Wednesday Liturgy: Follow-up: Anointing for Mental Disorders
ROME, OCT. 26, 2010 (Zenit.org).- Answered by Legionary of Christ Father Edward McNamara, professor of liturgy at the Regina Apostolorum university.
Our discussion on anointing of the sick (see Oct. 12) generated much positive interest, and I wish to revisit the topic by sharing some of the insights offered by our readers.
A medical researcher from Australia offered two especially pertinent comments.
First: "The physical basis of a state of illness, while relevant to treatment, can be a somewhat slippery science, especially in mental and psychiatric illness. As you dutifully point out, severity and pathology are better distinguished; the former is relevant to the sacrament while the latter probably much less so. The particular question of whether a certain kind of illness is primarily 'physical' can be somewhat academic -- and even more so if trying to dissect the contribution of 'physical' and 'non-physical' components behind the suffering of a particular individual."
I agree with our correspondent that severity is the principal consideration to make in deciding when to anoint. As our reader points out, diagnosis is very difficult in these cases. One of our correspondents commented that she had been misdiagnosed for 20 years as suffering from mental illness when the cause was a severe food allergy.
Although the possible physical origin of apparent mental illnesses is not a fundamental argument, I thought it germane to the theme as in former times there was much insistence on the sacrament of the sick being primarily orientated to physical illnesses.
Second: "You say, '[S]uch situations should be handled on a case-by-case basis and in consultation with the person's physician.' I agree that case-by-case is the only sensible option, and I hope I have not misunderstood your intention but it seems that you also advise uncertain priests to routinely approach the individual's treating physician. For better or for worse, in the majority of situations the treating physician will probably be unwilling to discuss particular patients, even with a priest. I can think of exceptions, for example, some hospital chaplaincy contexts, but these would be the exceptions to the rule. It may be that physicians may be flexible for priests in very Catholic countries (of which I claim no experience) but again, this would represent an exception to the usual practice. Also, in community-based (i.e., non-hospital) situations, access to the treating physician usually has to be via the patient and this also raises potential complications.
"I don't have access to the 'Pastoral Care of the Sick: Rites of Anointing and Viaticum' document; however, based on what you have quoted, the document (PCS, No. 8) says, 'If necessary a doctor may be consulted.' This does not appear to imply the person's actual treating physician, and I read this as recommending that an uncertain priest could approach an uninvolved doctor for generic advice.
"Accessing the patient's own treating physician won't usually be feasible, but any priest should be able to find a friendly and reliable doctor for generic advice quite easily and independently of the person in question. As well as helping the priest with the 'seriousness' assessment, a doctor can also provide advice on how best to interact with the person if their condition includes problematic features unfamiliar to the priest (e.g., psychosis, delusions, etc.)."
Again, I agree with this thoughtful comment. The judgment of a doctor is to help gauge the degree of severity in cases in which a priest might have little expertise. The indications of canon law regarding doubtful cases are also important in this regard:
"Can. 1005 This sacrament is to be administered in a case of doubt whether the sick person has attained the use of reason, is dangerously ill, or is dead.
"Can. 1006 This sacrament is to be conferred on the sick who at least implicitly requested it when they were in control of their faculties."
There might be some exceptions in which it is very useful to consult with the treating physician in order to best help the patient. I had personal experience of a now-deceased parishioner who suffered from a severe mental illness with a particularly religious bent. The unfortunate gentleman was constantly petitioning prayers of exorcism and blessing, believing himself possessed by his ancestors. Although such blessings brought some temporary relief, it also tended to keep him away from the doctor and might have hastened his mental and physical decline.
Another priest, who is also a trained mental health counselor, suggested: "To promote 'frequent recourse to the sacraments of reconciliation' continues to place mental illness, which is never in my professional experience chosen," in the realm of a condition of sin.
It was certainly never my intention to make any such association. I suggested the frequent use of reconciliation because it is one of the normal means of grace among other means, such as frequent Communion. I recognize that there are surely forms of mental illness where such a suggestion could be counterproductive, but there are surely others where the habitual life of grace contributes to the healing process.
On a related point a priest correspondent asked: "Are there guidelines for giving Communion to Alzheimer's patients? Is some degree of awareness of Our Lord necessary? Can it be presumed or assumed? Especially if the patient has been a lifelong practicing Catholic even though they show no consciousness of their surroundings now? Who is to make the judgment call in these cases, if it comes down to such a decision: spouse, family, caregiver, Eucharistic minister, or priest?"
While there are clear requirements of knowledge for first Communion, there are no corresponding restrictions for declining years. Since viaticum may be given to the dying even if not fully conscious, there seems to be no reason not to offer it to those for whom the dying process is drawn out over a long period.
We are also ignorant of their true level of awareness. Sometimes, deep-down religious habits are the last to go. Many priests have experience of parishioners who do not respond to questions but who make the sign of the cross or join in the Our Father or hymns learned as a child. The decision to give Communion usually falls upon the minister after having discussed the issue with the family. But I believe that in general the tendency should favor the administration of the sacrament.
I would be reluctant predominantly in those cases of people not fully in control of their reactions and who might inadvertently profane the sacrament.
Another priest, writing from Rome, asked: "Can a Catholic priest validly/licitly anoint a baptized non-Catholic who at his sick bed consciously requests the sacrament from him (the priest)? He has no intention of becoming a Catholic but desires this sacrament because he believes in its efficacy. What about if he is in evident danger of death?"
In such cases the following norms from the Ecumenical Directory are applied.
"130. In case of danger of death, Catholic ministers may administer these sacraments when the conditions given below (n. 131) are present. In other cases, it is strongly recommended that the diocesan Bishop, taking into account any norms which may have been established for this matter by the Episcopal Conference or by the Synods of Eastern Catholic Churches, establish general norms for judging situations of grave and pressing need and for verifying the conditions mentioned below (n. 131). In accord with Canon Law, these general norms are to be established only after consultation with at least the local competent authority of the other interested Church or ecclesial Community. Catholic ministers will judge individual cases and administer these sacraments only in accord with these established norms, where they exist. Otherwise they will judge according to the norms of this Directory.
"131. The conditions under which a Catholic minister may administer the sacraments of the Eucharist, of penance and of the anointing of the sick to a baptized person who may be found in the circumstances given above (n. 130) are that the person be unable to have recourse for the sacrament desired to a minister of his or her own Church or ecclesial Community, ask for the sacrament of his or her own initiative, manifest Catholic faith in this sacrament and be properly disposed."
Our discussion on anointing of the sick (see Oct. 12) generated much positive interest, and I wish to revisit the topic by sharing some of the insights offered by our readers.
A medical researcher from Australia offered two especially pertinent comments.
First: "The physical basis of a state of illness, while relevant to treatment, can be a somewhat slippery science, especially in mental and psychiatric illness. As you dutifully point out, severity and pathology are better distinguished; the former is relevant to the sacrament while the latter probably much less so. The particular question of whether a certain kind of illness is primarily 'physical' can be somewhat academic -- and even more so if trying to dissect the contribution of 'physical' and 'non-physical' components behind the suffering of a particular individual."
I agree with our correspondent that severity is the principal consideration to make in deciding when to anoint. As our reader points out, diagnosis is very difficult in these cases. One of our correspondents commented that she had been misdiagnosed for 20 years as suffering from mental illness when the cause was a severe food allergy.
Although the possible physical origin of apparent mental illnesses is not a fundamental argument, I thought it germane to the theme as in former times there was much insistence on the sacrament of the sick being primarily orientated to physical illnesses.
Second: "You say, '[S]uch situations should be handled on a case-by-case basis and in consultation with the person's physician.' I agree that case-by-case is the only sensible option, and I hope I have not misunderstood your intention but it seems that you also advise uncertain priests to routinely approach the individual's treating physician. For better or for worse, in the majority of situations the treating physician will probably be unwilling to discuss particular patients, even with a priest. I can think of exceptions, for example, some hospital chaplaincy contexts, but these would be the exceptions to the rule. It may be that physicians may be flexible for priests in very Catholic countries (of which I claim no experience) but again, this would represent an exception to the usual practice. Also, in community-based (i.e., non-hospital) situations, access to the treating physician usually has to be via the patient and this also raises potential complications.
"I don't have access to the 'Pastoral Care of the Sick: Rites of Anointing and Viaticum' document; however, based on what you have quoted, the document (PCS, No. 8) says, 'If necessary a doctor may be consulted.' This does not appear to imply the person's actual treating physician, and I read this as recommending that an uncertain priest could approach an uninvolved doctor for generic advice.
"Accessing the patient's own treating physician won't usually be feasible, but any priest should be able to find a friendly and reliable doctor for generic advice quite easily and independently of the person in question. As well as helping the priest with the 'seriousness' assessment, a doctor can also provide advice on how best to interact with the person if their condition includes problematic features unfamiliar to the priest (e.g., psychosis, delusions, etc.)."
Again, I agree with this thoughtful comment. The judgment of a doctor is to help gauge the degree of severity in cases in which a priest might have little expertise. The indications of canon law regarding doubtful cases are also important in this regard:
"Can. 1005 This sacrament is to be administered in a case of doubt whether the sick person has attained the use of reason, is dangerously ill, or is dead.
"Can. 1006 This sacrament is to be conferred on the sick who at least implicitly requested it when they were in control of their faculties."
There might be some exceptions in which it is very useful to consult with the treating physician in order to best help the patient. I had personal experience of a now-deceased parishioner who suffered from a severe mental illness with a particularly religious bent. The unfortunate gentleman was constantly petitioning prayers of exorcism and blessing, believing himself possessed by his ancestors. Although such blessings brought some temporary relief, it also tended to keep him away from the doctor and might have hastened his mental and physical decline.
Another priest, who is also a trained mental health counselor, suggested: "To promote 'frequent recourse to the sacraments of reconciliation' continues to place mental illness, which is never in my professional experience chosen," in the realm of a condition of sin.
It was certainly never my intention to make any such association. I suggested the frequent use of reconciliation because it is one of the normal means of grace among other means, such as frequent Communion. I recognize that there are surely forms of mental illness where such a suggestion could be counterproductive, but there are surely others where the habitual life of grace contributes to the healing process.
On a related point a priest correspondent asked: "Are there guidelines for giving Communion to Alzheimer's patients? Is some degree of awareness of Our Lord necessary? Can it be presumed or assumed? Especially if the patient has been a lifelong practicing Catholic even though they show no consciousness of their surroundings now? Who is to make the judgment call in these cases, if it comes down to such a decision: spouse, family, caregiver, Eucharistic minister, or priest?"
While there are clear requirements of knowledge for first Communion, there are no corresponding restrictions for declining years. Since viaticum may be given to the dying even if not fully conscious, there seems to be no reason not to offer it to those for whom the dying process is drawn out over a long period.
We are also ignorant of their true level of awareness. Sometimes, deep-down religious habits are the last to go. Many priests have experience of parishioners who do not respond to questions but who make the sign of the cross or join in the Our Father or hymns learned as a child. The decision to give Communion usually falls upon the minister after having discussed the issue with the family. But I believe that in general the tendency should favor the administration of the sacrament.
I would be reluctant predominantly in those cases of people not fully in control of their reactions and who might inadvertently profane the sacrament.
Another priest, writing from Rome, asked: "Can a Catholic priest validly/licitly anoint a baptized non-Catholic who at his sick bed consciously requests the sacrament from him (the priest)? He has no intention of becoming a Catholic but desires this sacrament because he believes in its efficacy. What about if he is in evident danger of death?"
In such cases the following norms from the Ecumenical Directory are applied.
"130. In case of danger of death, Catholic ministers may administer these sacraments when the conditions given below (n. 131) are present. In other cases, it is strongly recommended that the diocesan Bishop, taking into account any norms which may have been established for this matter by the Episcopal Conference or by the Synods of Eastern Catholic Churches, establish general norms for judging situations of grave and pressing need and for verifying the conditions mentioned below (n. 131). In accord with Canon Law, these general norms are to be established only after consultation with at least the local competent authority of the other interested Church or ecclesial Community. Catholic ministers will judge individual cases and administer these sacraments only in accord with these established norms, where they exist. Otherwise they will judge according to the norms of this Directory.
"131. The conditions under which a Catholic minister may administer the sacraments of the Eucharist, of penance and of the anointing of the sick to a baptized person who may be found in the circumstances given above (n. 130) are that the person be unable to have recourse for the sacrament desired to a minister of his or her own Church or ecclesial Community, ask for the sacrament of his or her own initiative, manifest Catholic faith in this sacrament and be properly disposed."
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