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Newsletter, May 2019

International conference on Church Care for Mentally Ill People

Below are papers read at the International conference on Church Care for Mentally Ill People
November 13-14, 2018, Moscow (continuation)

Mental Illness and Possession

Archpriest Vladimir Vorobyov

1. Spirit, Soul and Body. Trichotomy and Dichotomy

The Apostolic Epistles, specifically the epistles by Apostle Paul, speak about dichotomy and trichotomy of human nature. Dichotomy teaches that human nature consists of the soul and body; trichotomy says that human nature consists of three elements, the spirit, soul and body. The Fathers of Alexandria, in particular St Clement of Alexandria and St Gregory of Nyssa, referred to trichotomy, whereas most of the Church Fathers speak about dichotomy. The contradiction is ostensible, since they speak about different things. Apparently, they mean mortality of the body and immortality of the soul, when they divide human nature into two aspects. The term trichotomy is used to analyze the concept of soul, when its various properties are identified and the spiritual is set against the mental in man's life.

St Gregory of Nyssa (4th c.) clearly speaks about the incomprehensibility of the essence of human nature by human reason like the nature of God is incomprehensible, "… since one of the attributes we contemplate in the Divine nature is incomprehensibility of essence, it is clearly necessary that in this point the image should be able to show its imitation of the archetype. For if, while the archetype transcends comprehension, the nature of the image were comprehended, the contrary character of the attributes we behold in them would prove the defect of the image; but since the nature of our mind, which is the likeness of the Creator evades our knowledge, it has an accurate resemblance to the superior nature, figuring by its own unknowableness the incomprehensible Nature" [1]. St Anastasios of Sinai wrote the same, pointing at two important features that make man's soul similar to God - "it is foreign to any [other] created nature" and "man's mind is incapable of comprehending either reasonable grounds of existing of the Devine, or similar grounds of the essence of our soul; likewise it is incapable of comprehending how it was created and came into being" [2].

Mental, bodily make of man will stay secret forever at its ultimate depth. The deeper science goes in man's nature, the more the ultimate incomprehensibility of human being will become obvious. With the physical nature of man partially opening to science and lending itself to experimental study, man's soul remains an incomprehensible mystery in its essence and allows study of manifestations only 'visible' to our eyes, i.e. of a very limited phenomenology. The spiritual sphere allows us to comprehend only what is revealed to us by God, by the spiritual world. All these spheres are closely linked with each other, and it would be na?ve to think their nature can be studied separately. We are face to face with a mystery, when we find out that these or those hormones influence people's psychic, mental life. It is specifically difficult to speak about the division of mental and spiritual in a man. We can only register observations of man's spiritual and mental life. The rest remains a mystery, and our speculations should not be regarded as an attempt to unveil it, but rather to somehow describe it, feel its depth and hear the revelations from the above, which bring us a little bit closer thereto.

A good way to describe man's spiritual and mental organization is through the image of fire and iron which can well be distinguished one from the other in the beginning, but later with iron warming up in fire, they merge completely, and iron gets imbued with the nature of fire to the extend, that it can set other objects on fire when they contact therewith. Man's soul which has spiritual nature, is capable of entering in the grace of the Holy Spirit or connecting with the spirits of darkness. This connection of man's soul with the grace of God's Spirit may at least partially explain the trichotomic understanding of man's making. This image seems to explain better than any other the teaching of the Holy Fathers about passions as actions of a dark spiritual force in men, about possession with devils and casting of devils out of the possessed men which is so well known in Christian history.

2. Passions and Addictions in Man

Nearly all people are carriers of some passions or addictions, this way or another - gluttony and voluptuousness, lust, greed for money and covetousness, wrath and temper, melancholy, sloth, vanity, pride and their derivatives. According to the Holy Fathers, passions are active energies of soul, distorted by the original sin, that has lost their original chastity and harmony. The original sin, having settled in human nature, grows in the form of personal sin in each and every human being, like weed plants grow again and again every year. As rusty iron can be purified by fire, so human soul can be cleansed of sin and passions, which are sinful energies, and transformed through God's grace that makes it perfect, holy. However, a different thing is possible: a dark spiritual power imbues a man's soul and can trigger a malignant growth of passions therein, affecting the man's good will, submitting it to an evil inclination, turning the man into a prisoner of preposterous evil wants. Passions are divided into bodily (gluttony, lust) and spiritual. Actually, all passions have spiritual nature, although some of them act through excitation of desires of the flesh. Passions can, so to say, act moderately in a man, being curbed by rational will that does not allow them to get fully out of control. Such a man may not commit major (deadly) sins, but will not stay completely free thereof, does not get cleansed or improve in a due way, and fails to attain holiness, which God calls him to achieve.

3. Possession by an Evil Spiritual Power

A man, imprisoned by a passion, be that alcohol or drug addition, gambling or greed for money, can be called possessed by such a passion, and according to the teaching of the Holy Fathers - by the demon of this passion. Indeed, we all know absolutely normal people - adequate industrious, creative, married people - who nevertheless suddenly commit some crazy acts. This can be vividly illustrated by the gambling passion, which is capable of turning even a rich person into a bankrupt, make him cheat and steal large moneys. Not in a drunken state! Alcoholism and drug addiction, another example, are capable of imprisoning a great number of people who have recently shown no sign of inadequacy or illness. There are numerous reports of actions by demons in such cases. Here is just one of them, described by Rev. Konstantin Rovinsky in the early 20th century [3]. A certain man was fond of occult experiments. A group of friends gathered in a house to do fortune-telling on a saucer and thus get some advice from a spirit. That man gambled on a stock exchange and asked the spirit through the saucer if he should place his money stake hoping to win. The saucer prompted him to do so, and the man won a large amount, then he repeated this again and again. The last time he asked, the man was instructed, 'Place all your money and you shall win'. He did so, and lost all his wealth. He asked his adviser through the saucer what had gone wrong, and heard nothing but 'Ha-ha-ha!', and so he went mad. That accident cannot be explained by a hike or drop of testosterone, serotonin or adrenaline, i.e. some biochemical changes.

As a rule, the attribute possessed is applied to those who have completely lost control over themselves and whose mind and will has been fully enslaved. The Gospel and hagiography give us numerous examples. I believe, every experienced priest has run into such phenomena. From the Gospel we know that a single word by Christ was enough to drive demons out of a possessed man, the same as Christ healed bodily ailments with just a word alone. Great saints also had such power over demons - apostles, Venerable Sergius [of Radonezh], Righteous John of Kronstadt and many others. However nowadays such possessed people are locked in psychiatric hospitals as mentally ill persons and are offered medication. What does this mean? Does it mean that 'possession' is nothing but another type of acute mental disorder and nothing else? If that can be corrected with medication, why speak about demons?

4. Psychotherapy and Spiritual Help

Dmitry E. Melekhov, prominent psychiatrist of the 20th century, said that humble people did not have mental illnesses. Obviously, he did not believe it to be a proven theory, but he was clearly guided by the teaching of the Holy Fathers about sin being the source of illness in general, and pride (a spiritual state opposite to humbleness), in particular, in its ultimate development, causes insanity, i.e. a psychiatric disorder of mental and rational life of a person. If sin is a cause of illness, it should primarily be treated by repentance, hence it is necessary to win a victory over sin. Is there a place to doctors and medication in this case?

Actually, this has no contradiction. If a smoker has developed lung cancer, his doctor will prohibit him to smoke, but will not deny him of medical treatment required for a malignant tumour. Following the prohibition to smoke is already a starting point of repentance, whereas the consequences of the sin will be treated or eased with medicines. This stays relevant for psychiatry. If depression started with the sin of despondency or it was triggered by genetic disposition as a sinful heritage from ancestors, pharmacological therapy will in no way exclude a spiritual fight against despondency and victory over it through strengthening of faith, hope and love to God and the neighbour, learning to thank God and take joy in the beauty of God's world. This can be achieved through prayer and blessed church life.

Obvious possession with an evil spirit is the most mysterious case. There are numerous evidences of such possession, which cannot be confused with a regular mental disorder or psychic endogenic illness. We come across this in the Church so often that every priest learns to identify such a state quickly.

If the level of possession is high, this is a state of indescribable gloom, heaviness and horror. Those who once got a firsthand experience seeing that will never confuse such presence of an evil spirit in a man with an ordinary illness. However, the state of possession is more often combined with a mental illness. This is not surprising, for a mental illness affects man's rational will, and they no longer can resist the evil spirit the way a healthy person can do.

Are there convincing signs of possession? Yes, it is the reaction to sacred objects and saints. You may remember the man with the unclean spirit from the country of the Gadarenes, who ran to Christ crying, "What have you to do with me, Jesus, Son of the Most High God? I adjure you by God, do not torment me" (Mark 5:7). Sometimes even babies in arms, who understand nothing yet - start struggling and crying when they are brought to the Holy Chalice. The same happens with older children even more often. It always turns out that such a child is brought for the first time or has not been brought to communion for a long time. If things do not go well at home, the evil spirit starts impacting younger children. Speaking about possessed adults, one may not stop to be surprised at the way they respond to the presence of a sacred thing without even knowing this.

On the other hand, I personally knew some people with a severe form of schizophrenia, who would often take communion, pray and be an embodiment of holy humbleness and blessed life. Their illness would show itself in particular mental disorders, inability to be actively involved in some work, absence of adequate contact with the surrounding reality and people. But along with that, there was no sign of possession by a passion; on the contrary there was an obvious turn to spiritual reality and God. The death of such people was blessed. In case of possession, we should persistently pray and employ all possible means to facilitate the lot of the suffering person. If there is a holy person who can cast the demon away with his prayer, then no medicinal treatment will be necessary. However, if there is no such an ascetic, who has prepared himself through fast and prayer and was granted from God the power to "cast out devils" and "lay hands on the sick, and they shall recover" (Mark 16:18), then doctors' and medicinal help is not excluded and can bring significant reduction to the illness, for instance, to eliminate horrible affective states of possession. However, possession as spiritual captivity by an evil power will stay, but will become less obvious though.

As for exorcism, there is no simple answer to this. A prayer always does good, but exorcism brings so many different people together - clinically ill people who are in need of medicinal treatment, various types of hysterical women, genuine or merely playing such a role, who can sometimes be 'cured' with just a good scare. One of such hysterical women began to scream at a patriarchal worship service, so the father superior pushed her into an auxiliary room and ordered an assistant to bring a bucket of cold water. That was winter time; when that woman realized that in a moment's time she would be splashed with cold water and driven of the church right in the frost outside, she started to plead the priest to let her go, promising never to return to that church. There is much noise and great cry during exorcism, so truly mentally ill persons are not advised to attend such rites. There are ascetic priests who truly help possessed people with their prayer. And there are those who virtually turn exorcism into a show-business.

One thing is clear for sure, that a spiritual illness, which comes with sin, leads to a mental illness, if the sinner does not repent, i.e. does not turn for spiritual healing. A mental illness, if not being cured, often leads to death or severe bodily illnesses. A spiritual illness 'goes down' the ladder of man's spiritual-mental-physical making. It is good if the physiological cause of a disorder is identified by biochemical methods and gets corrected. But if it were only chemistry that would determine man's spiritual life, they would have stopped being human long ago. The mystery of verbal mind, godlike freedom, creative genius, understanding of the essence of life, kindness, spiritual beauty - all this cannot be reduced to chemistry or biology. Likewise, spiritual illnesses find their roots in the wrong of the life of the spirit and cannot be fully reduced to the level of hormones.

References

  1. St Gregory of Nyssa, On the Making of Man [Григорий Нисский, святитель. Об устроении человека. СПб: Axioma, 1995. С.31]
  2. St Anastasios of Sinai, Three discourses on man being made in the image and liking of God // Selected works. M.: Palomnik [Паломник, 203. С.43.] Quoted after the paper by V.Rev. Guennady Yegorov "On dichotomy and trichotomy of human nature and the paradox of person in anthropology of St Theophan" ["Проблема дихотомии-трихотомии человеческой природы и парадокс личности в антропологии святителя Феофана"].
  3. Rev. Konstantin Rovinsky, Dialogues of an Old Priest and his Spiritual Children [Ровинский Константин, прот. Беседы старого священника со своими духовными детьми. ] ? М.: Изд-во ПСТГУ, 2015.

Mental Illness and Spiritual Life of the Patient: Pastoral Care for the Mentally Ill in the Modern Healthcare System

Rev. Fr Jesus Colomo Gomez

I would like to address the issue of pastoral care in terms of practice and my personal experience. I shall not talk about the connection between religion and psychiatry or the mind and the brain1, and will not give statistics on pastoral care of the mentally ill in different countries.

1. Introduction

Viktor Frankl, Freud's successor at the Department Psychoanalysis and Psychiatry of the University of Vienna, has been one of the brightest scientists to me since the beginning of my university studies. It is well known that he has transformed psychoanalysis (based on the concept of sexual instinct dominating in human psychology) into logo therapy, the main idea of which is that life itself makes sense.

I was introduced to his works, when I studied psychology at my third year of the Medical School. We were to write a paper at the end of the course. I thought about writing about mental "norm and pathology", but my friend convinced me to do a coursework as a comment to Frankl's book Man's Search for Meaning2.

I was deeply impressed with his story about how he had been prisoner in the Auschwitz and Dachau death camps. I read with shudder the account of his torturous experience and the discovery he had arrived to through suffering: prisoners, falling victim to any disease, died faster when they lost hope that they would ever be liberated, that is, when their lives and their suffering would become meaningless. On the contrary, thoughts about work he would have after his release and prayers to God so that his wife, who was also in the concentration camp, would escape all the suffering he had endured, helped him, a practicing Jew, to survive. The meaning of life and the use of his sufferings made it easier to Frankl to accept the circumstances of his life. "Those who know "why" to live will overcome almost any "how"". This phrase by Nietzsche is very often repeated in Frankl's work.

That experience made him realize the value that is given to every person, including mentally ill people: to find a meaning of life and be able to give a meaning to life. This set the beginning for the development of the third branch of the Western school of psychotherapy: logotherapy, which had been preceded by Freud's psychoanalysis and Adler's individual psychology.

My medical education was at the very beginning at that time, but I had already developed an impression - naturally superficial - that a pharmacological intervention was the only effective way of treatment of mentally ill individuals. This was the main idea of the so-called organic psychiatric schools. Books by Frankl helped me to understand that it was necessary to combine medication with an adequate psychotherapy. He made me realize the importance of each person asking himself about the meaning of life and discovering it himself. And not only the meaning of life that each person chooses, but also the meaning of those circumstances that are beyond his own will. I was able to confirm the significance of this when I became chaplain at the Navarre University Hospital.

A chaplain's work consists of different tasks. One of them, the fundamental one for a successful gospel preaching, is to help us understand that our lives always make sense, although sometimes it is difficult for us to identify it. The true meaning of life - we, the Christians, know this well - is to enter the Kingdom of Heaven. To attain it, we must fulfil the two commandments that Christ himself reminds us of, "The first of all the commandments is: 'Hear, O Israel, the Lord our God, the Lord is one. And you shall love the Lord your God with all your heart, with all your soul, with all your mind, and with all your strength'. This is the first commandment. And the second, like it, is this: 'You shall love your neighbour as yourself. ' There is no other commandment greater than these" (Mark 12:29-31).

2. Mental Patients in Europe3

Before we talk about pastoral care for the mentally ill in Europe, I would like to begin by looking at the situation with mental patients in the European health care system.

Patients with severe and chronic mental illness have been isolated and mistreated for centuries. In all societies, they were among the most disadvantaged groups and could count only on the support of their own families or some charity organizations, most often set up by the Church. At different times, and in different countries, they were often considered to be dangerous to society and therefore had to be locked in institutions known as madhouses. Unfortunately, these institutions would often turn into real prisons: patients would be disobliged and subjected to all sorts of torture and humiliation.

Success in promoting respect to every person on the basis of the Universal Declaration of Human Rights, as well as progress in the development of treatment methods in psychiatry, had promoted a radical change in these institutions, which had become psychiatric hospitals, very common until the last third of the 20th century. These institutions were meant as places of residence for the mentally ill, where patients were not always treated4. Often, mentally ill individuals could stay there until their death.

Subsequent discoveries of psychopharmacologists have made it possible to significantly improve the status of some patients. In this regard, it was recognized appropriate to reduce the number of psychiatric hospitals and to open psychiatric wards in clinics and general hospitals. It became possible for individuals to continue treatment as outpatients, staying with their families and their habitual communities, with temporary hospitalization when the patient's condition worsened. This health policy had been developing in Europe since the 60s or 70s, and by the 80s it had spread to almost all countries: psychiatric hospitals almost disappeared from the public health system. Most countries have retained psychiatric hospitals only within the penitentiary system, where criminals, sentenced for various crimes and recognized as mentally ill by courts, are held5. Besides, there are other psychiatric hospitals - private or established by various religious institutions - that address the problem of patients' long-term stay.

3. Pastoral Care for Mental Patients

A mental patient is a person who is ill in a very specific way - this is an important starting point for all those concerned, patients themselves, their family members and everyone involved in the care process. A mental illness may be severe or mild, of longer or shorter duration, curable or not, with or without symptoms... but it is an illness, or rather an ill person. He or she may have different kinds of limitations, as is the case with any patient, but they need - like any other patient - adequate human and spiritual attention.

Pope John Paul II reminded us in one of his speeches, "Those who experience a mental illness always contain the image and likeness of God, just like every other man. Besides, they always have an inalienable right not only to be considered God's image and, consequently, a personality, but to be treated as such" (image of God)6.

3.1. Various Situations with Mentally Ill Persons

There are two different situations from the point of organization of the healthcare system:

a) Hospitalized Mentally Ill Persons

Hospitalized patients may be visited by a chaplain on their request at an appropriate time. The chaplain understands that he deals with a mentally ill person and may even be aware of the diagnoses. The chaplain must always follow the advice, provided by a psychiatrist. In some cases, the doctor may say that the priest cannot provide pastoral care to a particular patient.

In case of a public health psychiatric hospital, the chaplain has ample opportunity to visit patients, ranging from a few days to only a few hours a week, the latter being the most frequent situation. If we talk about a general hospital, there is usually no chaplain who attends exclusively the psychiatric ward; any hospital chaplain provides pastoral care to mental patients when necessary.

If the hospital is run by a religious institution, the scope of pastoral care expands greatly.

b) Non-hospitalized Mentally Ill Persons

Non-hospitalized patients with a mental disorder may contact any priest who, except for very specific cases, may not be fully aware about the person's situation. There may be members of the parish who have already been diagnosed with a mental illness. The priest may intuitively sense that there is a mental illness, judging by what the person shares with him:

  • Dysphoria, fatigue, persistent decline in habitual activity, difficulties in performing new tasks, lack of goals, excessively long pain, etc. may be symptoms of depression.
  • Strange or absurd ideas and behaviours accompanied by loss of contact with the reality can be a sign of a mental disorder, earlier know as paranoia.
  • Doubts or obsessive thoughts may correspond to thinking disorders previously known as paranoia.

In all of these cases, it is appropriate to refer the person to a psychiatrist; it is advisable to be consulted by several specialist, not just hear one opinion. These doctors should be practicing Christians and act in accordance with the teachings of the Church.

3.2. Chaplains' Work

The mentally ill should be treated with special care and attention. Very often they have a subtle ability to sense the inner state of their interlocutors. Moreover, we should not forget that mentally ill people rarely meet people who are willing to listen to them.

3.2.1. Dialogue with Patients and their Family Members

3.2.1.1. Questions and Answers in the Face of Any Serious Illness

A severe illness - not only mental - causes confusion in both those who suffer from it and their relatives. In such cases, there are fundamental questions that are difficult to answer. To begin with, it is worth clarifying some points:

a) Illness was Contracted with No Fault of the Man

Very often patients ask about the cause of a serious illness, they have developed, and consider themselves innocent: "Why is this happening to me? I haven't done anything particularly bad, have I?" Or, on the contrary, the person believes him/herself be guilty: "God punishes me for the sin I have committed".

Indeed, we may be guilty of having committed some evil against ourselves or against others, but the consequences of this evil are well expressed by the phrase: "God always forgives; men sometimes forgive; but nature never forgives"7. If we go against nature, it is very likely that we will cause serious harm to ourselves and others; and in some cases, this can lead to a real tragedy.

However, God does not tend to punish in this life. Although he can do so, He rewards us or punishes us in the other life. We should insist on this reality when communicating with a patient, in particular, by reminding him that suffering helps to cleanse our sins and reduce the time we will spend in the Purgatory.

b) Mystery of Suffering

"Why is this happening to me?" And in a more general form: "Why do the innocent suffer?" These are rhetorical questions, if we do not take God's will into account.

We all understand why the guilty suffer. If a car driver gets drunk and speeds along the highway at 200 km/h, the trip will end in a car crash; and we shall probably think: "He looked for that". But if a child develops leukemia or some other serious illness, if a driver gets in a car accident because of another immoral or insane driver, or if there is a natural disaster, we face the mystery of innocent people's pain.

In the book Crossing the Threshold of Hope8 - a long interview with St. John Paul II edited by Vittorio Messori - the journalist asks about the suffering of the innocent, and the Pope answers that it is a mystery.

  • We do not find a full explanation for this mystery in the Old Testament: the Book of Job offers us the Divine will as the only explanation. In the last chapters of the Book of Job, when the Lord intervenes, saying: "Who is this that darkeneth Counsel by words without knowledge? (...): Where wast thou when I laid the foundations of the earth? declare, if thou hast understanding" (Job 38:2-4 (KJV)).
  • Jesus give no theoretical explanation in the Gospel either9. He does not explain, but he does something which is much more: he suffers with us. So, no one can tell him, 'You do not know what suffering is'.
  • Thus, the mystery becomes even more profound: how is it possible that God the Father would want to save us by sacrificing his Son on the Cross? God does this to show us His love and the possibility of salvation with Christ10.

Saint John Paul II develops this thought in his Encyclic Salvifici doloris11.

c) Acceptance of God's Will

There is no need to ask questions in the face of suffering: we simply must accept God's will, and only then will there come an explanation for the suffering - our union with Christ crucified on the Cross acquires a redemptive value. With all our lives, but especially through our suffering, we partake in what was accomplished through the Atonement.

3.2.1.2. Thoughts about Specific Mental Pathologies12

In addition to what has already been said, it is important that the priest should advise the mentally ill person to follow the specific recommendations given thereto by his/her doctors.

I shall focus only on the most common pathologies:

a) Patients with Affective Disorders (Depressions)

Saint Teresa opposes what she calls melancholy, in a specifically clear way. The saint warns us against the seriousness of this condition for two reasons. First, melancholy does not look like an illness, because it does not require confinement to bed, such patients do not have fever and do not need to call for a doctor at all...13 Second, this condition does not lead to death. Although it is not treatable. This is more than strange: melancholy is not curable, but it does not lead to death14. Therefore, Teresa insists that those who suffer from this condition deserve mercy. They do not harm anyone. But the only way to stop melancholy is through the awe to the clergy15.

Patients with depression are particularly sensitive to pastoral attention. They should be made aware that this is an illness, and not their fault. Although the illness is accompanied by suffering, the patient has an opportunity to connect him/herself with Christ's suffering on the Cross16. It is also necessary to support the hope of recovery, which very often becomes reality.

We need to help people understand the meaning of their suffering or suggest that meaning. As I said above, when he was imprisoned, Frankl initially regarded all his suffering as a way to spare his wife from suffering. He also described how he managed to reduce depression in a man who had recently lost his wife; and that was a very good marriage. His wife would have suffered terribly, had he died first; this man's suffering was the price he paid to spare his wife from this suffering.

Along with this line of reasoning, it is appropriate to encourage the patient to find strength to get out of loneliness, go in for sports, walk in the open air ... but above all, take care of his piety: prayer and participation in the sacraments.

b) Psychotic Disorders (Schizophrenia, etc.)

They are an intermittent pathology, relapses are followed by periods of completely normal behavior, when patients do not need any special attention. In relapses with hallucinatory images, when touch with reality is lost, it is more appropriate not to contradict the patient. You can listen to the person without expressing disagreement with what we think is wrong. The patient can be gradually brought to the idea that s/he should not be completely convinced of the reality of what s/he thinks or sees, as it has already happened to them more than once, and that their current condition is caused by a new attack of the illness17.

c) Addictions

Addictions of any type may initially be mild mental disorders, but they progress and can be stubborn: alcoholism, drug addiction, sexual addiction, gambling, addiction to pornography, they can completely destroy the life of the patient and their family.

It is important for the addict to become aware of their illness and turn to a doctor. It is highly likely that they will need to join groups that work with this pathology; the most famous one is Alcoholics Anonymous (AA) where they help to overcome alcoholism. However, there are also some new groups that are constantly set up to treat other addictions.

Pastoral care should be offered with such frequency at which the mentally ill person is willing to accept it and the priest is ready to provide, even daily. We should always maintain hope for recovery in patients. Sometimes frequent confessions are required, and it is strongly recommended to avoid situations that would destroy this "addiction".

3.2.2. Church Sacraments

Let's consider only the general rules here. In moral and dogmatic theology, each case is considered individually and needs specific approach. This is especially necessary in the case of mentally ill people: there are not only differences between such patients, but also between individual periods of life of each patient. The following should be taken into account:

  • Level of awareness;
  • Ability to act independently;
  • The family's opinion should be taken into account in some cases.

a) Baptism and Anointment

If patients wish to accept these sacraments freely, on their own free will, these sacraments are administered to them.

These sacraments can also be administered for fear of death and if there is no objection made by the patient or his/her family. If there is doubt whether the person was baptized or anointed earlier, these sacraments are offered in a special rite of sub condicione.

b) Confession

This sacrament can also be offered whenever the mentally ill person so desires, under the same conditions that apply to any Christian - first of all, the possibility to examine their consciousness and to repent their sins.

Sometimes, for example, the person's will may be weekend because of addiction or obsessive states18. In such cases, the father-confessor should assess the moral state of the penitent, but always in a merciful way.

c) Communion

In principle, any mentally ill person can participate in the Eucharist and receive communion every time they are ready for it. This sacrament is not offered only to those who, through their actions, may make it difficult to serve the Eucharist.

In case of some types of dementia, such as severe mental impairment or intellectual disability, patients may well receive communion. Even if they are unable to distinguish between an ordinary bread and the Eucharistic bread, they can be offered the communion by the faith of the Church. Such cases are similar to the baptism of infants who have not developed a full power of the mind yet; they are baptized by the faith of their closest relatives, their parents and God-parents, as well as by the faith of the whole Church19.

d) Marriage

This is a particularly delicate topic: the decision about a church marriage depends on the severity of the illness and the extent to which it has affected the mind and will of potential participants thereof. A person with mild depression and a person with schizophrenia on medication to have his/her behaviour controlled, are two completely different cases. It is necessary to be especially careful when making pastoral decisions to support such marriages.

e) Sacrament of Order

Here we could say the same thing as about marriage, although each case should be considered individually with even greater stringency.

f) Extreme Unction

In case of a grave illness or fear of death, this sacrament may be administered whenever the patient or his/her family do not mind.

4. Conclusion

Progress in medical care of the mentally ill has been particularly obvious in the recent decades, but there is still a long way to go for psychiatry.

Pastoral care for the mentally ill must also be improved:

  • The staff at each diocese could devote more pastoral attention to the mentally ill; the best choice for this purpose is priests with experience of ministry to mentally ill people;
  • It would be useful to introduce "Pastoral Psychiatry" in the curriculum of seminaries, as well as to organize courses or master classes for the clergy who could develop this area of pastoral care;
  • It would also be useful to have psychiatrists who are willing to cooperate and have good doctrinal training that would help them deal better with their patients and avoid using psychotherapeutic methods incompatible with Christian life.


1You may find very interesting ideas on this topic in the paper by John Paul II, Address to the Participants of the International Conference "Human Mind", 17.XI.1990, in the book by Pablo Mercier Mazzala (ed.), del Psicologia y Psiquiatria. Textos Magisterio Pontificio, B.A.C., Madrid 2011.pp. 180-186. Texts of papal Magisterium can also be found on the official web-site of the Holy See, www.vatican.va.

2Viktor Frankl, El hombre en busca de sentido, Herder, Barcelona 1962.

3A comprehensive study "Mental Health in Europe: Policy and Practice. Future Lines of Mental Health" was undertaken by the Health Ministry of Spain, published on: https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/.../saludMentalEuropa.pdf

4See Paul VI, Address to a Group of specialists from the Italian and French Association of Neurologists, 8.VI.74, - in Pablo Mercier Mazzala (ed.), Psicologia y Psiquiatria. Textos del Magisterio Pontificio, B.A.C., Madrid 2011, pp. 109-111.

5For more details see: www.sespas.es/informe2002/cap15.pdf . Chapter 15: La salud mental en Espana: cenicienta en el pais de las maravillas.

6John Paul II, Address to the Participants of the XI International Conference on Pastoral Health Care, in the book of Pablo Mercier Mazzala (ed.), Psicologia y Psiquiatria. Textos del Magisterio Pontificio, B.A.C., Madrid 2011, p. 212. See also the Encyclic Dolentium hominum. Revista del pontificio consejo para la pastoral de los agentes sanitarios, n. 34 (Ano XII - N. 1) 1997; the same volume of the magazine contains many articles on mentally ill people.

7The authorship of this phrase is not clear: some attribute it to Darwin, others to Claudio Albis ... In any case, it is quoted very often. Pope Francis cited it in several speeches; among other things, during the General audience on 21.V. 2014.

8Juan Pablo II, Cruzando el umbral de la esperanza, Plaza y Janes, Barcelona 1994, pp. 77-79.

9It is Apostle Paul who does this in his Epistle to Colossians, "I now rejoice in my sufferings for you, and fill up in my flesh what is lacking in the afflictions of Christ, for the sake of His body, which is the church" (Col. 1:24).

10Jesus taking the Father's love to all people in His human heart "loved them to the end" (John 13:1), because "Greater love has no one than this, than to lay down one's life for his friends" (John 15:13). His human nature, both in His suffering and death, became a willing and perfect tool of His Devine love that wants to save people. Actually, He willingly accepted his suffering and death out of love to His Father and people, whom the Father wants to save, "No one takes it from Me, but I lay it down of Myself" (John 10:18). This results in an unlimited freedom of the Son of God, who goes to death on His Own decision (Catholic Church Catechism No. 609).

11John Paul II, Encyclic Salvifici doloris, 11.II.1984.

12This section briefly presents thoughts from Miguel Angel Monge, Medicina pastoral, EUNSA, Orcoyen (Navarra), 2002, 439-447.

13Libro de las Fundaciones, en Teresa de Jesus, Obras Completas, 11a edicion, Aguilar, Madrid 1979, 556.

14Ibid.

15Ibid, 554.

16See above, 3.2.1.2.

17One schizophrenic patient, a practicing Christian and a very good person, used to come to my office. From time to time he would be sure that he was God. I would always be following the guidelines and say nothing, but that he shouldn't be too sure, because it could be another psychotic attack. A few days after, with psychoactive support, he would come to me, saying that that idea had already passed.

18To make a correct judgement about moral responsibility of a person, it is necessary to take into account such factors as affective immaturity, the power of habits, torments of conscience, and other mental and social factors that may mitigate or lessen, and sometimes even reduce to the minimum, the person's moral guilt. (Catecismo de la Iglesia Catolica. n. 2.352).

19Communion must be offered, whenever it is possible, to mentally ill disabled people - baptized and anointed; they receive the Eucharist by the faith of their family or community that is accompanying them (Benedict XVI, Exhortacion Apostolica Sacramentum caritatis, 22.II.2007, n. 58 in fine).

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