Ethnomedical Anthropology and Paul's “Thorn” (2 Corinthians 12:7)

The Health Care System

Medical anthropologists have discovered that there are many ways of understanding and experiencing health and illness, and further, that the ways in which an individual or group perceives, symbolizes and reacts to health and illness are determined by the framework of a specific culture. Arthur Kleinman, e.g., one of the most widely recognized authors in the field (Kleinman 1980; Kleinman & Good 1985), has attempted to understand medicine as a system that includes all elements related to health in a given society. He writes:

In every society, a “health care system” is generated by a collective view and shared pattern of usage that operates at a local level; however, as Santiago Guijarro explains, “the health care system is not a real entity but rather a conceptual model elaborated on the basis of what the persons involved think and do with respect to health and illness in a given social context” (Guijarro 2000: 103). So, for example, Kleinman has constructed a structural model of a health care system, which he suggests can be used to analyze the system in any society. Kleinman's model, and any such approach of medicine as a (heuristic) cultural system, essentially rests on three premises:

As Kleinman sees it, in its overall structure a health care system consists of three overlapping sectors: the popular, the professional, and the folk. The popular sector is defined as the nonprofessional network of the family and local community (including self-help strategies); the professional sector as organized, institutionalized, and socially sanctioned healing professions; and the folk sector as non- (and/or quasi-) professional, non-bureaucratic specialists (e.g., shamans, spiritualists, herbalists). These three sectors are defined differently within each culture, and even within various social groups in the same culture, and, furthermore, each culture establishes an implicit hierarchy that determines the way a sick person will pass from one sector to another in search of health.

Because the whole system heals, not just the “healer,” and because “health beliefs and practices must be viewed within the context in which they occur, since focusing on them in isolation distorts or detracts from their meaning and function” (Blum & Blum 1965: 20; cf. Kleinman 1980: 415), it is necessary to conduct both a macro- and a micro-analysis to see how one small-scale event (Paul's “thorn”) within the healing system in its three sectors relates to large-scale social structure and processes. In other words, to understand the story behind Paul's “thorn” we need to have a basic knowledge of these three sectors in his world. To that end, in the next part, I offer a brief overview of the popular, professional, and the folk sectors (and their interactions) within the health care system(s) of the first-century Near Eastern and eastern Mediterranean world (s).

In the simplest sense, all ethnomedical systems have three interrelated parts, which, collectively, construct and define both health and illness: a theory of the etiology (causation) of sickness; a method of diagnosis based on the etiological theory; and the prescription of appropriate therapies based on the diagnosis (Brown 1998: 15, 108). The first and second constitute the cognitive components of an ethnomedical system, and I consider them in the third part of this article: “Explanatory Models and Paul's World.” The third comprises the behavioral component of an ethnomedical system, and I consider it in the article's fourth part: “Therapeutic Strategies and Paul's World.” Kleinman's five “core clinical functions” of health care systems (1978: 416–71), adapted by Pilch to the ancient context (2000: 27–29), are also helpful, and I will refer to them throughout my analysis below: construction of hierarchies of health values; governing of experience of illness; ordering of cognitive response to illness; therapeutic activities; and managing of potential outcomes of the healing process.

The Disease-Illness Distinction

Throughout the development of the field of ethnomedical anthropology, the distinction between disease and illness has had a central importance. Disease refers to observable, organic, and pathological abnormalities in organs and organ systems, whether or not they are culturally recognized. The concept of disease is fundamental to biomedicine, a term that refers to the tradition of scientific, biologically oriented methods of healing, and curing is the corresponding biomedical attempt to restore biological order or normality. On the other hand, illness refers to an individual's perceptions and lived experience of being sick or diseased—that is, culturally disvalued states including (but not limited to) disease. Disease is considered a biological phenomenon, whereas illness includes psychological and social dimensions as well. Healing of an illness, then, may include a biomedical response to disease, but more broadly involves the attempt of a health care system to provide culturally relevant meaning for the disruption caused by illness.

The disease-illness distinction was first described in a seminal article by Leon Eisenberg, who argued that it reflected differences between professional and popular/folk ideas of sickness (1977). The logic subsumed under Eisenberg's formulation—which, in a sense, implied that disease was real but illness was not—has been a central target of analysis in critical medical anthropology. In recent years, the disease-illness distinction has also been criticized because its separation of biological facts from cultural constructions falsely suggests the superiority of a “culture-free” biomedical model. In my opinion, prior application of medical anthropological theories and methods to the study of New Testament and related writings have largely glossed over such biases subsumed by the disease-illness distinction, and, consequently, have participated in perpetuating the myth of a “culture-free” biomedicine. In a cultural sense, a medical system is any organized set of ideas referring to a particular healing tradition, and while the (Western) scientific biomedical system is technologically sophisticated, international, cosmopolitan, dominant, and hegemonic, it is not, however, culture-free: when viewed as a cultural system, biomedicine becomes one ethnomedicine among many others (Rhodes 1996: 165–82). Researchers have also studied the significant and fascinating national and regional differences in the practice of biomedicine (Payer 1988). It is important to remember that all ethnomedical systems (including the Western biomedical tradition) are rooted in cultural presuppositions and values, associated with rules of conduct, and embedded in a larger context. (Brown 1998: 109). In the course of this study, while attempting to acknowledge the above complexities, I follow the concept of the disease-illness distinction as it has been modified in the work of Kleinman and, more recently, considered in detail by Robert Hahn (1995), and Thomas Csordas and Arthur Kleinman (1996: 3–20). I have opted here to employ the terms “illness” and “healing” (as opposed to “disease” and “curing”) in this more holistic manner.

The Popular Sector

The largest sector of every ethnomedical system is the popular sector, which embraces the “lay, non-professional, and non-specialist” (Pilch 2000: 78). This sector's function in the healing system is primarily one of maintaining health, and when a person's health status goes awry, this is the sector that first observes, defines, and labels the deviance. There are several levels to the popular sector of the healing system including individual and community beliefs/practices and the larger social network (including kinship). The distinction of the status and roles of dyadic individuals in collectivistic cultures is at the center of much social-scientific revaluation of New Testament writings—individuals are socialized to behaviors which emphasize obedience, duty, sacrifice for the group, cooperation, favoritism toward the in-group, acceptance of in-group authorities, nurturing, and interdependence (Triandis 1993: 368; Malina 2001: 58–80). Perhaps just as significant then is the application of the concept of social network (Schweizer & White 1998: 1–14), the set of contacts through which individuals maintain a social identity, receive emotional support, material aid, services, and information, and develop new social contacts (Wasserman & Faust 1994) to the ancient Mediterranean world (Malkin, Constantakopoulou, & Panagopoulou 2007).

At the level of dyadic individuals, the Pauline writings describe three cases involving Paul's ill co-workers who were not healed (explicitly) by the methods which Jesus used in the Gospels and the apostles used in the Acts: Epaphroditus (Phil 2.25–30); Timothy (1 Tim 5.23); and Trophimus (2 Tim 4.20). In each of these cases individual sickness is given meaning through a collectivist filter: illness denotes a social-cultural perspective in which “many others besides the stricken individual are involved” (Pilch 2000: 76). Epaphroditus is “extremely distressed” (adēmonωn) that news of his illness may be causing the community at Philippi emotional turmoil; Timothy's stomach ailments (and their potential relief) are a matter for the community and the ordering of its elders; and the ill Trophimus is left in the care of the community at Miletus. Paul also describes certain individuals afflicted (some to the point of death) by an undisclosed sickness, apparently owing to some connection with the communally oriented Lord's Supper (1 Cor 11:30). Finally, Paul speaks of his own physical infirmity, which he regards, in one instance, as the very reason for his ministry to the Galatians (Gal 4:13–15), and, in the second instance (our reference passage, 2 Cor 12:7–10), as an instrument of the demonstration of the power of God to his communities.

The importance of kinship ties in Paul's world is perhaps best demonstrated by Paul's use of images and language of household and familial kinship throughout his letters as part of his deliberate rhetorical strategies to (re)assert his authority and (re)establish harmony and order in the communities of his conversation partners (Birge 2002; Malina 2001: 134–60; and Balch 2003: 258–92). Considering the centrality of the family in Paul's world, it is safe to assume that such dyadic individuals would have relied on kinship and/or fictive kinship ties, such as relations with neighbors, clients and/or the patron (Lampe 2003: 488–523), for advice and help in the assessment of sickness.

While we have little evidence about the sort of health care that was given in Paul's world at the level of the social network, such care likely would have included various forms of divine communication—simple petitions or therapeutic confessions (Avalos 1999: 37–38) as suggested perhaps by Paul's counsel to the Corinthians regarding “discerning the body” (1 Cor 11.27–34)—or household/natural remedies. Cross-cultural studies by medical anthropologists indicate that the use of natural remedies is a widespread mode of self-help, regardless of the socioeconomic stratum of patients (Etkin 1996: 149–58), and such studies have been fruitfully employed in discussions of the world of the biblical texts (Jacob 1993: 27–46). When these resources were exhausted, the social network may have played some role in helping ill individuals seek care beyond the popular sector, from either the professional or the folk sector. So, for example, we see in the Gospels and Acts, kinship and fictive-kin groups interacting with Jesus and the Apostles on behalf of their needy/ill (Mark 1:33; 7:32; 8:22; Matt 9:1–2; Acts 3:1–4.22).

One final, key element governing the behavior of dyadic personalities and the social networks in which they are located is the cluster of commonly held beliefs and practices (Gaines 1982: 243–44), especially the culturally shared beliefs concerning etiology, or theory of disease causation, which I discuss at length in the article's third part.

The Professional Sector

The professional sector of ethnomedical systems includes “the professional, trained, and credentialed healers” (Pilch 2001: 94). The practice of professional medicine in Paul's world is documented, at least within those social groups under Greek influence, from the Hellenistic period on. Ben Sira, for example, praised physicians and their profession, but at the same time he reminded his readers that healing was always in God's hands (Sir 38:1–15) (Noorda 1979: 215–24). In the same vein, the Jewish historian Josephus mentions several times the activity (and failures) of physicians in first-century Palestine (The Life of Flavius Josephus 404; Antiquities of the Jews 7.343; 19.157; Wars of the Jews 1.598). The traditional (perhaps “official”) attitude towards physicians in ancient Israelite society, however, was one of distrust. Israelite monotheism could think of Yahweh alone as the source of health, and consequently (official) healing could be acquired only through legitimate mediators, especially through the prophets, who were the authorized consultants in the traditional health care system of the Israelite society. This, according to Avalos (1995: 265–77), is the definitive word on healing in ancient Israel's ethnomedical system, though some of the particulars of his claims call for retooling (Hogan 1992; 2001: 120–121): Avalos's assertion that the rophim (healers) were “non–Yahwistic health consultants” (Avalos 1995: 290–91) is gratuitous and tends to ignore the evidence of Ben Sira (Sir 38), in which the physician prays for his patients; his suggestion that even in the pre-exilic period the “most important consultant in health care was the person designated as the prophet” (Avalos 1995: 394) is speculative and based on the evidence of some prophets praying for the healing of a few people; and, as Avalos himself admits (1995: 289), the presence of female medico-religious professionals in Israel (described in texts such as Gen 25:22; 38:27–30; and Ezek 13.17–23) whose responsibilities included attending women during birth (i.e. the midwife), frustrates any oversimplification of attitudes towards “professional” medicine in Israel (Avalos 1995: 128–72; Gursky 2001: 62–101; and Bowen 1999: 425–26).

As in the rest of the Hellenistic-Roman world, professional physicians, following the teachings of Hippocrates, sought to find out the causes of illnesses and their remedies. These professionals had a global, philosophical perspective on the cosmos and an integrated idea of the human person (Seybold & Mueller 1978: 98–100; and Scarborough 1988: 1227–48). Historians of ancient medicine have provided many basic discussions covering the span of Greek and Roman medicine from the earliest textual evidence of the Homeric poems (eighth century BCE) through the Later Roman Empire (seventh century CE) (Sigerist 1951–1961; Grmek 1989; and Nutton 1992: 15–58; 1995: 39–70; and 2004). If we take the Greek word iatros, “one who undertakes the cure of physical ailments” (BDAG 465), to be a reliable reference to this “professional” healer—although also considering that “professions,” as they are known and understood in the contemporary world, did not exist in the ancient world (Freidson 1970)—then, there is only one such reference in the entire Pauline corpus (Col 4.14), where Paul extends the greetings of his “fellow worker,” Luke: Loukas ho iatros ho agapētos, “Luke, the beloved physician.” While this passage has led to much speculation that Luke was Paul's doctor during his imprisonment, there is no convincing evidence for this. Luke is also mentioned in Philemon 24 (and also in the Pastorals, at 2 Tim 4:11) as Paul's fellow worker; only here, however, is he called “the beloved physician.” The well-established scholarly consensus regards all attempts to show by linguistic means that the author/redactor of Luke-Acts was a qualified doctor (and also the primary referent of Col 4:14) as more or less forced exegetical acrobatics (Hobart 1882; von Harnack 1909; Clark 1933: 405 ff). Consequently, there is little reason to believe that Paul sought professional medical assistance, concerning his “thorn” or any other ailment, from Luke (Morton & Macgregor 1964: 3).

The only other possible reference in the stream of Pauline tradition to a case involving professional medicine occurs at 1 Tim 5:23. Here we find a directive, which at first sight appears to be so out of place that it has at times been treated as an interpolation (Falconer 1937: 151), although this view has not found favor with the majority of scholars (Bernard 1899: 89; Spicq 1947: 180; Dornier 1969: 97; Kelly 1981: 128). The command for Timothy to stop drinking water only, suggests that he had made a decision to abstain from drinking any wine (Fee 1988: 132), for whatever reason (Lock 1936: 64; Bürki 1974: 183; Bernard 1899: 88; Kelly 1981: 128–29; Merkel 1991: 46; Dibelius and Conzelmann 1972: 80–81; and Roloff 1988: 23). Though it is difficult to be certain about the specific background of this statement, what is sufficiently clear from the text is that the command not to drink water only is linked closely to Timothy's health (Dornier 1969: 98). The instruction to “drink a little wine on account of your stomach” (oinω oligω chrω dia ton stomachon) seems to have been a veritable commonplace in antique professional medicine (Plutarch, Advice about Keeping Well 19; Pliny the Elder, Natural History 23.22.38; as discussed in Nutton 2004: 13) and likely suggests a professionally sanctioned (albeit popularly recognized) medical prophylaxis or treatment.

To this same sector of professional medicine can be ascribed most of the activities carried out in the sanctuaries of Asclepius, which, in the ancient Mediterranean world, served as a religious center for healing. Influenced likely by the methods and practices of Hippocrates, the Asclepian cult used herbal formulae and medicinal applications intricately connected with cult rituals and worship (Pettis 2006). Collectively, Homer (e.g., Iliad 4. IV.189–219; Odyssey 1.261; 2.325–29; 10.394), Theophrastus (e.g., Inquiry into Plants IX.8; IX.9.1–.9.4; IX.9.9.1; XI.15.1–15.3;), and Pliny the Elder (e.g., Natural History XVI.14; XX.2.3; XX.39.99) all relate a world immersed in the knowledge and use of varieties of plants used for internal and external medicines, and these traditions likely have roots in ancient Near East civilizations such as Assyria and Babylonia (Scarborough 1991: 162). Though the Asclepian healing cult was widespread in the ancient Mediterranean world, what is most significant for the purposes of our study is the fact that this cult was extremely popular in the city of Corinth (Roebuck 1951; Kasas & Struckmann 1978; 1990)). According to Roebuck (1951: 154), the historical and archaeological evidence indicates that the Ascelpian cult was introduced in Corinth in the late fifth century BCE, and it rose to a grand scale, even if only locally, in the late fourth century BCE.

Though there are no direct references to the professional healing of the Asklepium in Paul's Corinthian correspondence (or any of his other writings for that matter), it has been suggested by at least one scholar that the beliefs and activities of the Temple of Ascleipus in Corinth may have influenced Paul's “body” theology/imagery which occurs so prominently in these letters (Hill 1980; Oster 1992). Aside from the Corinthian correspondence, where the “body” is a central illustration (1 Cor 12:14–25), the image only occurs two other times in the undisputed letters (Rom 7:4; 12:4–5) and in five passages of the disputed letters (Eph 1:22–23; 4:12, 16; 5:23; Col 1:18, 24; 2:17, 19). Excavations conducted at Corinth reveal that patients who came to the Asclepium for treatment often left votive offerings, in the form of terra-cotta representations of individual body parts, to the god as an expression of their gratitude for healing. Paul, no doubt, would have been familiar with such practices (since it was apparently Paul's custom to visit the temples of the cities he ministered in, if we can trust the account of Acts 17.22–23), and it is at least a possibility that this emphasis on the individual dismembered body parts, in contrast to the whole (newly healed) person, might have contributed to Paul's language and rhetoric. As is well-established, Paul is not shy about extracting other illustrations from the everyday life in the city of Corinth: e.g., the image of the builder (1 Cor 3), prostitution and slavery (1 Cor 6), food from the agora and temple worship (1 Cor 8), and the illustration of the runner, the boxer and the winner's wreath from the Corinthian Isthmian Games (1 Cor 9). We also may reasonably inquire whether the strong presence of the Asclepius cult in Corinth had something to do with Paul's rhetorical emphasis on “gifts of healing,” which is unique to his Corinthian correspondence, as I discuss below.

The Folk Sector

The folk sector is the non-professional, non-bureaucratic, specialist sector of ethnomedical systems that blends many different components from the other sectors, though most are derived from and related to the popular sector (Pilch 2001: 85). Some anthropologists divide this sector into sacred and secular, but that distinction blurs in analyses of the ancient world, where, in contrast to modern Western medicine, religion and health care were intricately intertwined (Avalos 1999: 20–22). Folk medicine is the realm of magic and spirits, and the arena of popular healers who constitute its most representative figures. Though folk healers in general vary widely from culture to culture and even within a culture, some common traits can be observed across cultures. Most folk healers:

It is by now perhaps stating the obvious—but it is an important obvious fact—that (from an etic perspective) the majority of healings in early Christian communities, including those established by Paul and his co-workers, belong to the folk sector of our ethnomedical model (Avalos; Pilch; Guijarro; and Albl). I reserve my comments on the folk sector for the last part of the article, as I have much more to say there concerning the topic of folk healing and its “therapeutic strategies” in Paul's life (as evidenced by the story behind his “thorn”) and in the world of his Corinthian auditors.

Etiologies of Illness in Paul's World

Among the basic questions that an EM answers is the question of etiology: what is the cause of my particular illness? Medical anthropologists—following the work of Foster (1976)—make a basic distinction between two broad areas of etiology/causation: naturalistic and personalistic. Naturalistic systems tend to have etiological explanations that are restricted to the disease symptomology and a single level of causality, while personalistic etiologies extend to the domains of social relations—with living people, ancestors, and other spiritual entities (Avalos 1999: 23). For_Foster, personalistic etiologies have a higher degree of religious involvement than naturalistic etiologies. Responsibility for the illness resides with the patient in naturalistic etiologies, while responsibility for the illness is beyond the patient's control in personalistic etiologies (Foster 1976). While the division into personalistic and naturalistic etiologies may be useful, as we will discover with respect to the understanding of illness and healing in Paul's symbolic world, we must be more specific in the various subcategories and implications of these basic types. Pilch, for example, has argued that Foster's system can be refined for application to the New Testament by subdividing personalistic etiologies into illnesses in which (a) a malevolent spirit is involved and (b) no malevolent spirit is involved (although God is or might be so perceived) (2001: 104). Though, as Avalos has noted, Foster's etiologies also need refinement in other aspects: Foster's ideas that a personal agent is responsible for an illness does not align with the degree of patient responsibility seen in the ancient Near East; some gods may send illnesses because a patient has sinned (and so the patient is deemed responsible), or because the gods are simply capricious (and so the patient is not deemed responsible) (Avalos 1999: 23).

George Murdock (1980), on the other hand, has constructed thirteen theories of illness, divided into major divisions:

In societies like the ancient Near East and eastern Mediterranean, sickness and healing is best categorized by the overlapping realms of witchcraft, sorcery, and spirit aggression (Murdock 1980: 73). Murdock notes that while causation of illness by witchcraft and sorcery is most characteristic and deep-seated in the circum-Mediterranean region, he also contends that without exception, every society (in the sample) which depends primarily on animal husbandry for its economic livelihood regards spirit aggression—defined as the attribution of illness to the direct hostile, arbitrary, or punitive action of some malevolent or affronted supernatural being—as either the predominant or an important secondary cause of illness (1980: 58). Murdock suggests that this correlation might possibly derive from the “risk” dimension of life, because shepherd-types appear to be at greater risk than land-owner types and deal with aggression on a regular basis—that is, shepherd-types must protect themselves and their animals from other people/animals and must always be prepared to use aggression to ward off aggression (1980: 82). While evidence for spirit aggression, as defined by Murdoch, abounds in the Gospels and Acts (Matt 4:24; 8:28–34; 9:32–34; 12:18–31; 15:22; 17:14–20; Luke 4:38; 8:2–3; 10:17; 13:10–16; 22:3, 31–34; Acts 8:7; 12:23; 16:16; 19:12, 14–16), Paul's particular understanding of etiology of illness, especially with respect to our reference passage (2 Cor 12:7), is decidedly more complex, as discussed below.

We ought to heed the warning of scholars who rightly caution that naturalistic and personalistic etiologies are not mutually exclusive (Foster 1976: 776; Avalos 1999: 55). In the ancient world, both etiologies may be used by the same community or even by the same person. Ben Sira, for example, shows a remarkable balance between respect for the physician's skills and recognition of God as the ultimate source of healing (38.1–2), while the Chronicler sets the physician's art and God's healing in opposition (2 Chr 16:12–13). Furthermore, we should not impose a post-eighteenth-century dualism of “natural” and “supernatural” upon the first-century Near Eastern and eastern Mediterranean world (Harris 2005: 948–51). The most widely known proponent of this sort of warning is Hans Frei (1974), but Frei's view of referential meaning is inadequate, and his notion of fictive meaning requires clarification in the light of Wolterstorff (1995). Dale Martin also critiques such a distinction between “natural” and “supernatural,” offering his own distinction between an “imbalance” etiology (disease results from an imbalance of elements that are natural to the body) and an “invasion” etiology (disease is caused by an invasion of the body by a foreign element) (1995: 139–62). Martin correctly notes that a naturalistic/personalistic dichotomy may be linked with a modern dichotomy between the “natural” and the “supernatural” that actually distorts ancient concepts. “Natural” was not necessarily the opposite of “supernatural” or “divine”; “nature” itself was often understood as divine. The Hippocratic treatise On the Sacred Disease illustrates this point well. The author argues that a certain disease (usually thought to be epilepsy) should not be considered more “divine” (theia) than any other disease: “This disease styled sacred comes from the same causes as others, from the things that come to and go from the body, from cold, sun, and from the changing restlessness of winds. These things are divine” (… tauta d’ esti theia; Sacred Disease 21). Nevertheless, the naturalistic/personalistic distinction remains useful and appropriate. For both ancients and moderns, a personalistic worldview is evident in treatment options such as prayer or exorcism where appeal is made to a personal force. In contrast, a naturalistic worldview reveals itself in options that seek to manipulate “natural” elements or forces in the body without necessarily appealing to a personal force. I thus employ the naturalistic/personalistic distinction as basic, but will also refer to other models. Paul's symbolic world is personalistic—God, the Lord (Jesus the Christ), s/Satan and/or other adversative “messengers” are all forces to be reckoned with in dealing with illness—though not exclusively so.

One scriptural etiology explains illness as directly sent by God (Exod 4.11; 15.26; Deut 7.15; 28.22; 32.39; Job 5.18; Isa 45.7; Amos 3.6), and Paul, too, is not hesitant to assign the origin of certain illness to God. With regards to our reference passage (2 Cor 12.7), although the agent behind the verb edothē (“it was given”) is left unnamed, there are really only two possibilities—either Satan (or his angelos) or God (or “the Lord”). As Harris observes, “If Satan was seen by Paul as sometimes a source of human illness (cf. 1 Cor 5.5) and the skolops was some sort of physical malady, it is con-ceivable that the passive voice of edothē conceals a reference to Satan” (Harris 2005: 855). However, because this “gift” embodied a positive function/purpose (which I consider below, in the third part)—to assist Paul in his struggle with excessive self-praise—it is unlikely that Paul would have assumed that ultimate agency in the giving of the “thorn” belonged to anything (or anyone) other than God. Also, as Plummer observes, if Paul had intended to imply that Satan was the agent, didωmi, a word often used of the bestowal of divine favors, would probably have been replaced by a more apposite term such as epitithēmi (Luke 10.30; 23.26; Acts 16.23), or epiballω (1 Cor 7.35) (Plummer 1915: 348). To understate the case, the vast majority of scholars identify the giver of Paul's thorn as God (1 Cor 10.1–13; 11.32), primarily because the verb, didωmi, occurs in the passive voice. This form, commonly known as the “divine/theological” passive, is frequently used in New Testament writings to make reference to the activity of God without naming God as subject (Harris 2005: 855; Zerwick 1963: 76).

The connection between sin and illness was a well-known concept in Judaism as classically expressed, for example, in Deuteronomistic theology (Deut 28:22; 2 Kings 20:3; 19:15–19; Tobit 1:18; Sirach 3:26–27; m Shab. 2:6; b Shab 32a-33a; b Ned 41a; b Ber 5a. T). The connection is also not unknown in New Testament writings (Mark 2:1–12; Luke 13:1–5; John 5:14; 9:2–3; Davids 1982: 194–95). While it is true that Paul is careful at times to avoid expressing a close etiological relationship between sin and sickness (Rom 5:12–21), at other times he expresses interest in exploring how sin and sickness are connected. In 1 Cor 11:27–34, for example, having warned his conversation partners that they “eat and drink judgment” against themselves when they do not “discern the body” (diakrinωn to sωma) and therefore eat and drink in an unworthy manner (11:27–29), Paul identifies some of the results of such actions: “many are weak and ill and a number have died” (polloi astheneis kai arrωstoi kai koimωntai hikanoi; 11:30). One could argue that sickness and death are related to the Eucharistic elements in a causal way—that is, sickness and death are metaphysical results of abusing the elements themselves (Goguel 1910: 177–78; Nock 1964: 130–31; Héring 1962: 120). However, while the Corinthians may have had a somewhat “magical” view of the sacraments, there is less indication that Paul did (Conzelmann 1975: 203; Senft 1979: 154).

Somewhat differently, and on the basis of the Corinthians’ possible association with demons mentioned in 1 Cor 10:20–21, C. K. Barrett concludes that demons were the probable cause of the physical disease present in the congregation (1973: 275); though, Paul neither identifies demons as a possible cause nor does he give any hints as to the presence of demons in 11:30. The text of 1 Corinthians 11 itself seems to suggest another option, for in v 32 Paul makes clear that such calamities have come from God as a form of, in the words of F. F. Bruce, “disciplinary chastisement” (Bruce 1971: 115; Gundry 1976: 67; Senft 1979: 154; Harrisville 1987: 202). Several scholars have felt compelled to modify or soften such a suggestion (Fee 1987: 565; Conzelmann 1975: 203, n. 115; Marshall 1981: 115), and while, for Paul, sin and sickness are not always linked, as discussed above (Gal 4:13–15), Paul does seem to make an equation between sin and sickness on this occasion, corresponding to a number of other NT writings on the topic (John 5:14; Acts 5:1–11; Acts 12:23; and especially James 5:15–16). On this point, we may agree with Ulrich Mueller when he notes that the attitude of early Christian communities toward the relationship between sin and sickness was not a unified one” (Mueller 1978: 168). Indeed, even Paul himself appears to have a variety of perspectives on the issue.

If, for Paul, sickness is only sometimes and indirectly caused by sin, does Paul accept another view, witnessed in contemporary Jewish and Christian documents (4Q560; Josephus Antiquities 8.46–49; Testament of Solomon 18; Mark 9:17; Luke 13:11), that evil spirits also cause illness (Penney and Wise 1994; Avalos 1999: 63)? As we have seen in our reference passage, although Paul implies through the divine passive that God gave the thorn to him, at the same time Paul ties this thorn to the work of (a messenger of) Satan. Employing Dale Martin's “invasion” model, we might envision sickness resulting, in the mind of Paul, from an invasion of evil spiritual forces into the godly, integrative realm (Martin 1995: 143–44): Paul's thorn was administered by Satan (or a messenger thereof) (Price 1980: 33–40; Furnish 1984: 529, 547; Spittler 1975) and involved some sort or cooperation on the part of God and Satan, whether God allows Satan to take such action (Bruce 1971: 248) or Satan unknowingly accomplishes God's will in this work (Danker 1989: 193).

Paul's thought on illness also demonstrates aspects of a more naturalistic, “imbalance” etiology. According to this concept of disease, which also underlies Hippocratic traditions, health is defined as the proper balance of elements or “humors” within the individual body; disease results from imbalanced elements (On the Nature of Man 4; Martin 1995: 143–153). By comparison, at times Paul assumes that other internal elements can be controlled or kept in balance. Troy Martin has identified such a concern for balance at work within 1 Cor 11:27–34, where Paul's statements reflect the ancient physiology of pneuma in attributing health and life to the Spirit (Martin 2006). The same concern for balance may also be at the root of Paul's advice (in 1 Cor 7:9) concerning spouses coming back together after bouts of abstinence (for prayer) in order to control the “burning” (pyrousthai) of passion/desire (Parry 1992: 263; Martin 1995: 212–13; Alexander 1998: 254). In our reference passage (2 Cor 12:.7), too, Paul describes his illness as originating from an influence of excessive external forces (“revelations”) (tē hyperbolē tωn apokalypseωn) upon the composition of Paul's person, resulting (potentially) in an imbalance of internal elements, excessive self-exaltation (hyperairωmai) (Cairns 1996; Watson 2003: 89–95). Such concern for balance is connected to what is a key reference point in Paul's rhetoric not only here (2 Cor 12:7–10), but also in his overall moral discourse: the notion of self-mastery (or lack thereof) with all of its attendant, gendered implications. Paul uses many of the major terms that philosophers employed in their discussions of self-mastery and its opposite, including (among others): “self-mastery” (enkrateia; Gal 5:23); “to practice self-mastery” (enkrateuomai; 1 Cor 7:9; 9:25); “lack of self-mastery” (akrasia; 1 Cor 7:5); “passion/emotion” (pathos; Rom 1:26; 7:5; 8:18; 2 Cor 5:5, 6, 7; Gal 5:24; Phil 3:10; 1 Thess 4:5); “desire or passionate desire” (epithymia; Rom 1:24; 6:12; 7:7, 8; 13:14; Gal 5:16, 24; Phil 1:23; 1 Thess 2:17; 4:5); “to experience desire” (epithymeω; Rom 7:7, 13:9; 1 Cor 10:6; Gal 5:17); “endurance” (hypomonē; Rom 2:7; 5:3, 4; 8:25; 15:4, 5; 2 Cor 1:6; 6:4; 12:12; 1 Thess 1:3); and “to be restrained or moderate” (sωphroneω; Rom 12:3; 2 Cor 5:13). Such terms shape in turn the masculinized rhetoric of significant portions of his letters, as a number of recent scholars have shown (Larson 2004; Marchal 2005; Marín 2006; Ivarsson 2007). In many respects we might then affirm that Paul was a participant of his culture and did not escape the politics of self-mastery” (Stowers 2003: 540). Indeed, balance (and lack thereof) of bodily composition mattered to Paul. Thus, in my opinion, Avalos’ suggestion that, “It is probably fair to say that, aside from these naturalistic traditions in Greco-Roman medicine, most traditions, including Christianity, saw natural factors as ultimately the instruments of a deity” (1999: 66), seems essentially unfair and reductive—that is, in the thought of Paul, “natural factors” involved with illness (imbalance) appear to be as much in the control of individuals as they are in the hands of a deity. As Paul uses these concepts in various ways and to various ends in his letters, I will have more to say below about Paul's specific rhetorical use of “self-mastery” in our reference passage (2 Cor 12.7).

In summary, the etiologies of illness produced by the EM(s) of Paul's world do not clearly signify a single cause of illness. While such etiologies seem to reject that sin is the dominant cause of illness—in contrast to what is perhaps the prevalent etiology in second-Temple Judaism, which does take sin as the dominant cause of illness (Avalos 1999: 64–65)—they also assume that a number of other factors work synergistically to produce illness. God was believed to be the ultimate cause behind all illnesses, and a given illness could be brought about concretely by various other co-agents: imbalance and disruption of “natural” composition; “messengers” (angels, demons, etc.); sin; as well as the mysterious designs of the deity.

Significance of Illness in Paul's World

A crucial aspect of every EM is the way in which it determines the socioreligious status of the sick person (Avalos 1999: 61–71). In most cultures sickness is interpreted in terms of social deviance (Pilch 1981: 108–09), and consequently it attaches a stigma to the sick person. The degree of stigmatization and its precise meaning depend on how a particular sickness is perceived. In the Levitical ethnomedical system, for example, some chronic diseases, such as leprosy, attached to the sick person a stigma that required her or his exclusion from the community (Lev 131–5). The exclusion was not for sanitary purposes, but was the consequence of a purity system. This same understanding of purity determined that those who were affected by some physical blemishes such as lameness, deafness or blindness were not allowed to enter the Temple (Webb 2006).

To rightly understand the meaning of these (and other) stigmas we need to bear in mind that in the first century Mediterranean society the deviant status of an ill person was understood and expressed in terms of the core or pivotal social value of honor (Crook 2009). So, for example, when ancient rhetoric handbooks refer to the enkωmion, they treat good health as an attribute of the honorable person, but illness as something dishonorable (Sampley 1988). While anthropological literature on the contemporary cultural value of honor in the Mediterranean basin and the Middle East has become a common part of studies of ancient (including biblical) texts, I need not rehearse all of the details here (Pitt-Rivers 1965: 19–78; Herzfeld 1985; Gilmore 1987). Bruce Malina pio-neered NT research on the importance of “honor and shame” for biblical interpretation; his synthesis of various field studies from countries bordering on the Mediterranean which led him to develop a model of this “pivotal value,” is well-known and widely received (Malina 2001; Malina & Neyrey 1991: 97–124). Other studies, however, have rightly criticized earlier literature on “trans-Mediterranean honor” for its functionalist circularity, for its focus on normative aspects of the honor code in small-scale communities, for its overemphasis on sexual aspects (at the expense of values such as hospitality, honesty, and cooperation), for perpetuating “the myth of male dominance,” and for ignoring the shifting reality of peo-ple's experience as gendered beings (Wikan 1984; Herzfeld 1987: 11–12; Lindisfarne 1994: 82–96; Lindisfarne 1998: 246–60). At times, such critiques risk overshooting the mark. I endorse the sensible reply by David Cohen, who argues that, despite many differences, there are typical patterns of social practices that characterize a wide range of Mediterranean communities, and which display a considerable similarity in the underlying normative structure (1991: 38–41). Indeed, Paul gives us a number of indications concerning the sort of honor-driven, socioreligious (and gendered) significance he (and others) may have attached to his “thorn” (skolops). This appears from the description of the thorn (and related texts), where Paul has the following things to say.

The thorn was a given thing (2 Cor 12:7). The aorist passive edothē prompts two questions related to time and onset of symptoms: when was the “thorn” given, and by whom? We have already introduced a probable answer to the latter question, positing that edothē is a divine passive referring to the activity of the deity. Related to the perception of sin as the transgression of formal law, suffering and misfortune might be interpreted as God's just judgment, which requites evil according to a lex talionis (Neyrey 1990: 167–68). A number of exegetes have argued that such a view helps explain what Paul may have meant in his letter to the Galatians regarding their “temptation” (peirasmon; Gal 4.14)—that is, the Galatians may have been inclined to “despise” (exoutheneω and/or ekptyω; Gal 4.14) Paul owing to the belief that such infirmity was a sign of divine rejection (Thomas 1998: 58, n. 86). Paul may have undergone similar opposition in Corinth: perhaps some of the Corinthians had despised Paul as one rejected by God, owing to his illness. While Paul grants that illness may at times be divine punishment for sinful behavior (1 Cor 11:30; cf. Rom 1:24–28; 2:6–10; 2 Cor 5:10; Gal 6:7), there is no indication that he attached such significance to his own circumstances. On the contrary, Paul's statements in our reference passage dispel the notion that the onset of his symptoms resulted from sin. Rather, Paul regarded his thorn as a charisma to prevent sin (hyperairωmai; 2 Cor 12:7). Paul's discourse here serves to emphasize the contrast between the socioreligious significance Paul (and others) may have attached to his “thorn” (skolops).

Paul also indicates that his thorn was in some way an “agent of Satan” (2 Cor 12:7). Such a notion coheres with the first century Mediterranean belief in a warring spirit-world, where suffering and misfortune also result from assaults by evil forces (Neyrey 1990: 168). More specifically, in the Jewish world of Paul's day, Satan was viewed as a cosmic, hostile agent who tested, apprehended, and punished God's followers (Brown 2015). So, for example in 1 Cor 5:5 Paul portrays Satan as the one entrusted with the fate of the disloyal follower, the “destruction of [his] flesh” (olethron tēs sarkos). In 1 Cor 7:5, Paul intimates that spouses indefinitely continuing their separation from one another might unwittingly lend a hand to Satan in his role as “the tempter” (ho peirazωn; cf. Matt 4:3; 1 Thess 3:5b), twisting a sacred time for prayer into one characterized by harmful trials or licentious behavior. Though Neyrey argues fervently that suffering is most often understood by Paul as “the attack of Satan and Evil Powers on God's holy people” (Neyrey 1990: 168), the fact remains that in only one text (our reference passage, 2 Cor 12:7) does Paul explicitly identify “adversarial” forces as having a hand in illness, and, even here, Paul suggests that Satan does not work apart from the ultimate agency of the deity. Rather than overstate the evidence concerning Paul's understanding of suffering, simply because it is this “understanding of suffering and misfortune as caused by the attacks of Evil Spirits that we continue to investigate” (Neyrey 1990: 168), we ought to acknowledge (and perhaps leave unresolved) the complexity in Paul's thought that, at least in reference to his own physical infirmity, one and the same skolops is simultaneously given by God and used by Satan (Harris 2005: 856).

Furthermore, the socioreligious significance (stigma) to “human suffering caused by the attacks of Evil upon Good” in the first century Mediterranean world is not as simple as Neyrey would have it (Neyrey 1990: 180). While illness may at times be understood in terms of “unjust” torment—good people suffer from undeserved hostility of the Evil One (Wisdom 2.24)—illness was just as likely to be taken as stigmatic demon possession. Indeed, according to Hans Dieter Betz, this was the implicit reason behind the Galatians’ “temptation” (peirasmon; Gal 4.14)—that is, the Galatians were inclined to “despise” Paul owing to the belief that demon possession, as marked by physical infirmity, was incompatible with the claims of one sent by God (Betz 1979: 225; Thomas 1998: 55–61, nn. 92–93). Again, Paul may have undergone similar opposition in Corinth: (at least some of) the Corinthians had despised Paul as demon possessed, owing to his illness. Paul's description of his demon-possessed opponents in 2 Corinthians 11.3, 13–15, may in fact be a counter accusation. While Paul does grant that his illness was in some way administered by Satan, his statements in our reference passage also dispel the notion that the course of his illness was ultimately determined by possession. Rather, Paul's specific reference to the thorn as an “agent of Satan” seems shaped by Paul's view of his own calling and mission in the fulfillment of God's eschatological program: Paul regarded, his thorn as an external enemy to “contend with” (kolaphizē; 2 Cor 12:7), and, further, as evidence of a type of “triumph over” (dynamis; 2 Cor 12:9–10) this particular—and personal—opposition to his mission (Brown 2015: 180–193). Again, Paul's discourse here serves to emphasize the contrast between the socioreligious significance Paul (and others) may have attached to his “thorn” (skolops).

As to the question of “when” the thorn was given, the conjunction kai, the first word in v 7, suggests a specific link between the “heavenly ascent” experience recorded in vv 2–4 and Paul's receiving of the thorn. A number of studies have looked at the role of “heavenly journeys” in early Jewish, Christian, Gnostic, and other sources (Arbel 2003; Himmelfarb 1995; Young 1988; Halperin 1987; Schäfer 1984; Bowker 1971). With regard to the purpose or outcome of such journeys described in ancient literature, J. D. Tabor identifies four generally distinct types of ascents:

Tabor regards the first two categories as relatively rare (77), places 2 Cor 12:1–10 in the fourth category (81, 124), and finds the best parallel to Paul's language here in the Life of Adam and Eve (25:3). According to Scott (1998: 61–64, 221, 224, 237), 2 Corinthians 12:2–4 (like 10:4) relates to Paul's heavenly encounter with the merkābâ (the divine “throne-chariot” of Ezekiel 1 and 10), also alluded to in 2 Cor 2:14. If, as Harris suggests, the skolops was given “because of the extraordinary character of the revelations” (Harris 2005: 853) conveyed to Paul during his “heavenly ascent,” it seems reasonable to suggest that he received the thorn subsequent to, or even during, this experience, that is, some fourteen years prior to the time of writing (v 2). Price was the first to propose that Paul's thorn was literally a malevolent angel sent to thwart Paul in the heavenly throne-room itself for his pride in his enviable privilege as a recipient of ineffable revelations (1980). Appealing, as Price also does (1980: 36–37), to Jewish “throne-mysticism” texts that depict “adversative angels” as attacking visionaries who were deemed unworthy of ascending to heaven, Scott develops the possibility that the angelos satana tormented Paul during his journey to reach the divine throne room (1998: 228). David Abernathy (2001) suggests that the angelos satana is the concrete referent of the figurative skolops, that the adversative angel/demon and the thorn are one and the same thing. Similarly, David Litwa argues that “the thorn is the angel he encounters in an ascent to heaven” (2011: 243, emphasis original), and further that 2 Cor 12:7–9 describes another heavenly ascent parallel to, though distinct from, the ascent described in vv 2–4, one that parodies Moses’ “dominance over the angels in his Sinaitic/heavenly ascent” (2011: 255, emphasis original), as found in Ezekiel's Exagoge (ll. 86–88) and L.A.B. 32.9 (OTP 2.346) and later in b. Šabb. 88b-89a (Gooder 2006: 171). My suggestion here is that, while the thorn and/or the “adversative angel” (angelos satana) may have been “given” to Paul in one/more heavenly ascent, that it remained with Paul in the form of a chronic, bodily infirmity (Dawson 2008: 201–203; Baird 1985: 651–662; Goulder). As Colleen Shantz notes, “Whether Paul's experiences of pain and altered states of consciousness actually coincided in time remains beyond the evidence of the text” (Shantz 2008: 200). What is certain is the fact that illness and ecstatic visions, “trauma and transcen-dence”, coincided in some persistent way in Paul's body, and, in Paul's interpretation of events (in our reference passage), he holds them together.

Paul also provides us with hints of the course and physical manifestations of his illness. The thorn caused Paul acute pain (skolops), which prompted him to seek its removal (vv 7–8). While the thorn perhaps originated some fourteen years prior to writing, Paul's use of the two present subjunctives, hyperairωmai and kolaphizē (v 7), and the negative divine response to his three requests for its removal (vv 8–9), suggest that his illness was a continual and/or recurrent (chronic) condition. Harris suggests that Paul suffered three acute episodes from his skolops tē sarki (2 Cor 12:7): in Cilicia about 43 ce (fourteen years, by inclusive reckoning, before the writing of 2 Corinthians 12 in 56 ce), in Perga (which prompted his passage inland to Pisidian Antioch; Acts 13:13–14; cf. Gal 4:13–14) about 47 ce, and in Troas (2 Cor 1:8; 2:12; cf. 7:5), perhaps in the spring of 56 ce, the most severe attack. It was perhaps during these (three or more) acute episodes that the thorn came like an enemy to fight with Paul and to humiliate him, comparable to receiving vicious blows about the face (hina me kolaphizē; v 7) (Harris 2005: 164–77).

The origin and persistence of Paul's thorn in the flesh, then, was no mere wile of fate, nor was it caused by any “weakness” of Paul's. According to Paul, the thorn was “given” (by God) to Paul at a definite point in time, as a direct consequence (dio, v 7) of the “heavenly ascent” described in vv 2–4, and remained with him for a very specific purpose: to prevent Paul's becoming excessively elated, hina mē hyperairωmai (v 7), over the extraordinary nature of revelations received (Harris 2005: 853, 856). That Paul goes out of his way to valorize the circumstances of the origins and persistence of his thorn suggests that his audience may have viewed his physical condition in other (less positive) ways. In the ancient Mediterranean world, it was commonplace to associate outer physical characteristics (and especially infirmities) with inner moral qualities. While the ancient study of the relationship between the physical and the moral was known as “physiognomy,” interest in physiognomic implications was not limited to those who wrote technical treatises (Malherbe 1986: 170–75; Malina & Neyrey 1996; Ford 1996; Ballók 1996; Harrill 2006; Parsons 2005). Rather, there developed a widespread “physiognomic consciousness” that permeated the Greco-Roman thought world (Evans 1969; Kiilerich 1988). At times Paul himself finds aspects of physiognomy useful—most notably with respect to the public (and gendered) comportment of “orators” in the gathered Corinthians assembly (1 Cor 11:2–16) (Penner & Vander Stichele 2004), and also in Paul's rhetorical use of the belly-topos as a (physiognomic) marker of some kind moral deficiency (Phil 3:17–21; Rom 16:17–20; 1 Cor 6:12–20; cf. 1 Cor 10:7; 11:17–34; 15:32) (Sandnes 2002). However, Paul seems to have grave reservations about using physiognomic conventions to exclude anyone from the “social body” of the community (Gal 3:6–14; Phil 3:2–5) (Sanders 1990: 18–20; Tomson 1990: 62–72, 87–96, 222–29)—unlike Pythagoras (Aulus Gellius, Noct. Att. 1.9), the Qumraners (4Q186; Alexander 1996: 387), and even Ambrose (Off. 1.18.72)—and, more importantly for the purposes of this study, Paul subtly but forcefully opposes the conventions of physiognomy being applied to himself in relation to his authority/status within his communities.

Paul perhaps feared that his thorn had (and would continue to) result in the Corinthians “despising” him (and his authority in the community). The term exoutheneω carries this meaning in the Pauline literature (Rom 14:3, 10; 1 Cor 1:28; 6:4; 16:11; 1 Thess 5:20), and, interestingly enough, in 2 Corinthians 10:10, where it is used to describe Paul's inability as a speaker, exoutheneω occurs in close juxtaposition with “weak bodily presence” (tou sωmatos asthenēs). Paul's opponents charge, “On the one hand, the epistles are weighty and strong, but on the other hand his presence of body weak and his speech despisable.” According to a number of scholars, such invective against Paul in 2 Corinthians 10:10 conforms to physiognomic conventions of what a “weak bodily presence” would have signified in the ancient Mediterranean—weakness or deficiency in character, with all of the attendant gendered implications (Plummer 1915: 282–83; Bultmann 1985: 190; Schmithals 1971: 176–77; Betz 1972; Hock 1980: 59–60; Black 1984: 135–38; Forbes 1986; Marshall 1987: 317–40; Lüsdemann 1989: 83–86; Harrill 2006)—and Paul chose to quote this invective because it served a rhetorical aim of overturning physiognomic reliance on outward signifiers.

In our reference passage (2 Cor 12.7), too, Paul deliberately invokes a cultural physiognomic bias (against the infirmed) in order to expose the fallacy (according to Paul) of its logic. Paul assures his Corinthian conversation partners that his skolops did not issue from some weakness or deficiency inherent to his character. On the contrary, Paul's skolops was a direct consequence of an immediate encounter of/with God during a “pneumatic” experience of epic proportions: God gave Paul the thorn because of “the extraordinary character of the revelations.” Thus, according to Paul, if the skolops should signify anything, it ought to signify his very authority as one who had received a charisma of suffering, “so that Christ's power may rest on me. That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong” (2 Cor 12:10). The rhetorical movement of the “Fool's Speech” (11:21 b-12:10) proves both that Paul is not weak, through a hardship list that boasts—“foolishly”—that he is a better servant of Christ (11:21b-11:29), but simultaneously divinely weak, boasting of his weaknesses with a climactic divine oracle that valorizes the weakness critics disdain (11:29–12:10) (Sampley 1988; Robert 2002; Harrill 2006: 56). In effect, then, Paul sought to make the physiognomic charges to backfire, exposing his accusers as the ones truly deficient in character.

The onset and persistence of Paul's skolops produced an accession of “strength” (dynamis; vv 9–10). Paul will not boast except in his “weaknesses” (astheneia), because it is there that Christ dwells in him and there that Christ's power is made perfect in him (vv 7b-9). As Plutarch advised (De laude 541A), Paul is mediating his boasting by referring to a personal, physical “weakness.” Yet, in this case the weakness is interpreted as “strength” (dynamis). Thus, what typically would soften boasting in Greco-Roman society is used to strengthen it within Paul's wrangling with this early Christian community (Watson 2003: 89). Paul's choice of language (“weaknesses, insults, hardships, persecutions, and calamities”; v 10) also puts him in dialogue with the philosophical and religious elites of the Empire, where notions of virtue and hardship are commonly and closely associated with one another. Paul's skolops is his quintessential hardship, the final entry in his catalogues of hardships in the Corinthian correspondence (1 Cor 4:11–13, 2 Cor 4:8–9; 6:4–5; 11:23–28).

The work of John T. Fitzgerald on hardships (lists) in ancient moral philosophy (including Paul) has proven to be a rich resource in this respect (1988). Critics of Fitzgerald underestimate the power of the Greek philosophical tradition on the Jewish sources that, it is claimed, were more of an influence on Paul. Furthermore, they fail to understand Fitzgerald's main contribution, to show how the rhetorical use of hardship lists flowed out of the central teachings of the philosophers on the relation between virtue and endurance (Talbert 1991; Willert 1995). According to David E. Fredrickson, who builds on the work of Fitzgerald, by Paul's time most philosophers had abandoned absolute distinctions between the wise and foolish man and had settled on a doctrine of progress in moral virtue: “The notion that hardships train the proficiens in virtue and that suffering produces character in one striving for wisdom had widespread appeal” (Fredrickson 2003: 174–175). In light of this, and from the picture we get in 2 Corinthians 12, we might say that Paul's hardships (and the skolops as a metonym for the entire set) represent his progression along a path of wisdom. For fourteen years Paul had wrestled with intense physical suffering. Naturally enough, Paul seems to have been initially repelled by such suffering and to have been unaware of the benefit that it had brought him or could bring him, for he prayed fervently for its “removal” (hina apostē ap’ emou, v 8). Then, at a critical point in Paul's paideia we might say, Paul's request for removal of the thorn was denied. However (highlighting the full force of the adversative kai in 12.9), at that time a much greater divine gift was received—the assurance of strength to cope with weakness, especially the weakness occasioned by onslaughts of the skolops. In the narrative/epistolary present, Paul advises his auditors that he now, actually, “delights” (eudokω) in his hardships, and that he will continue to boast of his weaknesses, because it is in this state that he is “wrapped/clothed” by the strength/power of Christ (hina episkēnωsē ep’ eme)—using this rare verb perhaps to allude to the glory/power of the Lord descending upon the Tabernacle (skēnē in LXX) in the wilderness according to Ex 40.34–38. Paul's skolops is a stark sign both of the “sufficiency” (arkeω) of Christ's grace and the “completeness” (teleω) of Christ's power (v 9). In Fitzgerald's words, Paul's thorn provides “the proof that he is educated” and marks (pun intended) “who he is, what he has become.” (Fitzgerald 1988: 115).

At first glance, then, the implied narrative behind Paul's skolops recites the philosophical notion that hardships train the sage in virtue. Here, as elsewhere in his letters (cf. Rom 5.3–4), Paul demonstrates his proficiency in philosophic discourse concerning hardships and suffering. However, Paul both employs and subverts the patterned discourse of philosophy with its confidence in reason to conquer hardships. The irony is crucial. According to Hans Dieter Betz, 2 Corinthians 12:7b-10 is a parody of an account of healing miracles, being a contemporary form of religious propaganda—Paul mimes a Hellenistic narrative of a healing miracle but the expected divine oracle provides no cure (Betz 1975: 72–73, 84–100). Certainly a healing narrative without an actual physical healing could be understood as parodic; yet I would also suggest that the story behind Paul's skolops serves to reinforce its tenacious humiliating quality: If I must boast, I will boast of the things that show my weakness” (11:30). The one who came to the Corinthians with “signs and wonders and mighty works” (sēmeiois te kai terasin kai dynamesin; 2 Cor 12:12—Acts 13.11; 14.8–10; 16.18; 19.11–12; 28.3–6, 8), has failed in his attempt to influence the superhuman sphere for his own benefit. Furthermore, while hardships endured by a philosopher or teacher were understood to be evidence of the truth of their philosophy or teaching (Fredrickson 2003: 174–175), the controlling motif of Paul's boast is not the virtue or quality of his behavior/reason under hardship, but rather the hardship and humiliation itself. Physical illness is one of the last things a person would normally want to parade before a physiognomic-conscious audience such as the Corinthians, and yet for Paul it indicates his true apostolic status (Forbes 1986). Indeed, “So far is Paul removing himself from the conventional attitudes of his opponents that, when ‘forced’ to boast, he will do so only ironically, in order to satirize precisely those kinds of achievements of which his opponents were most proud” (Fredrickson 2003: 175). In one sense, Paul's honor defense conforms to the challenge-riposte conventions prescribed by notables of his day. Yet, there is also a highly subversive thread running throughout this discourse. In effect, Paul's boasting of his thorn (and its failure to be removed) challenges the value system of his conversation partners: weakness in Christ is true strength. Thus, while Paul's illness was a direct result of his “surpassingly great visions,” and “given” by God for the purpose of preventing sin, it was also a permanent reminder (to himself and to all those who had witnessed its effects on Paul) of his weakness and therefore Christ's power, a badge as it were, the proof of who Paul claimed to be, namely an authoritative “apostle” of God.

Again, Paul's bold discourse here serves to emphasize the contrast between the socioreligious significance Paul (and others) may have attached to his skolops. In all likelihood Paul's understanding of illness (his EM) did not substantially overlap with that of (at least some of) the Corinthians. It is perhaps no wonder, then, that Paul seems to have taken a different route, in terms of “therapeutic strategy,” towards healing than what appears to be the norm for his conversation partners in Corinth. It is to this question of “therapeutic strategy,” and its different manifestations in Paul's life and in the world of his Corinthian auditors, that we now turn.