By Fiona Chen and Benjamin Doolittle.
Fiona Chen is an M.Div. Candidate at Yale Divinity School and is the Chaplaincy Intern at Saint Thomas More, the Catholic Chapel and Center at Yale. Her work focuses on medical anthropology, narrative pastoral care, and storytelling. She can be reached at fiona.chen@yale.edu. Benjamin Doolittle, M.D., M.Div., is Professor of Medicine (General Medicine), Pediatrics and Divinity, Yale School of Medicine and Professor of Religion and Health, Yale Divinity School. His research interests explore the intersection of medicine and spirituality, wellness and burnout. He can be reached at benjamin.doolittle@yale.edu.
INTRODUCTION
In German devotions from the 16th century Reformation onwards, a theme of “Christ as healer and pharmacist” emerged. This Christ provides “spiritual prescriptions” in his “heavenly pharmacy of the Soul.”[i] In Martin Luther’s theology of suffering and grace, he proposes an interesting paradigm that juxtaposes Christ as the sacrificial scapegoat (pharmakos), whose death cleanses humanity of sin, with Christ as the divine healer (pharmacist), dispensing spiritual remedies. Thus, these motifs subtlety embody Christ’s dual nature as Pharmakos and Pharmacist, highlighting a fascinating theological and cultural dialogue that intersects themes of suffering, redemption, and healing. This duality also reflects theological insights and medical advancements during the medical renaissance and the Protestant Reformation. This interpretation has important implications for a modern understanding for Christ’s role of salvation.
This understanding of Christ as pharmakos and pharmacist follows a logical historical and theological arc. First, Rene Girard, the 20th century historian, articulates the theological and cultural foundations of the scapegoat mechanism from ancient sources. Second, Luther’s Theology of the Cross, as elaborated in The Bondage of the Will, captures these ancient sources to provide a modern interpretation of Christ as pharmakos and pharmacist. Third, the Reformation deeply influenced the sixteen-century medical renaissance and vice versa such that physical health was intertwined with spiritual health. In particular, the Isenheim altarpiece, created in Germany at the dawn of the Reformation, reveals this theological paradox of suffering and healing, emphasizing Christ’s solidarity with the afflicted. Finally, this paradigm presents a framework for understanding the modern healthcare system, where themes of sacrifice, blame, and healing intertwine. By doing so, this metaphor of Christ as both pharmakos and pharmacist informs contemporary approaches to justice, care, and community.
THE THEOLOGICAL FOUNDATION OF PHARMAKOS: ANCIENT TIMES
To understand the motif of pharmakos, it is necessary to delve into the theological foundation of ritual sacrifice, which can be found in the development of nearly all human religions. One of the most prominent figures who has done elaborate studies on sacrifice and the scapegoat mechanism is René Girard, who defines scapegoating as a psychosocial process through which communal violence and rivalry are alleviated by projecting collective tensions onto a single individual or group. This victim, designated as the scapegoat, is expelled or sacrificed for unity and the restoration of social wellness. Girard traces this process back to ancient rituals, such as the scapegoat ceremony in Leviticus 16, where sins were symbolically transferred to a he-goat that was then sent into the wilderness. For Girard, the scapegoat mechanism is not only a recurring solution to communal crises but also the foundation of cultural and religious institutions.[ii]
The New Testament authors were approaching the death of Jesus in a world where ritual sacrifice is a commonplace event. They are familiar with the details of temple sacrifice in Jerusalem.[iii] In other words, the New Testament and the Christian understanding of the death of Jesus were molded by the stories that had already begun in the Hebrew Bible, which include the sacrificial practices and the language of the Psalms and the prophets. The Christian religion also absorbed the culture of the Mediterranean world,[iv] where “Sacred killing does not register as killing. Sacrifice is seen as natural and as beneficial as the turn of seasons, or the cycle of predator and prey.”[v]
It is in these contexts that we understand the role of Christ as a pharmakos, or sacrificial scapegoat. The word pharmakos derives from pharmakon (from which comes the word “pharmacy”), which means both poison and cure. The pharmakos is thus considered a figure that absorbs the pollution for the cleansing of the community. As Mark Heim writes, “The person sacrificed served at once to absorb and represent all that was wrong – the infection in the body – and also (by his death) to provide the antidote or remedy for the problem. Violence is the disease that needs curing, and violence is the cure.”[vi] Christ is considered a pharmakos precisely because of his role as the sacrificial victim who bore the sins of humanity so that it might be saved. The concept of Christ as pharmakos has a direct connection to the theology of Martin Luther.
HISTORICAL AND CULTURAL CONTEXT: THE SIXTEENTH-CENTURY
The Reformation and Luther’s Theology
A significant historical backdrop for this dual theme of Christ as pharmacist and pharmakos is the Protestant Reformation which took place in the 16th century. Particularly significant is Martin Luther’s Theology of the Cross, which emphasizes grace and redemption through the Divine’s revelation in weakness and suffering.[vii] This new school of thought was the direct opposite of the Theology of Glory, which emphasizes God’s visibility and triumph. For Luther, God became flesh to be crucified to take away the sins of the people he created and loved. This, Luther came to believe, must mean that suffering is necessary for salvation and that since Christ suffered willingly, Christ did not die in vain.
This Theology of the Cross is unreservedly demonstrated in the Heidelberg Disputation, especially in theses 19 to 22. Luther claimed that a good theologian does not speculate the unrevealed things about God through observing those already revealed but rather focuses on the visible and manifested things of God, which are encapsulated in Christ’s suffering on the cross.[viii] He defended the statement by quoting Romans 1:22, claiming that knowing the invisible features of God, which are virtues, wisdom, justice, and so forth, does not make one wise. For Luther, a good theologian should set their mind on the way God revealed himself and the way he wished to be recognized, which are through his human nature, weakness, and foolishness, manifested in the crucified Jesus.
Thus, the concept of pharmakos aligns with this theology by showing how Christ’s sacrifice subverts human understanding of justice and merit. Rather than asserting dominance, as according to the Theology of Glory, God’s grace is shown through the ultimate act of self-giving love where Christ his only begotten Son willingly bears the blame due to others. Therefore, this understanding of salvation and grace parallels the paradox of Christ as pharmakos: just as a pharmakos is an innocent outcast sacrificed to cleanse the community of diseases, Christ is the ultimate scapegoat who bore humanity’s sin and suffered to redeem it.
These two concepts have connections that go beyond etymological ambivalence: The pharmakos embodies the paradox of weakness and suffering, achieving communal purification through marginalization, while Christ as the “wounded healer” exemplifies this dynamic as the sacrificial victim who heals. Therefore, Christ’s death becomes the ultimate remedy for sins, or spiritual ailments, which transform the Cross from a symbol of victory into the embodiment of God’s care for humanity’s pain and failure. Therefore, the dual motif of pharmakos and healers underscores a theological paradigm where suffering and redemption are intertwined.
The embracement of suffering and weakness speaks to another important aspect of Luther’s theology: that salvation is a free gift of grace available to all. In The Bondage of the Will (1525), Luther highlights Christ as the ultimate source of spiritual healing whose redemptive work is available to all. For Luther, grace is the sole remedy for the sinfulness of humanity. He emphasizes that salvation is entirely the work of God, freely given through Christ. This theology helps explain the theme of Christ as the divine pharmacist who administers healing to restore humanity to spiritual wellness. Through the lens of the Theology of Grace, Luther not only affirms the sufficiency of God’s grace, but also emphasizes its accessibility, making Christ the ultimate healing to whom all have access.
Indeed, the accessibility of divine healing is demonstrated iconographically. As mentioned by Jacek Kowzan, in many artistic depictions of Christ as an apothecary or pharmacist, a scroll draped over the counter and bears the text from Matthew 11:28: “Come to me all who labor and are heavily laden and I will give you rest.” This motif of rest corresponds to Fritz Krafft’s claim that theologia medicinalis and pharmacologia scara served to propagate the Lutheran doctrine of justification, particularly the idea that sola fide, or faith alone, is enough to release the sinner of all the maladies of the soul.[ix] Care for the poor was also one of the key values of Paracelsus, an influential physician and theologian whose life directly coincided with the Reformation and who often mentioned Luther.[x] According to Paracelsus, true liberality involved the unrestricted distribution of not only wealth, but also medical knowledge according to the needs of the poor.[xi]
That being said, Luther’s Theology of Grace emphasizes the pharmakos role of Christ, who disrupted worldly power structure and value systems: Christ embraced the pharmakos identity and associated himself with the outcast and the condemned rather than aligning himself with the dominant forces. By being rejected and suffering on the Cross, Christ accomplished radical reorientation and demonstrated that true power is not in dominance but in sacrificing oneself. By flipping values of strength and weakness, Christ also challenged systems of oppression and systems that prioritize status and control.
The Medical Renaissance
Besides the Reformation, another historical development that shaped the iconography of German devotion is the medical renaissance of the sixteenth century, which is the renaissance of classical learning and practice in the universities, known as “humanism.”[xii] During that time, medical scholars were seeking out ancient Greek medical manuscripts, especially the writings of Galen. Galen’s influence on medicine during the Reformation was enduring and transformative, and reformers such as Melanchthon (Luther’s close friend and collaborator) brought new perspectives on Galenic medicine through the integration of theology, philosophy, and medicine. As Vivian Nutton writes, “Melanchthon, and his Lutheran followers, posited a strong interaction between body and soul, and hence a knowledge of medicine, the art of the healthy body, was essential if one was to preserve the health of the soul. Anatomy revealed not only the structures, arrangement, and purpose of the body, but also the ways in which the activities of the Christian soul were mediated in thought, imagination, or will.”[xiii]
The connection between the medical renaissance and the Reformation presented the idea that only by anatomy could one come to see where the mind or soul could go wrong. Following a strongly Galenic line, the reformers at Wittenberg, where Luther was a faculty member, made little distinction between madness and immorality. To them, sin has a physical effect that corrupts both the soul and brain and prevents them from functioning correctly. They also believed that, in some cases, this corruption could be reversed by medicine.[xiv] They also believe that anatomy, which reveals the majesty of God the Creator, cannot be left solely to physicians, as both moral philosophy and natural philosophy were essential for Christian education.[xv] “By dissecting, and by learning from others’ dissections, they were not only saving the body from disease and defeating illness in this life. More importantly, they were gaining the imparting knowledge that would save [the] soul and preserve it in the eternal life of heaven that they so earnestly sought.”[xvi]
That being said, medicine under the Reformation gained a renewed emphasis on integrating theological philosophical principles with medical practice, leading physicians and theologians to recognize that healing is not only about the physical body, but also the soul. This integration reflected a broader emphasis on holistic care, where the individual’s well-being was understood as both a spiritual and physical concern. Under the influence of the Reformation, physicians and theologians alike began to view their roles as complementary. This perspective fostered a greater appreciation for the interconnectedness of physical healing and spiritual restoration, which reinforces the idea that true healing must be holistic: it must address the whole person. Such an approach paralleled the contemporary motif of Christ the divine healer, whose sacrifice provided a remedy for spiritual ailments.
CHRIST AS PHARMACIST AND DIVINE HEALER
Healing in Christian Tradition
In the Bible, Jesus’s ministry is often exemplified but his healing miracles. The healing tradition in the Bible not only developed in patristic writings, but it continued to be prevalent in the Christian tradition. For instance, in a prayer that comes from Thomas Aquinas, it was written: “I come to Thee as sick man to the physician of life, as a dirty man to the bath of mercy, as a blind man to the eternal light. Heal my sickness, wash my defilement away, enlighten my blindness.”[xvii] This motif can also be found in literature towards the end of the Middle Ages and at the beginning of Early Modern times.[xviii] William Dunbar’s Lament for the Makaris is only one of the numerous examples:
I that in heil wes and gladness
Am trublit now with gret seiknes
And feblit with infermite:
Timor mortis conturbat me.[xix]
Sickness, whether it is presented in physical or spiritual forms, represents the devil’s dominion over humankind. The medieval Office of the Dead also voiced the theme of sickness and God’s therapeutic ministrations; for the first nocturn of Matins, the faithful would pray:
Miserere mei, Domine,
quoniam infirmus sum;
Sana me, Domine,
quoiam contubata sunt ossa mea.[xx]
However, in the sixteenth century, Christ was not only considered the heavenly physician but also an apothecary or a pharmacist who dispenses remedies for the soul. This might be because, during the medical renaissance of the sixteenth century, there was no rigid divide between the physicians and the pharmacists as put forward by older histories of medicine.[xxi] The most fascinating piece of literature on Christ as an apothecary who prepares and dispenses heavenly medicine comes from Thomas More. As he noted in The Last Things:
“The physician sendeth his bill to the apothecary, and therein writeth sometimes a costly receipt of many strange herbs and roots, fetched out of far countries, long-lain drugs, all the strength worn out, and some none such to be got. But this physician sendeth his bill to thyself, no strange thing therein, nothing costly to buy, nothing far to fetch, but to be gathered all times of the year in the garden of thine own soul. Let us hear, then, what wholesome receipt this is. ‘Remember, saith this bill, thy last things, and thou shalt never sin in this world.’ Here is first a short medicine containing only four herbs, common and well known, that is to wit, death, doom, pain, and joy.”[xxii]
Using rich metaphorical language, More frames spiritual healing as an accessible process rather than a pursuit of costly remedies. The physician’s “bill” directs the soul to reflect on “death, doom, pain, and joy,” which are universal and available perpetually within the “garden of thine own soul.”
Blood of Christ as Balm
As mentioned previously, the motif of Christ as a pharmacist was born out of Luther’s theology of grace and justification. However, it is important to note that the Reformation is not a one-sided theological affair – there are reformations and counter-reformations. That being said, in response to Protestantism, Catholics also developed devotional images depicting Christ as a pharmacist. In contrast with Lutheran images which focus on grace and sola fide, the Catholic images depict a host and a chalice, as the Eucharist is considered the highest and most effective “healing medium.”[xxiii] The emphasis on the Eucharist was also expressed through images of Christ as Man of Sorrow, which expresses the idea of Christ as the “wounded healer” who, like those in need of healing, experienced physical ailment and spiritual suffering of human life and ultimately death.[xxiv]
The Catholic devotion to the Eucharist, where Christ’s blood is revered as the “medicine of immortality,” reflects a broader theological and devotional tradition that celebrates the blood of Christ as a healing balm. This imagery extends beyond the Eucharistic context to mystical writings and prayer practices, where Christ’s wounds and blood are venerated as sources of spiritual and physical restoration. Devotion to the blood of Christ was significant in Flemish devotions of the sixteenth century, not to mention that the Feast of the Most Precious Blood was first celebrated in Spain around the same time. These connections highlight how the imagery of balm, blood, and healing coalesce in the Catholic Christian imagination to offer a vision of Christ as the divine healer who offers remedies for the soul.
With regards to Catholic devotion, healing, and the Man of Sorrow motif, the Isenheim Altarpiece created by Matthias Grünewald between 1512 and 1516 serves as one of the most famous visual representations of Christ’s dual roles as pharmakos and wounded healer. The altarpiece was originally commissioned for the Monastery of St. Anthony in Isenheim, which specialized in caring for patients suffering from ergotism, and it was designed to provide comfort and hope to those afflicted with the disease. Grünewald vividly emphasizes the grotesque wounds and a disfigured body of Christ, which would have mirrored the suffering endured by the patients at Isenheim, creating a sense of identification between the viewer and the suffering Christ.[xxv] In this way, Christ is presented as the ultimate pharmakos, bearing the pain and disease of humanity to bring about spiritual purification and redemption.
Significantly, the Isenheim Altarpiece is considered a Catholic monument created at the dawn of the Protestant Reformation as it integrates the Catholic theology of transubstantiation. The altarpiece references the Eucharist, particularly the dripping blood of the crucified Christ and other uses of red in the painting. As argued by Andree Hayum, “Christ’s livid, sore-covered flesh in the Crucifixion and the Lamentation is a choice that would have provided the special audience of the hospital with a strikingly relevant physical image through which to perceive the process of transubstantiation.”[xxvi] Viewing the Eucharist through the hospital healing context thus gives the Eucharistic blood a layer of meaning: healing and salvation.
The depiction of blood in the Isenheim Altarpiece comes to bear healing significance also because of the symbolic parallel between Christ’s body and the Spiritual Woods, a concept that originated with the mendicant orders in the domain of female piety.[xxvii] As Gregory Bryda argues in his article, “The Exuding Wood of the Cross at Isenheim,” “… the corollary to Christ’s formal semblance to the metaphoric tree is his containment of its salvific resins and turpentines, which, like the blood of a human body, are extracted through injury to a tree’s bark.”[xxviii] Additionally, “Exploited figuratively as a parallel for the sacramental blood Christ shed on the Cross, tree exudates like resin and turpentine formed the basis of medieval medicine and, most importantly, were prescribed by the Isenheim monks to treat skin pustules and boils and soothe the burning sensation associated with Saint Anthony’s fire.”[xxix]
Christ’s “botanical blood” is also associated with balm or balsam. As Elly Truitt points out, the word “balm” or “balsam” would have been used to describe the resinous secretions from plants, most notably turpentine from conifer trees.[xxx] In the late medieval period, balsam was believed to be a panacea capable of healing illness and had a significant association with Christian virtue based on travel writing and itineraria from the Middle Ages.[xxxi] This association between balsam and healing extended to theological metaphors, where Christ’s blood was frequently likened to a divine balm capable of curing not only physical ailments but also spiritual wounds. In this context, Christ’s “botanical blood” functions as both a medicinal remedy for human weakness and a moral exemplar, highlighting Christ’s role as the “wounded healer.”
PRACTICAL IMPLICATIONS FOR HEALTHCARE
So, how may Christ’s role as pharmakos, as articulated through Luther’s Theology of the Cross and under the influence of the medical renaissance, reshape our understanding of healthcare? First, it invites practitioners and systems to take special care to support marginalized people and reject any blame or shame that society imposes on them. The idea that Jesus voluntarily took on the role of the pharmakos challenges the healthcare system to examine its own blame culture where patients are blamed for systemic failings, particularly the tendency to moralize health outcomes. As Jesus challenged systems of oppression, we, too, should examine systems and health determinants that are conducive to health inequity.
Additionally, just like salvation is a free gift for all, society should promote healing models on a systemic level. Through this vision, healthcare may heal not only the bodies of individuals in a literal sense but also the “body” of society. When we see patients through a Christlike lens, we come to focus on accountability and collaboration, which reduce the tendency to scapegoat individuals who have intrinsic value and are the image of God. Thus, by seeing Christ through the lens of pharmakos, we can not only better understand the role of sacrifice, blame, and healing in the healthcare system, but also may radically reorient a system that externalizes and scapegoats individuals.
[i] Jacek Kowzan, “I Will Put None Of These Diseases Upon Thee For I Am The Lord That Healeth Thee’: Christ As Pharmacist And Healer in Iconography And Literature Of Late Medieval And Early Modern Times” in The Apothecary’s Chest: Magic, Art And Medication, edited by Konstantina Georganta, Fabienne Collignon and Anne-Marie Millim(Newcastle upon Tyne : Cambridge Scholars Pub., 2009).
[ii] René Girard, The Scapegoat (Baltimore: Johns Hopkins University Press, 1986). For a summary of Girard’s work on the scapegoat mechanism also see: https://iep.utm.edu/girard/#:~:text=Girard%20is%20also%20fond%20of,the%20sacred%20from%20the%20violent.
[iii] S. Mark Heim, Saved From Sacrifice: A Theology of the Cross (Grand Rapids, Mich.: William B. Eerdmans Pub. Co., 2006), 23.
[iv] Heim, Saved From Sacrifice, 37
[v] Ibid, 16.
[vi] Ibid, 45.
[vii] Walther von Loewenich, Luther’s Theology of the Cross (Minneapolis: Augsburg Pub. House, 1976).
[viii] Cf. Heidelberg Disputation, thesis 20.
[ix] Kowzan, “Christ As Pharmacist And Healer,” 113.
[x] Charles Webster, “Paracelsus: Medicine as Popular Protest,” in Medicine and the Reformation, ed. Ole Peter Grell and Andrew Cunningham (London and New York: Rutledge, 1993), 57.
[xi] Webster, “Paracelsus,” 66.
[xii] Medicine and the Reformation, 5.
[xiii] Vivian Nutton, “Wittenberg Anatomy,” in Medcine and the Reformation, ed. Ole Peter Grell and Andrew Cunningham (London and New York: Rutledge, 1993), 12.
[xiv] Vivian Nutton, “Wittenberg Anatomy,” 21.
[xv] Ibid, 23.
[xvi] Vivian Nutton, “Wittenberg Anatomy,” 26.
[xvii] Sjaak van der Geest, “Christ as a Pharmacist: Medical Symbols in German Devotion,” Soical Science and Medicine 39, no 5 (1994), 727-32, at 731.
[xviii] Kowzan, 109.
[xix] I. Ross, “Dunbar’s Vision of the ‘Four Last Things’” in Bards and Makars: Scottish Language and LiteratureL Medieval and Renaissance, ed. A.J. Aitken, M.P. McMiarmid, and D. S. Thomson (Glasgow: University of Glasgow Press, 1975), 93. Quoted in Kowzan 109.
[xx] Kowzan 110 n.9
[xxi] The Medical Renaissance of the Sixteenth Century, ed. A. Wear, R.K. French, and I.M. Lonie (Cambridge; New York: Cambridge University Press, 1985), xiv.
[xxii] Thomas More, “The Last Things,” in English Works of Sir Thomas More. vol. 1, ed. W.E. Campbell. (London: Eyre and Spottiswoode; New York: Lincoln Mac Veagh, 1931), 467-68.
[xxiii] Kowzan, 113.
[xxiv] Ibid.
[xxv] Andree Hayum, The Isenheim Altarpiece: God’s Medicine and the Painter’s Vision (Princeton, NJ: Princeton University Press, 1989).
[xxvi] Hayum, The Isenheim Altarpiece, 70.
[xxvii] Gregory Bryda, “The Exuding Wood of the Cross at Isenheim,” The Art Bulletin, 100:2 (2018), 6-36, at 9.
[xxviii] Bryda, “The Exuding Wood of the Cross at Isenheim,” 12.
[xxix] Ibid.
[xxx] Elly R. Truitt, “The Virtues of Balm in Late Medieval Literature,” Early Science and Medicine vol. 14 no. 6 (2009), 711-736, at 714-15. Bryda, 19.
[xxxi] Ibid.
You may contact Fiona Chen at fiona.chen@yale.edu. You may contact Benjamin Doolittle at benjamin.doolittle@yale.edu.