Thriving in the Face of Mortality: Kenosis and the Mystery of Life

By Daniel B. Hinshaw and Fr. John Behr

Kenosis, a Greek word meaning "depletion" or "emptying" and a concept borrowed from Christian theology, has deeply profound implications for understanding and ordering life in a world marked by suffering and death. Whereas the divine kenosis was voluntary, human beings experience an involuntary kenosis which is characterized by the inevitable losses experienced during the lives of mortal creatures. How one chooses voluntarily to respond to this involuntary kenosis, regardless of faith commitments, in effect defines us, both in our relationships with other suffering creatures and with the entire cosmos. This book offers a unique perspective on how the losses of involuntary kenosis choreograph the suffering which is such a defining aspect of the lives of persons, communities, and the environment in which they live, and how the kenotic process, rather than being a source of despair, can be a source of hope presenting opportunities for extraordinary personal growth.

• Language: English
• Publisher: Cascade Books
• Release date: Jan 27, 2023
• ISBN: 9781666744842

Daniel B. Hinshaw

Daniel B. Hinshaw is a physician and emeritus professor in the University of Michigan Medical School. A direct descendant of Quakers who strove to assist freedom seekers in the antebellum period, the author was drawn to write this piece of historical fiction. He is the author of Suffering and the Nature of Healing (2013) and Touch and the Healing of the World (2017). Neither Bond Nor Free is his first work of fiction.

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Introduction

In thrall to time, we struggle to pause in awe at the wonders that inhabit the world. Human beings have the extraordinary capacity to perceive and reflect upon, even extol in poetic terms, the beauty that surrounds them, and yet, a pervasive restlessness presents a continual distraction from such contemplation. In the restless anxiety born of our mortality, we are haunted by the first half of Augustine’s profound observation (quoted in the epigraph above) regarding the change to which creation is subject. Obsessing that "the extent to which something once was, but no longer is, is the measure of its death, we forget to draw comfort from the second half, the extent to which something once was not, but now is, is the measure of its beginning."¹

While there has been increasing openness to discussing death in Western society,² much of this interest is still centered on the inevitability of human mortality with relatively little consideration given to how death defines life and the inherent opportunities it poses for human beings once they are able to engage meaningfully with their mortal condition. Just as Augustine emphasized, the life of creatures is marked by change. Death is often viewed as a final outcome—an end point or full stop. However, it is the premise of this book that mortality is intimately woven into the fabric of our earthly existence from its beginning to its end and that its presence is reflected in a continuous process of change unto death—i.e., dying. Certainly, this process is fraught with suffering, but it is also pregnant with opportunity. Regardless of one’s religious or ideological commitments, this dynamic by which mortality inserts itself into our lives affects everyone and has profound implications for how we might choose to live within the boundaries of our mortal condition. A theological term from traditional Christianity—kenosis—may come closest to fully capturing how both the positive and negative aspects of dying define the life of mortal creatures.

In classical Greek, kenosis meant emptying or depletion,³ and was appropriated by Christian theology in describing the incarnation of Christ. "Have this in mind that Christ Jesus, who being in the form of God did not consider equality with God robbery but emptied [Greek—ekenōsen] himself, taking the form of a slave, becoming in the likeness of human beings; and assuming human form he humbled himself becoming obedient unto death, death on a cross.⁴ The divine kenosis revealed the very nature of Divinity—Christians worship a supremely humble God. Indeed, in the traditional Christian understanding it is precisely in the divine kenosis that the glory of God is revealed illumining a path for union between Creator and creature created in his image. Reflecting on this passage from Paul’s Letter to the Philippians, the early Christian scholar and theologian Origen (AD 184–253) stated succinctly the key theological insight that informs the analysis in this book. We must dare say that the goodness of Christ appeared greater and more divine and truly in accordance with the image of the Father when ‘he humbled himself and became obedient to death, even death on a cross,’ than if ‘he had considered being equal to God robbery,’ and had not been willing to become a servant for the salvation of the world.⁵ Or as John Behr has observed, By his kenosis Christ reveals divinity more fully than had he merely remained in the form of God: lowering is exaltation."⁶

In the humility of his voluntary kenosis, the Second Person of the Holy Trinity submits to being circumscribed within a mortal human body, uniting Divinity with humanity in order to die and thereby conquer death. By the manner of his death, he has provided the ultimate model of voluntary kenosis for those who would imitate him—If anyone wishes to come after me, let him deny himself, and take up his cross daily, and follow me.⁷ It is this voluntary renunciation of self that is at the heart of Christian asceticism. In the ascetic tradition, one voluntarily embraces and models one’s life on the example provided by the humble self-emptying of the incarnate God.

The human nature that God assumes in the incarnation is mortal and by virtue of its mortality not only experiences death and decay as the end of physical existence in this life, but also experiences its effects as a temporal process extending throughout life. Thus, the myriad cumulative losses of a lifetime represent for mortal human beings a type of involuntary kenosis, whether the losses are primarily physical (e.g., chronic disability, increasing debility associated with aging, the ravages wrought by disease), psychological (e.g., an increasing burden of grief, anxiety and depression), social (e.g., constriction of one’s roles and relationships in life), or spiritual (e.g., loss of one’s sense of purpose or value in life with the constriction of social roles).

The inexorable changes to which mortal creatures are subject on their journey toward death are largely beyond human control, and yet each human person can choose how they will respond to the involuntary kenosis unfolding in their life story. Within the Christian tradition this may best be described as the tension between Christ’s invitation to his followers to voluntarily take up their crosses daily and the involuntary nature of the individual crosses that are offered. Thus, we may have extremely limited ability to alter the circumstances of our birth or the various challenges that come to us in life, but we do have a choice in how we respond to those challenges.⁸ Indeed, according to the ascetic tradition of the church we are even encouraged to exercise discernment in every moment as we are confronted with choices regarding our thoughts.⁹

Among health professionals providing care to the terminally ill, there has been a consensus understanding that dying persons may experience healing independent of cure. "Healing is distinguished from cure . . . it refers to the ability of a person to find solace, comfort, connection, meaning, and purpose in the midst of suffering, disarray, and pain. The care is rooted in spirituality using compassion, hopefulness, and the recognition that, although a person’s life may be limited or no longer socially productive, it remains full of possibility."¹⁰ This statement from the secular medical literature resonates with Augustine’s observation that "the extent to which something once was, but no longer is, is the measure of its death; and the extent to which something once was not, but now is, is the measure of its beginning."¹¹

In this book, the terms involuntary and voluntary kenosis are utilized to describe, respectively, the inevitable losses and the choices human beings can make in response to those losses that are constitutive of the dying process (i.e., of living life in the shadow of death). In effect, the losses or little deaths that come unbidden in the lives of mortal human beings are kenotic, i.e., they represent a depletion or emptying of the self that is consistent with the original meaning of kenosis in classical Greek. Within the Christian tradition, the humility and self-renunciation of the divine kenosis demonstrated in the incarnation of Christ serve as the model for how human beings may choose in their own voluntary kenosis to respond to the involuntary kenosis that defines their mortal condition.

By virtue of their mortality human beings are essentially prisoners of time. Before exploring how kenosis so thoroughly pervades, defines, and transcends human existence, it is essential to further define kenosis as it applies to human beings confronted by the exigencies of temporal existence. Whereas the kenosis of the Word of God, his self-emptying, was completely voluntary, human beings as creatures subject to mortality experience an involuntary form of kenosis as they live bounded within time. It is to this very human form of kenosis, which begins at the biological or physical level and extends to all dimensions of the human experience, that we now turn. For the discussion that follows, it is important to emphasize that kenosis is a process with elements both common among and unique to individuals with death as the outcome.

As the psychiatrist and survivor of the Holocaust Victor Frankl noted, human beings have the freedom to choose their response to unavoidable suffering. Even the helpless victim of a hopeless situation, facing a fate he cannot change, may rise above himself, may grow beyond himself, and by so doing change himself.¹² In observing the response of his fellow inmates to their unimaginable sufferings in the Nazi concentration camps, Frankl described this powerful dynamic in stark terms. "In the concentration camps . . . in this living laboratory . . . we watched and witnessed some of our comrades behave like swine while others behaved like saints. Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions."¹³ Thus, involuntary kenosis is the temporal process of suffering played out in individual lives and through human relationships spreading to others and ultimately the cosmos. As a process, involuntary kenosis is a continual reminder of our ultimate destination as mortals and prompts us to act—to choose how we will respond to this reality that confronts each of us and so order our lives and relationships in that response.

Thus, at the most basic, physical level, involuntary kenosis may be understood to be a stripping away, depletion, emptying, or impoverishment of those elements that support function and independence. But, acting over a lifetime, the process of involuntary kenosis spreads across the physical, psychological, social, and ultimately spiritual aspects of the person. It is an evolving encounter with losses and the limits they impose, both internal and external to the person over time.

But what comprises the universe of loss? The congenital or acquired absence of traits, functions, or relationships understood to be the common or normal possessions or characteristics of the majority in a community, society, or species may provide a broad working definition of loss as it pertains to our discussion of involuntary kenosis. Loss in this definition could apply to a wide range of conditions affecting human well-being and, in turn, even the well-being of the cosmos to the extent that passible human beings interact negatively with their environment. For example, hearing or visual loss, whether acquired or congenital, represent losses of sensory function that could fit within this definition. Declining physical strength and stamina or impaired balance with increased risk for falls represent other forms of acquired loss as part of the evolution of aging. Bereavement from the death of loved ones, disruption of close relationships through separation and divorce, and even the normal transitions occurring with maturation (e.g., adult children separating from their parents) are representative of another form of relational loss fitting within this definition. On a larger scale, congenital and acquired losses extend to the basic security and integrity of human beings and their environment through poverty, famine, pollution of air and water, epidemic illness, natural disasters (e.g., floods, fires, earthquakes), and conflict (e.g., violent communities, war).

The congenital aspect of loss reflects the unequal nature of human inheritance. We do not choose our parents, the epoch, culture, country, or social conditions in which we are born. Children enter this world in unequal circumstances, including varying levels of economic security, wide-ranging intellectual, emotional, and physical abilities, differing opportunities for education, and, most importantly, variably stable family situations. It is not unreasonable to consider this variation in the circumstances of living that present at its outset as the starting point from which involuntary kenosis begins to play out in each individual life. Thus, there may be a component of involuntary kenosis that is inherited or congenital. Various types of losses experienced as involuntary kenosis by prior generations may be passed on to the next generation and perversely give the affected individuals a head start on the kenotic journey. This trans-generational aspect of involuntary kenosis may span the range of conditions comprising nature vs. nurture from heritable biological variation (e.g., genetic mutations causing disability or disease) to altered environmental circumstances (e.g., unstable social and limited economic opportunities).

Interestingly, the added challenges imposed by congenital elements of involuntary kenosis on life’s struggles are not necessarily viewed as entirely negative by many of those who actually live with and adapt to those challenges. An alternative view of heritable loss and the nature of disability has emerged within the disabled community. In discussing the potential role of gene editing in treating the so-called orphan diseases (i.e., rare genetic disorders like hereditary blindness or deafness), Rosemarie Garland-Thomson has argued that there is a societal misperception of such disabilities and the potential for suffering associated with them. The experience of minorities is always challenging for those in the majority to imagine. While disability can occasion suffering, living with disabilities is not necessarily a limitation, a reduction of future opportunities, or a predictor of distress or suffering.¹⁴ In describing how she and other friends with rare genetic disorders have flourished, she emphasized the great importance of the environments in which they developed as persons. We flourished as the genetically distinctive human beings we were because we were embedded in environments that sustained our emotional, psychological, social, physical, and material needs. We have flourished, not in spite of our disabilities, but rather with our disabilities.¹⁵

Here is an example of how one can voluntarily engage with one’s involuntary kenosis in a positive and constructive manner. These members of the disabled community have transformed the losses associated with their rare disorders into strengths by choosing to work with rather than deny the challenges imposed by their involuntary kenosis. Indeed, their choice to actively engage with their disabilities in supportive environments was essential to their formation as mature persons. What might have been perceived as only tragic loss became a creative source of opportunity for personal growth. This willingness to engage directly with one’s disabilities, to adapt, especially with the collaborative support of a community can serve as a useful model for how human beings in general may respond constructively to the losses encountered during their own unique journeys of involuntary kenosis and experience healing independent of cure.

How do these definitions of kenosis relate to the phenomenon of suffering? In a classic article (and later book), suffering has been defined by Eric Cassell as the state of severe distress associated with events that threaten the intactness of the person.¹⁶ In his definition, Cassell has emphasized that suffering depends upon perception of the threat by a person. By way of contrast, the emphasis in the ancient understanding of the Greek word pathos was on something, usually bad, that happened to a person, regardless of the degree to which it was perceived by the person. Thus, although suffering may be consciously perceived as a threat to one’s integrity, it extends beyond conscious perception and is fundamentally ontological; it is a state of being.¹⁷

Consistent with this broader definition, the pioneering medical anthropologist and physician, Victor von Weizsäcker (1886–1957) described human existence as being pathic.¹⁸ Indeed, for von Weizsäcker, health is not the actual human condition. Rather, human beings live a pathic or suffering existence in which they may strive for health as an ideal, but never quite achieve it during life. In his model of pathic existence, he described the life of a human being as always being at the intersection of five competing categories: what s/he must do, is permitted to do, wants to do, should do, and can do.¹⁹ The conscious and unconscious tension between these categories is dynamic and may become particularly intense toward the end of life. Describing this in a different way, a legal philosopher has highlighted the limits imposed by suffering on human beings in an excellent study of the biblical story of Job. To constrain, humble, or crush the will is . . . the very core of what is classically meant by suffering. To suffer is to endure that over which our will has no power, that which is against our will. To suffer is to be the patient, not the agent.²⁰ From close observation at the bedside of many terminally ill cancer patients, Dame Cicely Saunders (1918–2005), the founder of the modern hospice movement, defined suffering as total pain. Making a clear distinction between physical pain and suffering, she conceived of suffering or total pain as the sum of pain or distress experienced across four distinct but highly interconnected dimensions of the person: physical, psychological, social, and spiritual.²¹

Suffering (Greek—pathos) and kenosis are closely related. Whereas suffering encompasses in the broadest sense the many bad things that may happen to human beings during their lives, kenosis is more descriptive of the process and outcomes of suffering that develop during the course of human existence. Where pathos is experienced largely in a passive manner,²² kenosis for the purposes of this discussion has both passive (involuntary) and active (voluntary) aspects. Processes lead to outcomes and outcomes can also engender responses. Thus, kenosis in its totality as the combination of its involuntary and voluntary forms is more descriptive of the arc or trajectory of suffering that plays itself out over the course of individual lives. Indeed, to use a theatrical metaphor, kenosis could be described as the choreographer of the suffering that is manifested through common as well as unique elements in each human life.

Suffering and death are inextricably linked. This is reflected within the traditional Christian understanding expressed in the fourth-century Nicene Creed: "He [Christ] was crucified for us under Pontius Pilate and suffered [Greek—pathonta] and was buried."²³ There is no explicit mention of the word death (Greek—thanatos) in the original creed. It is unnecessary, for suffering culminates in death. Just as night inevitably follows twilight, so death is the ultimate denouement of suffering.

Although healing independent of cure has been identified as a real possibility, even an ideal to strive for, in the care of those who are terminally ill,²⁴ what may constitute such healing remains an open question. If dying as kenosis is indeed a process that is integrated into the life of human beings from the very beginning of existence, it would seem unnecessary and unfortunate to limit the scope of inquiry regarding the nature of healing independent of cure to the very end of life. The concepts of involuntary and voluntary kenosis together offer a novel lens through which to evaluate human suffering and mortality, and, in turn, place the phenomenon of healing in death within the broader context of an entire life lived in the shadow of death.

Although human suffering has often been considered as a phenomenon predominantly experienced by individuals, Cicely Saunders’s insightful inclusion of social pain as a critical dimension of total pain serves as a much-needed corrective. For example, major concerns of terminally ill persons have often centered on the health of their relationships.²⁵ In a large national survey concerns about relationships that were considered to be important to persons at the end of life included: being at peace with God, not being a burden to family or society, and being able to help others.²⁶ In another context, social connectedness has been noted to be an important predictor of suffering. For patients undergoing major operations, the size of patients’ social networks (number of social contacts) correlates inversely with postoperative anxiety and pain. Larger social network size appears to confer protective effects with respect to postoperative anxiety and pain translating into shorter lengths of stay in the hospital.²⁷ This relational aspect of suffering, highlighted by the social dimension of total pain, supports a broader conceptualization of illness and health that extends beyond the individual through relationships to a larger community.

In many respects, the rise of public health in the nineteenth century was a reflection of efforts to address the communal or social determinants of human suffering that have been linked to sickness and disease. The growing recognition that the health and suffering of individuals have a communal dimension was in no small part due to the efforts of a nineteenth-century German physician, Rudolf Virchow (1821–1902).²⁸ Revered as the father of modern pathology, Virchow was also a major pioneer of the emerging discipline of social medicine (public health).

As a young physician in 1848, Virchow experienced a transformative encounter with communal suffering, which was to define him both as a professional and even more importantly as a person. As a result of his investigation of a typhus epidemic in Upper Silesia (a Polish-speaking part of Prussia at the time), he came to the realization that the underlying causes of the outbreak were largely social in nature.²⁹ Poverty, famine, and lack of education all played major roles in initiating the public health crisis in which approximately 10 percent of the local population died. Coming back to a Berlin caught up in the revolutionary fervor of that year, he expressed his new sense of identity in a letter to his father: I am no longer a partial man, but a whole one, in that my medical creed merges with my political and social creed.³⁰

Virchow’s revelation that poverty, inadequate nutrition, unsanitary living conditions, and lack of education are fundamental causes of illness lifted the convenient veil separating a physician practicing a more narrowly defined medicine from the social distress of his fellow citizens. He expressed this new understanding of the nature of medicine and its relationship to society in a pithy, but powerful statement. Medicine is a social science and politics is nothing else but medicine on a large scale.³¹ Virchow’s transformed understanding of disease and health enabled him to see the world more broadly in a unified manner, breaking down boundaries between his professional identity, his identity as a citizen of his country, and ultimately as a compassionate human being living in the nineteenth century. In some ways, his holistic vision represents a secular cognate of the traditional Christian anthropological understanding in which the healthy human creature is fully integrated within the cosmos through relationships with Creator and creation.

It is not the intention of this book to use Virchow’s vision of medicine to expound a particular political agenda. Rather, it is his broader holistic view of the social or relational determinants of health and disease that offers a useful framework for inquiry regarding the concept of kenosis, since it more closely resonates with the traditional Christian understanding of the interrelatedness within the creation. With these expanded secular and religious perspectives in mind it may then be possible to more fully explore the implications of kenosis, both in its involuntary and voluntary forms, for experiencing healing independent of cure. The tension between involuntary and voluntary kenosis could exert a powerful pedagogical function, teaching human beings how they might live well while fully aware of their mortal condition, not only individually, but together within community, and ultimately in relation to the cosmos.

The book is organized into three parts. The first part will examine the pervasiveness of kenosis within human experience. Keeping in mind Virchow’s broad vision of medicine, in the first chapter examples will be presented of the challenges posed by and the human responses to the involuntary kenosis that profoundly shapes individual human lives, and through relationships communities, and ultimately the cosmos. The second chapter will review the changing attitudes toward human mortality