Hildegard of Bingen is the only medical author whose book sits permanently next to my chair at the clinic. She wrote Causae et Curae — Causes and Cures — sometime between 1150 and 1160, in a Benedictine monastery on the Rhine, eight hundred and seventy years before the iPhone that most of my patients are now clutching as they describe their sleep problems. She was declared a Doctor of the Church by Pope Benedict XVI in 2012, seven years after I started seeing my first pediatric patients. The book is unembarrassedly medieval. The Latin has to be worked through. The humoral physiology is wrong about the mechanism. And every time I read it, I encounter a clinical intelligence that is recognizably my own profession's, a thousand years before my profession had a name.
What follows is a description of five things Hildegard gets right — not right in the narrow Popperian sense of scientific correctness, which she does not aspire to, but right in the older sense of fitting the patient. I bring her into most of my well-child visits now, silently, as a frame for what I am trying to see. It is the best clinical frame I know.
She begins with viriditas, not with pathology
The root concept in Hildegard's medicine is viriditas — greenness, the life-giving force in creation that makes plants grow, wounds heal, children thrive, and saints pray. It is not a metaphor. For Hildegardviriditas is a real theological-biological property that God pours into creation and that can be nourished or starved in any given patient. A healthy human being is viridis, green; a sick one has lost their greenness; the physician's job is to restore it.
Modern pediatrics begins the other direction. We open the encounter by scanning for the abnormal: the growth chart flag, the developmental red line, the concerning screening score. That is important work, and I do it. But I have come to believe that beginning with pathology is clinically unsustainable as a worldview. The child is not, in the first instance, a risk profile. She is a viriditas-bearing creature whose default is flourishing. Illness is a deviation from her nature, not her nature. This is the harder thing for contemporary parents to hear: your child is, almost always, constitutionally well, and the work of medicine is to keep her that way. I borrow Hildegard's phrase almost every day. Is this child green? When I can answer yes, the visit is largely done.
She takes the passions seriously
Hildegard devotes long passages to what she calls the passiones animae — the movements of the soul: anger, grief, joy, fear, love. She treats them as having real physiological effects. Grief cools the body; anger dries it; sustained fear disorders the humors. This is the pre-scientific version of what we now call the stress response and the hypothalamic-pituitary-adrenal axis. Hildegard understood, eight hundred years before neuroendocrinology, that a child who lives in chronic grief or chronic fear will become physiologically sick. Her intervention was spiritual and communal: the child needed love, belonging, beauty, the singing of psalms, the regularity of monastic hours. Our interventions are narrower. The frame is identical.
I cannot tell you how often a parent brings a child to me for a somatic complaint — headaches, stomachaches, insomnia, rashes, tics — and I find myself working my way slowly toward the real question: What is going on in this child's life? The nine-year-old with chronic abdominal pain whose parents are fighting nightly. The teenager with newly erratic eating whose older sister just left for college. The first-grader with hair pulling whose mother is pregnant with twins and exhausted. Hildegard's passiones animae are not hidden from the exam. They are the exam. When I name them accurately, the somatic complaint often starts to recede before any prescription is written.
She knows sleep is a moral category
This is the Hildegard passage I have probably taught to the most parents. She writes that sleep is the time when the soul lays down its work and the body is given back to its Creator for repair; that children especially require long, dark, unbroken sleep, because they are still being formed; and that disordered sleep in children is a medical emergency because it disrupts the whole economy of body and soul. She wrote this before the electric light, before the refrigerator, before the cathode-ray tube, before the screen, before the algorithm, before the dopamine architecture of the modern smartphone. Her argument was already, in 1155, that sleep is sacred.
What I now spend an astonishing percentage of my clinical time on is sleep. Children are not sleeping. Teenagers are getting an average of six hours when they need eight to ten. First-graders are being taken to their rooms at 10 p.m. because their parents work late. Four-year-olds are falling asleep watching YouTube. Hildegard would read the modern American pediatric sleep literature and weep. The good news is that the interventions she would have prescribed — darkness, silence, routine, a bedtime prayer, no light after sunset — still work, and the evidence base for them is more robust every year. Cognitive-behavioral therapy for insomnia (CBT-I) in adolescents is a monastic sleep rule with a modern acronym. I often prescribe it with a quiet smile.
The body lives in the rhythm that it has been given. When we give it no rhythm, it sickens. When we give it the wrong rhythm, it sickens differently. Restore the rhythm, and much of what looked like disease disappears.
She treats food as creation, not as input
Hildegard wrote extensively on the dietary properties of particular foods — spelt, fennel, chestnut, nettle — often with remarkably shrewd clinical intuitions about digestion, inflammation, and mood. Most of her specific recommendations have not held up. But her framing has. Food, for Hildegard, is creation addressing the body. It is not fuel. It is not a macronutrient stack. It is not a product. It is gift. The child who eats receives, and the receiving is itself formative. Parents who feed their children on the couch, from packages, in front of screens, have not merely chosen a less nutritious meal. They have failed to enact the thing that eating is.
I say a milder version of this to parents weekly. Eat together. Sit at a table. Pray before the meal. Do not eat in the car unless you cannot help it. The child will absorb, from the shape of the meal, a lesson about what food is that no lecture can replace. Hildegard assumed this; modern nutrition research is slowly catching up, particularly in the family-meals literature coming out of Rush University Medical Center and elsewhere, which shows consistent effects of shared family meals on adolescent mental health, substance-use outcomes, and academic performance. The Benedictines already knew.
She knows the physician is a creature too
This is the last thing, and it may be the hardest. Hildegard writes that the physician cannot heal from a position outside the condition she is treating. She is a creature among creatures, a viriditas-bearer, a sinner under grace, a body in need of the same rhythms she prescribes. The Benedictine monastic frame would not permit her to imagine a sovereign clinician hovering above the patient as a technician of diseases. She was a nun first. She prayed the hours. She ate in the refectory. She confessed. She slept when the bell rang. She then saw patients, and her authority at the bedside came, in part, from the fact that her life was ordered by the same things she was asking her patients to let order them.
I take this seriously. I cannot write a sleep plan for a teenager if I am not sleeping. I cannot counsel a family about screens if my own phone is on my bedside table. I cannot discuss the passions of the soul if I am not regularly in confession. The Christian clinician is, in Hildegard's frame, a fellow creature rather than a sovereign technician. This is hard on the ego and good for the work. I think the contemporary burnout crisis in medicine — which is real and catastrophic — is partly a result of a profession that has been asked to heal without being itself incorporated in any healing frame. Hildegard would not be surprised.
What I do with her
Most of my use of Hildegard is silent. Parents who come to me for a well-child visit do not need me to quote a twelfth-century abbess at them. What they need is a clinician whose clinical imagination is bigger than the fifteen-minute CPT code. Hildegard gives me that. When I ask about sleep, meals, anger, grief, light, darkness, routine, prayer, I am asking the questions she taught me to ask. When I begin by expecting the child to be viridis, I begin where she taught me to begin. When I refuse to see a somatic complaint as merely somatic, I am refusing it because she refused it first.
We have placed her patron portrait near the top of the Vitae home page and the Schola Medica section of the curriculum for a reason. She is not a decoration. She is the argument the clinic and the curriculum are both making: that the body and the soul have always been one subject, and that the Christian tradition has always known how to hold them together. She is, I think, the patron we need.