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.