by Metropolitan Hierotheos of Nafpaktos and St Vlassios
I thank Professor Dimitrios Linos for the invitation to take part in this online course on the general subject of ‘Health and Religion’.
I regarded this invitation as a challenge, and at first I hesitated to accept it. I have spoken on many occasions to different audiences inside and outside Greece about Orthodox psychotherapy and about human health in general from different viewpoints, and I did not want to repeat the same things. For that reason I looked for a subject which would contribute something new to what I have written until now.
I therefore chose the general title ‘The Orthodox Church on Human Health’, but it conceals within it some specific analyses. I shall emphasis three particular points. Firstly, ‘modern Western science’; secondly, ‘human wholeness’; and thirdly, ‘psychotherapy and Orthodox theology’.
1. Modern Western Science
After scholastic theology (11th to 13th century AD), various currents developed in Western Europe, such as the Renaissance, the Reformation and the Enlightenment, which attempted to break away from the identification of physical things with metaphysical things, as scholasticism taught. As a result, the sciences developed independently of faith in God, as preached by scholastic metaphysical theology.
We should also examine medical science in this context. Until the Enlightenment of the 17th and18th centuries, medical science regarded people’s illnesses in terms of their relationship with God, demonic energies and their surroundings. Treatment therefore involved both soul and body, using the various local religious perceptions of society and human beings. From the Enlightenment onwards, however, medical science, like the other sciences, regarded the human body as a machine.
I shall refer, as an example, to René Descartes (1596-1650), the French philosopher and mathematician, who is regarded “as the father of modern philosophy”, Cartesianism, which “derives from the Latinised form of his name.” Descartes “asserted that the universe is a huge machine, that all the things that exist in the natural world are machines – even animals, whom he called automatons, are machines.” As for human beings, he upheld that they have a body that functions as a machine, and a soul that is “the essential part of their existence.” However, the basic feature of the human soul is reason, whereas the basic characteristic of the material body is “extension”, which constitutes the essence of material in space. He asserted that we can observe the body through our senses because it has “extension”, whereas we cannot grasp the soul, which is immaterial, through our senses, but can only think of it.
With these presuppositions, the ‘Cartesian cogito’, cogito ergo sum, “I think, therefore I am”, is familiar. It originates from “I doubt, therefore I am”, which means that certainty of the self’s existence comes from universal doubt. According to Descartes, the fact that I doubt means that I exist, because I would not be able to doubt if I did not exist. Hence, “I doubt, therefore I am” is linked with “I think, therefore I am.”
Cartesian philosophy was the starting point for the major trend that, from the 17th century onwards, influenced the science that developed in the West, medical science as well as the natural sciences. Science regarded the human being as a machine, regardless of psychological states. Thus biology moved on to molecular biology, cells and genes, and scientists strove to identify illnesses, to make diagnoses and to proceed to treatment, in almost the same way as animals are diagnosed and treated. Various sciences developed, such as genetics, genomics, epigenetics, proteomics, metabolics, comparative genomics, transgenomics, bioinformatics, pharmacogenetics, pharmacogenomics, and so on.
It has been observed that modern Western medical science divides into five areas of activity, each of which has lent its name to a type of medicine. Firstly, “bedside medicine”, according to the Hippocratic method, which interprets health and disease in terms of humours and temperaments, and works through observation, placing prognosis above diagnosis, with doctors regarding themselves as servants of nature. Secondly, “library medicine of the Middle Ages”, which was theoretical, based on the study of various writings that encouraged them to dissect the human body. Thirdly, “hospital medicine”, which developed from the French hospital medicine in the 1790s with the diagnosis of disease, and is linked with “routine post-mortem examination”, “comprehensive disease description” and “a generally sceptical attitude to therapeutics.” Fourthly, “community medicine”, which appeared during the period of industrialisation and urbanisation, when they noticed “the prevalence of disease in cities” and were concerned about public health. Fifthly, “laboratory medicine”, that is to say, the “systematic pursuit of experimental medicine” centred on the laboratory, which gave rise to various disciplines, such as bacteriology, pharmacology and immunology.
It is clear that Cartesian philosophy also influenced modern medical science, which regards human beings as physically ill, as living machines that have broken down and need treatment or repair. These humans consist of genes, DNA, cells, tissues, organs, chemical compounds, and the most that can be said is that they are a thinking beings, and therefore exist.
This one-dimensional perception of human beings made it necessary to find their inner depths, because they are more than their bodies. This led to the development of German idealism, with freedom as the transcendence of natural necessity; of existentialism, as a response to the existential questions of human beings; and of the various schools of psychology, psychoanalysis, psychotherapy and so on. This was due to the realisation that, beyond the rational faculty and the bodily senses and organs, there is another world that plays a significant role in human health and sickness.
It is now possible for us to examine humans from many angles, to see that they are interdependent and mutually co-inherent beings, and that, apart from the rational faculty and the senses, they also have a soul. In this perspective, the Orthodox Church plays a major role with her therapeutic method, which for many years now I have called ‘Orthodox psychotherapy’.
2. Human Wholeness
Human beings, according to Orthodox theology, were created by God with a soul and body, as living entities, to live and behave ‘wholly’ towards God, other people and their surroundings. This is theological ‘holism’, without abolishing what is ‘particular’. Their creation makes this clear.
Human beings before the Fall had all the elements that I have mentioned, and this constituted their spiritual and physical health. However, this was fragmented by the choice that they made, contrary to the commandment given them by God. Thus their wholeness was shattered, their relations with God, themselves, their fellow humans and creation were broken, and they live the ‘particular’.
In the Orthodox Church the Fall of man is interpreted from the perspective of the “garments of skin”. The fact that, after human beings had been stripped of divine grace, God clothed them in “garments of skin” means that they put on mortality, corruption and passibility, which break up human wholeness.
The entrance of death into humans is the entrance of a ‘beast’ that consumes their existence and creates many physical and spiritual problems. The genes of ageing, of death and diseases, are present in cells from when the ovum is first fertilised, and the disintegration of wholeness begins from there. The cells in the body die, with a distinction being made between programmed cell death, which is a natural process, and unnatural death, which is called ‘necrosis’.
The mortality that we inherit is linked with corruptibility. Death and corruption wrestle with our life, which holds the whole together, and as a result we are continuously fragmented. Together with mortality and corruptibility, liability to suffering also develops as an unnatural movement of the powers of soul and body. Instead of these powers moving towards God, they move in the opposite direction and are split up from one another, with the result that the wholeness of the human being is lost, and human experience is ‘particular’ and fragmented.
Because they experience mortality, corruptibility and passibility, human beings are always going through “successive crises of death”. From childhood, when at seven or eight years of age they realise that death is a non-reversible event, as Piaget established, they move on to adolescence, when the meaning of life and death concerns them, giving rise to outbursts and rebelliousness. Then they reach middle age, with the awareness of illnesses, decreasing physical powers, disillusionment with their relationships with others, and finally they end up in the third age, in retirement, and see death approaching. In all these phases of life death dominates, producing continuous existential crises.
Through the incarnation of the Son and Word of God, human beings return to the wholeness with which they were made. Christ assumed the whole human nature, together with a mortal body subject to suffering, because “what is not assumed is not cured”, in order that in it He might conquer death and bring immortality and incorruptibility to humankind. He was victorious over death and corruption. This is how we see the work that is done in the Church. From fragmentation we arrive at unity, from isolation we come into communion, and from the particular we reach wholeness, universality.
This is the meaning of true love and the real lover. According to St Dionysius, who conveys the teaching of St Hierotheos, “Love (eros), whether we call it divine, angelic, noetic, psychological or physical, means a certain unifying and uniting power, which moves superiors to provide for subordinates, those of the same rank to support one another, and, finally, those who are lower to return to those who are better and higher.” Elsewhere he writes that the names of love (eros and agape) “denote the unifying, binding and especially uniting power in the beautiful and the good.”
According to St Dionysius the Areopagite, Christ, “the cause of all things, loves everything in His exceeding goodness, makes everything, perfects everything, keeps everything together, and brings everything back. Divine love is good, from a good source, and for a good purpose.” By contrast, love that is not true, which is “divided”, “bodily” and “separated”, is “a mere image of real love, or rather the loss of it.”
This is experienced in the Orthodox Church through the Sacraments and the ascetic life. The Sacraments, such as Baptism, Chrismation and Holy Communion, unite human beings with Christ, and the ascetic life is the precondition for them to become spiritually whole, in soul and body, in the family and community.
Within the Church cognitive psychotherapy is lived in a harmonious way, with the healing of thoughts and life being given a meaning, and behavioural psychotherapy is experienced through incorporation into the Church, which is a community of God and human beings.
Precisely because humans have been clothed in the garments of skin, in corruption and mortality, we also make use of the results of scientific research, as well as everything Orthodox theology offers. The one does not exclude the other, as the spiritual unification of human beings has an effect on their physical state, and the well-being of the body also influences the well-being of the soul.
Christ is described as a physician of souls and bodies and the Church is called a spiritual hospital. Theology is spiritual therapeutic science. God’s commandments are characterised as medicines, priests are regarded as spiritual doctors, sin is called an illness or disease, and holiness means being cured.
These terms are to be found throughout the New Testament, the liturgical texts and the patristic writings. Care is needed, however, lest this terminology and the Church’s mission and task be seen as replacing the science of the body. We accept medical science that treats the body and helps the body to accomplish its work and service but subject to bioethical rules, which medical science itself defines. We neither make a god of science nor demonise it. Since the human being is a psychosomatic whole, theology should collaborate with science.
3. Psychotherapy and Orthodox Theology
The American Psychological Association published a large book entitled Handbook of Psychotherapy and Religious Diversity, the purpose of which, as is written in the Preface, is “to help mental health professionals work more effectively with members of specific spiritual traditions.” This book offers “a more in-depth understanding of the religious beliefs, cultures, practices, and clinical issues of members of specific religious denominations.”
This arose from the need for “mental health professionals” to understand “the religious diversity that exists in the world”, in order to “increase their competence in working with clients from diverse traditions.” Τhis is essential, because it has been ascertained that “the majority of people who present for psychotherapy are religious – many of them devoutly so.”
In the Preface, the editors of the book write that they “are pleased that the American Psychological Association, the American Psychiatric Association, the American Counseling Association, and other professional organizations now include religion as one aspect of diversity that their members are obligated to respect and seek competency in.”
Among the chapters in the book is one entitled “Psychotherapy with Eastern Orthodox Christians”, written by Tony R. Young PhD, who at that time was a graduate of Fuller Theological Seminary Graduate School of Psychology, an adjunct professor of psychology at Louisiana Tech University, and a private practitioner of clinical psychology.
I shall highlight a few interesting points from this article that show that the Orthodox Church contains intensely psychotherapeutic elements.
a) Acquaintance with the Orthodox Church
The article begins with a brief history of Christianity until the schism of 1054, so that readers can recognise the boundaries of the Orthodox Church and differentiate it from Roman Catholicism and Protestantism. Reference is then made to the Orthodox Churches working in America, so that psychotherapists can identify where Eastern Christians are active in American society.
It is noted, significantly, that “Christians of the East have a very different past from that of Christians of the West, Roman Catholics and Protestants alike. The Eastern Christian background has no Middle Ages, no Reformation and Counterreformation, no Inquisition, and no Renaissance. Christians of the East and West start with different questions.”
Some elements of Orthodox teaching are then set out about the Triune God, the creation of human beings and their Fall, through which death came into their lives, mentioning that “Orthodox understand the fall of humanity as the loss of the likeness of God”, whereas the image of God “is never lost in any human.” All the Church’s teaching is recorded in Holy Scripture, the liturgical texts, in the writings of the divinely inspired Fathers of the Church and their interpretation of Scripture and Tradition. The foundation of all these things is the Orthodox Church herself, and the word Orthodox denotes “right worship” and “right belief”.
“Worship for Orthodox is a distinctive feature and is central to the Church’s ethos.” Orthodox Christians in the Church have as their basis the Sacraments, including Baptism, Chrismation, Confession, Marriage and the Divine Eucharist.
Along with the Sacraments, the Orthodox Church also ascribes great importance to fasting, which “is part of Orthodox askesis or spiritual training”, to prayer in the morning and evening and at meals, and to the spiritual father, or staretz, as he is called in the Russian tradition: “Orthodox do not set out on the spiritual path with any seriousness without a spiritual father.”
Among prayers, the “Jesus Prayer, sometimes called the Prayer of the Heart” has an important place. “In many ways the Philokalia, a collection of the writings of the Fathers, is a manual for those following this path.”
Overall, as the author writes, “The goal of life in the Church and of life itself for the Orthodox is to achieve theosis or divinization, that is, becoming by grace what God is in His nature.” This is the meaning of the Christian’s salvation. “The Orthodox soteriology is oriented around the incarnation, the coming in the flesh, and the resurrection of Jesus Christ.”
It is explained that “other Christian faiths hold to a more legal or propitiational view” of salvation. By contrast, “For Orthodox, by His coming in the flesh and His victory over death in His resurrection, Jesus Christ provided a way for humans to defeat death. This salvation is accomplished by a synergy of the gift of God’s grace and man’s effort. Orthodox do not speak of having been saved [apparently as the Protestants do] but of being in the process of being saved.”
The article notes that “there are many intertwining ways of speaking about spiritual development in the Orthodox Church. One is theosis. Another is transforming or overcoming the passions. Another classical formulation relates the image of God in humans, which is never lost or changed, and the likeness of God which for most of us is either very dim and weak, if apparent at all. Orthodox are asked to become more like God to increase the likeness of God on the basis of the image of God in each one of us.” “The true aim of our Christian life consists in the increasing acquisition of the Holy Spirit of God.”
b) The Orthodox Church as a Spiritual Hospital
Within this framework it is clear that the Orthodox Church resembles a spiritual hospital that cures Christians’ spiritual diseases. The article writes: “The Church has taught that it is a hospital for sinners who seek spiritual health. She offers her cure in full to all. For Orthodox, repentance, or metanoia, is the way to keep from allowing sin to become a permanent state of being and is a change of mind – a turning about of one’s mind and behavior. The Church sees Herself as composed of persons who are continually repenting.”
The Christian’s path is seen as therapeutic treatment that is given in the spiritual hospital, the Church, by spiritual doctors who are spiritual fathers. The goal is the health that is described as theosis.
The author writes: “Orthodox believe that a life of holiness is required to please God. The moral standards are high; however, in practice a great deal of flexibility is found. The interpretation and implementation of rules may be strict or lenient, depending on the situation. Human weakness is recognized.”
This article by Tony Young refers to the “Orthodox perspectives on healing and spiritual development” of Orthodox Christians, which takes place within the Orthodox Church. As well as many things that have already been mentioned, he writes that “the spiritual practices and beliefs of Eastern Orthodoxy can have a positive emotional or psychological effect”, aside from theosis. “This is despite the fact that they are not designed for psychological health, but for spiritual health.” A distinction is made here between psychological and spiritual health. The Orthodox Church aims at spiritual health, which is perceived as deification, but also influences the psychological health of Christians.
This is clear in “the two most important of these practices”, which are the Sacrament of Confession and “the practice of the Jesus prayer”. The Christian’s soul is healed through confession, and “the Jesus prayer, in addition to focusing the mind and heart on God and moving the person toward living minute-by-minute in the consciousness of His presence, tends to have a calming effect. It leads a person to better awareness of the self and its passions and to self-knowledge.”
c) Orthodox Psychotherapy
The writer of the article, to illustrate the “Orthodox perspectives on healing and spiritual development” of Orthodox Christians in the Orthodox Church, refers to two authors who have worked to demonstrate this fact in relation “either to the psychology of spiritual development in Orthodoxy or to Orthodox practice as therapy.”
The first author to whom he refers is “Archbishop Chrysostomos of Etna” in California, who follows the Old Calendar. Taking elements from the book Evergetinos, he selected sayings from the Fathers on four subjects that “touch on each aspect of the process of transformation known as theosis or divinization.” This resulted in four books entitled Humility, Obedience, Repentance, and Love. “Humility and obedience lead to repentance, the changing of the mind – metanoia” and this brings about “the return to our true nature, the authentic purity of the image of God in us”, which is love for God and our fellow human beings. This is “the pinnacle of development.”
The second author to whom he refers is myself, from the time when I was a priest and had written the book Orthodox Psychotherapy. He writes that in this book, which he has read, he understood that the author had “systematized the ideas of the Church Fathers on the therapeutic aspects, goals and activities represented by the Orthodox spiritual tradition.”
He notes from this book that “the principal therapeutic goal of Orthodoxy [is] the healing of the nous”, through which one knows God. “Nous is distinct from reason, feeling, and conceptual knowledge.” The nous is “the eye of the soul”, which, once it has been cleansed, “is capable of immediate experience of God as opposed to experience of mere ideas or notions about God. Other ways of speaking of this state would include becoming Christlike and becoming pure in heart.”
The book Orthodox Psychotherapy points out that the Church is like a hospital that is concerned with “pathology”, in other words, the healing of passions. Passions darken the nous and pervert what is natural in human beings. Some basic passions, such as self-love, love of glory, ignorance and forgetfulness of God, laziness, and love of possessions “are seen as leading to a long list of the ills and sins of the soul.” “Cure of the passions and their transformation” leads to “the ultimate goal”, which is “communion with God and vision of God.”
d) Orthodox Psychotherapists
Tony Young, having briefly referred to and described the psychotherapeutic elements of the Orthodox tradition, notes the reasons why some Orthodox, even though they could accept such therapeutic methods, nevertheless turn to psychotherapists. He writes that this depends, firstly, on “the frequency with which they [Orthodox Christians] participate in the liturgical life of the Church”, in the services and Holy Communion; secondly, on the extent to which they pray; thirdly, on whether they avail themselves of the Sacrament of Confession; fourthly, on whether they practise the Jesus prayer; and lastly, “whether they have a relationship with a spiritual father or guide.”
I should, of course, add that it also depends on the neurological state of each individual’s organism, which may require help from science. Also, Tony Young observes that “The Orthodox Church makes little or no effort to reconcile faith and reason. Orthodoxy accepts support from the sciences but feels no need to justify Herself to the findings of science.” This is because, as we Orthodox theologians know, the nous, which must be purified in order to attain to the experience of God, is not the same as the rational faculty, through which human beings communicate with their environment and become involved in science.
Once he has briefly, but correctly, explained the therapeutic elements of the Orthodox tradition, the author draws the attention of psychotherapists to how they should behave towards Orthodox Christians who for various reasons turn to them for help.
Under the heading “Psychological Interventions Congruent with Orthodoxy”, he writes that “most Orthodox will not respond well to spiritual interventions in psychotherapy or counseling”, because “they will likely see the area of spiritual guidance or development as the domain of their priest.”
The psychotherapist should therefore avoid conflict with them and should “consider carefully interventions that are intended to influence a client’s religious views, as would be the case in dealing with clients of any tradition.”
Before the psychotherapist treats someone who is seeking help, “a conference with the client’s parish priest, of course with the person’s permission, would also help any therapist to plan better and more effective interventions.” This is essential because “many, if not most, Orthodox clients will have spoken with their priest about their psychological problems before making an appointment with a therapist. In most cases, the priest will have already made his suggestions to the client. The suggestions will have covered both the psychological and spiritual aspects of the situation.”
Psychology, psychoanalysis and psychotherapy developed in the Western, mainly Anglo-Saxon, world, where Roman Catholics and Protestant Christians are distinguished by rationalism and moralism respectively, so something new was required to meet the human being’s inner needs. On the other hand, agnostics, humanists and atheists needed support in their existential and psychological needs.
However, the findings of psychological, psychoanalytical and psychotherapeutic research projects, which are also coordinated with neuropsychiatry, have broadened out to include the religious domain, and even Orthodox Christians, who were either ignorant of their own psychotherapeutic tradition, or had neurological problems due to the biochemical functions of their organism.
Orthodox theology is not dominated by antagonism between faith and science. Therefore, as Tony Young writes at the end of his study, “Orthodox clergy are open and willing to work with psychotherapists. Many clergy have training in psychotherapy, and several are clinical psychologists.”
In any case, Orthodox clergy “may feel more responsibility for members of their flock than other pastors.” Collaboration is therefore required for the sake of human beings, so that the findings of these sciences can also be used, although they developed in the West. However, because they presuppose the Anglo-Saxon type of human being, they must be reinforced with “indigenous psychotherapy”, as Kenneth Gergen advocated, which is the Orthodox tradition.