Workshop on problems of pastoral care for mental patients

On January 22, 2018, a workshop of the International Christmas Educational Readings was held for the first time on the theme 'Pastoral psychiatry: A challenge of today', at the Russian Orthodox Church's synodal department for church charity and social service. It was organized, along with other organizations, by the Russian Orthodox Church's Inter-Council Presence Commission for church education and diakonia, in which there is a working group for the pastoral care of mental patients.

The meeting was chaired by Metropolitan Sergiy of Voronezh and Liski. The workshop was supervised by Ms. Margarita Nelyubova, secretary of the Commission for church education and diakonia and staff member of the Moscow Patriarchate department for external church relations secretariat for inter-Christian relations; and Ms. V. Leontyeva, member of the working group for the pastoral care of mental patients and head of the aid to the disabled office of the synodal department for church charity and social service.

Participating were priests of the Russian Orthodox Church, who carry out service at psycho-neurological institutions, psychiatrists and specialists in Christian psychology. Participants pointed to the importance of cooperation between the Church and medical doctors in helping those who suffer from mental diseases.

In his remarks, Metropolitan Sergiy emphasized that people's mental health is an area of joint responsibility of medics and clergy, saying, 'Modern psychiatry is capable of giving answers to many questions about the causes of mental diseases and their treatment, but the number of the mentally sick does not decrease. The mentally sick turn for help to both a doctor and a priest, and it should be admitted that on the social level the mental health of the population is an area of common responsibility of doctors and clergy'.

According to the Metropolitan, in this joint work one tends to encounter a persistent social prejudice and fear of psychiatry. 'This fear can be traced back not only to the history of psychiatry in our country but is also supported by the present experience of treatment in the healthcare institutions that still suffer from deficit of love for patients', he said, 'The Church regards as inadmissible the psycho-therapeutic approaches based on the suppression of the personality of a patient and humiliation of his or her dignity'.

'Partly', he continued, 'it is the fear of psychiatry that makes one turn to the Church for healing. Without making a proper distinction between the spiritual and mental levels of the human organization, the mentally sick and their relatives often tend to substitute a priest for a psychiatrist'. He said that one of the topical tasks of the spiritual education today is the study of pastoral psychiatry. 'To train both pastors-to-be and the serving clergy for psychiatry is a very important task since it would not be an exaggeration to say that in his daily practice any priest encounters a considerable number of people suffering from mental disorders'.

Vasily Kaleda, PhD, deputy director of the Russian Academy of Medical Science's research center of mental health and professor at the St. Tikhon Orthodox University of the Humanities, made a survey entitled 'The mental health of the population of the Russian Federation today'. In the beginning, he focused on the very notion of 'mental health': in the Christian understanding it is 'a harmony of spirit, soul and body'. Therefore, mental health is 'an area of common responsibility of psychiatrists and clergy', he said echoing the metropolitan's statement. This 'area' is large: according to the 2015 data, in the Russian Federation only 3% of the population sought psychiatrists' attention, while almost 5 times as many people suffer from mental disorders. Having described the basic manifestations of mental diseases, Prof. Kaleda warned against both the hypo-diagnostics assessing mental condition only from the psychological or spiritual point of view and the hyper-diagnostics interpreting all the spiritual and mental problems only within a psychiatric diagnosis.

Ideally, cooperation between the Church and medicine with regard to a particular patient is seen by the speaker in this way: a patient in the acute stage of the disease needs, first and foremost, a doctor; in case of a progressing remission, a doctor and a priest can work together; and it is already in a stable remission that the priority belongs to a priest. He said that any priest is obliged to know the basics of pastoral psychiatry (it has been taught in Moscow Theological Academy since 1990) so that his duty before a mental patient could be fulfilled, namely, by helping him become aware of his disease, encouraging him to turn to a doctor and visiting him at the inpatient clinic, 'to lead him to accept that a mental disease is a cross helping him towards salvation'. Prof. Kaleda also spoke of the problem of the distortion of religious life caused by a mental disease - the so-called pathological faith.

Archpriest Vladimir Novitsky, rector of the St. Nicholas church-at-Solomennaya-Lodge, had worked as a psychiatrist doctor before his ordination, he made a report on 'The natural-scientific and the theological views of the causes of mental diseases'. Speaking about the present level of knowledge about mental health, he focused on 'the somatic conditionality of mental diseases'. If body is understood as 'the instrument of expressing soul', then it is necessary 'to tune' this instrument, which is impossible to do without skilled treatment, he stressed. Father Antoniy Ignatyev of the same church made a report on 'Peculiarities of spiritual care of mental patients in psychiatric institutions'.

Gregory Kopeiko, MS, deputy director of the RAMS research mental health center, sought to deflate in his address the prejudices concerning mental diseases by looking at them in the context of 'the long story of distrust and even antagonism between psychiatry and religion'. The scientist stated that myths about the incurability of mental diseases and the danger and unpredictability of the mentally sick lead to the stigmatization of people with mental diseases. Speaking about the need for clergy and medical doctors to cooperate, he pointed to the declaration of the World Psychiatrist Association, which states, 'Psychiatrists, whatever their personal beliefs, should be willing to work with leaders/members of faith communities, chaplains and pastoral workers, and others in the community, in support of the well-being of their patients… Psychiatrists should demonstrate awareness, respect and sensitivity towards spirituality and religion. An understanding of religion and spirituality and their relationship to the diagnosis, etiology and treatment of psychiatric disorders should be considered as essential components of both psychiatric training and continuing professional development'.

Archpriest Andrey Lorgus, director of the Institute of Christian Psychology, shared his experience of pastoral care for mental patients in a psycho-neurological institution. For 13 years since 1994, Father Andrey was rector of the hospital parish consisting of the extremely disabled who 'will never be healthy' and the institution personnel of 50-70 people. The priest recalled that he was full of hope for introducing a fundamental transformation in the spiritual climate of the state institution through celebrating the Divine Liturgy. However, it did not happen. He failed to change the staffers' and bureaucrats' attitude to the sick as if they were 'people of the other sort, as if they were animals'. 'One priest for one thousand patients is too few. And it was only one of the conclusions made by Father Andrey. In addition, he spoke of a rapid pastoral burnout, the need to work not only with the sick but also with their families, and 'it is very difficult both morally and physically'. Service in such a place is 'too terrifying'; not all are capable of it; both a priest and a volunteer need not only a special training but also a voluntary conscious choice. Besides, there is no need to set any goals in taking care of the mentally disabled, it is sufficient 'to simply live by their side and love them', the priest summed up his remarks.

Archpriest Boris Mozhayev, rector of the church of the Akhtyrskaya Icon of the Mother of God in the Moscow region, also has an experience of working as a psychiatrist in hospital. He testified to the extreme degree of degradation that a mental patient can reach if not treated and thus warned priests who are reluctant to give their blessing to those who need to turn to psychiatrists. Numerous examples that Father Boris cited from his pastoral practice boiled down to the fact that baptism and giving communion to children as well as frequent communion of adults make a beneficial impact on their mental health and 'prevent mental diseases'.

The meeting of the section was live-streamed, which helped clergy and laity in various dioceses and countries to put questions to the speakers.

From materials of the DECR Communication Service and Yu. Zaitseva on blagovest-info.ru

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