Science in Christian Perspective
GERIATRICS AND THE BOOK OF ECCLESIASTES
Thomas M. Durant, M.D., F.A.C.P.
There is a great need for discussion by physicians of the manner in which the Word of God may be used in the consultation room to supplement the other methods of medical practice.- It is my conviction that the Bible is an indispensable item on the doctor's desk, and that prescriptions from its pages should be an important part in his therapeutic armamentarium. It is with these thoughts in mind that I have presented a brief discussion of the book of Ecclesiastes in relationship to that very important field of medical practice, Geriatrics, or the science which deals with the processes of aging.
Recently there came to my office a 65 year old widow whose presenting complaints were largely referable to the cardio-vascular system. Ordinarily in a person of this age one would expect such complaints to be based on organic disease, but in this instance complete investigation revealed a heart and vascular system which were very normal for her age. Furthermore the history obtained at the first visit strongly suggested a background of emotional disturbance, the somatic complaints appearing only as surface manifestations. Such was proven to be the case as the affective element in the patient's difficulty was uncovered, She was a woman of Germanic stock whose parents had migrated to this country in her youth and had managed to provide the necessities of life for their children only by dint of constant hard labor. Integrity had been the keynote of the parental instruction. The married life of the patient had been one of mixed happiness -and drudgery, and strict economy had made possible the building of a reasonably comfortable nest egg. Following the death of her husband'. however, the patient fell a victim of men who preyed upon a widow's gullibility, and, for the first time in her life, she was faced with the realization of the depths of deceit which lie behind the apparently trustworthy exterior of certain fellow men. The loss engendered bitterness which was projected in the form of racial hatred, an emotion which was-in conflict with her own idealized image. Thus she had entered the evening of life in emotional turmoil, completely disillusioned, and with practically no spiritual resources to turn to for solace.
An example such as this one is by no moans isolated in medical practice. In fact, the more physicians have come to stress the ever expanding problems of our increasingly aged population, the more it has been realized that the psychological difficulties of senescence are of the utmost importance. If medical science is to increase the life span of human happiness and contentment to run parallel to the increased chronological life span, provision must be made to alleviate the factors which detract from the former. The development of psycho-somatic medicine as applied to geriatrics is an important step in this direction.. but this is not enough, since man is trichotomous, not dichotomous. We must therefore stress what Dr. Wm. Witeley has termed PNEUMO-PSYCHO-SOMATIC medicine -which places proper emphasis upon the importance of the SDirit or Pneum in life,
As one listens to the stories of the aged and the aging one cannot but be impressed by the fact that many of their deeper thoughts are a paraphrase of the book of Ecclesiastes, though most of them are, of course, unaware of it. It is the viewpoint of man "under the sun," and all is vanity and vexation of spirit. The patient referred to at the beginning of this paper might well have said, as did the author of Ecclesiastes, "There is a vanity which is done upon the earth; that there be just men, unto whom it happeneth according to the work of the wicked; again, there be wicked men, to whom it happeneth according to the work of the righteous; I said that this is also vanity" (Eccles. 8:14).
Numerous other examples could bo cited from Ecclesiastes as descriptions of common senescent viovmoints, but time permits the elucidation of only two others. One of those concerns the man whose life has been centered around his business. He has worked hard with but few vacations and the development of no hobbies. Success, has attended his efforts'. but throughout the years he has dreamed of the day in which he might enjoy the fruits of his labors upon retirement. When that day.does come, however, the fruits are found to be bitter in his mouth. Recreation based upon physical exertion is denied him. His years of swivel chair existence have prevented complete metabolism of' his rich diet and the linings of his important arteries are swollen with fat preventing sufficient increments of blood supply to permit exertion without pain or shortness of broath. Furthormore$ the years of rigid adherence to work do not now permit the sudden dovolopment of abili ' ty to enjoy relaxation. Great refftlessness is the result, and, if he tries to alleviate this by dabbling a little in business once more the younger generation which is now enjoying the management of his business finds his methods far too conservative for their more youthful spirits and disagreements arise which may be quite serious. Anxiety reactions and a feeling of loneliness are quite likely to result. In some instances there may be added to this the fe6ling that the younger generation is waiting for the day when his resources will be divided. We then turn to Ecclesiastes 6:1 (Moffatt) and read, "There is indeed an evil I have seen under the sun, that presses heavily on men--God making a man rich, wealthy, and honoured, till he has everything his heart desires, and yet he is unable to enjoy it; an outsider gets the good at it. This is vain, a sore misfortune."
The other senescent viewpoint which we will discuss is the lamentation which we hear in practice so often over the physical handicaps of aging, and the difficulty which is experienced in achieving acquiescence to these degenerative manifestations# In Ecclesiastes this is expressed in a fashion which has often made me marvel at the powers of observation of the author. If symbolism were not used in the wording, one could well imagine the description to be that of a well trained clinician. In verse 3 of chapter 12 there is first mentioned the trembling of "the keepers of the house," or the arm tremor, presumably of paralysis agitans, which is such an extremely common neurological disorder of senility. This is followed by a reference to the fact that "the strong men bow themselves." Here the bowing of the legs which results from the lessened activity of osteoid tissue in bones following the decline of adrenal stimulation is described. This is followed by a reference to the loss of teeth and to the decline of visual activity which are so commonly the lot of the aged. In verse 4 there is allusion to the auditory difficulties of aging, the early rising of the elderly, and the feeble voice that is characteristic of extreme senility. Verse 5 refers to the anxiety states, the white hair, and the feebleness and impotence of the aged. Verse 6 refers apparently to the three most common terminal events of life. The "loosing of the silver cord" (the spinal cord) and the breaking of the "golden bowl" (brain) would seem to indicate the hemiplegic death of cerebral hemorrhage, "The pitcher broken at the fountain" may well refer to the death in respiratory failure of pulmonary emphysema oases since the lungs are filled entirely by the effort of surrounding muscular structures, and are therefore in a sense passive as is the pitcher in the function it serves. Finally, the "wheel broken at the
cistern" seems to refer to the ancient method of water supply whereby a system of conduits was supplied by a rotary wheel at the cistern. We therefore can visualize this as a reference to cardiac and circulatory failure. "Then shall the dust return
to the earth as it was and the spirit shall return unto God who gave it. Vanity of vanities, saith the preacher; all is vanity."
The physician has therefore in the book of Ecclesiastes a presentation of the feelings of futility and despair which belong to a senescent, individual whose life has been lived "under the sun-" One is struck by the fact that the viewpoint is an entirely selfish one. It is of interest that the personal pronoun "I" is used 87 times in this short book. Nowhere are we led to believe that the author my have dedicated the utilization of his God-given gifts for the benefit of his fellow man. On the contrary., every attempt had apparently been made to use those gifts for the gratification of his own responses, and, as with the narcotic addict, increasing dosage was constantly necessary, loading to final complete disaster. It is of interest to mention at this point that Geriatric texts recognize the therapeutic importance for the elderly of attempting to stimulate those people by indirect suggestion toward attempting to alleviate the distress of others less fortunate than they arc.
In giving us this book of Ecclesiastes in the Canon of Scripture, the Holy Spirit provided for us a picture which demands an answer, and, at the same time, shows us very definitely that the answer is not to be found "under the sun." If a man who was as richly blessed as the human author in all that this world has to offer can only say as he contemplates life under the sun that it is altogether vanity and vexation of spirit, then it is evident that ran must look to God for the realization of his hopes and aspirations, It is an example of Verity through Vanity. In pointing out to our patients the fact that their viewpoints are echoed by a man who had all of the human advantages of the author, we are happily enabled by a loving God to present to them the fullness of His revelation. We can turn to the 7th Chapter of Romans to show once again the human viewpoint as depicted by Paul (the personal pronoun 'I' is used'34 times in this chapter), and then show that this is followed by that magnificent 8th chapter which begins with "no condemnation" and ends with "no separation." This glorious answer through the love of God which is in Christ Jesus our Lord is, of course, the final and perfect answer to all of the strivings of man under the sun, and is the 1coystono to the Penumo-psycho-somatic approach to medicine.
In conclusion, there is one more point which should be stressed from the teach ings of Ecclesiastes, and this belongs to the realm of prophylaxis rather than treatment. In the first verse of the final chapter we road, "Remember now thy Creator in the days of thy youth." This powerful word of advice to the young takes into account the fact that there is a fixation of thought processes in the elderly, and to produce major deviations from the well-worn ruts of habit is extremely difficult. The nuronal pathways follow courses through areas of low synaptic resistance, resistance, which has been lowered by oft-repeated stimuli throughout the years. Thus it becomes extremely difficult for the elderly to be shown a now approach to any problem, and this is no less true in spiritual matters than it is in the world of the material. We can well understand then why it is that with advancing years, the likelihood of a person accepting Christ declines rapidly, and those who have had much experience in the field of evangelism tell us that" this decline is practically in direct proportion to the age. We must therefore realize the tremendous importance of giving the word of God to-the young, long before the time when, in the words of the Preacher, the evil days come, and the years draw nigh when they shall say they have no pleasure in them.