I have to digress—for a very lengthy moment—about the word functional. The older term was psychosomatic, and it has been mostly retired. "Psychosomatic" suggests that there is a psychological cause, that the mind made the body create the symptom. Sometimes this could be the case: many people with functional symptoms do have psychological factors in play; the evidence for this is that psychological treatments alone can relieve the physical problems. But this is not true for everyone. Many patients have no identifiable trigger, no trauma, no underlying depression, and in this case the word psychosomatic carries an accusation—you are doing this to yourself—which is cruel when it is wrong. And it frequently is wrong. Medicine has been confidently mistaken about this label before. Peptic ulcer disease was for decades thought to be psychosomatic: stress, acid, and a driven personality. But then, as I described earlier, Marshall and Warren discovered that ulcers were actually caused by a bacterial infection!
The current term is functional, meaning a disorder of function rather than structure: the hardware is intact, but the signalling has gone wrong. The shift is not a denial that psychology matters—it is a refusal to require it. Diagnosis no longer depends on hunting for a stressor; it rests on positive physical signs. In functional leg weakness, for instance, the leg that cannot be pressed down on command will press down perfectly well, by itself, the moment the patient is asked to lift the other one. The pathway works. But what fails is the access to it. The term functional could sound like a polite evasion or even a euphemism for psychosomatic, but it has an advantage: it says what is happening without insisting on a particular cause.
Causation for functional problems runs across a wide range, and much of it is simply unknown. At one end there are cases where psychological factors are evident—the old vocabulary of somatization and conversion, where distress that has no other outlet arrives in the body. At the other end are patients in whom no one has ever found anything of the kind, and where the mechanism is a genuine mystery: something has gone wrong with prediction, attention, and the brain's model of the body. There is also another category of cases—the factitious, where symptoms are produced or faked for the sake of the sick role and the care that comes with it; and outright malingering, where the payoff is money, drugs, or an escape from something. But these cases are not functional; they are in a separate category altogether.
But let's get back to the stage: at a faith healing event, different people might have different problems. Someone with a functional gait disorder might genuinely walk. Someone who has felt comfortable in a sick role might be willing to take on the role of a healed person. Some people might have been paid to throw down a crutch. And others might have some combination of these problems, since categorization is not necessarily tidy—labels that look crisp in a textbook might blur in a real person under a spotlight, with a crowd roaring and a preacher's hand on her forehead. Not every problem is one thing. The question "Was it a miracle?" cannot be answered from the stage—not because miracles have been ruled out, but because we do not even know what was wrong.
Most people with severe medical problems who pursue faith healing will not experience remission, because many illnesses are not primarily functional and are not particularly amenable to community support, suggestion, or adrenaline-soaked collective emotion. Yet devout people may then conclude that they did not have sufficient faith, or that they were not worthy of divine intervention. Or they may conclude that it is God's will for them to continue suffering, while others, for reasons no one can explain, receive a miracle.
The danger is worst when faith healing replaces medicine rather than accompanying it. One review found 172 U.S. child deaths between 1975 and 1995 after parents refused care on religious grounds—most of them children who would very likely have lived with ordinary treatment. An adult is capable of weighing the risks or benefits of his or her own convictions. A child cannot.
Most of the healings invoked as miracles involve serious organic disease, and there, what looks like a cure is almost always something else. Placebo and context effects are real, but limited. They can change pain, fatigue, nausea, breathlessness, and the felt sense of being cared for. They do not shrink tumours, reverse sepsis, or repair a severed nerve—a ritual can change the experience of illness without changing the disease.
Miracle stories in religious texts—blindness cured, paralysis reversed, even the dead raised—are awe-inspiring if taken literally. But they should be read against the background rate of suffering in the ancient world. In pre-modern settings, roughly a quarter of newborns died within the first year of life, and close to half did not survive childhood. Maternal death in childbirth was also far more common. In such a world—saturated with infection, malnutrition, injury, and loss—miraculous healing would have had to be common and broadly distributed to register as a genuine explanation of reality. Instead, what we mainly have are vivid stories about rare exceptions (or legendary claims) in a sea of ordinary, relentless suffering, with the miracle-giver doing nothing for the massive public health problems while singling out some lucky individual.
Miracle stories are a little bit like discussing lottery winners: if miracles truly occur, they are extremely rare, and the narrative focus on the "winner" distracts from the millions who hoped, prayed, suffered, and received nothing. And some of these millions had problems that could have been solved through simple interventions, nothing magical required. As with lotteries, one would be unwise to build one's medical, psychological, or moral planning around the hope of an exception.
There are also some predictable cognitive and statistical illusions at work here. One is selection bias: the "miracle stories" are the ones that get put on stage, recorded, and retold, while the far more numerous failures quietly disappear. Another is regression to the mean: many symptoms fluctuate naturally, and people are most likely to seek dramatic interventions when they are at their worst—so improvement afterward can look like a miracle even when it is simply the usual swing back toward baseline. Base-rate neglect adds to the distortion: a vivid testimony feels more compelling than the boring, brutal fact that most people do not improve. And then motivated reasoning does the rest: once someone has publicly declared faith, donated money, and staked identity and relationships on the story, it becomes emotionally costly to admit that nothing supernatural happened. The narrative hardens, not because the evidence is strong, but because the social and psychological incentives are.
Miracle stories are a little bit like discussing lottery winners: if miracles truly occur, they are extremely rare, and the narrative focus on the "winner" distracts from the millions who hoped, prayed, suffered, and received nothing. And some of these millions had problems that could have been solved through simple interventions, nothing magical required. As with lotteries, one would be unwise to build one's medical, psychological, or moral planning around the hope of an exception.
There are also some predictable cognitive and statistical illusions at work here. One is selection bias: the "miracle stories" are the ones that get put on stage, recorded, and retold, while the far more numerous failures quietly disappear. Another is regression to the mean: many symptoms fluctuate naturally, and people are most likely to seek dramatic interventions when they are at their worst—so improvement afterward can look like a miracle even when it is simply the usual swing back toward baseline. Base-rate neglect adds to the distortion: a vivid testimony feels more compelling than the boring, brutal fact that most people do not improve. And then motivated reasoning does the rest: once someone has publicly declared faith, donated money, and staked identity and relationships on the story, it becomes emotionally costly to admit that nothing supernatural happened. The narrative hardens, not because the evidence is strong, but because the social and psychological incentives are.
Before accepting a miracle claim, ask for the medical equivalent of a chart: the diagnosis beforehand, objective evidence after, independent verification, what treatment was already underway, how long the improvement lasted, and how many others at the same event were not healed.
The same selective attention appears in religious appeals to nature. For example, there are many biblical references to birds, with the insinuation that they live joyfully and are fed through divine providence. This is an attractive image, but it reflects a limited understanding of biology. Wild creatures face high mortality from starvation, disease, and predation. Birdsong has natural functions—communication, territory, mating—not simply the expression of joy or a benevolent performance for human listeners. Similarly, "lilies of the field" (another symbol of divine providence) have a difficult existence shaped by competition, pathogens, drought, and chance: the blooming lilies that catch our eye do not reveal the many that did not survive. In other words: nature is beautiful, but it is not reliably gentle—and any spirituality that wants to use nature as moral reassurance has to be honest about what nature actually does. The same selective gaze that romanticizes birds and flowers can romanticize miracle claims as well: it fixes on the striking exception and looks away from the background rate of suffering.
I can't help but mention a passage from a sweet, delightful children's book, which was made into a movie I enjoyed with my own children many times: E.B. White's Charlotte's Web. In the story, the whole valley is marvelling at the words a spider spun into her web and calling them a miracle. The old country doctor gently points out that everyone has missed the real marvel: nobody, he says, noticed that "the web itself is a miracle." He cannot explain how a spider learned to spin at all—how a creature taught by no one produces something so intricate and exact—and that, he suggests, is the thing worth our astonishment. The web, the bird, the lily, the human eye, the sheer fact of a universe that has produced creatures able to wonder about it—these are astonishing enough without being pressed into service as supernatural signs. The error was never in feeling awe; awe is the correct response to nature. The error is in mistaking the ordinary, ubiquitous miracle of the world for a rare and personal exception to it.
A review of 172 child deaths in the United States between 1975 and 1995 in families that relied on faith healing instead of medical care. In 140 of the cases, survival rates with standard medical treatment would have exceeded 90%, and a further 18 had expected survival above 50%. The study documents the lethal consequences of substituting religious ritual for effective treatment, particularly for children, who have no voice in the decision.
Barnett, A. G., van der Pols, J. C., & Dobson, A. J. (2005). Regression to the mean: What it is and how to deal with it. International Journal of Epidemiology, 34(1), 215–220. https://doi.org/10.1093/ije/dyh299
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., LaFaver, K., LaFrance, W. C., Jr., Lang, A. E., Nicholson, T., Nielsen, G., Reuber, M., Voon, V., Stone, J., & Morgante, F. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology, 75(9), 1132–1141. https://doi.org/10.1001/jamaneurol.2018.1264
A consensus review of functional neurological disorders (FND)—genuine and often disabling conditions such as functional movement disorders and psychogenic non-epileptic seizures. It documents the field's shift away from the term "psychogenic" and away from requiring a psychological stressor for diagnosis, emphasizing that the symptoms are real and shaped by attention, expectation, and prediction rather than feigned. Relevant to why suggestion-rich settings can genuinely influence such symptoms.
Kaptchuk, T. J., & Miller, F. G. (2015). Placebo effects in medicine. New England Journal of Medicine, 373(1), 8–9. https://doi.org/10.1056/NEJMp1504023
A concise overview presenting placebo responses as genuine biopsychosocial effects of expectation, conditioning, and context on the experience of symptoms—rather than mere imagination or spontaneous fluctuation. Useful for understanding how expectation and suggestion can produce real symptomatic change in conditions sensitive to those factors.
Volk, A. A., & Atkinson, J. A. (2013). Infant and child death in the human environment of evolutionary adaptation. Evolution and Human Behavior, 34(3), 182–192. https://doi.org/10.1016/j.evolhumbehav.2012.11.007
A synthesis of infant and child mortality across 20 hunter–gatherer and 43 historical pre-industrial populations, estimating that approximately 27% of infants died within the first year of life and approximately 47.5% of children died before reaching puberty. Provides the demographic background against which ancient miracle claims must be read.
References
Asser, S. M., & Swan, R. (1998). Child fatalities from religion-motivated medical neglect. Pediatrics, 101(4), 625–629. https://doi.org/10.1542/peds.101.4.625
A review of 172 child deaths in the United States between 1975 and 1995 in families that relied on faith healing instead of medical care. In 140 of the cases, survival rates with standard medical treatment would have exceeded 90%, and a further 18 had expected survival above 50%. The study documents the lethal consequences of substituting religious ritual for effective treatment, particularly for children, who have no voice in the decision.
Barnett, A. G., van der Pols, J. C., & Dobson, A. J. (2005). Regression to the mean: What it is and how to deal with it. International Journal of Epidemiology, 34(1), 215–220. https://doi.org/10.1093/ije/dyh299
A widely cited methodological review of regression to the mean—the statistical tendency for unusually high or low measurements to be followed by ones closer to the average. Because people typically seek dramatic interventions when their symptoms are at their worst, any subsequent improvement can be misread as a treatment effect (or a miracle) when it is simply the expected return toward baseline.
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., LaFaver, K., LaFrance, W. C., Jr., Lang, A. E., Nicholson, T., Nielsen, G., Reuber, M., Voon, V., Stone, J., & Morgante, F. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology, 75(9), 1132–1141. https://doi.org/10.1001/jamaneurol.2018.1264
A consensus review of functional neurological disorders (FND)—genuine and often disabling conditions such as functional movement disorders and psychogenic non-epileptic seizures. It documents the field's shift away from the term "psychogenic" and away from requiring a psychological stressor for diagnosis, emphasizing that the symptoms are real and shaped by attention, expectation, and prediction rather than feigned. Relevant to why suggestion-rich settings can genuinely influence such symptoms.
Kaptchuk, T. J., & Miller, F. G. (2015). Placebo effects in medicine. New England Journal of Medicine, 373(1), 8–9. https://doi.org/10.1056/NEJMp1504023
A concise overview presenting placebo responses as genuine biopsychosocial effects of expectation, conditioning, and context on the experience of symptoms—rather than mere imagination or spontaneous fluctuation. Useful for understanding how expectation and suggestion can produce real symptomatic change in conditions sensitive to those factors.
Volk, A. A., & Atkinson, J. A. (2013). Infant and child death in the human environment of evolutionary adaptation. Evolution and Human Behavior, 34(3), 182–192. https://doi.org/10.1016/j.evolhumbehav.2012.11.007
A synthesis of infant and child mortality across 20 hunter–gatherer and 43 historical pre-industrial populations, estimating that approximately 27% of infants died within the first year of life and approximately 47.5% of children died before reaching puberty. Provides the demographic background against which ancient miracle claims must be read.
White, E. B. (1952). Charlotte's web. Harper & Brothers.
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