Orthodox America

  When a Parishioner is Mentally Ill

            It sometimes happens that a priest suspects, in the course of Confession – but more often in the context of pastoral counseling and home visits – that a spiritual child may be suffering from some kind of mental illness.  Although some priests have degrees or training in psychology, the average pastor may be unsure of what help he should give.  The Church herself has made no definitive statement on this subject and there are no clear guidelines.  Some pastors take the position that recourse to professional therapy under any circumstances is dangerous and to be avoided at all cost, while at the other extreme some clergy have no reservation whatever about making referrals to unscreened mental health services.  The purpose of this article is to briefly suggest a middle ground, based upon personal experience both as a missionary priest dealing primarily with converts, and having also served as pastor in a regular Russian parish.

            To begin with, a priest must understand the difference between “pastoral counseling” and “professional therapy.”  He must make this distinction, first, for the sake of his spiritual child’s welfare, and secondly, because we live in a time when priests, ministers, and rabbis are being held accountable in courts of law for advice that touches on explosive emotional problems; in other words, some clergy have been sued for “malpractice.”

            For example, a teenage member of the parish is pregnant out of wedlock.  She tells the priest that she is very depressed and remorseful, but is also considering abortion.  The priest will first of all lead her to complete repentance for her sin, through the Sacrament of Confession.  He will not only manifest the forgiveness of Jesus Christ, but will show his own genuine love and care for her, in appropriate verbal ways.  He will instruct her in the law of God regarding the sacredness of unborn life and the Church’s teaching regarding abortion.  If necessary, he will also counsel her family (and the father of the unborn child, if possible) and, if needed, act as liaison with an agency that specializes in helping unwed mothers who do not want to terminate the life of their unborn child.

            All of this falls within the proper purview of pastoral counseling because the conscience and will of the unwed mother are not paralyzed or dysfunctional; with information (the Church’s teaching), guidance (the application of this teaching to her life), and support (emotional and practical encouragement from priest and family), she can make the right moral choices.

            “Professional therapy,” on the other hand, is the remedial treatment of mental disease by trained and licensed professionals.  Clear examples of such disease – although not to be “diagnosed” by the priest – are manic-depressive, schizophrenic, psychopathic and sociopathic personalities.  Less obvious but more easily identifiable are those behaviors that involve chronic depression (as opposed to occasional sadness), addiction (such as alcohol and drug abuse and sexual addictions), the enormously destructive effects of incest or other sexual abuse, spouse or child beating, suicidal thoughts, eating disorders, etc.  These are all areas in which the individual’s will often becomes so severely disabled or defective that the individual is usually unable to act rationally and responsively to even the best and most loving pastoral guidance, information and support.

            In an Orthodox context, then, the priest’s understanding of the “will” is critical.  St. Diadochos of Photiki says, “Free will is the power of a… soul to direct itself by deliberate choice towards whatever it decides.  Let us make sure that our soul directs itself deliberately only towards what is good (Philokalia).”  Elsewhere he says that temptations are permitted by God, “for in this way man’s free will is constantly put to the test” and strengthened.  And St. Maximos the Confessor states that by exercising free will “each soul either reaffirms its true nobility or through its actions deliberately embraces what is ignoble” (Ibid.); the more it embraces the “ignoble,” the less free and more dysfunctional the will becomes until, finally, it becomes its own appetite, empty of contact or direction (like hunger or lust), craving only to be relieved of its energy.

            (A good example of this is the effect of pornography on the will.  Like a mood-altering drug, it disables the will, leads to other sexual sins and disorders, and even sometimes to criminal behavior, because it takes more and more powerful “doses” of pornography to get the same result.  It becomes an addiction as potent as heroin in its self-destructive possibilities.  Unless a wise and pious priest or parent can intervene at an early stage, it becomes a vicious cycle as the will becomes more and more disabled.)

            Patristically and psychologically, true freedom of will depends upon the information or content it has been given from birth to act upon.  Certain kinds of mental illness, however, either result in, or arise from, a will that is so disabled or blind that it can no longer integrate information; there is no longer full and free interaction between mind and will.  The will then starts to will what can’t be willed; it becomes irrational, impulsive, addictive, violent and, ultimately, manifests itself in life-threatening extremes.  It has lost its way.  In such circumstances, pastoral counseling quickly reveals to the priest that his rational instruction and guidance can be of very little help unless he has specialized training or the help of those who do.

            Of course, the presence of mental illness does not mean that prayer should be neglected for a single moment.  Quite the contrary.  Prayer, the grace of the Sacraments, contact with holy relics and wonderworking icons – all of these must be assiduously brought into contact with the mentally ill.  This assures that the demonic element (which is sometimes present because of the cause-effect relationship between certain kinds of sin and emotional disorder) will be subdued, and that the afflicted one will be receiving maximum spiritual support during a period of professional therapy.  This, of course, is also  the way in which miraculous healing can take place, if God so wills.

            But, just as we have recourse to a medical doctor after first turning to God for help in case of physical illness – believing that God will also act through the hands and medications of the physician, so we sometimes turn to doctors of psychology, believing that God will also minister to the emotionally ill through their wisdom and experience.  Here, however, the priest must fill a critical role in guiding his sick spiritual child into safe and wise hands.

            A pastor can browse through library shelves and bookstores in order to give himself at least an overview of the various kinds of mental illnesses and the treatments currently available.  (I know of both bishops and priests who have done this.)  Naturally, the best course is to contact an Orthodox Christian (whether priest or layman) who has had extensive training in psychology or who may even be practicing in the field.  In a large metropolitan area, one may even have such a resource within one’s own parish.

            Lacking this, the simplest and perhaps fastest solution is to contact a local mental health agency.  Set up an appointment with the administrator of psychological services, and “interview” him.  The priest will discover what services are offered by this particular agency and will then explain a bit about Orthodoxy as a moral and ethical way of life (this is not the place to go into theology or church history).  He will want the agency to know about these things so that they can recommend a counselor or therapist who would be best suited to treat an Orthodox Christian, if one were referred to him – a professional who will not interfere with the religious beliefs of the patient.  Clergy will unfailingly find mental health agencies to be cooperative in this regard.

            Once this groundwork is complete and a spiritual child has been referred to a professional, the priest continues to stay in touch with his spiritual child, prays for him, and urges him to remain closely involved with the life of the Church.  In this way, both strengthening and healing grace restore the emotionally disturbed to more normal and functional life.

Fr. Alexey Young