A Call for Discretion when offering Spiritual Advice for Clinical Depression

Pardon this “off topic” post, but I feel a need to address this issue.

This post has been making the rounds, though it is an article written in 2013. It attempts to offer St. Silouan’s aphorism “Keep your mind in hell, but don’t despair” as a “cure” for depression.

This is at first glance quite insensitive to those who struggle with depression, as if a “cure” could be so easily offered on a blog. Upon reading it closely, it is irresponsible, if not very dangerous. If a person diagnosed with clinical depression were to stop taking their medication on the advice of a blog, it could precipitate a dangerous decline in mental health that could result in suicide in a worst-case-scenario.

The advice that St. Silouan purportedly received from God was the result of a very long and hard-fought battle against his own passions as well as demonic powers. St. Silouan was, at the time, already advanced in ascetic discipline even though he was a relatively recent initiate to the monastic life. After receiving a vision of the Lord very early in his struggle, his subsequent despair and struggles came as a result of failing to recapture the ecstasy of that experience.

In short, St. Silouan’s case is not something that will apply to the vast majority of Orthodox Christians. And even if it were, such advice should be given by a spiritual father-confessor and monitored with great care.

Clinical depression is a serious illness that involves brain chemistry. It requires psychiatric care involving counseling and medication as well as spiritual care from a qualified pastor. Such clinical care cannot be cast aside as a “cruch,” and such talk is absolutely reprehensible.

But what is a biblical and Orthodox approach to the inner life? Are we commanded in Scripture to “keep our mind in hell?”

Quite the opposite.

If then you were raised with Christ, seek those things which are above, where Christ is, sitting at the right hand of God. Set your mind on things above, not on things on the earth. For you died, and your life is hidden with Christ in God. When Christ who is our life appears, then you also will appear with Him in glory. – Colossians 3:1-4 (NKJV)

Our minds ought to be on Christ, in Heaven seated at the right hand of the Father, for “our lives are hidden with Christ in God.”

“Keep your mind in hell, but don’t despair” is advise given for a very specific situation, where extreme humility is needed to combat and eradicate pride, but it is not a biblical or normative spiritual mindset. Let this be a call to pastors and spiritual fathers to be very careful in the application of this saying, for it could have disastrous effects that could even have legal ramifications.

Please, please, do not let “piety” get in the way of common sense or biblical theology and spirituality. It as if we have forgotten Scripture and replaced it with sayings from various saints and elders, and this is a spiritual malady in itself.


*UPDATE* It is becoming apparent from some of the comments that people are confusing St. Silouan’s metaphorical “hell” for the equivalent of a depressive mental state. This is THE EXACT OPPOSITE of what it was intended for. The command to “KEEP oneself in hell” was for a person who was too elated with his spiritual and ascetic progress and had thus fallen into pride. The “hell” of clinical depression is NOT a place where one should be told to “keep one’s mind.”  So, let’s be very clear hear exactly the context in which St. Silouan received this word and not extend it to places where it was not intended.


  1. I have two observations:
    First, regarding the quote specifically, there are plenty of times when keeping your mind in hell is not entirely optional, and for me the potent focus of the quote is a reminder that even while stuck in the pit, despair is not a necessity (precisely because “our lives are hidden with Christ in God). My priest had given me that little morsel early on and it’s been a potent reminder that depression and grief are not at all inseparable from despair, and that’s huge (again, given the right context.)

    Second, I also have to say that one of the best pieces of advice my priest has given me was insisting that I find someone to talk to who actually has expertise in counseling. While, not at all brushing me off, he made clear that some issues require other types of help. I thank God he did, I’m far too stubborn to have done so otherwise and can’t be entirely sure I’d be here otherwise.

    bottom line: my priest is pretty great. (and you know, Jesus and so forth…)

    1. The disassociation of the “hell” of depression and despair is very important, though somewhat counter to St. Silouan’s intent. In other words, pastorally, the same point can be made without recourse to St. Silouan. It can even be dangerous if taken at its word “keep your mind in hell.” I don’t think it is good for those who suffer from depression to be told to “keep” their minds there, even if they are able to not despair. In other words, the advise given to St. Silouan was intended for a strong monastic disposition suffering a loss of grace due to pride, not for someone struggling with depression.

      It is good that your priest is wise and helpful, but not every priest is capable of dealing with these situations, hence why is it very unwise to advocate on a blog what should be a very personal matter between a person and medical professionals and qualified spiritual advisors.

  2. Thank you Eric for this much needed post. It should also be pointed out that being unable to remove ones mind from Hell so to speak but rather being continually assaulted with painful memories and terrors, so that one loses the energy to work, are characteristics of depression. If a monk got depression he would lose the ability to serve the monastery; fortunately in the days before we had anti depressants some abbots were equipped by God to deal with this, but despair was a severe problem many monks battled with, and some lost the fight for biological reasons. But win modern medicine, the fight can be won.

    Also if you abruptly stop taking antidepressants, that in particular can cause suicide. Antidepressants take a while to start working and should not be discontinued suddenly. Fortunately, most, if not all, Orthodox priests know this, and aren’t stupid enough to give this advice of St. Silliam to their spiritual children in such cases. The real problem is Orthodox or inquirers into Orthodoxy or people in uncanonical jurisdictions run by lunatics, of which a few exist, reading this and trying it on their own, and thus putting their life in danger.

    1. Okay, but lets be clear here: St. Silouan’s aphorism is “KEEP your mind in hell.” This is not saying, “If your mind happens to be in a metaphorical hell due to depression or some other psychological malady, then you should stay there and not despair.” What it is saying is, “If you are elated with pride in your spiritual and ascetic progress, then humble yourself with the site of your own sinfulness and rightful condemnation, while not despairing because of faith in divine mercy.”

      I’m a little disturbed that people are misconstruing St. Silouan’s “hell” with a depressive state of mind. This is the EXACT OPPOSITE of its intent.

      1. Indeed, I agree entirely. And what is more, if someone with depression tries to do that and stops their meds, that would be very dangerous, because if you stop antidepressants abruptly you can lapse into a severe disruption and the risk of suicide increases. This is suicide not due to intentional causes but rather a biochemical urge to self destruction, a malfunction of the brain.

        And St. Silouan and the monastic fathers knew about this, and had different procedures for dealing with those in despair vs. those experiencing spiritual pride. The procedure outlined here by Silouam is a treatment for excess spiritual pride a monk can fall into, developing literally a Holier Than Thou attitude, which is kind of the opposite of depression, closer to mania.

  3. Eric,

    Thank you for posting this. I have a history of depressive episodes and I have also been referred to this quote. It is something that comes to mind during those times and I don’t think I have ever understood it correctly. I have heard it interpreted as praying for everyone to escape hell first and yourself last. I can relate to St. Silouan’s inability to recapture that elation he experienced early in his spiritual encounter, I am in that place right now. I will reevaluate that quote from now on instead of wallowing in my misery.

  4. Christ’s famous admonition to St Silouan (in “keep thy mind…”) can only be understood through the lens of Pascha (i.e. the coming of the Lord to St Silouan was itself the cure for his hell, death, clinical depression, etc.). Trying to find the nugget in Christ’s word without having an inkling of what the gifts of Theophany really are (Kyrie eleison, Kyrie eleison) is a bit like a man born blind trying to teach an artist how to paint a rainbow, without a brush. Forgive me, a sinner.

  5. I disagree mainly because I read much of St Silouan , Fr Sophrony and Elder Raphael. I read “hell” here fully congruent with the idea that there is NO salvation but THROUGH the Cross (not around, not jumping ahead to “Resurrection”). For me, that both validates and transfigures the suffering (“hell”), where grace comes not “in spite of it”, but THROUGH IT. Is not that the reason we sing and say , “O Thrice blessed Cross”… ?

    1. This is not about salvation, but mental health, which is a physical malady as well as a psychological and spiritual one. We are not denying the theology of Christ transfiguring suffering. We are talking about the prudence of indiscriminately offering this advice to someone struggling with clinical depression. One can state that Christ transfigures suffering without telling people to keep their mind in hell!

    2. This is an example of what I said, where theology and piety get in the way of prudence and common sense. Your theology is correct, but offering it in St. Silouan’s terms to someone with depression is very imprudent.

      1. I agree with the “imprudence”. Pastoral skills come as an “art”, using the right tool at the right time. As a chaplain I have worked long enough with patients suffering from real psych disorders and I would NEVER advise against medical intervention, nor would I suggest that with enough prayer, humility, etc. one will be “fine”. I also think spiritual, mental and physical conditions are so intertwined it’s very difficult if not impossible to draw lines. To take your comment to the other extreme: was St Silouan clinically depressed? How about Fr Sophrony? What if they received “sufficient” medication? (that might actually reflect today’s quest for the pure scientifical “cure of everything”, including dying and death).

  6. This discussion is (or should be) as important and illuminating as any in our life in Christ. It’s where the “rubber meets the the road”.

    My younger brother Linus passed away a few days ago. I grieve miserably for Linus. He suffered from chronic depression. His departure might be attributed to many confounding factors related to his condition. His confession was of the SNR or NotA (none of the above) variety, but, as his brother, I found it unmistakable to discern his apprehension of his fundamental being as a person in the image of God. Linus was not so blessed to apprehend this to any great extent. May his memory be a blessing to us. Forgive me and pray for Linus.

    I too have suffered through chronic depression, as described by contemporary psychology. I have not conquered it, though I do not suffer this malady to the degree that I had before receiving Orthodoxy. My spiritual Father issued to me St. Silouhan’s adjuration, along with important readings to combat my despondency (which may correspond to, but be differentiated from clinical depression).

    The discernment that Eric Jobe speaks of here reveals a greater reality. The apparent duality between the spiritual and material dissolves within our life in Christ. There is no doubt that a depressive person experiences chemical imbalances, often modulated by a negative feedback loop between body and brain. When can a person invoke the immutable and perfect image of God upon the coarse condition of our bodies and brains?

    “Keep your mind in hell and despair not” reminds me so much of Ephesians 4:26-27 which admonishes us to “Be ye angry, and sin not”. These seem both such stark dualities. How can one do both?

    I would invite any who would venture to answer this question to listen to Fr. Tom Hopko’s reflection at http://www.ancientfaith.com/podcasts/hopko/on_sadness_and_grief_in_human_life

  7. Good point Eric. This talk about depression by St Porphyrios is more attuned to the issues of clinical depression and life in the world:

    Of course neither does it replace proper counseling and clinical care, but it addresses the issue more immediately. St Porphyrios also had a different character and formation and experiences from St Silouan, and tended to emphasize joy more than contrition. Both are wise words from one shepherd, and need to be applied by everyone as is necessary for their individual cases.

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