Sin and Sickness: An Orthodox Perspective

27 January 2023

One of the most beautiful modern examples of our Church’s precepts says that we can’t speak drily on this sensitive issue and not empathize[1]. It might be we think that, given our own state of good health, we don’t empathize with sickness, but if we have even a grain of Christian self-awareness we can’t claim that we don’t empathize with sin.

There’s an underlying danger and fear for those who wish to see the connection between sin and sickness from the theological perspective: that of confining this burning issue to harsh stereotypes which all too often can be heard even in sermons and which show theology and the Church as being strict and inhumane in the two ultimate and detrimental conditions for the human person: sickness and sin. Yet this is precisely where the wounded person, the sinner and the patient, have greatest need of the priest, the Church, of the theologian and every Christian.

It therefore needs genuine spiritual experience and great discernment to approach this close-knit pair, sin and sickness, with the truth of the faith and theology, but without overlooking the core of the faith and theology, which is love and kindness. Saint Gregory Palamas says that for us who lack the  immediacy of this experience, the surest path is to have recourse to the experience of the holy Fathers and discerning Elders, who were guided by the Holy Spirit. Our starting-point should always be the certainty of our Biblical texts which, according to Saint Sophrony in Essex, are a safeguard for us against gauche speculation.

We’ll therefore attempt to place this issue within the framework of Biblical narratives, with brief historical references, and, thereafter, to highlight certain facets which we believe are of particular importance not only because of their theological gravity, but more as regards their pastoral implications.

Sickness and pain have posed a fundamental problem for people throughout the ages, in particular one of rationale. In ancient times, people did not wish merely to cure pain and sickness, but to explain them. It may be that, in earliest times, when the tools for treatment were few and often ineffectual, people necessarily sought a metaphysical interpretation for pain and sickness, rather than a biological cause. In the ancient East, both Far and Near, people saw sickness as a scourge unleashed by spirits or the gods because of some oversight in religious observance or some hubristic act. The spirits or gods were enraged and, as a consequence of their anger, visited sickness upon people, who then tried to repel it with exorcisms, supplications or sacrifices[2]. It is no coincidence that, in most ancient religious systems, the role of doctor was assigned to the priest or shaman, as an intermediary between the material and spiritual world.

Things changed greatly once the ancient Greeks founded and developed medicine into a natural science and art through systematic observation. The continuum through history from Hippocrates and the Christian Galen down to the present day is familiar to many people. It may be worth emphasizing at this point, however, that medicine not only first saw the light of day in Greek culture, but continued to flourish there for many centuries. According to the sources, Greek doctors were far superior to those of Rome. The Byzantines always had exceptional doctors. At the time of the Turkish occupation of Greece, the Greek diaspora produced doctors of significant stature. Even the murdered first governor of Greece after the revolution, Ioannis Kapodistrias had studied to be a doctor. To this day, Greeks excel at medicine, both at home and abroad, to the extent that, in the developed countries of the European Union, Greeks are the most sought-after doctors. If we ignore the urban myths about professional recognition, it may be that, behind this general acknowledgement there lies a truth, another expression of  Greek tradition, which wants people to be healed of their wounds and restored to health. We’ll close this parenthesis here, having offered it as food for thought and reflection as regards the discussion which will follow.

We now come to the way in which holy scripture treats the issue of sickness. The Biblical revelation continues the ancient tradition of the East and Mesopotamia, to which we referred above. Its attention is centered almost exclusively on the religious aspect of sickness and cure, within the context of the divine plan of salvation. Besides, the power of death over humankind is expressed by sickness (I Cor. 11, 28-32).

In the Old Testament health, and life in general in all its manifestations, presuppose life force. It’s rare for natural causes to be sought for illnesses, and medical observations are exceptionally limited. Everything depends on God and sickness is no exception. So there are a great many references to God allowing illnesses which usually involve the mediation of spiritual forces such as an avenging angel, or, as in the case of Job, the devil.

In the Biblical narrative, the connection between sin and sickness is so close as to be almost automatic. Sickness isn’t to be found in the intent of the creative force through which God made the cosmos and humankind. It came as the consequence of sin. At the same time, it appears as a one of the signs of God’s wrath which will strike sinful people, sinful Israel and the sinful world. There’s also an instructive aspect to the experience of sin, however, in that its purpose is to sharpen the awareness of our conscience to sin. It’s indicative that in the psalms, a request for a cure is always accompanied  by a confession of sins before God: ‘there is no healing in my body… for my sins have risen over my head… for in you have I hoped, Lord’ (Ps. 37). There’s also sickness which strikes the people of God collectively, without the recipients necessarily being guilty. Here the great and perplexing issue of God’s judgement is posed: Unde malum? Where does evil come from? Who’s to blame? Please retain this reflection for later. The predicament it creates in today’s rationalistic era is greater than that which existed in the times of ancient Israel. And the pastoral challenge of dealing with it is equally great.

We have a different case when the righteous fall sick and suffer, as happened with Job and Tobias. In these instances, the answer is provided by scripture itself: the purpose is to show the faithfulness of the righteous person and for the name of God to be glorified: ‘Blessed be the name of the Lord’[3].

There is also the prophetic- or, we might say, eschatological- version of sickness. The Servant of Yahweh in Isaiah bears the ills of the people of God and takes upon himself their pain with the aim of atoning for the sins of this people (Is. 53, 4).

It must be said that in the Old Testament, recourse to the art of medicine is nowhere forbidden, as regards the treatment of sickness. On the contrary, in the Wisdom of Sirach the doctor is an honored personage, not only as regards their usefulness but also as holders of an office favored by God himself (‘for the Lord made him’). Having said that, there is a clear preference for addressing God and seeking a cure from him, who is acknowledge as the lord of life. We humbly confess our errors, bemoan the wretched state into which we’ve fallen because of sickness, and await grace and mercy from God. In this way, the cure is a sign of God’s presence.

Despite its constructive character, sickness is always thought of as something bad and its total abolition can only be conceived of from an eschatological point of view. At the end of time, when God renews the world, the cause and consequence, sin and sickness, will be erased.

At the time of the New Testament, Jews by and large lived in the same state as we’ve described. The case of the paralytic at the sheep’s gate and the question of the disciples concerning the blind man (‘Lord, who sinned?’) confirm that the triptych of sickness/sin/divine intervention was more or less still in place.

Christ’s presence, however, marked a shift towards a different practice and a different prospect. Christ responds directly to the sick. He feels sorry for them and cures them by setting them free of their bonds to sickness. It’s important to note that there are instances which involve maladies of the body, of the soul (such as demonic possession), and yet others which combine the two, such as the woman who was bent double. The combination of sin and sickness seems to have been present in the healings of Christ and is demonstrated by the Lord himself. But there’s another factor which we can’t overlook. Christ first heals, but then says ‘Sin no more’.  His prime concern isn’t regret but faith and trust in him. Once he’s given his grace and his gift, He requires repentance as a shift away from the life of sin towards real life. He wants this as the result of sharing in his love. As an inspired state, not as a necessary imposition. For Christ, the sick have already been subjected to enough difficulties. He had no wish to add more. He wanted to give them wings, fill their soul with hope and vigor, so that repentance would be the product of freedom.

In cases such as that of the Canaanite woman, or of the father with the possessed son, Christ seems to make things difficult, not so much for the invalid personally but more to provide a lesson for those present, particularly those in the circle of his disciples. And we should also consider something equally important. The Biblical narrative shows that Christ liked to heal the sick when a third party asked it of him. In other words, when the request for healing was made by a neighbor, especially in a climate of humble courtesy, as was the case with the centurion. This was even more true when the neighbor came from a different social class, nation, race and so on. Το put it another way, Christ cedes a part of his healing power to someone who proves to be an imitator of him by expressing the dual commandment of love by humility towards God and loving kindness towards one’s neighbor.

Naturally, none of this means that sickness disappeared with Christ’s coming into the world, despite the fact that Christ himself marks the presence of God through his own person, when he proclaims the healing of the sick. Apart from ‘Sin no more’, Christ prophetically warns  ‘So that worse may not befall you’. This warning wasn’t directed merely at the particular invalid, but was also a prophetic dramatization of the miseries that would ensue for the future of humankind. The mystery of the divine dispensation is now an accomplished historical fact, because of the incarnation, crucifixion and resurrection. Our flesh has been assumed in a therapeutic and unifying manner by divine nature and has been seated at the right hand of the Father. Even so, the whole edifice of salvation can’t remove the all-powerful essential, human freedom, which is given to each of us without reservation, since we’re all made in the image of God. So, despite Divine Benefaction and God’s warning, both in Paradise and also in the Gospel, through Christ, humankind reverted to sin and brought ‘the worst’ upon itself. In this case, ‘the worst’ is not simply that there is a danger of someone falling more ill than before. It is the hardening of the heart when a person forgets or, even worse, scorns the gifts of God: when healing from sickness and sin does not lead to joyful praise and the security of repentance. Then, out of self-love and egocentricity, we alter the healing from an opportunity for salvation into a chance to sin.

This is where a particularly notable fact of the therapeutic process becomes clear. If the healing is to be complete, it requires human acceptance and cooperation. God heals as being almighty, but not as an autocrat. He awaits the response of human freedom to his gift, so that, apart from the sickness of the body, he can also heal the will. So that he can make us able to desire and love him, freely. So that the image can permanently be turned towards the Archetype.

In the Bible narrative, then, it is clear that Christ considers sin to be the basic sickness of human nature. This is why he often begins the healing by granting remission of sins. As Creator, he knows the terms of our nature better than anyone, and so he understands that it is difficult for people to be instructed either through the fear of sickness or the benefaction of healing. He offers his death on the cross as the drastic and final healing of sin which is the central feature of sickness. That is where sickness and human pain in general acquire a different content. Christ proclaimed that when he was raised up he would draw everyone  to him. This attraction marks a qualitatively different perspective to human existence, one which, to a large extent, reverses things. The prophecy of Isaiah is fulfilled and Christ does for us what we cannot do for ourselves, that which is expressed in such tragic language by Saint Paul in his Epistle to the Romans: ‘Wretched man that I am. Who will deliver me from this body of death?’. Sin is defeated once and for all through the cross, and death is conquered through the resurrection.

All of this is, in the end, a mystery for us, inexplicable in its essence but one in which we can participate through the life of the Church. The sacramental change people undergo through baptism, chrismation, the divine eucharist, and holy unction gives them the opportunity to view their ailment as participation in the cross, which leads to the resurrection. No longer as a means of instruction, but as a state of grace which leads to deification. In this way, sickness is viewed through the perspective of the dispensation of salvation.

Even if we concede that, so far, we have made an imperfect sketch of the relationship between sin and sickness from a theological point of view, there remain burning questions for ourselves and also for those who will inevitably address them to us:

  1. How does each of us experience, in practical terms, the relationship between sickness and sin?
  2. How can we classify, explain and understand these twin phenomena in other people, those who are close or distant? Especially in difficult cases, such as severe ailments in young people, the sudden death of someone we love and so on.
  3. In what way can we talk about all of this to other people? Are all other people in a position to hear and understand the same things?

There is perhaps no other more appropriate prism through which to view these questions than the ascetic writings of our niptic tradition. Through its dissection of the human personality, the niptic tradition is able to penetrate the mystery of our psychosomatic entity, in a spirit of humane discretion and with the aim of sanctifying and healing us as a whole. There are many references in the texts of the early ascetic Fathers. I have chosen, however, to accompany me in my efforts here, to rely on texts by our modern saints and discerning Elders, such as Saint Païsios, Saint Sophrony in Essex, and Elder Aimilianos Simonopetritis.

Interaction with students, for almost ten years now, at the University Ecclesiastical Academy of Thessaloniki, has shown that in sensitive issues, which touch upon the personality and depend on the way of life which our present times impose through their specific features, the words of discriminating Elders who dealt with our generation have been understood more readily. We shouldn’t forget that, even when they were addressing monastics rather than the laity, they were well aware that these were people who were born and grew up in the modern era of rationalism, of the questioning of everything, of consumerism on all levels, of bionic technology, and the quest for convenience. As our, then, principal at the Athoniada Academy, the holy Bishop of Rodostolos aptly said: ‘On the Holy Mountain we only give death certificates, not birth certificates’. What he meant was that we all, to some extent bear the experience, the problems and the sins of the world.

In his interpretation of Abba Isaiah, Elder Aimilianos says: ‘Since we’re dust, we suffer from ailments of the body, the soul and the spirit. Our body has a propensity to every sin and it’s prone to all sicknesses, as is the soul. What if somebody hurts us? Our egotism immediately takes over. Somebody makes us feel bad? We’re troubled. What is all this? Ailments. Isn’t jealousy a sickness of the soul? Isn’t vainglory a disorder? Isn’t it a sickness to bridle? All our passions are ailments. People in general are invalids. This is why Christ is called the physician of souls and bodies.

We’re sick because we sin, wittingly or unwittingly. For this reason Abba Isaiah says: Never fear sickness. Never be afraid that you’ll fall ill. Don’t be troubled if you are unwell. There’s no greater blessing from God than sickness. Those who are sick are under the protection, the love, the benefaction and the care of God; they’re in his embrace.

Sick people can become apostles of God, chosen vessels, whereas those who are well are, as a rule, callous, insensitive, uncharitable and unable to open their hearts. This is why sick people are usually sweet and caring; they show compassion to others and are able to beseech God.  

So don’t fear illnesses… those who are afraid of bodily ailments can’t attain to what is natural in Christ; they’ll always remain with the unnatural.

But what if they love God and are fainthearted? If you’re fearful… then fall on your knees, humble yourself, bow down to God and tell him: ‘God, I’m afraid I’ll fall ill’ or ‘I’m afraid I’ve fallen ill’ and shed tears. Do whatever you must to make God take pity on you. He alone can bring you rest.

Faintheartedness is the result of the deification of our self, of the desire to extend our life, to enlarge it, to avoid pain, to evade worry, to escape difficult situations and to have others look after us’.[4]

For the Fathers, although worry about health is understandable and, to some extent excusable, in the end it’s carnal, and it distances us from our ultimate goal, which is sanctification. Cowardice in the face of death and giving undue importance to bodily health, things which seem greatly increased in our own day, are used by the cunning devil in order to disorientate us and darken our mind. This is why the saints consider interest in one’s health to be humiliating and unworthy  of Christ’s call[5].

For Elder Aimilianos, there’s a contradiction in the spiritual life. God shows that he delights in sicknesses. But this is so strange. Basil the Great says that although God made us hale and hearty, he immediately gave us sickness, even though he wants us to be joyful and peaceful. Why? Because when we embrace sickness, when we love it, when we draw positive conclusions from it, when, because of it, we surrender to God, then illness becomes the quickest way for the acquisition of salvation and freedom from the passions… Sickness is God’s best gift to us. People who can’t boast of their ailments, as Saint Paul did, or laugh at them, can’t make any progress in the spiritual life[6]. Here Elder Aimilianos agrees with Saint Païsios who considered that he had greater benefit from a relatively short illness than from long years of arduous asceticism.

Most illnesses befall us because of sins. Not as divine punishment, but as necessary schooling… And the more severe the ailment, the closer God is to us, even if we’re suffering as a result of our sins. When David became ill, he fasted and covered his head with ashes, not in order to seek expatiation from God but to restore his relationship with him. This means that, in his sickness, which may have been caused by sin, he retained the sense of God’s love.[7]

This feeling of God’s love is also the basic feature and means whereby we may be able to transmit to ourselves, as well as to others- even if only as a starting-point- the notion of sickness as instruction. Otherwise God appears to be relentless and cruel. No matter how aware we are of our sinfulness, we’re brought to repentance only with difficulty, even through trials. Knowledge of our sins often makes us more callous. It’s the sense of God’s holiness, love and glory that lights the flame of repentance within us[8]. This feeling is granted directly by the Holy Spirit. But we may also receive it through the presence of holy people close to us, or by sharing in the love and support of our brothers and sisters. Then, according to Saint Païsios, the soul is moved, it’s put on its mettle and shows awareness.

It’s important to say that all this instruction which we’ve briefly quoted, isn’t directed by the Elders and Fathers towards those who are sick, but to the healthy. In particular, Elder Aimilianos directed these teachings of his to the communities of Simonopetra and Ormylia, in the early years, when most of the monks and nuns there were still young and healthy. His aim was to school his spiritual children in such a way that they’d be ready to face the trial of sickness. This is true for both monastics and laity. It’s a preventative pastoral approach in which the spiritual father has the luxury, is justified, we might say, in setting the bar of spiritual demands high. In the military, there’s a maxim: ‘What’s hard in training makes it easy in battle’. Saint Sophrony teaches that, above all, Christians have to be ascetics. This means that the more they’re committed to the ascetic struggle, the better prepared they’ll be at a time of trial or temptation.

And what happens when that time of trial arrives? When sickness comes, especially in the form of painful or even mortal illness? As to how we deal with this on a personal level, when the trial affects us, we should probably seek the answer in the lives of the saints and in their personal example. The issue becomes entirely different when it has to do with other people, with our ‘neighbors’. Then, what we see in the teaching and life of the Fathers and Elders is that loving kindness and discretion should come first.

Loving kindness means that when you fall ill you can be as harsh and strict as you like with yourself. But not with your brothers and sisters. You offer them relief in any way you can. You don’t mind at all the medical and pharmaceutical care. You express your genuine interest in their health. You take care of their needs. You pray that they’ll become well. You share their anxiety with a calm bearing.

The way in which you’ll speak to them about God when they’re sick is with discretion. And, above all, you’ll listen to them. The message and the theology that you know, which we described above, will be in your mind and heart but won’t easily leave your lips. The other person must experience Christ in your face, in your person, and not just hear platitudes about him. First we must offer love with kindness and support, and then through words. Often, love becomes the message itself, making words superfluous.

This example from the life of Saint Païsios is particularly apt. We all know the fortitude and the bravery to the point of harshness towards himself that he showed in the last stage of his illness. Yet when his fellow monk Fr. Athanasios Stavronikitianos fell ill, Saint Païsios went down to Athens and sat beside him for a month, providing aid and comfort, praying fervently, supporting him until the last moment. Him and other sick people who were in need. Since he had the necessary discernment, Saint Païsios urged the doctors to explain to the patient the severity of his condition. When Father Athanasios became despondent, Saint Païsios stood by him and, through his example and words, changed him from someone at death’s door to a preacher of the true life, despite the fact that Fr. Athanasios passed away shortly afterwards.[9]

Things are more difficult when we have to deal with cases of young people and children with an incurable disease, and with their parents. Children who are sick often surprise us with their faith, their wisdom and their maturity, which goes beyond their physical age. As Sister Magdalene from Essex says, they become teachers who keep trust in God alive, even when our hearts bleed.

Before we close, I’d like to quote the case of a 9-year-old girl who was suffering from cancer.

The mother was in despair and, in front of the child, kept bemoaning the lack of love shown them by God. I thought I should show the girl a more positive approach, so I took her for a walk in the garden. As we were walking, we looked at the birds and chatted. Part of our discussion went something like this.

Sister Magdalene: You know that your headaches don’t mean that God doesn’t love you. He knows what it feels like to be in pain as you are, because he himself felt pain on the cross. You’re a special friend of Jesus Christ. He loves everyone, but he allows the brave to have headaches, and so they share his pain on the cross.

The girl nodded seriously and I saw that she already knew all this and didn’t need me to tell her. Moreover, she had the wisdom to add: ‘But, sister, please don’t talk to my mother about this, because she doesn’t like it. She thinks I should live’.

A couple of very brief observations:

  1. The person with the problem in this instance was the mother. But we see that Sister Magdalene didn’t say anything to her. Not as a slight, but because she had the discernment to see that the woman was in no state to listen.
  2. She focuses her interest on the sick girl, seeks and finds an appropriate way of speaking positively about the trial of her sickness, and thus restores spiritual contact with her.
  3. She realized that the girl had spiritual maturity and was aware of her condition and she, Sister Magdalene, makes her own pedagogical and pastoral self-critique when she writes that, in the end, she didn’t need to speak to the girl.

[1] Sister Magdalene, Conversations with Children, Holy Monastery of Saint John the Baptist, Essex, 2007.

[2] Λεξικό Βιβλικής Θεολογίας, Άρτος Ζωής, Athens 1980, p.150.

[3] Job, 1, 21.

[4] Archimandrite Aimilianos Simonopetritis, Λόγοι Ασκητικοί: Ερμηνεία στον Αββά Ησαία, Ινδίκτος 2005, pp. 437-438.

[5] Saint Neilos, pp. 172-174.

[6] Saint Neilos, p. 225.

[7] Ἀγαλλιασώμεθα τῷ Κυρίῳ, p. 184.

[8] Ibid, p. 228

[9] Βίος Γέροντος Παϊσίου (Life of Elder Païsios), p. 218 ff.