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2.b   Sickness and healing in Orthodox Theology



How does Orthodox Theology imply - and how should the Church understand - "sickness" and "therapy", if not with the use of idealistic, physiocratic or psychological-utilitarian  forms and notions?

In our attempt to provide a reply to this question, let's borrow the following fundamental principles from Patristic theology:

1. Sickness - every form of sickness - is the consequence of man's Fall.  This means sickness is linked to sin, and not to human nature and as such, it is not "natural" for man to become sick; it is in fact unnatural - it is "contrary to nature". At first glance, this appears to lead us to the state that we named "physiocratic" (ruled by nature) or "ideocratic" (ruled by ideas), where  "therapy" and "cure" would seem to imply a conforming to nature.  And yet, certain clarifications can draw us far away from every physiocratic perception.  Given that man's origin is ex nihilo, his nature per se is convertible - in other words, it is prone to deterioration and death and consequently to sickness. However, even nature itself can transcend this tendency - not with any innate powers of its own, but only if united with the imperishable and eternal God. The transcending of this convertible and corruptible state which is intrinsic to human nature has been given to man as a "reason", as a final destination whose realization has been allocated to man's freedom as a person: the first man as a free person was called to direct nature - either towards itself or beyond itself, towards God.  Adam - the first man - freely chose the first of the two (to turn nature towards itself), thus sickness as a natural possibility became a natural reality.  It is no longer possible for human nature to not become sick; sickness became a "natural" phenomenon, not because it was an unavoidable thing, but because that is where human freedom led matters.  The consequences of this stance in the matter of therapy we hope will become apparent, further along.

2. Sickness - like sin - has now become a general and worldwide reality, which human freedom cannot retract, despite the fact that its appearance and its consolidation are attributed to it.  And the reason for this is because with death (which entered existence and from a natural possibility became a natural reality), human nature was segmented and was no longer borne by each person in its totality, in its fullness.  Thus, the personal freedom of one person does not influence human nature overall; consequently, not only do sinners become sick, but saints also.

3. Final, actual therapy - as a complete elimination of the sickness - is impossible and cannot be achieved by human nature, nor by human freedom.  Deterioration and mortality are bequeathed biologically from generation to generation, and together with them, sickness also.  To break that vicious circle, we believe -in theology- that external intervention was necessary; an intervention that for us was realized, in the Person of Christ, in Whom the joining of human nature to the divine (which was the first man's calling and destination) was realized without the passage through biological birth, which perpetuates deterioration and death and is something that is impossible for every post-Fall human.  Christ is the only truly "healthy" Person - not because He is also God (as the notions of "healthy" or "sick" do not apply to God) - but because of His human nature, which is unaffected by any inherited deterioration, and permanently joined (voluntarily and freely) thanks to the hypostatic - the personal - union with God, He has transcended deterioration and death. Consequently, no therapy (as a true and radical elimination of sickness) can be considered without Christ. Therapy is possible, only as an incorporation in Christ - the only truly healthy human. It is not without significance that - for the Church - the Mystery of the Divine Eucharist has such a central importance for therapy, and the ascetic endeavours of human freedom do not suffice for one to become cured.

4. Nevertheless, human freedom continues to be the key to the proper understanding, both of the meaning of sickness  and of therapy.  Given that sickness passed into existence through human freedom, therapy and healing cannot but likewise pass through the same gateway.  This was a secret that the ascetic Fathers of the Church were well aware of, which is why they placed so much importance on the exercising of human freedom as a liberating of oneself from passions.  At this point, it is especially important to note what Saint Maximus has to offer us.

Therapeutic axioms of Saint Maximus

According to Saint Maximus, the quintessence of morbidity is found in self-love.  Self-love is not simply a passion; it is the generative cause of all passions: «Do you want to be free of passions? Then cast out the mother of all passions: self-love» (Chapters on Love, II, I). As Photios faithfully analyzes Maximos' thought (Library of Codices 192 – ΡG  103, 637), self-love - which replaced the love towards God - gave birth to hedonism; but because hedonism was mingled with grief, man became entangled in an interminable and desperate attempt to hold on to hedonism and cast out the grief. It was from within this agonized attempt that the «multitude of passions» was born. And Photios explains Maximos' thought: «That is, if we renounce the hedonism in self-love, we give birth to gluttony, to pride, to avarice, and to the things that hedonism provides by whichever means; and if we only flee from the grief in self-love, we give birth to anger, to envy, to hatred, to despair and to whatever else the grieving predisposition lacks. From the mixture of both are born: hypocrisy, flattery deceit, and quite simply, all other malicious things that are the fabrications of this mixed wiliness».

In other words, if we renounce hedonism but retain self-love, we provoke gluttony, pride, avarice and everything else that provides hedonism in any way; and if we were to renounce and avoid grief but again preserve self-love, we provoke anger, envy, hatred, despair and whatever else contains a deprivation of hedonism.  If again we were to mix both of these together and avoid them (ie, both hedonism and grief) but still preserving self-love, we land in hypocrisy, flattery etc..  The conclusions are important.

a. Cure from passions cannot be achieved through any direct struggle against the specific passions. On the contrary, as we noticed in the passage that I just read: in view of the fact that the problem per se of spiritual sickness is born of the deprivation of hedonism - always in conjunction with self-love - the more deprivation that we provoke, the more the passions that we give birth to.  What does this mean? That, in order to be cured of passions, we need to allow passions to exist and to function?  Of course not.  But, it does mean that as long as self-love is being prolonged, the excision of specific passions is not only unattainable, but that even when it is achieved, it can be dangerous, because with the deprivation of hedonism that is entailed, it will give birth to other passions.  Thus it often happens that those who rid themselves of carnal passions may develop the passion of avarice or pride etc.. Therefore we are not speaking of therapy, when only specific passions are eliminated.  The sole therapy is found in the elimination of self-love, which is the root of all those passions.

b. Given that grief is an inseparable element of hedonism in man's post-Fall state, it is an erroneous perception of "sickness" : the one that we named earlier, as utilitarian; it is an analgetic approach, and it appears to prevail in the contemporary philosophy of medicine.  Grief is not eliminated by removing it, but by embracing it.  Therapy comes with the invitation and the experiencing of grief.  Of course it often happens that grief is unbearable, and experiencing it can be exhaustive.  That is why every therapeutic treatment needs to be adjusted to the patient's tolerance (oikonomia).  But in no way should we regard the patient cured, just because he is psychologically "comforted" or does not suffer.  The tragedy of existence lies within the Cross of Christ, and no therapy can bypass the Cross.  We often forget that hedonism is not only carnal, but psychological also. By extracting grief from therapy we are only providing hedonism, which constitutes an escape from reality and true therapy.

c. The proper cure for passions presupposes - according to Saint Maximus - three basic distinctions.  He describes them in the following passage, taken from the chapters on love: «The mind of a God-loving person does not fight against things, nor the notions thereof, but against the passions that are coupled to those notions.  That is, he does not fight against woman, nor against the one who sorrowed him, nor against the imaginations of them, but against the passions that are coupled to those imaginations. All the struggles of a monk against the demons are about separating himself from the passions of the notions; for otherwise, he is not able to see things impassionately. An actual thing ("object") is one thing, "notion" is something else and "passion" is also something else.  For, an "object" is - for example - a man, a woman, gold, and the suchlike. "Notion" is -say- the memory of one of the aforementioned. And "passion" is -say- an unreasonable befriending or an uncritical hatred of one of the aforementioned. A monk's battle - therefore - is against "passion"».

We regard these distinctions by Maximos to be extremely important for the matter of therapy. First of all, they point out that the fight against "objects" - of beings per se - is an erroneous method, because they give rise to temptations and difficulties. For statements like these to have been uttered by a monk like Maximos - who had departed from "objects" and had distanced himself from the world - reveals that escaping from "objects" is not a solution, nor does remaining close to "objects" (as with those who live in the world) constitute a cause for sickness.  For example, to recommend divorce to someone who is suffering psychologically in the presence of their spouse does not constitute therapy for that person.  Divorce may remove that person's grief for a time, but the problem itself remains intact. That is how the current perception (that a monk leaves the world in order to be "cured" of passions by avoiding temptations) should be regarded as erroneous.  The entirety of ascetic tradition stresses that temptations become even more powerful when one departs from the "objects" that provoke them, because the "notions" of those "objects" - which test the person - remain.

But the same applies to the "notions" of "objects".  The memory and the re-presentation of beings is not per se discommended.  Contrary to what Maximos writes, there are many who oppose art, culture, and whatever else the function of human imagination entails, for the sake of being liberated from passions.  This is an Origen- and Evagrios-like spirituality that Maximos surely had in mind and opposed, because ideas like those were, at the time (and I am afraid they continue to be) prevalent among monks.  Maximos stresses that monks' struggles are neither against "objects" nor against the "notions" thereof, but against the passions that are coupled to them.  A proper therapy demands such distinctions. Otherwise, spiritual freaks are produced: mentally sick patients, who are in need of therapy more than anyone else.

d. But, how can one distinguish between "passion" and "objects" and "notions"?  The answer is provided by Maximos, in the paragraph that follows immediately after the previous one, mentioned above:  The impassioned "notion" is «a composite thought, consisting of "passion" and "notion". When we separate the passion from the notion, what remains is merely a subtle thought. And we can separate them, through spiritual love and continence, if we so wish». The separation of "passion" from a "notion" cannot be done, except by means of love, continence (=self-control) and free will.  However, these elements require more analysis.

Love as freedom, and freedom as love

Albeit keys for a proper therapy, the meaning of the term "love" as well as "freedom" are likewise subject to their own pathologies.  Thus, "love" can, in essence, be a form of narcissism; that is, a love of one's self through the image - the mirror - of another.  Narcissism is considered a disease; however, its forms are so many and indiscernible that it usually cannot be confronted at its root cause.  In reality, every erotic love contains elements of narcissism - the kind that we previously called "self-love", in the words of Maximos.  The "passion" of erotic love consists of the demand for exclusivity that it contains; hence, all of existence is built upon the two persons, as though no other beings exist around them.  Deep down, eros is an egocentric form of love, which can lead to numerous pathological situations (dependence, separation anxiety, etc...)

The same applies, in the case of freedom.  Freedom, as a liberation from the other, can signify the crudest form of self-love - a pathological independence from others - which can lead to depression or even suicide, when one discovers that the others are necessary for him, but not desirable.  Thus the problem arises as to which way love and freedom can not only liberate us from our passions, but also liberate themselves of their own pathology.  At this point, theology could offer the following positions:

a. The transcendence of exclusivity in love. «If you hate some, or, you neither love them nor hate them, and you love some but only with measure, while you love others intensely, then know that you are far from the perfect love, which is supposed to love every person equally.» Exclusivity negates love, because underlying it is some form of self-love.  We love our friends, our children, our relatives, our "lovers" etc. more than the others, because we expect some sort of reciprocation from them, or because some kind of need - psychological or biological - bonds us to them.  The love of those close to us conceals the passion of self-love.

b. The love of enemies.  No form of love is freer than this, and no form of freedom can relate more, than the form that is the love of one's enemies. «If you love those who love you, what is the grace in you? [...] for even sinners do the same» (Luke 6:32).  A love that expects reciprocation is «sinful»; it is pathological. A love that does not expect any reciprocation - or, better still - is directed towards those who harm us, is truly "grace" - that is, freedom.  Loving God "in Christ", "while we are still sinners", as well as loving God's enemies (ie., love towards sinners) is the only liberated love.

In conclusion, it is only when love coincides with freedom that we have therapy.  Love, without freedom, and freedom without love, are pathological conditions that require therapy.

But, how can these two coincide in practice?  It is easy for one to opine on that which should be done, but what does theology have to say, about how to do that which should be done?

The Church as a "therapeutic clinic"

We now come to the crucial point of our homily: in what manner can the Church cure man in practice?

First of all, we need to clarify a misunderstanding that is broadly prevalent.  The Church does not cure so much with what She has, but rather, with what She is.  This detail is extremely important. As a rule, we all seek the means for salvation inside the Church, but salvation lies in the very event called "Church", and our incorporation in Her.  The difference is huge, and it has a practical significance, in regard to therapy.

The Church has spiritual fathers and the mystery (sacrament) of Confession (which should more correctly be called Repentance).  Much emphasis and significance has been placed on this element, when it comes to therapy.  The perfect spiritual father-confessor and a perfect method of confession etc. are sought out, but what is overlooked is that it is not the spiritual father who heals.  He might be tired during the hour of confession, or, he may not have the appropriate knowledge: quite usual things.  Therapy will not occur during the hour of the Mystery, quite simply because the Mystery has man's incorporation in the Church as its objective, and only in there will therapy occur, slowly and in the long term.  How will that happen?

The Church is a therapeutic clinic, because She provides man the potential to transit from the state of an "individual" to that of a "person". What is the difference?  And how does that occur in the Church?

"Individual" is an arithmetical notion, which springs from one's isolation from other individuals - which simply is what it is, because it is not something else.  Deep down, "individual" is a negative notion.  When man exists and acts as an individual, he fences himself off psychologically; he "excises" himself from others. This is a pathological condition, which constitutes a host of morbid phenomena and perhaps is the very source of all sicknesses - it is that which Maximos calls "self-love".  "Individual" does not only comprise a problem of a moral or psychological nature; it also has ontological dimensions.  It is linked to death, which is the par excellence "feeder" and simultaneously disintegrator of the individual; death is that which highlights individualism, by separating it finally from other individuals (each one of us dies individually), and eventually disintegrating it, into decomposition and nonexistence.  Individualism is a carrier of sickness or sicknesses, precisely because deep inside it lurks the fear of death - the ontological nihilism - if this bizarre albeit true contradiction may be permitted.  The same applies, for the body. If, like Maximos, they link self-love to the body, it is not because the body is evil, but because it expresses par excellence the fortress of individualism where lurks the potential for excising ourselves from the others and where death eventually sets its sights and succeeds.  Individualism is the first pathological stage that man goes through,  when he is need of therapy.

The second stage is that of communion. For man to be cured of individualism, he needs to move on, to his relationship with others, with any form whatsoever, even if a negative one: to get angry, to beat or even kill someone.  What is usually known as "defusing" is a form of transcending individualism - a form of "therapy" according to psychiatry.  This is not about the notion of "person"; it is however a form of relationship and communion which appears as therapy, without actually being.

The stage that the Church aspires to bring mankind is beyond this stage, and to the stage of "person".

What is the "person"?

The Church borrows the notion of "person" from Her faith in the Trinitarian God and, after taking it through Christology and Pneumatology, applies it inside the Church. In the Holy Trinity, "person" is a positive notion - an affirmative notion - and not a negative one.  The three Persons of the Trinity differ between each other, not because they are isolated and excised from each other, but on the contrary, because they are joined together inseparably. The more inseparable the unity, the more it will give birth - produce - otherness.  This fact secures ontological completeness and stability, absence of death, and true life. The "other" not only is not an enemy, but is the confirmation of my own identity and uniqueness: it is the You that makes me a "Me" and without which, the "Me" is nonexistent and inconceivable.

And something more.  In the Holy Trinity personal otherness and uniqueness are not justified psychologically, but ontologically. The characteristics that distinguish between the three Persons are only ontological:  each Person is what It is, and nothing else.  The person is not judged by its characteristics, but by the simple affirmation of its identity as a unique and irreplaceable being.  The person is not a personality - that is, a coordinate of characteristics (height, beauty or ugliness, virtue or malice, genius or stupidity etc.); the person is free of characteristics and is not judged by them.

This perception regarding the person is passed into the Church in the form of God's love and freedom towards the world, the way it was expressed "in Christ", with His love towards enemies and sinners.  The Church is the place in which man is not judged by his characteristics (that is what forgiveness means, which he receives with Baptism and Repentance), but by the fact that he is who he is.  Forgiveness and acceptance of someone as a person, as a unique and irreplaceable identity, within the community of the Church, is the quintessence of ecclesiastic therapeutics.   The Church heals, not with the things She says, but by that which She is: a community of love, a love that is not a sentiment (so that we might seek it in the inner self and the disposition of the individual), but a relationship, which demands coexistence and acceptance within a specific community - a community of love, without exclusivity and conditions.  The Church heals, by being such a community, in which the incorporated person becomes freely addicted to loving and being loved; where, in the words of Saint Maximos, «perfect love does not split the one nature of humans... but, forever aiming at it, loves all people equally...  That is why our Lord and God, Jesus Christ, in displaying His love for us, suffered for all of humanity... » (chapters on love, I, 72).

The practical and relentless question however, is: Is the Church a community of love, a place where one passes from "self-love" to "brotherly love"? From sickness to healing?  To the degree that the answer is affirmative, one can refer to the Church as a therapeutic clinic.  Otherwise, She is a pharmacy, which provides people with analgesics, without transforming them from individuals to persons.  Because the term "persons" has the prerequisite of "relationship", and "relationship" entails "community"; otherwise, they continue to be isolated individuals with an "illusion of sanctity". Extra ecclesiam nulla salus (there is no salvation outside of the Church) not because that is where the means for salvation exist, but because in there is where the Trinitarian mystery of the inter-embracing of persons is manifested.

Most people in The Orthodox Church have, to a large degree, lost the awareness of "community", and if today they speak of a "therapeutic clinic", they probably mean it as a pharmacy. But the Church continues to be the true Ark of Salvation, because She has preserved unadulterated not only the faith in the Personal Trinitarian God and the Christ of all-encompassing love, of the Cross and of the Resurrection, but also because She continues to be the genuine eucharistic ("thanksgiving") community, in which are offered those loving relationships that can heal man, by transforming him from an individual to a person. It is this faith, this synaxis and community that we must preserve genuine and active, if we want to regard the Church as a therapeutic clinic.

Going over what I tried to say, I feel that I must point out the following:

For the Church and theology, therapy is not a psychological or moral matter, but an ontological one.  The aim of therapy is not to provide relief for the symptoms of man's sickness, but to ensure his rebirth, by transferring him from the space of self-love where passions are born, into the space of brotherly love, where true therapy through love is found.  This passage from the one space to the other is painful, because it has the Cross as a prerequisite, or, in the words of Saint Maximos, the experiencing of the pain that coexists with pleasure. It is a passage that must be guided with care and philanthropy, «so that what is lame may not be dislocated, but rather, be healed» (Hebr.12:13).

In this attempt, the Church and theology can provide, not so much the technique, the specialization, but rather the faith in the personal God, from which springs the faith in man as a person, an image and a likeness of God; also the love of Christ which has no boundaries and exclusivities, and the Church, as a eucharistic (thanksgiving) community which actualizes that love, as a personal existence and relationship.  The battles against passions and their riddance do not constitute an end in itself for the Church. They aspire to the surfacing of the true person from within them, to the re-joining of fragmented nature, and for man to rediscover his proper relationship with God, with other people and with material nature.  Health, for us, is the proper relationship of man with these three factors (God, fellow-man and nature), which comprise the definition of the human being.  "Sickness" is the upsetting of this triple and three-dimensional relationship.  Perhaps this is what hugely differentiates theology from psychiatry - or perhaps not; you will be the judge.  What is certain, is that both the Church and medical science must coincide in this basic discovery, should a dialogue develop between them.



From the Minutes of a Meeting on «Theology and Psychiatrics in Dialogue»
Minutes published by the Apostoliki Diakonia pages 141-156, (extract)

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Translation by A. N.

Article published in English on: 14-8-2011.

Last update: 14-8-2011.