Monday, 2 June 2014

Medical Aspects of the Monastic Vocation

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.
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.

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