Cappadocian Infirmity

The Cappadocian Fathers on Human Fragility and the Church’s Response.

John A. McGuckin

Throughout the ancient Greek-speaking world in the time of the Christian Fathers, Plato and Aristotle still represented a core and pervasive theme in ongoing societal attitudes to the question of the value that was held on life by wider Greek society. Those Christian Fathers, such as the Cappadocians, who were deeply educated in the classics, can often be seen to be making an explicit bridge between Hellenic concepts and biblical traditions, where each plays a part in a freshly posited synthesis designed to allow the light of evangelical values to inform a new culture. In matters of ethics, however, the evangelical prescripts generally play a specifically corrective role, for the Greek Fathers, both to the earlier Hebraic as well as to the Greek philosophical traditions. This can be clearly seen in the Cappadocian approach to physical deformity (specifically in regard to the much-feared scourge of leprosy in antiquity), as well as in relation to chronic sickness. As Monica Tobon has pointed out, all three major Cappadocians, as well as Evagrius of Pontus, their common disciple, specifically de-stigmatize the chronically sick person in ways that elevate him, or her, to a position of significance in contributing to the body of the church in a deeply spiritual way, both as holy icon and practical teacher of virtue: and this in marked contrast to Augustine, for example, who is much more inclined to the negative view of the sick and the person with atypical body in line with the classical tradition of the leper as a horror of inutility, and the biblical aspect of the sick person as example of one punished by God for sinfulness.

Plato and Aristotle had each suggested that legislation surely ought to be introduced by the authorities to make compulsory the killing of all deformed infants (an ubiquitous part of ancient society without widespread healthcare systems worth speaking of). If common Hellenic opinion had shied away from their drastic positions, which both thinkers had (perhaps ironically) posited as provocations more than serious policy, it was nevertheless the kind of small detail that gives us pause. However ironical it had been meant, clearly neither thinker was meaning to dissent from the position that the sick person had lost his role as a fully functioning member of human society. Apart from the philosophers, wider Greek society certainly placed little intrinsic value on any infantile life that was not perfectly aesthetically formed, albeit preferring to leave the actual death to the obscurity of a socially sanctioned abandonment (which was then supposedly acceptable to the gods since it had not been directly inflicted by the parents).

Even in those cases where medical attention was available in Antiquity, a Greek physician was trained to identify those matters which he had a good possibility of curing, and would refuse to treat a patient whose condition was beyond him; not least on the grounds that accepting such a case would damage his own reputation. Those lucky enough to access a skilled physician would be the rich, or perhaps the valued slaves of a rich household. And yet, if the medical and operating conditions attending the armies even into the late nineteenth century give us good cause to shudder, one can only imagine the conditions applicable in Late Antiquity. Otherwise, for the ordinary ancient, life was cheap and very often short.

The pre-Christian Greek world philosophized that a person’s value was entirely determined by what they could offer society at large; and for this reason a chronically sick or permanently disabled person was seen by Plato to have little positive value, more of a negative charge on the body politic. This is why the Academician has Socrates voice the story of Herodicus as a warning. The latter was a medically skilled man who, we are told, fought against his advanced ageing decline by healthcare self-treatments. Plato dismisses him as an example of a foolish person who spent his life energy struggling pointlessly against death but, in, and because of, that very process, being rendered unfit for life.

Illness and disability were widely seen by the ancients as a punishment or curse sent on human beings from the gods; either for an individual’s wrongdoing, or that of his ancestors. The idea is also frequently found in the Hebrew scriptures, not consistently so by all means, but alongside other views which attribute illness to natural causes. The Old Testament associates illness with ritual impurity, or sees it as a punishment for sinfulness (an attitude that ran on into Christianity too, despite Jesus’ teaching in Jn. 9. 1-38) and this was undoubtedly the case for Greek society as well. All in all, it amounted to an admixture of very fearful attitudes to human sickness and impairment. Among the Greeks the notion of illness as a curse sent from the gods was common. Less common was the concept raised in parts of the Hebrew scriptures, and seen particularly in the Psalms, that human illness and suffering might be good cause to move God to pity through prayers for help: a notion that becomes particularly dominant in the more positive of the Christian approaches to infirmity. The early monastic writings, for example, make it an especial commandment for others not to attribute an ailing monk’s sickness to any sinfulness on his part (demonstrating that such a corrective was necessary by the fourth century); and, as A.T. Crispin has shown abundantly, the philosophy of caring attentiveness to the sick and aged of the community, put into social practice by the early monastic houses, became a factor in Christian social thought that would give rise to the idea of a more extended healthcare system: even though hospitals in Late Antique and Byzantine society never catered to more than a very tiny population.

The monastic communities emerged in a conscious self-distinction from local society. This was not a radical cutting off from secular local communities, of course, but in Egypt certainly a massive self-distancing from the kind of secular healthcare on offer, at the well-attended temple-clinics of the Isis and Aesculapian priests. These were seen by the Christian hierarchs to be fundamentally tainted by demonic influence, and while ordinary local Christians may well have had recourse to them (a complaint addressed even into the fifth century by Cyril of Alexandria) the monastic communities from the outset determined to perform their own healthcare ‘in-house’, as a work of the highest order of charity.

In this respect, monastic estates were following an even older praxis of classical society, which expected the master of an estate to be skilled enough in medical knowledge as to offer basic care and healing services for the members of his estate, who were regarded as an extended household. It is this which leads us on to the Cappadocian Fathers, for such is exactly the path by which three very wealthy estate owners, saints Basil of Caesarea, Gregory of Nazianzus, and Gregory of Nyssa, came to reflect on the place of those persons with disabilities and the sick, within their new ‘extended households’ of the episcopal dioceses to which they had each moved, after first inhabiting their own private estates composed of family and servants. All three were also deeply aware of the monastic initiatives; Basil and the elder Gregory having both studied a wide array of monastic communes during the time of their classical education. Gregory of Nazianzus reflects a lot in his poetry on his own sense of recurring illnesses, and he tells us also that Basil’s consciousness of the fragility of the sick derived from the latter’s personal experience of fragile health. By caring for others, Gregory says, Basil mastered his own condition.

Basil and Gregory Nazianzen made a deliberate synthesis of monastic and aristocratic landowner behaviours in their own episcopal dioceses. Gregory of Nyssa, the brother of Basil, was educated by his sister, the abbess Macrina, on the monastery which doubled as their own country estate near Annesos, and he also took higher studies with Gregory of Nazianzus. Basil and the latter Gregory were very close friends from university days at Athens. Gregory Nazianzen, who is called ‘The Theologian’ in the Byzantine tradition, spent ten years in the schools of rhetoric there as well as at Alexandria, and his own brother, Caesarius, was a skilled physician who personally attended the Emperor Julian. He and Gregory of Nyssa both mentored the education and employed the services of the deacon Evagrius who later went on to become one of the leading lights in Egyptian monasticism, and who composed one of the most important guides in early Christian literature to mental health. It was Gregory of Nazianzus who named his friend ‘Basil the Great’ and collaborated with him as a scholar, and a practical colleague in the working out of his diocese: not without mutual frictions .

All three intellectual bishops came together on a project designed to move charity and care for the sick out of the private domain and into a more broadly structured social context, by securing funding (not least that of the imperial household of Valens) for the construction of a large health and welfare centre outside the metropolis of Caesarea Cappadocia. This was initiated in the early days of Basil’s assumption of the metropolitan episcopal see there, and instigated his co-option of the two Gregories to assist him in the project; which is why we have specific reflections on the topic from all three. Gregory of Nazianzus’ Oration 14 ‘On the Poor’ is, in all probability, the actual fund-raising speech which was addressed in 368 first to the local crowds at Caesarea present at the annual festival (whom Gregory reminds how fearful they were because of the numbers of lepers assembling on the fringes of their great fair) but then also to the imperial court at Constantinople, from whom he was hoping for the major funds for endowment, if the locals at least initiated the building. Basil, as metropolitan archbishop was to direct monastics to staff it. In this way both he and Gregory the Theologian re-shaped the monastic charism by bringing it from the desert fringes, into the suburbs of the city and towns, and setting at the heart of its longstanding charism of hospitality, the new concept of the regular, long-term, care for the sick, the elderly, the impaired and the poor.

All three theologians had certainly studied basic medicine and fundamental principles of healthcare in the course of their youthful studies. It led them not only to think focusedly about welfare, but this new practical involvement made all three bishops lay down the first systematic theologico-philosophical reflections on illness and disability by Christian intellectuals in the Late Antique era. Accordingly we can now consider, more specifically, the Orations 1 & 2 On the Love of the Poor by Gregory of Nyssa, Oration 14 on the Poor by Gregory of Nazianzus, and selected parts of Basil’s ascetical writings, to see what foundational elements were emerging out of four centuries of Christian reflection on evangelical principles by these classically trained and remarkably creative Greek minds.

Basil became one of the most important legislators for Christian monasticism. In the Long Rules (Asceticon) that he set out for monastics he specifically deals with the question of the care of the sick. One presumes that some monastics, who had persuaded themselves that the ‘real monk’ was one who wholly abandoned society and social constraints, had complained about him ‘tying down’ monks not only in obedience to a bishop, but also through the day-to-day service of the poor (which was Basil’s idea of a ‘real monk’). The response to Question 55 of the Asceticon is his answer to critics. He begins by acknowledging that the medical arts, as currently practised, have indeed been associated with pagan gods, but insists that the medical art, qua tale, is the gift of the One True God, and as such is holy. It becomes necessary, just as ploughing sowing and eating crops became necessary for humanity, as the result of our original immortal and pain-free nature collapsing and now having to eke out its existence in this present world:

When we were commanded to return to the earth whence we had been taken and were united with the pain-ridden flesh doomed to destruction because of sin and, for the same reason, also subject to disease, the medical art was given to us to relieve the sick, in some degree at least.

Basil does not mean here that an individual’s sickness is the direct result of their personal sin; rather that alienation from God’s first blessing of our prior immortal and beatific nature resulted in a general collapse of human beings generally into that ‘second human nature’ that had degenerated into ontological decay: namely death, that brought along with it a panoply of ills including sickness. But just as sickness is the corollary of the fact that we now die, so too the healing arts are the divine gift that symbolizes the potential of healing, and which ultimately foreshadows the rescue of that basic flaw of the ‘second nature’: divine redemption and promise of restoration.

All the Cappadocians followed Origen’s strong lead in concluding that the Genesis account of the Fall could not be taken literally, but nevertheless did connote that present-day humanity was not the original, or even the primal ‘divinely-destined’ nature of Humanity, rather its sad fall into decay (Ptharsia), and that it was into this ontological collapse that the Incarnation of the Divine Word came about as restorative healing (Soteria). The implication of this initial premiss was that even the apparently healthy person is chronically ill, afflicted with a false nature (the body of death) and in this is no different substantially (that is, ‘naturally’ speaking) from those who are more obviously chronically sick in physical terms. There is no ‘Us and Them’, healthy and sick, in this schema. As Heather Morgan has eloquently argued, there is only the one body of afflicted human beings being called back into a mystical union of charity into the oneness of Christ’s healing body; his communion of salvation and immortality. It is a theological point which Gregory of Nazianzus will also major on.

Basil goes on to argue that our experience of illness which naturally evokes anxious concern for the body, is given a positive value by God as a reminder that we ought to be as assiduous for the care of the soul, the root of our truer and immortal capacity. For Basil, illness demands a spiritual analysis at the outset: ‘When we suffer the blows of calamity at the hands of our God, who ever directs our life with goodness and wisdom, we must first ask of Him understanding of the reason He has inflicted such blows; and then deliverance from our pains or patient endurance of them, to this end that, along with the trial, He may also grant that we may be able to bear it.’ Basil significantly warns that not every illness is the result of a physical malfunctioning. If this were the case we should always simply seek for a practical healing art to match whatever troubled us. But some illnesses, he says, come from other than physical causes. Some are malevolently caused by demonic forces, some are willed by God as a corrective or admonition, and accordingly it is very important to discern for oneself, or seek a spiritual guide’s superior discernment, how the soul is to be led through the bodily experience to a new condition of trust in the divine source of life; rather than treating the body as if it were a physical thing apart; the common context of almost all medical healing today. Whether in sickness or in health, Basil argues, the soul ought to trust in God’s loving and unremitting mercy and live through the body to give glory in all things until the blessedness of the Kingdom is restored to us.

In his Oration On Mercy and Justice, Basil turns his mind to his favoured modality of practical applications. The Church he says, is called to be far more philanthropically inclined than anything we find in the Old Covenant. There, the fields were not to be stripped bare at harvest time, for the sake of the poor, who could glean after the reapers had passed. But now, he says, Christ has commanded us to exceed the Pharisees in our virtue if we are to have any hope of entering the Kingdom, and the Apostle has ordered believers to work diligently that they may have enough resources to aid the poor. Monastics who have already followed the ‘perfect way’ to dispossess their goods for others might indeed be justified in moving on towards a spiritual ministry; but the general body of believers, he argues, are committed to an unending ministry of charity so as to provide an ikon of God’s mercy to the world: ‘God requires a continual sharing and communicating of the goods we possess, that, by showing mercy, sharing our goods, and conferring benefits, we may reproduce in ourselves the benevolence of God. As he said: ‘Give and it shall be given to you.’ What is more, God has promised that if we practice these virtues, we will be made one with Him.’

For Basil, this action of practical philanthropy at the very heart of the Church’s daily life and, thus, social praxis, is a sacramental participation in the redemptive philanthropy of Christ. It ‘makes’ the Church; for it renders it into the mimesis of Christ the Philanthropos and thereby gives it a share in the redemptive work of God:

Ready kindness shown to the saints is piety toward Christ and he who ministers zealously to the poor man becomes a comrade of Christ, not only if he is rich and shares great possessions, but even if he offers to the needy the little that he has; even if it is merely a cup of cold water which he gives a disciple to drink, in the name of a disciple. The neediness of the disciples (which to the worldly mind is just poverty) is a source of true riches to you, O wealthy man, for thus you become a co-worker with Christ. You nourish the soldiers of Christ, and this, not under compulsion but willingly.

The harvests of the year 369 had drastically failed in Cappadocia and that year following, the region suffered the worst famine for generations. Basil immediately used the forces at his command as bishop to organize relief kitchens, but the extent of the deaths demonstrated to him that far more was needed. With Gregory the Theologian, by 368 he had already planned to provide a solution to the paucity of healthcare in his diocese, and now in response to the crisis, he went beyond the emergency food kitchens and rallied Gregory Nazianzen to circulate his oration to solicit the larger funds needed to build an extensive complex of buildings on the outskirts of Caesarea.

Gregory’s appeal for funds was a pioneering and major treatise on the Christian philosophy of charity and care for the sick. It was eventually sent as far as the imperial court at Constantinople, where the theologian had many friends in high office, but it was also used at the festivals of the local saints, the Cappadocian fairs celebrating the martyrs, which brought large crowds together, even in this time of recovery after the famine. The aftermath of that latest disaster was not a time when people felt they had excess money, and this is why the orator focuses his work on appealing for funds to build a shelter for lepers. The eventual complex has been given the name of Basiliad and because of Gregory Nazianzen’s generous encomium of Basil in his Oration 43, has generally been assigned as Basil’s chief philanthropic work; but while it was certainly a mind-child of Basil, the two Gregories, of Nazianzen and Nyssa, were equally involved in the project.

The orations on the love of the poor from both these latter theologians appealed to the common interest of the local crowds, who were terrified at the manner in which throngs of lepers also gathered at the fringes of the festivals, seeking these occasions of collecting subsistence alms. The church’s plan to give them a stable base and obviate their wandering around on the highway seemed a good proposal on all fronts. The Basiliad, however, had a wider remit than simply being a leprosarium to contain the diseased in a disguised quarantine. It was intended to treat sickness positively and to demonstrate that the concept of rampant infection, which had so terrorised the locals, was an exaggerated one. Basil ordered his monastics to staff the complex. He had learned that concept from seeing what his mentor Eustathios of Sebaste had accomplished in his own monastic foundation, which Basil had witnessed at first-hand.

The Basiliad seems to have been made up from a set of separate portico buildings. At the centre of which were the church and next to it a two-story dwelling for the bishop himself and (on the lower floor) his senior staff. This was not the permanent episcopal residence, to be sure, but an important official resting place and staging post nevertheless, complete with post-horses and waggons which he also used to convey the sick to the ‘Ptochotropheion’. In an official letter, Basil deliberately places this residence at the convenience of the local Governor and other imperial officials: thereby not only advertising its presence but encouraging them to take note of it, use it in their official business and perhaps support it from official funds; even perhaps to emulate it in different parts of Cappadocia. Other than the church and episcopal residence, there were buildings to house the monastic staff, and separate buildings for the old infirm, for orphaned children, for contagious diseases, for lepers (a keluphokomeia), a hostel for the indigent homeless and for passing travellers, and training shops to give the sufficiently recovered an occupation that would help them lead more independent lives. All in all, Basil’s innovating contribution has been compared to the invention of the concept of hospital; but his practical mindset has gone further than this term might suggest, in relating all the healing arts in a systemically structural way that envisages the healing of varied illnesses as a concept necessarily welded to that of providing a planned path to self-sufficiency. What is more, the needs of the suffering, often understood in a sense as a certain ‘passivity’, are rendered by him into a positivity, by virtue of the fact that these ‘recipients of charity’, he says, thereby become the ‘teachers of virtue’ of the monastics who serve them: their higumens in a real sense, that is those who ‘lead them’ in the way of ascetical perfection.

Comparing it to a new and better ‘wonder of the world’, St. Gregory the Theologian gives one of the most enthused descriptions of the Basiliad, in his funeral encomium (Oration 43) for Basil: ‘ Go forth a little way from the city [of Caesarea],’ Gregory says, ‘And behold the ‘New City’, the storehouse of piety, the common treasury of the wealthy… where disease is regarded in a religious light, and disaster is thought a blessing, and sympathy is put to the test.’ Subtle as ever in his expression and biblical allusions, Gregory tests his listeners’ theology, seeing if they can recognize his allusion to the Basiliad as a new city which concretely represents the ‘New City’ of the Heavenly Jerusalem on the earth: made real there by the exercise of Christ’s philanthropy. Here, in the scripture to which he alludes sub-textually, Gregory is envisaging the effort towards healing the sick in the bosom of the Church as a palpable fulfilment of that prophecy that the Bride, the Church, will be glorified in that supreme divine healing and mercy which is to be made apparent in the End Day. In short, Basil’s Ptochotropheion is, for Gregory, no less than the Church (acting in philanthropy) becoming an eschatological sign of the New Age.

Basil’s insistence that the healing process should lead on to self-sufficiency for those who are in need at the Basiliad, is taken a stage further by Gregory of Nazianzen in his treatment in Oration 14. In this most important, but relatively neglected discourse, Gregory shatters the Hellenic notion of the sick or impaired person as societally useless and as cursed by the gods and turns his argument instead on the concept of the disfigured leper as the Ikon of Christ in the world. The notion must have struck the Hellenists as ridiculous and even the Christians as somewhat blasphemous: to compare the glorious Son of God to the poorest of the poor among Late Antique humanity. Gregory’s consistent point, however, is that the eternal Son of God emptied himself out in a shocking Kenosis in order to save, heal and sanctify the human race. It was his disfigurement in his Passion that became humanity’s path to glorification, and even, in the mystery of the Church, the believer’s potential deification (Theōsis). It is precisely this salvific economy (Sotería) which allows the leper to be seen as a vividly true Ikon of the Son of God, one meant to elicit and inspire the fire of love and compassion within the Church, so as to make it become what it was meant to be within the world: the true society of compassion.

Gregory argues in the Oration that to serve the poor and the suffering is to serve Christ whose Ikon they are: ‘If we place any reliance on Paul or on Christ himself, then we shall take love as the first and greatest of the commandments…and accordingly take love for the poor as the highest pinnacle of charity… in no other way whatsoever can God be served religiously except through mercy.’ He goes on to argue that the present prevalence of suffering in society is largely the result of the great imbalance present in social resources: the rich having too much and the poor being left to suffer the unfair consequences. His constant appeal in the Oration to ‘rebalance’ financial assets by generous almsgiving is in accord with his philosophical doctrine of ever seeking the golden mean (the wise balance). In the human nature, which for Gregory is the ‘third creation’ (a problematic mix of spiritual awareness and physical fallibility), that balancing point in a life which tips towards the physical, brings with it untold suffering. The balancing point which Christ Philanthropos came to restore was moved back towards the divine and immortal, the gift of theosis. Those, Gregory says, whose charity is not moved by pity for the suffering in order to offer concrete help and sustenance, are thereby themselves proven to be more sick than the worst cases of leprosy that so horrify them.

Gregory of Nyssa’s first Oration on the Love of the Poor (which is aware of the earlier work by Gregory Nazianzen) was composed in Lent, as a sermon concerned with advocating fasting and almsgiving. From the outset Gregory redefines fasting in the manner of Isaiah: that a truly pure fast would be to: ‘Share your bread with the hungry and lodge in your own house the poor who have no shelter.’ Daniélou suggested the sermon came from 382, because of the references to war refugees coming in to the area and causing a crisis in local social welfare systems. Gregory’s appeal begins with an explicit call to the rich to alleviate the sufferings of the poor, but also calls on the ordinary faithful to console the troubled with the word of God, but not, in doing that, to neglect practical assistance: ‘For dialectic will hardly enrich those who are in straits.’ The sick and bedridden are included in his remit of ‘the poor’ and he urges his listeners to remember that these are ‘the other poor’: ‘Let everyone take care of his neighbours. Do not allow someone else treat those of your own neighbourhood. Don’t allow someone else rob you of this treasure laid out for you.’

As with Gregory Nazianzen, the sick indigent, whom some (he says) might be tempted to scorn are defined as a living and dynamic ikon of God: ‘Do not despise those who are laid out on the ground, as if they deserve no respect. Consider who they are, and you will discover their true worth. They bear the very visage (prosopon) of Our Saviour; for the Lord in his goodness has given them his own visage in order to cause the hard hearted, who hate the poor, to blush with shame.’ The practice of mercy to the needy, he argues, is an energeia that positively transforms the beneficent person into the image of God himself: ‘Mercy and good deeds are the works that God loves. When they become habitual in persons, they divinize (theoūsin) them and stamp them into being the likeness of the supreme goodness so that they may even become the ikon of that pure, immortal, nature which surpasses all conception.’

‘Beneficence (eupoiía)’, Gregory says, ‘Is more exalted than other feat of prowess, and assists God who is the friend of the good man…. the author of philanthropy.’ Using the philosophic trope that a good person lives temperately, Gregory gives many examples of excess and debauchery common in the lives of the wealthy and, alluding to the parable of Dives and Lazarus where the rich man met his judgement for refusing to assist the beggar at his gate, he concludes: ‘Think of all the wine bowls, tripods, jars, ewers, platters, varied cups, jesters, mimes, kithara-players….. all the equipment of debauchery ….. and all the while a myriad of Lazaruses sit at the gate……but they cannot be heard over the cackling laughter.’

He turns his audience’s mind to consider the judgement so starkly set out in the Dives parable: how the rich man was condemned for his obliviousness to the pain of others and concludes: ‘So, how can you elude this threat? By choosing the way, which is alive and fresh, as indicated in the scripture…I was hungry, I was thirsty, I was a stranger, naked, sick, and a prisoner. Whatever you have done for one single person, it is to Myself that you have done this. So come then, blessed of my Father.’ His practical advice follows shortly after: ‘I think above all of those victims of a terrible illness. The greater the attention [you offer], the vaster will be the blessings that await a faithful servant of the command.’ Gregory appeals to common human compassion to remember that the deformed leper is a human being, a child of God, bearing his sacred image: and yet, he says: ‘They have been driven out from all lands, as if they were the enemies of the human race. They are not considered worthy of a roof, a common table, or any stick of furniture.’ At the culminating point of his appeal for sympathy for the sick, and well aware of the continuing existence of the Basiliad as a model, Gregory turns his argument to a precise practical point: Rhetorical sympathy is not enough on his part and sad poems that his audience might sing about the plight of the leper are offensive to natural justice: ‘Is one not sinning against the natural law by reducing this person’s suffering to theatrical phrases, treating the disease with a speech or memorializing it with a sad song? Is it not necessary, rather, to let our compassion and love for one another shine forth radiantly in action’? And he has something quite precise in mind: the passionate appeal that Leprosaria should not be built up from any policy of placing such institutions on the far outskirts of the empire, out of sight, out of the way, and eventually out of mind: ‘Let no man say that some place far away from our life is perfectly sufficient and send them off to some frontier with a supply of food. A plan of that kind displays neither mercy nor sympathy, but under the disguise of goodwill it is designed to banish these people utterly from our life…Resolve that this inhumanity will not triumph!’

In the end of the discourse, like his brother Basil and his teacher Gregory Nazianzen, Gregory commends the care of the sick, because there is only one body: comprising those of good health and poor health alike, bonded in the love of God who transfigures all in a divinizing redemption: the healthy receiving God’s mercy just as they themselves are called to afford their energy to those in need. ‘For sympathy to all the unfortunate, in this life, is a very profitable thing for the healthy. It is a beautiful thing for a soul to provide mercy to others who have fallen into misfortune. For all humanity is governed by a single nature. No person possesses a guarantee of continual happiness. We must never forget the Gospel precept that we should treat others as we would wish others to treat us.’

In conclusion: what is common in this approach from all three theologian friends, therefore, is a remarkable attempt to change the axis of social opinion on the sick and disabled, by a combination of practical action and philosophical dialectic. Beginning with an appeal to the self- interest of their local community, they offered the prospect of removing the frightening practice of lepers congestedly congregating at the town limits on the regular occasion of the gatherings for country fairs (coming to seek alms for basic subsistence). The theologians offered the prospect of a dedicated health care facility in return for the locals’ financial support. But in their conception, such a facility would not be for the confinement of lepers (as some locals might have hoped) but would expand far beyond that to the shelter, treatment, and support of lepers, the elderly, temporarily sick and homeless: even to providing those who could benefit from adopting a livelihood with vocational training. This expansion of imagination they offered to their people, moved to include a refusal to allow the suffering to be placed at the fringes of society: out of sight and out of mind. Their common insistence was that the care of the needy was a duty that fell upon everyone, not just specialists, and more than this, the close involvement with the needy in some degree was important for the so-called healthy, actually to repair their own diseased state (of mind and soul) wherein they often thought to categorize the sick and needy as ‘inferior other’, thus failing to recognize that all human beings share the same fragility of nature (the ‘body of death’). This common lot of humanity tending towards death and corruptibility could only be reversed, the theologians argued, by assuming the philanthropic love of Christ who emptied himself out in solidarity with the corrupted race, in order to lift it back into a process towards immortality and health (Theosis or divinization): this praxis of love (or the life of ascentive virtue) being exemplified above all in the loving care of the needy and the sick. Those who engage in this process will find, so they argue, that what was once a frightening matter becomes a labour of love and the truth that there is one humanity and one ‘common body’ of Christ on earth will become manifest. The sick and poor thus emerge, far from being an offence, as in truth a primary Ikon of the divine Lord, and no less than ‘teachers in virtue’ to the majority who do not realize how sick they are in spirit, because their physical health masks them to themselves.

To end, we may remind ourselves of St Gregory Nyssa’s warning that rhetorical dialectic alone does not remedy the needs of the suffering; and we may recall St. Basil’s constant preference for action and planning as well as his genius for organization. Accordingly, we might turn our thoughts briefly to the question how does all this affect us today? especially in a time when, at least in the developed world, we have organized systemic processes of health care that exceed the boldest dreams of these Philoptochoi bishops and when often the care of the sick has largely been taken out of the hands of church.

Well, some things still strike me as enduringly relevant. Firstly the sense that so many places in the world continue to subsist in more or less the same state of health-care starvation that applied in the ancient world of the time of the Fathers. So much governmental budgets in the rich West are spent on secondary matters while still ‘a myriad of Lazaruses yet sit at the door’ as Gregory Nyssa once lamented. The Church could do much more in applying its oratorical focus to call out just how little a percentage of national budget is given to world aid, and how strangely that is applied. Such a little expenditure, relatively speaking, could make so vast a change in healthcare among the poorest of the world’s poor: if only there was a focused and intelligent philanthropic interest given.

Secondly, Basil the Great makes a profound point when he argues that not all illness can be located to a physical cause, and that spiritual discernment is required. In modern healthcare the differentiation of physical, mental, and spiritual health has developed to be not just a separation but more of a radical alienation. Materialist reductionism has so become the standard ideology that spiritual care, or the notion of seeking a balance between material, mental and spiritual energies in a human being is often dismissed as a nonsense by those most technically involved in caring for the sick. The Cappadocians did not want to supply an occasional chaplain to overlook large numbers of the sick, but rather to provide a wholistic environment of spiritual care where love is exchanged mutually between all who are equally ‘carers’, and who realize that they are mutually dependent: not one being ‘sick’ and the other being ‘OK’ but all standing in need of one another since all share the same body of fragility. This aspect that the sick should not be cared for solely by a set of specialists who can thus corral them into discrete places and to an extent isolate them there, has certainly not been entirely lost by the demands of today’s technological health industry (care in the community and care at home is still vitally important) but it has surely been massively impacted: and the resultant chasm between health ‘professionals’ and the sick who must be passive in the face of the treatment they receive from them is perhaps no less now than it was in Late Antiquity. The result remains the same: the sick and and those classed as disabled are locked into a false category in the general mentality, at best of the ‘other’ and at worst of ‘inferior’; which as the Cappadocians so persuasively set out so long ago, is contrary to logic, contrary to natural justice, and contrary to the vision that a loving God established for our common ascent out of the ‘body of death’ and to a common redemption to glory.