Quality of Life: Psyche or Zoe? – Dr Bo Wong

We are created with a life that seeks something greater


From Luke’s Journal 2021 | Dying & Palliative Care | Vol.26 No.2

The decision to treat or to palliate a patient with a life-threatening condition is often dependent on the expected quality of life after treatment.

“Quality of life” is defined by the World Health Organisation as “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.” 

Everything we do to patients is done with the hope of improving, or at least maintaining, their quality of life. We try to reduce pain, maintain function and promote mental well-being. However, quality of life is a perception related to a person’s expectations in life. Regardless of how much we do for patients, if their expectations exceed what we can do, they may still be unhappy with the treatment they receive.

One of the questions patients frequently ask is, “Why do I have arthritis (or another condition) now? I have never had it before.” Such a question implies their expectation to remain in good health forever. They often seem surprised that their health is deteriorating. The more severe the defects are, the harder it may be for people to accept. Our desired quality of life may be unrealistic regardless of what condition we are in.

“Our desired quality of life may be unrealistic regardless of what condition we are in.”

Sometimes I wonder how Adam and Eve would have considered their quality of life. They lived in a world without sickness or death, with everything they needed provided for them. However, they still had a feeling that something was lacking. They knew that they were not exactly like God. They wanted to improve themselves. They thought that they could be more like God when they were ‘mature’ enough to decide for themselves to eat the fruit which God forbade them to eat. However, being independent from God did not make them more like God. Instead, it made them more like the devil. For the sake of being independent, they chose to ignore good advice and follow bad. They would have been more like God by obeying God, rather than disobeying him. 

We live in the same culture. We base our expectations of life on our experience and passions. We still want to decide what we want in life independently. We may listen to advice, but we tend to accept only opinions which agree with our hearts. It is therefore difficult to improve a patient’s quality of life without first addressing his/her heart.

A life not complete in itself?

Over the past few months, I have started trying patients on medicinal cannabis for chronic pain and anxiety. For me to prescribe such medications under the Special Access Scheme, I need to do a quality-of-life assessment every month for each patient. When I compare patients’ scores for their quality of life, I am often disappointed that though medicinal cannabis does seem to relieve pain and anxiety, there has not been much improvement in their quality of life scores (which mostly stay around 3/10). Patients often have new problems they wish to have resolved when pain or anxiety have settled. 

It appears that we are created with a life which is not complete in itself. 

Even Adam and Eve were looking for something greater. We are created with a life that seeks something greater, and this something is not creatable, it can only be reached by being intimate with the Giver of life. There are two types of life: one we are born with, the other we get by being intimate with God. 

In John 12:25, Jesus said, “Whoever loves his life loses it, and whoever hates his life in this world will keep it for eternal life.” In Greek, Jesus’ statement was expressed as “Whoever loves his Psyche loses it, and whoever hates his Psyche in the world will keep (it for) Zoe.” In this statement, Jesus was contrasting two types of life – Psyche and Zoe. In the Bible, Psyche is often translated as ‘soul’ in English. It is sometimes translated as ‘life’ as in John 12:25. Zoe is often translated as eternal life, it is sometimes translated as ‘life’, as in John 1:4 (In him was life, and the life was the light of men). 

“Psyche is often translated as ‘soul’ / ‘life’. Zoe is often translated as ‘eternal life’ / ‘life’.”

Psyche is life as we know it. However, Jesus knew more than Psyche, as he also had Zoe (“And the Word became flesh, and dwelt among us…” John 1:14 ). Psyche is life that comes with a perishable body. Zoe is life that will inherit an imperishable body. (In His resurrection, Jesus was the first to inherit the imperishable body). Both Psyche and Zoe struggle with the perishable body. Psyche struggles to keep the perishable body going forever. Zoe struggles to keep the perishable body under control.

When we have only Psyche, we will try our best to keep our bodies going for as long as possible. We will also keep looking for something better. Psyche is designed to thirst for something greater than itself. We will never be satisfied with the quality of our Psyche. In John 4:13-14, Jesus said, “Everyone who drinks of this water will be thirsty again, but whoever drinks of the water that I give him will never be thirsty again.” Medical interventions and counselling may reduce our thirst temporarily, but until we drink the living water from Jesus, our quest for a better quality of life will not end.

Photo Thirdman Pexels

Counter-intuitively, Zoe is not something we can achieve. It does not come by doing, but by knowing. In John 17:3, Jesus said, “And this is Zoe, that they know you the only true God, and Jesus Christ whom you have sent.” Life is largely about relationship. Zoe comes purely by us knowing and relating to God through Jesus Christ. Psyche is also established by how we relate to others. To have a stable Psyche, we need to have some sort of anchor. Most patients have poor quality of life not because of physical disability, but due to psychological uncertainty. They do not have someone whom they can trust or depend on. Once again, we see the limited effectiveness of medical and psychological intervention in improving a person’s quality of life. These do not solve the problems of love, justice, and forgiveness.

For people who are facing imminent death, having someone present with them is often more important than medication. This is especially so in our individualistic world where people do not value relationships whilst they are healthy. However, most health professionals are too busy to spend much time with patients. This is where patients may benefit from a chaplain, pastoral carer or other personal support. People who have Zoe have an anchor in Jesus and therefore have less fear facing the demise of their bodies. People who have only Psyche need lots of reassurance and encouragement to go through the valley of the shadow of death. As Christian health professionals, we have the opportunity of offering Zoe by our presence, prayer and pastoral care. 

Dr Bo Wong
Dr Bo Wong was born in Malaysia and is married to Lay. He has a daughter, Joyce (who is married to Jeram), and a son, Joel. Bo completed an MBBS at the University of Sydney (1997). He works as a GP in Mayfield, Newcastle, and serves as an Elder at Grace Evangelical Church Newcastle.

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