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Spirituality, Religious Wisdom, and the Care of the Patient

Anger in the Context of Illness: An Anglican Perspective

Some years ago now Elisabeth Kübler-Ross popularized the idea that a patient approaching death should expect to move through various 'stages' of emotional response, including anger, before being able to accept a peaceful end.¹ Whilst the theory had the merit of making acceptable - and even expected - a degree of anger in terminal illness , it did not I think confront in any effective way the degree of rage that is potentially present - at least in my experience as a chaplain intern - in any suffering patient, and which is by no means always happily resolved before death, either. Perhaps at base this is what, in theological terms, we might call the intrinsic rage of creatureliness - my fundamental realization that I am not God, that I am a dependent being to whom life is given, rather than autonomously controlled by myself.² 'Dust thou art and to dust thou shalt return' (Gen. 3. 19b), in the words of God to Adam - which are echoed in the yearly rite of the imposition of ashes at the start of the Christian observance of Lent.³ If, then, anger should be expected as a likely undercurrent of all sickness, not just as a passing manifestation of a terminal condition, what can the Christian tradition - and more specifically the strand of Protestantism to which I belong - Anglicanism - say about anger that might assist health-care professionals?

Let me divide these very brief remarks into three (even shorter) sections: first, a word about distinctive attitudes to 'anger' in the New Testament (most of them strongly dependent on the matrix of Judaism out of which they came: here you will see clear continuity with some of Solomon Schimmel's remarks); secondly, some particularly interesting insights on 'anger' from the early Christian monastic tradition, in which New Testament teaching had already become somewhat entangled with aspects of Greek philosophy, specifically with Platonic and Stoic views on the emotions; and thirdly, some distinctive thoughts on anger to arise within Protestantism: in the great Protestant Reformers Luther and Calvin (themselves very different characters - one [Luther] much more irascible than the other - and, if I'm right, interestingly distinctive on the question of anger); and then in the Prayer Book and liturgy of the Church of England - which was influenced both by the European Reformers but also by a considerable remaining commitment to elements of Roman Catholicism.

1. Anger in the NT. First, then, is there a distinctively Christian view of anger in the New Testament that distinguishes itself from the Judaism of the time of Jesus? Yes and no, I think. The initial distinctiveness lies not so much in the teaching on anger as such, but more in Jesus's demands about forgiveness in response to it: 'Love your enemies'; 'turn the other cheek'; 'forgive 70 times 7 (i.e., endlessly)':⁴ these are all amongst the 'hard sayings' in the gospel tradition that appear - on account of their very distinctiveness - to go back to Jesus himself, and we can actually watch other strands of thought in the New Testament already stepping back from what seems impossible here: 'Love one another', says the Jesus of the gospel of John (John 13. 34); or 'leave it to God to avenge', says Paul (Romans 12. 19): not at all the same thing, surely, as the command to 'love one's enemies'. But on anger itself it seems that Jesus also made rigorous demands, though not ones unknown within his Jewish milieu: 'If you are angry with a brother you will be liable to judgment . So when you are offering your gift at the altar, if you remember that your brother has something against you, leave your gift there . and go, first be reconciled' (Matt 5. 22-24). So anger it seems must - according to Jesus - be overcome, controlled, dissipated, and as soon as possible; if not, it will lead to judgement - God's wrath against us. So there is an implicit distinction here between righteous divine wrath and sinful human negative discharge, the latter of which must be speedily overcome. But it is not clear that the sayings of Jesus tell us how to overcome it, only that we must.

In the Pauline and deutero-Pauline writings of the New Testament, however, there is a further distinction and a further twist. Quoting from Psalm 4. 4, the epistle to the Ephesians insists: 'Be angry and sin not (orgizesthai kai me hamartanete). Do not let the sun go down on your anger' (Eph. 4. 26). As we shall see, the interpretation of this verse was to cause continuing discussion and difficulty within Christian tradition down the centuries. Did it mean that it was all right - indeed even laudable - to be angry in some circumstances as long as one did not 'sin'? Or did the Hebrew - and then the Greek, both in the imperative - mean something else? Surely if Jesus had said that anger could lead to damnation it could not here be encouraged? The only way around this problem was to make a further distinction within human anger, between 'righteous indignation' on the one hand (such as evidenced by Jesus himself in the cleansing of the Temple), and 'sinful anger' on the other, the former being wholly justified in some circumstances, but never if it led to the destructive consequences of the latter. (It seems to me that this distinction is crucially important, by the way, in dealing with patient anger - we shall want to discuss this further later on.) On either interpretation, however, the choices lie within a discussion wholly explicable in a Jewish milieu: either prophetic, righteous anger or negative, destructive anger.

What is perhaps not so explicable in Jewish terms is a further, and distinctively Christian twist on anger that we get in Paul's letter to the Galatians. Here, in chapter 5, Paul famously lists, on the one hand, the 'works of the flesh', which include 'enmities, strife, . anger, quarrels, dissensions, factions ..', and on the other hand, the 'fruit of the Spirit': 'love, joy, peace, patience, kindness, generosity, faithfulness, gentleness, and self-control' (vs. 22-23). What I mean by the Christian 'twist' here is the distinctively Pauline insistence that the virtues he lists, including 'self-control' (not, note, repression or apathy), are gifts of grace through faith in Christ. Thus we emerge from the New Testament with a certain paradox set between Jesus and Paul: anger must on all occasions be set aside, seemingly by human will and effort (so Jesus); yet such a possibility of 'self-control' is actually a matter of ceding control to the grace purveyed by the Holy Spirit (so Paul). Let us now see, in our two remaining sections how this paradox works out in later Christian tradition.

2. Anger in Early Christian Monasticism. I touch down here briefly in early desert monasticism (of the fourth and fifth centuries) because the experience of monks who withdrew from the 'world' to avoid the occasions of negative passion was - oddly and interestingly - that such withdrawal if anything intensified the 'demons' of passion with which they had to do, not least anger and lust. It is Evagrios the solitory, in the late-4th. century, who draws up the list of the '8 deadly thoughts' (later to become in the West the '7 deadly sins') which distract and undermine the monk's life of prayer: anger is of course amongst them. He, and the slightly later Western author Cassian (who was greatly influenced by Evagrios, and in turn strongly influenced the Benedictine Rule and thus the whole later tradtion of Western monasticism), come up with some intensifications, but also potential resolutions, of our New Testament paradox on anger which show the particular psychological insights of those committed to deep interior prayer, and which sometimes - interestingly - draw on explicitly medical metaphors.

What we get here, in short, is the beginning of the idea that the passion of anger is a force that in some way can be metabolized, even redirected in positive directions. I mention here only four brief points from their writings: i. Evagrios actually argues that anger is bad for your health, because it is the worst thing for preventing you from praying - indeed it kills prayer stone dead. Whilst we are obsessing with angry thoughts, not only can we not pray, he says, but we develop nightmares, and may even start to hallucinate 'poisonous snakes'. Thus anger must at all costs be nipped in the bud before it starts off psychological disturbances.⁵ ii. On the other hand, Evagrios is the first to suggest that anger can, if rightly expressed and used, be an aid to prayer in being flung against distracting 'thoughts'.⁶ iii. Cassian, in a remarkable extended medical metaphor, develops the demand of Jesus to make it up with our accuser, by listing all the ways in which our sickness of anger can fester on even when we have pretended to make such amends. But, he says, 'The Doctor of souls [i.e., Christ], wishing to root out the soul's excuses from the heart, tells us to leave our gift and be reconciled not ony if we happen to be upset by our brother, but also if he is upset by us, whether justly or unjustly; only when we have healed the breach through our apology should we offer our gift'.⁷ iv. Finally, Cassian again radicalizes the hard gospel saying of Jesus by insisting that it is not enough to curb our tongue when angry; it is what festers in the heart that is really psychologically damaging: it is this that prevents the possibility of 'apatheia' (passionlessness) to which the monk strives (and here is the added influence of Greek - especially Stoic - philosophical thought.) But the monk in the desert, fortunately unable to take it out on another human being, will become even more humiliatingly aware of this internal disorder and 'sickness' when he finds himself kicking the dog or even the furniture!⁸ What then is the answer? For both monastic writers it is another form of the paradox of the New Testament: anger stops prayer, but only prayer - in and through the Holy Spirit - can purge anger. It is this possibility of anger's purgation, however, that desert spirituality has now put on the Christian agenda, and it seems to me to have continuing significance in our contemporary medical context: anger, and its destructive potential for health, must be owned and acknowledged before it can be repented of and its energy transformed to a good end.

3. Anger in the Reformers. Finally, let me make a couple of remarks about anger in the tradition of the European Reformation. It is possible that you associate Protestantism primarily with the repression of passion; and it cannot be denied that this tendency has been a feature of Calvinism in England and in this country - a complicated story too long, however, to explicate in this context. When we compare Luther and Calvin themselves, however, on the disputed text Eph. 4. 26, discussed above: 'Be angry and sin not', we get an interesting divergence, true perhaps to the distinctive characters and theologies of the two great Reformers. Luther, who was somewhat notorious for 'blowing his top' under provocation, insists that we take the imperative literally: yes, 'be angry', be indignant and 'burn with a holy wrath against vanity and lies' (i.e., in righteous indignation), but always about 'past' sin, since the life of the 'new man' takes us forward into the 'future' to 'get a new spirit and a new heart [in Christ]'.⁹ Whereas Calvin, commenting both on Psalm 4 and on Eph. 4, is insistent - wielding his formidable humanist scholarship - that neither text should be read 'be angry', but rather the Hebrew rigzu should be translated 'tremble' (i.e., tremble at the prospect of God's wrath). He then goes on to make the distinction - now classic - between anger at sin (appropriate) and anger at the sinner (always to be avoided).¹⁰ It is a fascinating divergence here between Luther and Calvin, which we may well encounter in the spiritualities of our patients: Luther acknowledging the importance of at least backward-reflecting purgation of anger, and Calvin more strictly aligning himself with Jesus's demands to put it away altogether, unless used impersonally against sin itself.

Finally, let me add a short postscript about my own form of Protestantism, Anglicanism, which - famously or notoriously (depending on your point of view) - is defined more by its liturgy and its Book of Common Prayer than it is by its doctrines or creeds. Whilst anger, both human and divine, is dealt with in various ways in the Prayer Book by means of prayers of confession (and by a now-suppressed liturgy of cursing sin on behalf of God called the Commination¹¹), if I had to speak of one distinctive feature of Anglican liturgy and life for the subject of anger, I would undoubtedly mention the absolute centrality of the chanting of the Psalms, which - until recent prayer-book changes - would all have been recited or sung in the course of each month. Here is Anglicanism's continuity with Catholicism's monastic tradition, of course, and thus too its great point of congruence with the psalmic spirituality of Judaism. The great imprecatory Psalms, then (the angry Psalms 58-59, especially,¹² or the bloodthristy features of Psalms 137 and 139, where hatred of enemies and of their children is openly expressed) represent in my view a form of catharsis of anger in the face of frustration, sickness or defeat which are striking, shocking, and extraordinarily powerful. Most regrettably in my opinion, sqeamish Anglican 'reforms' now allow for the suppression or sanitization of these 'angry' verses in the public liturgy or private office; but I believe they serve a crucial function in the expression of 'affect' in a way designed not to incite actual violence but to vent the feeling safely. More than once I have prayed Psalm 139 with a dying patient ('O Lord you have searched me out and known me . Will you not slay the wicked O God . Do I not hate them, O Lord that hate you? Try me O God and seek the ground of my thought') - and subsequently been specially asked by the patient to have the Psalm read at his funeral.

To conclude: Christian, and more specifically Protestant, attitudes to anger are not in radical discontinuity with Judaism's views, although there are twists of difference where issues of grace are concerned. The main points of pressure and paradox, however, I have argued, lie in reflecting on how anger as a vital and passionate force may be acknowledged, heard, and ritually channeled in such a way that any 'righteous indignation' may be attended to, and 'sinful anger' purged and purified. When patients or relatives of patients are angry with doctors or nurses, and perhaps even more when doctors or nurses are angry with patients, it is better not to deny the event or to repress the memory out of guilt, regrettable as an outburst or loss of control may have been. Insofar as health-care professionals are up against challenges of anger on a daily basis, both in their patients and in themselves, we can - and surely must - draw deeply on the wisdom of our spiritual traditions to help us confront this task.¹³

Notes

1. Elisabeth Kübler-Ross, On Death and Dying (New York, Macmillan, 1969).

2. I am grateful to Rabbi Shai Held for a discussion that has helped me in the shaping of this short paper, and especially for his stress on this fundamental theological point.

3. See The Book of Common Prayer, According to the Use of the The Episcopal Church (New York, Seabury Press, 1979), 'Ash Wednesday', 264-9, at 265.

4. See Matt. 5.44/Luke 6. 27; Matt. 5. 39/Luke 6.29; Matt. 18.22.

5. See the illuminating discussion of these themes in Evagrios in Simon Tugwell, O.P., Ways of Imperfection (London, D.L.T., 1984), ch. 3, especially at p. 27. The most significant material on anger in Evagrios can be found in his de Oratione ('On Prayer'), and his Praktikos, tr. John Eudes Bamberger (Cistercian Studies Series, Spencer, MA, 1970). The 'On Prayer' is also in the Philokalia, 1, eds. and tr. G. E. H. Palmer, Philip Sherrard and Kallistos Ware (London, Faber, 1979), 55-71.

6. See Tugwell, op. cit., p. 29, and Praktikos 24, 42, 86, 93.

7. John Cassian, 'On the Eight Vices', in Philokalia, 1, 84.

8. See ibid, 85-6.

9. Martin Luther, 'First Lectures on the Psalms', I, in ed. Hilton C. Oswald, Luther's Works, vol. 10 (St. Louis, Concordia, 1974), pp. 64, 65.

10. John Calvin, Commentaries on the Epistles of Paul to the Galatians and Ephesians, tr. William Pringle (Grand Rapids, MI, Baker Book House reprint, 1981), pp. 297, 298.

11. 'A Commination or Denouncing of God's Anger and Judgements against Sinners', in The Book of Common Prayer (1662) (Cambridge, C.U.P., n.d.), 338-46.

12. There is some evidence that the idea of violent language in the psalms being expressionistic/cathartic rather than literal is a surprisingly early idea: the Psalm titles to Psalms 57, 58 and 59, for instance, link these Psalms to the events of 1 Sam. 24, and David's self-restraint in not slaying Saul when he had the chance. Gary A. Anderson of Notre Dame (in a recent, unpublished paper, 'King David and the Psalms of Imprecation') traces the early rabbinic and patristic interpretation of Psalm 58, and shows that it is read as expressing blood-thirsty ideas precisely in order not to act them out: 'The imprecatory Psalms give witness to that deep abyss of personal hatred that David, through Divine grace, was able to overcome' (ibid, p. 6). I am grateful to Gary Anderson for an illuminating discussion on this matter.

13. A final word may perhaps therefore lie with John Cassian, who persistently favors the medical metaphor for Christ: 'the Lord commands us to leave our offering before the altar and be reconciled with our brother (cf. Matt. 5. 23-4), since our offering will not be acceptable so long as anger and rancour are bottled up within us. . We are often indifferent to our brethren who are distressed or upset, on the grounds that they are in this state through no fault of ours. The Doctor of souls, however, wishing to root out the soul's excuses from the heart, tells us to leave our gift and be reconciled not only if we happen to be upset by our brother, but also if he is upset by us, whether justly or unjustly; only when we have healed the breach through our apology should we offer our gift' ('On the Eight Vices', Philokalia, 1, 84, my italics).

Solomon Schimmel, "Anger in the Context of Illness- Perspectives from Jewish Tradition"
Anger: Introduction
Table of Contents

Published: January 12, 2005