A clue, if not a key, to understanding some of the initially puzzling features of the sacrament of unction of the sick may lie in English etymology.  The English words ‘holy’, ‘whole’, and ‘heal’ have common roots.  The following information is taken from the website etymonline.com

First, ‘holy’ comes from ‘Old English halig, “holy, consecrated, sacred; godly; ecclesiastical,” from…Proto-Germanic *hailaga-…from PIE [Proto-Indo-European] *kailo– “whole, uninjured” (see health).’

Secondly, the word ‘whole’ comes ultimately from the same root, *kailo-, with the ‘wh-’ spelling appearing in the 15th century. 

Thirdly, the verb ‘heal’, a verb meaning to ‘make whole’, also comes from the same Proto-Indo-European root:  ‘Old English hælan “cure; save; make whole, sound…well,” from Proto-Germanic *hailjan…,literally ‘to make whole’ (from PIE *kailo- ‘whole;’ see health).  Intransitive sense from late 14c.’

While it is difficult to determine fully the pre-Christian meaning for ‘holy’, it seems clear from this etymological information, that the ideas of holiness, wholeness, and health are at their roots internally and intimately connected.  To be healed or to be healthy means to be sound, to be whole, and to be holy.  ‘Health’ and good health are not merely physical states, but include integrity and completeness, and furthermore include also what Christians understand as sanctity and, in an ultimate sense, salvation. 

To this etymological information one should add the obvious fact that for Christians human beings are complex, composed of physical, mental, and spiritual dimensions that are interwoven and that mutually affect each other.  The health and holiness of the whole person involves body, intellect, spirit, and immortal soul.  The complex interaction of the elements composing the whole or entire person is permanent, though body and soul temporarily separate between physical death and resurrection.  Because of this mutual influence and normal complexity, that which affects the body, for example, also affects the intellect.  Likewise, that which oppresses the spirits or depresses the intellect influences the body and the soul.  The sacrament of holy unction assumes and depends upon this complex nature of human being.

Unction of the sick rests on New Testament authority.  Jesus in Saint Mark’s gospel sends forth the Twelve two by two, with power over ‘unclean spirits’ (6:7).  The Twelve so sent forth preach repentance and ‘they cast out many devils, and anointed with oil many that were sick, and healed them.’ (6:13)  The General Epistle of James similarly connects the ministry of the authoritative leaders of the community of Jesus’ followers with confession or repentance, with anointing with oil, and with healing as a consequence.  James writes,

Is any sick among you?  Let him call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord:  and the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him.  Confess your faults one to another, and pray one for another, that ye may be healed. (5:14-6)

The central tradition of Christendom understands these texts as the foundation of the sacrament of unction of the sick.  A few Protestants believe that these texts reflect a practice of the apostolic age which passed with the closing of the canon and the end of the age of miracles.  This belief is eccentric and contradicts both the actual practice of the universal Church of the first millennium and also the theological consensus of opinion in that Church.

The biblical and ecclesial authority of the sacrament of unction, however, does not by itself answer all reasonable questions about that sacrament, its presuppositions, and its practice.  All sacraments are mysteries, which involve efficacious divine actions that exceed human understanding.  Despite – indeed because – of this fact, Christians should as much as possible seek to understand the sacraments and their operation and should seek the answers to questions about such sacraments, their presuppositions, operation, and effects. 

The way in which unction is effective does not seem very difficult to comprehend if we begin by accepting the Christian belief, already noted, of human complexity.  If one accepts the interrelatedness of the elements of the human being as just noted, then it is not surprising that a spiritual remedy may have physical and mental effects.  People readily accept the idea that physical sicknesses and weaknesses often have emotional causes:  psychosomatic illness.  Likewise, people readily accept that physical illness can retard intellectual acuity or produce emotional depression.  Given the ready acceptance of such influences, there seems no reason for Christians to doubt that a primarily spiritual remedy may have physical and emotional benefits.  There is no one-to-one correspondence or automatic or magical effect of sacramental act X, on the one hand, and physical or emotional effect Y, on the other.  But that such effects often occur seems easy to understand.  The united human being has multiple dimensions which mutually interact and affect each other. 

Unction is not the only healing sacrament.  The Twelve preach repentance (Mark 6:12), with the subsequent verse mentioning the exorcism of devils, anointing the sick with oil, and healing (6:13).   Likewise, James associates prayer, confession, unction, and healing.  Repentance, confession, and absolution have healing effects as the improvement of spiritual health restores or at least encourages human wholeness.  Likewise, devout reception of Holy Communion, with prior repentance and confession, brings healing influence upon the whole person. 

While unction is not the only healing sacrament, it nonetheless brings an important and valuable, if not absolutely essential, specification of grace, perhaps analogous to the way in which confirmation bestows specific gifts and graces that strengthen and supplement the initial graces of baptism.  As confirmation is always helpful, even if not absolutely essential, so unction is always helpful to the sick.

It is noteworthy that the minister of all the healing sacraments is an authoritative leader appointed by Jesus or by his Church.  The Twelve are sent forth immediately by Jesus in Mark 6 (and in Matthew’s version of this mission in Matthew 10).  In James’ epistle prayer and unction for healing seem to be specific work of the ‘elders (presbyters) of the church’.  While James does not then explicitly limit confession to these same elders, the universal Church clarifies this text by limiting authoritative absolution to priests and bishops.  One may confess to anyone but can only receive sacramental absolution from a priest or bishop. 

To summarize to this point, then:  1.  health, wholeness, healing, and holiness are closely related; and, 2.  healing is, in accordance with New Testament and Church authority,  properly forwarded in part by spiritual means, including notably unction of the sick. 

After stating these initial points, some questions remain. 

Since sacramental grace is objectively and always offered when a sacrament is faithfully bestowed and received, does the sacrament of unction automatically and always result in healing?  We may answer the question with a qualified answer of ‘Yes’.  The qualification is that the healing in question is bestowed upon the whole human being and does not necessarily and always involve a physical healing.  Unction may be sought by and bestowed upon someone who is very likely going to die.  Nonetheless, because the sacrament always brings an objective offer of grace (ex opera operato), a healing grace is offered and, if the sacrament meets an appropriately disposed recipient, is received.  But the healing in question may be the remission of sins and other graces disposing the sick person to eternal life.  The healing sacrament does not fail if its recipient dies a physical death.  While the sacrament is bestowed with an intention for healing for the whole person, body, mind, spirit, and soul, the integration of the whole person means that the effects of the sacrament are complex and, ultimately, are known to God alone.  Even if the dying person in fact dies, the sacrament bestows healing effects, which reach beyond the ramparts of the visible world. 

For this reason, unction of the sick should be sought and bestowed even when there seems little or no chance of physical recovery in this life.  ‘Healing’ of the dying does not necessarily mean their recovery to temporal, transitory life, but rather may mean healing into eternal life.

In older Roman Catholic thought, unction of the sick was called ‘Extreme Unction’ and its subject or recipient was supposed to be ‘in danger of death from sickness or old age’, though the danger did not ‘need…be obvious and certain’[i].  Some explain the adjective ‘extreme’ as connected to this idea that the sacrament was limited to those in extremis.  Others explain the name as referring to unction’s place as the last anointing received in the normal order of Christian life.  Since the sacrament may be repeated, its delay until the danger of death is present seems inappropriate.  There is no suggestion in the biblical texts that only the dying were to be anointed. 

The effects of the sacrament traditionally have included healing or ‘the receiving of bodily health if expedient to salvation’ (Davis, p. 1).  But that ‘if’ suggests an emphasis also on the other effects of the sacrament:  ‘spiritual health and comfort of the soul’ and the ‘expiation of sin, extinction of the relics of sin, [and] disposing the subject for celestial happiness’ (Davis, p. 1). 

While the limitation of unction to the dying seems overly restrictive, modern practice often is too loose, with its regular repetition of the sacrament for the same person at brief intervals.  Traditionally the sacrament is not repeated for the same illness ‘unless the sick person…has recovered and has again fallen into the danger of death’ or illness (Davis, p. 8).  Since the sacrament is objectively efficacious, God will bestow its benefits as he sees fit in the circumstances and does not require constant prompting.  The weekly repetition of the sacrament is unnecessary and may suggest inappropriate doubts.  Davis suggests that repetition once a month to a sick person is sufficient. 


[i] Henry Davis, S.J.  Moral and Pastoral Theology in Four Volumes.  New York:  Sheed & Ward, 1935.  Volume IV, page 7.  Further citations in the text with ‘Davis’ and page number.

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