Religion, Medicine and Miracles
Modern culture tends to separate medicine and miracles, but their histories are closely intertwined. The Roman Catholic Church recognizes saints through canonization based on evidence that they worked miracles, as signs of their proximity to God. Physician historian Jacalyn Duffin has examined Vatican sources on 1400 miracles from six continents and spanning four centuries. Overwhelmingly the miracles cited in canonizations between 1588 and 1999 are healings, and the majority entail medical care and physician testimony. Here we reproduce the Author’s Conclusions. Chapters’ titles are: 1. Making Saints - 2. The Supplicants and Their Saints - 3. The Miracles - 4. The Doctors - 5. The Cure as Drama
Do you believe in miracles? I am often asked that question when I speak about my work. After years of hesitating, now I answer comfortably, "Yes, I do." It is a historian's belief, and it challenges my medical identity.
I believe in the goodwill and honesty of these witnesses, be they educated or illiterate, religious or atheist. I believe in the accuracy of the scribes and translators. I believe in the plausible wonder that these tales meant to the players and the people involved in their collection, transmission, preservation, and use as evidence. I believe in the remarkably careful scrutiny conducted by the Church officials with the help of the best science and medicine available at the time. These stories are true. As a result, they are indeed miracles. Rather than appealing to an abstract philosophical definition in answer to "What is a miracle?" this ensemble defines the concept pragmatically: these events were miracles for the people involved.
The sheer number of healing miracles and their relentless stability command respect in this bottom-up approach to the definition. But I do not contend that these miracles represent all miracles imaginable. Far from it. They are mostly of one kind gathered for the specific purpose of serving the Roman Catholic process of canonization. The need for credible evidence has always pushed the selection process toward healings, by virtue of the witnesses, including doctors. The presence of an objective, educated, "nonpartisan" witness in the person of a physician was one factor that would favor healings over other wondrous events. The evidence was compelling.
In this conclusion, I will explore the remarkable stability of the healings and relate it to parallels in both the "nature" and the "doing" of medicine and religion. I am not the first to recognize these parallels, but my work on the miracle tales for this book brought the message home in a vivid way.
The Stability of Healing Miracles and the Nature of Medicine and Religion
Traditionally, historians look for change through time. Analysis of more than 1.400 miracles deriving from the sixteenth century to the end of the twentieth revealed some important changes in form, in diagnoses, in numbers of physicians involved, and in modalities of appeal. But the most remarkable feature of this survey is not change, but stability. The structure of the healing narratives and the investigative impulse, with its commitment to science, are remarkably constant in many different times and places. As shown in chapter 5 [The cure as drama], a dramatic "arc" defines each tale. Why should this be so? Two contradictory reasons can be considered.
On the one hand, as shown in chapter 5, the narratives are shaped by the formal questions. The stability, nature, and sequence of those questions generate an organized set of replies that tends to mold the story to a prescribed form. The questions might increase or decrease in number with time and place, but they were always directed at the same information; they were clearly delineated and usually compiled in a list in every complete file. The more files that I examined, the more familiar became the questions and the easier it was for me to ferret out the particular material that I sought. Regardless of the century in which they were written, I could count on these records to "deliver" in a reliable way through those numbered questions. Gradually I realized that the questions were "ordering" the story itself, even as they elicited its details. (In a similar manner, doctors "order" patient histories to make them amenable to their canons of knowledge-a point to which I will return in the "doing" section below.) This observation implies that the stability of miraculous experience was a product of the process, more apparent than real.
On the other hand, consider the opposite possibility that these narratives reflect a certain timelessness in human suffering and transcendence. Could the intrinsic nature of human experience have generated the questions that shape the records and the process? This explanation invites the possibility that religious and medical traditions are constructed in response to the perennial, inevitable challenges of suffering and death. Three surprising and telling elements of these files tend to support this second explanation.
First, the most constant aspect of medical (and religious) reality is the subliminal intelligence that we all must die. As a wag teacher used to quip, "Life is the only 'disease' that has one hundred percent mortality." In the many tales of "lives saved" resides a surprising irony: almost all witness who testified-be they miraculés, clerics, caregivers, or family are now dead; if not, they will die soon. Sometimes, as discussed in chapter 2 [The Supplicants and Their Saints], the person who had been miraculously healed had already died before the investigation took place. As a result, the "miracle"-the thing of wonder-had nothing to do with breaking natural law by replacing death with immortality; rather, it lay in the contemporary inability to explain the recovery. All healings, natural or miraculous, are not about "lives saved"; rather they are tales of death delayed.
The second surprising feature of the records is their deep commitment to scientific evidence and the essential ingredient of medical surprise. The extent to which the religious observers relied on scientific skepticism came to me as a genuine shock. In the process of canonization, religion draws from and is instructed by science-and not just any random science, but the best available. Daniel Dennett, a famous atheist, labels this process a form of going "through the motions" . But it is far more sincere, deliberate, and committed than his grudging words would suggest. With the exception of ignoring the events altogether, no other "motions" or methods are available to us mortals. Even Dennett must admit that there is no science other than that which is known today, and he overstates his premise that the process does not challenge its witnesses .
As this analysis of four centuries of inquiries has shown, the clerics question every witness and they readily defer to the opinion of scientists. They withhold a judgment of supernatural agency until they are convinced that the diagnoses are accurate, the investigations and treatments up-to-date, and the experts prepared to label the events inexplicable. In this sense, religion celebrates and endorses medical science, and it appears to have no need to refute it. Religion relies on the best of human wisdom before it imposes a judgment from inspired doctrine. When science provides a plausible explanation, religion will wait.
A corollary arises to this observation: religion sits more comfortably with medical science than vice versa. Of course, one advantage is that the process itself emerges from religion; the clerics are "at home," the medics are not. However, medical discomfiture stems not so much from the details of individual cases, but from the heart of medical identity. As shown in chapter 4 [The Doctors], some treating physicians expressed doubts about the entire process; similarly, a few experts hesitated to pronounce on the cures, as if cooperation would constitute a betrayal of their own belief systems. Their skepticism originates in the built in commitment of Western medicine to the idea that diseases and their cures are not, and can never be, of divine origin.
In the fifth century B.C., the Hippocratic author wrote the following on the "sacred disease," or what we call epilepsy: "It is not, in my opinion, any more divine or more sacred than other diseases, but has a natural cause, and its supposed divine origin is due to men's inexperience and to their wonder at its peculiar character" . In Western medical tradition, all diseases are natural; therefore, all cures must be natural too, even if we cannot explain them yet, or ever. This objection is not new. Absence of an explanation does not automatically turn an event into a miracle, a position strongly argued in debates between Protestants and Catholics during the nineteenth century . A hematologist colleague insists that "we may never find the natural explanation, but one must exist." This recognition that people are not to be blamed (too much) for their ailments has consequently pervaded Occidental medicine. I will return to this essential trait of medical science below.
The third surprising feature of these records is the fact that history is relevant to the interpreters. Religion little cares if an explanation may come along in the future; medicine confidently expects that it will, and if it does, the explanation may disqualify the miracle retroactively. In this sense, religion proves more tolerant than does medicine of the human plight, anchored in time and space.
In the eighteenth century, Prospero Lambertini seemed to reckon with the possibility that perceived miracles might find natural explanations in an unforeseen future. With his insistence on heroic virtue as a necessary condition before considering miracles, a canonization would nonetheless remain justified, as it was for martyrs whose recognition did not require miracles. Saints were human, and like us they were once confined to time and space; invocations are similarly anchored in physicality. For all its emphasis on the eternal, in the domain of saint making, religion displays a surprising comfort with temporal relativism. Science does not, and the gap counts in this process.
These three surprising features of the miracle records suggest that the regularity of human experience in confrontation with suffering and death have shaped the questions and the process. This possibility is unimagined by skeptics, including many of my medical colleagues who are baffled by this research. They simply assume that all the healings must have been produced by autosuggestion, as described in the section on hysteria (Chapter 3), or worse, by deception. Their discomfort stems from the idea that I, together with the doctors in the past, and perhaps also the miraculés themselves, have been duped by well intentioned, wishful thinking. They are confident that modern techniques of examination would have exposed the majority of the diagnoses as honest mistakes or frauds. They may be right, but their objections are metahistorical, even presentist. Medical scientists are uncomfortable with relative truth; for them, somebody must be lying or misled. This posture flows from the commitment to natural if unknown explanations cited above, and it has been a characteristic of medicine since antiquity .
These concrete attitudes about truth and demonstration inform the recent randomized controlled trials on the effectiveness of intercessory prayer for healing. Attempts to gauge the effectiveness of prayer stretch back at least to the nineteenth century . In these studies, people are prayed for at a distance by collectivities of strangers or friends; the outcomes are assessed together with those of controls who ostensibly suffered without the benefit of prayer. Improved outcomes in the prayed-for group are construed as evidence for the effectiveness of prayer and the immanence of transcendence in our lives. Equal or worse outcomes are construed as evidence in favor of atheism and futility. Skeptics often refer to these studies and their failures as "proof" that appeals for divine help do not "work" and never will.
But the so-called evidence-based method cannot really address the questions that are most pressing. On the one hand, as the Vatican's chief medical expert explained, the miracle is in the particular, in the exceptional; statistics cannot prove or disprove that singular cause-and-effect relationship . Furthermore, neither God nor the elusive and as-yet-unknown natural explanations, which my medical colleagues are convinced must exist, can be falsified. The possibility of falsification is used to design experiments and is considered a hallmark of the scientific method . Both are beliefs, and they fall outside the realm of scientific method as we know it. Because the one belief utterly pervades the scientific community, it seems not to be a belief but a "fact."
Our predecessors, both medical and religious, lived within their own eras, and were obliged to reckon with problems by applying the best wisdom available, just as we are obliged to dwell within the limitations of our own time. One such limitation seems to be the tautological argument of positivist medics that wonder is impossible, because a natural explanation must exist and that it might eventually be found. Therefore, if something strikes us as wondrous, we must either ignore it or reject it as illusion, lying, posturing, or naiveté, because nothing can really be wondrous. Ironically, as explained above, this confidence in the existence of an unseen and unfathomable natural explanation is a belief masquerading as fact, which cannot be falsified any more than the proposition that God exists. In this context, Woodward wrote, "to assert that miracles cannot occur is no more rational-and no less an act of faith-than to assert that they can and do happen" .
Somehow, doctors have trouble accepting that claim. I understand the problem; in the clinic, I always behave according to that belief. As a physician, I must. But I do not lose anything by admitting it is a "truth" on the order of belief. Nor do I lose anything by respecting and acknowledging my patient's belief in God and the "enduring appeal of the miraculous," not only of the distant past, but also in our present .
Yes, I believe that these stories are miracles. And through them, I have come to reconsider the nature of medical thinking as another form of faith, a system of belief. That is one parallel with religion. Another parallel emerges in the functioning, or the doing of both medicine and religion: the reading of signs.
Medicine and Religion as Semiotic Endeavors
Everyone-devout and skeptic alike-knows that their hour will come. If we are unlucky, death will be a deliberate or accidental killing. If we are lucky, the best possible end will be to die of illness in old age under the care of wise and kindly people.
These healing narratives, which the subjects chose to call "miraculous," are temporary postponements of the inevitable; as described above, they are stories of life improved and death delayed. They bespeak a longue durée that could serve as the very definition of medical practice: medicine, like life, has always been (and may always remain) a noble but losing struggle against our mortality. Many medical practitioners are uncomfortable with that definition too; they gloss over it when they claim to "save lives."
The processi reveal striking similarities between the actual performance of both religion and medicine on the personal level. Clerics and doctors together are tasked with bringing their elaborate systems of knowledge to bear upon an individual problem of suffering. Confronted with a sick person, both doctors and saint makers must observe each situation carefully, gathering evidence, reading "signs" that connect the particular to the established canons of wisdom from their respective disciplines. The evidence is the same; the method is the same; it is the interpretation that differs.
In the symptoms and the physical examination, the doctor searches for signs to confirm the diagnosis and the prognosis, and for signs of recovery and decline. To elicit the patient's history, the doctor asks a set of routine questions and performs physical manouvers in a specific way that allows the tale to be ordered and the body explored according to the demands of the diagnostic process. The resulting evidence can more easily be juxtaposed to prevailing wisdom about disease, investing the particular with interpretive power, turning observations into signs. This practice used to be called medical semiology in English, as it still is in many other European languages. Similarly through their formal approach and rigorous questions, the clerics look for signs of sanctity to be found in evidence that the case was truly desperate, that the best medicine was given, that an appeal was indeed made, and that no scientific explanation can be found. Beyond passive observation, the examinations in both medicine and religion are active: the canonical wisdom of both traditions participates in the process, directing the inquiry and investing the particular circumstances with meaning, transforming them into signifiers for deeper interpretation.
The difference between these two perspectives does not require us to discredit any of testimony as lying or wishful thinking. Rather, it resides in the interpretation of the evidence. For doctors, the medical canon is immersed in an antideistic tradition, as described above: only nature-not God-can ever be the cause or cure of diseases. For religion, all plausible scientific explanations, be they human or natural, must first be eliminated before the case becomes a contender as a reliable sign of transcendence or holiness. In both cases, what is left is that which is unknown; religious observers are prepared to call it God. They accept divine agency within their interpretive framework through belief in God and the inspirational nature of scripture; such faith is often described as a miracle itself. It is the source of a burgeoning, hoary literature of theological explication on such questions as "Why does God send plague?" .
But medical scientists are not prepared to attribute the unknown to God. As described above, their discomfort also arises from a kind of faith-the absolute belief in the nontranscendence of earthly events. Like those who believe in God, they believe in the existence of a natural explanation, as yet unknown but open for discovery. A commitment to this article of secular faith is found in the popular writing of atheists, who strive to contrast religion with reason . But as Mark Corner wrote, "there can be no certainty (since we obviously cannot anticipate what medical science will know in a century's time) that a miracle has taken place. At the same time, however, there is no certainty that a miracle has not taken place" . As outlined above, only another form of belief sustains that interpretation.
Although these miracle stories emerged through the Roman Catholic tradition, I think that they also represent human response to illness everywhere, and assimilating this message could be useful to doctors. Sick people from many times and places consult physicians and carefully follow their advice. But they simultaneously look for other ways out of their predicaments. They may see doctors, as instruments of healing, but they are equally comfortable with, if not more inclined to, the opinion that cures are effected by ourselves, by nature, or by deities with help from saints and long-lost predecessors. Getting better is directly connected to gestures of personal history, lifestyle, sacrifice, supplication, penance, and worship. The Lord helps those who help themselves.
It is these personal gestures of appeal to medicine and beyond that link the illness and healing experiences of all people, whenever or wherever they may have lived and whether they are religious or not. Those who eat tofu, run marathons, practice yoga, quit smoking, avoid the sun, watch their weight, curb their alcohol, play. sports, make sacrifices-or swallow aspirin, multivitamins, antioxidants, and hormones-are also pilgrims and penitents actively hedging their bets against the inevitable. Those gestures may have nothing to do with religion, but they have everything to do with interpretation and faith; they in still and enrich our existence with meaning because they are connected to beliefs about how the world works. This struggle for continuity in the face of death marks our lives. The Roman Catholic process of inquiry is shaped by it. I believe that the static structure of the healing stories reflects this timeless and pervasive reality of human experience.
In these remarkable files, two ancient, human-built traditions of knowledge confront each other on the mysterious terrain of human suffering. Medicine has been elaborated to prevent or relieve suffering; religion, to reconcile us to it. Departing from radically different premises, both are positioned to confront the inevitability of death: medicine trying to postpone it; religion, to console us. In their confraternation around the stories of death delayed and life restored, we learn more about their striking operative similarities.
In order to pronounce, religion and medicine are obliged to gather, order and assess the evidence emerging from a single locus of human misery before they can connect it to their respective and elaborate bodies of wisdom, each of which relies on a commitment to what must govern the unknown . Therefore, medicine and religion emerge as remarkably similar belief systems and semiotic endeavors – applying their ever-evolving canons of wisdom to locate meaning in the careful observation and interpretation of signs, of diagnosis, of healing, and of wonder.
 Dennett, Daniel. Breaking the Spell: Religion as a Natural Phenomenon (New York: Viking 2006), pp. 21, 26.
 Ibidem, p. 325.
 Hippocrates. The sacred Disease, in Hippocrates with an English Translation, vol. 2, ed. W.H.S. Jones (London: Heinemann,1923), esp. pp. 139-183.
 Mullin, Robert Bruce. Science, Miracle, and Prayer Gauge Debate., in When Science and Christianity Meet, ed. David C. Lindberg and Ronald L. Numbers (Chicago: University of Chicago Press, 2003), pp. 209-211.
 Van Dam, Raymond. Saints and Their Miracles in Late Antique Gaul (Princeton, N.J.: Princeton University Press, 1990), pp. 83-86.
 Benson, Herbert et al. Study of the Terapeutic Effects of Intercessory Prayer (STEP) in Cardiac Bypass Patients: A Multicenter Randomized Trial of Uncertainty and Certainty of Receiving Intercessory Prayer, American Heart Journal 151 (2005), n. 4, pp. 934-942.
 Giunchi, Giuseppe. L’esame del miracolo sotto il profilo medico-scientifico: Esperienze di un perito della Consulta Medica per le Cause dei Santi, in Miscellanea in occasione de IV Centenario della Congregrazione per le cause dei santi (1588-1988) (Città del Vaticano: Guerra, 1988), pp. 211-220.
 On falsification, see Popper, Karl. Conjectures and Refutations: The Growth of Scientific Knowledge (London: Routledge and Kegan Paul, 1963), pp. 33-39. See also Larmer, Robert A. ed. Water into Wine. An Investigation of the Concept of Miracle (Montreal: McGill Queen’s University Press, 1988), pp. 83-92; Ramsey, Ian T. Miracles: An Exercise in Logical Mapwork (1952), in The Miracles and the Resurrection. Some Recent Studies, ed. Ian T. Ramsey et al. (London: S.P.C.K., 1964), pp. 1-30.
 Woodward, Kenneth L. Making Saints: How the Catholic Church Determines Who Becomes a Saint, Who Doesn’t, and Why (New York: Simon and Schuster 1990), p. 200.
 Ditchfield, Simon. Liturgy, Sanctity, and History in Tridentine Italy: Pietro Maria Campi and the Preservation of the Particular (Cambridge: Cambridge University Press 2002), p. 129.
 Binetti, Stefano, Sovrani ed efficaci rimedi contro la peste (Rome: Ignazio Lazaii, 1656). BAV Chigi. IV.47
 Harris, Sam. The End of Faith: Religion, Terror and The Future of Reason (New York - London: Norton 2004).
 On this subject, see Corner, Mark. Signs of God: Miracles and Their Interpretation (Aldershot, U.K.: Ashagate, 2005).
 Elsewhere, and inspired by Carlo Ginzburg, I have used the semiotic notion of evidence to connecyt the practice of medicine not with religion, but with history. Duffin, J. A Hippocratic Triangle, in Locating Medical History. The Stories and their Meaning, ed. F. Huisman and J.H. Warner (Baltimore, MD: Johns Hopkins University Press, 2004); Ginzburg, Carlo. Clues: Roots of an Evidential Paradigm (1986). In Clues, Myths, and the Historical Method, (Baltimore, MD: Johns Hopkins University Press, 1989), pp. 96-125.
J. Duffin, Medical Miracles. Doctors, Saints, and Healing in the Modern World (Oxford: Oxford University Press, 2009), pp. 183-190.