In the medical world, people go to the doctor because something is bothering them. They may have an upset stomach or a spot on their neck that is making them nervous, or a bad headache. When they go to the doctor, they tell her about the problem, and sometimes the doctor does what is necessary to solve this obvious problem – what is called the presenting problem – but often the doctor will ask a lot of questions or order some tests to see if the presenting problem is all that is wrong, or if there is something more complicated, an underlying disease of some sort that is causing the presenting problem.
It’s the same in counseling, as my husband will tell you. A husband and wife will come in for counseling because they’re fighting all the time. The counselor might address the ways they communicate with each other and teach them ways of interacting that will defuse the moment, but more often than not, there is something else that is under the surface, bubbling away, that is the real source of the conflict. And until the counselor guides them in conversation to that unseen thing that is causing the symptoms – the fights – all the communications coaching in the world won’t fix the warring couple.
It seems like we’ve got two good examples of this presenting problem vs underlying disease in our readings today.
Poor Moses! He’s been guiding the Israelites through the desert toward the promised land, and it has not been an easy journey. They complained about food, and now they’re complaining about water, or the lack of it.
They’re stuck somewhere in the middle of nowhere, Rephidim, to be exact. They whine and complain, not surprisingly, because there is no water for them or their livestock to drink. They tell Moses that he is a failure as a leader, they quarrel with him and with each other. Is this difficult journey what they are supposed to be doing? Is Moses really the right guy to be leading this trek? Is God really among them?
The presenting problem is the lack of water. It makes sense that they are upset. People and their livestock are trudging through the desert. It is hot and dry. They are thirsty, and there is no water to be found. They could have said to Moses, “Hey, guy, we’ve got to keep moving and find an oasis somewhere, because we’re really thirsty.” But that’s not what they say. They moan and complain and turn into the ancient version of drama queens, flopping all over the place saying “Why did we follow you?”
And that’s the clue that the presenting problem – their thirst – masks their real problem.
It is a problem of faith. Do these people really believe that God is talking to Moses? Do they believe that Moses is conveying God’s wishes to them correctly? Are they starting to believe that this was all a great big foolish mistake?
And Moses feels that underlying doubt. The whining about the water is the symptom. The real problem is that they are starting to doubt that the Lord is among them and guiding them, keeping them safe on the journey.
The immediate symptom needs to be addressed of course. They need water. But the underlying root of the disease also needs to be treated. Fortunately, God takes pity on poor Moses, the object of all that complaining, and directs him to solve the immediate symptom by doing something that attacks the underlying disease. Moses is to use that staff that had shown God’s might and will by parting the Red Sea when they left Egypt. He is to strike a particular rock, and water will flow out of it.
Certainly, the people would be glad for the water, but they would also be reminded that the solution to their thirst came from Moses transmitting God’s power and concern for them through that staff. He was striking the rock, but he was also striking their doubts at the same time. God works that way sometimes, showing us in surprising ways that God is right there with us, helping us when we get weak and afraid.
In the gospel, we hear another story of presenting symptom and underlying disease.
Jesus is in the temple, teaching. This is what rabbis do: they are teachers, and Jesus was an extraordinary rabbi. But he wasn’t part of the system of the temple – he was like a lay preacher walking into a big cathedral with no credentials. No surprise, then, that the religious leaders in the temple came up to him and said, “What gives you the right to come here and do your preaching and teaching?”
If you asked the chief priests and the elders, they would say that in that moment, the presenting problem was that someone who had no credentials walked in and started preaching without checking in with the leadership. It’s like when a husband and wife are fighting, and the husband tells the counselor, “Well, she always goes shopping and buys all sorts of expensive things we can’t afford.” And the counselor thinks to himself, “It’s not about the shopping, friend.” But they can’t face the fact that it is not about credentials. They want to address that symptom because they can handle that one…it’s the area in which they have the power and the law on their side.
So they ask him that question. “What gives you the right to come here and do your preaching and teaching?” “By whose authority do you do these things?”
And Jesus knows that it isn’t about credentials, so he turns it back to them in another question: “When John baptized people, was it from heaven or was it just his own personal thing, and it didn’t really mean much at all?”
Now the leaders are boxed into a corner. If they say that John’s baptisms come from heaven, they’ll look like fools or worse for not believing what John said about the coming Messiah. They let Herod kill him without saying a word. If they say John’s baptisms aren’t from heaven, they will incur the wrath of the people, who certainly believe that John was a prophet. They flocked to him for baptism.
So, unable to come up with an answer that saves face, they simply say, “We don’t know.” And Jesus says, “If you don’t know the answer to that question, where John’s authority comes from, you cannot possibly understand where my authority comes from.”
Jesus knows that their challenge to him isn’t about credentials, it’s about fear of losing power in the current system. If Jesus is the Messiah, they think, the religious leadership’s power is diminished. They like their lives. They don’t want things to change, and Jesus is nothing if he isn’t about changing the status quo.
So the presenting symptom may be Jesus’ authority, his credentials, but the underlying disease is that they don’t want to recognize his authority. They don’t want to see who he is. They are afraid that he really is who he appears to be – the Messiah, the Anointed One – and they don’t know what to do with it.
And that’s why Jesus’ parable is so interesting. He frames it as a story about obedience. A father asks his son to do something. He sounds like a teenager “Yeah, yeah, dad, I’ll get to it.” And then he promptly goes back to playing the 1st century equivalent of Xbox and forgets his promise. The father asks his second son to do something. The youngster says, “Sure, right on it,’ and gets it done immediately. He is the more obedient one.
Jesus says the true underlying disease is whether or not we respond when God says to do something – to follow Jesus. It’s not about credentials. It’s about opening one’s eyes to see that the Messiah is right in front of us, and we are supposed to get up and follow him.
And then he adds the kicker. The ones who are truly obedient are not the ones who know the law and spend all their time reading and studying Torah – it might as well be an Xbox for the amount of good it does. They should recognize who he is without thinking twice – after all, isn’t he the fulfillment in every way of all those prophecies in Torah about the Messiah? No, the obedient ones are the ones who just get up and follow. They don’t check the credentials first. They simply hear and respond. The symptom of trying to disbelieve because it challenges their status quo is a clue to the real disease: they don’t want to follow, because it feels like they’ll lose something if they do.
If any of you are fans of the TV show “House,” you’ll remember that House and the doctors on the team spend most of every show trying to figure out what is a symptom and what is the underlying disease. Sometimes they wander down a wrong pathway, and the medical solution they offer doesn’t fix the problem. Sometimes there are so many symptoms that it’s hard to figure out what is really going on under it all.
But the very realistic premise of those stories hold: the presenting problem is not what really needs fixing – it’s the underlying disease. And for us as followers of Christ, most of the time it is about faith, about believing that God is really present among us. Perhaps we resist believing that he is really present and really Lord of our lives, because that requires that we change our lives. Perhaps we’ve become accustomed to emptiness in what St Augustine called “the God-shaped hole” in our souls, that place where we hunger for relationship with the divine. Perhaps we’re afraid that if we know God, God will know us, and will not like what he sees.
Nevertheless, the underlying disease must be treated for the symptoms to go away.
That’s what House would tell us. We’ve got to get to the root of the problem to make it go away.
That’s what St Augustine would tell us. We long for relationship with God, we crave it, and when we don’t have it, we feel an emptiness.
And that’s what Paul tells us in the reading from Phillippians today. How do we heal? We recognize and obediently follow Christ, because “ it is God who is at work in you, enabling you both to will and to work for his good pleasure.”
We are not our own physicians or counselors. God is the one who gives us the tools, like a staff to strike a rock and make water gush out. God is the one who gives us prophets to point the way. God is the one who has given us his own son who teaches and preaches and heals. If we want to be healed, not just the symptoms but deep in our souls, we can do it – just follow him, along with all the other struggling people through the centuries have done. God will help us out of our disbelief if we follow.