Is Any Body Modification OK Just Because It's Your Body?

It's no secret the culture has shifted regarding the personalizing of one's body. I've been exploring the question of body modification in a series of articles where I hope to bring some clarity to this contentious issue. I first argued that the human body holds intrinsic worth; the body has value in itself as opposed to merely having value because we give it value. Thus, we should be thoughtful as Christians when thinking about any kind of body modification.

In my last article, I also said that one shouldn't discount any type of modification as some kind of violation of that worth. I offered reconstructive surgery, braces, hair plugs, or even certain forms of tattoos as examples that demonstrate one cannot simply classify any tattooing or body modification as sinful or wrong. But those fall into one aspect of the four different classifications of body modification. There are other types of modifications that are not so easily dismissed.

Further complicating the issue is the question of personal autonomy. As human beings, we know our bodies better than anyone else. We control them and they affect us, not others. If we wish to alter our bodies, shouldn't we have that right? Even some of the more extreme cases, most people are reticent to tell others they cannot do as they wish with their bodies. Take Pixee Fox, a North Carolina woman who had several plastic surgeries including 1400cc breast implants and the removal of six ribs to provide a cartoon-like hourglass shape. Most may call such actions foolish, but would they describe them as sinful or wrong?

Damage for Self-Fulfillment

I think there are instances where certain modifications that present themselves as violating the inherent worth of the body and shouldn't be allowed, even though they may infringe on the autonomy of the person requesting them. There are of course modifications done forcibly against one's will or before one can give consent, such as female genital mutilation. Since informed self-choice doesn't really factor into such cases, I would consider them separate issues.

I'd like to look at a group of people that are becoming better documented in medical literature. These people suffer from a condition called Body Integrity Identity Disorder (BIID) and they have the common trait in feeling that one of their body parts is foreign to them and needs to be amputated. Realize these are healthy limbs or appendages that function normally; there is nothing physically wrong with them. Those with BIID, though, "feel ‘over complete' and want to have the alien limb amputated."1 They will seek out medical intervention, although there are no hospitals that currently allow the amputation of healthy limbs.2

Many may say that such an extreme condition is clearly a mental disorder, and shouldn't be included in a discussion on body modification, but some in the medical community feel the issue isn't quite that cut and dry. Tim Bayne and Neil Levy argue that patients suffering from BIID have an autonomous right to modify their body just as those who undergo extreme breast enlargements or other plastic surgeries have the right to alter healthy body parts for their satisfaction. They note that reproductive surgeries, such as tubal ligation or vasectomy cripple healthy organs, too. They also state BIID patients "who succeed in procuring an amputation seem to experience a significant and lasting increase in wellbeing" and stop seeking to self-amputate, which is much more dangerous and has led to death in prior cases. 3

An Autonomous Lifelong Desire

Sabine Müller points out that those suffering from BIID are not making their choice off the cuff. Instead, they have agonized over their foreign limb and they report having these feelings since childhood. She states "Because of the early onset of the disturbance of the body image, BIID patients cannot remember a life in which the affected limb was integrated into the body image."4

Annemarie Bridy argues the initial revulsion over removing the offending limb as a form of treatment may be simply showing a bias most people have. She writes:

In contemporary society, the body is regarded not as a physiological given to which we must reconcile ourselves, but as a malleable instrument of self-expression amenable to a wide range of medical and surgical interventions…

At the turn of the twentieth century, many physicians believed that cosmetic surgery undermined fundamental tenets of the medical profession by violating the ethical injunction against doing harm…. Body parts perceived to be too small are augmented; those which are thought to be too large are reduced in size or prominence. While the dramatic shift in attitudes toward cosmetic surgery hardly forces the conclusion that elective amputation will one day be as common as rhinoplasty is today, it does suggest that beliefs about the integrity of the body and the nature of bodily harm are culturally mediated and historically contingent. As anomalous as it may seem when viewed in a historical vacuum, elective amputation becomes less incomprehensible when it is viewed as a manifestation of the continuing social and cultural evolution of attitudes toward the body and its modification.5

What further complicates the issue is the question of autonomy. All of those writing on this issue underscore how important it is to respect autonomous decisions by the patient even when we disagree with their decision. Bayne and Levy point to decisions based on religious autonomy that may be harmful, such as Jehovah's Witnesses refusing blood transfusions.6  Yet, not all procedures are morally justified by claims of autonomy. Müller uses the example of an anorexic patient who deeply desires stomach-stapling surgery.7

Where Do We Draw the Line?

While Bridy along with Bayne and Levy see circumstances where they believe amputation of healthy limbs is permissible for BIID patients, I agree with Müller who sees the condition as primarily a psychiatric affliction that should be treated as such. As a Christian, I would recognize the body has a telos, that is it shows design for a purpose. To claim that one's arm or leg is foreign to the individual is to claim there is no objective telos to the body. The only value or purpose the body has is whatever the individual wishes to ascribe to it. Those with BIID are being honest in their feelings of detachment from one of their limbs and their misery in their current state. However, they seem to believe their mental state should dictate their physical state. This doesn't follow for me. Anorexics have mental states seeing themselves as fat, but it would be immoral to allow them to modify their bodies through stomach stapling or some other procedure. It is their mental understanding that is failing them.

BIID is an extreme aspect of body modification. I would argue it holds strong parallels to those who seek sexual reassignment surgery and the issues are nearly identical, although individuals who claim to be transgendered do have the opportunity to modify their bodies to match their mental state while BIID patients do  not. Why? What's the difference? One of the reasons for opposing SRS is that it also disregards the intrinsic worth of the body and gives subjective value to it.

The real question, though, is just how far down the road should Christians go? What about less drastic forms of body modification? Where do we cross the line from personal expression and harmless autonomous choices to demonstrating a subjective value for the body God gave us? Does tongue-splitting qualify? How about vasectomy or tubal ligation? These aren't easy questions, but in a future article I hope to perhaps offer some guidelines to explore them more fully.

References

1. Müller, Sabine. "Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?" The American Journal of Bioethics, 9:1, 36-43,
(2009) DOI: 10.1080/15265160802588194
2. Bayne, Tim, and Neil Levy. "Amputees By Choice: Body Integrity Identity Disorder and the Ethics of Amputation." Journal of Applied Philosophy 22.1 (2005). 75. Web. 10 Mar. 2016.
3. Bayne and Levy, 2005. 78-86.
4. Müller, 2009.39.
5. Bridy, Annemarie. "Confounding Extremities: Surgery at the Medico-ethical Limits of Self-Modification." The Journal of Law, Medicine & Ethics 32.1 (2004): 148-58. Web. 10 Mar. 2016.151-152.
6. Bayne and Levy, 2005. 80.
7. Müller, 2009.40.
Image courtesy Jenny O'Donnell [CC BY-SA 2.0 uk],

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Star Trek, Saving Private Ryan, and the Problem with Evolutionary Morality

Morality is real. There are ways one should or should not act. There are values and duties that attach to being human, such as killing babies for no reason other than pleasure is always wrong. Some people don't agree with this view, holding morality as a useful fiction, but I will place them to one side for the moment. I think most people would agree with me that morality is a real thing; good and evil are real concepts.

I would think that most people would agree that there are certain oughts to which people should adhere. One ought not to enslave another human being, for example. The point of disagreement is rooted in where these kinds of oughts come from and why we should follow them. Atheists and humanists feel that moral laws came about because they conferred a certain evolutionary advantage to the group, as Herbert Gintis, et. al writes:

From an evolutionary viewpoint, we argue that ethical behavior was fitness-enhancing in the years marking the emergence of Homo sapiens because human groups with many altruists fared better than groups of selfish individuals, and the fitness losses sustained by altruists were more than compensated by the superior performance of the groups in which they congregated.1

A Utilitarian Morality

In the evolutionary view of morality, it is the survival value of the altruistic act that becomes the crucial thing. Those societies that encourage helping one another, even to one's own detriment, will be "more fit" than others, increasing the survivability of the group as a whole.

Such a scenario makes some sense. If one is to save others at the cost of even one's own life, it is easy to see how survivability is increased. This is a utilitarian concept of morality that philosopher Jeremy Bentham pioneered, but most people would be more familiar with how Leonard Nimoy's character Spock voiced it in the movie Star Trek II: The Wrath of Khan. There, Spock heroically exposes himself to lethal radiation levels to save the ship, then pronounces "It is logical. The needs of the many outweigh the needs of the few, or the one."

What if Morality Contradicts Survivability?

While a utilitarian view of morality seems plausible and fits within an evolutionary framework, it runs into problems in other circumstances. For instance, let's take a different scenario of altruism, the one offered in Steven Spielberg's Saving Private Ryan. There, a platoon of soldiers is sent deep into enemy territory in order to extract one man—Private Ryan—whose three brothers had already been lost in combat. A real-life scenario similar to the film played out in the Niland family, and their four sons Robert, Preston, Thomas, and Joseph. The Canisus library reports:

Robert was killed on D-day while manning his machine-gun post in Neuville, a city not far from the beaches. Preston was killed the next day near Omaha Beach. Fritz, meanwhile, had been dropped between Omaha and Utah beaches while Thomas was involved in a glider unit that landed in France. Joseph, 25, was not involved with the invasion.

When the Army heard of the tragic story, they determined that the Nilands would not suffer the death of their last child.2

In the film, the Army seeks to do the right thing in removing Private Ryan from potential harm and restoring at least one son to the family. However, the cost is high. In order to save one person, many in the company are lost. Also, significant resources such as these battle-hardened soldiers are not spent engaging the enemy, but rescuing this one young soldier. In any analysis, it seems this situation is all about the needs of the few or the one trumping the needs of the many.

So, here's the question: does the Army act morally in the Saving Private Ryan scenario? Was this the right thing to do or was it evil? If the utilitarian ethic is all there is, that is if survival value is all morality boils down to, then sacrificing so many for the life of a single man is not only not morally good, it is the opposite. That makes it evil of the Army to order Tom Hanks and company to go save Matt Damon.3 But I think people will intuitively understand to call the actions in Saving Private Ryan evil simply doesn't work. There's more to morality that the result of survivability which means that morality cannot be as simple as an evolutionary mechanism.

In order for morality to be real, God must be real, too.

References

1. Gintis, Herbert, Joseph Henrich, Samuel Bowles, Robert Boyd, and Ernst Fehr. "Strong Reciprocity and the Roots of Human Morality." Social Justice Research 21.2 (2008): 241. Web. 8 Mar. 2016.
2. "The Niland Boys." The Niland Boys. Andrew L. Bouwhuis Library, July 2006. Web. 08 Mar. 2016. http://library.canisius.edu/archives/niland
3.As an aside, just how many times is Matt Damon going to need to be rescued? He's rescued from a poor life in Boston, from enemy territory, from Mars, from a planet on the other side of a black hole, and even from himself in The Bourne Identity.

Does Modifying Your Body Disregard Its Intrinsic Worth?

It's no surprise that culture is changing at an ever more rapidly pace. Norms that had been held consistently for centuries have in a couple of decades undergone radical redefinition. Marriage is one of these, but it is far from the only one.

One stark example may be the huge increase in the popularity of tattoos and other forms of body modification. According to a 2010 report by the Pew Research Center, nearly four-in-ten Millennials have at least one tattoo and half of those who have at least one have more than one. Additionally, "nearly one-in-four have a piercing in some place other than an earlobe — about six times the share of older adults who've done this."1 Tattoos and other forms of body modification are just as likely to be found on evangelical Christians in the pew as they are in the general public, which underscores their ubiquity in our culture.

What Do We Mean by Body Modification?

Within the Christian community especially, body modification has become a very controversial issue. In fact, whenever the topic comes up a contentious discussion usually ensues, especially online. It's that contention that bothers me the most, for I fear that Christians need to be careful and think about all the implications of their particular stance. That's why I want proceed with caution as we think through many of the facets that encircle the debate, some of which most people haven't yet considered .

First, as I argued in this article, the human body is not nothing. It has intrinsic value, which places it in a very limited category. Therefore, taking care to think about what modifying one's body means is appropriate for the Christian. There may be a different answer for those who don't share a Christian worldview. My thoughts in this and the articles to come are primarily targeted to those who hold the body as something that holds intrinsic worth. It seems to me that intrinsic worth is really where the main objections to body modification can be centered. I say this because when one looks to define just we mean when we talk about body modification, the categories are a lot larger than most people let on.

Four Categories of Body Modification

In the book Brave New World of Health, sociologist Isabel Karpin provides a very helpful overview of the various ways human beings have modified their body. She breaks these down into four primary areas: modifications that are therapeutic, cosmetic, enhancements to the body itself, or what she terms radical modifications.2 Usually, the first and at least some forms of the second set are non-controversial.

Therapeutic modifications are defined as "performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumours or disease. [They are] generally performed to improve functions, but may also be done to approximate a normal appearance"3  Thus, breast reconstruction and tattooing would fall into this area. Many breast cancer survivors will receive tattoos to simulate lost areolas. If applying ink under the skin is by its nature a violation of the intrinsic worth of a body because it is artificial, then these types of modifications would be considered wrong. However, I don't see anyone arguing that way.

What about cosmetic modifications? I will leave aside temporary modifications such as haircuts/dyes for the moment and focus on only those things that permanently change the body. Are they different? Here Karpin defines cosmetic modifications as things like tummy tucks and breast augmentation. However, permanent cosmetic modifications also include such subtle things as braces for straightening teeth, ear piercings, hair transplants and permanent eyeliner. To condemn all cosmetic modifications would be to condemn these as well.

The last two categories are normally where there is more contention. Enhancements are those like people having magnets implanted under their skin to pick up metallic objects.4 Radical modifications are those that are the most non-conformist in our culture.  Radical modifications include nipple or genital piercings, skin braiding, scarring, branding, 3D implants, such as silicone horns, metal screws to attach whiskers, tongue slitting, Karpin defines this category somewhat subjectively as "as the alteration of someone's appearance in a way that does not accord with cultural ideas of the normal and the natural."

Modification and Worth

So, does modifying the body show a disregard for its worth and dignity? I don't believe it does specifically. Therapeutic modifications seem to recognize the value of a healthy, fully formed body and recipients are seeking to emulate that. I also don't believe that simply because a modification is done for cosmetic purposes, it invalidates the body's value. Sometimes, permanent eyeliner or laser hair removal is undertaken as simply a time saver rather than a statement. The appearance of those individuals still conforms to societal standards.

Even when defining radical modifications, societal standards play a central role. That's the key, it seems to me. I don't think body modification is something that violates the recognition of the body's intrinsic worth by definition. That isn't to say no body modifications ever disregard the body's intrinsic worth.  The issue is actually more complicated than that. One must know if and when modification does demonstrate disregard for the worth of the body. That means Christians shouldn't approach body modification with abandon. I'll tackle that in an upcoming article.

References

1. "Millennials: A Portrait of Generation Next." Pew Social Trends. Pew Research Center, Washington, D.C., Feb. 2010. Web. 2 Mar. 2016.
2. Karpin, Isabel. "Constructing the Body Inside and Out: Genetic and Somatic Modification." Brave New World of Health. Belinda Bennett, Terry Carney, and Isabel Karpin, Eds. Sydney, NSW: Federation, 2008. 77-81. Print.
3. Karpin, 2008. 80.
4. Karpin, 2008. 81.

Why Doesn't God Prove He Exists? Because It Wouldn't Help Disbelief

One of the more popular questions that atheists ask is "Why does God make it so difficult to believe in Him? If he would just give us some proof he exists, I'd believe." I've heard such statements many times, but I don't think their claim is true. I think the atheists are misstating their case in what devotion to a real God means. They fail to understand the stubbornness of the human heart and the animosity the natural man holds against God.

One way to better understand how people in the real world react to a righteous and holy God, we can simply look to the past. For argument's sake, let's assume the stories of the Israel's deliverance from Egypt are true. There, God does a series of miracles to free the Israelites from their slavery and set them in a promised land. These are not run of the mill miracles, either, but show-stopping affairs. God dried up the Red Sea and then drowned the Egyptian army in that same sea. He provided both meat in a desert and manna with the dew each morning. He cleansed the bitter waters and also produced water from the rock at Meribah. He led them in a cloud by day and a pillar of fire by night. God gave as much evidence as one could possibly want to the Israelites.

Ignoring Evidence is a Very Human Thing to Do

One would think such grandstanding would make believing in Yahweh a slam-dunk, right? Unfortunately, no. Even though the Israelites were direct witnesses to some of the most obvious proofs of God's existence, it did not stifle their desire to abandon God and do what they pleased. The psalmist summarizes the reaction of the people in Psalm 106. Time after time, they disobey God, they don't trust God, or they turn to foreign gods. God's provision of proof didn't make the Israelites more faithful; it simply highlighted how selfish and demanding their hearts were. Nothing other than getting everything they wanted at the time they wanted it would do.

When I read the accounts of the ancient Israelites, I find their reaction to be completely human and believable. Even if you're an atheist who doesn't hold to the historicity of the accounts, you must admit that stubborn rejection of proof is a real possibility. In fact, this scenario is more probable than not. That's why people still start smoking cigarettes regardless of how big the Surgeon General's warnings appear on the package. No one is saying, "Why didn't anyone provide proof that cigarettes cause cancer?" They all know it does, but their desire trumps the evidence. The proof doesn't matter.

The resurrection of Jesus is a really good example of just how this plays out in the question of God's existence. We have as much evidence for the historical fact of the resurrection of Jesus as we do any event in ancient history. If Jesus rose from the dead, then it provides evidence that God exists. There is compelling evidence that Jesus rose from the dead. Therefore, there is evidence that God exists. However, atheists will contort, excuse, deny the resurrection as not evidence, or even deny that Jesus ever lived at all (!) because they don't like the conclusion. They won't use the same standard to measure the resurrection as they would other acts of ancient history.

Thomas Nagel is a famous atheist philosopher who admits that modern materialist explanations of the emergence of consciousness fail. In his book The Last Word, he made a very honest statement about his lack of belief in God. Nagel wrote:

In speaking of the fear of religion, I don't mean to refer to the entirely reasonable hostility toward certain established religions and religious institutions, in virtue of their objectionable moral doctrines, social policies, and political influence. Nor am I referring to the association of many religious beliefs with superstition and the acceptance of evident empirical falsehoods. I am talking about something much deeper–namely, the fear of religion itself. I speak from experience, being strongly subject to this fear myself: I want atheism to be true and am made uneasy by the fact that some of the most intelligent and well-informed people I know are religious believers. I want atheism to be true and am made uneasy by the fact that some of the most intelligent and well-informed people I know are religious believers. It isn't just that I don't believe in God and, naturally, hope that I'm right in my belief. It's that I hope there is no God! I don't want there to be a God; I don't want the universe to be like that.1

I think most people would agree. While many people form an idea of God that comports to their view of the world, most don't want to be beholden to a holy, righteous God that tells them the things they want to do are not good and they shouldn't do them. As long as that is fundamental to the human condition, proof of God's existence will never suffice to change their minds. It can always be explained away.

References

1. Nagel, Thomas. The Last Word. New York: Oxford UP, 1997. Print. 130.

Mark Feb 24 as a Key Date in the Battle for Religious Freedom

Today is a significant date in Christian history, for it was on February 24, 303 AD that the edict was issued by Roman Emperor Diocletian that began the first empire-wide and most bloody persecution of Christians. Prior to 303, Christians had been persecuted in various provinces of the Roman Empire, but this was different. It was systemic and all-encompassing.

The Diocletian Persecution is important partially because of how it began. Historian W.H.C. Frend explains the crafting of the laws that launched the persecution:

The persecution resembled Valerian's more than Decius's. It had been carefully planned and the consequences had been weighed. Diocletian recognized the danger of making Christians martyrs. No blood, he insisted, must be shed. The aim was to recall the Christians to their duty of recognizing the majesty of the Roman Gods. The edict he promulgated on 24 February ordered throughout the empire churches were to be destroyed, and the sacred books of the Christians handed over to be burned. Christians in public offices were to be removed from them. In private life Christians in the upper classes (honestiores) were to lose their privileges. In particular, they could not act as plaintiffs in cases of injury, adultery, or theft. Christian slaves might not be freed. But there was no requirement for universal sacrifice. The attack was concentrated on the organization of the church, its life as represented by the Scriptures and buildings, and on its influential members. (Emphasis added.)1

Notice the thought process by Emperor Diocletian who had to initially be convinced to issue the edict. We're not going to force people to worship Roman Gods. It's simply the duty of those who enjoy the benefits of Rome's governance to recognize there is a social standard to which they must adhere. Thus, Christians should be removed from public offices since their Christian beliefs run counter to the beliefs the state wishes to promote. Wealthy Christian businessmen should lose any protections they hold, especially those that would protect them legally. The church as an organization should be attacked as a wrong-thinking institution. But no blood should be shed and Christians can believe what they will in the privacy of their own homes.

The Loss of Freedom Today

Of course, we are not in Diocletian's Rome. Frend spends several pages discussing why conditions in the Empire at that time made the persecution more likely than before. Those conditions do not exist today and I'm not arguing that we are heading for another Diocletian Persecution. However, the trend to weaken religious freedom is increasing, and many of the justifications used sound eerily familiar. If you're a Christian court clerk in Kentucky who refuses to sign a marriage certificate, people demand you be removed from public office. If you are a baker or wedding photographer, your beliefs and your conscience are secondary to what the state feels is moral. Here's how the Harvard Law Review summarized the judgment against one such photographer:

Justice Bosson concluded that "[i]n the smaller, more focused world of the marketplace, of commerce, of public accommodation, the Huguenins have to channel their conduct, not their beliefs, so as to leave space for other Americans who believe something different. . . . [I]t is the price of citizenship."2

The freedom of religion is often referred to as the "First Freedom." In the United States, it is the first freedom to be recognized in the Constitution's Bill of Rights, but it is the first freedom in more ways than that. Without the freedom to not simply "do whatever we want in the privacy of our homes," but to incorporate our beliefs into our broader lives, we are not truly worshiping freely. It is the state that is setting the rubric of what counts as true beliefs verses what counts as inconsequential beliefs. How much can you belief something if it never affects the way in which you live? The short answer is: you can't. By dictating which beliefs must be sacrificed for the price of citizenship is effectively setting a state religious litmus test.

Escalating from Legislation to Volience

The second reason why we should remember the Diocletian persecution is how quickly it elevated from a calculated, no-blood political move to an all-out blood bath against Christians. The Christian History Institute sums it up nicely:

Before the end of the year, Diocletian issued two more proclamations against Christians and Maximian issued a fourth the following year. One ordered the imprisonment of Christian teachers, filling the prisons with bishops and clergy. The next ordered that these prisoners either sacrifice to the pagan gods or be tortured. The third directed that all Christians should be required to sacrifice on pain of torture.

Christians suffered terribly, especially in the eastern empire. Some were thrown to wild beasts, others burned alive or roasted on griddles. Some were skinned or had their flesh scraped from their bones. Others were crucified. A few were tied between trees that were bent so as to meet and, when the branches were released, the force ripped these victims limb from limb. Eventually the Romans wearied of this and set the remaining Christians to work in mines or gave them menial jobs. In many instances, they gouged out an eye or maimed a hand or foot before sending the workers off. From this period come many notable martyrs, including the young girl, Agnes of Rome.3

While the powers that be began in limiting their scope of the edicts, it quickly grew out of control. The tortures were fierce and had gone beyond what the designers had imagined. Even those Christians who had adopted Roman customs were not immune. Frend writes, "For some, the Persecution must have come as a great shock. Even in towns where they were most numerous, we find Christians sharing fully in the Greco-Roman culture, taking part in city life as councilors, and not adverse to references to Hades and the Muses on their tombstones."4 To have assumed those who just "go with the program" or one who agrees with the state and capitulate to its edicts means they will not be targeted was mistaken. Just the name "Christian" was enough to condemn one to death or to slave labor.

AS we mark the anniversary of the Diocletian Persecution, we should consider these things and think about what we risk in our own society. People are people and they tend to repeat themselves. What lessons should we learn before we allow our religious freedom to be adjudicated into something less than an irrevocable right held by all mankind?

References

1. Frend, W. H. C. The Rise of Christianity. Philadelphia: Fortress, 1984. Print. 457.
2. "Constitutional Law — First Amendment — New Mexico Supreme Court Holds That Application Of Public Accommodations Law To Wedding Photography Company Does Not Violate First Amendment Speech Protections. Elane Photography, LLC v. Willock, 309 P.3d 53 (N.M. 2013)." Harvard Law Review 127.5 (2014): 1485. Web.
[. "Start of Diocletian's Great Persecution | It Happened Today." Christian History Institute. Christian History Institute, 24 Feb. 2016. Web. 24 Feb. 2016. https://www.christianhistoryinstitute.org/it-happened-today/2/24/
4. Frend, 1984. 445.