Doctor-Patient Relationships and the Process of Repentance

If anyone has ever studied the Sociology of Health and Illness you will have certainly come across Talcott Parsons’ ideas on the ‘Sick Role’.  This ‘paternalistic’ model of the Doctor-Patient relationship and other models like it (i.e. the co-operative and the consumerist) can be applied to the process of seeking help from a Bishop in the process of repentance.  This analogy is based on an assumed similarity between the roles of Bishop/Doctor & ‘Sinner’/Patient.  I think this is a useful, though not flawless, comparison but it is one that might help us think through how a Bishop could respond to someone who is seeking to confess and repent.  Further I think it could also facilitate discussion upon the issue of how ‘Sinners’ can navigating this difficult relationship.

Parsons’ model speaks from a position where the physician possesses a high degree of control and therefore outlines for the patient what is in their best interest.  In this view, the Bishop then is one who diagnoses and then prescribes the necessary course of action for the sinner.  The patient is expected to comply with these directions otherwise the sick role is not ascribed to the patient, if this role is not available or accepted other exclusionary measures are enforced.  In this way, the sick role can be a good place to be, for it can mean that the individual can be justifiably relieved from normal day-to-day expectations.  Applying this to the Bishop-Sinner relationship it is possible to see the Bishop as the person who allows the sinner to enter a particular, transitory relationship with the Lord and the Church that can reduce the need for excommunication.  In my experience this is the model most Bishops use and most ‘sinners’ expect.

There are of course some problems with this approach.  The sinner becomes quite powerless after they confess.  Their role is not wholly passive but there is clear sense that power lies with the Bishop.  In situations where a person feels extreme guilt it might be counter-productive for a Bishop to assume a role that implicitly removes an individual’s spiritual autonomy and which further separates them from the Lord by being the one who becomes the receiver of His will.

In addition to this view, there are at least two other types of model that have been discussed regarding Doctor-Patient interactions.  The Consumerist model is another possibility.  In this model, the Patient (Sinner) has high control and uses the Doctor (Bishop) more as an advisor rather than as a source of reliable healing knowledge.  Clearly in this view there is no ‘need’ to confess sins to a Bishop in order to achieve full repentance and this might contrast with the views of some who would see this as essential.  Moreover, in the organisational context of the Church this model might be considered problematic if standards of worthiness are to be formally delineated.  For in this model some people would be within their rights to avoid the Bishop, but more than that they might be able to argue that going to the Temple or taking the Sacrament would be most helpful in their repentance process.

The third model is often described as one of mutuality.  In this relationship both parties are active and where ideas and beliefs are shared.  In this view both the Bishop and the Sinner discuss the issues and try to understand the constraints and possibilities of the other side.  Though I suspect that most people reading this would find ‘mutuality’ an appealing way of approaching these issues I think there are some real problems with it.  For example, there is a strong possibility that both parties might have irreconcilable views upon these particular issues and if this is the case how then are they to proceed.  This is especially likely if revelation is claimed on both sides.  Further in this model this incompatible revelation must be respected and valued.  Moreover, you have to consider whether such a form of interaction is possible in an environment where Priesthood, revelation and judgement are centralised in the leader regardless of the forms of discourses used around such issues. 

I do not believe that any of these approaches is inherently destructive.  I see the benefits of a paternalistic relationship in a situation where someone is blind to the damage they are causing to people around them.  However, I can also see the benefit of the Bishop seeing his role as helping someone to judge themselves in a more co-operative sense.  I can see the wisdom, for example, of a Bishop asking the ‘Sinner’ to pray about whether they should take the sacrament or not. Yet, considering that forgiveness is a gift offered by grace, I can also see that a consumerist model is also useful in not allowing the Bishop to become the person who distributes forgiveness.  Moreover, I suspect that the consumerist model would reduce those (rare) instances of ecclesiastical abuse. 

My questions then are these: which approach do you think Bishops should adopt in their interactions with ward members in the process of repentance?  Which model should the sinner adopt?  Can these approaches be different and have a satisfactory conclusion?  Further, I am curious as to how you think these models would play-out in real situations?


  1. Interesting questions, Aaron.

    I think you summed it up well in the end. I think Bishops should be flexible enough to act in all modes when appropriate.

  2. Mark Brown says:

    I think the bishop should be willing to use any of these methods, depending on the person. He might even use different approaches with the same person at different stages of the process.

    The question of how it would all play out in real life is tricky. Sometimes it is hard to get a good read on your bishop. I’ve been in a ward before where I realized that if I had done something which could likely result in getting ex’ed, I would rather move out of the ward than confess to the current bishop.

  3. Aaron R. says:

    Thanks for your thoughts so far.

    The problem I see with flexibility is that it breeds inconsistency. Which for those outside the situation can be a painful experience, esp. if their situation felt ‘paternalistic’ whilst their friend had a co-operative approach.

    Moreover I am sceptical about the possibility of achieving co-operative or consumeristic practice within the framework of the Church more generally. If this is accurate it seems that flexibility is not an option. Further, I am aware of situations where the person coming to the Bishop expects a ‘paternalistic’ approach but could probably benefit from another one (perhaps co-operative/mutuality). This can led to a silent form of conflict and dis-comfort.

  4. I think that since it’s up to the bishop (as the judge in Israel) as to which model might work best for a given individual, it’s really the paternalistic model used in every case. The bishop does have the ultimate say on how to proceed. Therefore, if he chooses to use one of the other two models, he’s only doing so within the paternalistic umbrella.

  5. Mark Brown says:

    The problem I see with flexibility is that it breeds inconsistency.

    Aaron, don’t you think our church disciplinary system is already wildly inconsistent? An offense which might get you disfellowshipped in one ward, but the bishop of the neighboring ward might only ask you to not take the sacrament for a few weeks.

    I think this is a problem, and I don’t know what to do about it. One possible solution might be for the church to publish a book listing various offenses and then prescribing the appropriate punishment. But this is a solution that is probably worse than the original problem.

  6. Mark Brown says:

    Martin, while I get what you are saying, I think the member does have some control. For instance, a person wishing to repent might make only a partial confession at first, to see how the bishop reacts, then take it from there. This happens all the time.

  7. Aaron, thanks for this interesting post. I agree with your #3 response.

    The question is this: the term Judge implies punishment. If you have done wrong there is a price for that. Does every sin require a punishment as in our legal system? Should the transgressor be made to suffer in response to sin by having a paternalistic judge pass some sort of judgment and extract a penalty?

    At least in the physician model punishment is not the object but cure. Can the idea of punishment ever be removed from the office of Judge in Israel?

  8. Actually, what happened in the Catholic Church might be instructive. The pedophile priests were treated for a cure when they should have been held up for punishment.

    This is a difficult dichotomy.

  9. All of the above, none of the above. The framing of the question is wrong all together IMHO.

    My understanding of the bishop/sinner role is that it facilitates the repentance process to reunite the sinner with the Church. Healing our relationship with God is a sinner’s personal responsibility, only part of which is the work he/she does with the bishop.

    The bishop is the agent of the Church, he is given stewardship by the Church and speaks for the Church in these matters. If he says excommunication, or disfellowship, or a stern lecture, it is completely within his rights. Those rights are bestowed upon him by the Church as it’s representative. (I guess a sinner could always try to talk to the stake president if they felt the bishop’s judgement was in error. But my guess is that the stake president will support the bishop 95% of the time.)

    So in my mind you can work out your salvation with the Church and still have incomplete repentance with God. But because regaining good standing with the Church is part of the reconciliation with God, you can’t be in good standing with God without being in good standing with the Church.

    As far as the Dr/patient analogy – I’ve been to many doctors within the last year and ultimately the decision for my course of treatment, which doctor I should see, and if I should do anything at all, was entirely my choice. They all had drastically different opinions as to how I should be treated. Doctors don’t corner the market on answers, it was my choice and thankfully I chose wisely (all better).

    To a certain point you are stuck with the bishop you’ve got. So the lesson to be learned is don’t screw up big-time if you’ve got a crappy bishop.

  10. Molly Bennion says:

    How the models play out would seem to be impacted by many case by case factors including gender. For women for whom patriarchal organization is an irritant, a purely paternalistic approach could be counterproductive. Flexibility is key.

  11. “To a certain point you are stuck with the bishop you’ve got. So the lesson to be learned is don’t screw up big-time if you’ve got a crappy bishop.” (Jendoop, #9)

    So true. Which is why I believe it is possible to work out your repentence with God and be in good standing with God while still not being in good standing with the Church.

  12. Martin (#4) I agree with Mark. Just because a Bishop chooses does not mean that he is always the one with power. I also agree that most likely that decision is made from a paternalistic viewpoint but this is not necessary.

    Mark (#5) I completely agree. It is wildly inconsistent and I also would hate a rigid rule book, which why I think this post, IMHO, is important. Instead of giving rules we can give approaches coupled with the clear goals (save the sinner, protect the innocent and the name of the Church etc.) I am merely noting the problems of both sides.

    Rob (#7) I think it depends upon how you define Judge. If the Judge is someone who discerns (which is my own sense) then that can be applied to discerning cure. Moreover, I think that in this discerning process it is important that Bishop’s help people judge themselves (not in the sense of punishment but being responsible for their own spirituality).

    Jendoop (#9) I think that most Bishops and the CHI would argue that the Bishop’s role is very must to facilitate your repentance with God and with the Church, though the Bishop can only forgive for the Church.

    Moreover, regarding the Dr./P. split, you have to remember that I am fom England and that we don’t get that same degree of choice. It is v.much like having a Bishop.

    Molly (#10) I think that is an important insight and one I neglected, thank you.

  13. Catharine, I think God knows that some bishops are going to mess up with this process. But we still have to work within the frame work He has given, the Church. The excuse of living in an imperfect world isn’t going to cover our sins. It falls under the “life isn’t fair” umbrella.

    Aaron, Does that mean we can turn this thread into a political discussion about socialized medicine then? ;)

  14. “But because regaining good standing with the Church is part of the reconciliation with God, you can’t be in good standing with God without being in good standing with the Church.”

    I am not sure what this means.

    The Church, for administrative reasons, imposes certain waiting periods before certain disciplinary sanctions can be lifted. I personally do not think reconciliation with God is subject to the Church’s administrative waiting periods.

    I like the approach of Elder Ashton in a talk he gave about such waiting periods:

    “‘Yea, verily I say unto you, if ye will come unto me ye shall have eternal life. Behold, mine arm of mercy is extended towards you, and whosoever will come, him will I receive; and blessed are those who come unto me’ (3 Ne. 9:14).

    “This scripture indicates that in life there is no waiting period before we can come unto God. In our weakness we know where we can turn for strength. What good advice and wise direction for our lives can be gleaned through study of the scriptures! Self-esteem can be renewed and strength to do His will can be revived. People must always count more than programs.” Marvin J. Ashton, “While They Are Waiting,” Ensign, May 1988, 62

    I do not believe the formality of reinstatement is a pre-condition for coming unto Christ, and being received by Him, nor to feel of His spirit.

    In the same manner, I do not believe receiving forgiveness from any other person or entity is a pre-condition to reconciliation with God. (For example, being on correctional probation may, for Church purposes, defer a person’s baptism or advancement in the priesthood (or perhaps even partaking of the Sacrament). But I do not think God waits for the legal system to run its course before embracing us if we turn to Him.)

  15. I approach this as a surgeon, which is my profession, but not as a bishop, as I’ve never had that particular office.

    I look at my role as a doctor as providing various options to my patients. I explain processes, risks/benefits, etc. but largely leave the choice for treatments up to them. They all come to me with different backgrounds. Some have had surgery. Some can’t do therapy because of work and family constraints. Some can’t take particular medicines. Some have insurance or money constraints. Some conditions are serious and some are more trivial. But I don’t believe in the paternalistic approach that was so common in medicine before. I make the patient be a part of the decision. Occasionally, someone isn’t really sure so they ask what I’d do. I tell them honestly what I would do if it was me, but also explain that my situation is different than their’s so it’s not necessarily the right answer.

    I look at bishops in the same regard. Ultimately, my path in life is to be a good person in mortality and develop a good relationship with God for eternity. I look at the Church as just another tool to help me on my way. My relationship is with God and not the institution of the LDS Church as currently instituted. If our relationship with the Church was absolutely essential, then the 99.8% of the world who aren’t LDS are doomed. The people who lived before the LDS Church was here are doomed. Etc. No one believes this, so there is obviously a mechanism for the vast majority of the population who aren’t LDS to get back to God (whatever that may be). It therefore implies that belonging to the LDS Church in mortality can NOT be essential to our eternal salvation.

    Long story short. My relationship is with God. There are things in the LDS Church that help me with that. If there was something that I couldn’t resolve on my own with God where a bishop might help, I’d talk to him. Hasn’t happened yet, but it’s there if I need it. And if there were something where the Church as an institution felt I needed to be excommunicated, my feelings would play a bigger role than anything else. If I truly did something that offended God, I would use that as an opportunity to change my path. But if I truly and honestly felt that I was right with God, perhaps that is a sign to me that my path back to God lies outside the institution of the LDS Church, as they are not necessarily the same thing.

  16. Hopeful Dad says:

    Speaking on deep background here, I did 5 years as bishop. Without disclosing anything that I think I should not, I’ll just make two observations.

    1. Every person, and every case was different. Some people come to you looking for the paternalistic approach, and with others there is a lot of feinting and exploratory movements, not wanting to give up any more than is necessary.

    2. Really glad that the handbook, as Mark pointed out, didn’t spell out specifics, and take away either the initiative of the person seeking help, or the bishop trying to help. As everyone’s case was different, so did the repentance process have to take on different characteristics.

    One last note. There are many different ways of reconciling with God, and often the formal church discipline process is really, really helpful. Some are pretty good at working it all out on their own, and then come to the Bishop as kind of a final step to finish the process. But you also come across some who are only interested in reconciling with the Church, and not so much with God. Those are tougher to work through.

  17. Interesting post, Aaron (I always look for yours first…)

    Jendoop (#9) I think you’re on the right track (despite Aaron’s subsequent comments). The bishop’s role is to sort out your relationship to the church. As much as being “right” with the church is required to be “right” with the Lord, then the two are related. But (and Aaron, I think the CHI backs me up on this, though I haven’t had one for a while) the bishop cannot proclaim that one is forgiven, only that one has met the terms of reinstatement from whatever restrictions may have been imposed.

    The repentant member must work during the period of restriction to find his or her own repentance, and my own experience taught me that it was at least as important for the member to have a sense of being forgiven as it was for the bishop to have the sense that the person was ready to be reinstated.

    This is one reason why a pre-determined code of infractions and punishments will not work, because reinstatement and true repentance are dependent not only upon “time served” but all of the positive actions a person should take during that period, including (depending on instructions given) scripture study, prayer, church attendance, service to others, and so on.

    I’ll also take exception to the comment that suggests the bishop is executing punishments (7). In the early 1990s (could have been late 1980s) when the “new” CHI was introduced, church “courts” became “disciplinary councils.” One of the teachings associated with that change was to help all involved see that this was not a matter of meting out punishments. As Aaron suggests, the purpose is to faciliate the repentance process. Generally (in my experience) a repentant member will be given the opportunity to meet regularly with the bishop during the period of restriction in an effort to teach, encourage and strengthen. I suppose some bishops don’t do this, but I haven’t observed that.

    As for Mark’s comment in #2 — I think you’re right that some members don’t feel comfortable with their present bishop, which is why a new bishop often gets a few confessors right after a change in leadership is made.

  18. Aaron R. says:

    Thanks again for the comments.

    Jendoop, I think that would be fair move…

    DavidH (#14) I think your response reflects one position regarding this process, i.e. the consumerist approach. This is not supposed to reflect my disagreement but rather that your comment, like some of the others is symptomatic of the struggles that both Bishop and ‘Sinner’ have i understanding one another.

    Moreover, I think that the Bishop has a tough job in trying to help Individuals return to God whilst trying to work within the framework of the Church.

    Thanks Mike S (#15) for your comment. I think it articulates some of the difficulties of being of both sides of that fence. It is interesting that you approach these issues (it seems to me) in an attempt to achieving mutuality.

    #16 – I think you share some valuable insights. I agree that trying to help people reconcile with God when they are only interested in the Institutional side must be a difficult thing.

    Paul (#17) I did not intend to convey that Jendoop was wrong but merely that the CHI would not support her position. That is a challenge because, as she notes, we have to work within the framework of the Church. I agree that Bishop’s cannot forgive on behalf of the Lord but the CHI does counsel Bishop’s to help people repent or be reconciled with the Lord.

  19. Over the years I have seen people leave the church because of Bishop interviews, as well as people repent and feel good again.
    I am glad I am not nor ever will be a Bishop and I pray for ours daily. The reason I pray for ours daily is because I have seen the damage they can do.
    I just wonder if they realize the power they have to change people’s lives with the things they say, or don’t say.

  20. #19 Roblynn,

    I also hope bishops get this. The ones I have known well do, though they are not perfect. I think good bishops also hope members will remember that. I think that acknowledgement of imperfection opens the door for discussion when there isn’t good understanding.

    I agree it’s good to pray for bishops.

  21. Hopeful Dad says:

    Roblynn and Paul, # 19 & # 20.

    I’ve known some great bishops, and that’s who I tried to emulate. I also know I made some mistakes along the way, and tried to own up to them. I know I probably said a few things that went totally the wrong way, and was misunderstood on occasion, and I’m sure that I misunderstood situations as well.

    One of my mentor bishops told me when I was called that the reason bishops normally serve just five years is that each year, you’ll piss off 20% of your ward, so after five years, no one will talk to you anymore, possibly including your wife.

    I was fortunate, my wife still talks to me.

  22. “So the lesson to be learned is don’t screw up big-time if you’ve got a crappy bishop”. But really, if you can control it, you shouldn’t screw up big time at all, should you?

  23. Simon B says:

    Main Observations:
    This discussion is about true repentance vs. justification.

    Bishops are called to preside over a specific flock at a specific time. Their style may not suit all but they should always treat each case individually and be guided by the Spirit.

    Sustaining the Office of Bishop is key here.

    The main point is how much does a person really want to change (repent) and, if so, how humble are they? It is this that really needs to happen for any long-term benefit to be derived.

  24. While the doctor patIent metaphor is useful; I think it would be helpful to point out how bishop/ sinner and doctor/ patient relationships are also different.

    A doctor has studied extensively about the body, how it works, and illnesses pertaining to it. While it could be argued that patients have the ‘choice’ about accepting the medical advice they receive, I would be very surprised to know of anyone that had not sought out any medical advice, and attempted to deal with a serious health problem by themselves.

    It is clear to see that when it comes to physical sickness or injury, we need advice from a specialist, and then continue to need their expertise & resources to carry out the agreed plan (whatever that is)

    This dependency is much less clear in the case of bishops. What exactly do they have that is needed? Is it just the opportunity to confide in a trusted person? Do they have ‘executive’ spiritual powers that facilitate repentance? What is the nature of the ‘mantle’ they have as it pertains to counselling with members?

    The term ‘mantle’ implies a certain uniformity, which in my experience, simply is not the case between different bishops. In the case of surgeons/ doctors etc, they will understand the methodology employed by another pracitioner, even if it is not their preference. In contrast different bishops/ stake presidencies sometimes don’t even acknowledge the viability of another leaders approach.

    My current view (although this always subject to change) is to see bishops as more of an organizational, and less of a spiritual expediency. 

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