One of the crown jewels of the Book of Common Prayer is the General Confession in Morning and Evening Prayer. In theological terms, it offers a clear-eyed depiction of what Christians believe is the human condition: we are prone to curve inward away from God, we need his forgiveness. In literary terms, it is a superbly balanced composition that is full of memorable phrases, such as “erred and strayed like lost sheep” and “the devices and desires of our own hearts.”((For brief rhetorical analysis of the General Confession, see Alan Jacobs, The Book of Common Prayer: A Biography (2013) 61-64.)) The sources of this short prayer are at least sixteen biblical passages.((“The Confession is a tissue of Biblical phrases, based in general upon St. Paul’s analysis of sin in Rom. Vii.8-25. The passages quoted occur in the following order: Isaiah liii.6, Psalm cxix.176, 1 Pet. ii.25, Prov. xix.21, Jer. xviii.12, 2 Chr. xxviii.13, Matt. xxiii.23, Psalm xxxviii.3, Luke xviii.13, Psalm li.1, Neh. xiii.22, Psalm li.12, Rom. xv.8, 1 John ii.12, Tit. ii.11-12, John xiv.13.” Massey Hamilton Shepherd, Jr., The Oxford American Prayer Book Commentary (1950) 5-6.)) These words of repentance have etched themselves into the memory of generations of Anglicans. The prayer did not appear in the first Book of Common Prayer (1549), but it was composed for the second (1552),((For brief discussion of the books, see Diarmaid MacCulloch, “Putting the English Reformation on the Map: The Prothero Lecture” (2005) 15 Transactions of the Royal Historical Society 75, 85, 87-88.)) and these words have remained essentially unchanged in traditional Anglican prayerbooks.((Examples include the Episcopal Church’s 1928 prayerbook and the Reformed Episcopal Church’s 2003 prayerbook.))
For some modern revisers, however, the clause at the very center of the prayer has proved troublesome: “And there is no health in us.” The source of the trouble is not semantic drift or grammatical change. Peter Hitchens notes that the words of the General Confession are not “archaic or difficult,” but “are plain English words of one or two syllables.”((Peter Hitchens, The Rage Against God (2010) 79.)) The issue is not linguistic, but rather that “these are not easy words to say, if you mean them.”((Id.))
In the current prayerbook of the Episcopal Church, BCP 1979, the General Confession remains largely intact in the traditional language service (Rite I). Nevertheless, the revisers chose to omit “And there is no health in us.”((As with the bowdlerization of the Venite, there is a precedent for the omission in Benjamin Franklin’s abridgment of the Book of Common Prayer. Bryan D. Spinks, Liturgy in the Age of Reason: Worship and Sacraments in England and Scotland, 1662—c. 1800 (2008) 155.)) In the contemporary language service (Rite II), an entirely different confession is used and Cranmer’s prayer disappears from view. Both revisions—the one that keeps Cranmer’s prayer but omits a clause, and the one that replaces Cranmer’s prayer entirely—seem to reflect a view that the old prayerbook was rather intense about this sin business and needed to be Toned Down. There was also concern that the clause is “questionable theology, since it seems to imply that there is no goodness left in us as a result of our sins.”((Christopher L. Webber, A User’s Guide to the Book of Common Prayer: Morning and Evening Prayer (2005) 8. Reinhold Niebuhr, by contrast, came to emphasize the liturgical expression of the doctrine of original sin, particularly as found in the General Confession and its clause “And there is no health in us.” David R. Bains, “Conduits of Faith: Reinhold Niebuhr’s Liturgical Thought”(2004) 73 Church History 168, 182.))
Enter the Anglican Church in North America, which is developing its own prayerbook, largely a touching up of the services from the Episcopal Church’s 1979 book. There are competing imperatives for this revision, which include taking some steps back toward the classic prayerbook tradition while also using more contemporary language. For the General Confession, the revisers had to decide what to do with “And there is no health in us.” Their decision is a revealing one—about how hard liturgical revision is, and about why there is no easy separation of liturgical form and liturgical content.
To understand the difficulties facing the revisers, we need to start long ago. Health is one of a cluster of English words that we use today—whole, hale, holy, health—that trace their way back through Old English to a common Germanic root.((Old English hāl, German heil.)) In older usage the dominant sense for health is soundness, whether in body or in soul. In religious usage, health could be a synonym for salvation. Thus William Tyndale, when translating the story of Zacchaeus in the Gospel of Luke, has Jesus say to the penitent tax collector, “this daye is healthe come vnto this housse” (Luke 19:9).((William Tyndale (Pentateuch, Jonah & NT), 1530-1534 (Chadwyck-Healey Bible in English database). George Herbert uses health in this sense in his poem “The Holy Scriptures,” when he speaks of our finding salvation through them: “Thou art all health, health thriving, till it make / A full eternity.” Note that Herbert’s description of finding salvation in the Scriptures, like the statement in Article VI that “Holy Scripture containeth all things necessary to salvation,” is about our knowledge of salvation, not about its ultimate source. Oliver O’Donovan, On the Thirty-Nine Articles: A Conversation with Tudor Christianity (2d ed., 2001) 46.)) The rendering more familiar to readers of the English Bible, “This day is salvation come to this house,” does not emerge for several more decades.((Bishops’ Bible, 1568 (Chadwyck-Healey Bible in English database) (“This daye is saluation come to this house”). The rendering of the Bishops’ Bible was then adopted by Geneva, Douai-Rheims, and the King James Version. The Greek word is σωτηρία.))
The older usage of health suggests two different senses for “And there is no health in us” in the General Confession.
One is a metaphor of physical health. Just as sickness ravages the body, so sin ravages the soul. Along with metaphors of burden and debt, disease is a common metaphor for sin in the Bible.((Joseph Lam, Patterns of Sin in the Hebrew Bible: Metaphor, Culture, and the Making of a Religious Concept (2016).)) As Richard Hooker says, “repentance,” “the secret conversion of the heart,” can be described without hyperbole “as a recoverie of the soule of man from deadly sicknes.”((Richard Hooker, Of the Laws of Ecclesiastical Polity, Book VI (P. G. Stanwood, ed. 1981) (Folger Library Edition of the Works of Richard Hooker, W. Speed Hill, general ed., vol. 3) ch 5.5, 59.)) The idea is not that we are all as bad as we can be, for our disease may progress (our burden grow, our debts accumulate). Instead the idea is that for each us, every part, every faculty we have, is unhealthy. For this sense of “no health” as pervading sickness, Cranmer had an antecedent in Isaiah 1:6. In the translation popularly attributed to John Wycliffe, the Lord says of Israel that from the sole of the foot to the head “helthe is not ther ynne.”((John Wycliffe (Late), c. 1395 (Chadwyck-Healey Bible in English database). For a critique of the association of this translation with Wycliffe, see Henry Ansgar Kelly, The Middle English Bible: A Reassessment (2016). For Isaiah 1:6, Coverdale chose whole: “From the sole of the foote vnto the heade, there is no whole parte in all yor body.” Miles Coverdale, 1535 (Chadwyck-Healey Bible in English database).))
The second sense comes from the equation of health with salvation or deliverance. At this point in the General Confession we have just confessed our sins of omission and commission, and now the question is to whom we can look for deliverance. In the words of St. Paul, “who shall deliver me from the body of this death?” (Romans 7:24). Not ourselves, is the answer in the General Confession. Cranmer also had ready antecedents for the sense of “no health” as “no salvation” in the Psalms. Consider, for example, Psalm 146:2 in Coverdale’s translation:
O put not your trust in princes, nor in any child of man : for there is no help in them.
Where Coverdale has “help,” the translation attributed to Wycliffe had “health” (helthe).((John Wycliffe (Late), c. 1395 (Chadwyck-Healey Bible in English database), using the Vulgate’s numbering (i.e., Psalm 145). The KJV has “help” with a marginal reading of “salvation,” the Vulgate has salus, and the LXX σωτηρία. Another instance of “health” as “deliverance” in an English rendering of the Psalms can be seen in Psalm 119:154-155 in Coverdale’s translation: “Avenge thou my cause, and deliver me: quicken me, according to thy word. Health is far from the ungodly : for they regard not thy statutes.”)) Trust not in any child of man, we could say, for there is no health—no salvation—in them.
There is no need to choose between these two senses of the clause (i.e., that we are unwell, and that we cannot cure ourselves). As one of the old commentators on the Book of Common Prayer puts it, “I know not which to prefer, and therefore thought it best to join ‘em together.”((Thomas Bennet, A Paraphrase with Annotations upon the Book of Common Prayer (2nd ed., 1709) 24. A similar conclusion is implicit in Richard Mant, The Book of Common Prayer with notes, vol. 1 (abridged ed., 1824) 11, and Hugh Evan Hopkins, Morning and Evening Prayer: An Exposition of the Daily Offices (1963) 74-75. It has long been noticed that the General Confession corresponds at almost every point to some phrase in Romans 7, and that is true of both senses in which we can take “And there is no health in us.” In the General Confession, we are saying, with St. Paul, “in me (that is, in my flesh) dwelleth no good thing” (no soundness) as well as “who shall deliver me from the body of this death?” (no salvation).)) In the words of the spiritual,
There is balm in Gilead,
To make the wounded whole;
There’s power enough in heaven,
To cure a sin-sick soul.
Yet the clause still sticks in the craw of some modern worshippers. To say that there is some sickness in our souls—that is a point all Christians could agree on. But what about saying “there is no health in us”? Are we quite as bad as that? Does the grace of God achieve nothing in our lives? And if questions are raised here in the mind of a worshipper—well, a service of Morning or Evening Prayer has only just begun, and the worshipper might already be sidetracked.
For the draft ACNA prayerbook, the revisers chose to add a short phrase right before the offending clause. It now reads: “and apart from your grace, there is no health in us.” The concern behind this revision is undoubtedly pastoral, to avoid the misconception that nothing in us is precious to God. And the solution is clever. Cranmer’s clause remains intact, but with a little gloss to avoid confusion. It is not that “there is no health in us” full stop, but rather that whatever health may be in us is a work of divine grace. Sola gratia, as the Reformers would say. Indeed, it is hard to argue that the added phrase is wrong. On many different views of the relationship of nature and grace, it can be truly said to God, “apart from your grace, there is no health in us.”
Yet truth does not quite settle the question of whether the qualifying phrase should be inserted into the General Confession. Many true things do not find their way into this short prayer. Moreover, as Protestants, Anglicans hold as an article of faith that the Scriptures are the one supreme authority (Articles VI and XIX).((Edward Harold Browne, An Exposition of the Thirty-Nine Articles of Religion: Historical and Doctrinal (1865) 140 (“[W]hen we search for authority in favour of any doctrine, we can tell at once where to go, if Scripture be our rule.”).)) Thus the words we say in the Book of Common Prayer are supposed to be conformable to the pattern of the Scriptures. It is worth asking the question explicitly: does the little gloss “apart from your grace” move this prayer closer to, or further away from, how repentance is expressed in the Scriptures?
Once that question is posed, the answer is quite easy. “And there is no health in us” is richly biblical language. In one of the verses already mentioned, God says to his people through the prophet Isaiah (Isaiah 1:5-6):
“Why should ye be stricken any more?
ye will revolt more and more:
the whole head is sick, and the whole heart faint.
From the sole of the foot even unto the head
there is no soundness in it;
but wounds, and bruises, and putrifying sores:
they have not been closed,
neither bound up, neither mollified with ointment.” ((King James Version, as printed in The New Cambridge Paragraph Bible (David Norton, ed. 2011).))
The prophet is using the metaphor of the body, the body politic, and describing in graphic terms its lack of health. There are no qualifications like “From the sole of the foot even unto the head there is no soundness in it, apart from my grace.” Sixty-three chapters later, the prophet says “all our righteousnesses are as filthy rags” and “there is none that calleth upon thy name” (Isaiah 64:6-7). Again there is no intruding qualification.
But maybe that is just the Book of Isaiah. What if we look to the Psalms? In Psalm 38, a Psalm of David, we find these words in Coverdale’s translation:
“Put me not to rebuke, O Lord, in thine anger : neither chasten me in thy heavy displeasure.
For thine arrows stick fast in me : and thy hand presseth me sore.
There is no health in my flesh, because of thy displeasure : neither is there any rest in my bones, by reason of my sin.”
There it is almost exactly: “There is no health in my flesh.” Once again we see no hint of qualification. Does David need to say “There is no health in my flesh,” while we can slide by with “Apart from your grace, there is no health in my flesh”?
Nor is it only Isaiah and David. When Daniel confesses his sins and the sins of Israel, he does so at length (Daniel 9:4-19). But there is no hint of this kind of qualification.
And what of the New Testament? One prayer of confession is placed on the lips of a tax collector. In contrast to the self-righteousness of the Pharisee, the tax collector prays: “God be merciful to me a sinner” (Luke 18:13). Again there is no caveat: it is not “God be merciful to me, who apart from your grace is a sinner.”
In fact, it is quite doubtful that there is any biblical confession at all that has this kind of qualification about God’s grace. But to simply say “And there is no health in us” resonates fully with the biblical pattern. The pattern is not only in these prayers of repentance but also in the Beatitudes (where we begin poor in spirit) and in our Lord’s instruction to the rich young ruler to sell everything. (Wouldn’t selling 90% of his possessions have made the point?) When we say “all our righteousnesses are as filthy rags,” we do not hasten to add “except for those good works that you ordained for us to walk in.” When we sing “Nothing in my hand I bring” we do not rush to say “except what I have by your grace.” Even where a qualification is denotatively true, its destruction of the proper attitude can make it connotatively false.
Thus the Cranmerian phrase is not a stylistic exaggeration, but rather part of a biblical pattern of abandoning our own defenses, prerogatives, possessions. And herein lies the significance of the clause’s ending: “in us.” Not “in us in Christ.” But “in us” in the sense of “in us ourselves, in us considered by ourselves.” When considered by ourselves—“in us”—no part of us is well, no part is healthy. There is no health in us.
Moreover, the qualifying gloss throws off the balance of its sentence. This clause is the last in a sentence of three clauses: “ We have left undone those things which we ought to have done;  And we have done those things which we ought not to have done;  And there is no health in us.” The first two clauses are longer and precisely balanced. The third sharply departs from the parallelism of the previous clauses in syntax and length, maintaining their sense even while shifting the mood to a more emphatic assessment of our condition.
This is a recognized kind of syntactic effect. The rhetorician Virginia Tufte notes: “Parallel structures are used at times to set off and emphasize an abrupt departure from them.”((Virginia Tufte, Artful Sentences: Syntax as Style (2006) 232.)) Tufte then gives two examples, in both of which she says “the repeated patterns build toward a climax that breaks with the parallelism.”((Id.)) This is her first:
“According to the Almanac, Mae West was born in 1893.
According to Mae West, Mae West is 28 years old.
The Almanac lies.”((Id. (quoting Burt Prelutsky, “At Home with Mae West,” 4).))
This is her second:
“The man who thus called upon a saint was later to repudiate the cult of saints. He who vowed to become a monk was later to renounce monasticism. A loyal son of the Catholic Church, he was later to shatter the structure of medieval Catholicism. A devoted servant of the pope, he was later to identify the popes with Antichrist. For this young man was Martin Luther.”((Id. (quoting Roland H. Bainton, Here I Stand: A Life of Martin Luther, 15).))
That is very nearly how “And there is no health in us” works in the General Confession: a finely balanced parallelism is intensified by an abrupt and syntactically clashing conclusion.((Cf. Ian Robinson, “Religious English: Deus non potest apprehendi nisi per verbum” (1967) 2 The Cambridge Quarterly 303, 332 (noting the “effect of progress” in the General Confession that leads to the one “phrase that draws the rest together,” namely, “And there is no health in us”); Daniel Swift, “The Book of Common Prayer,” in The Oxford Handbook of English Prose 1500–1640 576 (Andrew Hadfield, ed., 2013) 576, 584 (recognizing the “leap to the third clause”).)) The effect disappears when the clause is lengthened to “and apart from your grace, there is no health in us.” Cranmer’s words are still there. But in Cranmer’s sentence, because of the structure of his sentence, they had a special intensity.
Finally, “apart from your grace” undermines the shape of the prayer as a whole. In Cranmer’s prayer, “And there is no health in us” comes at the very end of the first half of the General Confession. It is the bottom of a downward slide, the trough as it were. With the very next words the ascent begins. These words are what Alan Jacobs calls “the sudden pivot”((Jacobs, The Book of Common Prayer, at 63.)): “But thou, O Lord.”((The draft ACNA prayerbook downplays this pivot in other ways, too. “But thou” disappears; the clause begins “O Lord.” Also absent is the pattern of pronoun usage that emphasizes the pivot. Alan Jacobs explains: “Perhaps most striking of all is what Cranmer does with the grammatical subjects of his clauses: ‘We have erred and strayed . . . We have followed . . . We have offended . . . We have left undone . . . we have done’—this pronoun ringing like a bell—and then the sudden pivot: ‘but thou, O Lord, have mercy . . . spare thou . . . restore thou.’” Id. at 62-63. In the ACNA draft, all the second person pronouns after the pivot are gone.)) In this way, Cranmer is controlled by biblical rhetoric. In Ephesians 2, St. Paul says to the Ephesians that they were once “dead in trespasses and sins,” a point he proceeds to elaborate in a string of clauses (Ephesians 2:1-3). Then come the stirring words: “But God.”((The disjunction in Ephesians 2:4 is no artifact of the English translation: ὁ δὲ θεὸς.)) From this antithesis, this divine interruption, St. Paul immediately proceeds to speak of mercy: “But God, who is rich in mercy, for his great love wherewith he loved us” (Ephesians 2:4). So does Cranmer: “But thou, O Lord, have mercy upon us.” What St. Paul is reporting, Cranmer is requesting. For both, there is no facile separation of form and content. Divine grace is disjunctive; their language is, too.
Yet all of this is muddled with the qualification “apart from your grace.” Instead of the clause serving as the bottom of the sinner’s descent—the pigsty for the Prodigal Son—this moment of complete vulnerability and need is weakened perceptibly by this assurance that “there is no health in us” is not the last word, the only word that could be said about us. That assurance is unneeded, though. There are more words. They are coming in the very next sentence. All we need is the patience to wait for them.
In the meantime, like the Psalmist and like the prophet Jonah, we go down to the depths, down to the Pit of Corruption, from which God grasps us with a firm hand and pulls us up. With this prayer, we reenact and describe as deeply true of our own souls, the rake’s progress and the sinner’s redemption. But the melody can be lost with a discordant note.
These observations might be resisted as merely a matter of style. Yet our Lord, speaking in the power of the Holy Spirit, as one who had authority (Mark 1:22), did not disdain to use rhetorical devices. Nor does Cranmer. In the General Confession, we see a prayer that is carefully crafted. It follows closely the biblical models for expressing repentance. It draws together two threads of biblical thought, one describing our sins with a metaphor of sickness and the other speaking of our inability to cure ourselves. The prayer makes use of a rhetorical technique to heighten the force of its central clause. And it employs a spatial structure that takes us through stages of descent and ascent, just as in the Psalms of David and Jonah. It would be an overstatement to say, as David Daube did of biblical law, that “the form is the message.”((David Daube, “The Form is the Message,” in Ancient Jewish Law: Three Inaugural Lectures (1981).)) But it would be a clarifying overstatement. The form can be an integral part of the message. “How something is said” is “part of what is said.”((Samuel L. Bray and John F. Hobbins, Genesis 1–11: A New Old Translation for Readers, Scholars, and Translators (2017) 7.))
For a reviser contemplating this phrase, what could be done? One choice would be to add a single word, so that it reads: “And there is no saving health in us.” That usage, the pairing of “health” with the explanatory “saving,” is found elsewhere in the Book of Common Prayer, namely in the Prayer for All Conditions of Men and Coverdale’s translation of Psalm 67. That revision would bring to the surface both the sense of soundness (health) and the sense of deliverance (saving). It explicates the metaphor for a literal age. But even that revision might soften the blow. To add a word would slightly weaken the pressure of Cranmer’s abrupt assessment that we are sick and unable to be our own physicians.
More important, there is a theological reason to reject “And there is no saving health in us.” As used here in the General Confession it could be taken to support a Pelagian inference—as if there were some health in us, just not quite enough for salvation. Any such understanding would be clearly contrary to the Anglican doctrinal standards (Articles IX, X, and XI and the Homily on the Salvation of Mankind). Article IX even calls out Pelagians by name.
Another choice would be to replace health with another word, such as salvation, deliverance, help, or hope. The gain would be an unmistakably clear understanding of one meaning of Cranmer’s phrase. But there would be a closing down of the other meaning, a loss of the metaphor of health,((Cf. Eliot’s deliberate choice of health, and his rephrasing of “no health in us” as “Our only health”:
The wounded surgeon plies the steel
That questions the distempered part;
Beneath the bleeding hands we feel
The sharp compassion of the healer’s art
Resolving the enigma of the fever chart.
Our only health is the disease
If we obey the dying nurse
Whose constant care is not to please
But to remind of our, and Adam’s curse,
And that, to be restored, our sickness must grow worse.
T. S. Eliot, “East Coker,” in The Four Quartets (1943) 23, 29. For discussion, see John Booty, Meditating on Four Quartets (1983) 59-61. “Eliot is careful to point out that the Church”—the nurse—“is not here to please us, but to remind us of our sin,” that we might receive the cure. Id. at 60.)) with its resonance with the many biblical passages that speak of sin and forgiveness in the language of physical disease and recovery (e.g., Leviticus passim, 2 Kings 5:10, Psalm 103:3, Isaiah 53:5, 1 Peter 2:24).
The best possibility, it would seem, is simply to leave the Cranmerian clause alone. There is a double sense to “And there is no health in us.” It does require explanation.((For useful examples, see the sermon of Charles Simeon, “Christ our Physician,” in Horae Homileticae, vol. 9 (1832), and the sermon of David Kennedy, “And There Is No Health in Us,” preached at Durham Cathedral on October 6, 2013. Both Simeon and Kennedy begin with soundness and move to deliverance—with Jesus as the physician (Simeon) or the only healthy one (Kennedy). Kennedy says of the General Confession:
“the prayer is a plural prayer, and while we might think that it has . . . in mind the local congregation, we who have gathered here this morning, there is I think also something universal in what we say. Remember that Jesus himself said that we are all defiled not by what we eat, by what goes into our bodies, but by what comes out of the heart, and he lists many vices, and even if we feel we avoid some of them, we know that all of them are part of our strange human nature, capable of so much good and such rank evil. With the Psalmist we cry out for a new heart. And Jesus also reminded us that our desires are as culpable as our actions. All this casts a cloud over our goodness; it mars the image of God within us.
And there is no health in us.”)) But no one seems to have thought, perhaps until Eugene Nida came along in the twentieth century, that a liturgical service or a Bible translation is supposed to be comprehended without effort and without instruction.((See Stephen Prickett, Words and The Word: Language, poetics and biblical interpretation (1986) 4-36; Barry Spurr, The Word in the Desert: Anglican and Roman Catholic Reactions to Liturgical Reform (1995) 63, 72.)) It is not a fault of Isaiah, nor of the Holy Spirit who spoke through Isaiah, that the Ethiopian eunuch needed someone to guide him (Acts 8:31). When we say Morning and Evening Prayer, and we utter the words “And there is no health in us,” we are descending with David and Jonah, with Isaiah and St. Paul. Let us go down all the way to the depths.