This being a season when many of us are suffering more than usual from colds and coughs, sore throats and the flu, we probably pay more attention than usual to news stories about health and medicine. Many of you doubtless read the cover article in the New York Times Magazine last week on the placebo effect. For those of you who missed it, the article began with a story about a surgeon named J. Bruce Moseley. Six years ago, Moseley, who as part of his practice serves as a team physician for the Houston Rockets basketball team, had ten patients at the Houston Veterans Hospital scheduled for arthroscopic surgery to relieve arthritis pain in their knees. The patients were all middle-aged men; all had served in the military. They had also all agreed to take part in an unusual medical experiment.
Each of the ten in turn would be taken into an operating room, draped, examined and anesthetized. Two of the ten would then undergo the standard arthroscopic surgery for their condition-the scraping and rinsing of the knee joint-and three would have the rinsing alone, but five would have no recognized surgical procedure at all. Moseley would simply make the usual incisions to cause the usual wounds and soreness, but nothing more. To make certain Moseley himself did not give the game away, only the anesthetist and the nurse assisting him knew beforehand whether the procedure would be real or fake. Just before he lifted his scalpel, Moseley would open a sealed envelope that told him what to do. After the procedure, all ten were taken in the same way to the recovery room and, the next morning, sent home equipped with crutches and a painkiller.
The study was designed to answer the following question: does the benefit of arthroscopic surgery for arthritis of the knee come from the procedure's direct help in healing the knee joint, or does the improvement occur because the patients expect healing? The answer, according to this study, is simple: the placebo worked. Six months after the surgery, none of the ten patients knew whether their surgery had been real or faked. All reported much less pain. All were pleased with the outcome of the operation.
The most interesting part of the story to me, however, is not the way researchers have tried-so far mostly without success-to account for placebo effect, but rather the way their research has expanded the discussion of what it means to be sick. For example, many researchers now recognize the distinction between the experience of the patients and the condition of their bodies. One physician quoted in the article describes that distinction as the difference between illness and disease. Illness is what the patient feels; disease is what the doctor finds. Illness is the experience of pain in your body and despair in your heart, knowing that you are falling behind at work, wondering whether you can keep up at home, fearing the economic and even social consequences of having a chronic or a stigmatized condition.
Disease, on the other hand, is the virulent bacteria you can culture in a petri dish, or the abnormal growth you can see on an MRI. Some diseases require the intervention of medication or surgery; others, like the flu, simply need time to run their course. Illness and disease are obviously related, but they are not the same thing. For any treatment to be completely effective, both must be addressed. The body must be set free from the ravages of disease, and the heart and mind must be set free from the pain and despair of illness.
It seems to me that this distinction is also helpful when we consider the social ills people experience, and the educational and economic diseases from which they suffer because of their race or the circumstances of their birth. This weekend we as a nation celebrate the birth and commemorate the life of Dr. Martin Luther King, Jr. While Dr. King believed more fervently than most in the American dream, he also recog-nized the deep spiritual paradox of a nation founded on a belief in the equality of all, yet created by stealing land from Native Americans and built by the labor of slaves from Africa. The American dream is a dream only for some. For others, even in this time of economic expansion, it remains a nightmare.
Dr. King described this central paradox of our nation as the American dilemma. It's still a dilemma. Dr. King's words are as telling today as they were nearly forty years ago: "The hour is late; the clock of destiny is ticking out. It is trite, but urgently true, that if America is to remain a first-class nation she can no longer have any second-class citizens."
The legacy of our racist past as a nation is both an illness and a disease, both of which substantially threaten the lives of many people and the health of our body politic. Just step outside these sanctu-ary doors and walk north on Park or Lex or Third or Second. You see the pain of parents who can't send their children to a decent school, the despair of teenagers who can't even read the help-wanted ads, the hopelessness of children who have no access to adequate health care. The illness they have inherited is devastating; the symptoms are sometimes unbearable.
Signs of the underlying disease are not hard to recognize either. As you doubtless know, the wealthiest census tract in New York City begins just 7 blocks from this church; the average household income in that 12-block area is just over $300,000 per year. The poorest cen-sus tract in the city begins only a few blocks further north; the average household in-come in that area is about $5,000 per year. We have lots of second-class citizens in our city and our nation, and many more in the making, if current policies and trends continue.
If our nation is to remain-or become-first-class, to use Dr. King's language, we must heal both the illness people feel as well as the underlying disease that makes them ill in the first place. Here in the sanctuary on Thursday night, some of us gathered to hear Alfonso Wyatt speak on "What's Next for America's Inner Cities." He is Vice President of the Fund for the City of New York, and one of our nation's most eloquent and persuasive voices on behalf of urban children. He is also an ordained minister on the staff of Allen AME Cathedral, a 13,000 member congregation in Jamaica, Queens. He was a compelling speaker, both in style and in substance.
Rev. Wyatt pointed to the telling irony of a city that seems unable to find money to buy sufficient chalk and books or provide sufficient classrooms to educate all our children, but always seems to find money to build prison cells to lock up the young people who, as a consequence of their inadequate education, remain illiterate and sometimes turn to crime. Eighty percent of our young people who are send to prison, by the way, were once in either special education or foster care.
But Rev. Wyatt also addressed both the illness people feel and the disease from which they suffer. First, the illness: he reminded us that, with few exceptions, every young person who has made it out of a tough situation-poverty, illiteracy, academic failure, overt cases of discrimination, as well as more middle class life challenges-has been able to make it through because a caring adult showed up and helped them out. Or, in the words of one medical researcher, a crucial part of the healing process is the reassurance that comes from knowing that you're in somebody's hands. Someone gave them hope.
In other words, we can only heal the world one person at a time. We don't each have to help everyone out, just someone. Find someone who faces a daunting challenge. Help them learn to read or how to use a computer, help them find them a place to live or work. This is an achievable goal for each of us: to make one person who's suffering feel that they are not alone anymore.
That may turn out to be the easy part, because the disease that has created systemic poverty is hard to cure. But here Rev. Wyatt's wisdom can be helpful as well. Look at Bedford-Stuyvesant or Brownsville or Harlem, he says. What do you see? A deficit that only consumes energy and drains resources, or an asset that we have not yet utilized in ways that can serve our common good? If we look at those communities and see only deficits, that's what we are likely to find when and if we look more closely. After all, the best a deficit can ever do is to consume enough resources to make it back to zero.
On the other hand, we can view such communities as resources that have been insufficiently developed and refined. You can shovel all the sand you want into your PC, but it won't run until the sand is first refined into silicon then made into a semi-conductor. In the meantime, it's the fault of neither the sand nor the computer that the screen stays blank. By the same token, it seems short-sighted to blame an illiterate young man who turns to crime because he has few other options, or a young woman who refuses to work because she cannot afford adequate day care for her child. When all the public schools in this city are as good as those in this neighborhood, and all the nursery schools are as good as the one at All Souls, and all the children have day care and after-school care as good as your children and mine do, then we can begin to take into account individual differences in talent and initiative. But probably not until then.
These are difficult matters to confront, especially for people like me, to whom the accidental entitlements of birth and ability have been especially generous. I realize that I have been very, very fortunate. For much of my life, I have known hope and health. I have been able to find a place for myself and to imagine a future for my daughter. But think how much our lives would be enhanced if everyone around us-all God's children, as Dr. King said-could live in hope and in health as well. It's my duty, and yours as well, both to help ease the pain of the illness we encounter and to help find a cure for the disease we confront.
But it's a cooperative venture. Which is why I like the way Marge Piercy imagines how we can work together in her poem "The Low Road":
Two people can keep each other sane, can give support, conviction, love, massage, hope, sex.
Three people can join to form a committee, a wedge. With four you can play bridge and start an organization. With six you can rent a whole house, eat pie for dinner with no seconds, and hold a fund raising party.
A dozen make a demonstration. A hundred fill a hall. A thousand have solidarity and your own newsletter, ten thousand, power and your own paper, a hundred thousand, your own media, ten million, your own country.
It goes on one at a time, it starts when you care to act, it starts when you do it again after they say no, it starts when you say We and know who you mean, and each day you mean one more. Each day one more: that is our hope and our commitment. Copyright AllSouls 2000.