Tomorrow's Education in Medicine and Ministry
285
Tomorrow's Education m Medicine and Ministry
KENNETH
L. V A U X
Even a passing acquaintance with the educational literature in the fields of medicine and ministry today impresses on one the fact that both systems are undergoing radical self-examination and transformation. In medicine one need only glance at the journals of Medical Education and The N e w Physician or meet with the Student American Medical Association to feel the tremors. In religion one can read the journal Theological Education or note the frightened and frantic innovation fad in the seminary quarterlies. The curriculum structures of both medical and ministerial schools are becoming as fluid as the institutional walls. The recent medical student strikes in Berlin and Prague and the occupation of McCormick and Union Seminary buildings in this country reflect, beyond the immediate grievances, a profound philosophical struggle concerned with the nature of medical and ministerial education. The winds of change now blow through the musty corridors of both kinds of institutions, creating an atmosphere in which constructive criticism that leads to greater institutional relevance is not only tolerated but welcomed. It would be interesting to explore the transition in both education systems. This larger task must be foregone for a more specified one in this paper. The fogginess of institutional identity is not so much my concern today as is the THE REv. KENNEXHL. VAVX,Tn.D., is Associate Professor of Ethics at the Institute of Religion and Human Development and Baylor College of Medicine in the Texas Medical Center, Houston.
286
Journal of Religion and Health
clarity with which both institutions are moving in similar directions toward what look like identical purposes.
Leading medical educators are now calling for a multi-track system. The needs of the late twentieth century clearly demand several types of medicine men. There is certainly the need for the pure scientist. This man must concentrate on hard research and investigation in order to push back the frontiers of scientific knowledge. He may become a hospital pathologist. He may do intensive research in malignant cell physiology. There is also the need for practicing specialists. The skilled urologist and cardiovascular surgeon are indispensable to our society, but there is also a need for what might be called "health generalists." These scientist-physicians must be adept at working in the community as coparticipants in the prevention and care of disease. This successor to the bygone general practitioner must be a focal point for all community resources committed to the wholeness of man. I think that eventually the sensitive cleric would work in his office along with the social worker and community development staff. The medical school curriculum that is responsive to the demands of our time will have at least these three options. Undergirding this curricular variety there must be a context of learning where the fundamental questions of environment and medicine, human ecology, health, epidemiology, and human values are raised. No scientist, whether he be in theological or life science, can fail to be a social scientist in our time. Several medical schools are pioneering this innovative concept of education. The University of Pennsylvania at Hershey; Mt. Sinai, Albert Einstein, and Stony Brook in New York; and the San Antonio and Baylor Medical Schools in Texas are good examples. At Hershey a department of humanities seeks to enrich the curriculum. At San Antonio Dean F. C. Pannill has recognized that the medical school must be involved in the "total fabric of health
Tomorrow's Education in Medicine and Ministry
287
care for a region. ''1 The program features a component on human ecology where medical students are assigned to community centers in the blighted urban area. Here they discover the weight of the human problem in its socioenvironmental context, an experience full of frustration and challenge. Here at Baylor Medical College the Introduction to Medicine course and the comprehensive care seminar attempt to see the whole man with reference to the big picture: his home, his work, his world-view, as these contribute to his disease or health. In the future, joint programs with The Institute of Religion in interdisciplinary research and ethical studies will add to the current programs of cotherapy with psychiatric and ministerial residents. This fall our two institutions will be challenged by the coming of two bright medical students who have insisted on a joint program that will integrate the insights of theological and biomedical sciences. Medical schools are in an exciting period of transformation. The fact that medical students have not found it necessary to demonstrate or occupy buildings is less a tribute to their inbred conservatism and intense academic compulsion than it is to the perception and vision of medical school faculties. II Centers of theological learning are also responding to the present imperatives to change. The imperatives are clear. Theology must be studied in ecumenical settings, preferably at clusters in the great metropolitan areas. It must take place in an interdisciplinary context. This means integral programs with the secular universities and professional schools whose research and action focus on the sciences of man. Thirdly, theological education must be involved in the secular world. Call this the clinical context; call it the religion-inqife setting. It means that education for ministry can no longer take place in rural rest homes or even urban bastions walled off from the press of the surrounding ghetto. 1Pannill, F. C., "Mandate for Medical Schools," ]. Postgraduate Med., 1969, 45, 221.
288
Journal of Religion and Health
These understandings are demanded by our new perceptions of the nature of the church, the meaning of theology, and the significance of the world. They necessitate radical change in our centers of theological learning. They insist on renewal of what Liston Pope called two decades ago "the theological curriculum.., still largely medieval in structure and purpose. ''2 In the church we are at last being released from the fixation and stalemate of the Reformation-Counter-Reformati0n detente and the pietist-social gospel tension that has controlled ecclesiology for four centuries. W e are being propelled by mission urgency and spiritual insight to recover the unity necessary for the world again to believe. In theology, the post-Barthian mood has realized that theology is not a pure science, but a crazy, mixed-up science. She may be the Queen, but she is a harlot queen. She needs many suitors. Led by Vatican II and contemporary secular European theology, we are being rescued from the sterility of seeing the theological enterprise as preserving a truth once delivered or the embalming of a tradition. W e are now free to celebrate secular springs of theological insight. Theological education now knows that it must listen to social science and life science as well as its unique biblical-theological science. W e also know that theological education must be done where men and women are struggling to become whole and where the presence of the sufferings of the world signal the presence of God. The Simeon Stylites flag pole or the advance into the world-retreat-from-world dialectic are no longer relevant models of the theological reflection-action endeavor. Only the man who daily quakes with the touch of human need and the world's groaning to be reborn can really study theology. Then he can meaningfully read Colossiam, Calvin's Institutes Bk. I, Luther's Galaterbrie~ or the Summa Theologica. Theological centers are beginning to respond to these understandings in church, theology, and the world. The ecumenical clusters in Berkeley, Chicago, and Boston are attempting to move in the directions deemed necessary, but they are continually beset by long-standing stratified traditions. Bridston, K. R., and Culver, D. W., Pre-Seminary Education. Minneapolis,Augsburg Publishing House, 1965,p. 97.
Tomorrow's Education in Medicine and Ministry
289
The only good example of a concrete interdisciplinary definition of theological education is at the Comenius faculty in Prague, where the Marxist context has forced theology into confrontation with the social, psychologic, and political sciences. The Seminar on Sexuality in Hamburg with ethicist Helmut Theilicke and gynecologist Gerhardt Giese, Paul Ramsey's program in Genetic Ethics at Georgetown Medical School, the Ethics and Law Seminar at Perkins School of Theology, Harvey Cox's Technology and Ethics Seminar at Harvard are also good examples. The doctor of ministry programs at Chicago and Berkeley could become relevant if allowed to become radically interdisciplinary. A number of interdisciplinary efforts by seminaries are hopeful signs of response to this imperative. W e need more centers of theological inquiry that are interdisciplinary at heart. This is the potential genius of the new Max Planck Institute of Futurological Research on Man in a Technological World in Munich and the Texas Medical Center's Institute of Religion and Human Development. The imperative to genuine involvement in the secular life of man is gaining much better response from the seminaries. M U S T in N e w York, the Urban Training Center in Chicago, and the many hospital clinical programs are a good start. As the AATS has suggested, we must also develop programs of ministry in business and industry, in family life cycle, in centers of ministry in the arts, in medicine and technology, in secondary and higher education. The distinction made between academic and clinical structures must cease. There can no longer be teaching and field-work departments in seminaries. Theological formulation must occur in the secular laboratory. Pure theological speculation on the one hand and unreflective pastoral doing on the other must blend into a meaningful discernment of religion in life.
III Education for medicine and ministry is being transformed. A potential convergence that seems to be most exciting appears on the horizon. Three apparent aspects of the convergence are: the blending of disciplines, the dis-
290
Journal of Religion and Health
covery that education is engagement, and a common commitment to healing. If this convergence is valid, I see no reason why we should not begin right now with a specific program. Let us select ten of our best minds in the value sciences and ten in the life sciences and launch them on an integrated graduate program of medicine and ministry. This program could be detailed at any one of the centers capable of doing it. The logical centers would be Duke, Vanderbilt, University of Chicago, Harvard, the Union-Columbia Joint Program in New York, or the Texas Medical Center in Houston. The first point of convergence is the significant way that disciplines are blending today. In classic Western thought the grenze der Wissenschaften (boundaries of disciplines) were clear cut. N o w the demarcations are quite arbitrary. Anatomy blends into physiology; biochemistry, biomathematics, bionics, biological engineering are mixed disciplines. Psychophysiology, therapy, and pastoral counseling are integral endeavors. As the whole man in his world becomes the focus of research and care in medical and ministerial science, the old boundaries are blown to bits. Although the most explored zone of convergence has been psychiatry and religion, there is no reason why general medicine and environmental health should not be explored as zones of mutuality. Both fields now see education as engagement. The French noun engagement and the German verb engagieren are better. They mean commitment. If medical education is truly concerned with human health and research as only a subordinate endeavor toward that basic end, and if pastoral education is truly concerned with salvation and not merely institutional longevity or tradition perpetuation, then we have a thrilling convergence. Our mutual goal is commitment to the healing of man in society, and our educational styles are identical styles of engagement. Finally, is there not a convergence in the commitment to healing? Medicine and ministry have been allied endeavors since their emergence in Egyptian and Hebrew monotheism and Greek philosophy. The embarrassing days of medicine man and witch doctor should not beset the whole convergence that is so urgent today. Salvus and salvation, Heil and Heiligkeit, healing and
Tomorrow's Education in Medicine and Ministry
291
wholeness, the goals of medicine and ministry must not be further polarized in our broken world. Paul Tillich has spoken of this convergence: The physician cannot avoid the question of human nature since in practicing his profession he cannot avoid the distinction between health and illness, existential and pathological anxiety. This is why more and more representatives of medicine generally and psychotherapy specifically ask for the cooperation with the philosophers and theologians . . . . The medical faculty [and the theological faculty] need a doctrine of man in order to fulfill its theoretical task; and it cannot have a doctrine of man without the permanent cooperation of all those faculties whose central object is man. The medical profession has the purpose of helping man in some of his existential problems, those which usually are called diseases, But it cannot help man without the permanent cooperation of all other professions whose purpose is to help man as man. Both the doctrines about man and the help given to man are a matter of cooperation from many points of view. Only in this way is it possible to understand and to actualize man's power of being, his essential self-affirmation, his courage to be. 8 There must be convergence of medicine and ministry in our day. Healer must become savior and savior must become healer as together they participate in the emergent life of H i m w h o is Savior and Healer in this world.
Tillich, Paul, The Courage to Be. New Haven, Yale Paperbound, 1952, p. 71 ft.
285
Tomorrow's Education m Medicine and Ministry
KENNETH
L. V A U X
Even a passing acquaintance with the educational literature in the fields of medicine and ministry today impresses on one the fact that both systems are undergoing radical self-examination and transformation. In medicine one need only glance at the journals of Medical Education and The N e w Physician or meet with the Student American Medical Association to feel the tremors. In religion one can read the journal Theological Education or note the frightened and frantic innovation fad in the seminary quarterlies. The curriculum structures of both medical and ministerial schools are becoming as fluid as the institutional walls. The recent medical student strikes in Berlin and Prague and the occupation of McCormick and Union Seminary buildings in this country reflect, beyond the immediate grievances, a profound philosophical struggle concerned with the nature of medical and ministerial education. The winds of change now blow through the musty corridors of both kinds of institutions, creating an atmosphere in which constructive criticism that leads to greater institutional relevance is not only tolerated but welcomed. It would be interesting to explore the transition in both education systems. This larger task must be foregone for a more specified one in this paper. The fogginess of institutional identity is not so much my concern today as is the THE REv. KENNEXHL. VAVX,Tn.D., is Associate Professor of Ethics at the Institute of Religion and Human Development and Baylor College of Medicine in the Texas Medical Center, Houston.
286
Journal of Religion and Health
clarity with which both institutions are moving in similar directions toward what look like identical purposes.
Leading medical educators are now calling for a multi-track system. The needs of the late twentieth century clearly demand several types of medicine men. There is certainly the need for the pure scientist. This man must concentrate on hard research and investigation in order to push back the frontiers of scientific knowledge. He may become a hospital pathologist. He may do intensive research in malignant cell physiology. There is also the need for practicing specialists. The skilled urologist and cardiovascular surgeon are indispensable to our society, but there is also a need for what might be called "health generalists." These scientist-physicians must be adept at working in the community as coparticipants in the prevention and care of disease. This successor to the bygone general practitioner must be a focal point for all community resources committed to the wholeness of man. I think that eventually the sensitive cleric would work in his office along with the social worker and community development staff. The medical school curriculum that is responsive to the demands of our time will have at least these three options. Undergirding this curricular variety there must be a context of learning where the fundamental questions of environment and medicine, human ecology, health, epidemiology, and human values are raised. No scientist, whether he be in theological or life science, can fail to be a social scientist in our time. Several medical schools are pioneering this innovative concept of education. The University of Pennsylvania at Hershey; Mt. Sinai, Albert Einstein, and Stony Brook in New York; and the San Antonio and Baylor Medical Schools in Texas are good examples. At Hershey a department of humanities seeks to enrich the curriculum. At San Antonio Dean F. C. Pannill has recognized that the medical school must be involved in the "total fabric of health
Tomorrow's Education in Medicine and Ministry
287
care for a region. ''1 The program features a component on human ecology where medical students are assigned to community centers in the blighted urban area. Here they discover the weight of the human problem in its socioenvironmental context, an experience full of frustration and challenge. Here at Baylor Medical College the Introduction to Medicine course and the comprehensive care seminar attempt to see the whole man with reference to the big picture: his home, his work, his world-view, as these contribute to his disease or health. In the future, joint programs with The Institute of Religion in interdisciplinary research and ethical studies will add to the current programs of cotherapy with psychiatric and ministerial residents. This fall our two institutions will be challenged by the coming of two bright medical students who have insisted on a joint program that will integrate the insights of theological and biomedical sciences. Medical schools are in an exciting period of transformation. The fact that medical students have not found it necessary to demonstrate or occupy buildings is less a tribute to their inbred conservatism and intense academic compulsion than it is to the perception and vision of medical school faculties. II Centers of theological learning are also responding to the present imperatives to change. The imperatives are clear. Theology must be studied in ecumenical settings, preferably at clusters in the great metropolitan areas. It must take place in an interdisciplinary context. This means integral programs with the secular universities and professional schools whose research and action focus on the sciences of man. Thirdly, theological education must be involved in the secular world. Call this the clinical context; call it the religion-inqife setting. It means that education for ministry can no longer take place in rural rest homes or even urban bastions walled off from the press of the surrounding ghetto. 1Pannill, F. C., "Mandate for Medical Schools," ]. Postgraduate Med., 1969, 45, 221.
288
Journal of Religion and Health
These understandings are demanded by our new perceptions of the nature of the church, the meaning of theology, and the significance of the world. They necessitate radical change in our centers of theological learning. They insist on renewal of what Liston Pope called two decades ago "the theological curriculum.., still largely medieval in structure and purpose. ''2 In the church we are at last being released from the fixation and stalemate of the Reformation-Counter-Reformati0n detente and the pietist-social gospel tension that has controlled ecclesiology for four centuries. W e are being propelled by mission urgency and spiritual insight to recover the unity necessary for the world again to believe. In theology, the post-Barthian mood has realized that theology is not a pure science, but a crazy, mixed-up science. She may be the Queen, but she is a harlot queen. She needs many suitors. Led by Vatican II and contemporary secular European theology, we are being rescued from the sterility of seeing the theological enterprise as preserving a truth once delivered or the embalming of a tradition. W e are now free to celebrate secular springs of theological insight. Theological education now knows that it must listen to social science and life science as well as its unique biblical-theological science. W e also know that theological education must be done where men and women are struggling to become whole and where the presence of the sufferings of the world signal the presence of God. The Simeon Stylites flag pole or the advance into the world-retreat-from-world dialectic are no longer relevant models of the theological reflection-action endeavor. Only the man who daily quakes with the touch of human need and the world's groaning to be reborn can really study theology. Then he can meaningfully read Colossiam, Calvin's Institutes Bk. I, Luther's Galaterbrie~ or the Summa Theologica. Theological centers are beginning to respond to these understandings in church, theology, and the world. The ecumenical clusters in Berkeley, Chicago, and Boston are attempting to move in the directions deemed necessary, but they are continually beset by long-standing stratified traditions. Bridston, K. R., and Culver, D. W., Pre-Seminary Education. Minneapolis,Augsburg Publishing House, 1965,p. 97.
Tomorrow's Education in Medicine and Ministry
289
The only good example of a concrete interdisciplinary definition of theological education is at the Comenius faculty in Prague, where the Marxist context has forced theology into confrontation with the social, psychologic, and political sciences. The Seminar on Sexuality in Hamburg with ethicist Helmut Theilicke and gynecologist Gerhardt Giese, Paul Ramsey's program in Genetic Ethics at Georgetown Medical School, the Ethics and Law Seminar at Perkins School of Theology, Harvey Cox's Technology and Ethics Seminar at Harvard are also good examples. The doctor of ministry programs at Chicago and Berkeley could become relevant if allowed to become radically interdisciplinary. A number of interdisciplinary efforts by seminaries are hopeful signs of response to this imperative. W e need more centers of theological inquiry that are interdisciplinary at heart. This is the potential genius of the new Max Planck Institute of Futurological Research on Man in a Technological World in Munich and the Texas Medical Center's Institute of Religion and Human Development. The imperative to genuine involvement in the secular life of man is gaining much better response from the seminaries. M U S T in N e w York, the Urban Training Center in Chicago, and the many hospital clinical programs are a good start. As the AATS has suggested, we must also develop programs of ministry in business and industry, in family life cycle, in centers of ministry in the arts, in medicine and technology, in secondary and higher education. The distinction made between academic and clinical structures must cease. There can no longer be teaching and field-work departments in seminaries. Theological formulation must occur in the secular laboratory. Pure theological speculation on the one hand and unreflective pastoral doing on the other must blend into a meaningful discernment of religion in life.
III Education for medicine and ministry is being transformed. A potential convergence that seems to be most exciting appears on the horizon. Three apparent aspects of the convergence are: the blending of disciplines, the dis-
290
Journal of Religion and Health
covery that education is engagement, and a common commitment to healing. If this convergence is valid, I see no reason why we should not begin right now with a specific program. Let us select ten of our best minds in the value sciences and ten in the life sciences and launch them on an integrated graduate program of medicine and ministry. This program could be detailed at any one of the centers capable of doing it. The logical centers would be Duke, Vanderbilt, University of Chicago, Harvard, the Union-Columbia Joint Program in New York, or the Texas Medical Center in Houston. The first point of convergence is the significant way that disciplines are blending today. In classic Western thought the grenze der Wissenschaften (boundaries of disciplines) were clear cut. N o w the demarcations are quite arbitrary. Anatomy blends into physiology; biochemistry, biomathematics, bionics, biological engineering are mixed disciplines. Psychophysiology, therapy, and pastoral counseling are integral endeavors. As the whole man in his world becomes the focus of research and care in medical and ministerial science, the old boundaries are blown to bits. Although the most explored zone of convergence has been psychiatry and religion, there is no reason why general medicine and environmental health should not be explored as zones of mutuality. Both fields now see education as engagement. The French noun engagement and the German verb engagieren are better. They mean commitment. If medical education is truly concerned with human health and research as only a subordinate endeavor toward that basic end, and if pastoral education is truly concerned with salvation and not merely institutional longevity or tradition perpetuation, then we have a thrilling convergence. Our mutual goal is commitment to the healing of man in society, and our educational styles are identical styles of engagement. Finally, is there not a convergence in the commitment to healing? Medicine and ministry have been allied endeavors since their emergence in Egyptian and Hebrew monotheism and Greek philosophy. The embarrassing days of medicine man and witch doctor should not beset the whole convergence that is so urgent today. Salvus and salvation, Heil and Heiligkeit, healing and
Tomorrow's Education in Medicine and Ministry
291
wholeness, the goals of medicine and ministry must not be further polarized in our broken world. Paul Tillich has spoken of this convergence: The physician cannot avoid the question of human nature since in practicing his profession he cannot avoid the distinction between health and illness, existential and pathological anxiety. This is why more and more representatives of medicine generally and psychotherapy specifically ask for the cooperation with the philosophers and theologians . . . . The medical faculty [and the theological faculty] need a doctrine of man in order to fulfill its theoretical task; and it cannot have a doctrine of man without the permanent cooperation of all those faculties whose central object is man. The medical profession has the purpose of helping man in some of his existential problems, those which usually are called diseases, But it cannot help man without the permanent cooperation of all other professions whose purpose is to help man as man. Both the doctrines about man and the help given to man are a matter of cooperation from many points of view. Only in this way is it possible to understand and to actualize man's power of being, his essential self-affirmation, his courage to be. 8 There must be convergence of medicine and ministry in our day. Healer must become savior and savior must become healer as together they participate in the emergent life of H i m w h o is Savior and Healer in this world.
Tillich, Paul, The Courage to Be. New Haven, Yale Paperbound, 1952, p. 71 ft.
