Thursday, May 2, 2013


Andrew Crislip, Thorns in the Flesh: Illness and Sanctity in Late Ancient Christianity. Divinations: rereading late ancient religion. Philadelphia: University of Pennsylvania Press, 2013. Pp. 238. ISBN 9780812244458. $65.00.

Reviewed by Wendy Mayer, Centre for Early Christian Studies, Australian Catholic University (

Version at BMCR home site


The topics of Egyptian monasticism in particular and late-ancient asceticism in general have sparked a veritable explosion of research in the past decade, to which Crislip's latest book contributes substantially. The subject is a natural extension of his earlier work on the locus of the origins of organized health care in Pachomian monasticism,1 particularly Chapter 3 of that book ("The Social World of Monastic Sickness and Health"), where he reflected in brief on the ambiguities surrounding the refusal of treatment by some monks, who "hypervaluated" sickness as a form of ascetic discipline. The central preoccupation of Thorns in the Flesh is exploring how late ancient Christians, notably ascetics and their followers, made meaning of the illness of the saints. Crislip concludes that early Christian attitudes towards illness were in themselves an ambiguous territory. The sick ascetic did not presage any stable meaning. If there is one mild frustration with this otherwise thorough book it is that, while deftly opening up that territory to our gaze, he has difficulty (at times) resisting the urge to stabilize it.

Crislip conducts his exploration in six chapters: three dealing with health and sanctity, three with sanctity and sickness, in which each topic is addressed in roughly chronological order. These are prefaced (pp. 6-12) by a careful discussion of the sources used – mostly Egyptian (to the mid sixth century), some Palestinian, some Cappadocian – and a rationale for why others (the works of Shenoute, for instance) have been left out. In this respect Crislip sees this book as an initial exploration of the topic rather than an end in itself, with potential for expansion. The author displays a firm command of the textual and transmission difficulties associated with his sources, laying a firm foundation for the chapters that follow.

Chapter One ("Illness, Sanctity, and Asceticism in Antiquity: Approaches and Contexts") begins by evoking Palladius' accounts of the sick monks Benjamin and Stephen in the Historia Lausiaca, two homilies by John Chrysostom in which he reflects on why the saints fall ill, and John Cassian's Conferences on the moral ambiguity posed by the deaths and illnesses of saints and sinners. For Crislip these works are characteristic of a common focus in Christian literature on the moral and religious interpretation of illness and are adduced as an entry point to the variety of ways in which illness is accorded meaning as a signifier of sin and sainthood. The second half of the chapter contains a discussion of Crislip's method and approach. In his reading of illness in late ancient literature he identifies two interrelated concerns: function and meaning. These he draws out through an eclectic set of interpretive frames, appealing to the work of Susan Sontag, Byron Good, and Alfred Schutz, among others, to demonstrate the complementarity of the narrowing of experience and transformation of the normal life-world of both the ascetic and the sufferer of illness. Studies of the dissociation of self and body brought about by illness, the disruption by illness of sociality (illness as alienation from society), and the distorting effect of sickness on the perception of time all serve to explain how illness itself could be viewed as ascetic practice. Similarly, the problem of bodily control noted by the sociologist Arthur Frank, and the analysis of the destabilization of the autonomous self by the action of bacteria and parasites by the psychologist David Barash, are adduced as an aid to understanding how illness came to be viewed as a threat to asceticism. Turning from function to meaning, the explanation by the medical anthropologist Arthur Kleinman of the multiple significations that illness gives rise to, the importance of social context, and the constantly shifting states of such signification, is appealed to as a basis for expecting the sufferings of the saints to be laden even more deeply with moral and religious meaning.

Chapter Two ("Asceticism, Health, and Christian Salvation History: Perspectives from the Earliest Monastic Sources") introduces a theme prevalent in one strand of monastic literature: the enjoyment by monks of extraordinary and preternatural health (the monastery as a type of Eden, the desert as the realm of health). This is prefaced by a discussion of the relationship between materiality and transcendence as evoked in stories such as that of Apelles in the Historia monachorum, which sets the scene for the real focus of the chapter: the view of illness and health as a component of monastic life in three corpora of early monastic letters. In the letters to the monks Nepheros and Paphnutius of the monastery of Hathor concerns for the monks' health signify little more than the tenuous nature of the benefits that the monks bestows on their clients (access to the divine is only as secure as the monks' health). By contrast Crislip reads Pachomius' Letter 5 in the light of his earlier work on the role played by Pachomian monasticism in the development of the hospital: sickness is both an opportunity for acts of mutual aid and a threat to that obligation. While sickness is of moral and theological import, it "warns of the moral precariousness of the healthy, rather than … of the sufferer" (p. 48). The Letters of Antony, on the other hand, are rich with an Origenist medical christology that focuses on humanity's reclamation of its primordial health. What Crislip sees as exceptional and new in Antony's reception of Christus medicus theology is the role of the ascetic. The sacraments are sidelined in favor of locating Christ's saving medicine in ascetic practice.

Chapter Three ("Paradise, Health, and the Hagiographical Imagination") explores what happened in between Antony's letters and the Historia monachorumby turning to hagiography (the Life of Antony, Life of Paul of Thebes, and Life of Onnophrius). For Crislip, Athanasius argues in the Life of Antony that proper ascetic practice leads to the elimination of illness, while in the other two lives Jerome and Paphnutius subtly critique the Antonian model. Jerome attempts via the presentation of an alternative hyperhealthy hermit who has reclaimed paradise to dislodge the canonical status of Antony as the desert ascetic to be emulated; Paphnutius hyperbolizes the paradisiacal character of the interior desert to the point that its extraordinary prelapsarian health is no longer accessible to the monks of his generation.

Up to this point the focus has been ascetic health. Chapter Four ("Choosing Illness: Illness as Ascetic Practice") moves to what Crislip considers to be the far more interesting topic of making meaning out of ascetic illness. Here he moves from setting out the thesis that the association between ascetic health and merit made ascetic illness contentious to exploring the meaning located in ascetic illness in the writings of Basil and Evagrius and in the Life of Syncletica. For Basil, self-induced illness is a threat to (communal) monastic discipline and orthodoxy, while illness is at the same time a model for ascetic practice (it imposes self-control). For Evagrius, illness induced through extreme ascetic practice is viewed negatively and attributed to the misappropriation of role models from hagiography and the Bible. Crislip notes that this reading is in direct contrast to the spiritual benefits attributed to such practice in Evagrius' own life in the Greek and Coptic bioi. In the Life of Syncletica illness (which should be endured thankfully) imposes ascetic discipline (the benefit of voluntary submission), while all other forms of voluntary suffering (extreme ascetic practice) are viewed as excessive. In this context, to continue askesis in spite of illness is the subject of condemnation. Framing illness as a choice, on the other hand, transforms illness itself into a spiritual exercise.

Chapters Five ("Pestilence and Sainthood: The Great Coptic Life of Our Father Pachomius") and Six ("Illness and Spiritual Direction in Late Ancient Gaza: The Correspondence of Barsanuphius and John with the Sick Monk Andrew") explore how the spiritual exercise of illness became elaborated in two different domains: hagiography and spiritual direction. The latter chapter, with its appeal to medical anthropology, offers insight into how the relationship between illness and sanctity continued to be troubling and to require elucidation. The former is invaluable for Crislip's novel analysis of Pachomius as a model for the sick saint.

There are some minor problems. In Chapter 2 (p. 42) Crislip states that sixteen of the thirty-five letters to Nepheros and Paphnutius "explicitly mention the author's hopes for the monks' continued health", but many of these turn out to be standard epistolary topoi (e.g. errosthai se euchomai) and his claim that one can read an increased insistence of worry into the topoi expressed in this particular body of letters raises the question as to why we should accept his case that concern over the addressee's health has special meaning in a monastic context. Also in Chapter 3 Crislip presents Jerome's Life of Paul as a subtle critique of the meaning of asceticism and health presented in the Life of Antony, but this has little to do with the ideology of monastic health, which, as Crislip himself admits, is in both works essentially the same. Finally, in Chapter 4, although he draws a coherent meaning for illness from the Life of Syncletica, his own analysis suggests that there are two divergent views promoted in the biographical chapters (1-21, 103-13) and the collected teachings (22-102) that they bracket. In all of these instances one wonders if an urge to stabilize the meaning of the sick ascetic, despite the instability for which he argues, has led to a degree of over-interpretation. None of these quibbles seriously undermines his argument, however. Thorns in the Flesh is as valuable for the analysis and insight it offers into individual texts and epistolary corpora as it is for its insights into the sick saint. At the same time it offers a reflection on the meaning of illness that resonates well beyond the late ancient world into the present.

The book is remarkably free of typographic and grammatical errors, an increasingly rare phenomenon in modern publishing, and both author and editor are to be commended.


1.   Andrew Crislip, From Monastery to Hospital: Christian Monasticism and the Transformation of Health Care in Late Antiquity, Ann Arbor: University of Michigan Press, 2005.

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