Religion and Epidemic Disease

Louise Marshall. Encyclopedia of Pestilence, Pandemics, and Plagues. Editor: Joseph P Byrne. Volume 2, Greenwood Press, 2008.

Religious beliefs have always been a primary lens through which people have viewed and understood the experience of epidemic disease. Religion entails the cultural practices and beliefs that have as their goal relationship and communication between human beings and those (usually) unseen spiritual entities or forces that are believed to affect their lives. As anthropologists have noted, the dominant motif of a religion—its fundamental characteristics—is often most clearly revealed in the ways in which it explains misfortune and sickness and by the steps recommended to avert them. Classifying such beliefs as “primitive” or “civilized” according to the degree to which they approach or diverge from some external, imposed ideal (whether monotheism or modern scientific medicine) is less useful than recognizing the extent to which all religions have offered a way of making sense of common human experiences of danger, suffering, and disease.

In the case of epidemics, religious beliefs are forged in the furnace of catastrophic mass disease and high mortality, affecting not just one or two unfortunates but large numbers of sufferers at the same time. For many societies, this represents a qualitatively different situation from individual experience of sickness and health, generating different explanations and responses. Because epidemics affect entire communities at a time, prescribed actions are most often public and collective rather than private and individual, because the goal is to end the epidemic and restore health for the entire group.

Religion may offer more than one possible reading of events and could be integrated within or coexist alongside other, more empirically inflected, ideas of epidemic disease causation and cure. Ancient Assyria, for example, is known for its extensive medical corpus of naturalistic therapies, but Assyrian scholarly healers were also exorcists and priests who performed propitiatory rituals to soothe the angered gods and made no distinction between natural and supernatural causes of disease. Similarly, religious and naturalistic interpretations and practices have coexisted in Indian Ayurvedic medicine, Confucian China, medieval Islam and Christendom, early modern Europe, and in many societies today. Religion is thus not necessarily monolithic as an explanatory model, nor is it automatically exclusive of other models. Most often, people will find explanations that work for their particular set of imperatives. Being conscious of such diversity and pluralism of understandings allows us to recognize the robust creativity and resilience of human responses to epidemic disease across time and space.

Understanding Causes: A Twofold Model

The most important role that religion played in relation to epidemics was in explaining what was happening in terms that made sense to that particular culture. Usually, such explanations were two-pronged, looking upward to the supernatural realm and outward (or perhaps better, inward) to contemporary society. Epidemics were usually understood as having been let loose upon the world by supernatural forces: one or many gods, demons, or spirits of the dead. In most cases, these heavenly beings were not seen as acting randomly, but as responding to particular human actions that offended them. A society’s identification of the behaviors that would prompt the infliction of mass suffering and death upon an entire people reveals a great deal about the values and worldview of that culture. These vary considerably among cultures, but usually revolve around definitions of the sacred—which could be polluted, profaned, or neglected by deliberate or inadvertent actions—and of acceptable standards of moral behavior within the community.

For all cultures, explaining epidemic disease is less focused on addressing the disease symptoms of individual sufferers, and much more about the cosmic disorder that such diseased bodies manifest. Epidemic disease represents the world out of joint, a disastrous upset of the expected cosmic harmony. Religion aims to identify the causes, redress the problem, and restore good relations between heaven and earth. To do this, adherents draw on specially designated human intermediaries. These men and women—priests, chanters, oracles, diviners, seers, prophets, soothsayers, exorcists, and other specialists—are attributed with special skills and status that enable them to clarify the wishes of the supernatural powers and identify the human failings responsible. From these individuals, too, would often come specific recommendations for remedial devotional and ritual action.

Divine Agency and Divine Cure

When epidemics are viewed as divine punishments for human error, the gods that send the disaster are also those who will lift it, if correctly approached. In both heavenly pantheons and monotheism, the gods are inherently dualistic, both benevolent and punitive, the source of the scourge and the means of deliverance. In ancient Mesopotamia (modern Iraq), the underworld god Nergal was a benefactor of humanity and protector of kings, as well as a “destroying flame” and “mighty storm,” a fearsome warrior god who looses war, pestilence, and devastation upon the land. His destructive powers are enthusiastically celebrated in a hymn in his honor from the second millennium BCE:

Lord of the underworld, who acts swiftly in everything, whose terrifying anger smites the wicked, Nergal, single-handed crusher, who tortures the disobedient, fearsome terror of the Land, respected lord and hero, Nergal, you pour their blood down the wadis [gullies] like rain. You afflict all the wicked peoples with woe, and deprive all of them of their lives.

Such hymns were part of placatory rituals designed to mollify the angry gods and restore their good humor by heaping up their praises.

This dualism is not unique to ancient Mesopotamia. Greco-Roman Apollo was god of learning and the arts, as well as the death-dealing archer raining plague arrows on those who offended him, as he did upon the Greeks at Troy. Yoruba divinities supervise all aspects of human existence, but punish with misfortune, disease, and epidemics. The most feared is Shopona, powerful as a whirlwind, who attacks by sending smallpox, insanity, and other crippling diseases. Judaism, Christianity, Islam, and monotheistic African religions like those of the Neer and the Masaai, have all recognized the supreme creator God as both author of their devastation and source of their liberation. In India, Sitala has been venerated since the sixteenth century as the goddess of smallpox. The heat of her anger causes the disease when she possesses the body, but if she is appeased and cooled by human propitiation, she will leave, and the sufferer will recover. Today, she is the major village deity in Bengal and elsewhere, annually celebrated as “the mother” of the village, who takes away the fear of smallpox.

Arguing One’s Case Before an Angry God: The Plague Prayers of King Mursilis

Some of the earliest and most vivid examples of prayers composed to request divine aid against an epidemic come from ancient Anatolia (the Asian part of modern Turkey), from the reign of the Hittite king Mursilis II (r. c. 1321-1295 BCE) (see sidebar). Faced with a devastating 20-year pestilence, the king appeals to the gods through the intermediary of a priest reciting the prayer aloud. He begins with a dramatic evocation of unending death, reproaching the gods for their harshness—even, one might say, for their irresponsibility—in allowing the plague to last so long. He comes to the gods as an urgent petitioner, seeking answers to a terrible situation.

Like a defendant in a law case, Mursilis uses every means he can to present his case favorably to the gods ranged in judgment. He stresses his piety and devotion to the temples of all the gods, and his many attempts, so far unsuccessful, to convince them to lift the plague. He points out that the epidemic is against the gods’ own self-interest, since so many have died that there is no one left alive to honor them. In the divine court, the accused must admit guilt. Consultation of oracles has revealed that Mursilis’s father angered the storm god by breaking a treaty oath (sworn on the gods) and failing to maintain certain rites. Though himself blameless, Mursilis accepts that punishment of his father’s sin has fallen on him. Moreover, because the king is the priestly representative of his people before the gods, royal offenses implicate the whole society in their punishment.

Confession disarms the angry judges, who are further appeased with the offering of gifts, in the form of sacrifices and libations. The identified offenses are rectified—the king repairs the broken oath and promises to restore the neglected rites. Finally, Mursilis reminds the gods to be merciful, like a good patron with an erring dependent. Gods and humans exist in a hierarchical but reciprocal relationship, which imposes responsibilities on each party: the king to admit faults and rectify offenses, the gods to be compassionate and receptive to pleas for help. The king has fulfilled his side of the bargain, and it is now time for the gods to do their part.

Heavenly Bookkeeping

Heavenly pantheons are envisaged in terms that make sense to a particular society. In China, from the twelfth century CE, the influence of Confucian ideals led to belief in a hierarchically organized celestial bureaucracy, with a Ministry of Epidemics presided over by five powerful deities, the Commissioners of Epidemics. These divine bureaucrats drew up heavenly balance sheets of good and evil deeds for every person on earth, rewarding meritorious acts with health and sending disease when the balance tipped too far toward the negative. Epidemics occurred when the score sheets of an entire community were so unfavorable as to be judged beyond saving. Like bureaucrats everywhere, the Commissioners themselves stayed in their offices and sent their assistants to earth to carry out their commands. A host of plague gods (wenshen) acted as their emissaries, carrying out annual inspections of morals and inflicting epidemics on those deserving of punishment.

As the active causative agents, it is the wenshen who receive cultic veneration. Images of the plague gods were set up to receive homage and worship, and festivals in their honor were held around the time when they were believed to be making their annual tours of inspection, to persuade them to return to heaven without marking the community down in their black books. Similar festivals were also held when an epidemic broke out. Prayers and ceremonies of cleansing and purification culminated in a procession to drive out demons (who could be enlisted by the plague gods) and see the gods on their way. The gods’ departure was visibly enacted by placing images of the wenshen on boats made of paper or grass that were then floated away or burnt.

What Makes the Gods Angry?

Crimes that stir up the gods vary according to cultural priorities. In the plays of the Greek poet Sophocles (496-406 BCE), Oedipus’s murder of his father, the king, and his marriage with his mother, though unwitting, polluted the land in the sight of the gods and cried out for vengeance. Only the suicide of the queen and Oedipus’s own blood offering (he blinds himself) and banishment could begin to wipe the stain clean. Disrespect or profanation of a divinity’s cult was equally fatal. In the Iliad, Apollo inflicts an epidemic on the Greek army at Troy after their king, Agamemnon, captures the daughter of the priest of Apollo and refuses to ransom her back to her father. Yoruba deities were angered not by moral shortcomings but by failure to maintain their cult properly, including neglect, disrespect, and breaking taboos. Hindu and Buddhist ideas of reincarnation and inherited karma raised the possibility that epidemics could be heaven-sent punishments for unrighteousness or misdeeds in a previous life.

Judaic understanding of the causes of epidemics was determined by Israel’s sense of mission as God’s chosen people. Directed against Israel’s enemies, pestilence was an aspect of God’s unique sovereignty, his unlimited power over all creation, and his ability to trump the gods of any other peoples. Yet Yahweh could also turn this fearful weapon upon his own people. This was the burden as well as the promise of the covenant between nation and God, a mutual agreement that promised divine favor and protection on condition that Israel faithfully obeyed the divine commandments. The polarities of judgment and deliverance, destruction and sustenance, are thus central to the relationship between God and his people: “I will kill and I will make to live, I will strike, and I will heal, and there is none that can deliver out of my hand” (Deuteronomy 32:39-41). The only hope is repentance of sin and cleaving once more to God, for he has promised compassion after judgment, rewards after suffering, the renewal of divine favor, and blessing upon a chastised and penitent nation.

This concept of a God at once merciful and severe, who punishes his people for their own good, is also a central feature of Christian and Islamic understandings of epidemic disease. When plague broke out in the mid-third century CE, Christianity was a minority religion in a hostile Roman world. According to bishops Cyprian of Carthage (d. 258) and Eusebius of Caesarea (c. 260-340), although the epidemic appeared to strike down pagan and Christian indiscriminately, the purposes and end results for each were very different. For the enemies of Christ, the plague was a justly deserved punishment that led straight to eternal torment. But for Christians, the plague was to be welcomed as a way of testing one’s faith and making sure the believer followed Christ’s injunctions to care for the poor and the sick. Christians who died were called to paradise and eternal rest, and those who died caring for others were equal to the martyrs in the way they testified to the faith at the cost of their own lives. Thus, a paradoxical interpretation of hope and mercy was wrested from a seemingly calamitous situation. Early Islamic teachers similarly viewed epidemic disease as differentially freighted according to belief: for infidels, plague was a punishment and a disaster, but for faithful Muslims, it was a mercy and a reward, a martyrdom sent by God that led directly to paradise.

When Christianity became the state religion of the Roman Empire, this kind of dialectic explanatory model was less appropriate. Instead, like the Israelites, Christians recognized God was punishing them for their sins, chastising them into better behavior. Thus, Pope St. Gregory the Great (c. 540-604), in a sermon preached in Rome during an episode of the Plague of Justinian in 590, stated, “May our sorrows open to us the way of conversion: may this punishment which we endure soften the hardness of our hearts.” Interior repentance and conversion of morals had to be proven by collective rituals performed under the divine gaze by a united and reformed community, “so that when he seeth how we chastise ourselves for our sins, the stern Judge may himself acquit us from the sentence of damnation prepared for us.” Some later Islamic authorities also interpreted plague as divine castigation of sins, such as adultery, prostitution, usury, or drinking alcohol, with a consequently greater emphasis on reformation of morals, as well as individual prayer and collective processions.

Spirits of the Dead: Community Beyond the Grave

As agents of epidemic disease, the ancestor spirits of certain African religions share many characteristics with the gods: they watch over the living and expect to be honored with correct cultic veneration. Like the gods, they are both agents of affliction and sources of healing. They are angered by neglect of their rites, breaches of taboo, and flouting of acceptable behavior. Like the relatives they once were, they can be difficult, exacting, and demanding, holding grudges until they are properly propitiated. Kongo nikisi spirits, the oldest and most powerful of a hierarchically ranked series of ancestor spirits, are each associated with a particular disease. Epidemics are caused by Mayimbi spirits, particularly potent nikisi who belong to a family of “smashers.” Severe epidemics are the work of male Mayimbi, whereas less serious outbreaks are attributed to female Mayimbi spirits. To appease their anger and give them the honor and respect they require, these spirits must be invoked and propitiated by sacrifices.

Ancestor spirits may also be more constrained than gods by close-knit ties of kinship joining the living and the dead in community, with their sphere of abilities limited to their own living relatives. In societies with strong traditions of sacred kingship, even if disrupted or abolished by colonial rule, such as the Sukuma and the Kongo, only the spirits of deceased chiefs can cause an epidemic afflicting many families at once. During their lifetimes, chiefs were religious representatives of the entire territory, responsible for the correct performance of rituals maintaining the health of the community, and this power continues after death.

Elsewhere, relations between the living and the dead could be more fraught, as in the Chinese belief in hostile or hungry ghosts, vengeful spirits of the unquiet dead, who had suffered premature or violent deaths. Their bodies unclaimed, their rites neglected, they cannot return home, but instead roam the countryside, searching for victims. Alone, they inflict disease on individuals, but joined together in packs, they are even more dangerous, capable of causing epidemics. These spirits are the polar opposites of African ancestor spirits, unconstrained by family ties, representing an uncontrollable, potentially lethal supernatural force, defining these particular dead as more demonic than human.

Hostile Demons and How to Get Rid of Them

As supernatural agents of epidemic disease, gods and ancestors share the essential quality of moral duality: they might punish, but they will also heal. Humans enter into cultic relations with them as a way of keeping the lines of communication open, so that disagreements can be resolved and harmony restored. But demons are another matter, fundamentally malevolent and chaotic. Different strategies are therefore required. Where gods and ancestors are praised and petitioned, demons are exorcised, battled, and even tricked. In Vedic India (c. 1700-800 BCE) and in China from at least the sixteenth century BCE, all diseases, including epidemics, were thought to be caused by demons, who attacked the body from outside and possessed it. A Chinese dictionary from the second century CE defined epidemics as corvée, or harsh servitude from which there is no escape, clarifying that “it refers to the corvée exacted by demons.” With incantations and prayers, Vedic and Chinese healers engaged in a ritual battle to expel demons from the body. Subsequently, in China, belief in demonic origins of epidemics existed alongside or was combined with the heavenly bureaucracy discussed above. Demons might act on their own, but more often they were thought to be under the control of the wenshen, or plague gods.

Demons sometimes appear in Christian art as secondary supernatural agents of the plague. However, if demons are allowed to harry humanity with epidemic disease, it is only because God has given permission for them to do. The demons act not in their own right but as part of the divine plan. Sometimes they cooperate with angels in imposing punishment on sinful humanity. Nevertheless, such a withdrawal of active divine agency from the task of chastising sinners does leave open the possibility for others, such as saints and holy people, to wrest control from the demons and provide protection from the plague.

Heavenly Helpers

In addition to the supernatural beings who cause the plague, many religions provide for lower-level heavenly helpers. Bhaiajyaguru, the medicine Buddha, dispenses a range of healing benefits, including protection against epidemics. Until the decline of smallpox as a serious threat in the modern era, several Shinto deities in Japan were petitioned for protection against smallpox and other epidemics. Both the Christian belief in a triune godhead and the cult of the saints offered many possibilities for playing one heavenly power against another. Before an angry God the Father, Christians could appeal for relief to Christ the merciful son. If Christ is enraged, then one might invoke his mother, the Virgin Mary, known to be especially forgiving of sinners and enjoying a mother’s privilege in overriding or deflecting her son’s destructive impulses. As the special friends of God, the saints were also well placed to intercede with the deity, acting as impassioned advocates before the throne of the divine judge. Whether name saints, local patrons, or specialist healing and plague saints, they could be relied upon to respond to their worshippers’ appeals.

Religion as Help and Hindrance

By providing an explanation of events that was judged meaningful and satisfactory by a particular society, and by offering concrete solutions that were believed to avert or change events, religion has offered believers a way of making sense of the world and thereby, perhaps, gaining some measure of control over it. In times of epidemics, religion often functions as a significant coping strategy. Such positive psychological effects have sometimes been paid insufficient attention when historians have considered the psychological effects of epidemics upon any given society.

Many religions emphasize care of the sick as part of their work in the world and have contributed significantly to the creation of institutions and personnel providing much-needed nursing and medical care of victims of epidemic disease. In some instances, such as the practice of variolation as a part of the worship of the smallpox goddess Sitala in India, or the emphasis of cleansing and ritual purity, religious beliefs can have demonstrable positive therapeutic effects.

Conversely, religious rituals involving the coming together of many worshippers at a time, such as processions and pilgrimages, often facilitate the spread of epidemic disease. Along with conquering armies, missionaries can be the cause of spreading epidemic diseases to previously unexposed populations they are attempting to convert (though modern Christian missionaries usually shared the miracles of modern medicine along with those of the Gospel). All too often, conquering Europeans interpreted the resulting catastrophic mortality of indigenous peoples in waves of epidemic diseases as divine judgment on the savage heathens. This use of religious beliefs to justify stigmatization and persecution of minorities and outsiders—Jews, women, the poor, the lower classes, foreigners, racial minorities, homosexuals, practitioners of other religions—of whom the dominant group does not approve is the most troubling element of the encounter of religion and epidemics, and as the recent history of the AIDS epidemic has demonstrated, it remains very much with us today. In sum, religion cannot be ignored in any attempt to understand past, present, and future encounters with epidemic disease.