completely different at home and church to what we are at work. How can we do it? How can we believe that Jesus Christ is King of Kings and Lord of Lords and yet act as if he has nothing to do with work, the place we spend so much time and energy? We do it and it makes us spiritually ill. If we let it continue we will eventually become spiritually apathetic, blunted and confused.

Why is this such a problem? It's not exclusive to medics. There appears to be a serious deficiency in the teaching of the contemporary church on the subject of work. Mark Green, Director of Development at the London Bible College, recently reported that 50% of Evangelicals had never heard a single sermon on work and that 75% had no idea of God's view of work.

As Christian medics submitting to the Lordship of Christ and Scripture and empowered by the Holy Spirit, we can make a huge difference to our patients, fellow staff, practices and hospitals. However, making a difference as Christian doctors involves more than having a well-thought-out biblical position on issues such as abortion and euthanasia (important as these are). In order to make an impact, we need a biblical understanding of our work and the way it relates to our own lives and relationships with our co-workers in the health service.

I want to look at two key areas: the theology of work (how God views our work) and the ethics of work (how we behave and relate at work). First I want to take you on a lightning tour of 2,000 years of human thought about work. Which view best represents the way you see work?

Historical views of work

The Classical (Greek and Roman) view of work was that work was a curse, an obstacle to leisure and the province of slaves. This view still shapes a lot of people's thinking: 'If only I could win enough on the lottery then I could give up work and enjoy myself'.

The Middle Ages developed a secular/spiritual dichotomy. The only true vocation was to be a monk or nun - anything else made you a second-class Christian. This attitude is dangerous: it suggests that God is not interested in our secular work and so does not care how we carry it out. Nothing could be further from the truth, yet many parts of the church still act as if only the priest or Bible teacher has a worthy calling.

The Renaissance brought a move to regarding secular work as having dignity. The real sea-change came with the Reformation, the Puritans and the now much misunderstood 'protestant work ethic'. The reformers fought to break down the barriers of sacred and secular, believing that God was sovereign in all areas of life. They taught that all moral work should be done to the glory of God and was thus sacred. They developed the doctrine of calling or vocation to work in a world where God has placed us as stewards.

The Enlightenment (so-called) brought a perversion of the protestant work ethic. The spirit of humanism replaced the spirit of God. Work became man-centred not God-centred; a means to the end of personal success and money. Work was removed from the idea of partnership with God in the stewardship of his world and was exclusively understood as self-interest. This is well illustrated by Adam Smith, one of the architects of capitalism who said:

'It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves not to their humanity but to their self-love'.

The Nineteenth Century saw two opposing views of work: unrestrained capitalism and Marxism. But as Brian Griffiths quotes in 'Morality in the Marketplace':

'The trouble with capitalism is that there is no limit to man's greed and the trouble with socialism is that there is no limit to man's desire to control'.

Do you recognise your views above? For many Christian doctors it is the Enlightenment view: we work hard for maximum personal gain and to gratify our personal ambitions. When we are thwarted in this we react with cynicism, despair or anger and God is not glorified.

The theology of work

What is God's view of work?

First, God is a worker: 'By the seventh day God had finished the work he had been doing; so on the seventh day he rested from all his work' (Genesis 2:1). Jesus makes it clear that God continues to work: 'Jesus said to them, "My father is always at his work to this very day and I too am working" ' (John 5:17). We are created in the image of God and work is part of God's perfect plan for us. Second, work is a creation ordinance: 'The Lord God took the man and put him in the Garden of Eden to work it and take care of it' (Genesis 2:15). Work is part of stewardship and partnership with God. It expresses an aspect of the divine character within us. God works through us to achieve his purposes. Third, work is marred by the Fall as described in Genesis 3:17-19. Work becomes toil, often appearing futile and senseless: 'Yet when I surveyed all that my hands had done and what I had toiled to achieve, everything was meaningless, a chasing after wind; nothing was gained under the sun' (Ecclesiastes 2:11). Through the Fall, work becomes subject to abuse: idleness, unemployment and exploitation. Many people find work burdensome, boring and apparently pointless. They count the days until retirement. For others, including doctors, work becomes an idol. We define ourselves by it and draw all our self worth from it. If we lose it or it goes wrong, we despair.

Fourth, the good news is that work can be redeemed. When we become Christians we move out of the kingdom of darkness into the kingdom of light.

Let's look at three perspectives on the redemption of work:

  1. Jesus' work on the cross. Colossians 1:15-21 teaches that Jesus is the creator, sustainer and reconciler of all things: '...through him to reconcile to himself all things... by making peace through his blood, shed on the cross' (Colossians 1.20). All life is God's. He created it, sustains it and redeemed it. God is interested in whatever we do and can be glorified by it: 'So whether you eat or drink or whatever you do, do it all for the glory of God' (1Corinthians 10:31).
  2. The worker is a steward for God. One of the most significant passages about work is Jesus' parable of the talents in Matthew 25:14-30. It teaches us that God provides us with talents, opportunities and materials. He expects our service (laziness is harshly judged). Furthermore as stewards we exercise choice and responsibility in our actions. Our faithful work is rewarded, often with more responsibility.
  3. The worker is called by God. The reformers talked about two callings: the first was to salvation, godliness and discipleship, the second to work for God. Prior to the Reformation this was seen simply as a call to 'religious' work; Luther and Calvin extended the concept of vocation to every moral form of work. They based this calling to work on both Old and New Testament Scripture. In Exodus 35:30-35 God called Bezalel and Oholiab as craftsmen and teachers. In Ephesians 2:10 we are called to do good works, which God prepared in advance for us. In 1 Corinthians 7:17 Paul teaches that 'each one should retain the place in life that the Lord assigned to him and to which God has called him'.

Should we accept the idea that work, in our case medicine, is a vocation or calling from God, a number of important implications arise:

  1. Contentment. Paul in Philippians 4 talks about being content in every situation. If God has called us to our work then the knowledge that we are serving him makes even a difficult or dull work special.
  2. Persistence with vocation. This is particularly relevant given the high medical delinquency rate. If God has called us to medicine, we should not readily give it up.
  3. Service. If work is a calling from God then it is not just an arena in which to serve God. Our work is part of our service to God.
In summary, the Christian doctrine of work starts with God working through us as workers in his image. Work was initially an entirely good gift which became marred through the Fall: it can be difficult and frustrating. Work can be redeemed through the knowledge that we are stewards called by God into our work which we do for and with him.

As Paul says in Colossians 3:24, 'Whatever you do, work at it with all your heart, as working for the Lord, not for men'.

The Ethics of Work

The practical implications of the theology of work are enormous. Some of them are at a political level. If work is so important, is it right to have an economic system that focuses on profit and efficiency without taking into account the impact on the numbers and nature of jobs? Some of them are at an immensely personal level. Work is not just paid employment, or even what we do in our churches. It includes caring for children, housework and voluntary work; these are equally important areas of activity needed to sustain us as communities.

However, I want to concentrate on how God's view of work should impact on our behaviour as Christian medics.

First, work is a moral imperative. This strong theme of the Reformers is well borne out in the book of Proverbs which is full of criticism of 'the sluggard'. Paul teaches in 2 Thessalonians 3:10: 'If a man will not work, he shall not eat'. Skiving is out! You can be absolutely sure that not pulling your weight in a team will destroy your Christian witness.

Secondly, however, work must not become an idol. This is a real danger: Christian medics must not put work before God. Exodus 20:3,4 clearly teaches this is wrong.

Third, as the Body of Christ at work in the world, our work should meet human needs. We need to consider this in choosing our speciality. Richard Baxter, a 17th century Puritan, said: 'Choose not that calling in which you may be most rich and honorable in the world, but that in which you may do the most good'.

Fourth, we serve an excellent God so we should aspire to excellence: 'Do your best to present yourself to God as one approved, a workman who does not need to be ashamed' (2 Timothy 2:15). However, excellence must extend beyond just technical or academic excellence (important though these are). It should encompass a vision for excellence as a service to people.

Fifth, work has to be done in a way glorifying to God. He hates dishonesty; we need to beware of the subtle ways doctors can be dragged into this. Dishonesty ranges from consultants doing too much private work in NHS time to a medical student on the ward round saying, 'The results aren't back from the lab' when meaning 'I forgot to take the blood!' It can be as serious as forging research results or as trivial as allowing your secretary to say you are out when you're in! We need to work hard to ensure our own Christian integrity and the integrity of our organisation.

Sixth, we should be enthusiastic for work! Colossians 3:23 says,'Whatever you do, work at it with all your heart, as working for the Lord, not for men'. One of the most corrosive and debilitating forces in medicine is cynicism. Almost every ward round, management meeting and canteen meal is poisoned with cynical remarks. It prevents excellence and undermines teaching; relationships are reduced to two-dimensional caricatures. We will never be salt and light in our workplace if we are infected by cynicism .

The antidote to cynicism is Christian enthusiasm; this is not equal to mindless optimism. As Christians we are realistic about work in a fallen world. We know that it may be monotonous or difficult at times. However, we also know we have been given our work by a sovereign and powerful God. Christian enthusiasm doesn't ignore things that are wrong but gets its energy, power and vision from God. We know that our contacts with other people are often very significant; it is us as individuals who will largely determine the quality of that contact. As doctors we have the opportunity, through direct contact with patients and colleagues, to show the love of God to tens or even hundreds of people every week. In the power of the Holy Spirit, we must work enthusiastically. Then we will make a difference to our patients and institutions.

Finally we should seek to build Christ-centred relationships at work. The health service is based on relationships between doctors, patients, nurses, health professionals, managers and students. Many of these relationships have become damaged and corrupted by sin. Restoring and rebuilding these relationships is a key way in which we can serve God in our work. How can we do this?

Building Christ-centred relationships

  1. Be Servants. 'Do nothing out of selfish ambition or vain conceit, but in humility consider others better than yourselves... Your attitude should be the same as that of Jesus ... (who took) the very nature of servant' (Philippians 2:3-8).

    Doctors are not good at being servants! Being a servant means looking to others' interests rather than our own. We will listen to other disciplines and seek the good of the whole service, not just our speciality. We will seek to serve our patients and colleagues.

  2. Be Holy. '...just as he who called you is holy, so be holy in all you do' (1 Peter 1:15). In practice this includes avoiding gossip (hospitals are full of it!): 'Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up' (Ephesians 4:29). It also means being peacemakers: 'Make every effort to live in peace with all men and to be holy'(Hebrews 12:14). Finally it means sexual purity. Relationships between staff are often close and emotionally intimate. Sexual temptation can be very strong but '...among you there must not be even a hint of sexual immorality....' (Ephesians 5:3).
  3. Be careful with anger. There is such a thing as righteous anger (eg Jesus cleansing the temple). It may be right to be angry when incompetence, laziness or bad management put people at risk. But we must be very careful what we do with our anger: 'In your anger do not sin' (Ephesians 4.26). The health service is full of gossip and rumours: it is very easy to get angry at something which has little or no factual basis. James writes wisely on anger: 'My dear brothers, take note of this: everyone should be quick to listen, slow to speak and slow to become angry, for man's anger does not bring about the righteous life that God desires'(James 1:19).
  4. Exercise Christian leadership. In many hospitals and practices there is a vacuum in medical leadership; we have the opportunities to fill this. We should be willing to take positions of responsibility but as servants, not for self-aggrandisement. As a medical student there are opportunities to be salt and light in Medsoc or the student council. As a junior doctor there is the thankless but vital task of organising the on-call rota. Consultants or GPs have numerous opportunities to give a Christian lead in the management of the hospital or practice.

    Whatever our area of responsibility we need to exercise it with prayer for 'The Lord gives wisdom, and from his mouth come knowledge and understanding' (Proverbs 2:6).

  5. Be prepared to 'give an answer to everyone who asks you to give the reason for the hope that you have... with gentleness and respect' (1 Peter 3:15). Work is not the arena for evangelism but certainly is an arena for evangelism. There is an issue of patient/doctor power imbalance. It is my view that we should pray for opportunities and then wait to be asked, particularly as a student. But there is plenty of opportunity to tell other students, doctors and team members of the hope that we have in the Lord Jesus. You'll find many of them are desperately searching for hope.

Practical Applications

Avoiding spiritual schizophrenia is not easy. I want to finish with four practical ways to ensure that our work is an integral part of our Christian lives.

  1. Develop an accountable relationship. We need another Christian who we can trust and develop a close and honest relationship with. They need to know us and the pressures that we are under. We need to give them permission to ask searching questions about our behaviour and attitudes at work.
  2. Develop prayer partnerships. If our work in medicine is part of God's work then we should be praying for it. Pray for our service, institution, patients, colleagues, and ourselves. Prayer works!
  3. Seek Christian career guidance. Romans 12:3 exhorts us to have a right view of ourselves. Think about taking up jobs locally where you can keep in contact with church and Christian friends. Have a realistic view of your skills, response to stress and ability to withstand sleep deprivation. Do not take a job that is going to stretch you beyond your limits unless God tells you very clearly to do so!
  4. Spend time with God in Bible study, prayer, worship and meditation. Work is an integral part of our Christian life but it must not take the place of building our relationship with God. Our work will fade and die but our relationship with God will last for all eternity.

Further Reading

  • Ryken L. Work and Leisure in Christian Perspective. IVP.

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