Anointing for Mental Illness

I follow Fr Edward McNamara’s weekly liturgy Q&A feature on Zenit. Even if I disagree with his response (which I do this week) I have to admit the guy is willing to engage some of those who write to him. It’s not unknown for him to change his mind.

This week’s question:

Could someone who has mental problems/disorders receive the anointing of the sick? … I have a friend in Nova Scotia who visited a shrine in Quebec last summer. The shrine held a special anointing of the sick, but the priest announced that it was only for those truly ill and/or with a life-threatening illness. My friend was truly upset and didn’t know whether to receive the anointing. She has had cancer and now suffers an anxiety/panic disorder, always living in fear of the cancer returning.

We covered this in the Pastoral Care rites at length two years ago. The sacrament is for those who are seriously ill. The documentation doesn’t distinguish between physical or mental illness. Anointing is usually done once per illness, unless there is a remission or the person is elderly.

More instructive than the lists in PCS 8-12 is the intent of the sacrament. Anointing is not equated with healing and recovery. It is meant to serve for situations in which the person’s serious illness impinges on their faith.

I’m not familiar with the particulars of an anxiety/panic disorder. But it would seem to me that the sacramental situation is better addressed in the person’s home parish. Ponder it: you could get your infant baptized or get married while on pilgrimage–theoretically. But for many reasons, it wouldn’t be the first choice.

I appreciate that a religious shrine would offer anointing of the sick for pilgrims. Elderly people might benefit–and by the way, Fr McNamara errs in assigning an age to this category. The rite does not. (I think that some people age 70 are far from elderly, and certainly many younger people are “older” in the sense of their general weakness and attitude toward life.)

A cancer survivor with anxiety about the disease returning … this is a situation for pastoral counseling and spiritual direction. For a diagnosed disorder, it would be the occasion for anointing–once for a non-elderly believer.

Cases like this need to be handled more sensitively and creatively. If you get one anointing for a mental illness, then perhaps such an anointing should be planned to coincide with a breakthrough in therapy. The celebration of the sacrament might include a preparation period in which the purpose of anointing is carefully explained and applied to the individual’s situation. Anointing would be best done in the local community, surrounded by loved ones and other supporters. At minimum by the person’s pastor, someone presumably involved with the situation.

As I read this situation I was struck by the missed opportunity involved with a person getting anointed while on pilgrimage. What do you think?

 

Anointing Palms Down

A retired priest was in line for Anointing of the Sick. He presented his hands palms down for anointing. The parishioners behind him noticed, and figured the clergy must know best, so the whole line presented themselves for anointing backhanded. My present pastor was at the sacramental end of that line and after the liturgy asked his elder brother priest why he set that example for everyone.

Once a priest’s palms are anointed, the explanation went, they cannot be anointed for anything else. Ever hear of that, my pastor asked me. I had not. Have you?

 

Anointing: Not So Easily Categorized

It is a feature of post-conciliar catechesis to subdivide the seven sacraments into three neat categories: initiation, healing, and vocation. If one looks at the surface, it makes sense to group Baptism-Confirmation-Eucharist as the liminal event that completes one’s initiation into the Body of Christ. Penance and Anointing share a remedial quality. As practiced in the West, Marriage and Orders are almost always tines of a fork in adult life, each leading to its own expression of vocation.

A close examination shows these divisions are not so self-contained. Baptism inspires a vocation as well: the call for the believer to be priest, prophet, and king witnessing to Christ in the world. Many believers emphasize Baptism as the primordial sacrament of vocation. I would not disagree.

Baptism also forgives sin. Indeed, it may be the primordial sacrament of forgiveness, as practiced in the early Church, as well as when it is celebrated with believers who have reached the age of reason. We might recategorize the three sections with a symmetrical three sacraments each:

Yet details of pastoral practice frustrate an absolute delineation. In effect, Penance is now part of the initiation sequence. Its catechesis is required before completing the initiation of the infant-baptized. Some believers seem to lump it in with the non-repeatable sacraments like Confirmation. Even if some theologians might argue Penance is an elementary-age interloper, in practice, it is the second of four initiation sacraments.

Consider, too, that other category, the repeatable sacraments: Eucharist and Penance in practice. Anointing in theory. Orders too, in that a person can be ordained twice and consecrated (a bishop) once.

In a word, our sacraments have issues when we try to box them in. But I’d like to consider a notion that sacraments, instead of being easily categorized into three neat boxes, are actually a tangle of threads. Where our practice is clear and spiritual fruitfulness is great, the sacraments are a beautiful tapestry. Where not, perhaps a tangle of knots and confusion. Where does Anointing lie? In the tangle, or in the tapestry?

As we’ve just completed an exhaustive survey of the pastoral care rites, it seems timely to devote some reflection space to Anointing. I’d like to propose that Anointing of the Sick has qualities of vocation. This is not a new idea. I was exposed to it in grad school through Jake Empereur’s book Prophetic Anointing. The Benedictine Sister Genevieve Glen also has contributed significantly in the theology and pastoral reflection of this sacrament. While I don’t profess an up-to-date familiarity with the current scholarly approach on Anointing, I would offer a few thoughts, channeling Empereur and Glen somewhat, and my own observations from a few years spent in ministry to the sick and dying.

Anointing of the sick and especially the elderly, has an echo of baptism. At our moment of being born again, we are designated priests, prophets, and kings. The sick person serves the faith community in each of these roles, though in a distinctive way. The Old Testament understanding of the priest was a person who prayed to God, interceded on behalf of the people. Prayer is one way in which sick people serve and assist the Body.

I once spent two months in bed from a back injury and subsequent surgery and recovery. It was a frustrating time, eight weeks of doubt and concern. But I tried to pray. When I got sick of praying for myself, I tried to pray for others. 

Many elderly folks I’ve known have been superb at maintaining prayer as a connection to their parish. Like priests of old, they are set apart, and they have time, silence, and the space in which to pray for others.

As prophets, the sick and the elderly stand in stark witness in a culture that tries to cover up illness and death. As the media bombard us with visions of young people full of vitality, strength, beauty, and accomplishment, the sick stand in contrast. The elderly and the sick remind each of us, and all of us, that we are mortals, that our bodies and minds will fail, and eventually we will hand over our lives. Will we do so with dignity? Or will we be dragged kicking and screaming into what lies in the afterlife? Get a clue, the ill and the dying are saying to us.

The experience of illness is also one of identification with Christ the King. Christ was a King who acceded to sacrifice, handing himself over, and surrender to the Father’s will. The royalty of a Christian is based not on the finery of externals. Nor does it accompany the use of power. Few believers have the opportunity to witness to the true royalty of Christ in asuch a profound way than when we are sick and dying.

Anointing is also a sacrament of vocation. The elderly believer enters into a stage of life, crossing a threshhold into a time of decreased mobility, vigor, and … is there anything positive? The sick person struggles with meaning, decreased freedom, a change in lifestyle sometimes short-term, sometimes not. Can there be a positive from this,too? One would hope so. Jake Empereur suggests the sick and the elderly have a special vocation, and Anointing of the Sick is the ritual celebration for both the anointed and for the Church: 

This sacrament is a celebration of the fact that because of Christianity, the sick and old person who is fragmented can be brought back together again. It is an articulation of the truth that by dying to oneself, by being the kind of marginal human being a sick and old person is, one opens oneself to a fra greater wholeness. In turn, the sick and old person who is anointed, as well as the rite itself, speaks to the Church reminding it that there is a deeper meaning to sickness and old age than what can be explained by the medical and psychological professions. Thus, those who are anointed minister to the rest of the Church who are well and in the fullness of life. (Jake Empereur, SJ, Prophetic Anointing, p 141)

This is why the Church’s liturgies for pastoral care of the sick and dying are so important. It is vital that the anointed experience in the rite what is expected of them. They are not passive recipients of spiritual healing. They are not being sent off alone with a blessing and a prayer. Likewise, the faith community, especially the family and friends of the anointed, will need to see through the rituals that there is something beyond a person’s failing body. How do we find an encounter with Christ in the midst of suffering and failure?

I’d like to leave off with that thought for now. It is worth exploring in more depth, but I’ll leave that for a better theologian or after some reflection time. Meanwhile, any of your thoughts to add?

 

PCS 299-305: Rite of Penance for the Sick and Dying

The PCS has one appendix. It deals with the Rite of Reconciliation of Individual Penitents.

299. This form for celebrating the sacrament of penance is for use when it is necessary in the following cases: during communion of the sick; during the celebration of anointing; during the celebration of viaticum. As far as possible, the indications contained in the pastoral notes preceding these rites should be observed.

In other words, adaptations are largely accomplished here. The basic outline includes:

PCS 300: Invitation to Trust
301: Revelation of State of Life
302: Confession
303: Acceptance of Satisfaction
304: Penitent’s Prayer of Sorrow
305: Absolution

Commentary:

The invitation to trust reads like an extended ritual greeting. Here’s option C:

The Lord does not wish the sinner to die but to turn back to him and live. Come before him with trust in his mercy. R. Amen.

The revelation of the state in life is known to most Catholics as the preface before the confession: how long has it been, particular difficulties, and “anything else which may help the priest to exercise his ministry.”

The Confession is preceded by a general formula like the Confiteor or something similar “where it is the custom.” As we’ve read before a “generic” confession may be judged sufficient by the confessor.

What sort of act of satisfaction might be given a sick or dying person? The rite explains a bit:

This act of penance may suitably take the form of prayer, self-denial, and especially the uniting of sufferings with those of Christ for the salvation of the world. This will underline the fact that sins and their forgiveness have a social aspect, and will emphasize the important role the sick have in praying with and for the rest of the community. 

#304 refers to the penitent’s act of contrition. The rite gives two options I’ve never seen memorized before. Each is well-soaked with Scriptural references: Peter’s denial and forgiveness, the prodigal son, the repentatn thief.

In giving absolution, the priest is cautioned about not permitting the gesture of extending his hand to be confused with the ritual acts in the sacrament of anointing. And that finishes up the Pastoral Care rites. I may take a day or two to reflect and offer some final comments. Meanwhile, the floor is all yours.

 

PCS 297-298: Scriptures for the Pastoral Care Rites

The Pastoral Care rites offer lots of readings. Section 297 offers suggestions for visiting the sick, praying for the sick, and anointing. The nine Old Testament offerings are a pretty weak variety. Four from Job, three from Isaiah, plus Elijah in 1 Kings and Wisdom 9. Whoever was on the committee researching these did not do his or her job.

New Testament choices include four from Acts (for the Easter Season) and nineteen from the other books. I can think of more than two selections from 2 Corinthians.

Responsorial Psalm options are better: fourteen in all, including Isaiah 38, Psalm 6 and 86. Off the top of my head, Psalms 62 and 130 are notably absent. Twenty choices are offered from the four gospels. Many, but not all, are healing miracles of Jesus.

PCS 298 offers seventeen total texts for the Mass for Viaticum–even more of an impoverished selection. Notably missing from the Old Testament choices would be Isaiah 25, the Messianic banquet, among others. Only five psalms and two gospel readings.

It’s no wonder the rite has mentioned several times that clergy, planners, and family are free to use these or other appropriate readings. We’ll finish up tomorrow with an appendix on Penance, and some final summation thoughts later this week.

 

PCS 292-296: Viaticum and Concluding Rites

These five sections finish up emergency initiation. They follow closely the viaticum rites discussed earlier at 192-196. PCS 292 introduces and prayer the Lord’s Prayer. 293-294 give the Communion rite.

The blessing is given in 295, with options. If any of the Eucharist remains, it may be used to make a sign of the cross in blessing the sick person. This section refers back to blessing forms given earlier in PCS 147, option B or C, the concluding rituals for anointing outside of Mass or within Mass. As we saw before in other rituals, the sign of peace is placed at the end of the initiation liturgy.

Peace as a gesture of leave-taking seems to be the theme of the PCS. I note that in the initiation option without Communion (289) the rite gives no provision for an exchange of peace–the Lord’s Prayer concludes the liturgy.

 

PCS 285-291: Liturgy of Christian Initiation

When we get to the examinatino of RCIA, we’ll look at the full adult initiation rites thoroughly. The emergency rites in the PCS date between the provisional first edition of RCIA (the brown book, 1972) and the current rite (1988)–remember the PCS dates to the early 80′s.

Initiation on the death bed is straightforward. PCS 285 asks the sick person to reject Satan, his works and his empty promises. A profession of faith follows (286). Choice one: the baptismal profession (PCS 190) made at viaticum, the question and answer format. Choice two: the Apostles’ Creed. Baptism immediately follows (287) with the Trinitarian formula, no prior questions.

A priest or deacon anoints if confirmation will not be following (288). The following invitation is offered if neither confirmation or viaticum will be celebrated. I would imagine a lay person would lead this if she or he did not bring the Eucharist:

N., God our Father has freed you from your sins, has given you a new birth, and made you his son/daughter in Christ. Soon, God willing, you will receive the fullness of the Holy Spirit through confirmation, and will approach the altar of God to share the food of life at the table of his sacrifice. In the spirit of that adoption which you have received today, join us now in praying as our Lord himself taught us …

And the Lord’s Prayer follows, prayed by all. Note the balanced description of the Eucharist: meal and sacrifice.

PCS 290 gives the ritual for confirmation. There is a brief instruction or introduction. In turn, there follows a period of silent prayer, the laying on of hands, a prayer over the candidate, then anointing and the exchange of peace. This is as given in the Rite of Confirmation (introduction blogged here) sections 54-56. One final section:

291. In case of necessity, it is enough to anoint with chrism, while saying the words: “N., be sealed with the Gift of the Holy Spirit.” If possible, the priest should first lay hands upon the sick person with the prayer: “All-powerful God.” After confirmation, viaticum, if possible, should be given to the neophyte. Otherwise, the celebration ends with the recitation of the Lord’s Prayer by all present.

It would seem a curious thing or unusual event if a priest were prepared to celebrate confirmation, but not viaticum. That prayer referenced, “All-powerful God,” is the text of the prayer that occurs after the laying on of hands and before the sacramental anointing.

Any comments?

 

PCS 283-284: Liturgy of the Word

PCS 283 suggests two possible gospel readings: Matthew 22:35-40 (the greatest commandment) and John 6:44-47 (belief leads to eternal life). Section 284 gives the text of a litany–eight intercessions that focus on the intentions of the sick person, focused mainly on the nature of baptism:

Father, increase his/her faith in Christ, your Son and our Savior; in faith we make our prayer: R. Lord hear us.

Grant his/her desire to have eternal life and enter the kingdom of heaven …

Fulfill his/her hope of knowing you, the creator of the world and the Father of all …

Through baptism forgive his/her sins and make him/her holy …

Grant him/her the salvation which Christ won by his death and resurrection …

In your love adopt him/her into your family …

(Restore him/her to health so that he/she may have the time to know and imitate Christ more perfectly …)

Keep united in faith and love all who have been baptized into the one body of Christ …

These intercessions may be adapted, or eliminated entirely, if the condition of the sick person would merit.

 

PCS 281-282: Brief Instruction and Dialogue

The initiation rites begin with an informal greeting followed by a dialogue with the sick person. First:

281. The minister greets the family and then speaks with the sick person about the request for baptism and, if the sick person is not a catechumen, about the erasons for conversion. After deciding to baptize him or her, the minister should, if necessary, instruct the person briefly.

Then the minister invites the family, the godparent, and some friends and neighbors to gather around the sick person, and selects one or two of these as witnesses. Water, even if it is not blessed, is prepared.

The minister makes inquiries of the people present, differently worded from what you would hear in a church baptism:

282. The minister addresses the sick person in these or similar words:

Dear brother/sister, you have asked to be baptized because you wish to have eternal life. This is eternal life: to know the one, true God and Jesus Christ, whom he has sent. This is the faith of Christians. Do you acknowledge this?

R. I do.

As well as professing your faith in Jesus Christ, you must also be willing to follow his commands, as Christians do. Are you willing to accept this?

R. I am.

And are you prepared to live as Christians do?

R. I am.

(Promise, therefore, that once you have recovered your strength, you will try to know Christ better and follow a course of Christian formation. Do you so promise?

R. I do.)

Turning to the godparent and to the witnesses, the minister asks them the following questions in these or similar words.

You have heard N.’s promise. As his/her godparent do you promise to remind him/her of it and to help him/her to learn the teaching of Christ, to take part in the life of our community, and to bear witness as a true Christian?

R. I do.

And will the rest of you, who have witnessed this promise, assist him/her in fulfilling it?

R. We will.

The minister turns to the sick person and says:

Therefore you will now be baptized into eternal life, in accordance with the command of our Lord Jesus.

The questions channel the intent of the various rites of initiation. They also reinforce the role of the godparent and the communit: faith is lived as a community experience; it is reinforced and lived by people assisting each other in the grace of Christ.

Other comments?

 

PCS 278-280: Recovery and Children

Let’s wrap up the introduction to Christian Initiation for the Dying. First, two sections that describe the church’s expectations should a dying person recover after being initiated:

278. One already admitted as a catechumen must make a promise to complete the usual catechesis upon recovering. One not a catechumen must give serious indication of being converted to Christ and of renouncing pagan worship and must not be seen to be attached to anything that conflicts with the moral life (for example, “simultaneous” polygamy, etc.). The person must also make a promise to go through the complete cycle of initiation upon recovering.

279. If persons who were baptized in proximate danger of death or at the point of death should recover their health, they should be given a suitable formation, be received at the church at a fitting time, and be given the rest of the sacraments of initiation.

Children present the same challenge to the parish’s priest and pastoral care ministers:

280. As far as possible, the Rite of Baptism for children and the Rite of Confirmation are celebrated in the usual way. The eucharist completes the sacraments of initiation. A dying child with the use of reason shares the common responsibility of receiving viaticum. It is also desirable that an even younger child complete his or her initiation by the reception of the eucharist, in accord with the practice of the Church.

Commentary:

There seems to be an expectation that the catechumen will be baptized, and that the renunciation of what conflicts with Christ has already taken place. This is more instructive on what the Church teaches about the entry into the catechumenate, that there is already a movement in the newcomer’s life to conform to Christian belief.

For the person not in the Church (Catechumens are seen as part of the Body of Christ–they are not “outside.”) there are perhaps two promises to be made. It would be left to the minister of baptism to ascertain a genuine renunciation.

The expectation is that a recovering neophyte will complete initiation (confirmation, and perhaps the Eucharist) at the church. This permits the faith community to welcome a new member, as they welcome regular catechumens.

What about non-Catholic Christians? Obviously the Church does not re-baptize someone who is already a valid part of the Body. Orthodox Christians, Protestants, and Anglicans may request the sacraments of the Catholic Church and validly and appropriately receive them in true pastoral need. The time of death would certainly qualify.

Children younger than seven may be confirmed and receive viaticum. I wouldn’t imagine there is an age limit, given the long Christian tradition of giving Communion to infants.

Thoughts?

 

PCS 276-277: Baptism, Confirmation, Eucharist

276. Anyone, catechumen or not, who is in danger of death may be baptized with the short rite that follows, as long as such a person is not at the point of death and is able to hear and answer the questions. When no priest or deacon is available, any member of the faithful may baptize.

If the sacred chrism is at hand and there is time, a priest who baptizes should confer confirmation after the baptism; in this case the postbaptismal anointing with chrism is omitted.

Also whenever possible the priest or deacon, as well as a catechist or layperson having permission to distribute communion, should give the eucharist to the person newly baptized (with the special words proper to viaticum). In this case the sacrament may be brought before the celebration of the rite and placed reverently on a table covered with a white cloth.

277. When a person is at the point of death or when time is pressing because death is imminent, the minister, omitting everything else, pours natural water (even if not blessed) on the head of the sick person, while saying the usual sacramental form.

The Church has catechized lay people well; practically everybody knows that a baptized person may baptize in case of emergency and no cleric is present. We should be aware that the short rite can take place only when the dying person can respond to the questions of the rite. And in case of true need, one only needs natural water and the sacramental form.

 

PCS 275: Christian Initiation for the Dying

The considerations of initiating a dying person cover the last major portion of the rites of pastoral care of the sick (275-296). We’ll take it in several posts, starting with the first of six sections of the introduction:

275. The rites of Christian Initiation are normally celebrated over a period of time. This allows the dying person, family, and friends to benefit fully from their celebration. In such circumstances, the rite of Christian Initiation of Adults should be used.

When we get to the RCIA and its 597 sections, plus national statutes, we’ll see how such provisions would be made for a sick person not in immediate danger of death. The Church does place great spiritual value in a gradual catechumenate, based mainly on the witness of the great Doctors of both West and East and their witness in the Christian tradition.

These emergency rites provide a most abbreviated form of baptism, as we’ll see.

 

PCS 264-274: Emergency Rites

Here are the priorities for the emergency rite:

PCS 264: The sacrament of penance is celebrated if the dying person wishes. As we read in PCS 241, “in case of necessity, the confession may be generic.”

265: The apostolic pardon for the dying (see PCS 195)

266: The Lord’s Prayer

267: Distribution of Communion as Viaticum. Here, the priest shows the blessed sacrament under either or both forms and concludes with the brief prayer:

May the Lord Jesus Christ protect you and lead you to eternal life. R: Amen.

Others present may receive Communion.

268-270 give the anointing ritual, if time and circumstances permit:

There is a final blessing (PCS 271) and the instructions given for the Sign of Peace and follow-up pastoral care (272-274) echo what we read in PCS 256-258.

Whew! Any commentary?

 

PCS 263: After Death

Unfortunately, some families and individuals do not call the parish for a priest until after their loved one has died. The rite foresees this unfortunate option:

263. When a priest has been called to attend a person who is already dead, he is not to administer the sacrament of anointing. Instead, he should pray for the dead person, asking that God forgive his or her sins and graciously receive him or her into the kingdom. It is appropriate that he lead the family and friends, if they are present, in some of the prayers suggested at the end of the “Commendation of the Dying,” as already mentioned. Sometimes the priest may find it necessary to explain to the family of the person who has died that sacraments are celebrated for the living, not for the dead, and that the dead are effectively helped by the prayers of the living.

Note the value attached to participation by the mourners of the dead: the priest leads the loved ones and friends in some of the prayers given in the rite. The rite assumes that this prayer will be a comfortable one, perhaps for people who experience a disconnect from the Church–one that may have delayed their call for a priest. It would seem the litany form might ease inexperienced people in to the moment of prayer.

Most difficult for the priest would be the situation in which he finds himself confronted by a possibly angry family expecting him to anoint, and give pardon and communion to an obviously-dead person. In that case, I don’t think the wording above will calm concerns. The PCS rite has lots of prayers and readings. The body may be sprinkled with holy water (PCS 225). Most families would be satisfied with something substantive.

If there is doubt about death, however, the Church is prepared here, too:

If the priest has reason to believe that the person is still living, he may anoint him or her conditionally. In this case, the sacramental form is introduced with the words: “If life is in you: …”

Thoughts?

 

PCS 261-262: Sacramental Priorities

Continuing with some sacramental details in the extreme emergency situations, we read:

261. If the dying person wishes, the sacrament of penance is celebrated first. If necessary, the confession may be generic. Because of the emergency situation, viaticum follows immediately. Christians in danger of death are bound by the precept to receive communion. If there is still sufficient time, the anointing of the sick may then be celebrated. The brief rite which follows has been provided for the celebration of these sacraments in such a situation. The priest should judge, in light of the particular circumstances, how much or how little of this rite is possible.

262. After the celebration of the abbreviated rite for emergencies, the priest should continue in prayer with the dying person, if possible, and with the family and friends, as suggested in the “Commendation of the Dying” (PCS 212 ff). When death has occurred, some of the prayers suggested at the end of the “Commendation of the Dying” may be said with the family and friends.

Commentary:

The pastoral judgment of the priest is important. More than the good ol’ red-n-black.

Though we know that anointing isn’t just about healing, note that it still has third position in the sacramental priorities at the time of death.