The atheist problem of disease: Who’s to blame?

‘So explain this again to me, Dr Collins, why have I got this cancer? After all, I’ve not smoked, I don’t drink much alcohol, I cycled to work every day for the last 30 years, and now I’ve retired, ready to enjoy myself, and you’ve landed me with this. It just doesn’t seem right.’

So says Mr W., a 66-year-old man who has just been diagnosed with diffuse large B-cell lymphoma, a type of cancer of the lymphatic system (the drainage system of the body) for which no cause is known and for which no lifestyle factors have been implicated. Although he has a reasonable chance of cure with modern-day treatments (around 60–70 per cent), a six-month road of chemotherapy and radiotherapy lies ahead, with all the associated side effects of fatigue, nausea, hair loss, infection risk and possible organ damage. ‘I also have to consent you for death,’ I explain. ‘I mean, it’s rare to die on chemotherapy, but not impossible.’ As a fearful expression passes across his face, I realize I could have explained that a bit better!

Why me? An age-old question which is still frequently asked by patients today, of all faiths and none, when faced with a life-changing (and possibly life-shortening) diagnosis. It was the question asked by Job as he faced tragic loss and debilitating illness. Yet he had an answer: ultimately God must be behind it in some way. As Katherine Southwood puts it in her article, ‘… a menacing El (God) is physically attacking for no reason’. In many ways, this raises more questions than it answers. ‘Why has God let this happen?’ – a particularly poignant question for those who believe in a God of love and faithfulness. But the surety of God’s existence and hand in the situation give a focus for Job’s question, a person behind the madness and someone to whom he can appeal and in whom he can hope. Shortly after he has condemned his friends as, in Southwood’s terms, ‘quacks’ or ‘empty healers’, he reaffirms his hope in the God who is hurting him with the remarkable statement of faith-in-the-face-of-adversity: ‘Though he slay me, I will hope in him’ (Job 13.15). In the book of Job, we see God answering ultimately, albeit in a fashion that humbles Job, by reminding him who is the creature and who is the creator (Job 38—41), which is followed by the restoration of Job’s fortune (Job 42).

While there is no biblical warrant to always expect physical restoration for the faithful on this earth, the Christian is promised ‘treasures in heaven where neither moth nor rust destroys’ (Matt. 6.20) and a future in which God will ‘wipe away every tear from their eyes’ (Rev. 7.17). So Christian faith provides a hope similar to that which kept Job going in the face of adversity.

What, though, for the atheist or agnostic? As medics we respond as honestly as we can to the ‘Why me?’ question. For a cancer for which no cause has been identified a typical response might be: ‘As we go through life, our DNA accumulates genetic mutations. It happens in everybody, but the pattern of mutations varies. Some mutation patterns cause cancer and others don’t. I’m afraid your particular pattern does seem to have caused a cancer.’ In other words: it’s just bad genetic luck!

While scientifically plausible, such an explanation not only leads to more questions than it answers (like Job implicating God), but it offers no hope and no focus for the emotional outpouring which so often follows a cancer diagnosis (unlike Job’s implicating God). While Richard Dawkins has used anthropomorphic language to describe genes and their behaviour (such as in the title of one of his books, The Selfish Gene), genes ultimately do not provide a person behind the madness and someone in whom we can hope. Indeed, would the medic in this scenario not be aligned with Job’s friends, the ‘empty healers’ who offer explanations of a sort, but offer no empathy? Carel’s reflection on the leukaemia diagnosis, cited in Southwood’s article, could be seen as a damning indictment of the medical profession: ‘There are many terrible things about illness; the lack of empathy hurts the most.’ Maybe we, as medics, need to focus more on empathy and less on explanation. When patients ask the ‘Why me?’ question, perhaps Job teaches us not only to provide answers which may make sense superficially, but which ultimately leave the suffering person deep in their distress. Instead, it is a call for compassion and empathy. Furthermore, it is a call for humility to realize that scientific explanations don’t satisfy the deep questions arising from personal tragedy. Doctors are sometimes referred to as modern-day priests. Job teaches us that when it comes to offering hope in the midst of tragedy, they are most certainly not!

There is another element to the ‘Why me?’ question, which is evident in the book of Job and seen in clinical practice. Job’s so-called comforters assume there must be a simple explanation between Job’s suffering and his behaviour. Southwood notes the ‘continual accusations from his so-called friends about having brought illness on himself through sin’. We see this behaviour frequently today. In 2013 Charlotte Huff wrote an article in The Independent in which she highlights the experience of many cancer patients not only having to deal with the disease itself but with the suggestion that they brought it on themselves. ¹ She writes of Linnea Duff, who was diagnosed with lung cancer even though she never smoked. In many ways she experienced a similar thing to Job as she was accused of having in some way ‘deserved’ her suffering. ‘“It’s just so inappropriate,” says Duff, who believes that people with other serious illnesses don’t have to field so many intrusive questions.’

So much is written in the press about health promotion, and about how lifestyle factors can contribute to cancer, that an inevitable side effect is a sense of blame if the said cancer does arise. When a lymphoma diagnosis (or similar) is made and there is no simple answer to the ‘Why me?’ question, patients are often rather shocked and confused that such a shattering event can arise seemingly arbitrarily. In some ways, a lifestyle explanation would at least give an explanation which doesn’t have ‘bad genetic luck’ as the underlying cause. On the other hand, it means that a ‘Job’s-comforter’ reaction from friends, family and health professionals is completely inappropriate.

The book of Job is a summons to people to accept that simple explanations are often not correct, are usually not helpful and rarely offer comfort to the suffering individual. Such comfort cannot be given by explanations of molecular or genetic causes. Mutations, disease and death are mute impersonal forces we can only await. A hope that comforts, however, springs from a personal presence who embraces the patient, even in and beyond their physical demise.