What is an obsessive thought called? Psychiatry and spiritual life
6.2. Thought disorders
Thinking is a function of cognition with which a person analyzes, connects, generalizes, and classifies. Thinking is based on two processes: analysis(decomposition of the whole into its component parts in order to highlight the main and secondary) and synthesis(creating a complete image from individual parts). Thinking is judged by a person’s speech and sometimes by actions and deeds.
Disorders of the form of associative process
Accelerated pace (tachyphrenia)– thinking is superficial, thoughts flow quickly and easily replace each other. Characterized by increased distractibility, patients constantly jump to other topics. Speech is accelerated and loud. Patients do not correlate the strength of their voice with the situation. Statements are interspersed with poetic phrases and singing. The associations between thoughts are superficial, but they are still understandable.
The most pronounced degree of accelerated thinking is leap of ideas(fuga idiorum). There are so many thoughts that the patient does not have time to speak them out; unfinished phrases and speech are characteristic. It is necessary to differentiate with broken thinking, in which associations are completely absent, the rate of speech remains normal, and there is no characteristic emotional intensity. An accelerated pace of thinking is characteristic of mania and stimulant intoxication.
Mentism– a subjective feeling when there are a lot of unrelated thoughts in your head. This is a short-term condition. In contrast to accelerated thinking, this is an extremely painful condition for the patient. The symptom is characteristic of Kandinsky-Clerambault syndrome.
Slow pace (bradyphrenia). Thoughts arise with difficulty and remain in consciousness for a long time. Slowly replace one another. Speech is quiet, poor in words, responses are delayed, phrases are short. Subjectively, patients describe that thoughts, when they appear, overcome resistance, “tossing and turning like stones.” Patients consider themselves intellectually incompetent and stupid. The most severe form of delayed thinking is monoideism, when one thought persists in the patient’s mind for a long time. This type of disorder is characteristic of depressive syndrome and organic brain lesions.
Sperung– interruptions of thoughts, “blockage of thinking”, the patient suddenly loses his thoughts. Most often, experiences are subjective and may not be noticeable in speech. In severe cases - sudden cessation of speech. It is often combined with mental influxes, reasoning, and is observed with clear consciousness.
Slipping Thinking– deviation, reasoning slipping into side thoughts, the thread of reasoning is lost.
Disjointed thinking. With this disorder, there is a loss of logical connections between individual thoughts. Speech becomes incomprehensible, but the grammatical structure of speech is preserved. The disorder is characteristic of the late stage of schizophrenia.
For incoherent (incoherent) thinking Characterized by a complete loss of logical connections between individual short statements and individual words (verbal okroshka), speech loses grammatical correctness. The disorder occurs when consciousness is impaired. Incoherent thinking is part of the structure of the amentive syndrome (often in a state of agony, with sepsis, severe intoxication, cachexia).
Reasoning- empty, fruitless, vague reasoning, not filled with specific meaning. Idle talk. It is noted in schizophrenia.
Autistic thinking– reasoning is based on the patient’s subjective attitudes, his desires, fantasies, and delusions.
Often there are neologisms - words invented by the patient himself.
Symbolic thinking– patients attach special meaning to random objects, turning them into special symbols. Their content is not clear to others.
Paralogical thinking– reasoning with “crooked logic”, based on a comparison of random facts and events. Characteristic of paranoid syndrome.
Duality (ambivalence)– the patient affirms and denies the same fact at the same time, often found in schizophrenia.
Perseverative thinking– getting stuck in the mind of one thought or idea. It is typical to repeat one answer to different subsequent questions.
Verbigeration– a characteristic speech disorder in the form of repetition of words or endings with their rhyming.
Pathological thoroughness of thinking. There is excessive detail in statements and reasoning. The patient gets “stuck” on circumstances, unnecessary details, and the topic of reasoning is not lost. Characteristic of epilepsy, paranoid syndrome, psychoorganic syndromes, paranoid delusions (especially noticeable when a delusional system is substantiated).
Disorders of the semantic content of the associative process
Super valuable ideas- thoughts that are closely fused with the patient’s personality, determining his behavior, having a basis in the real situation, and arising from it. Criticism of them is flawed and incomplete. In terms of content, they distinguish overvalued ideas of jealousy, invention, reformism, personal superiority, litigious, hypochondriacal content.
The interests of patients are narrowed to overvalued ideas that occupy a dominant position in the consciousness. Most often, overvalued ideas arise in psychopathic individuals (overly self-confident, anxious, suspicious, with low self-esteem) and in the structure of reactive states.
Delusional ideas– false conclusions that arise on a painful basis; the patient is not critical of them and cannot be dissuaded. The content of delusional ideas determines the patient's behavior. The presence of delusions is a symptom of psychosis.
The main signs of delusional ideas: absurdity, incorrectness of content, complete lack of criticism, impossibility of dissuading, determining influence on the patient’s behavior.
According to the mechanism of occurrence, the following types of delirium are distinguished.
Primary delirium– delusional ideas arise primarily. Sometimes present as a monosymptom (for example, with paranoia), as a rule, systematized, monothematic. Characterized by the presence of successive stages of formation: delusional mood, delusional perception, delusional interpretation, crystallization of delirium.
Secondary delusion– sensual, arises on the basis of other mental disorders.
Affective delirium. Closely associated with severe emotional pathology. It is divided into holothymic and catathymic.
Holothym delirium occurs in polar affective syndromes. With euphoria - ideas with increased self-esteem, and with melancholy - with decreased self-esteem.
Catathymic delirium occurs in certain life situations accompanied by emotional stress. The content of delusions is related to the situation and personality characteristics.
Induced (suggested) delusion. It is observed when the patient (inductor) convinces others of the reality of his conclusions, as a rule, it occurs in families.
Depending on the content of delusional ideas, several characteristic types of delusions are distinguished.
Persecuratory forms of delusion (delusion of influence) At delirium of persecution the patient is convinced that a group of people or one person is persecuting him. Patients are socially dangerous because they themselves begin to pursue suspected persons, the circle of whom is constantly growing. They require hospital treatment and long-term observation.
Delusional relationship– patients are convinced that those around them have changed their attitude towards them, have become hostile, suspicious, and are constantly hinting at something.
Delusions of special significance– patients believe that TV programs are specially selected for them, everything that happens around has a certain meaning.
Delirium of poisoning– the name itself reflects the essence of delusional experiences. The patient refuses to eat, and olfactory and gustatory hallucinations are often present.
Delirium of influence– the patient is convinced that imaginary pursuers in some special way (evil eye, damage, special electric currents, radiation, hypnosis, etc.) affect his physical and mental state (Kandinsky-Clerambault syndrome). Delusion of influence can be inverted when the patient is convinced that he himself influences and controls those around him (inverted Kandinsky-Clerambault syndrome). Delusions of love influence are often identified separately.
Delusions of property damage(robberies, burglaries) are characteristic of involutional psychoses.
Delusional ideas of greatness. Delusions of grandeur include a group of different delusional ideas that can be combined in the same patient: delirium of power(the patient claims that he is endowed with special abilities, power); reformism(ideas about reorganizing the world); invention(conviction of a great discovery); special origin(patients’ belief that they are descendants of great people).
Manichaean nonsense– the patient is convinced that he is at the center of the struggle between the forces of good and evil.
Mixed forms of delirium
Nonsense of staging. Patients are convinced that those around them are performing some kind of performance especially for them. Combines with delirium of intermetamorphosis, which is characterized by delusional forms of false recognitions.
Symptom of negative and positive double (Carpg syndrome). With the symptom of a negative double, the patient mistakes close people for strangers. False recognition is typical.
With the symptom of a positive double, strangers and strangers are perceived as acquaintances and relatives.
Fregoli's symptom - the patient thinks that the same person appears to him in different reincarnations.
Delirium of self-blame(they are convinced that they are sinners).
Megalomaniac delirium– the patient believes that because of him all humanity is suffering. The patient is dangerous to himself, extended suicides are possible (the patient kills his family and himself).
Nihilistic delirium(delusion of denial) - patients are convinced that they do not have internal organs, there is no possibility for the organs to function safely, patients consider themselves living corpses.
Hypochondriacal delirium– patients are convinced that they have some physical disease.
Delusion of physical handicap (dysmorphomanic delusion) characteristic of adolescence. Patients are convinced that they have external deformity. In contrast to dysmorphophobia (which has been described within the framework of depersonalization syndrome), behavioral disturbances are very significant, combined with delusions of attitude and depression.
Delirium of jealousy often has absurd content, and is very persistent. Patients are socially dangerous. Characteristic of older people, sometimes associated with the decline of sexual function.
Rare variants of the content of delusional ideas
Retrospective (introspective) delusion– delusional ideas relate to a past life (for example, delusions of jealousy after the death of a spouse).
Residual delirium– observed in patients after recovery from psychosis, a state of altered consciousness.
Delusional syndromes
Paranoid syndrome– the presence of monothematic primary systematized delirium. One theme is typical, usually delusions of persecution, jealousy, and invention. Delusion formation is primary, since delusion is not associated with hallucinatory experiences. Systematized, since the patient has a system of evidence that has its own logic. It develops slowly, gradually, and has a long course. Prognostically unfavorable.
Paranoid syndrome– diverse delusions, several variants of delusions (relationships, special meaning, persecution). The structure of this syndrome often includes perception disorders (hallucinatory-paranoid syndrome - diverse delusions, the content of delusions is secondary, often determined by the content of hallucinations). The content of delusional ideas changes dynamically. Something else joins the delirium of persecution. Accompanied by an affective state (fear, anxiety, melancholy). Characterized by delusional behavior and delusional perception of the surrounding world and current events.
An acute course (acute paranoid) is characteristic of schizoaffective psychoses, paroxysmal schizophrenia, organic brain diseases, and intoxications.
A chronic course occurs in the paranoid form of schizophrenia; a common variant is hallucinatory-paranoid Kandinsky-Clerambault syndrome.
Paraphrenic syndrome. The structure of this syndrome includes delusional ideas of power and persecution, hallucinatory experiences, and fragmented thinking. The content of delusional ideas is constantly changing (often completely ridiculous and fantastic), the system is completely absent, the plot changes depending on the emotional state. The mood is either complacent or apathetic. The above syndromes (paranoid, paranoid and paraphrenic) are a kind of stages in the development of delusions in the paranoid form of schizophrenia. There are two variants of the syndrome: expansive and confabulatory.
Cotard's syndrome. Observed in involutional psychoses. Delusional ideas of nihilistic content are accompanied by anxious-depressive affect.
Body dysmorphomania syndrome. Delusions of external ugliness, delusions of relationship, depression. Patients actively visit doctors and insist on plastic surgery. Suicidal thoughts and actions are possible.
Obsessions. Obsessive thoughts (obsessions) are memories, doubts, unnecessary thoughts, experiences, alien to the patient’s personality, arising in the patient’s mind against his will. The patient is critical of such extraneous thoughts, aware of their painful nature, and struggles with them.
Contrasting obsessive desires - desires to perform actions that do not correspond to the moral principles of the individual are never fulfilled.
Obsessive-compulsive syndrome (obsessive-compulsive-phobic) occurs in neuroses (obsessive-compulsive neurosis), with decompensation of asthenic psychopathy, and in the initial stages of low-gradient schizophrenia.
Obsession options:
1) thoughts of blasphemous content;
2) arithmomania - obsessive counting;
3) phobias – obsessive fears (a huge number of options, which is why the list of phobias received the unofficial name “garden of Greek roots”):
A) nosophobia– obsessive fear of getting sick, as particular variants often include cardiophobia (fear of a heart attack) and cancerophobia (fear of cancer);
b) position phobia, agoraphobia– fear of open spaces and claustrophobia– fear of confined spaces;
V) erythrophobia– fear of blushing in public;
G) scoptophobia– fear of appearing funny;
d) pettophobia– fear of missing intestinal gases;
e) lissophobia (maniophobia)– fear of going crazy;
and) phobophobia– fear of developing a phobia.
At the height of the experience of obsessive fears, patients experience pronounced autonomic disorders, often motor (panic) agitation.
Compulsions are obsessive desires (for example, craving for drugs without symptoms of physical dependence).
Rituals are special obsessive protective actions that are always combined with phobias.
Habitual obsessive movements (which do not have a protective component for the patient) - biting nails, hair, thumb sucking.
Features of delusional development in childhood and adolescence
1. Hallucinogenicity - in adults, primary delusional formation is more often, and in children it is secondary, based on hallucinatory experiences.
2. Catatism (affectogenicity) - the themes of delusional ideas are associated with books read, computer games, films watched, which made a strong impression on the child.
3. Fragmentation (fragmentation) – vague, incomplete delusional constructions.
4. Delusional mood - manifests itself in a feeling of distrust towards relatives and teachers. The child becomes withdrawn and alienated.
5. The younger the child, the more primitive the delirium. Characteristic are delusions of other people's parents, delusions of pollution (they constantly wash their hands until maceration), hypochondriacal delusions, and dysmorphomanic delusions. Ideas of monothematic content are close to paranoid delusions.
In Moscow, in the Church of the All-Merciful Savior b. Sorrowful Monastery, a meeting took place between Pravmir readers and the editors. At the meeting, psychiatrist Vasily Glebovich Kaleda gave a lecture “Psychiatry and Spiritual Life.”
Vasily Glebovich Kaleda is an employee of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences, deputy chief physician for medical work, leading researcher in the department for the study of endogenous psychoses and affective states. Teaches a course in pastoral psychiatry at the Orthodox St. Tikhon's University for the Humanities, professor of the department of pastoral theology. Son of a professor, (1921-1994).
Video recording of the lecture
Audio recording of the lecture:
Physical illnesses
A physical illness often affects a person’s mental life and mood. His mood may deteriorate, which, accordingly, may affect his spiritual life. He can commit certain actions that can and should be assessed within the framework of moral theology as human sin. And at the same time there is a different relationship between these three spheres. When the human spirit is very strong, when a person lives a strong spiritual life, bodily illnesses can only strengthen it. He, as a believer, will perceive bodily illness as the providence of God, will perceive it as a test that is sent to him by God.
In Rus' it was customary to say that when a person gets sick, when some misfortune happens to him, “the Lord visits him.” And any illness, any suffering was perceived as a visit from God, as a sign of God’s special attention, the Lord notes. Saint Ignatius Brianchaninov wrote that “the bed of illness can be a place of knowledge of God.”
The sphere of the human spirit, the illness of the human spirit, is the sphere where the spiritual doctor, the priest, heals. The sphere of the human soul is the sphere in which a psychiatrist treats. These areas are inextricably linked: there are quite a lot of conditions where close cooperation is necessary between a priest and a psychiatrist, in some cases a somatologist, or a general practitioner.
Mental illness
When we talk about mental illness, there are very different conditions. In one case, priority belongs to the psychiatrist and the patient is not advised to communicate with the priest; moreover, it can even lead to an aggravation of his condition. When we are dealing with acute psychoses and the patient has delusions and hallucinations, he completely inadequately perceives the surrounding reality, and here, first of all, drug treatment is necessary. After this acute condition passes, we try, if possible, to invite a priest. Moreover, if we take the area of so-called borderline psychiatry, then here the treatment of the patient should be joint, and in some cases, priority gradually shifts to the priest.
In our Center there is an Orthodox church, which was opened in 1992. Now every hospital has an Orthodox church or prayer room. But then, 18 years ago, the time was completely different - the Soviet system had just collapsed. And in our Center, which was perceived as an “outpost of Soviet psychiatry,” a temple was very quickly opened. What does this mean? This suggests that even then the leading psychiatrists of our country, who worked at our Center at that time, not only respected the activities of the Russian Orthodox Church, but also perfectly understood that religious values are very important for strengthening a person’s mental life, very important , if you want, for conducting psychotherapeutic activities.
Today, society’s attitude towards people with mental illness is, to put it mildly, very inhumane, which reflects the general level of the spiritual state of our society.
What do we have today in the Orthodox environment? Unfortunately, we very often encounter a lack of understanding that there are spiritual illnesses and there are mental illnesses. Very often we come across the fact that priests try to combine all illnesses, all conditions associated with a person’s mental life and spiritual life into one whole and attribute them to their sphere of competence, and do not understand certain mental states and mental problems that the patient has. A number of tragic examples can be cited.
One patient who was treated at our Center suffered acute psychosis, came out of it, graduated from an institute (a fairly prestigious institute), worked, at some stage he had some problems and turned to a priest. The priest advised him to stop taking the medication. A few days later, about two weeks later, the man ended his life.
Another example can be given when a patient developed an acute condition called anorexia nervosa, when the patient refused to eat. He talked with one priest who said that “this race is driven out only by prayer and fasting,” and that one must pray and fast. stopped due to death.
In the same way, other examples can be given where, on the contrary, some psychiatrists completely do not understand and do not recognize the role of the priest. There are psychiatrists raised in Soviet times who consider any manifestation of religious life to be a manifestation of pathology. We may recall that in Soviet times, we, people of faith, were considered “abnormal.”
Recently I had a graduate student at PSTGU - a priest from Belarus, he takes care of patients in one of the psychiatric hospitals. In this hospital there was a department head who also believed that all manifestations of religious life are pathology, and the most striking carrier of this pathology, accordingly, is the priest, and the degree of severity of their pathology is such that it is almost a stationary case. While this head headed the department, the priest could only go there when he was on vacation or on sick leave.
But now, of course, in psychiatric hospitals the situation in the relationship between psychiatrists and priests is fundamentally changing.
In psychiatry, a distinction is made between major psychiatry and minor psychiatry. These two names in no way reflect the degree of significance of these areas of clinical psychiatry; such names have been fixed historically. Major psychiatry deals with endogenous psychoses, that is, diseases such as schizophrenia, schizoaffective psychosis, manic-depressive psychosis: mental disorders are caused by a purely biological cause, usually a genetic predisposition. When the emphasis of treatment is primarily on biological methods of treatment - on pharmacotherapy.
In addition, there is minor psychiatry, borderline - that area of psychiatry that is associated with the neurotic level of mental pathology, with that pathology of mental activity that has a mild degree of severity, but is still extremely painful for a person. This pathology, on the one hand, has a certain constitutional predisposition, is associated with a person’s personal characteristics and, therefore, is inextricably linked with his worldview, attitude, worldview, his upbringing, and the religious values that he adheres to. This so-called minor psychiatry includes personality disorders, obsessive states, anxiety-phobic and somatoform states, and reactive states. Here we can say that there is such a field of psychiatry as Orthodox psychotherapy, that is, the methods that are used here are based on the Orthodox worldview, on the traditions of church counseling that come from the Fathers of the Church. In recent years, Orthodox schools of psychotherapy have developed in our country.
Currently, you can find a number of books on bookstore shelves that are dedicated to psychiatry. These are primarily the works of Dmitry Evgenievich Melekhov, Jean-Claude Lachey, the work of Vladeta Erotich, priest Anatoly Garmaev, Abbot Evmeniy, V. Nevyarovich, Dmitry Avdeev. But with all this, most of these books, except for the work of Dmitry Evgenievich Melekhov, are essentially devoted to Orthodox psychotherapy. And therefore, their authors rely primarily on the experience of their psychotherapeutic work with patients of a neurotic level. In some of these works, it is very strongly felt that their authors do not have their own personal experience of working with psychotic patients.
But among the books that can be found on the shelves of Orthodox stores, one can find books whose authors adhere to an anti-medical and anti-psychiatric orientation, which runs counter to the official position of the Russian Orthodox Church as set out in the Fundamentals of the Social Concept.
As an example, we can cite a book that belongs to Bishop Varnava Belyaev. His consecration took place in the early 20s under Patriarch Tikhon, he was a bishop, and soon he became a fool, stopped serving as a bishop, and died in 1963 in Nizhny Novgorod. He wrote a large five-volume book, The Fundamentals of the Art of Holiness. The book is quite large; it contains a huge number of sayings of the holy fathers. But with all this, there are statements about the complete non-recognition of medicine, that “.. there can be no modern medicine in the sense in which it is perceived by educated people, ... that when a patient is treated, then his body you have to fight not only with diseases, but also with the medications that the doctor prescribes. That is, the patient survived not because of the treatment, but only in spite of the treatment.” Such statements are completely at odds with modern Orthodox understanding. We can take as an example the saint of the Russian Church of the 20th century, canonized, Archbishop Luke Voino-Yasenetsky: in his works we will find a completely different attitude towards medicine.
Hell on earth
Mental illnesses and mental suffering are the most severe - “the soul hurts.” A person who adheres to the Orthodox worldview understands perfectly the value of human life, the gift that the Lord God gave him, the gift that he must cherish. And therefore, among Orthodox people, the incidence of suicide is clearly lower. But when it comes to major psychiatry, about severe depressive disorders, truly severe depression, here a person is, as it were, at the depths of an abyss. His perception of the world around him, of all the values that he has, sharply narrows. He loses the ability to take into account the suffering of his loved ones; thoughts about the experiences of relatives, parents, wife, children can no longer stop him. He is unable to think about what awaits him later, because the suffering that he is experiencing now is akin to the suffering of those in hell. Therefore, for a person, whether there is a state of hell here or there, it makes no difference.
I have a priest friend who suffers from severe depressive states of a deep psychotic level. He said that he perfectly understands people who, in a state of psychosis, commit suicide.
The problem of various obsessive states
Obsessions can be different - simple, psychologically understandable, uncomplicated, when a person has an obsessive thought, an obsessive melody, from which a person cannot in any way get behind. There are severe obsessions - these are the so-called contrasting obsessions. For example, when a woman has an irresistible desire to hit her child, throw someone under a train on the subway, or stab someone. This thought is completely alien to a person, he understands perfectly well that this cannot be done, but, nevertheless, the person suffers, experiences terrible mental suffering, because this thought persistently exists. Also classified as contrasting obsessions are the so-called blasphemous thoughts, when a person seems to have blasphemy against the Holy Spirit.
I had one patient who suffered an acute psychotic state within the framework of schizophrenia with all the manifestations of this condition. After some time, the symptoms went away, depression developed and blasphemous thoughts appeared. For an Orthodox Christian, blasphemous thoughts are painful. He went to the priest for confession, and the priest told him that everything would be forgiven to a person except blasphemy against the Holy Spirit. What could he do in such a situation? To begin with, he attempted suicide. Before he could realize his suicidal intentions, he, fortunately, came to us. As part of the therapy we carried out, everything went away quite quickly for him and in the future (more than 15 years passed) it did not happen again.
This suggests that many manifestations of mental and spiritual illness are very similar. There are cases when blasphemy against the Holy Spirit occurs as a manifestation of demonic influence, and there are cases when mental illness occurs.
Commentary by Archpriest Alexander Ilyashenko
- Vasily Glebovich, if such a person came to me, I would tell him so: these thoughts are not yours, this is completely obvious, you are absolutely not to blame here, do not be afraid of anything, this is not blasphemy against the Holy Spirit, because your head, your brain is yours, but your thoughts are not yours. The evil one has given you thoughts. Pray, fight. How adequate is this approach? Or should I go to the doctor about this?
“In this case, the patient was discharged from a psychiatric hospital, so he had to be sent to a psychiatrist. Today we can clearly say that all these contrasting thoughts are subject to a certain effect of pharmacotherapy and need treatment. As a rule, they are still accompanied by depressive disorders of varying severity.
Two extremes
The Fundamentals of the Social Concept of the Russian Orthodox Church (XI.5) clearly states that there are two extremes. The first extreme is to explain all mental disorders by demonic influence, and the other extreme is to completely deny the presence of demonic influence.
Demonic influence exists, and in psychiatry there is a “demon possession syndrome”, when a person says that he is possessed by demons, that they influence him, and tells how they affect him physically, jump, grab him, and so on, similar to the descriptions of the holy fathers. But, nevertheless, each such case should be considered individually.
Recently, a priest I know, respected and educated, visited the holy Mount Athos. I visited with my friend, a very successful businessman, a deeply church-going man. It is clear that this person is quite rational in his structure. They lived in, went to services. Services there start quite early, and they decided that they would not go to the early one, but would go a little later. Very early, at about five in the morning, the priest woke up from the fact that his neighbor in his cell was getting up, making some movements with his hands, getting dressed and leaving. Literally a minute later, the priest feels something pounce on him and tries to grab him. The priest reaches out his hand to cross himself. He crossed himself - and this phenomenon passed. I lay there for a few minutes, and after a while this phenomenon repeated again. It is clear that in such a situation you need to get up and go to the temple of God. While he was walking to the fraternal building, this phenomenon repeated. He comes to the temple and meets his friend there and expresses his surprise to him. He answers: after all, we are on Mount Athos, such a place, we’ll sleep at home in Moscow.
Then after some time they started talking, and it turned out that the same phenomenon happened to his companion. How should we feel about this? First, I know the priest, this man, well. It is clear that people are different in their mental structure. There are very emotional people, with a very rich imagination - he will go to the cemetery at night, there he will definitely see or hear something. If you tell such a person that you are going to the holy Mount Athos, and there are all sorts of temptations of various kinds, then 99% of the time this will happen to this person. So, this priest did not belong to this category of persons, I am ready to testify. And his businessman friend also did not belong to this category. This is a classic example of temptation in holy places.
When the Lord was on earth, this was all a mass phenomenon; these phenomena always occur near the shrine.
Outwardly similar phenomena are encountered in psychiatric practice, when a patient talks about how he feels the influence on himself, how dark forces whisper something, how they move into him, live in him, toss and turn, jump. Recently I had a patient who experienced all sorts of sensations, said that there was a dark force inside him that “tapped him with a fist, on his liver, sometimes on his back.” When he went down to the subway, these forces left him, and he saw something flashing around him. We examined this case in classes on pastoral psychiatry together with priests and students of PSTGU and came to the conclusion that this condition is a manifestation of mental illness, psychotic experiences that have a biological rather than a spiritual basis, which have such a coloring.
Avatar
Our patients in a state of psychosis perceive what surrounds them, perceive what is in the environment. Recently I consulted a patient who considered himself an Avatar, a character from one of the latest. He believed that he was here, and besides that, he was an Avatar, therefore, somewhere he had a foreign body. He watched the film, and when he developed psychosis, the themes of delusional disorders turned out to be borrowed from the film. At one stage he believed that he was fully the Avatar, then he believed that he lived in two worlds.
I had a patient who in one attack believed himself to be Cheburashka and heard the voice of the crocodile Gena, and in the next attack he was already exposed to dark forces. Those. in one case, the theme of delusional experiences was related to a children's cartoon, in the other it had a religious theme. I recently had a patient who claimed that he had nanorobots circulating in his blood.
The Lord said unequivocally about dark forces that this kind is driven out by prayer and fasting. When we talk about mental illness, these symptoms go away with pharmacotherapy - in medicine there is a diagnostic method based on the effectiveness of drugs. A classic example is angina pectoris, various chest pains that go away while taking nitroglycerin. And when we talk to you about mental disorders, if the conditions resolve during our therapy, then this is declared one of the diagnostic tests.
In conclusion, besides Dmitry Evgenievich Melekhov, I would like to recall another founder of Orthodox pastoral psychiatry - Professor of the St. Sergius Orthodox Institute of Paris, Archimandrite Cyprian (Kern). In his work on pastoral theology there is a chapter called “Pastoral Psychiatry.” There he has such wonderful words that I want to quote. These words lay down our basic concept in relation to our spiritual, mental, and somatic illnesses.
“... asceticism gives wise advice inherited from the fathers and teachers of the Church for the healing of sins and vices: pride, despondency, love of money, vanity, gluttony, fornication, etc. Psychiatry seeks the causes of those spiritual states of a person that are rooted in the innermost recesses of the soul, in the subconscious, in the inherited or acquired contradictions of the human being. Psychiatry turns its attention to what ascetics are essentially not interested in: obsessions, phobias, neurasthenia, hysteria, etc.” He believed that “...there are mental states that cannot be defined by the categories of moral theology and which are not included in the concept of good and evil, virtue and sin. These are all those “depths of the soul” that belong to the realm of psychopathology, not ascetic.” He further noted that “... the fields of psychiatry and moral theology do not coincide, since for one the riddles of the soul often arise, where the other solves everything with the simple definition of “grave sin.” Father Cyprian believed that the pastor himself should read one or two books with psychopathological observations, “... so as not to indiscriminately condemn as a sin in a person what in itself is only a tragic distortion of mental life, a mystery, not a sin, the mysterious depth of the soul , not moral depravity..."
Father Cyprian also posed the following question: is illness evil? “There is no doubt that it is a consequence of original evil, but is illness in itself an evil subject only to penance? Should neurasthenia be treated only with ascetic means? Is this neurasthenia or manic state on the same line as love of money or pride? ...and a case of pure psychopathology, as well as this or that illness or the sin of judging loved ones - all together are the consequences of original sin. But all these consequences cannot be brought under one concept of sin. Only the third of these examples is a sin.” However, Father Cyprian did not advise inviting a psychiatrist to the lectern, but rather the priest himself to study the psychopathology of mental illness. In each specific case, Father Cyprian urged to act “with caution,” with extreme caution and imbued with the spirit of compassion and pity, attention and inner tact.
Rector of the Orthodox Humanitarian Institute of Assistance under the Department of Religious Education and Catechesis of the Russian Orthodox Church P. O. Kondratiev:
“Very often people call us who want to get medical help in our office and ask: do they tell you off?” People who want to receive psychotherapeutic help insist in advance on.
Archpriest Alexander Ilyashenko:
— At one of the diocesan meetings, His Holiness Patriarch Alexy, speaking about the reprimand, said that one priest was very carried away by the reprimand, so it came to the point that he himself had to be properly reprimanded in my office.
Vasily Glebovich Kaleda:
— The official point of view on this matter, as I already said, is set out in the Fundamentals of the Social Concept of the Russian Orthodox Church: “Highlighting the spiritual, mental and physical levels of its organization in the human structure, the holy fathers distinguished between illnesses that developed from nature and illnesses caused by demonic influence or resulting from the passions that enslave a person. In accordance with this, the distinction seems equally unjustified, both the reduction of all mental illnesses to a manifestation of possession, which entails an unfounded rite of expulsion of evil spirits, and the attempt to treat any spiritual disorders by treatment with clinical methods.”
If a patient has a mental illness, a mental illness, he goes for a lecture and waits for the effect. The report is being made. He may feel better for a few days. This is a psychotherapeutic effect. A few days pass and all the disorders return. There are patients who have been lectured a certain number of times, but their illness is of a different nature and requires a different influence.
In such cases, there is a differential diagnosis. I cited the case of a priest on Mount Athos, who is practically healthy, who lacks a rich imagination, fantasies, and is a very focused and highly spiritual person. There are no questions here. Mental illnesses have certain patterns of course, manifestations and combinations of various symptoms that gradually arise and which are in the structure of psychosis. The patient says that various dark forces influence him. But during a conversation, the doctor will find a number of other types of delusions and other psychopathological disorders. Each case needs to be examined individually.
— Is it possible to diagnose obsession?
— There was a wonderful old man, Archbishop Meliton of Tikhvin (1897-1986). Once, at the end of the 20s of the last century, he walked through St. Petersburg at night and carried a wrapped portrait of Father John of Kronstadt. A man walked towards him and began to use foul language, including against Father John of Kronstadt. Here we are dealing with obsession, and many such examples can be given.
When an possessed person comes to church and the Chalice with the Gifts is brought out, he begins to scream and scream. Or when the transubstantiation of the Holy Gifts takes place at the liturgy, when outwardly nothing special happens, the Eucharistic canon is going on, there are no solemn moments, there is only internal content, and the possessed person must react to the manifestation of the shrine. There was such a bishop Stefan Mozhaisky (1895-1993). He is a doctor by training, and while in prison, he bore the Holy Gifts, since priests were constantly searched. One day he was called as a doctor to the daughter of the camp commander. He comes in, and suddenly she begins to rage - a reaction to the shrine. With demonic possession there must be a reaction to the sacred. Father Adrian from the Pskov-Pechersky Monastery said that the main sign of demon possession is the fear of sacred things.
— In the Orthodox community, there are a large number of specific Orthodox fears - at first for ten years everyone was afraid of the Taxpayer Identification Number (TIN), they didn’t want to change their passports. In general, you can collect a large collection of specific Orthodox phobias. Please tell me how you can comment on their emergence and survival in the Orthodox environment. And is this generally a characteristic of believers? Or does each population group simply have its own fears?
— Probably, different groups of the population have their own fears. However, we must clearly understand that in our Orthodox community the number of people with mental disorders of varying severity is significantly greater than the average in the population. This is a fact, and there is nothing offensive to the Church in this, on the contrary.
What is this connected with? Where can a modern person turn with his mental problems? Where can he find support, consolation, where can he find the most important thing - the meaning of life? Only in the Church. We essentially have no other option. And therefore there are quite a lot of such people in the Church.
In any case, these fears that are present - tax identification number, expectation of the end of the world, etc., arise in people with certain personal characteristics. This is that fear, that phobia that arises on a certain constitutional basis, which does not correspond to the concept of a harmonious or normal personality. In psychiatry, there is such a thing as highly valuable ideas - these are not just ideas that are especially significant for a given person. These are ideas that occupy a dominant position in the human mind that does not correspond to their meaning and displace the possibility of a holistic perception of a particular phenomenon. Because of this, some people almost went into schism, breaking the Eucharistic connection with the Church.
As for the INN and other “Orthodox fears,” there is the hierarchy, there is the official point of view of the Church on various issues. Probably, we need to rely on this - on church traditions, church traditions, on church leadership. This is the only way, there is no other way.
I have heard the statement many times that a person came to Orthodoxy and became ill with a serious mental illness. Or, for example, a person ended up in a sect and became mentally ill. I object: sorry, don’t say that. A man came to the Church, but he already had serious mental problems, which is why he may have become interested in religion.
There is such a psychiatric term - metaphysical intoxication. It often happens that schizophrenia diseases are most often diagnosed in adolescence. This age is characterized by quests. At this time, a person is trying to answer the questions: Who am I? What awaits me? What is the meaning in my life? And for a person with a mental illness, all this happens distortedly. He goes to the Orthodox Church, converts to a sect, Buddhism, Hinduism, reads Marx, Lenin, and so on. At some stage, psychosis develops. I had a number of acquaintances of my age with whom I communicated in my youth, and whose spiritual quests completely fit into this syndrome with subsequent patterns. Here there was an endogenous disease with different consequences.
— I would like to know your opinion on two issues. First, is Gogol’s confessor’s misunderstanding the reason for his death? Secondly, Melekhov has a wonderful chapter of recommendations for pastors on how a pastor should contact an Orthodox psychotherapist. Do you think these recommendations are relevant?
— I deeply respect Dmitry Evgenievich Melekhov, and completely agree with everything that is written in his book.
As for Gogol, He suffered several severe psychotic depressions. And the task of the shepherd in this regard was to support him spiritually, to talk about God’s mercy, about the kindness of God. But his confessor, Father Matthew, said on the contrary that hellish torment awaited him, said that he needed to repent, repent and repent. Gogol, as we know, stopped eating and died. It is clear that at that time psychiatry was just emerging and did not yet know how to treat such conditions.
Dmitry Evgenievich said that all people are different, everyone must find a priest who is suitable to obey him. He gave the example of the island of Valaam, where there were two elders, one lived on the southern side of the island, the other on the northern. One was cheerful and loving, sang psalms of thanksgiving to the Lord God, greeted everyone with joy, and treated everyone to tea. The second was gloomy, lived on the northern part of the island, talked about asceticism, about the need to repent. But in the collective consciousness they were equally respected. That is, we are all different people, we are “molded from different clay and boil at different temperatures” (R. Emerson). There are subdepressed people who tend to blame themselves for everything. The priest must support them: Christianity, Orthodoxy is the joyful fullness of life in Christ. On the contrary, there are people who are very cheerful, active, and sometimes a little lightweight. The priest must “ground” such people and call them to repentance.
— Can a practicing Orthodox Christian, who takes communion weekly and follows the morning and evening rules, change the severe course of the disease up to complete remission?
- I would not separate these two things. In any case, a church person must lead a spiritual life as active as possible. But nevertheless, manifestations of a serious illness clearly require treatment. Be that as it may, schizophrenia is a serious mental illness. But there are different forms of flow. There is a form when a person suffered acute psychosis - he said anything, did anything, communicated with the cosmos, and then came out of this state and subsequently defended dissertations, received all kinds of titles, got married, had children. This disease is by no means a death sentence, but requires a very serious attitude and preventive therapy.
There is a severe form with increasing personality changes. Dmitry Evgenievich Melekhov noted (he had little experience in caring for Orthodox patients) that when a sick person is a believer, he retains his personality, he perceives a serious illness as a cross. This person has the most important thing - meaning in life. A number of our non-believing patients with schizophrenia at some stage have a question: why live if I can’t work? Parents die, the person is left alone, without help, and life has no meaning. The patient begins to think about suicide.
In this regard, the question arises: Can a seriously mentally ill person with the most terrible diseases achieve holiness? If someone carefully reads the lives of some saints, they will see the classic symptoms of certain diseases. This in no way diminishes, for example, my veneration for this saint, blessed because he had the cross of mental illness.
In the Moscow psychiatric hospital No. 3, in the former Preobrazhenskaya hospital located on Matrosskaya Tishina Street, at the end of the 19th century there lived a famous person - Ivan Yakovlevich Koreysha. He was very revered then. He had a severe form of mental illness: his speech was incoherent, and at some moments he had complete enlightenment, and the Moscow people came to him because he had the gift of insight. When he died, two hundred funeral services were celebrated in three days. He is buried at the temple, which is located in Cherkizovo. Many revere his memory as a blessed and visionary one. And at the same time he had a severe form of mental illness.
What are the causes of schizophrenia? I recently read the statements of the great Russian philosopher Vladimir Solovyov that “... he is deeply convinced, and soon everyone will be convinced of this, that all mental illnesses have no biological basis.” He said this in the 19th century. Let's take the twentieth century and the founders of modern psychiatry - they classified schizophrenia as a group of functional diseases - it is not the organ that is damaged, but its function. And schizophrenia was one of these diseases.
But already at the end of the 20th century, completely new technology, new possibilities appeared, and, naturally, our view of the nature of schizophrenia changed radically. It was found that in schizophrenia there is a change in the structure of the brain substance, and there is a decrease in the volume of some of its parts. Schizophrenia is based on serious biological changes - primarily a disturbance in the metabolism of dopamine, as well as a number of other neurotransmitters. This is the leading point of view; it was formulated in the early sixties of the last century by the Swedish scientist Arvid Carlson, who received the Nobel Prize for its development in 2000. All modern antipsychotic drugs are based on this concept.
— How were endogenous psychoses treated before the advent of pharmacotherapy?
— In hospitals there were a large number of straitjackets, and belts were widely used to restrain agitated patients. There are patients who are so excited that it is very difficult to restrain them. In Europe, so-called mechanistic methods of treatment were used. There were various swings, when a person was spun, and due to the rush of blood to the head, nausea and vomiting occurred, and the patient calmed down. Various baths were used, where the patient was doused with ice water to calm him down. These methods were not very humane, and they were not used in Russia.
In addition, malariotherapy (1918), insulin comatose therapy (1935), and electroconvulsive therapy (1938) were used. There was phototherapy, sleep deprivation, psychosurgery. Of these non-drug treatment methods, only electroconvulsive therapy is now widely used throughout the world.
— Is paranoia treatable? How should family members of a sick person behave?
— To one degree or another, it lends itself. You need to behave very carefully and remember that paranoia is a delusional disorder. This is a false conclusion that does not correspond to the surrounding reality, does not follow from the patient’s existing experience and cannot be corrected. Proving something to him, of course, is a waste of time, but on the other hand, playing along and supporting his delusional plot is also impossible. The main thing is to smooth out rough edges and avoid conflicts. There is special literature on how to behave with mentally ill people.
— Is it possible for a mentally ill person to participate in the sacraments of weddings and baptisms?
- This is always very subtle, and in each specific case it is very individual. There are church rules, canonical, that mentally ill people are not allowed to get married. But the severity of all mental disorders is very different. For example, a person suffered a serious illness, recovered from it and is in a state of remission. Diseases are not inherited in one hundred percent of cases. When both parents have a severe form of the disease, their children have a 50 percent risk of developing the disease. Here the patient decides for himself.
We always insist that the “other half” knows that the person was once ill or was in a psychiatric hospital. This must be a conscious choice of that person. For our patients, the support of their immediate environment and family is always important.
As for baptism, it is still necessary to baptize, even if a person’s image of God is very distorted. Especially if you want to become a member of the Church. You also need to receive communion. But here, too, there may be different cases: I have a patient in my department who considers himself an Avatar. In this case, if he goes to confession and communion and says that he is an Avatar, then he cannot participate in these sacraments. We need to wait until he says his real name. It is clear that we should all pray for this person. The sacrament of anointing can be performed over him.
— Tell us how to deal with neuroses? Why are they classified as psychiatry and not psychology? Where to start?
— Psychology deals with psychological problems that arise in mentally healthy people—problems in relationships with family members, wives, and co-workers. The wife believes that children should be raised this way and not otherwise, the husband thinks differently. These are the kinds of problems psychology solves—the problems of healthy people. The psychologist says that the mother-in-law is a wonderful person, she needs to be taken care of, respected, and sharp corners should be avoided.
In our church environment, the functions of a psychologist, especially a family psychologist, are ideally performed by a priest. And besides him, no one can perform this function better, especially if the person goes to confession and his wife too. And one side will tell the priest something, and the other. Father will find the right words, and it will be like obedience. And when a person has a disorder, a pathology, even if it is mild, then the help of a psychotherapist who knows how to communicate with such persons is needed. Accordingly, he prescribes medications, sometimes in very small doses. Where to start? To begin with, it would be good to turn to the priest, listen to what he says and advises. When we turn to psychologists, it is very important to know who we are turning to, because sometimes they give advice that is simply unacceptable for an Orthodox person.
— Is alcoholism an independent mental illness or is it preceded by something?
- There are different combinations. It happens that this is an independent disease, to which there is a genetic predisposition, and there is also secondary alcoholism against the background of some kind of mental disorder. When a person, for example, is in an endogenous state and floods his state with alcohol and drugs. But there is everyday alcoholism, when a person begins to drink good drinks from a good life. This is spiritual licentiousness.
— Vasily Glebovich, thank you. We are very grateful that you found the time and gave us so much interesting information. We learned how alive this science is and how such problems are solved. This is food for thought for all of us. Thank you very much.
The text was prepared by O. Utkina, A. Danilova
Obsessive thoughts, which in psychiatry are called obsessions, are one of the manifestations of obsessive-compulsive neurosis, although in mild forms they may not be associated with this mental disorder. At the same time, the person himself is aware of the painfulness of his condition, but cannot do anything about it. Unlike the rational doubts inherent in every healthy person, an obsession does not disappear even after the patient becomes convinced of its groundlessness. The content of such thoughts can be very diverse and arise as a result of experienced traumatic circumstances, stress, insurmountable doubts and memories. Obsessions are also included in the symptom complex of various mental diseases.
Like delusional disorder, an obsession can completely take over the patient’s consciousness despite any attempts to drive it away. It is worth emphasizing that obsessive thoughts in their pure form are quite rare; much more often they are combined with phobias, compulsions (obsessive actions), etc. Since such a mental disorder creates discomfort and significantly complicates life in almost all areas, the patient, as a rule, begins to look for ways to get rid of obsessive thoughts or immediately turns to a psychotherapist.
Predisposing factors
Obsessive-compulsive disorder can occur for a variety of reasons, although scientists have not yet found an exact explanation for the etiology of this phenomenon. To date, there are only a few general hypotheses about the origin of the pathological condition. Thus, according to the biological theory, the causes of obsessions lie in the physiological or atomic characteristics of the brain and the autonomic nervous system. Obsessions can arise due to disturbances in the exchange of neurotransmitters, serotonin, dopamine, etc. Infectious and viral diseases, other physical pathologies, and pregnancy can provoke an increase in obsessive states.
Genetic predisposition is also a factor that can provoke the described mental disorder. As confirmation of this theory, one can cite studies conducted with identical twins, who equally had signs of the disease.
Obsessive thoughts, according to the psychological hypothesis, are a consequence of certain personal characteristics that could be formed under the influence of family, society, etc. Possible reasons for the development of this mental disorder may be low self-esteem, the desire for constant self-abasement, as well as, conversely, inflated self-esteem and the desire for dominance. Most often, problems with self-esteem are subconscious.
Any hidden fears can manifest themselves in the form of obsessions if a person lacks self-confidence. The lack of clear priorities and goals in life can lead to the fact that obsessive thoughts become a way to escape from reality or are considered by the patient as an excuse for their selfishness and irresponsibility.
Manifestations
Irresistible obsessive thoughts are the main manifestation of obsessions. The pathological symptoms that occur with this disorder can be divided into several groups:
As a rule, during an obsession, a person’s character changes – he becomes anxious, suspicious, fearful, and unsure of himself. Sometimes obsessive-compulsive disorder is accompanied by hallucinations. Obsessions often become a sign of pathologies such as psychosis or schizophrenia.
In a child, obsession can manifest itself in unreasonable fears, as well as compulsions, such as thumb sucking or touching hair. Adolescents with this disorder are able to perform some meaningless rituals, for example, counting steps or windows of buildings. Often school-age children suffer from an unreasonable fear of death, preoccupation with their own appearance, etc. It is important to note that in view of the instability of the child’s psyche, in case of obsessive-compulsive neurosis, help should be provided in a timely manner, since otherwise the development of more severe and difficult to eliminate mental disorders is possible.
Physiological symptoms of obsessive-compulsive disorder include:
If you ignore the manifestations of the disease, quite unpleasant and severe consequences may develop. Thus, a person may develop depression, alcohol or drug addiction, problems in relationships with family members and colleagues, and the overall quality of life will significantly deteriorate.
Aggressive obsessions
Aggressive obsessions in psychiatry are called contrasting obsessive thoughts. The patient may have pathological ideas about causing physical harm to someone, committing violence, or even murder. So, for example, a person may be afraid of strangling his own child, pushing a relative out of a window, etc. Obsessive thoughts about death and suicide also belong to aggressive obsessions, since in this case the patient may seek to harm himself.
People suffering from contrasting obsessive thoughts experience a strong fear that at one moment they may succumb to these impulses. If aggressive obsessions are not a motivation to action, they evoke in the mind clear images of certain violent actions.
Sometimes contrasting obsessions become so vivid and vivid that the patient begins to confuse them with real memories. Such people can perform various checks to make sure that they have not done anything like this in reality. Since the disorder, which occurs in an aggressive form, makes the patient dangerous both for himself and for others, competent treatment becomes an urgent need.
Therapy
Speaking about how to deal with obsessive thoughts, it is worth noting that mild forms of the disorder can be corrected independently, with some effort. Treatment of obsessive-compulsive disorder neurosis at home may include:
Treatment of obsessions may include the Thai method, such as writing them down. Patients are advised to record their thoughts in a specially designated notebook in order to throw out negative energy. As an alternative, you can express your own obsessive thoughts to someone close to you - this will allow you not only to express your feelings and emotions, but also to receive the necessary psychological support.
To overcome your own obsessive thoughts, you need complex treatment, which involves following the recommendations described above and making every effort to eliminate the problem. It is important to realize that this is only a temporary phenomenon that can be dealt with. If you cannot get rid of obsessive-compulsive neurosis on your own due to certain specific features of thinking, it is better to contact a qualified psychiatrist or psychotherapist who will offer effective treatment using psychotherapeutic and physiotherapeutic techniques, as well as medications.
Cognitive-behavioral psychotherapy has shown particular effectiveness in the treatment of obsessive-compulsive neurosis, in particular the “thought stopping” method is widely used. Also, obsessive thoughts are widely used in treatment using psychoanalysis and transactional analysis, which includes game techniques that allow the patient to overcome their own obsessions at the very beginning of the development of a mental disorder. Psychotherapeutic sessions can take place in individual and group form, depending on the character and psyche of the patient. In combination with psychotherapy, hypnosis, which is applicable even in childhood, can bring good results.
Blasphemous thoughts
A type of contrasting obsessive states; their content is indecently cynical and inappropriate to the situation.
. V. M. Bleikher, I. V. Kruk. 1995 .
See what “blasphemous thoughts” are in other dictionaries:
Blasphemous thoughts- – contrasting obsessive ideas. See Obsessions...
Thoughts that contradict the moral and ethical properties of the individual, the patient’s ideas about ideals, worldview, attitude towards loved ones, etc. Because of this, they experience extreme distress and depress the patient... Explanatory dictionary of psychiatric terms
blasphemous thoughts- obsessive thoughts, which in their content represent an outrage against the patient’s ideals (his worldview, attitude towards loved ones, religious ideas, etc.) and are painfully experienced by him... Large medical dictionary
Contrasting thoughts- the phenomenon of obsessive thinking in the form of the appearance of blasphemous, offensive or obscene thoughts when perceiving or remembering objects that are of special personal value to the individual. Synonym: Blasphemous thoughts... Encyclopedic Dictionary of Psychology and Pedagogy
Obsessive states- (synonym: obsessions, anancasms, obsession) the involuntary occurrence of irresistible thoughts (usually unpleasant), alien to the patient, ideas, memories, doubts, fears, aspirations, drives, actions while maintaining a critical attitude towards them... ... Medical encyclopedia
Obsession- Felix Plater, scientist who first described obsessions... Wikipedia
Sin- This term has other meanings, see Sin (meanings) ... Wikipedia
Obsessive ideas- – irresistibly arising thoughts and figurative, most often visual representations of inadequate, “crazy”, often contrasting content that contradicts reality and common sense. For example, the patient vividly and in horrifying detail... ... Encyclopedic Dictionary of Psychology and Pedagogy
SECOND COMING- [Greek παρουσία arrival, arrival, advent, presence], the return of Jesus Christ to earth at the end of time, when the world in its present state will cease to exist. In the New Testament texts it is called “appearance” or “coming”... ... Orthodox Encyclopedia
Gennady Gonzov- (Gonozov) saint, archbishop of Novgorod and Pskov. Almost no news has survived about his life before 1472; apparently he came from a boyar family (the Degree Book calls him “high-ranking”) and owned estates (by ... ... Large biographical encyclopedia
Vasily Kaleda
Pastoral psychiatry: distinguishing between spiritual and mental disorders
The relationship between spiritual ailments and mental illness is one of the problems that both the clergy and lay members of the clergy constantly have to face in church life. But more often than not, it is the priest who is the first person to whom a person with mental disorders turns for help.
Three lives
At the beginning of the year, there was a wave of publications in the media about a series of suicides among teenagers. Around the same time, a priest approached me with a request to advise his spiritual daughter, a teenage girl, who had repeatedly mentioned suicide in conversations with her confessor. Masha (name changed) came to the appointment with her mother, who arrived at a loss as to why the priest referred her daughter to a psychiatrist. Family members did not notice any changes in the daughter’s condition. Masha successfully graduated from school and was preparing to enter university. During our conversation, she not only confirmed the presence of suicidal thoughts, but also said that she opened the window several times to throw herself out of it. Masha skillfully hid her condition from her family and friends and only spoke to her spiritual father about her personal experiences. The father made a lot of efforts to persuade the girl to go to a psychiatrist. Masha had severe depression that required hospitalization. If not for the efforts of the priest, she would probably have joined the list of teenagers who committed suicide and left their family and friends in confusion and despair.
Around the same time, an ambulance received a call from a Moscow church. The priest called an ambulance to the young man. For the purpose of “spiritual improvement,” the young man completely gave up food and drank only water. In a state of extreme exhaustion, he was taken to the hospital, where he was in intensive care for ten days. It is noteworthy that his parents saw his condition, but did not take any measures. In both cases, the girl and the boy survived only because the priests recognized they had a mental disorder.
The third, tragic incident also happened in Moscow. The priest, out of incompetence, forbade the young man who turned to him for help to take medication, although he had suffered a schizophrenic attack several years ago. Two weeks later the patient committed suicide.
The prevalence of mental illnesses and disorders in our society is quite high. Thus, about 15.5% of the population suffers from mental disorders, while about 7.5% require psychiatric help. To a large extent, these statistics are influenced by alcoholism and drug addiction. Our country ranks second in the world in terms of suicides (23.5 cases per 100,000 population). According to official data, from 1980 to 2010, about a million Russian citizens committed suicide, which indicates a deep spiritual crisis in our society.
It is not surprising that people suffering from mental disorders turn to the Church for help more often than anywhere else. On the one hand, most of them find spiritual support, meaning and purpose in life only in the temple. On the other hand, which is no less important, many mental disorders during an exacerbation have a religious overtones. In addition, as noted by Doctor of Medical Sciences, Prof. Sergius Filimonov, “today people come to Church not out of their own free will to know God, but mainly to solve the issue of getting out of crisis life situations, including those related to the development of mental illness in themselves or close relatives.”
A new subject in the training of clergy
Today, many dioceses have gained serious experience in cooperation between psychiatrists and priests, which began in the early 90s. Then, with the blessing of the confessor of the Trinity-Sergius Lavra, Archimandrite Kirill (Pavlov), classes in pastoral psychiatry began at the Moscow Theological Seminary under the leadership of the vicar of the Lavra, Archimandrite Theognost (now Archbishop of Sergiev Posad). Father Theognost teaches pastoral theology, the structure of which included a cycle on pastoral psychiatry. Subsequently, the course “Pastoral Psychiatry” at the Department of Pastoral Theology (since 2010 - the Department of Practical Theology) appeared at PSTGU on the initiative of Archpriest Vladimir Vorobyov and at Sretensky Theological Seminary on the initiative of Archimandrite Tikhon (Shevkunov).
The first hospital church at the psychiatric clinic was consecrated on October 30, 1992 by His Holiness Patriarch of Moscow and All Rus' Alexy II in honor of the icon of the Mother of God the Healer at the Scientific Center for Mental Health of the Russian Academy of Medical Sciences. Then, speaking to psychiatrists, His Holiness the Patriarch said: “Psychiatrists and scientists are entrusted with the difficult and responsible mission of serving the spiritual health of the human souls entrusted to their care. The service of a psychiatrist is in the true sense an art and feat in the image of the service of Christ the Savior Himself, Who came into the world of existence poisoned by human sin in order to help those who need help, support and consolation.”
For the first time, a special guide for priests on psychiatry, based on the concept of a holistic Christian understanding of the human personality, was developed by one of the recognized authorities in Russian psychiatry, the son of a priest of the Ryazan province, Professor Dmitry Evgenievich Melekhov (1899-1979). He wrote his concept of the course “Pastoral Psychiatry” for students of theological academies and seminaries in Soviet times. And although he was unable to complete the book “Psychiatry and Issues of Spiritual Life,” Melekhov formulated the basic principles of collaboration between a psychiatrist and a priest in the treatment and care of those suffering from mental illnesses. This work was published in a typewritten edition shortly after the author's death. Later it was included in the Clergyman's Handbook, and later in numerous collections.
One of the central problems of this book is the problem of the relationship between the physical, mental and spiritual in a person and, accordingly, the relationship between mental and spiritual illnesses. The priestly confessor Georgy (Lavrov), well known in Melekhov’s youth, who labored in the Danilovsky Monastery, clearly distinguished between two groups of these diseases. He said to some: “You, baby, go to the doctor,” and to others: “You have nothing to do with doctors.” There were cases when an elder, helping a person adjust his spiritual life, recommended that he go to a psychiatrist. Or, on the contrary, he took people from a psychiatrist to himself for spiritual treatment.
In the book “Psychiatry and Issues of Spiritual Life,” Melekhov proceeded from the patristic trichotomous understanding of the human personality, dividing it into three spheres: bodily, mental and spiritual. In accordance with this, illness in the spiritual sphere is treated by a priest, mental illness by a psychiatrist, and physical illness by a somatologist (therapist, neurologist, etc.). At the same time, as Metropolitan Anthony (Blum) noted, “one cannot say that the spiritual ends somewhere and the spiritual begins: there is some area where mutual penetration takes place in the most normal way.”
All three spheres of human personality are closely interconnected with each other. Physical illness often affects mental and spiritual life. Saint John Chrysostom wrote about this back in the 4th century: “And God created the body in accordance with the nobility of the soul and capable of fulfilling its commands; created not just any, but the way he needed to be to serve the rational soul, so that if it were not like that, the actions of the soul would encounter strong obstacles. This is evident during illnesses: when the state of the body deviates even a little from its proper structure, for example, if the brain becomes hotter or colder, then many of the mental actions stop.”
This raises some fundamental questions: can a person suffering from a serious physical illness be mentally and spiritually healthy? The answer here is clear. We know such examples not only from the lives of saints and from the exploits of the new martyrs, but also among our contemporaries. The second question: can a spiritually ill person be formally mentally and physically healthy? Yes, it can.
The third question is: Can a person suffering from serious mental illness, including severe depression and schizophrenia, have a normal spiritual life and achieve holiness? Yes, it can. Rector of PSTGU Rev. Vladimir Vorobyov writes that “a priest must explain to a person that mental illness is not a shame, it is not at all some kind of condition that has been erased from life. This is a cross. Neither the Kingdom of God nor the life of grace is closed to him.” St. Ignatius (Brianchaninov) gave specific examples, “St. Niphon Bishop suffered from insanity for four years, St. Isaac and Nikita suffered from mental damage for a long time. Some St. The desert dweller, noticing the pride that had arisen in himself, prayed to God to allow him to suffer mental damage and obvious demonic possession, which the Lord allowed to His humble servant.”
The attitude of the Church to the problem of the relationship between spiritual and mental illnesses is clearly formulated in the Fundamentals of the Social Concept (XI.5.): “Highlighting the spiritual, mental and physical levels of its organization in the personal structure, the holy fathers distinguished between diseases that developed “from nature” and ailments that caused by demonic influence or resulting from passions that have enslaved a person. In accordance with this distinction, it seems equally unjustified to reduce all mental illnesses to manifestations of possession, which entails the unjustified execution of the rite of expelling evil spirits, and to attempt to treat any spiritual disorders exclusively by clinical methods. In the field of psychotherapy, the most fruitful combination of pastoral and medical care for the mentally ill, with proper delimitation of the areas of competence of the doctor and the priest.”
On the relationship between spiritual and mental states
Unfortunately, the high prevalence of performing the rite of “exorcism of evil spirits” in modern church practice is noteworthy. Some priests, without differentiating between spiritual illnesses and mental illnesses, send patients with severe genetically determined mental illnesses to perform “disciplines.” Back in 1997, Patriarch Alexy II at a diocesan meeting of the Moscow clergy condemned the practice of “reprimands.”
There are a number of states that outwardly have similar manifestations, but relate to spiritual or mental life and, accordingly, have a fundamentally different nature. Let us dwell on the relationships of some of them: sadness, despondency and depression; obsession and delirium of “non-obsession”; “charm”, manic and depressive-delusional states.
Among spiritual states, sadness and despondency are distinguished. With sadness, loss of spirit, powerlessness, mental heaviness and pain, exhaustion, grief, constraint, and despair are noted. As its main cause, the holy fathers note deprivation of what is desired (in the broad sense of the word), as well as anger and the influence of demons. It should be noted that St. John Cassian the Roman, along with this, especially emphasizes “causeless sadness” - “unreasonable sorrow of the heart.”
Depression (from the Latin depressio - suppression, oppression) is no longer a spiritual, but a mental disorder. In accordance with modern classifications, it is a condition, the main manifestations of which are a persistent (at least two weeks) sad, sad, depressed mood. With melancholy, despondency, loss of interests, decreased performance, increased fatigue, decreased self-esteem, pessimistic perception of the future. And also with the loss of the need for communication and sleep disturbances, decreased appetite up to its complete absence, difficulties in concentrating and comprehending. In addition, depression often causes unreasonable self-judgment or excessive feelings of guilt, and repeated thoughts of death.
Believers in a state of depression will experience a feeling of abandonment by God, loss of faith, the appearance of “petrified insensibility”, “coldness in the heart”, talk about their exceptional sinfulness, spiritual death, complain that they cannot pray, read spiritual literature. In severe depression, suicidal thoughts are often observed. Believers usually say that they cannot commit suicide, because hell awaits them for this. But, as practice shows - and you need to pay attention to this - they also commit suicide, although a little less often, since mental suffering is the most severe and not everyone is able to endure it.
Among depressions, there are reactive ones, which occur after traumatic situations (for example, after the death of a loved one), and endogenous ones (“unreasonable sadness”), which are genetically determined. Depression is especially common in older people, among whom they occur in more than half of the cases. Depression often takes on a protracted and chronic course (more than two years). According to WHO, by 2020, depression will take first place in the morbidity structure and will affect 60% of the population, and mortality from severe depression, often leading to suicide, will take second place among other causes. The reason for this is the loss of traditional religious and family values.
Among spiritual states, demonic possession stands out. Here are two examples illustrating this condition. The first of them is associated with Bishop Stefan (Nikitin; †1963), who, even before his ordination to the priesthood in the camp, as a doctor, bore the Holy Gifts. One day, as a doctor, he was asked to consult the daughter of the camp director. When he came to her, she suddenly began rushing around the room and screaming for the shrine to be removed, and the doctor was asked to leave. Another example from the life of Archbishop Meliton (Soloviev; †1986). It dates back to the late 1920s. One day, late in the evening, almost at night, he moved a portrait of St. from one apartment to another. John of Kronstadt. A man was walking towards him, who suddenly began to shout and call the name of John of Kronstadt. That is, the leading criterion for determining demon possession, as many pastors note, is a reaction to a sacred thing.
At the same time, mental illnesses include schizophrenic psychoses, when often, along with various delusional themes, the patient considers himself the ruler of the world or the Universe, a messiah called to save Russia or all of humanity from world evil, economic crisis, etc. There are also delusional disorders when the patient is convinced that he has been possessed by demons or shaitans (depending on what culture he belongs to). In these cases, the ideas of demonic possession, as well as the ideas of messianic content, are only the theme of the delusional experiences of a patient with severe mental illness.
For example, one of the patients in the first psychotic attack considered himself Cheburashka and heard the voice of the crocodile Gena in his head (auditory hallucinations), and in the next attack he said that he was possessed by dark forces (delirium of demonic possession) and the voices belonged to them. That is, in one case the theme of delusional experiences was associated with a children's cartoon, in the other it had religious overtones. Both attacks were treated equally successfully with antipsychotic drugs.
We had to deal with situations where priests qualified auditory hallucinations as the influence of demonic forces and did not recommend that patients see doctors. Although these patients regularly received communion, no changes occurred in their mental status, which should have been noted in case of demon possession.
Spiritual states also include the state of “prelest,” the most important manifestation of which is a person’s overestimation of his personality and an intensive search for various “spiritual gifts.” However, this symptom, along with the patient’s feeling of a surge of strength, energy, a special spiritual state, psychomotor agitation, disordered drives, and a reduction in the duration of night sleep, is one of the manifestations of manic states. There are other states when a person begins to be very actively “engaged in his spiritual growth” and stops listening to his confessors.
Some time ago, the parents of a girl approached me, who had come to faith about a year earlier, but in the last two months her spiritual life had become very intense. She lost so much weight that there was a real threat to her life due to dystrophy of internal organs. She prayed for about two hours in the morning, about three in the evening, and in the afternoon for about two hours she read kathismas and certain passages from the Gospel and the Epistle of the Apostles. She received communion every Sunday, and before that, every Saturday she stood in a long line for confession in one of the monasteries. She came to confession with numerous sheets of paper. In the temple she repeatedly became ill and had to call an ambulance. She did not hear the words of her confessor that she was not a schema nun, that she was not supposed to follow such prayer rules. She also did not hear the requests of her elderly parents. They asked to at least sometimes go to a temple near their house, since spending the whole weekend with her in the monastery was physically difficult for them, and they could not let her go alone. She stopped coping with work and communicating with her colleagues. She did not consider herself sick, but she spoke negatively about the priests who tried to limit her prayerful “exploits.” Under pressure from her parents, she passively agreed to take medications, which gradually restored her appetite and ability to work. The prayer rule (which the confessor insisted on) was reduced to the reading of morning and evening prayers and one chapter from the Gospel.
It is clear that in none of the monasteries would any abbess or elder bless a young novice for such “feats.” No one has canceled the old monastic rule: when you see a brother rising sharply, pull him down. When a person perceives himself as a “great specialist” in spiritual life and does not hear his confessor, it is customary to speak of a state of delusion. But in this case it was not delusion, but a mental illness that acquired a religious overtones.
Obsessive states and their forms
When discussing the topic of the relationship between spiritual and mental illnesses, it is necessary to dwell on the problem of obsessive states (obsessions). They are characterized by the emergence in the patient’s mind of involuntary, usually unpleasant and painful thoughts, ideas, memories, fears, and inclinations, towards which a critical attitude and the desire to resist them remain. There are motor obsessions, when a person repeats certain movements. For example, he returns to a locked door several times and checks whether it is locked or not. With mental illness, it happens that the patient bows and hits his forehead on the floor (this happened with both Orthodox Christians and Muslims). In addition, there are so-called contrasting obsessions, when a person has an inevitable desire to throw someone under a train in the subway, a woman has a desire to stab her child.
Such a thought is completely alien to the patient, he understands perfectly well that this cannot be done, but this thought persistently exists. Also included in contrasting obsessions are the so-called blasphemous thoughts, when a person seems to have blasphemy against the Holy Spirit, the Mother of God, and saints. One of my patients had a similar condition at the stage of depression after a schizophrenic attack. For him, an Orthodox man, blasphemous thoughts were especially painful. He went to the priest for confession, but he refused to confess him, saying that everything would be forgiven to a person except blasphemy against the Holy Spirit (cf. Matt. 12:31). What could he do? He attempted suicide. After psychopharmacotherapy, these psychopathological disorders were stopped and did not recur in the future.
Conclusions
The depressive states noted above, states with delusions of obsession, with obsessions, with manic and depressive-delusional states generally respond successfully to psychopharmacotherapy, which indicates the biological basis of these states. This was also noted by Metropolitan Anthony (Sourozhsky), who wrote that “mental states largely depend on what happens physiologically from the point of view of physics, chemistry in our brain and in our nervous system. Therefore, every time a person becomes mentally ill, it cannot be attributed to evil, sin or a demon. Very often this is caused more by some kind of damage to the nervous system than by demonic obsession or the result of a sin that has torn a person away from any connection with God. And here medicine comes into its own and can do a lot.”
Many classics of psychiatry and modern researchers noted that the Christian perception of life makes a person resistant to various stressful situations. This idea was formulated very clearly by Viktor Frankl, the founder of the theory of logotherapy and existential analysis: “Religion gives a person a spiritual anchor of salvation with a sense of confidence that he cannot find anywhere else.”
The difficulty of distinguishing between mental and spiritual illnesses acutely raises the question of the need for mandatory inclusion in the training programs for future priests in all higher educational institutions of the Russian Orthodox Church of a course in pastoral psychiatry, as well as special courses in psychiatry in the training of social workers. Professor Archimandrite Cyprian (Kern) wrote about the need for this knowledge for every pastor in his manual “Orthodox Pastoral Ministry”, devoting a special chapter to the issues of pastoral psychiatry. He strongly recommended that every priest read one or two books on psychopathology, “so as not to indiscriminately condemn as a sin in a person that which in itself is only a tragic distortion of mental life, a mystery, and not a sin, a mysterious depth of the soul, and not moral depravity.” .
The task of a priest, when identifying signs of mental illness in a person, is to help him think critically about the condition, encourage him to see a doctor, and, if necessary, to systematically take drug therapy. There are already many cases where patients, only thanks to the authority of the priest, with his blessing, take supportive therapy and remain in a stable condition for a long time. As practice shows, further improvement of psychiatric care is possible only with close cooperation between psychiatrists and priests and with a clear delineation of areas of competence.
Notes:
Data from the Scientific Center for Mental Health of the Russian Academy of Medical Sciences.
Filimonov S., prot., Vaganov A.A. 0 counseling for mentally ill people in the parish // Church and medicine. 2009. No. 3. P. 47-51.
Melekhov D.E. Psychiatry and problems of spiritual life // Psychiatry and current problems of spiritual life. M., 1997. P. 8-61.
Anthony (Blum), Metropolitan. Body and matter in spiritual life / Trans. from English from the ed.: Body and matter in spiritual life. Sacrament and image: Essays in the Christian understanding of man. Ed. A.M. Allchin. London: Fellowship of S.Alban and S.Sergius, 1967. http://www.practica.ru/Ma/16.htm.
Cyprian (Kern), archimandrite. Orthodox pastoral ministry. Paris, 1957. P.255
