Getting the Order of Treatment Right in the ‘Field Hospital’ of the Catholic Church

COMMENTARY: As the hymn ‘There Is a Balm in Gilead’ reminds us, we are in need of not only acceptance, but healing.

We must see the malady and understand the cure.
We must see the malady and understand the cure. (photo: Unsplash)

In college, while otherwise happy hymns were sung at Mass, I found myself carefully reading the words of one hymn in particular. I couldn’t read music and so had no idea of the melody, but I would quietly recite: “There is a balm in Gilead to heal the sin-sick soul. There is a balm in Gilead to make the wounded whole.” 

The words hit home. In my high-school theology classes, I had oft been assured there wasn’t much sin out there, mortal or otherwise: God accepts us as we are. But the words of the spiritual held out hope beyond mere acceptance. In that hymn, I found a way to put words to my own sense of sin-sickness and woundedness. 

But more deeply than that, I came to see that I could be healed; I could be made whole. I didn’t want to be “accepted” as sick and wounded, I wanted to be healed and restored. Healing and restoration, as the hymn taught me, requires seeing the malady and understanding the cure: the God who “died to save us all.” 


A ‘Field Hospital’ Ecclesiology

My devotion to this hymn is a reason why I am both impressed by and disappointed by Pope Francis reflections on healing. 

Pope Francis’ ecclesiology has been a great gift. The Church, as he teaches, is a field hospital in a battlefield. To see this battlefield is to know there is no pretending things are “just fine” in our spiritual life. That kind of pretending alienated me in my late teens. Such pretending makes incoherent Christ’s salvific actions that are meant to bring salvus, healing. 

To speak of a field hospital is to get the order of salvation right: Learning we are sick opens us to the possibility of healing. Thus, the Church is a collection of the wounded and bandaged. Called together, we are offered healing by Christ, who “took up our infirmities and bore our sickness” (Isaiah 53:4). 

Like Francis, T.S. Eliot presents Christ as our “wounded surgeon.” He writes, “Beneath the bleeding hands we feel /The sharp compassion of the healer’s art.” This is the intimacy of Christ as our healer, an intimacy that so animates Francis’ pontificate. Almost as remarkable as Christ acting as our Doctor is the truth that Christ invites us into his ministry of healing. Wounded, we work with the Divine Healer to help heal our fellow patients. This is at the heart of a vision of accompaniment: wounded and lame, we help each other walk. 

Francis draws us into this mystery in his teachings on mercy. Theologians often emphasize an attribute or name of God: Being, Love, the Good. For Francis, God is Mercy and, in that mercy, we are healed together within the Church. “Such a community,” the Pope wrote in Evangelii Gaudium, “has an endless desire to show mercy, the fruit of its own experience of the power of the Father’s infinite mercy.” 

In experiencing God’s mercy in the Church, we can express God’s mercy to those within and without the ecclesial community. To evangelize, in this sense, is to invite others to be patients with us. To join us in a life of being healed and of offering healing. 


Who’s Perfect Anyhow?

For all of Francis’ richness on mercy, he has often offered less helpful guidance, or at the very least guidance that has been misused. If Francis is a great witness to the meaning of the Church as a field hospital, he is not always as helpful in guiding us towards the right medicines at the right time. Many of those who claim to be following Francis, including those in the episcopacy, are far worse. 

One of Francis’ most quoted statements is that the “Eucharist is not a prize for the perfect but a powerful medicine and nourishment for the weak.” There are a few problems here. The claim depends on a strawman argument. Who actually claims that the Eucharist is a prize for the perfect? No member of the pilgrim people of God is perfect. Just as manna was unnecessary in the Promised Land, so too the perfected saints no longer receive the Eucharist in the heavenly city. 

There are further problems with Francis’ description. It is interpreted as a critique of traditional Catholics who hold that the Eucharist should not be received in the state of sin (as taught in Scripture, Tradition and canon law). Oddly, they are accused of being perfectionists. But this is wholly wrong. We must face and repent of our imperfection. To not receive in a state of sin is to know my imperfection as sin-sick and wounded. To receive after having gone to the sacrament of reconciliation is to know my imperfections are being healed and made whole by Christ. 

Catholics who never go to confession and always receive are the ones who think they are perfect. To advocate for open Communion treats people as perfect and the Eucharist as something owed to them. Besides, the statement is a failure to read the sign of the times. In the U.S., refraining from reception is rare. Never entering the confessional and always entering the Communion line is the norm. This is the sacramental problem we actually face, a culture of self-perceived perfection that does not repent of sin and so does not convert to the way of the Gospel. 

Finally, in describing the Eucharist as medicine, sacramental confusion is spread. Transubstantiation does not lessen the importance of the symbolism of bread and wine; it depends on it and heightens it. 

We need to understand the sacrament through its accidental signs to understand its substantial reality. The Eucharist is first and foremost food, a sacred banquet. In it, we receive spiritual nourishment (bread) and spiritual joy (wine). Food can have a healing quality, but that does not make it medicine.


Getting the Order of Treatment Right

For those of us who know our sin-sick woundedness, the ecclesial field hospital has medicine to offer: the sacraments of reconciliation and anointing of the sick. One of the key things I learned in Wilderness First Aid (besides how to splint a broken bone) is getting the order of diagnosis and treatment right. ABCDE: Airwaves, Breathing, Circulation, Decision, Expose. The basic idea is to prioritize life-threatening dangers first, spinal dangers second and severe injuries third. 

Francis has this exactly right: “It is useless to ask a seriously injured person if he has high cholesterol and about the level of his blood sugars! You have to heal his wounds. Then we can talk about everything else.” 

However, treating the Eucharist as medicine gets the order wrong. The baptized need the lifesaving remedy of confession first. Too many of us think we just have slightly high cholesterol when in fact we are theological asphyxiated, spiritual bleeding out, and morally paralyzed. Having repented and received absolution, we are ready for the restoring nourishment of Eucharist. 

Our pastors, who are meant to offer healing, too often tell us we’re fine. They are like a wilderness medic who gives a granola bar to someone who can’t breathe. 

Cardinal Robert McElroy, citing Francis’ statement on the Eucharist as medicine, recently wrote, “The church must embrace a eucharistic theology that effectively invites all the baptized to the table of the Lord, rather than a theology of eucharistic coherence that multiplies barriers to the grace and gift of the eucharist.” 

This would be news to St. Ambrose, who turned away an emperor from the Eucharist for massacring civilians, to Bartolome de las Casas, who turned away conquistadors for owning slaves, or Archbishop Joseph Rummel, who excommunicated segregationists. It would be news to St. Paul, too: “Whoever eats the bread or drinks the cup of the Lord in an unworthy manner will be guilty concerning the body and blood of the Lord" (1 Corinthians 11:27). Each saw that certain sins damage the soul too much for reception of Communion. 

Nowhere in Cardinal McElroy’s article, nor in the subsequent interview he gave, does he mention the sacrament of reconciliation. But he does in a recent talk at Sacred Heart University:

“The sacrament of reconciliation is a unifying and powerful reflection on this love and mercy. But the pastoral practices that had the effect of excluding categories of people from full participation in the life of the Church are at odds with the fundamental notion that we are all wounded and equally in need of God’s healing.” 

But while Cardinal McElroy is certainly right to draw on the field hospital ecclesiology to emphasize that “all are wounded,” he is wrong to claim that we are all “equally wounded.” 

To understand that some are more wounded by their sins than others is not to “exclude categories of people.” Rather, it is to recognize that some actions that I do separate myself from Communion. When I sin, it is I who erect barriers. Las Casas well knew this when he turned away the conquistadors but welcomed the Indigenous. The former were committing categories of sin that cut them off from communion with the Church. 

Cardinal McElroy is right that Catholics too often overemphasize sexual sins. As we see in Dante’s ordering of sins in both hell and purgatory, they are generally lesser sins than spiritual, economic, racial or even ecological sins. These latter sins generally make us more wounded. 

Pride is the greatest vice; greed is the root of evils. Catholics who hold to the teachings of the Church on sexuality as we ought to should interrogate ourselves about our own lack of charity to homosexual and transgender-identifying people. More of us should attend to how we are complicit in exploiting the poor and the racially marginalized. When St. Ambrose teaches that our excessive possessions are stolen from the poor, more rich Catholics should seriously ask themselves if their thieving means they should be receiving. 

All this is right. But it doesn’t mean that sexual sins are not grave, too.

That too many Catholics think sexual sins are the only grave sins is a failure of our moral teaching. Eucharistic coherence does not just apply to the divorced and remarried; it applies to all of us. To live this coherence means that we need to prioritize the sacrament of reconciliation as the healing needed for when we, in our sinning, erect barriers to the grace of Communion. 


Reviving Our Soul

This Lent, my choir is singing Balm in Gilead. Written on the page before me, they are written on my wounded heart. Singing them, I join Pope Francis in praying that God “anoint our whole being with the balm of His mercy.” Being healed, we need to be ministers of mercy, wounded healers offering healing to all. But this requires that we take seriously the gravity of our sins, our deep imperfection, the barriers sin erects that pastors must identify, and the right ordering of our sacramental lives: conversion, repentance, absolution, Communion. 

We benefit greatly from Francis’ field-hospital ecclesiology, but at the same time, Francis, and far more those who advance problematic pastoral approaches in Francis’ name, have at times downplayed the treatment we need. 

As I sing Balm in Gilead with my choir, I am faced with new forms of sin-sickness, new wounds on my soul. I need my pastors to help me see them and then to join me in the confessional so that we can join each other at the table of the Lord, as sinners healed and made whole by the God who “revives our soul again.”