Saint Thomas Aquinas draws out this doctrine by elucidating the difference between the First Cause of all that is, and the second causes that this First Cause causes to be: his creation. For Thomas, God the Prima Causa is not a competing cause with his created colleagues, but is Cause in a fundamentally different sense. His causal power operates on a different level entirely, acting in part as the cause of our own causal efficacy.

In the Summa Contra Gentiles, we read, “The same effect is not attributed to a natural cause and to divine power in such a way that it is partly done by God, and partly by the natural agent; rather, it is wholly done by both, according to a different way, just as the same effect is wholly attributed to the instrument and also wholly to the principal agent.” Reminiscent (even if only very loosely so) of the hypostatic union of Christ, in virtue of which he is said to be fully God and fully man, so also without contradiction are the created acts of finite beings said to be both fully divine and fully natural in the arena of causality.

Because God and I are not competitive causes, but are causes of entirely different sorts and identified by this common designation of “cause” only analogously, it is unnecessary to suppose that God must retract his causal influence in order to make room for me to act. (In fact, were he to retract his causal influence, there would be no “me” here to act, for I would cease to exist.) It is similarly unnecessary to deny the true causal power of created things in order to affirm the omnipotence of God. This belief that humans and other creatures don’t truly cause anything—and only God does— is known as “occasionalism,” and mistaken thinkers like Al-Ghazali and Malebranche have held to it. Because God’s causal ways are not our causal ways, the two can exist harmoniously alongside one another.

The overlooking of this traditional doctrine of divine transcendence has led to a whole host of problems in contemporary Christian thought, from creation to ethics to vocation. The branch that concerns us here is theology of suffering.

Returning to the tragedy of cancer, we note that the doctrine of transcendence puts the divine economy of creation into focus, correcting the errors of the heterodox hospital mourners who try to comfort the dying with false platitudes about God’s will. The import of transcendence for providence is that it reveals God’s involvement with creation to be neither interference nor interruption. God does not step into the workings of the cosmos to affect this or that—except in miraculous instances, which are the extraordinary exception—but rather is the complete cause of all that is in the cosmos at every moment. Thus in one regard, creation is radically dependent, for it can have no being apart from his creative activity at all. But in another sense, creation is radically autonomous, for within the created realm finite beings are wholly complete and, collectively, causally sufficient unto themselves.

Our dual denial of divine personalism and of causal occasionalism makes possible the statement of Joseph to his brothers in Egypt: “You meant evil against me; but God meant it for good.” This son of Jacob is not claiming that God prevented his brothers’ evil actions from having effect and stepped in to do good instead, subverting nature and replacing it with grace. Rather, Joseph is simultaneously affirming both that their acts were wicked within the human arena and that they were blessed within the arena of providence. It is a verification rather than a denial of their past wickedness. Thus, within the merely natural realm, their selling him into slavery was just evil, period.

Though it may seem less than consoling, that is often the best we can say to those who suffer tragedy as well. No patronizing pseudo-Christian sugarcoating is appropriate, nor is it honest. The truth is that my friend’s leukemia is horrendous. It is evil that he has it, especially that he has it again, and there are no words because within the order of second causes, that’s the whole story. Our reaction to cancer, like our reaction to all natural tragedies, should be not rosy-eyed optimism but miserable mourning—though not despairing hopelessness, mind you—for nothing else squares with the dreadful reality of these situations. No, rightly seen this cancer is not secretly just God stepping in to make you a better person or to draw your family closer to one another or to bring about world peace—though hopefully the first couple of those at least can be achieved by his grace during this trying time. But, to riff on Freud, sometimes cancer is just cancer.