What is the Eastern Orthodox Perspective on Members of Its Church Who are Depressed and Suicide?
In this paper I argue that the Eastern Orthodox Church has increasingly become sensitive to members of its Church who suicide due to clinical depression, offering them in some cases through economy (oikonomia [Gk]), full burial rites akin to those who have died due to natural causes (e.g. advanced age), physical illness (e.g. cancer) or accident (e.g. road fatality). Suicide is defined as the deliberate act of taking one’s own life, in actuality it is self-murder breaking with God’s sixth commandment (Exodus 20:13) and causing an immediate separation from the Holy Spirit, (1 Corinthians 6:19). Clinical depression, also known as major depressive disorder (MDD) is a form of mental illness (Hall-Flavin, May 13, 2017). It is more than just occasionally feeling down and having the “blues”, or suffering immense sadness, for example, at the death of a close relative. Clinical depression is marked by an ongoing depressed mood most of the day, disallowing the sufferer from engaging in normal activities and relationships for a contiguous period of time, lasting anywhere from a few weeks to a lifetime. Examples of depression subtypes include major depression, chronic depression (dysthymia), seasonal affective disorder (SAD), and bipolar disorder (manic depression) (WebMD, 2017).
One of the major difficulties for clergy of the Orthodox Church in determining how a suicide of a depressed person should be considered, may include the lack of available evidence towards the clinical assessment of the sufferer. A simple letter of support, written by the deceased’s mental health professional (e.g. psychiatrist), can be used to provide evidence of his/her ongoing condition (S. S. Harakas, 1987, p. 324). Additional complexities may include the identification of the range of spectrum of depression suffered by one who has taken their life. For example, what happens to one who has remitted from their severe state of depression for some years and then relapses and subsequently suicides? Or one who has never been diagnosed with a specific depressive disorder but has been assessed on the mood disorder (affective) spectrum? One could posit that anyone at the point of taking their own life has suffered so much mental anguish and torment that they must be severely depressed to kill themselves through self-inflicted injury, poisoning or suffocation. But this is not always the case if we are to regard suicide notes left behind by the deceased, as providing insights into the motivation for their suicide. People have taken their life for varied non-medical reasons such as the committing of a heinous crime, an onset of a terminal illness, falling pregnant out of wedlock (and especially after an abortion), unemployment and financial crisis, revenge toward a person for a wrongdoing, and even a philosophical desire to know “what’s on the other side”. These latter reasons for suicide are considered separately from one who has taken their life due to mental illness, and on the whole are seen as an individual not valuing the “gift of life” (Breck, 1998) given to us by God Himself.
Although major inroads have been made into understanding major depression and other forms of mental illness (e.g. schizophrenia), psychological instability remains a taboo in communities in many parts of the world (S. Harakas, 1990). Families dealing with a child or parent who is suffering from mental illness may hide or deny that their loved one requires medical attention and pastoral help (Hopko, March 24, 2010). Thus, it is possible that a sufferer’s condition can go undetected by the most discerning of priests, despite the illness often manifests itself outwardly in some visible behavioural traits (e.g. obsessive compulsive disorder). One reason for this difficulty could be that the parishioner with the major depression may be an infrequent participant to weekly Church Services and parish activities in general, or may have never sought medical treatment due to feelings of shame or perceived judgement. This is a dilemma for the serving priest, especially in the event of a sudden and “unexpected suicide”. Additionally, men who perceive themselves as self-reliant and reject seeking medical help from a general practitioner for their suicidality may also take their life suddenly. In fact, men are on average 3 to 4 times more likely to commit suicide than women (Lester, Gunn, & Quinnett, 2014). None of this is straightforward to address for a priest when there are grieving family members seeking answers to “why” a loved one has taken their life, what will happen with funeral preparations for the deceased, and what will happen to their loved one’s soul eternally. The due process is for the parish priest to present evidence to his hierarch, usually a Bishop, on behalf of the deceased’s family, and then await a decision on how to proceed toward funeral preparations (Theodosius, 1998). The parish priest’s care is also for the surviving family members who have to learn to go on without their loved one, and not to lose hope in God’s eternal promises. According to Archbishop Theodosius of Washington (1998) the “act of suicide is a profound tragedy affecting a parish. It necessitates prayers for forgiveness for the sake of the departed and exhorts the members of the parish community to repentance and sorrow”.
Raising Awareness of Suicide and its Effects in the Orthodox Church and Beyond
While the Eastern Orthodox Church plainly acknowledges that suicide is among the gravest sins against God, it also leaves the ultimate judgement to God who is all-knowing and intimately discerns human hearts in their fullness. It is clear that a severely mentally ill person is not morally culpable for their actions when they commit suicide (H. T. Engelhardt, Jr, 2004, p. 25; S. S. Harakas, 1987, p. 134; Nicodemus & Agapius, 1983, p. 746). Moreover, we could argue, that a person in the process of committing suicide, if they have their full faculties and sensibilities about them, could repent even at their last breath, even while in the process of dying after reaching the point of no return. God knows. It is not for us to ponder (Hopko, March 24, 2010). Today, the Church is not only asking itself what is the canonical response to suicide (for that has been spelled out through Ecumenical Councils and the collection brought together on Orthodox Canon Law, titled The Rudder (1983)), but also what should the pastoral response to suicide be (McCray, November 9, 2016). I believe this emphasis in thinking has occurred over the last two decades in particular, as the Church and its members, and indeed more broadly the discipline of medical science, have grown in awareness of mental health issues and the direct relationship between suicide and depression (SCOBA, May 23, 2007).
The number of suicides worldwide have steadily continued to increase over the last 20 years. About 800,000 people die every year (i.e. one person every forty seconds) by committing suicide in the world (1.4% of all deaths), and for every suicide there are an estimated 25 attempts (i.e. that is about 20 million attempts in total per annum) (AFSP, 2015; WHO, 2017). Of particular concern is that for 15-29 year olds, suicide is the second leading cause of death globally (WHO, 2017). Some have argued it has reached pandemic proportions, as it knows no barriers to geography, gender, demographic, religion, or income levels. Suicide not only affects the deceased who have chosen to take their life, but also many more millions of people who experience bereavement annually through the abrupt loss of their loved one (SCOBA, May 23, 2007). If this is not enough, we have also seen the introduction of laws in a small number of countries (e.g. The Netherlands, Belgium, Canada) allowing individuals to seek euthanasia or physician-assisted suicide for varying contexts, including old age, terminal illness, and depression (Breck, 1995; H. Engelhardt, Tristram, Jr. & Iltis, 2005; S. S. Harakas, March 6, 1997).
Of particular concern today is the manner in which suicide has become an acceptable option within our secularised society (G. Morelli, January 13, 2009). In a commentary on Emile Durkheim’s book titled Le suicide (1897), Robert Alun Jones (1986) writes that Durkheim insisted that “[t]he pathological increase in suicides [wa]s… a result of the "moral poverty" of our age”. If that statement was made in 1897, then what could be said 120 years on about the moral poverty of our age? Recent films like “Me Before You” that glorify euthanasia, are a fine example of the seed sown in individuals who may be disabled, terminally ill, or suffering from Post-Traumatic Stress Disorder (e.g. war veterans) who are unassumingly lured into thought experiments about the possibility of taking their life in order to prevent their prolonged suffering. Astoundingly a visit to the official website confronts the viewer with a splash page of the film, with the words scrolling across, “live boldly, live well, just live” (Sharrock, 2016), despite the movie is about euthanasia and cutting one’s life short. The message is, “there is a way out”, instead of living with the pain and suffering patiently until one’s end of life. As Fr. John Breck (2003, p. 183) notes, it is a message that proclaims, “die with dignity”, and yet an Orthodox Christian’s petitions during the Divine Liturgy are about completing “…the remaining time of our life in peace and repentance” and asking God for a “Christian end to our life, peaceful, without shame and suffering, and for a good defense before the awesome judgment seat of Christ” (Chrysostom, 2017). Secular society is promoting that one can “die before they have to die”, and yet the Orthodox Christian Paschal Troparion emphasises that Christ has already trampled down death by death, and thus as believers we have hope no matter how dark the circumstances are. Very disturbingly, a new Netflix series graphically depicting youth suicide titled 13 Reasons Why (Yorkey, 2017), has been met with public outcry by psychologists, educators and parents in the United States for its potential to glamourise suicide. Backed by Hollywood celebrities and stars, the influence among youth will be significant no doubt encouraging copycat acts (Devitt, May 8, 2017). Work on a second season has already begun for 2018. It is no wonder that that the primary cause of death by injury in the United States today is now suicide, then followed by vehicular road accident (Rockett et al., 2012).
The Orthodox Church’s Canonical Response to Suicide
The Orthodox Church has held fast to its canonical position that suicide is unacceptable under any circumstance, indeed even for sufferers of mental illness. This position has never been negotiable and has remained unchanged since the formation of the Church. Holy Scripture records nine unambiguous suicides (Meredith, 1980, p. 143f; Murray, 2000). We have the examples of Abimelek (Judges 9:54), Samson (Judges 16:30), Saul (1 Samuel 31:4), Saul’s armour-bearer (1 Samuel 31:5), Ahithophel (2 Samuel 17:23), Zimri (1 Kings 16:18), Ptolemy Macron (II Maccabees. 10:13) and Razias (II Maccabees 14:43-6) in the Old Testament and Judas Iscariot in the New Testament (Matthew 27:5). While we do not see a pronounced moral condemnation of the acts of the deceased by at least the narrators of these suicide events in Holy Scripture (which is in line with how sordid events are usually recorded in the Bible), we can at least deduce in the case of Judas Iscariot that the taking of his own life by hanging, was out of a deep sense of despair for how he had betrayed our Lord and Saviour, Jesus Christ. Judas, we are told in Matthew 27:3-4, “repented and brought back the thirty pieces of silver to the chief priests and the elders, saying, ‘I have sinned in betraying innocent blood’.” While we can point again to the Scriptures, “no expiation can be made for the land, for the blood that is shed in it, except by the blood of him who shed it” (Numbers 35:33), Judas contended with a dual crime, not only betraying Christ but also taking his own life, instead of believing that Christ could forgive all things. We can say therefore, that the condemnation of suicide, in the singular case recorded in the New Testament, is thus inferential. Whereas in the other suicides recorded in the Old Testament, for the greater part neutral language prevails. For example, Samson calls to the Lord God to “remember” him and beckons “I pray thee”, to allow him to grasp the two middle pillars of the pagan Philistine house and to let it topple on the Philistines and on him (Judges 16: 28-29). We are told reassuringly: “So the dead whom he [Samson] slew at his death were more than those whom he had slain during his life” (Judges 16:30). God seems to have answered Samson’s wishes giving him the strength to commit this act.
We can also reflect on the martyrs, both Early Church martyrs and neomartyrs, who willingly gave their life for Christ. Were these suicides? No, they were not. The Synaxarion (1998) includes saints whose lives came to an abrupt end when they refused to give up their Christian beliefs. For example, female Orthodox Saints of the first four centuries willingly:
- walked into fires on seeing their brethren thrown into flames (e.g. St Agathonike according to Eusebius’s account, and separately St. Apollonia who endured terrible sufferings to the point of having her teeth extracted);
- threw themselves from rooftops at the risk of rape (e.g. St Pelagia of Antioch); and
- threw themselves into rivers to drown, fearing impending rape by drunken soldiers (e.g. St. Domnina and her two daughters Berenice and Prosdoce).
Yet, the intent of the female martyrs had naught to do with suicide. Constantelos (2004) writes of the martyrs in his excellent paper: “[t]he usual motive for defying death was their steadfastness to their religious faith and moral principles.” These were men and women of faith who when faced with an imminent threat to their lives, acted in the glory of God. They did not go out actively seeking death or torture. The Church Fathers, in particular Saint John Chrysostom and Saint Augustine of Hippo, are often juxtaposed by western commentators as having diametrically opposing thoughts on the subject of premature death which is incorrect. Saint John Chrysostom gave full support to female saints who leapt to their deaths instead of allowing themselves to be raped and being defiled. Saint Ambrose of Milan also showed sensitivity toward these exceptional cases (e.g. recounting the death of 12 year old St. Agnes, Concerning Virginity I.2.5-9), as did Saint Jerome (e.g. writing to St Paula about the martyrdom of Saint Blæsilla in Letters 39.3). While on the other hand, Saint Augustine was adamant that no one should kill themselves, no matter the magnitude of their desperation, but was circumspect in the context of martyrdom. It is worth quoting him in full:
“But, they say, during the time of persecution certain holy women plunged into the water with the intention of being swept away by the waves and drowned, and thus preserve their threatened chastity. Although they quitted life in this wise, nevertheless they receive high honour as martyrs in the Catholic Church and their feasts are observed with great ceremony. This is a matter on which I dare not pass judgment lightly. For I know not but that the Church was divinely authorized through trustworthy revelations to honour thus the memory of these Christians” (City of God 1.26).
Saint Augustine sharply condemns the practice of suicide, emphasising, “that no man ought to inflict on himself voluntary death” (City of God 1.27). Likewise, Saint John Chrysostom also condemns suicide: “Whereas God punished such men [those who commit suicide] more than murderers, and we all regard them with horror, and justly; for if it is base to destroy others, much more is it to destroy one’s self” (Commentary of St. John Chrysostom on Galatians 1.4). Engelhardt (2009, p. 79) adds to these, the author of The Shepherd of Hermes (written between AD 90-150), Saint Justin Martyr (AD ca. 100-ca 160), Saint Clement of Alexandria (AD 150-220), and Lucuius Caecilius Firmianus Lactantius (AD ca. 260-330). For instance, Saint Clement of Alexandria writes, “He who presents himself before the judgment-seat becomes guilty of his own death. And such is also the case with him who does not avoid persecution, but out of daring presents himself for capture. Such a person…becomes an accomplice in the crime of the persecutor” (The Stromata, or Miscellanies IV.10). And Lactantius (The Divine Institutes III.18) writes: “If homicide is wicked because it is the destroyer of a man, he who kills himself is fettered by the same guilt because he kills a man.” The Fathers used very strong language to describe their beliefs about suicide for good reason (i.e. the highly public and influential deaths of philosophers by suicide was seen as acceptable in the Roman and Greek pagan worlds). However, as Engelhardt (2009, p. 79) so importantly reflects, “[a]t about the time St. John Chrysostom wrote [his] remarks [on Galatians], the Orthodox Church issued its first canon bearing on suicide, underscoring that those who committed suicide while insane should be given a Christian burial”.
Engelhardt (2009, p. 79) stresses that outside this context of insanity, “[a]ll that we have historically concerning the church’s life is incompatible with the praxis of suicide.” Thus, we know by the Orthodox Church’s canon law that 1) a person who willingly commits suicide and is not insane endures a separation from God and should not receive a funeral rite (1 John 3.15), and 2) one who commits suicide in the condition of insanity, is able, through economy under the Bishop’s authority, to receive a funeral rite. We have much to gain also in the distinction of the voluntary and involuntary murder as legislated in the canons 22 and 23 in the Synod of Ancyra in 314. Fr. Stanley Harakas reflects that independent of whether a murder was voluntary or involuntary, a period of repentance had to be fulfilled before the one who had committed the crime could partake in sacraments again. But the difference with a suicide was that no repentance for the act of self-murder could take place because the one who takes their life is instantaneously cut off from the ability to request forgiveness of their sins (S. S. Harakas, March 6, 1997, p. 25f). One reason the Church Fathers applied such strict definitions around suicide from the outset of the Church’s formation was because “the Greco-Roman world tended both to disparage the body and to endorse suicide in circumstances of severe hardship. The Cynics, Epicureans, Stoics, and Gnostics, for example, all endorsed voluntary death for reasons consistent with each group’s broader ethical vision” (SCOBA, May 23, 2007).
Ways Forward: An Integrated Canonical and Pastoral Response to Suicide
It is true that in some cases like in parts of rural Orthodox Russia, those who suicided were not buried in cemeteries as recently as the 1880s. According to Paperno (1997, p. 55), the custom was to bury suicides by a road, at a crossroads, at the edge of a field or in the woods, swamp, or ravine. But those who were considered as “insane suicides” committing the act “in a state of delirium, illness, or melancholia, were to be buried in a “special place” (that is, beyond the cemetery)…” (Paperno, 1997, p. 55f). Much has changed since that time, not in the Orthodox Church’s position on suicide, but in the primary importance of pastoral care and outreach. For the departed person who has suicided under mental duress, we are seeing that the funeral service which belongs to the “special liturgical rites of the People of God” is a practice in which the faithful can request forgiveness on behalf of the departed, and also come together to console the family, and bind the faithful in hope in God’s mercy. Farley (2017) who reflects on the vital 2007 pastoral letter to Orthodox Christians by the bishops at the Standing Conference of Canonical Orthodox Bishops in the Americas (SCOBA, May 23, 2007), states that “motivation is everything” when it comes to suicide. Since the early 2000s in particular, we have witnessed discussions within the Church on how we might be able to better respond as a community of the faithful in dealing with those in our parishes who are faced with mental illness (F. G. Morelli, September 23, 2009). For the Orthodox Church there is a fine line that cannot be crossed when making proclamations about suicide, before it opens the floodgates to the slippery slope argument (Smith, September 9, 2015). Yet, canonically, the Church has always known where it stands regarding suicide and the Fathers when consulted accurately have had one voice on the matter. What we are witnessing at present are significant pastoral responses that seek to communicate clearly that the Church is here for those who need it and that God will “wipe away every tear” (Revelation 21:4), no matter if one is struggling with mental illness, physical unwellness, very difficult life situations, or even atheism.
Last year, Kate McCray (November 9, 2016), a Canadian PhD candidate who spoke at the Orthodox Christian Association of Medicine, Psychology, and Religion (OCAMPR 2016) Conference with the theme “On Pain and Suffering” cited Fr. John Breck, suggesting the possibility that a specific funeral service for those who have suicided be devised. The idea of such a service would be to plainly acknowledge before God, that the “Servant of God who has taken their life be forgiven for their sins etc.” This would be more than is presently conducted in the Trisagion Service alone prior to burial (Constandinides, 1994). The precedence for this, according to Fr. John Breck could be argued in the existence in the altered wedding service of a divorced person who has decided to remarry. The Order of the Second or Third Marriage carries a certain penitential character about it, and can only be performed through economy and the local Bishop’s authority. Thus that too is an exception to the “rule” (OCA, June 5, 2017). By other clergy, it has been suggested that the current funeral service could be somewhat “tweaked”, blessed by the Church’s bishops, with the “prayers normally used at Christian burials expressing the ambiguous and tragic nature of the situation and accentuating the mercy of God” (Farley, 2017). Furthermore, Fr Lawrence Farley (2017) suggests “…that clergy should be allowed to preside at such funerals, and to offer the comfort of the Church’s intercession for the dead”. The awareness now, reached by many clergy of the Orthodox Church, as more and more suicides take place, and in the direct pastoral communications with the family of the departed, is that all suffer in a parish, and a single loss of life can send reverberations throughout the whole church (Cuceu & Pontikes, 2016; OCA, 2017). The pressing issue for us all perhaps, is not whether or not a person who has suicided will receive the prayers of a funeral service (albeit how important this is according to Church canon), but how over time the Church will play a major role in stifling and reducing the number of suicides of its parishioners. There is evidence to suggest, that religiosity plays an important role in keeping people alive. Sisask et al. (2010) found that: “individual-level associations between different dimensions of religiosity and attempting suicide exist”, and that “subjective religiosity… serve[s] as a protective factor against non-fatal suicidal behaviours”. There is thus a great deal that Christians can do to ensure that less of our young people, less men, and less depressed persons in particular, find themselves in a situation of vulnerability where suicide becomes an irrational option (Vlachos, 2005). Fr. George Morelli from the Antiochian Orthodox Church, who is also a clinical psychologist, has an excellent 12 part series available on Ancient Faith Ministries on the topic of suicide, and partly about the role of Church communities to be there for mentally ill persons (and brethren in general), to assist them with dealing with depression through the application of cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), mindfulness strategies and more (G. Morelli, Fr., 2008-2009).
As we move away from the classical point of view to be found in literature during the time of antiquity that says someone who has taken their own life might have done so in a rational manner, towards the point of view that denotes that a person who would self-life take is either insane or near the point of insanity, we are faced with the need to develop the way in which we as individuals, extended families, and a Church community respond to suicide. Plainly mental health issues substantially reduce one’s capacity to act rationally. Clergy and laity in the Orthodox Church, particularly over the last two decades have demonstrated a heightened pastoral awareness to suicide in general and have increased their outward facing communications on such vital matters, not in conflict with the Church’s canonical laws. The Orthodox Church is growing and learning about suicide at a pace akin to the medical science community. And with these new findings come pressing educational requirements, especially to graduate more clergy with backgrounds in mental health, psychology, social work, and even specialisations in psychiatry. But even more emphatic is the individual responsibility we all have toward the mentally ill, and to each other as parishioners and a co-suffering community. The emphasis today has to be on the pastoral outreach and response to suicide, as the number of suicides are reaching pandemic proportions. How can the Orthodox Church reach out those in need?
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