We
have received a very interesting email from a woman we shall call
‘Sarah Jean’. Here is the email, with some of the details
altered:
Dear
Orthodox Monk:
I
just started reading your blog, and have enjoyed it immensely. I was
just writing because I have a question.
I
am interested in becoming an Orthodox nun one day, but I have a
health condition. This condition does not keep me from leading a
normal life, but I have to take medication for it. Because of this,
I am going to have to have health insurance. I was just wondering if
I even have a chance of being considered for the monastic life.
Thank
you for everything.
Sincerely,
Sarah
The
issue here is whether a pre-existing medical condition might prevent
Sarah or anyone else from joining an Orthodox monastery.
There
are a number of aspects to this question. The first is the economic
issue of whether Sarah Jean can expect to be accepted into an
Orthodox monastery in the United States when she has a pre-existing
condition that requires medical insurance—obviously because someone
has to pay for the medication that she will have to take for the rest
of her life.
This
is part of a broader issue. Let us suppose that we screen random
young men or women in the population for pre-existing ailments,
removing those who have them so that we are left with 100 healthy
young men or women. Now let us put them into a monastery of monks or
nuns as the case may be for the rest of their lives. Obviously some
of these healthy young men and women are going to fall sick over
their lifetimes. They might have dental problems. They might have a
hidden ailment that is genetically based that comes to light after 20
years in the monastery. They might get cancer. They might have an
accident in a workshop or in a car. They might get mentally ill.
Any number of things can and might happen. So what then?
Should
the monastery accept postulants and make them monks or nuns for only
as long as they are healthy, expelling them if they get sick? Should
the monastery demand that each postulant have enough money to
purchase medical insurance for the rest of their life before they
enter the monastery? Obviously not. Clearly the monastery has to
make some provision for the medical and dental care of its monks or
nuns. This can range from private medical insurance to
self-insurance (i.e. the monastery is wealthy enough to pay its
monastics’ medical bills out of pocket) to government medical
insurance in those countries that have such a thing. So the clever
postulant would inquire what the policy is of the monastery that they
are thinking of entering concerning medical issues.
Now
we can see that Sarah Jean must necessarily ask about such a thing
even if she isn’t clever at all—she needs medication every day
and someone has to pay for it.
Now
every monastery is different and every monastery will have a formal
or informal policy on the matter. It seems to us that just as the
monastery will want to know about each postulant’s medical history
each postulant will want to know about the monastery’s policy on
medical and dental treatment. Only the foolish, naïve postulant
will accept an answer that God provides or similar handwaving.
Now,
as far as we know Sarah Jean is thinking of joining a monastery in
the United States. We frankly don’t understand Obamacare and its
ramifications for the medical treatment of monks or nuns on a
lifetime basis. This is not because we have a political position.
Rather, just as a practical matter we don’t know what the
implications of Obamacare are on this point. We do know that some
countries have cradle-to-grave medical care for citizens and perhaps
even for legal residents of the country who are not citizens.
Certainly Sarah Jean could join a monastery in a country in which the
state would cover her medical expenses for the rest of her life,
assuming that Sarah Jean was happy with the country and the monastery
and could integrate into the culture of the country; and both the
monastery and the country were happy with Sarah Jean. St John of
Sinai recommends ‘exile’—living in a foreign country as part of
the monastic vocation—but not everyone is capable of doing that or
even willing to do it.
This
is something that Sarah Jean will have to discuss with the monastery
she is thinking of joining. For to become a nun, Sarah Jean will
have to join a specific monastery; there’s no other way to become a
nun. Same for becoming a monk.
So
this is the economic dimension.
Now
there is another dimension. That is the impact of a pre-existing medical condition on the potential
monastic vocation. This is a
delicate matter and we do not want to offend anyone. There is a
broad spectrum of pre-existing conditions that a person might have.
Some of them are purely physical but some of them involve
genetically-based emotional disorders. In general, a medical
condition that allows a person to live normally if the proper
medication is taken should not affect a monastic vocation. However,
it should be understood that the monastic vocation is a struggle
towards perfection and therefore inherently more stressful than
married life in the world. Hence given the specific medical
condition that Sarah Jean has (and we have no idea what it is) one
would have to assess the effect of the monastic life on the potential evolution
of the condition.
One
can see that simple physical problems—let us say that the body does
not produce a certain enzyme and the person has to take the enzyme
orally—should have minimal effect on the vocation.
However,
because of the stress inherent in the monastic vocation complex
emotional problems might have a very serious evolution were the
person to become a monastic, so much so that major mental illness is
normally considered to be a natural impediment to the monastic
vocation.
In
the middle are more complex physical ailments such as type 1
diabetes, which requires constant medical monitoring and which has
serious ramifications both for the physical and for the mental
wellbeing of the person suffering from it. That is, while the person
suffering from type 1 diabetes might well be able to carry on a
successful professional career, their lives are by no means simple
and it is not at all obvious that they would be able to become a
monastic. In these middle cases, the monastery would have to make a
discernment whether it was the will of God for the person to
undertake a monastic vocation and whether it was the will of God for
the person to undertake the monastic vocation in that monastery.
Two different questions. In our example of type 1 diabetes, it
might be that the person has a vocation but to a specific monastery
where their condition can for some reason easily be monitored—maybe
the monastery is next door to the local diabetes clinic.
Also
in the middle are complex neurological conditions.
In
thinking about this issue of pre-existing conditions, one should also
consider the following. Going back to our hypothetical example of
100 postulants who are perfectly healthy, assuming that they were all
to become monastics in our hypothetical monastery, some of them will
develop a condition where they no longer produce a certain enzyme and
have to take the enzyme the rest of their lives; some of them will
develop major mental illness; and some of them will develop if not
type 1 diabetes, then type 2 diabetes, which can be just as difficult
to manage as type 1 diabetes. Moreover, some of the 100 postulants
will ultimately develop neurological illness, whether Alzheimer’s
or multiple sclerosis or whatever.
So
from the point of view of the monastery there has to be the
possibility of caring for these people who started off healthy but no
longer are healthy across the full spectrum of possible medical conditions.
This is both economic and spiritual. In other words it’s not just
a matter of paying for these persons’ medical care, but of being
able to care for these people emotionally and spiritually within the confines of the monastery.
Finally,
in considering a vocation the monastery has to consider the
following. What is going to be the effect on the rest of the
monastic community if the person under consideration is accepted?
Let us take the obvious case to see what we mean. Let us suppose
that we accept someone who is medicated for serious mental illness
into the monastery. Is the monastery resilient enough to accept the
stress of the entry of that person into the monastery without
excessive distortion of the monastery’s social system? A monastery
is not a refuge; it is a wrestling arena for healthy people to strive
for perfection. Hence if the monastery is large and robust, it might
conceivably be able to accept such a person into the monastery
without a distortion of its fundamental purpose. However, if the
monastery is not so large or not so robust, acceptance of such a
person might distort the social system of the monastery so much that
the monastery no longer meets its primary objective of providing a
wrestling arena for healthy people to achieve spiritual perfection.
In such a case, there is going to be a crisis in the monastery
because the serious spiritual seekers will be disappointed and leave.
This model analysis applies to all medical conditions from the
simplest and mildest to the most extreme.
So
to summarize:
1.
There is an economic issue which has to be discussed with the
monastery.
2.
There is the issue that the monastery has to care both economically
and spiritually for its members who fall ill on the road of life. A
monastery which didn’t wouldn’t be worth joining.
3.
There is the issue of whether the person entering with a
pre-existing medical condition can reasonably be expected to live a
serious monastic life given the particular stresses of such a life.
4.
There is the issue of whether the monastery is resilient enough to
accept the person with their medical condition without excessive
distortion of the monastery’s primary goal of seeking
after spiritual perfection.
We
would suggest that Sarah Jean discuss the above with her doctor, her
confessor and any monastery she is considering joining. As we said,
we have absolutely no idea what Sarah Jean’s condition is; we are
just trying to give a comprehensive analysis of the issues. We wish
Sarah Jean well.