Healing in Luke, Madagascar, and elsewhere.

Already in the second century the author of the Third Gospel was identified as "Luke, the beloved physician" mentioned by Paul in Colossians 4:14. (1) For centuries afterward readers of the Bible saw abundant proof of the medical expertise that informed the gospel that bears Luke's name. When historical criticism tested long-held assumptions about biblical authorship, one of the notions to fall by the wayside was the conviction that the Third Gospel is a text written by a physician. However, beginning in the late twentieth century, scholarship has again begun to see in the Gospel according to Luke a text that exhibits a focused interest on issues of health and healing.

By my count there are more than sixty episodic references to healing and health in Luke; twenty of the Gospel selections in the Cycle C Revised Common Lectionary incorporate this healing material. In this article I review some of the current research being advanced to challenge us to think about biblical healing in new ways. Although I reference and analyze some of the healing stories we will hear in Cycle C, this analysis is by no means exhaustive of Lukan healing references in the lectionary. Rather, I raise broader questions and issues that preachers and worshipers might keep in mind as we make our way through the Year of Luke.

Of toby and evil spirits

My interest in New Testament healing came about in a rather circuitous way--actually, in Madagascar, on the other side of the planet from where I live. In the summer of 2005, I spent three weeks of my sabbatical visiting two synods in the northern regions of this island nation off the southeast coast of Africa. (2) I went to Madagascar to see firsthand an amazing ministry of the Malagasy Lutheran Church; it is called Fifohazana, the Awakening Movement. The movement traces its beginnings to the 1940s and 50s and a visionary prophetess by the name of Volahavana Germaine, more often referred to as Nenilava, Tall-Mother. (3) When she was a child, Nenilava began to receive visions from Jesus instructing her how to develop a healing ministry. This ministry was to be an expression of pastoral care within the church that would also reinstate a New Testament model of healing, including exorcisms. When Nenilava became a young adult she shared her story with her pastor, who saw in her story a genuine revelation for Christian mission in Madagascar. Over the decades the church has continued to implement Nenilava's visions. Today the Malagasy Lutheran Church has a specific department for coordination and oversight of this visionary healing movement.

At the heart of Nenilava's revelation was the creation of toby. Toby (pronounced "too-bee") is the Malagasy word for a "compound" or "settlement." Throughout Madagascar the church has founded dozens of toby. Each toby is a community of healing to which anywhere from a dozen to several hundred people might come. Some live in the compound a few weeks; some spend most of their lives there. A toby is staffed by a team of mpiandry, or shepherds--lay men and women trained for two years in the scriptural bases for healing. The shepherds work with the pastor to offer services of healing in the toby as often as three times a day. A healing service begins with hymn singing, Scripture reading, and preaching. Always the four biblical texts that formed the core of Nenilava's vision are read--John 14:12-17; Matthew 18:18-20; Mark 16:15-20; John 20:21-23. During prayer, the shepherds put on their white robes and then begin a general exorcism of the congregation. With commanding voices and waving arms the shepherds announce in the name of Jesus that all evil spirits must leave. Persons who are ill and possessed come forward and the shepherds deal with them individually, casting out demons with convulsive force. After the expulsion, prayer with laying on of hands invites the Holy Spirit to take possession of the petitioner.

Such a practice with its accompanying liturgies is a challenge to the sensibilities of many twenty-first--century Westerners steeped in a postmodern scientific world-view. But, as any careful reader of Luke's Gospel will note, its worldview is probably much closer to the experience of Malagasy exorcisms than it is to the laboratories, hospitals, and doctors' offices of contemporary North America.

Thinking about health: An introduction to medical anthropology 

In recent decades, biblical scholars have teamed up with social scientists to help us think more critically about the cultural filters we use, often unconsciously, when we read healing stories in the Bible. It is very easy to assume that "health," "healing," and "disease" are universal concepts that have fixed referents in human experience. But all three terms are deeply embedded in cultural understandings of reality, and different cultures have radically divergent concepts of what these words mean and what realities they identify. (4)

Contemporary Western cultures approach these matters with a series of assumptions:

* The individual is more primary than the group.

* Disease can be understood, explained, and often influenced by identifying and managing the physical causes of disequilibrium in the structures and functions of organs and organ systems; these causes include such entities as "bacteria" and "viruses."

* Curing means "to take control of disordered biological and/or psychological processes." (5)

It is easy to imagine that all of these presuppositions apply to other cultures as well as to our own, but medical anthropology reminds us that ancient cultures and some contemporary non-Western cultures approach healing with radically different assumptions:

* Groups are more primary than individuals; individuals receive their identities from being part of a group.

* Illness is more important than disease. Illness has to do with the "human perception, experience, and interpretation of certain socially disvalued states" and "is both a personal and social reality and therefore in large part a cultural construct."

* Healing is not necessarily the same as curing. It is, rather, an "attempt to provide personal and social meaning for the life problems created by sickness."

Thus, a contemporary Westerner would be more concerned about how a pathogenic organism may have created symptoms that ought to be eliminated by taking a certain drug. However, a woman from a biblical culture may have been primarily concerned with how an illness had affected her network of social relationships, her social status within the community, and the meaning of the illness for her life and the life of her family and community. Lola Ramanucci-Ross gives an excellent insight into this difference between the how and why of healing when she quotes a Melanesian woman who asked her, "What good is your medicine if you can't tell me why I got sick?" (6) This profound question deserves reflection, if not an answer.

There is a second source of insight into the cultural contexts for healing in the ancient world. Some biblical scholars are exploring ancient medical texts in order to better understand how older cultures thought about health, the human body, and healing. A major reference source for these studies is the Corpus Hippocraticum, a compendium of medical knowledge from the Mediterranean region. Some of the material in this massive work dates back to the fifth century B.C.E.; the work probably reached its final form during the first or second century C.E. By reading the New Testament through the lens of this ancient medical text we can sometimes achieve clearer understanding of the biblical text. Annette Weissenrieder has shown that this is particularly true for the Third Gospel. (7)

These differences in cultural orientation deeply influence how twenty-first-century Christians in North America read, hear, and understand the stories of healing from Luke. If we are to incorporate this gospel's stories of healing into the church's life we need to do more than translate these stories from Greek into English. We must also place the stories into their cultural context and consider what Luke's constellation of meaning implies for life in our culture. Perhaps all that we can hope to do is correct our own cultural nearsightedness so that we are less likely to read invalid presuppositions into the Lukan texts. However, my experience in Madagascar convinces me that ancient texts such as Luke's Gospel can help contemporary Westerners better assess critically our own cultural assumptions; they can even open the door to a deeper form of health and wholeness than that which is available through contemporary medical knowledge and practice. Looking at some specific passages may provide an entree to that more challenging task.

An overlooked story of healing in Luke 1

It is easy to assume that the first serious reference to healing in Luke occurs in chapter 4, when Jesus quotes Isaiah and points to the "giving of sight to the blind" as a sign of "the year of the Lord's favor"; Jesus then goes on to perform exorcisms and healings.

However, the initial set of stories in chapter 1 almost acts as healing stories in disguise and creates a paradigm for reading the complete Lukan narrative. This chapter contains the cycle of episodes concerning the birth of John the Baptist. Elizabeth and Zechariah are childless. When the angel Gabriel tells Zechariah that Elizabeth will conceive, Zechariah asks how he will know this, for "I am an old man, and my wife is getting on in years." Gabriel tells Zechariah, "because you did not believe my words ... you will become mute" (1:20). Two verses later Zechariah's condition is described as [TEXT NOT REPRODUCIBLE IN ASCII], a Greek term that can mean either "mute" or "deaf" depending on context. It is likely that Zechariah's condition embraces both disabilities, for in 1:62 Zechariah's friends must "motion to him" in order to ask him a question--an unnecessary action if he suffered only muteness but necessary if he was also deaf. Thus, by the midpoint of this story

Elizabeth's barrenness is paralleled by Zechariah's loss of speech and hearing.

Modern readers may not recognize the conditions of barrenness and muteness as health issues, since they do not seem to have pathological origins in the story. We think of loss of fertility as the natural result of aging, while Zechariah's condition seems to be an unnatural result of direct divine intervention. However, at 11:14, Jesus casts out of a man a demon who is [TEXT NOT REPRODUCIBLE IN ASCII], and when the demon is cast out, the man who was [TEXT NOT REPRODUCIBLE IN ASCII] can speak. Here [TEXT NOT REPRODUCIBLE IN ASCII] looks like an illness that is healed.

Furthermore, in 7:22 Jesus sends messengers to John the Baptist to remind him of signs that point to Jesus as "the one who is to come": "the blind receive their sight, the lame walk, lepers are cleansed, the deaf ([TEXT NOT REPRODUCIBLE IN ASCII]) hear, the dead are raised, and the poor have good news preached to them." (8) The condition of [TEXT NOT REPRODUCIBLE IN ASCII] here is identified as illness, along with blindness, lameness, and leprosy. Because the episode about casting out the [TEXT NOT REPRODUCIBLE IN ASCII] spirit has not yet occurred in the narrative, the clear referent to Jesus' statement at 7:22 is to John's own father!

While there is no readily apparent act of healing in chapter 1, Zechariah's "illness" is resolved when Elizabeth gives birth. The relationship of Elizabeth's and Zechariah's conditions becomes more significant when we begin to look at their circumstances in light of ancient medical texts. (9) The Corpus Hippocraticum (CH) has several references to barrenness. In the CH, as in contemporary Western culture, a lack of fertility is associated with the aging process. However, there is another very interesting medical correlation between the CH and Luke 1. Ancient physicians thought that organs within the body were capable of migrating. If the womb were to travel upward in the body cavity and stay there too long, the patient could become mute. Another set of references from rabbis, quoted by Weissenrieder, creates an interesting correlation between Elizabeth's and Zechariah's conditions: "R. Hisda and R. Jichaq b. Evdami (explain it); for loosening the upper mouth, another explained it for loosening the mouth of the mute; Bar-Qappara explained it for loosening the mouth of the sterile." (10) Here the birth canal and the oral cavity are linked together by the word "mouth." In Luke 1, Elizabeth's "mouth" had been "closed" (she could not conceive) but then is "opened" (she becomes pregnant); Zechariah's mouth had been "open" (he could speak) but then is "closed" (he becomes mute). What may appear to us as two conditions with no "medical" correlation may have been seen as being medically related by some persons in ancient culture.

From this perspective, Zechariah enters his own nine-month "pregnancy of silence" parallel to Elizabeth's gestation. Both Elizabeth and Zechariah are taken up into an alternate reality where they are set apart, "consecrated" and "cleansed." The effects of old age and incredulity are undone. The radical character of this holy time is emphasized even more dramatically in the center of chapter I when Mary's "magnificent" poem ties the wonders of these pregnancies to God's plans for the world: "He has shown strength with his arm ... lifted up the lowly ... filled the hungry with good things" (1:47-55). These thoughts are further amplified by Zechariah, who speaks prophetically ([TEXT NOT REPRODUCIBLE IN ASCII], 1:67) at the occasion of John's circumcision. Like Mary, Zechariah interprets these events against God's plan for the world, "as [God] spoke through the mouth [!] of his holy prophets ([TEXT NOT REPRODUCIBLE IN ASCII]) from of old" (1:70). Thus Mary and Zechariah claim that the events of Luke 1 have meaning for the health of the entire world. As Mary's son would remind Elizabeth's son in chapter 7, "the deaf hear ... and the poor have good news preached to them." So from the very beginning of Luke's Gospel it does appear that "the year of the Lord's favor" is indeed coming--health for those who are ill and for the entire planet!

Medical knowledge in Luke

Is such a reading of Luke I legitimate, or are we making spurious connections between elements of the Lukan text and entries in the CH and elsewhere? We would be more confident of the connections if we could sense that the author of the Third Gospel was familiar with the concepts discussed in ancient medical texts. We do not have to prove that "Luke" was a physician who used CH as a desk reference. It would be sufficient to show that the medical ideas contained in the CH, Talmud, and elsewhere are part of a cultural world shared by "Luke" and perhaps also by his readers. Weissenrieder's work attempts to demonstrate this very connection. Two examples will help illustrate her argument.

Weissenrieder shows how the episodes of Luke 1 are organized around Elizabeth's pregnancy. The opening scenes (1:5-23) occur close to the time when she conceives. At 1:24. we are told that Elizabeth remained hidden ([TEXT NOT REPRODUCIBLE IN ASCII]; NRSV "in seclusion") for five months. In Elizabeth's sixth month, her kinswoman Mary is visited by Gabriel and conceives, and "in those days" (1:39) visits Elizabeth, staying with her "about three months" (1:56). The final episode in this chapter (1:57-79) occurs in the last month of her pregnancy, when Elizabeth gives birth to John. The chapter is thus divided into three episodes that correspond with three phases of Elizabeth's pregnancy: months one through five, six through eight, and nine. The Greek physician Soranus analyzed pregnancy in trimesters, the first of which should be spent "in seclusion" to avoid shocks that could disturb the pregnancy, and the second during which the movement of the fetus becomes pronounced (see Luke 1:44). (11) The Talmud defines pregnancy in three trimesters in which the uterus ascends in the body cavity and then descends to prepare forgiving birth. (12) The CH's correlation of "high uterus" with muteness seems again to be on the horizon of this text.

Another example of Luke's familiarity with medical knowledge can be seen in the way this gospel modifies the Markan text at Luke 9:37-43. In this story Jesus casts out an unclean spirit from a boy. Luke describes the symptoms as seizure. In the parallel passage in Matthew, the boy is described as epileptic ([TEXT NOT REPRODUCIBLE IN ASCII], 17:15), a "diagnosis" Luke does not mention. Mark's original differs from Luke, however. Mark says the evil spirit that plagues the boy not only convulses him but also makes him rigid. Is there a reason why Luke might drop Mark's reference to paralysis? Weissenrieder notes that in the CH, epilepsy can develop from either of two distinct causes. A disproportionate amount of phlegm will lead to a variety of epilepsy in which seizures occur in the daytime. On the other hand, too much bile in the brain leads to epilepsy marked by nocturnal paralysis. These are two separate diseases, but Mark seems to join them together. Weissenrieder suggests that Luke "cleans up" Mark's misdiagnosis to give a more accurate portrayal of a daytime epilepsy that presents with seizure. Thus Luke seems conversant with the medical literature of his day. Together with the greater number of references to healing when Luke is compared to the other gospels, these insights create a portrait of "Luke" as someone conversant with the medical knowledge of his day.

Healing and exorcism

Although there may be evidence that the author of the Third Gospel is conversant with medical knowledge contained in the CH and elsewhere, there is a way in which Luke differs significantly from the medical perspectives of the CH. Very often the illnesses Luke describes are related to demon possession. This is a perspective that Luke receives from Mark; Luke makes no attempt to expunge possession or exorcism from his text. Unlike the New Testament exorcism texts, the CH does not identify evil spirits as a factor in illness. The CH understands the causes of illness to be discernible by observation together with an understanding of the physical reality of our bodies. Many illnesses are identified in the CH as the result of a disruption in the equilibrium of the four primary bodily fluids: blood, phlegm, yellow bile, and black bile. Some conditions that could be described by Western medicine as disease may be seen by the CH as the body's attempt to therapeutically readjust its equilibrium (see discussion of leprosy below). Many of the CH's models seem bizarre and thoroughly "unscientific" to twenty-first-century Westerners--traveling uteruses and the like! But throughout, the CH shares a modern conviction that issues of illness and health can be understood and modified through observation and treatment; the approach is empirical, not supernatural.

Demon possession and exorcism add a complicating layer to this model of health. They inject a spiritual and otherworldly dimension to the understanding of health issues. It is easy to explain this as an expression of a more ancient worldview (and often possession/exorcism is explained by modern scholars just this way), but the CH demonstrates that ancient peoples could also analyze health issues without reference to demonic possession.

Demonic possession is a significant feature in all three Synoptic Gospels but plays no significant role in John. Thus, it would be fair to assume that demonic possession may have entered the canonical Gospel materials through Mark; from Mark it made its way into Matthew and Luke. The importance of demonic possession for Mark is signaled in Mark's first exorcism story, at 1:21-28. In this episode the unclean spirit is able to identify Jesus not only as "Jesus of Nazareth" but as "the Holy One of God." The discovery of Jesus' identity is a major theme in Mark, an insight that has guided biblical studies for more than a century now with exploration of "the messianic secret." Mark reveals Jesus' identity to his readers in the very first verse, but, as has so often been noted in the literature, it is only at the confession of the centurion who oversees Jesus' crucifixion (15:39) that characters in the story catch up with what the reader already knows. How curious, then, that already in the opening scenes of Mark's narrative demonic powers are also able to correctly identify Jesus! Mark creates the impression that the forces of an immense cosmic struggle between ultimate good and ultimate evil are aligning themselves over the character of Jesus of Nazareth. The demonic powers know and appreciate the threat Jesus poses to their hegemony. The cosmic showdown finally takes place at the cross, as the sun's light is extinguished and the temple curtain is ripped ([TEXT NOT REPRODUCIBLE IN ASCII], 15:38). However, this ripping has been prefigured in the tearing of the sky at Jesus' baptism ([TEXT NOT REPRODUCIBLE IN ASCII], 1:10).

[ILLUSTRATION OMITTED]

In other words, in Mark's Gospel from beginning to end cosmic powers of good and evil are aligning themselves in an opposition in which both heaven and earth are theaters of the conflict. Mark's story is not an apocalypse, but it has many points in common with the apocalyptic landscape. Exorcism episodes portray this conflict and locate it within the lives of characters who interact with Jesus. Throughout Mark's Gospel Jesus is shown to have power over unclean spirits; he is able to cast them out and conquer evil in all its variegated mani festations. This is expressed also through the stories of healing, where the "powers" of blindness, deafness, and paralysis are overcome. In other words, in Mark's narrative world exorcisms and healings are equally powerful examples of a great showdown between bigger-than-life constellations of reality: Good and Evil, Life and Death. What is ultimately definitive for the Jesus story that Mark tells is that in the end his central protagonist allows this battle to enter his own body. He dies, evidently powerless, on across. "He saved ([TEXT NOT REPRODUCIBLE IN ASCII]) others," the scoffers jeer; "he cannot save himself" (15:31). The Greek verb [TEXT NOT REPRODUCIBLE IN ASCII] is rich and multivalent; it means "save," "rescue," and "heal." In the end, Mark's powerful healer allows himself to be conquered by Death. He cannot heal himself. God must raise him from the dead. And God does.

These are all features of the way in which Mark shapes the story of Jesus and shares it with his readers. In this way of telling God's good news both healings and exorcisms become powerful demonstrations of the primary conflict that serves as the dynamo for Mark's story. This concern for exorcism is not an invention of Luke; Luke receives it from Mark. What is important for reading and understanding Luke, however, is to note that Luke embodies this basic understanding of Jesus and carries this motif into his own "orderly account" of the story of Jesus. For example, Luke amplifies the irony at the heart of Mark's Gospel by having Jesus quote a proverb in his inaugural sermon: "Doctor, cure yourself" (4:23)--the very thing Jesus will be unable to do (23:37; par. Mk 15:31). In Luke, healings and exorcisms continue to be coexpressions of a divine-earthly showdown between God and Evil, Life and Death. If the author of the Third Gospel is, indeed, conversant in the "scientific" knowledge about medicine in his day, he evidently sees no contradiction between that knowledge and the story of the cosmic battle which he has inherited from Mark. Healing and exorcism are twin realities; one can be an expression of the other. It is curious and important to note that when Jesus heals Simon's mother-in-law (4:39), Jesus "rebukes" ([TEXT NOT REPRODUCIBLE IN ASCII]) the fever, the very same action by which Jesus deals with evil spirits, gaining control over them and sending them away.

A deeper healing: Part 1

Twenty-first-century readers of Luke need to reflect upon how we interpret and apply Luke's understanding of illness and its relation to demonic possession and exorcism. One option, which has been adopted by a majority of exegetes in the modern and postmodern era, is to demythologize Luke's first-century worldview. In this approach demonic possession and exorcism are dismissed as artifacts of a worldview that can no longer be supported by scientifically minded Westerners. Demonic possession is "translated" into categories more acceptable to the paradigms by which we understand health. Possession is understood as a prescientific way of describing conditions such as epilepsy or mental illness.

However, insights from medical anthropology and a greater familiarity with the medical knowledge of the first century suggest to us that there is another way in which we can understand demonic possession. Perhaps we are too myopic when we claim that our disconnect with possession is a uniquely modem hermeneutical problem. If the author of Luke has fused the positivist categories of medical knowledge of his day with Mark's story of a cosmic battle between Good and Evil, it teases us to consider whether such a fusion might be possible--and desirable!--in our own era. Scientific Westerners will need some help to make this leap. We can find assistance from contemporary cultures in which a scientific practice of medicine coexists with belief in demonic possession and the practice of exorcism--in places such as Madagascar.

During my visit to Madagascar in the summer of 2005, I had a wonderful conversation with Pastor Andrianjafiherilala Ramarokoto of the toby at Betela and seminary professor Flavien Volatombo, who served as translator. I asked Pastor Andrian, "Are you able, with prayer and exorcism, to cure serious illnesses here at the toby--illnesses such as tuberculosis?"

"No!" the pastor exclaimed. "We cannot heal anyone; only God can heal."

I thanked him for that distinction, based upon more sophisticated theological language than I was using. I should have known better, as well: I had already seen the greeting painted on the wall above the reception desk at the Lutheran hospital at Antanamilandy. In Malagasy it proclaimed "We treat; God heals."

I rephrased my question: "Does God heal diseases such as TB here at the toby?"

"Oh, yes," Andrian replied.

I asked, "How does this happen? What if someone arrives at the toby and you suspect he may have TB? What do you do?"

The pastor outlined the process: Contact is made with the local hospital. The doctor sees the patient and confirms that he has tuberculosis. Then the patient is admitted and undergoes the first stage of treatment using intravenous drugs. After this the patient is discharged from the hospital and begins the second, more difficult, stage of treatment, which lasts for several months. Medication is taken orally, but the side effects are pernicious; patients often discontinue treatment in this phase, increasing the likelihood that their TB will become drug-resistant and untreatable. However, our patient leaves the hospital and goes to live at the toby, where he is surrounded by a supportive and encouraging community, takes part in the services of healing and exorcism, and, as Pastor Andrian said, "God heals him."

Noteworthy in this conversation is the Malagasy refusal to create an opposition between scientific and spiritual healing. Our modernist bifurcation of physical and spiritual reality has diminished our ability to deal holistically with issues of disease and health. Our individualistic approach to medicine closes the door to social realities that affect our well-being. In our culture, when a person enters treatment for cancer or struggles to recover from a serious heart attack or stroke, or when an HIV-infected patient must confront her own mortality, it becomes clear that we are involved in struggles of life and death. A battle is being joined within and around us, yet we may not have adequate language or ritual to comprehend or describe what is happening to us or tools to seek the full healing God can give. The network of relationships that support this person are not understood to be part of the disease or its resolution.

A radical encounter with the fusion of science and spirit in the Third Gospel could encourage us to think again about our definitions of health and illness. Third-world sisters and brothers in Christ might teach us about disciplines and tools we have forgotten or neglected as we seek the fullness of life God offers through Jesus. Exorcism is one of these; it is not an alien action that needs to be introduced into Christian reality from the outside. It is an integral part of the Christian's baptismal birthright--a feature of the ancient practice of baptism that disappeared for a while during the "dark ages" of our positivist modernism but that now is happily being anticipated, if not reinstated, in newer liturgical expressions of the baptismal rite. (13)

How might the church more powerfully support those who have committed themselves to say "No" to the powers of darkness that work against God and life because we have said "Yes" to grace? Much work needs to be done to reinstate a Christian rite of exorcism in our communities of faith. It will be more difficult for us in North America than it is in Madagascar, where indigenous understandings of possession provide a cultural reference and starting point. We need to do the difficult work of learning how to speak about evil and its power among us. M. Scott Peck's challenging work in this area, now more than twenty years old, is still an invitation that we have yet to enter and explore fully. (14) Perhaps a fresh reading of Luke's Gospel will encourage us to take up this difficult but important task.

A look at leprosy

Another feature of healing in Luke that is profitable for us to consider is leprosy. There are two stories in Luke about lepers who are healed by Jesus: a leprous individual at 5:12-16 and the ten lepers at 17:11-19. Jesus also refers to the healing of the leper Naaman at 4:27 and includes cleansing of lepers as a sign of "the one who is to come" at 7:22.

In modern medical science "leprosy" is a shorthand term for Hansen's disease, a bacterial infection that affects skin and nerves. Leprosy is encountered most often in tropical climates. It is a slowly progressing disease that creates numbness as well as eye problems. Loss of sensitivity in extremities can lead to serious injury, which, in combination with other opportunistic infections, can cause radical disfigurement. The English word leprosy is derived from the Greek noun [TEXT NOT REPRODUCIBLE IN ASCII], which is the Septuagint's translation of the Hebrew noun [TEXT NOT REPRODUCIBLE IN ASCII]. The most extensive description of [TEXT NOT REPRODUCIBLE IN ASCII] is in Leviticus 13-14. What makes these two chapters interesting is that the disease described there is not Hansen's disease. In the Bible, [TEXT NOT REPRODUCIBLE IN ASCII]/[TEXT NOT REPRODUCIBLE IN ASCII] seems to designate a variety of skin diseases, including psoriasis and perhaps ringworm. John Pilch suggests that a key to under standing leprosy is to note that in Leviticus 13-14 the term [TEXT NOT REPRODUCIBLE IN ASCII] applies not only to diseases of the skin but also to cloth (13:47ff.) and to the walls of buildings (14:34ff.). Leprosy, suggests Pilch, is a disease of boundaries. (15) He quotes Mary Douglas, who urges us "to see in the body a symbol of society, and to see the powers and dangers credited to social structures reproduced in small on the human body." (16)

If leprosy is a disease of boundaries, it would help to explain Luke 17:11-19, where concern over the medical condition is paralleled by the "boundary conditions" of Jewish and Samaritan territories. Jesus is in "the region between Samaria and Galilee." Luke's story contrasts two kinds of healing: the cure of a disease and the deeper healing of faith shown by the Samaritan--"The Other," a "foreigner" ([TEXT NOT REPRODUCIBLE IN ASCII])--who returns to thank Jesus. Pilch uses a typology from medical anthropology to suggest that Jesus' willingness to touch lepers and embrace them is the heart of healing stories concerning leprosy. The health issue for people of Jesus' day had less to do with the eradication of symptoms and nothing to do with the destruction of bacteria; it had more to do with the social estrangement lepers experienced when their boundary disease, seen as a social threat, excluded them from social interaction. The embrace of Jesus undid this diseased boundary condition and made them whole.

Weissenrieder is critical of Pilch's analysis on the basis of her reading of the CH. (17) She notes that although the CH at times identified skin diseases as independent illnesses, it also describes them as the body's own therapeutic attempts to rid itself of imbalanced fluids. Weissenrieder challenges Pilch's analysis of skin-as-boundary as an anachronistic misunderstanding of ancient ideas about skin and the human body. On the basis of CH, we can see that ancients saw skin as a semipermeable membrane. Pilch's analysis is further weakened, says Weissenrieder, by noting that in Luke 17:11-19 Jesus does not heal lepers by touching or embracing them; this is a feature of the healing story at 5:13. In the Ten Lepers episode it is sight that becomes the tool of healing.

Although Weissenrieder is correct in her analysis of Pilch on the basis of the CH, she may overstate her case by assuming that the author of Luke follows the CH unquestioningly. The strength of Pilch's analysis of the Ten Lepers story is seen in his sensitivity to the dynamics of Leviticus 13-14 and what seems to us to be the inexplicable juxtaposition of skin diseases, mildew in cloth, and dry rot in walls. Pilch's reading of the biblical material takes account of this fusion as examples of "leprosy"; this suggests that biblical culture may have operated with assumptions and insights about this condition that differed from those in the CH. Luke seems to embrace both sets of understandings. The CH may not see leprosy as a boundary disease, but Leviticus does; biblical culture may not have understood skin in a way identical with the CH. Finally, Weissenrieder's observation that healing in Luke 17 involves sight and not touch is well taken. However, Pilch's reading of Luke 17 works just as well if we employ the metaphor of sight instead of touch: how we look at The Other ([TEXT NOT REPRODUCIBLE IN ASCII]--whether leper or Samaritan) is simply another way of speaking about the boundaries that influence the way people touch each other. In later work on the Lukan material in Acts, Pilch explores the importance of sight as an instrument of healing for Luke. (18) Weissenrieder's insights on this matter would be supported by Pilch's subsequent research.

A deeper healing: Part 2

In my visit to Madagascar in the summer of 2005, I attended a service of healing and exorcism at the Toby Mahatsinjo just outside Antsiranana. The general exorcism of the congregation had given way to individual exorcisms and healings. I was participating as best I could by joining the congregation in singing Malagasy hymns. However, all of this radically changed when my translator, the sixteen-year-old daughter of my host, asked me, "Do you want to go forward?"

"For healing? For casting out demons?" I asked.

"Yes," she replied.

The question was a crisis for me. I had come to Madagascar to personally observe these liturgies. I was cautiously willing to consider them in their own cultural context and to suspend my Western scientific skepticism so that I might not be blinded by my own presuppositions. But now I was being invited to actually experience the reality from the inside. I asked, "Can I do that? I am vazaha." Vazaha is the Malagasy term for a white foreigner. I am "Other."

"Yes, you can go," my guide replied. "Do you want to?" she asked again.

I did, but there was also a deep dis-ease within me. Not being a part of this cultural reality I might not know how to respond. Could I appear unyielding to the power to cast out demons? Could I unwittingly side with the powers of darkness simply because I was not an insider to Malagasy cultural codes? I had no desire to pretend, and I did not want to give or cause offense. I struggled for a way to bring my fear to expression.

"What if I do fady?" I asked. "What if I don't act the way I am supposed to act?" Fady (pronounced FAH-dee) is a powerful concept in Malagasy language and culture. It can be translated as "taboo" or "offense." In Malagasy you say "aza fady" for "excuse me."

My guide answered my question with an extremely simple response: "You can't do fady here."

I had come to the place were fady is cast out. I was standing on holy ground. How could I hold back?

I went forward and knelt on the grass mat, as others were doing. The shepherd laid hands on my head and prayed for me in Malagasy phrases I could not understand. But the meaning of the event transcended what words could convey. I was touched, no longer vazaha, no longer Other. And fady was cast out.

That day when I phrased my concern to my translator in terms of fady I did not know how near I had come to the heart of the matter--I had been in Madagascar a very short time. What I would discover, however, is that fady is close to the very center of exorcism in indigenous Malagasy culture. (19) Fady comprises a complex system of things to be avoided or shunned. Both space and time in Malagasy culture are shaped by fady. There are fady days, fady places and directions, fady behaviors. If a person encounters fady it must be ritually neutralized; failure to do so can have deadly results. Indigenous Malagasy exorcism seeks to cure the effects of fady. Christian exorcism is understood to be an antidote both to fady and to the system of non-Christian belief and practice that maintains and attempts to deal with fady apart from the name of Jesus.

Perhaps from this brief overview of fady the reader can sense that this Malagasy concept has points of contact with both leprosy and exorcism in the Gospel of Luke. Like demon possession, fady needs to be cast out; it represents a malevolent power to be avoided and, if necessary, exorcised. Fady is also an issue of boundaries and uncleanness; it is an expression of the threat which The Other can impose upon us. If we can experience and grasp the concept of fady we may be in a much better position to resonate with the unified worldview of Luke, where illness is more than a morally neutral and dispassionately analyzed consideration of microbes and chemicals and their interactions. In Luke's world, matters of health and illness are part of the cosmic interplay of the elemental powers of Life and Death, Good and Evil.

As readers of Luke, we are faced with the same choice that faced me at Toby Mahatsinjo: Do we want to observe Luke's worldview as an outsider--as The Other--or are we willing to enter into this Word, allow it to claim us, to cast out from us that which is death-dealing and raise us to new insights and the possibility of a deeper life in tune with Life itself? What does it mean to read this Gospel as the baptized who have entered and been committed to the struggle between Good and Evil?

As scientifically oriented twenty-first-century Westerners, we may find our own cultural presuppositions about the meaning of health and illness and the practice of healing challenged. (20) But as servants of the Word we owe it to ourselves and those we serve to imagine what a recovery of New Testament healing might mean for the church. What would a North American toby look like? How could we better support each other if we created places where chemotherapy or difficult surgery could be supported by liturgical rites that cast out what is death-dealing to make way for God's renewal? What would happen if we reflected more deeply upon the implications of baptism and its accompanying exorcism for the practice of medicine and the quest for wholeness?

In the year of Luke, there will be ample opportunity to focus on such concerns. If we give ourselves more deeply to Luke's vision and let it claim us, we may discover that this is, indeed, a year of the Lord's favor.

Ronald W. Roschke

Grace Lutheran Church, Boulder, Colorado 

[e-mail]

1. For a discussion see Joseph A. Fitzmeyer, The Gospel according to Luke (I-IX), The Anchor Bible (New York: Doubleday, 1970), 35ff.

2. Thank you to Grace Lutheran Church, Boulder, Colorado, and Lilly Endowment, who supported this sabbatical. I also want to recognize the visionary Companion Synod Program of the Rocky Mountain Synod-ELCA for its groundbreaking work in building cultural and theological bridges with Madagascar.

3. For a description of the movement see Laurent W. Ramambason, Missiology: Its Subject Matter and Method. A Study of Mission-Doers in Madagascar (Frankfurt: Peter Lang, 1999), 60-79. Additional information is from an unpublished paper by James W. Gonia, "The Healing Ministry of the Renewal Movement of Madagascar."

4. An especially helpful introduction to this area of study is John Pilch, Healing in the New Testament (Minneapolis: Fortress, 2000). Much of my analysis in this section is based on his research.

5. Quotes in this section, unless otherwise noted, are from Pilch, Healing in the New Testament, 25.

6. Lola Ramanucci-Ross, "The Hierarchy of Resort in Curative Practices: The Admiralty Islands, Melanesia," Journal of Health and Social Behavior 10 (1969): 119: quoted by Pilch, Healing in the New Testament, 75.

7. In this article I rely particularly upon Annette Weissenrieder's insights in Images of Illness in the Gospel of Luke (Tubingen: Mohr Siebeck, 2003).

8. NRSV translates the last phrase "good news brought to them." This is a legitimate translation of the Greek [TEXT NOT REPRODUCIBLE IN ASCII], playing on the concept that the [TEXT NOT REPRODUCIBLE IN ASCII] is a "bringer of good news." However, the connection between the deaf hearing good news proclaimed could be weakened by the NRSV translation; I have reverted to the RSV's rendering of [TEXT NOT REPRODUCIBLE IN ASCII] as "preached." I believe we need to focus more on ears than on feet in this verse.

9. See Weissenrieder, Images of Healing, 81ff., for an extensive analysis of Elizabeth's barrenness as a medical condition.

10. Weissenrieder, Images, 123.

11. Weissenrieder, Images, 92.

12. Weissenrieder, Images, 91.

13. In my own liturgical tradition it is helpful to compare the baptism rite in The Lutheran Book of Worship with the newer rite in Evangelical Lutheran Worship (Minneapolis: Augsburg Fortress, 2006). The church is inching its way toward a more complete exorcism rite but still has a way to go. See, for example, ELW, p. 229. The renunciation of evil has been strengthened here; however, the rite still lacks an actual expulsion of evil spirits and, thus, still adopts a rather naive view that we are able to renounce evil without having it actually cast out of us.

14. See M. Scott Peck, People of the Lie: The Hope for Healing Human Evil (New York: Simon and Shuster, 1983).

15. Pilch, Healing, 39-54.

16. Mary Douglas, Purity and Danger (New York: Praeger, 1996), 115; quoted by Pilch, Healing, 50.

17. Weissenrieder, Images of Healing, 136ff.

18. Pilch, Visions and Healing in the Acts of the Apostles: How Early Believers Experienced God (Collegeville, MN: Liturgical Press, 2004). Sight, staring and "looking intensely," Pilch argues, are indicators of altered states of consciousness that were critically important to the healing arts of ancient cultures.

19. For an excellent discussion see Jorgen Ruud, Taboo: A Study of Malagasy Customs and Beliefs (Oslo and London: Oslo University Press and George Allen & Unwin Ltd, 1960).

20. Stanley Hauerwas's excellent volume Truthfulness and Tragedy: Further Investigations into Christian Ethics (Notre Dame and London: Notre Dame Press. 1977), is still a wonderful entry point to this discussion. Another worthwhile volume for reflection is Joel James Shuman and Keith G. Meador, Heal Thyself: Spirituality, Medicine, and the Distortion of Christianity (Oxford: Oxford University Press, 2003).