Paul Brand & The Gift of Pain

There is a list of people long since gone that I would love to sit down with over a cup of coffee and pick their brain.  I envision sitting for several hours (with an additional cup of coffee or three) captivated by stories of success and failure, joy and sadness, trial and error, despair and hope, dreams come true and dreams altered by circumstances out of their control. I would ask of their dreams for the future, what they would have changed given the chance, what advice they would give to people such as myself, and how they managed to align their priorities. What made them tick? The list includes people like John Wooden - legendary basketball coach, author, and teacher. Martin Luther King, Jr.- preacher, activist, and advocate of justice. Mother Theresa - servant to the poorest of the poor and saint. The list could go on and on.

Paul Brand is on the short version of that list. One of the most difficult decisions medical students have to make while going through their training is what field to pursue. For some this decision is based on length of training. For others it is based on the financial reward of a specific field. For others it is a calling of sorts and simply the 'right fit.' When I became interested in orthopedics, one of the major obstacles was the ability to use orthopedics overseas in mission settings. Orthopedics in the United States is heavily dependent on technology and sophisticated instrumentation that is simply too expensive and not available among the world's poor. During this decision process, I was given a book by a friend called Fearfully and Wonderfully Made, a book written by Dr Paul Brand sharing his insights into a life of mission work as an surgeon, specifically hand surgery. It was that book that pushed me toward what I felt God was calling me to do.

Dr Brand took a special interest in lepers. Thankfully leprosy (today called Hansen's Disease) is far less prevalent compared with history. Leprosy is referred to often in the Bible as a disease of the 'unclean,' preventing its victims from participating in society. Lepers could often be disfigured and cast away from their families and friends into a life of isolation and despair. Today, we know that leprosy is caused by a bacteria - Mycobacterium leprae - a bug in the same family as tuberculosis. Leprosy is best known for its disfiguring tendencies of the skin and yet one less known aspect of leprosy is that it attacks the body's peripheral nerves - those nerves in our arms and legs.

Lepers suffer from complete numbness as well as weakness and loss of function. People infected with leprosy lose what Dr Brand called 'The Gift of Pain." Without the presence of sensation, the human body has no way to know if what it is doing is causing self-harm. I remember reading Dr Brand's stories of lepers who would have their toes literally eaten off by rats during the night and not know it because they could not feel their toes. A leper does not know he is developing a blister on the bottom of his foot or holding a glass too tight, both of which can cause ulcerations and eventual necrosis requiring amputation. The Gift of Pain, thought strange to label as a gift, gave the person back the ability to interact with the world safely without further self-inflicted harm. To have no pain was not the utopian life we sometimes ask for but rather left one in a state of helplessness as their life was slowly taken from them. Dr Brand devoted the majority of his career to caring for lepers, refusing to believe they were any less important than any other individual on the planet.

I hope heaven has a coffee shop that I can sit down at with Dr Brand.

What is Structural Violence?

'Structural violence' and 'structural sin' are relatively new additions to my vocabulary. I first encountered the concept in a book by Dr Paul Farmer (Pathologies of Power, Univ Calif Press, 2005) who sought to provide insight into the causes of global poverty by using first-hand accounts from his trips to Russia, Mexico, and Haiti as concrete case studies for such exploration. Having spent over two decades of intentional and thoughtful work among the poorest people in the western hemisphere, Dr Farmer's words have a poignant quality lacking in many textbooks and other treatises who seek a 'neutral' and objective place from which to write. Farmer makes no such claims.

I am openly on the side of the destitute sick and have never sought to represent myself as some sort of neutral party. Indeed, I have argued that such 'neutrality' most often serves, wittingly or unwittingly, as smokescreen or apology for the structural violence described here. (p.26)

Via a hopeful anger and a fierce loyalty to the poor, Farmer exposes the far-reaching impact of abuses of power and the pathologies it spawns - poverty, disease (HIV, TB, cholera, etc.), deprivation, economic despair, lack of health care, and injustices ad nausea. These 'human rights violations', he argues, are not the problem but rather symptoms of a deeper and more sinister problem rooted in the human heart - the belief, whether conscious or not, that some people in the world matter more than others. Such a belief creeps into our hearts, our interpersonal interactions, our language, our social and political systems, our international policies, and so on creating systems, governments, and structures than enable such 'structural violence' to thrive with the poor and powerless seeing more than their share of negative consequences.

The biblical narrative names this fundamental problem as 'sin.' First encountered in the Genesis story, humanity's insistence on self-rule and refusal to see itself in its appointed place in the community of creation shatters the harmony, joy, and inter-dependence of the creator's design exposing everything and everyone to the effects of 'sin.' No part of creation was spared sin's pathologies and since then, our systems and structures at every level have been vulnerable to the selfishness and greed so deep within the human soul. 'Structural sin' remains, however, a difficult notion to grasp in large part due to the western influence of individualism. Sin (and spirituality as a whole) is viewed as a private matter to be handled in solitude and its effects therefore are perceived to be limited to individuals involved. 'Structural sin' casts a much larger net over our families, our communities, our churches, and our governments acknowledging that sin has spared no corner of creation. Yet the effects of sin are felt more harshly by those without the luxury of spiritualizing their situations. Dr Farmer defines the poor as "those whose greatest task is trying to survive." Such poverty means death, often an early death, for far too many. Sin means death and it is not simply a problem for the individual but a cosmic, permeative affront to the Creator that has managed to infiltrate every nook of our social, political, and economic systems.

Thankfully, the biblical story offers hope in face of seemingly impenetrable darkness. Jesus' most famous prayer - "...may your kingdom come. May your will be done on earth as it is in heaven" - points to the good news of a new way of life found in surprising places such as prostitutes, terrorists, tax collectors, lepers, poor widows, and simple fishermen. Within this kingdom, the rich and poor, powerful and weak, sick and healthy, male and female, popular and marginalized are equal. This is why they call it good news for the world. In this new reality, 'structural sin' is exposed by an inextinguishable light within a community committed to justice, love, and peace. And little by little, Jesus' prayer comes true - heaven is found here on earth and God's purposes are accomplished.  

I am still wrestling with this idea and above are my preliminary ramblings on the matter. Does the idea of 'structural violence'/'structural sin' make sense? If so, where have you seen this play out? What concrete examples of 'structural violence' do you see and what examples of 'structural redemption' (i just made that term up) have you seen? How can we become more attune to such injustice in our midst and have more honest discussion? Would love any thoughts, critiques, or further conversation. 

Blessings....