A little over a year ago my wife was diagnosed with a rare, cancer-like disease called pseudomyxoma peritonei (PMP). This disease begins with an appendiceal or ovarian tumor that ruptures and begins to spread thick mucin throughout the abdominal cavity. The tumorous cells multiply, attaching themselves to organs and slowly filling the abdomen with a bright yellow Jell-O. If left unattended over a long period, the slowly reproducing mucin will begin to crush organs and shut down the bowels, causing loss of appetite, vomiting after eating, and eventual death.

At age twenty-seven, my wife underwent the only recommended treatment for this disease: cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). CRS is an extensive tumor- and organ-removal surgery, and HIPEC is a heated chemo wash that clears out and destroys as many of the tumorous cells as possible. I thank God that my wife survived the ten hours of cutting, scraping, and drenching her insides—an amazing testament to the human body’s ability to heal and adapt. She is now, some six months later, almost back to her normal physical self—but what is “normal” after that? She is missing her appendix, gallbladder, spleen, ovaries, fallopian tubes, parts of her omentum, a third of her colon, and part of her pancreas. She is no longer able to become pregnant naturally, she is on hormone replacement therapy, and she will be monitoring her disease for the rest of her life.

Before being diagnosed, my wife had recently finished her BA and was praying about what to do next. The apparent response to her prayer was the PMP diagnosis and the most difficult year of her life. How was she to handle that kind of “answer” to prayer? What are we to do when we are afflicted in ways that seem arbitrary and unfair and possibly divinely orchestrated? How do we who believe in a good and powerful God make sense of war and violence, famine and natural disasters, poverty and injustice?

After her surgery and initial recovery, my wife shared her feelings with some people, hoping for encouragement and trying to make sense of her life. Instead, a few people leapt to explain her suffering by stating that God in his providence determines the events in our lives, both good and bad. When we suffer, they suggested, we can praise God for our life circumstances because we know they come from him and he desires our good. This is common enough language in some Christian circles, but is it right? If God actively controls everything, good and bad, does that mean he is responsible for our suffering? Did God intentionally give my wife a disease that ravaged her body? One or two people left no margin here and asserted that God does cause suffering, it’s for our ultimate good, and one day, perhaps, we’ll understand it.

Here we encounter the complicated intersection between suffering, God, and evil. Suffering is an experience of pain, but the suffering we are speaking of is more than natural, sensory pain (for example, when you burn your hand on the stove). Suffering—which can be physical, emotional, or psychological—runs deeper than that. My wife’s disease is certainly the result of physical causes (even though doctors cannot fully explain them), but if God actually caused those physical causes and the resulting suffering to bring about a greater good, what does that say about the relationship between God and evil? Does God willfully cause suffering, and if so, does that constitute evil?

We need to take a step back and define evil. One of the most frequently used phrases about evil in the Bible is that so-and-so “did evil in the sight of the Lord.” Evil is directly opposed to the character and will of God. We are told that God is good, that he is light, that he is love. Evil is anti-good, anti-light, anti-love. God is the source of life, and evil seeks to destroy life. A god who causes evil is not God but a devil. Indeed, it is Satan who leads the rebellion against God, against life, and connivingly escorts susceptible and complicit human beings to sin and death. The one true God opposes evil, hates it, and fights against it.

In his book, The Doors of the Sea, Eastern Orthodox theologian David Bentley Hart grapples at length with the questions of evil and suffering in the world and God’s relation to them. Toward the end, he concludes, “If it is from Christ that we are to learn how God relates himself to sin, suffering, evil, and death, it would seem that he provides us little evidence of anything other than a regal, relentless, and miraculous enmity: sin he forgives, suffering he heals, evil he casts out, and death he conquers. And absolutely nowhere does Christ act as if any of these things are part of the eternal work and purposes of God.”[1] God does not cause evil and suffering; he overcomes and transforms it. His purposes are always to bestow life and bring about the ultimate good. God desires a relationship of love with those whom he has created in his image and endowed with freedom.

So let me ask the question again: Did God give my wife her disease? Absolutely not. Although a loving God may bring good out of pain and suffering and evil, he does not inflict suffering on his creation to accomplish his purposes in the unfolding history of the world. In the beginning, everything that God created was inherently good. Pain and suffering are the result of humanity’s willful turning away from the Source of life and goodness; they are a by-product of our God-given freedom to “do evil in the sight of the Lord.” Consequently, even creation—the physical world around us and our physical bodies—suffers. We need only look around us, or in the mirror, to see the damaging and saddening effects of sin and evil. We should never be OK with this, living as if all is well. Nor should we attempt to assign a divine cause to every horrible reality, which may palliate some people’s anxiety but ultimately distorts the truth of who God is.

Jesus asks in Matthew 7:9–11, “Would any of you offer his son a stone when he asks for bread, or a snake when he asks for a fish? If you, bad as you are, know how to give good things to your children, how much more will your heavenly Father give good things to those who ask him!”[2] A disease in itself, or any other type of suffering, is not a “good thing” and should never be construed as such. To rebut this point and say that God’s understanding of good is above our understanding leads to an extremely problematic theological epistemology. If our human understanding of concepts like good or bad differ so drastically from God’s understanding, we really have no solid ground for understanding God’s character as revealed in the Bible. Though we are told that God is love, we would not be able to draw any safe conclusions from such knowledge. Worse, if God’s understanding of good and evil remains unlike our understanding even with the aid of revelation, the incarnation becomes senseless. If we cannot look at the words, actions, and sentiments of Jesus of Nazareth and attribute those to God, then God himself becomes a complete unknown. This problem arises in the distinction made by some theologians between God’s “hidden” and “revealed” wills.[3] How can we trust a God whose dreadful, inscrutable will lurks behind the salvific will revealed in the Word made flesh? Thankfully, this is not the case. God has revealed himself to us fully and accurately in Jesus Christ, who is the image of the invisible God. God is indeed transcendent, but he is also immanent. He desires to bless us, not curse us, in ways that align with our reality.

The problem of evil and suffering is exactly that—a problem. It is not a problem in the sense of a question that we must answer but a problem in the sense of a condition: the sad state of corrupted humanity and disfigured creation. It is reflected in my wife’s disease, in the HIV/AIDS epidemic, in the violent acts of brutal dictators, in the oppression of the poor, in the murder of millions of baby girls, and in the devastation of the earth through abuse and exploitation. We must never accept or tolerate evil; rather, like God, we must fight against it. Hart writes, “Our faith is in a God who has come to rescue his creation from the absurdity of sin, the emptiness and waste of death, the forces—whether calculating malevolence or imbecile chance—that shatter living souls; and so we are permitted to hate these things with a perfect hatred.”[4]

We must also remember that the problem of evil is not an ultimate problem, one without a solution. Sin, evil, and death have been defeated and overturned in the life, death, and resurrection of Jesus Christ. In his life, Christ inaugurated an order that opposes evil and brings healing and liberation to people who suffer. In his death, he bore our sin, wounds, grief, and estrangement from God. In his resurrection, he overturned the power of sin and death, freeing us from fear and bondage. Yet our earthly suffering continues and will continue until the consummation of God’s kingdom. As we experience the lingering, terrible effects of evil, we who trust in Christ have hope in the fulfillment of God’s kingdom, a kingdom free of suffering. This kingdom, constructed in the presence and power of God, now grows around us and within us and cannot be destroyed by any spiritual or earthly power—not by the devil and not by any bodily disease.

Not only are we to hate suffering with a perfect hatred and look ahead in hope to the consummation of God’s kingdom; we also are to see ourselves and act as people who have been re-created—paradoxically within our decaying physical bodies—by God’s Spirit. In Romans 8, Paul says that we who possess the life of the Spirit now, in advance of the coming kingdom, are the evidence that the whole universe will be freed from the shackles of suffering and death. Even in our present personal sufferings, we exhibit a force so strong—the life of God given to us by grace—that all of creation sees us and groans in longing for ultimate deliverance. Not only do we have a high priest and mediator, the crucified and ascended Christ who understands and sympathizes with our human suffering (Heb. 4:15), but also we ourselves are priests (1 Pet. 2:5 and 2:9), mediators between God and his creation. We are bearers of God’s grace even in our suffering. We are glimmers of life, love, and freedom that can never be extinguished, even in the darkness and despair of our world.

What steps can we take to realize and apply these truths in our lives? First, we can turn to God and express our weakness. We can pray, “Our Father in heaven . . . save us.” Even when our suffering makes the work of prayer seem beyond our ability, God’s Spirit aids us in our weakness and pleads on our behalf (Rom. 8:26). God dwells with us even if we cannot feel him. Second, we can mourn with those who mourn, listen to those who need a listening ear, and pay attention to the lives around us, especially those nearest us. True love (agape) is never selfish, and we are to make it our aim (1 Cor. 13:5 and 14:1). Third, in time and by God’s grace, we can come to see our suffering in a transformative way. Thomas Oden, who has written extensively on theology and pastoral care, writes, “I have come to a deeply held conviction that it is only from one’s unique history of suffering that one can define accurately one’s own calling. Only from a particular history of special anguish and personal travail can one come to know how God is calling one to be present to the suffering world even as God the Son has become present to it.”[5] And fourth, we can actively participate in building God’s kingdom on earth as in heaven by spreading truth, goodness, and beauty, combating evil, and alleviating suffering. Every Spirit-directed act we do, says N. T. Wright, will “find its way, through the resurrecting power of God, into the new creation that God will one day make. . . . In fact, it will be enhanced there.”[6]

It is not in our power as human beings to remove suffering from our world completely. Neither my wife nor I can change the fact that she was diagnosed with PMP, and we have little control over the long-term outcome of her treatment. Our responsibility in the midst of suffering is to hope— hope in the temporal nature of suffering and evil and in the eternal love of the true God, who does not cause disease and suffering to bring about the redemption of this world. And sometimes, it seems, all we can do is hope.


[1] Hart, The Doors of the Sea: Where Was God in the Tsunami? (Grand Rapids, MI: Eerdmans, 2005), 87.

[2] This Scripture reference and all subsequent references are from the Revised English Bible.

[3] See, for example, Martin Luther, “The Bondage of the Will,” in Martin Luther: Selections from His Writings, ed. John Dillenberger (New York, NY: Anchor Books, 1962), 190–91.

[4] Hart, The Doors of the Sea, 101.

[5] Oden, The Rebirth of Orthodoxy (San Francisco, CA: HarperSanFrancisco, 2003), 94.

[6] Wright, Surprised by Hope (New York, NY: HarperOne, 2008), 208–9.