Fearfully and Wonderfully

by Dr. Paul Brand

  Skin also gives clues to the emotional world within. Possessing few voluntary muscles on our skin, we humans cannot twitch it at will, as can a horse. Yet we do have mastery over the face, which expresses true feelings. A slight puffiness or downward curve of the lips can warn a spouse to walk on eggshells. Like scars on a tree trunk, facial contours may betray emotional wounds from childhood.

  Skin is endlessly adaptable, smooth as a baby’s stomach here and rough like a crocodile there. It flexes and folds around joints, facial bones, gnarled toes, and fleshy buttocks. View sections of scalp, lip, nipple, heel, abdomen, and fingertip through a laboratory microscope, and you can hardly believe they come from the same organ. Form and function go together: the tiny ridges crisscrossing the surface of our fingers increase the ability to grip, much like the tread on a snow tire. Yet each of us has a different pattern for these ridges, an embellishment that the FBI exploits with its fingerprint files.

  In comparison with other species, our outward appearance seems dull. We have nothing to compete with the design features of a scarlet macaw or killer whale or giraffe, not to mention the tropical fish found on coral reefs. Human skin is furless and nearly monochrome: shaded to yellow, brown, black, white, and red, to be sure, but unvarying across the body save for a darker palette on lips and nipples. Even so, artists since the days of cave dwellers have found an unending subject of fascination in plain human skin.

  A Great Wall of Defense

  We give inordinate attention to skin’s appearance, hardly its most crucial contribution. Skin forms a protective barrier, a Great Wall that keeps the inside in and the outside out. Sixty percent of the body consists of fluids, and these would soon evaporate if deprived of skin’s covering. Absent skin, a bath or dip in the pool would prove fatal, for foreign fluids would rush in to dilute the blood and waterlog the lungs.

  Civilization taxes skin’s capacities. On a given weekend we might dig in the garden gloveless, spill kerosene on our hands at the barbecue grill, and clean paint brushes with turpentine, then scour it all off with abrasive powder and a roughened pad. Somehow skin survives.

  If I clean out a muddy gutter with my bare hand or reach in to unstop a toilet, I’ll encounter a swarm of bacteria, yet my skin cells loyally guard against their entering my body. Each of us carries as many bacteria on our skin as there are people inhabiting this planet, and skin uses chemicals, electro-negative charges, and an army of defending cells to keep the marauders at bay.

  Larger animals make their home in skin’s fissures. For most of human history mites, fleas, bedbugs, and lice were an accepted part of skin’s landscape. Thomas à Becket’s hair shirt was studded with lice, and Samuel Pepys had to return a wig that came from the hairdresser full of nits. Even today an eight-legged creature just a third of a millimeter long, the Demodex folliculorum, burrows its way alongside hair shafts and contentedly lives out its days in its tunnel of choice, the eyelash follicle. Ophthalmologists find this cigar-shaped mite, apparently harmless, on almost every person they examine. Male and female Demodexes merrily mate in their tunnel, and as many as twenty-five of the creatures can congregate in one warm, oily fat gland.

  It’s a rough world outside, and as casualties mount among skin cells, the epidermis provides a continuous stream of reinforcements. Dying cells curl like cornflakes, ready to slough off and make room for fresh replacements underneath. Anatomists who count such things estimate we lose several million skin cells a day. Merely shaking hands or turning a doorknob can produce a shower of a thousand skin cells; who can calculate the loss during a game of tennis?

  Though we leave a trail of shed skin cells wherever we go, many of them stay close to home. Up to 90 percent of all household dust consists of dead skin—friendly scrapings of you, your family, and your guests, waiting to be removed with a dust cloth or vacuum cleaner without a moment of gratitude for their sacrifice.

  Hypersensitivity

  As our first line of defense, skin must respond to stresses that are constantly changing. While researching how best to protect the skin of leprosy patients, I gained great admiration for skin’s adaptive properties.

  We developed a mechanical device that presses a metal rod against the fingertips with measured force. If I put my hand under the tiny hammer, it feels rather pleasant, like a vibromassage. But if I let the machine run on for several hundred beats, my finger turns slightly red and feels uncomfortable. After fifteen hundred beats I must pull my finger out, for I can no longer bear the pain. When I return to the machine the next day, I can only tolerate a couple of hundred beats before yanking my finger away.

  Mild inflammation brings on a condition called hypersensitivity. My finger feels warm as blood surges to the point of stress, and swollen as the body cushions it with extra fluid. The same finger that endured many blows from a tiny hammer yesterday has become hypersensitive, and in its inflamed state just a few more thumps could lead to a blister or ulcer.

  Likewise, a burned finger becomes hypersensitive to heat. More than once I have put my hands in a basin only to discover that my hands are sending mixed signals. My left hand reports that the water is hot while my right hand says warm. Then I remember an incident from breakfast: a drop of hot bacon grease popped out of the pan and landed on my left hand. Nerve endings at that spot lowered their tolerance threshold and are now reporting warm water as hot because even a little heat might harm the mildly inflamed tissues.

  Who has not felt the irritation of a sore finger always seeming to get bumped every few minutes no matter how careful you are. That phenomenon has a sound physiological basis: pain cells near the site of injury have become ten times more sensitive to pain. In effect, pain cells “turn up the volume” so that I won’t foolishly subject my skin to more hot grease or hammer blows. In these remarkable ways, hypersensitivity produces a shield of protection around vulnerable areas.

  At times all of us experience a psychological form of hypersensitivity. An accumulation of small stresses builds up—overdue bills, work pressures, house repairs, irritating habits of family members—and suddenly every minor frustration hits like a sledgehammer. Pain, whether physical or emotional, works precisely because it is loud and insistent. Hypersensitivity alerts the body to skin’s urgent need of relief from stress. Likewise, emotional hypersensitivity in one member can alert the larger community to the need for respite or outside care.

  A healthy Body feels the pain of its weakest parts. We may be called on to bolster a bruised ego, mediate a dispute, or take upon ourselves some of the minor stresses that have piled on others. As a former missionary, I cannot overstate the life-sustaining role of people back home who supported me by praying and writing letters. These unusually sensitive cells in the Body sought out my hardships and nourished me in times of need. Such dedicated people make the difference between a missionary or aid worker who serves twenty years and one who breaks down after a short time.

  Once I served as a medical officer at a professional boxing match, assigned to treat the injuries that occurred during the match. I only accepted the assignment once, for the sight of two men pounding living cells to destruction offended all my medical sensibilities. One memory especially stays with me. The trainer of one of the heavyweight boxers rushed to the boxer slumped on a stool near where I stood. “The left eyebrow!” he yelled excitedly, pointing to his own dilated eye for emphasis. “Pound him on the left eye! You’ve landed some good ones—it’s already swelling. A couple more jabs and you’ll bust it open!”

  The boxer followed his instructions, targeting the inflamed, hypersensitive lump above his opponent’s eye. After the fight I had to sew up the remains of skin and eyebrow. The relentless pummeling had taken its toll.

  That scene has come to my mind in very different circumstances—such as a dinner party at a friend’s home. Everyone is conversing amiably until the husband says something to his wife that seems slightly charged. The wife flushes with obvious embarrassment, and the husband appears a bit smug. A blow,
genteel but deadly, has landed. Dinner proceeds with some awkwardness after the comment. In such an interchange—a remark, slightly veiled in humor, about housecleaning, some past disagreement, a personal habit, sexual performance, or in-laws—I hear replayed, “Hit him again. The left eyebrow!”

  I have seen the same pattern of destruction in other groups: church members gossip about their pastor, an employer mercilessly harasses a conscientious employee, parents or siblings needle a clumsy child. Where is the gracious adaptation that accommodates to weakness? All of us could take a lesson from the human body’s adaptations to stress. “Carry each other’s burdens,” said Paul, “and in this way you will fulfill the law of Christ” (Galatians 6:2).

  Distributing Stress

  The human body gives a striking model of how to respond to hypersensitivity: by redistributing stress.

  I go through this process whenever I buy new shoes. Although the loafers felt comfortable during my test paces in the store, when I walk a mile home a friction spot on my foot begins to call for help. If I continue walking, my body will redistribute stress away from the tender spot: I limp. The new gait, though awkward and unnatural, gives relief to the vulnerable tissues.

  Without stress distribution, our daily activities would be fraught with danger. I know, for I have treated scores of leprosy patients who will never walk again because a defective pain system failed to warn the brain to redistribute stress. Feeling no pain, they tend to walk on the very same part of the foot, rather than spreading out the stress across the foot’s surface.

  Even rest can represent danger. Nurses and caregivers must stay vigilant for bedsores, which develop when a person lies on the same area of skin without moving. If the body hears a whimper of pain, it will turn a bit, distributing the stress to other cells. But in paraplegics or those made insensitive by leprosy or diabetes, horrible bedsores may result. I thank God for the millions of sensors embedded in my skin that tell me when to shift weight in my buttocks or reposition my legs or back, or change my gait when walking.

  When I turn from the physical to the spiritual Body, I see the need for a similar adaptation. A spiritual Body must constantly evaluate which parts need special attention. Outer, frontline cells will require qualities of resiliency and firmness, while inner cells need refuge in order to lead lives of quiet contemplation.

  From my own observation, the church tends to fail at this principle of redistributing stress in two crucial areas. First, when we put leaders on the frontlines—pastors, priests, missionaries, other public representatives—we demand too much. We have unrealistic expectations, giving them no chance to “limp.” I caution such leaders to surround themselves with sensitive friends and associates who can detect danger signs and pursue ways to redistribute those pressures.

  My laboratory research proved that the subtler forces of repetitive stress hold greater peril for my patients than the obvious hazards of laceration or burning. We must not overlook the cumulative effect of everyday stress in the lives of pastors: incessant phone calls, a nettlesome board, financial pressures, the burdens of counseling, loneliness, social ostracism. These represent far greater dangers than more visible crises in the church.

  The church could learn a second major lesson from the human body: certain members need protection at vulnerable times, especially during their spiritual infancy. In the United States, especially, I have seen a pattern of showcasing new converts such as athletes, politicians, musicians, actors, and beauty queens. These enthusiastic new recruits may capture the attention of the media for a short time. After trying to project the image expected of them, some of them later abandon their faith in bitterness and disgust.

  The syndrome has a parallel in the human body: the skin disease known as psoriasis. The disease has one cause: skin cells that normally take three weeks to migrate to the surface force their way up in a few days. Those immature cells arrive unprepared for the stresses of light, ultraviolet rays, temperature, and atmosphere on the surface. They die quick, ugly deaths, scarring their miserable victims. Is there not a lesson here for the Christian subculture that insists on forcing newly converted celebrities into the spotlight without allowing time for spiritual maturity to develop?

  When it works well, the Body of Christ can surround a vulnerable person and wisely redistribute stress. I think of a divorced woman I know in a small church. After her husband left her for another woman, she struggled to hold her life together. Burdened by feelings of guilt and rejection over his leaving, she also had to cope with four children, an empty bank account, and a house in poor repair. Her local church community responded in loving and practical ways: by babysitting, painting the house, repairing the car, inviting her to special events. Today, five years later, she still leans on the church to help her cope. She has regained much health because church members, like cells in a body, surrounded her with their strength and relieved the pressures that could have destroyed her.

  Blister and Callus

  On a break from medical school, I spent one summer sailing on an eighty-foot schooner on the North Sea. The first week, as I pulled on heavy ropes to hoist the sail, my fingertips became so sore that they bled and kept me awake at night with the pain. By the end of the second week calluses were forming, and eventually thick calluses covered my fingers. I had no more trouble with tenderness that summer, for the calluses protected me. But when I returned to medical school, I found to my chagrin that I had lost the finer skills required in dissection. The calluses made my fingers so insensitive that I could scarcely feel the instruments. I panicked, worried that those thick pads of callus had ruined my career as a surgeon. In time, however, when my body sensed I had no need for the extra protection, it shed the layers as gladly as a molting insect sheds its shell. Sensitivity returned.

  The pattern repeats itself today when I ignore warning signs while using the spade in my garden. If I work too long, the top layer of epidermis separates from the layers underneath it and mushrooms up to form a perfect dome supported by the sudden influx of liquid: a blister. A temporary measure, the blister cools the area, cushions shock, and disperses stress—in short, it gets me through the day. Human beings have bad habits, though: we tend to repeat, over and over, the very stresses that bring on inflammation, hypersensitivity, and blisters. A tennis player will work through five consecutive blisters before she convinces her body of the need to develop a more permanent adaptation: skin then alters a blister into a callus.

  Skin struggles to find the proper balance between hypersensitivity and callus. Similarly, those on the frontlines of ministry, the “skin” on the Body, expose themselves to ever-changing stresses. Sometimes a person in ministry needs the fine skill of a surgeon, for the repair of human souls may require more sensitivity than the repair of human bodies. At other times the person in ministry, overburdened, short of resources, besieged by unsolvable problems, needs a layer of callus.

  I compare my field trips out into Indian villages, where hundreds of patients lined up for treatment, to the situation at Carville, where we have as many staff members as patients. The slower pace at Carville allows me time to research problems in-depth and to get to know each individual patient. On the Indian field trips, I had to forfeit that personal sensitivity for the greater demands of efficient medical procedures. I could not possibly have gotten personally involved with each of the patients.

  Medical staff, social workers, and counselors who work amid overwhelming human needs must sometimes develop a protective callus. Young doctors ask my advice on how to cope with these pressures without giving in to hardness and cynicism. I tell them to pray daily, asking God to identify one or two select patients with special needs. I cannot be equally sensitive to everyone, and I must not grow insensitive to all. Rather, I depend on the Spirit to help me sense those who need something beyond strictly medical care.

  Wheaton College in Illinois has formed a Humanitarian Disaster Institute to study the effect of disasters on aid workers as well as victims. What emoti
onal and spiritual care helps cultivate a spirit of resilience? How can aid workers keep from being overwhelmed by trauma? Christian ministry dangles on a pendulum between hypersensitivity and callus. Some workers remain so hypersensitive to the pain around them that they succumb to burnout, having failed to develop layers of protective callus. Others develop a callousness that keeps them from having true empathy for the victims of disaster.

  Those of us in support roles in the Body must accept the responsibility of carefully monitoring our representatives on the frontlines. We cannot expose them to unrelieved human sorrow, and these servants must rely on others to help convince them to pull back or to shift their load to someone else. Too much sensitivity—or too little—can immobilize either a physical body or a corporate one.

  Serving on the Frontlines

  In England I once spoke to a congregation in a centuries-old stone church. I noticed that the stained-glass windows portrayed saints with their hands together before them, almost in an attitude of prayer. It occurred to me that in normal life I rarely see people with their hands together like that—except in the operating room. After I scrub, if the patient is not ready, I join my hands fingertip to fingertip lest I touch anything in the room that might harbor germs. What a terrible image for saints! We should have our hands outstretched, embracing a contaminated world because we trust the protection of loyal skin cells in the spiritual Body.

  Some brave souls do find themselves on the frontlines: members of the persecuted church, relief workers in war zones and refugee camps and disaster areas, health workers fighting disease in difficult places. From the rest of us, they deserve support and prayer, for life on the surface of the Body is never easy.