Pastoral care for mental patients in a psychoneurological asylum

Archpriest Andrey Lorgus

The work of a priest with people suffering from mental diseases is a special work. I would like to share my experience of service in St Triphon domestic chapel in a psychoneurological asylum (PNA) in Moscow, in which I served as a priest for 13 years - from 1994 to 2006.

An asylum is not a medical institution. It does not offer medical treatment but keeps those who cannot live on their own or in a family, cannot work and attend to themselves. Those who stay there are disabled either from their childhood or those who became disabled at a mature age. People bring in their close relatives - children, young people and the aged and leave them there for good. Some inmates have no home, family or relatives. According to the asylum personnel, only 10% of the sick do have relatives and not all of them visit their kin. Many of the inmates do not realize what kind of place they are put in to live forever. In asylums, people live the rest of their lives and die there. Sometimes they are transferred from one asylum to another; sometimes they are placed at hospital for treatment and then brought back to the asylum.

The asylum in question was intended for one thousand people. When I began my service in it, there were some 400 children from 5 to 16 years old.

First of all, I would like to share my experience of the relationships that our community and I as a priest had with the asylum personnel. When I began serving in the PNA, there was no cooperation agreement as yet between the Russian Orthodox Church and the Social Protection Committee but we had arrangements between the dean and the asylum director. At first the PNA personnel treated us with suspicion. It took ten years for us to make friends with them. We had to engage in a kind of diplomatic work and to communicate not so much with the sick as with the staff. Many doctors were interested in getting pastoral assistance for themselves, some wishing to have their flat blessed, others to make confessions, still others to receive communion. Perhaps, it was precisely what played a very weighty role in establishing good relations with the staff.

The liturgical ministry itself required extraordinary efforts. For instance, I encountered this problem: how am I to hear confessions from teenagers who cannot say anything? I dared turn to His Holiness Patriarch Alexis. Once, during Lent in 1995, the Patriarch celebrated in one of the monasteries in Moscow and in the sanctuary I came up to him and asked him how should I do it. It was about the confession of sick children who have no power of speech. And he told me a very important thing, "Accept there confession as 'silent' confession". And later I used this advice in relations with my charges.

Among a thousand of the sick, there are people with very diverse diagnoses and conditions. Some can speak, others cannot. The words of some can be trusted while those of others cannot on any account. And there are many patients who ever change. There is no cross approach common for all. Each patient, if you get to know him or her a little bit, can be understood, may be today or may be tomorrow - only this way specifically, that is, today.

Unfortunately, the asylum staff treated the inmates as a different sort of people, non-humans, animals. Indeed, many patients looked altogether helpless. But they were living souls who needed not so much treatment as nursing, compassion and love. However, the PNA staff failed to develop fully such an attitude to them. Throughout the years of my service in the PNA, the attitude of the staff remained rather cynical and tough.

Admittedly, it should be taken into account that a PNA personnel work in it for decades and very soon develop professional burnout which affects all - medical nurses, orderlies, cooks - all those who attend to the sick. It is a serious problem.

I, just as many priests, thought up myths about service in an asylum. The first myth was that as soon as we begin celebrating the Divine Liturgy and sacraments, the climate in the whole asylum would change. It will change mystically; it will change spiritually and devotionally.

To a certain extent it did happen. Much changed in our understanding, in our attitude to the asylum and the church - it is my subjective assessment. Regular services, disciplined patients, doctors and nurses pulled themselves together in the days when a service was held - all this was visible and everybody liked it.

But, as I soon realized, the liturgical life was insufficient. Without any doubt, it is essential and constitutes the core of pastoral ministry. However, the celebration of a divine service itself does not change to any serious degree the psychological and moral climate in an asylum.

I considered it an important task for me to build relations with the sick and staff members, and this task could be more or less fulfilled. But I realized that only one priest for a thousand patients is too few: if a healthy person coming to the church can tell me about his or her problem within five or ten minutes, a sick person takes much more time. He should be given several days in a year, in which I can come to the ward or he to the church for us to talk for some time. In this case I will gradually understand what is happening to him, what his past was and what he expects from me. Such relations developed with some people in the PNA. But our community, which I knew and which I love to this day, consists of some 50 or 70 people, while there are a thousand people living in the asylum.

The second myth is that I as a priest can serve there and generally nothing threatens me. A priest who celebrates the liturgy is protected from professional deformation.

However, it turned out that in his ministry in such a place a priest faces many threats and, first of all, pastoral burnout. In such a place it overtakes you in a special way because the strain required of a priest in his service in an asylum is much higher than at an ordinary parish.

Another peculiarity of priestly ministry in a PNA is that the people there are mostly 'refusniks', that is, those who have no relatives. But some of them are still visited by parents, brothers, sisters, grandmothers, grandfathers, and their children sometimes come to visit elderly patients. And the work with them proved no less complicated.

The lives of these people are often tragic. For instance, a woman rang up - she accidentally got connected to me - and asked, 'How can I find…?' It turned out that she was looking for her daughter whom she placed in an asylum seven years ago and lost track of her. She had a dream after which she began searching for her daughter. I gave her the telephone number of the senior nurse and ultimately she found her; she did stay in our asylum. Then the woman came to the church together with her daughter, confessed, and so far we are friends. But the tragedy was that she placed her daughter into the asylum at the request of her husband. For seven years she was tormented by the feeling of guilt but she was afraid of saying to her husband that she was searching for the daughter. Years elapsed. We met with her husband and the elder son who, too, came to our church to help us. Much has changed in their family since.

It is very important that a priest should work not only with a patient but also with his or her family and with the personnel's families. It is difficult to find time for all that. This work is difficult both physically and morally and so a burnout is inevitable. Unfortunately, it is so.

The third myth: God's mercy and the grace of liturgy are sufficient to change the life of patients. Actually, what is necessary for one's life really to begin changing is the tireless work of a priest and the exceptional effort of the community and personnel. What is needed is a structured systematic work of dozens of people who comprise one organism, one team, so that the established system of social care may be changed. Christian norms and attitudes do not rapidly penetrate the life of an asylum. A liturgical and spiritual life is needed but also essential are the care of the sick and arrangement of an extensive internal life in an asylum.

These may include lessons, activities, art groups, music, letters and holiday post cards, making of gifts - all that we do at home, in the family and with children. This work requires selfless effort and sacrificial ministry.

I realize, of course, that I overestimated my resources at that time in 1994. I am aware that, despite my psychological education, I was poorly prepared for ministry in a PNA. Now I can clearly see that a priest going to serve in an asylum, in the first place, should do it of his free will and, secondly, should be trained for it.

This ministry is not for everyone. Priests and other people can't be just appointed there without their desire. They must give their consent. Candidates for this service should familiarize themselves with such a place by coming to it at least once. I happened to have some young students of various specialties including seminarians who came to help me in the asylum. And they left it in shock and half a year later would call me and say, 'Father, don't think I have vanished - I still cannot come to my senses'. That is, for them it was a very heavy and shocking experience.

It was mostly women who helped me - sometimes 10, sometimes 20, sometimes 30 of them. All are parishioners of my church. Many of them would come once, see the situation, faint and never come again. There were women who forced themselves to come ten times but they could not serve there. And there were others who stayed to the end and who still make up a certain community.

So, the service in a PNA requires the selection of voluntaries, very wise at that, with loving and warm attitude to people and consideration for their abilities. We should realize that not everyone at all is capable of such a work.

One more point: those who serve in such an asylum, be it medical nurses, priests, volunteers, church helpers - all should become subjects of our pastoral and psychological care (psychiatric care as well). It is very important that they should come there being healthy. They too might need rehabilitation and even diagnostics because the stress in this ministry is too great.

In the beginning of my ministry I thought that my most important task was to arrange a liturgy focused life in the asylum. After that the very atmosphere and relationships between people would change. Eventually I realized that the most important quality of a priest in an asylum is resignation to the fact that he cannot change anything. He can baptize, bury, celebrate the liturgy but he cannot work miracles. He should just live with the sick and love them and nothing more. He should not set himself high goals because in this case what is in store for him is a bitter disappointment. We should honestly say to ourselves (I mean asylum, not hospital) that these patients will never be healthy; they have 'a permanent residence permit' in an asylum, however terrible it may sound. Our task is not to heal them but to live with them. A parish in an asylum is a life inside this home.

The life in an asylum is tragic and painful, but for many people it is the only possible form of existence. The ministry of a priest in such a situation should be based on this very fact. A priest comes to an asylum not to judge or condemn its personnel, nor to change or 'liberate' people, but to live with them and serve them and be together with them.