International conference "Church care for mentally ill people. Church and psychiatry: facets of cooperation"

Mental illness according to Thomas Aquinas

Dr. Martin F. Echavarria, CEU Universities - Abat Oliba CEU University, Barcelona

In this article I will explain the ideas of Thomas Aquinas on mental illness. Although he is an author of the 13th century, and a theologian and philosopher, not a physician, I think he has some ideas about mental illness that are still worthy of consideration today. Aquinas applies the expression disease in an analogous way to three disorders of the soul, namely: mental illness with a bodily cause, moral disorder, and a specific disorder of the sensitive part of the soul.

1. Bodily mental illness

In Aquinas' philosophy of nature, the concept of illness is precisely delimited. According to Aquinas, illness is an indisposition of the organic body, which places it outside the natural order, as opposed to health, which is a good disposition of the body whereby its various components are in harmony. This indisposition is the consequence of the action of a pathogenic agent that produces a passion in the body, which drags it out of its natural disposition, and makes the body unable to produce its vital functions normally (Echavarr?a, 2008). When this bad disposition affects the organs of mental life, we find what today we would call a "mental illness".

The pathogenic agent that produces the indisposition that leads to illness can be a physical agent. Thus, Aquinas often speaks of dysfunctions of the faculties of the soul (such as imagination or memory) due to a lesion of the area of the brain in which these faculties are placed. But a mental agent can also cause illness, since, according to Aquinas, the passions of the soul (what today we would call "emotions") are not a purely spiritual reality, but a psychosomatic one (Echavarr?a, 2018, 2019; Lobato 1994). Therefore, for Aquinas, the extreme passions, especially the negative ones, such as sadness, fear or despair, can produce a true illness. Thus, even bodily mental illnesses can have a mental cause.

These are the natural causes of illness. Certainly, Aquinas states, following the Holy Scriptures, that illness can be caused by demonic influence. But, even when this happens, it is because the demon influences the organism, disturbing its functioning (Echavarr?a, 2005).

Aquinas does not make a detailed exposition of each mental illness, nor of its physical causes, nor of its medical treatment, although, in his allusions to these subjects, one can perceive the influence of Avicenna's Canon of Medicine, of Nemesius of Emesa and of the medical school of Salerno (Izquierdo Labeaga, 2002). To refer to mental illnesses, Aquinas uses, in a not too technical way, words such as melancholy, mania, fury, epilepsy, etc. (Echavarr?a, 2009).

2. Moral vices as diseases of the soul

By analogy, Aquinas sometimes calls moral disorders diseases or illnesses. First of all, for Aquinas, grace is a disposition infused by God into the soul, which is often called its spiritual health. On the contrary, original sin has left the soul deprived of that spiritual health, and can also be called a spiritual sickness or illness. Similarly, moral vices, that is, dispositions that are opposed to virtue, are often called diseases (morbus). These illnesses are cured by the medicine of the sacraments and by the exercise of the virtues (Echavarr?a, 2005a).

The virtue of temperance (temperantia, in Latin, sophrosyne, in Greek) has a special place in the health of the mind. Aquinas explains that the Greek word sophrosyne means mental health, and explains that, on the contrary, intemperance is a disease of the mind, by disturbing the right use of reason (Commentary on the Nichomachean Ethics, Book VI, lecture 4):

"Hence we call temperance by the name sophrosyne, as it were, a thing preserving prudence. Prudence does preserve an estimation of the kind mentioned, for while pleasure and pain do not distort or pervert all judgments (for example, that a triangle has or has not three angles equal to two right angles), they do affect those dealing with the practicable. The principles of practicable things are the ends for which they are done. But the principle is not clear to a man corrupted by pleasure or pain, nor does he see the obligation to choose and do everything for the sake of it and on account of it, for vice is corruptive of principle" (Aquinas, 1964).

Besides, following Aristotle, Aquinas puts some intermediate situations between the total health of temperance, and the deadly disease of intemperance. This is the situation of the continent and the incontinent men. Both suffer from an inner division between reason and emotions, due to the disorder of their passions. But the continent, applying his or her willpower, succeeds in resisting the passions, while the incontinent person succumbs to them, out of weakness. The word Aquinas uses for "weakness" of the soul is "infirmitas," which is a Latin word that also means illness or sickness, as Aquinas himself points out. We could cite, for example, the following text (De malo, q. 3 a. 9 co.):

"When any affection is not moderated according to the rule of reason, but falls into excess or defect, it is called an infirmity [infirmitas] of the soul. And this happens especially in the affections of the sensitive appetite, which are called passions, such as fear, anger, desire, etc.; hence the ancients called these kinds of passions diseases of the soul [aegritudines animae], as Augustine says in the book The City of God. It is said that man does out of weakness [infirmitas] what he does out of some passion, as out of anger, fear, desire, and the like."

Aquinas compares the incontinent to the sick person. The incontinent person is sick in his soul, because his parts are in a state of anarchy, and do not respond to the command of the faculty that naturally directs, reason, but, even though he knows what it is good for him to do, he is prevented from acting in that way at the moment when he is assaulted by the passion that dominates him (Echavarr?a, 2005b). Aquinas, commenting on St. Paul, says: "The sickness of man is manifested because he does what he understands that he should not do" (Super ad Romanos, c.VII, l.3, n.15).

3. The "animal (or psychological) sickness" (aegritudo animalis)

There is a third situation, distinct from bodily mental illness and moral disorder, which Aquinas describe and which, in my opinion, it is an original contribution of him, and which I have not found in other medieval authors. It is what Aquinas, commenting on Book VII of Aristotle's Nicomachean Ethics, calls "aegritudo animalis". It is a special kind of disorder, the specificity of which has not been extensively noticed.

In the Book VII of the Nicomachean Ethics, in dealing with the forms of incontinence by analogy, the Stagirite speaks of some vices which, by excess, go beyond the genus of human moral vices. These are the so-called vices contra natura. These disorders would occur in all kinds of vices, as extreme and unnatural versions of that vices. Thus, there would be intemperance against nature (paraphilias), cruelty against nature (sadism), fear against nature (phobias), gluttony against nature (bulimia), etc. While moral vices are affective disorders against the rule of right reason, these disorders are contrary, not only to right reason, but to the natural disposition of the sensitive appetite of the human species. Quoting John Damascenus, Aquinas emphasizes that all vices are against nature, but that human moral vices are contrary to man's specific difference, which is his rationality, while vices against nature are also opposed to the natural inclination of genus to which man belongs: "animal" (Super ad Romanos, c. 1, n. 149).

According to Aquinas, following Aristotle, these disorders of the animality of man are sometimes based on a bad organic constitution, sometimes on an organic illnes, and sometimes are caused by unnatural costumes that have affected the development of character, especially during childhood. Aquinas calls the sensitive appetite disorder that has a mental or behavioral cause "animal sickness" (aegritudo animalis). I quote Aquinas (Super Ethicorum, book 5, l. 5, 1374):

"Last, at 'Others become,' he offers examples of things contrary to nature that become delightful by reason of habit. Some enjoy unnatural pleasures because of mental unbalance or habitual perversion. For example, certain men out of habit take pleasure in pulling out their hair, biting their nails, eating coal and earth, and having sexual intercourse with males. All the preceding can be reduced to two classes. Some people do them because of the tendency of bodily temperament that they had from the beginning; others because of habit, becoming accustomed to things of this kind from childhood. Such people are like individuals who fall into this condition by reason of physical sickness, for evil habit [prava consuetudo] is a kind of psychological sickness [aegritudo animalis]." (Aquinas, 1964).

A perverse habit (prava consuetudo) is the disposition produced by a behavior contrary to nature. This "habit" can be called in a certain way an "animal disease" or "psychological sickness". We are here at a delicate boundary between moral vice and disease. These dispositions are contracted by habits, but they resemble a disease.

Following Aristotle, Aquinas points out the following three causes of unnatural tendencies with a behavioral cause: the lack of good laws, which favors perverse habits; affective shocks or trauma, especially in childhood; and progress in malice, which can lead to limits of enormous unnaturalness (Aquinas, 1964).

These disorders against nature, says Aquinas, could occure in all genus of vices (Super Ethicorum, Book VII, 1379):

"On the first point we must consider that such an excess of vice can concern vices opposed to all virtues, for example, folly opposed to prudence, timidity opposed to fortitude, intemperance opposed to temperance, and harshness opposed to gentleness; and it can concern each one of the vices, for some of them are brutish habits arising from a malignant nature, others are diseased habits arising from physical or psychological sickness, i.e., a bad habit." (Aquinas, 1964).

Among these disorders are counted, for example, paraphilias. St. Thomas deals with this subject by dividing lust into two genus: human lust and unnatural lust. The first consists of sexual intercourse outside of marriage. These are the disorders included in this category (Summa Theologiae, II-II, q. 154, a. 11):

"In one way, if without any kind of union, because of venereal pleasure, one procures pollution: which corresponds to the sin of impurity, which some call blandness. In another way, if it is done by union with a thing that is not of the same species: which is called bestiality. In a third way, if it is done by union with the unbecoming sex, as of a male with a male, or of a woman with a woman, as the Apostle says in Rom. 1; which is called sodomitic vice. Fourth, if the natural mode of union is not respected: either because unbecoming instruments are used; or by other monstrous and bestial modes of union" (Aquinas, 1947).

Also, as was pointed out, there can be a pathological disposition of aggressiveness, which corresponds to what today we would call psychopathy or sadism. In dealing with the vice of cruelty, opposed to the virtue of clemency, St. Thomas explains the difference of this sadism from wrath and cruelty in this way (Summa Theologiae, II-II, q. 157, a. 1, ad 3):

"The vice of anger, which denotes excess in the passion of anger, is properly opposed to meekness, which is directly concerned with the passion of anger; while cruelty denotes excess in punishing. Wherefore Seneca says (De Clementia ii, 4) that 'those are called cruel who have reason for punishing, but lack moderation in punishing.' Those who delight in a man's punishment for its own sake may be called savage or brutal, as though lacking the human feeling that leads one man to love another" (Aquinas, 1947).

The sadist feels pleasure in making his neighbor suffer, which is contrary to the natural tendency according to which every man is a friend of every man.

St. Thomas explicitly places this vice among the bestial or pathological ones (Summa Theologiae, II-II, q. 159, a.2 co.):

"'Savagery' and 'brutality' take their names from a likeness to wild beasts which are also described as savage. For animals of this kind attack man that they may feed on his body, and not for some motive of justice the consideration of which belongs to reason alone. Wherefore, properly speaking, brutality or savagery applies to those who in inflicting punishment have not in view a default of the person punished, but merely the pleasure they derive from a man's torture. Consequently it is evident that it is comprised under bestiality: for such like pleasure is not human but bestial, and resulting as it does either from evil custom, or from a corrupt nature, as do other bestial emotions. On the other hand, cruelty not only regards the default of the person punished, but exceeds in the mode of punishing: wherefore cruelty differs from savagery or brutality, as human wickedness differs from bestiality, as stated in Ethic. VII, 5. (Aquinas, 1947).

A similar disorder can also be found in fear. It corresponds to the current "phobias": "He does this at 'Someone', saying that temperament may be so timid as to make some afraid of anything, even the squeak of a mouse. This is the timidity of a dumb animal. One man became so fearful from a pathological condition that he was afraid of a ferret. "

We see then, that the Angelic Doctor explicitly mentions: unnatural lust; pathological cruelty, which seems to correspond to sadism; some forms of eating behavior disorders; phobias.

Conclusion

We see that Aquinas has some considerations that can be inspiring for those who research and work in the field of mental health. His conception of mental illness is broad and nuanced: we have mental disorders that are diseases in the strict sense, that is to say, imbalances of the organism that alter the functioning of the mind. On the other hand, we have moral disorders that undo the harmony of human life according to nature, the moral vices, which are like moral and spiritual diseases. Finally, we have those disorders of the sensitive mental life, caused by behavior, which are a psychological sickness (aegritudo animalis), whereby the imaginative and emotional life of man deviates from its natural disposition. I think that many neurotic, personality and behavioral disorders could come under the heading of the aegritudo animalis. These three categories should not be seen as closed compartments, but as realities that are mutually related in concrete people. Bodily illnesses sometimes condition moral freedom, and, in turn, mismanagement of the passions of the soul can make us sick. Between aegritudo animalis and moral disorder there can often be a close relationship. For this reason, a person-centered perspective from an ultimate transcendent and spiritual point of view is necessary to understand how, in each one, they are interrelated in a unique way. This is a perspective favored by the thought of Aquinas, who maintains that the person is the most individual being of all (Summa Theologiae, I, q. 29, a. 1).

References

1. Aquinas, Th. (1964). Commentary on the Nichomachean Ethics. Chicago : Henry Regnery Company.
2. Aquinas, Th. (1947). The Summa Theologica. New York : Benzinger Bros.
3. Echavarria, M.F. (2019). La corporalidad humana seg?n Tomas de Aquino. Revista Espanola de Teologia, 79(3), 345-366.
4. Echavarria, M.F. (2018). Las teorias psicologicas de las emociones frente a Tomas de Aquino. Bonino, S.Th. - Mazzotta, G. Le emozioni secondo san Tommaso. Roma : Urbaniana University Press, 47-82.
5. Echavarria, M. F. (2009). Las enfermedades mentales segun Tomas de Aquino [II] Sobre las enfermedades (mentales) en sentido estricto. Scripta Mediaevalia, 2(2), 85-105.
6. Echavarria, M.F. (2008). Las enfermedades mentales segun Tomas de Aquino [I]. Sobre el concepto de enfermedad. Scripta Mediaevalia, 1(1), 91-115.
7. Echavarria, M. F. (2005a). La praxis de la psicologia y sus niveles epistemologicos segun santo Tomas de Aquino. Girona: Documenta Universitaria.
8. Echavarria, M.F. (2005b). Santo Tomas y la enfermedad psiquica. Andereggen, I. (Ed.). Bases para una psicologia cristiana. Buenos Aires : EDUCA.
9. Izquierdo Labeaga, J. A. (2002). Alcune fonti dell'antropologia di San Tommaso (seconda parte). Alpha Omega, 5, 59-101.
10. Lobato, A. (Ed.) (1994). El hombre en cuerpo y alma. Madrid: EDICEP.

Role and place of religious experience during a spiritual crisis

Lebedeva A.A., Vitko Yu.S.

In this report we will speak about the role and place of religious experience in a spiritual crisis. Back in 1902, the American philosopher and psychologist William James raised the question of spiritual experience within psychology. He did the first large-scale psychological analysis of spiritual experience; the results are to be found in his book "The Varieties of Religious Experience". While doing research, he found this experience extraordinary, on the verge between normal and pathological. However, W. James made a conclusion that at that time hardly anyone could have expected: "Few of us are not in some way infirm, or even diseased; and our very infirmities help us unexpectedly. <…> What, then, is more natural than that this temperament should introduce one to regions of religious truth, to corners of the universe, which your robust Philistine type of nervous system, forever offering its biceps to be felt, thumping its breast, and thanking Heaven that it hasn't a single morbid fibre in its composition, would be sure to hide forever from its self-satisfied possessors?" [James, 2017, p. 22]

It turns out that spiritual experience, its psychological reality, can become a field in which relations develop not only between a person and the environment, but also between a person and God.

In our country, Fedor E. Vasilyuk made a huge contribution in the field of the psychology of spirituality. This outstanding Russian psychologist developed the notion of emotional experience and the concept of life worlds [Vasilyuk, 1984]. According to him, the life world is a "reference system" in which the same facts have completely different meaning not just for different people, but for people who are in fundamentally different systems in relating with the outside world. In addition, he tells us that it is possible to move between these worlds, solving problems existing in form of various critical situations. The life worlds are dynamic and mobile, but at the same time they are relatively stable and durable.

Developing these views, we came to the idea that there are "gaps" between stable life worlds, i.e. semantic gaps, because, moving from one logic of explaining the world to another, a person finds himself in a special space of "inter-world". Fedor E. Vasilyuk says that each world is characterized by its own critical situation (stress, frustration, conflict, crisis), experienced by a person as a crisis, that is, a catastrophe. The possibilities of the life world of a person in certain circumstances may be exhausted, and in this case the task is to overcome the previous view of being; it is necessary to make a qualitative jump through the abyss into a new life world (ibid.).

We assumed that the crisis as a separate phenomenon is not some kind of momentary jump. Experience shows that people can be in this state for a long time. M. Sh. Magomed-Eminov raises the question that existence in this transit state, that is, the transition, has a special quality that he calls "inter-existence": "Multiple life worlds of a person, connected into a single integrity, and the person's travel through life worlds, suggests the idea of a "between-existence" - specific life between life worlds" [Magomed-Eminov, 2006, p. 186].

We assumed that the spiritual crisis is a special case of the transient (that is, transitional) world, and is the experience of a critical situation that has occurred in a person's relationship with God.

We also assumed that the spiritual crisis has many faces. In order to determine the types of spiritual crisis, we have determined the psychological criterion by which it is possible to draw a demarcation line between different transient worlds. It is important to emphasize that we present not a spiritual or religious, but a psychological typology, which does not have the task of classifying a spiritual crisis as a spiritual phenomenon, but tries to highlight the features of the subjective experiences of this transition.

In order to single out the psychological criterion, we turned to the writings of Lev S. Vygotsky, the brilliant Soviet methodologist of psychology, who at a certain stage of his scientific work defined the concept of "meaning" as a unit of psychological analysis [Vygotsky, 1999], or rather, "dynamic semantic system" [Asmolov , 1983, p. 124]. Under "meaning" we understand the united individual experience and a culturally and individually determined system of meanings [Vitko, 2021]. We will use the term "mythologeme" to denote a culturally determined system of meanings that an individual uses when describing his spiritual and religious life [Isina, 2015]. And by individual experience we mean spiritual experience, that is, a nonverbal impression, the experience of Meeting (with God) in the transcendent, beyond the personality [Goryunov, 2009]. The criterion of preverbality means that spiritual experience goes beyond the capabilities of the categorial framework that is used to describe it: "The handiest of the marks by which I classify a state of mind as mystical is negative. The subject of it immediately says that it defies expression, that no adequate report of its contents can be given in words" [James, 2017, p.298].

Thus, we were focused on spiritual crisis, that is, on those experiences that are implicitly qualified by a person as spiritual. As criteria of the crisis, we have two components - religious experience and mythologeme.

To explore the phenomenology of a spiritual crisis, we conducted a study following the modern methodology of qualitative research. The study involved 31 respondents: 10 male and 21 female (age: average (M)=27 years; Min=19 years; Max=52 years). In the interviews the psychotechnical method of F.E. Vasilyuk [see Vasilyuk, Dr. I., 2008] was applied, the results were processed using descriptive phenomenological analysis by A. Georgi [Georgi, 1997]. 5 experts were invited to assess the compliance of the theoretical model with empirical data.

Our research resulted in a typology of four transient worlds (or subjectively experienced spiritual crises), the criterion for their separation were signs of presence or absence of religious experience and mythologeme (see Table 1).

Table 1. Typology of transient life worlds (spiritual crises)

So, in the first - mythological transient - world, the respondent reports that there is a mythologeme, but at the same time does not have a spiritual experience that would correspond to it. At some point, this "empty" religiosity falls apart due to contradictions that cannot be resolved, religion turns into a myth, a fairy tale, etc. for a person. The religious transient world is characterized by both - a mythologeme and spiritual experience - that come into conflict with each other. The symbolic transient world is a type of crisis experience in which neither spiritual experience nor mythologeme are represented. In this regard, we have the right to say that the symbolic transient world is not a truly spiritual crisis, but, perhaps, it is an attempt to move towards this spirituality. And, finally, the metaphorical transient world is characterized by a situation of collision with an extraordinary spiritual experience that cannot be described and comprehended within the existing mythologeme.

Let's analyze some statements in order to more clearly recreate the phenomenological picture of each crisis experience.

Respondents attributed to a mythological spiritual crisis (see Table 2), noted, for example, that they experienced it in adolescence, when they suddenly realized that they had no living faith in God. Many respondents have attended church since childhood and participated in divine services together with their parents or other close relatives. However, at some point they realized that they did not understand the meaning of the sacraments of Confession or Communion, did not experience contact with God and, in fact, God himself was rather Someone distant and incomprehensible to them, whom they had never felt as a real figure in their lives. The respondents also said that their main motivation for participating in religious sacraments came from the fear of punishment by adults. Religion was perceived by them as a set of rules that must be followed in order to get the approval of close people who were important to them. Many of those who were attributed by us to a mythological spiritual crisis left the Church due to the fact that they adopted a secular worldview spread among friends. Those who overcame this crisis and remained in a religious community said that as a result of the crisis, a sensual feeling of God opened up for them, the opportunity to build a dialogue with Him as with a living Person.

Table 2. Examples of respondents' statements classified as belonging to the mythological transient world

The respondents of the religious transient world (see Table 3) stated that they had a living relationship with God before the crisis, consciously fulfilled the commandments and attended divine services. The central problem of the religious crisis was a sudden discrepancy: either between the image of oneself and the image of a Christian, or between the image of God and some of His manifestations in life. Some respondents said that they committed a sin that they could not admit, and for which they were overtaken by a strong sense of guilt. Therefore, those experiencing a religious crisis began to feel a barrier between them and God. This barrier made itself felt also in prayer. The performance of religious rites caused fear, resistance; after some time it became mechanical and was no longer filled with special spiritual experience. Another part of the respondents spoke about encountering a situation that undermined their ideas of God as merciful, kind and loving. Those experiencing this type of crisis felt resentment against God, anger, conducted internal dialogues with Him, in which they expressed discontent. Some respondents left the Church as a result of the crisis, as in the previous case. Those who went through this crisis said that they began to feel faith as a way, they admitted that they might be imperfect themselves, and they might, among other things, not know all of God's plans for the world and their lives in particular.

Table 3. Examples of respondents' statements classified as belonging to the religious transient world

The stories of respondents who are in a symbolic spiritual crisis (see Table 4), as a rule, did not relate directly to the relationship with God and religion. The interview participants talked about solving existential issues related to the meaning of life, loneliness, death, and values. One of the respondents said that as a result of this crisis, she became a member of the church, because it helped her to survive a difficult period of life, find support and answers to her questions related to her personal life.

Table 4. Examples of respondents' statements classified as belonging to the symbolic transient world

The last crisis we are considering, a metaphoric one (see Table 5), was described by respondents as the result of an extraordinary spiritual experience that did not correspond to their ideas about the world (for example, some respondents were not deeply religious before the crisis). It was in the metaphorical transitory world that the vast majority of respondents said that their experiences had reached the level of psychopathology, so some sought psychiatric help. Respondents reported that they heard the voices of demons, talked about the experience of direct contact with the Spirit, with God, etc. Subsequently, this experience became a powerful impetus for changing the lives of the respondents, since for them the question arose of finding a new language that could describe the new world that opened up to them in this experience, and with which they can enter into a dialogue with another reality.

Table 5. Examples of respondents' statements classified as belonging to the metaphoric transient world

The above typology is an attempt to systematize, from a psychological point of view, those transient worlds in which people find themselves experiencing a certain "situation of impossibility" [Vasilyuk, 2005] in relations with the transcendent. Our research shows that the line between psychology, psychiatry, and theology can be very thin when it comes to a person experiencing a spiritual crisis. The one who sits in the psychologist's chair, talking about the experience of a critical situation in his religious life, can be the same person who talks during the confession about the influence of dark forces on him, and the same patient who tells the psychiatrist about hallucinations.

References:

1. Asmolov, A. G. On the subject of personality psychology // Voprosy psikhologii. 1983. V. 3. S. 118-125.
2. Vasilyuk, F. E. Distress and prayer (general psychological study). M.: "Meaning", 2005. 191 p.
3. Vasilyuk, F. E. Psychology of distress. M.: Publishing House of Moscow. University, 1984. 200 p.
4. Vasilyuk, F. E., Zaretsky, V. K., Molostova, A. N. Psychotechnical method of researching creative thinking // Cultural-historical psychology. 2008. V. 4. No. 4. S. 34-47.
5. Vitko, Yu. S. Spiritual crisis as an object of psychological research: graduation thesis. M.: NRU VSHE, 2021. 222 p.
6. Vygotsky, L. S. Thinking and speech. Ed. 5, rev. M.: "Labyrinth", 1999. 352 p.
7. Goryunkov, S. V. On the relationship between mythology and ontology (in the context of V.I. Vernadsky's ideas) // Noosphere and Artistic Creativity / Ed. V. V. Ivanov. Moscow: Nauka, 1991. 88-100.
8. James, W. The Varieties of Religious Experience: A Study in Human Nature/ Ed. S.V. Lurie. M.: "Academic project", 2017. 415 p.
9. Isina, G. I. Mythologeme as a component of worldview in the context of modernity // International Journal of Applied and Fundamental Research. 2015. No. 4. P. 160-163.
10. Giorgi, A. The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure // Journal of phenomenological psychology. 1997 Vol. 28. No. 2. P. 235-260.

Workshop of the XXX International Educational Readings "Church care for mentally ill people"

On May 21, the Department for External Church Relations of the Moscow Patriarchate hosted the workshop "Church care for mentally ill people: stress disorders and ways to overcome them", an event of the XXX International Educational Readings. The meeting was organized jointly by the DECR and the Commission for Church Education and Diaconia of the Inter-Council Presence, in which there is a working group for pastoral care of mental patients. Workshops on this issue have been held annually since 2018.

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 DECR staff member.

The workshop was attended by clergy and laity from eight dioceses of the Russian Orthodox Church, psychiatrists, employees of the Metal Health Research Center (MHRC), the National Medical Research Center for Psychiatry and Narcology named after V.P. Serbsky, the Russian National Research Medical University named after N.I. Pirogov, doctors, church social workers.

Metropolitan Sergiy opened the meeting with the report on "The experience of overcoming grief according to the texts of the Holy Scripture." The report says:

"Psychological and emotional stress in a person, caused by natural and social factors, has been described in the Holy Scriptures repeatedly and long before the term "stress" was introduced, which strongly suggests that anxiety, depression and other negative manifestations observed during stress occur in a person due to sinfulness.

The Bible story about the knowledge of good and evil tells that a person not only knows, but also does evil, interrupting his connection with God - the source of harmony, goodness and life. Violation of the commandment meant not only that the path of sin was chosen, but also that consequence of sin - death appeared, which had not yet been on earth: "sin entered the world through one man, and death through sin" (Rom. 5:12). From this moment on, man's sins and the threat of death are a source of grief and mental trauma. People's habits, including sinful ones, develop into a character that causes destruction and suffering of the surrounding world, which is under threat of destruction. According to the Apostle Paul, "the whole creation groaneth and travaileth in pain together until now" (Rom. 8:22). The most common causes of stress disorder are man-made disasters, military actions, violence and abuse. By creating life circumstances by sinful actions that become stress factors, a person himself becomes a victim of these factors. Thus, in the light of the Holy Scriptures, stress is a phenomenon rooted in the spiritual sphere of human life, which cannot be reduced only to processes considered in biology, psychology or medicine. At the same time, the moral assessment of human activity cannot be replaced by clinical diagnostics. And medical and psychotherapeutic effects on a patient with a stress disorder will never replace the role of spiritual maturity of the individual in healing the negative implications of life circumstances for mental health.

Caring about the implementation of a goal is a fundamental characteristic of human mind. If a person is concerned only with life going the way he wants, he will inevitably experience stress and its consequences. Life's difficulties in achieving a goal and a person's helplessness before the temptations of the world cause anxiety and worry, which are characteristic signs of stress. In the spiritual and moral context, psychological stress is a consequence of people's overestimation of their own capabilities. "Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight" (Proverbs 3:5-6), the wise Solomon instructs those who are trying to control everything that happens in their lives. The Apostle Peter directly says that it is a mistake for a person to entrust the care of himself to anyone other than the Lord: "Cast all your anxiety on Him because He cares for you" (1 Peter 5:7).

Psychological stress is usually associated with negative influences, as a result of which a person feels that he lacks his own strength and that he is left alone with harsh circumstances. In this state, a person discovers his vulnerability. He experiences, firstly, the fragility of his existence, which is experienced as the limit of human capabilities, and sometimes as the boundary of life and death. Secondly, his social fragility is revealed, which is the result of the experience of breaking ties with other people. And, thirdly, personal fragility, manifested by the feeling that a person has become "faceless", the experience of losing his own identity and "diminishing" the image of God in himself. In other words, stress allows a person to see the truth about himself: about his limitations, his dependence on the love of other people and God. Such a person's view of himself helps to answer the question about the meaning of suffering.

We live in a cultural environment where human suffering is usually regarded as something meaningless, as events that do not need to be remembered until they touch us or our loved ones. Perhaps this attitude is a manifestation of a person's deep inner aspiration to live again in paradise, where there was no suffering or death, where a person in a state of inner harmony could create a harmonious world around him. The experience of the Church of Christ opposes the sense of meaninglessness of adversity; it shows that sorrows have a deep meaning for a Christian. We, Christians, not only rejoice in the well-being sent to us by God, but also in the trials that strengthen our faith, hope for finding the benefits that the Lord promised: both in our earthly life and eternal life. The Apostle Paul reminds us: "We also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame " (Rom. 5:3-5). This hope for resurrection with the Lord, which we received from the moment of Baptism, would have remained in our infancy if there had been no sorrows. In addition, we are strengthened by the love of God, which is poured out on us along with grief: "God is faithful; He will not let you be tempted beyond what you can bear. But when you are tempted, He will also provide a way out so that you can endure it," the Apostle Paul tells us (1 Cor. 10:13). Thus, loss and heartache are understood by Christians in the context of benefits for the spiritual growth of a person. St John of Damascus said bluntly: "And remember that all the assaults of dark and evil fortune contribute to the salvation of those who receive them with thankfulness, and are assuredly ambassadors of help" (John of Damascus. An Exact Exposition of the Orthodox Faith. Chapter XXIX (43). Concerning Providence).

The Holy Scripture repeatedly tells about how a believer experiences unexpected hardships and losses. An example of one of the most detailed stories about the experience of sudden grief is found in the book of Job. Having lost all his possessions, seven sons and three daughters, struck with leprosy and became an outcast, this God-fearing and pious man could not speak for seven days and nights. He was unable to believe that this had really happened to him. Then words of indignation burst out of his mouth, in which he began to " cursed the day of his birth" (Job 3:1). Being a pious man, Job begins to seek God and turns to Him with demanding justice, as if negotiating with the Creator, as "a hired laborer waiting to be paid" (Job 7:2). An laborer who expects a fair reward for his work is an image of a person who has worked hard in the desire to be freed from sins and expects to receive retribution for this: " let God weigh me in honest scales and he will know that I am blameless," Job said (Job 31:6). In this demand for God's justice, he lacked humility, against which, according to the testimony of the holy fathers, even the devil is powerless (Apophthegmata Patrum, 15, 38). However, it is through trials that Job acquires this virtue of humility, confessing to the Lord with the words: "Behold, I am insignificant; what will I answer You? I put my hand on my mouth" (Job 40:4). After that, Job's peace of mind returns, and he accepts all the adversities that have befallen him, preparing him for a meeting with God: "My ears had heard of you, but now my eyes have seen you" (Job 42:5).

No wonder that the main stages of grief in the book of Job are used in the psychological model of Elizabeth Kubler-Ross, a well-known psychiatrist who, together with hospital priests and students of the Chicago seminary, summarized the main stages of the emotional stress of terminally ill patients. The stages of mental trauma described by Kubler-Ross were included into the Priest's Handbook (Priest's Handbook. Pastoral Theology. Vol. 8 / Moscow: Moscow Patriarchate. 1988. 800 p.) of the Russian Orthodox Church. Taking into account these grief stages, one shall know, that it is not always appropriate to talk about God with a person, to reason him of reason of the existence of the afterlife and the need for the priest's help: Job's friends talked about God in an inappropriate time, a lot and in vain.

Emphasizing the importance of the interaction of pastors, psychologists and psychiatrists who help patients with mental disorders associated with stress, one should understand the place of the priest in this. The task of a priest is not only to comfort a person, but also to help him connect with Christ, to experience communion with God. This determines the direction of pastoral ministry to people experiencing stress and its consequences. The pastor faces difficult tasks. Sometimes a priest has to catechize a person, to perform Baptism and Chrismation or resume his relationship with the Church, which was interrupted, perhaps, many years ago. The clergy should be prepared that, in extraordinary circumstances, many deep questions arise that people do not think about during the normal course of life.

In this regard, it is necessary to mention the problem of stress among the clergy. Some parish priests show symptoms of what is now called "professional burnout": anxiety, fatigue, irritability, a feeling of internal exhaustion. Priests, as well as representatives of other professions that help people, constantly face negative aspects of people's lives and their sorrows. The ability of the clergy to be compassionate, to be able to listen and to share grief is a very important ability necessary to alleviate the mental pain of other members of the Church. In this, the priest follows the example of our Lord Jesus Christ, Who is "able to sympathize with our infirmities" (Heb. 4:15). However, priestly ministry is associated with a high risk of negative effects of stress.

Therefore, the clergy need constant care for their own spiritual life and prayer in order to be able to receive strengthening from the Savior Himself. A clergyman needs an experienced confessor who helps to understand not only pastoral duties, but also the limits of his capabilities, to organize his life so as to cope with the stresses of everyday life. The words of the Apostle James, "confess your sins to each other and pray for each other" (James 5:16) are addressed, first of all, to the clergy. And we know that if a priest does not care about his spiritual life, he himself may need the help of a psychologist or a psychiatrist.

The clergy should take care of their physical health. Sufficient rest is needed, the need for which the Lord Himself tells the apostles: " Then, because so many people were coming and going that they did not even have a chance to eat, he said to them, "Come with me by yourselves to a quiet place and get some rest" (Mk. 6:31). The task of the clergy is to make full use of the possibilities of their body and soul to serve God and the Church. Hence the need for reasonable care for one's health.

Besides, one must be able to rejoice, according to Apostle Paul: "Rejoice always" (1 Thess. 5:16), "Rejoice in the Lord always. I will say it again: Rejoice!" (Phil. 4:4). In order to teach parishioners to rejoice, despite adversity, one must himself be the source of that joy about which the Savior of the world said: "I have told you this so that my joy may be in you and that your joy may be complete." (John 15:11). Our joy is not only because it is promised by our Lord Jesus Christ in the future, but also because His Kingdom begins in our earthly life by affirming the laws of love. We cannot but rejoice if every day in the church, at work, in the family and in society we manage to be co-workers with God in building and approaching His Kingdom of love. St. Basil the Great, who created the Basiliades - the first hospitals that became the embodiment of the charity of the Christian world, wrote: "…so, also, the soul must not constantly behold that which causes grief or be fixated on present sorrows, but must direct its gaze towards what is truly good. In this way will it be feasible for you always to rejoice, if your life always looks towards God and if hope of recompense alleviates life's sorrows" (St. Basil the Great, Homily IV on Thanksgiving).

Finally, the clergy must always cultivate their creative potential. Being the Image and Likeness of the Creator, we cannot but create. Moreover, creativity concerns not only the sphere of music, poetry, literature or painting. In the broadest sense of the word, creativity is the transformation of life based on the principles of truth, goodness and love, revealed in the Holy Scriptures and the Tradition of the Church. As St. John Chrysostom said about this, paraphrasing God's commandment to man about cultivating paradise: "I give you creative power - transform the earth into heaven, for you can do it." When this "creative power" disappears from a priest and he ceases to realize himself in the creative understanding of life and its transformation, he becomes especially vulnerable to stress.

Negative impacts on a person from the outside world are inevitable. However, our reaction to them depends on our spiritual maturity. Grief and suffering should not be a source of helplessness and vulnerability for a person, they should be the beginning of the path of ascent to God, Who is the source of fullness and harmony of life. A Christian can take advantage of life circumstances for his spiritual improvement and accept any events as factors of Divine Providence, trials and enlightenment. Following the experience of Christians transmitted to us by the Apostle Paul: " We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body" (2 Cor. 4:8-10)."

Prof. Vasily G. Kaleda, MD, chairman of the section on Clinical psychiatry of religiosity and spirituality, Russian Society of Psychiatrists, Deputy Director of the Metal Health Research Center, spoke about the clinical and psychopathological features of stress-related disorders. He noted that the problem of coping with stress has always been in the focus of attention not only in clinical psychiatry, psychology, but also in pastoral care.

Many international evidence-based medicine studies show that the response to stress depends on the spiritual maturity of a person: the more a person is rooted in spiritual values, the easier he perceives a stressful situation. Christians treat stressful events as a phenomenon that has an inner spiritual meaning. Having analyzed stressful situations in detail on the example of Job the Long-Suffering, St. Emilia, he spoke about psychological trauma and its consequences; about the factors affecting the development of psychogenic states; about the varieties of reactive states; about post-traumatic stress disorder, its causes, manifestations and treatment.

Archpriest Alexy Baburin, a cleric of the hospital church to the Icon of the Mother of God the Healer at the MHRC spoke on "Church life, spiritual and mental health". He cited the outstanding psychotherapist, psychologist and thinker Carl Jung (1875-1961) that "religions are systems of healing for psychic illness ", and that the Christian doctrine of original sin, the meaning and value of the suffering has an unsurpassed therapeutic value. Similarly, the belief in immortality gives life a continuous flow into the future, which helps to avoid mental congestion and regression. Father Alexy mentioned many theologians and Church fathers who believed that spiritual infirmity is cleansed by Confession, cured by prayer and fasting, and also testified about miraculous healings after Communion. He also spoke about the results of scientific research by modern foreign and Russian psychiatrists on the healing power of prayer and religious lifestyle in believing patients. Their opinions are in tune with the statement of Academician of the Russian Academy of Sciences Sidorov P.I.: "We can confidently say that religion is the oldest and most universal protective and compensatory civilizational resource that allows us to satisfy a wide variety of human needs, structuring man's mentality and identity. "Without questioning this assessment, Father Alexy suggested not to limit the attitude to religion only as an instrument of mental and psychotherapeutic influence, but to focus on the healing potential of church life in all its diversity and integrity. In conclusion he quoted St. Theophan the Recluse, who said that the doctoring of Christianity before the whole world has proved and still proves its healing power to all who use it without any wise wisdom; it would be an unforgivable mistake to exclude either one or the other, or the third element of its healing nature. This recipe is made in heaven and is put together from celestial substances."

The question of the place of religious coping strategies in the complex therapy of mental crises was raised in the report of three representatives of the MHRC Gedevani E.V., prof. Kopeyko G.I. and Borisova O.A. In the report, the results of numerous studies of stress states and ways of coping with them were presented, as well as various types of religious coping were considered. In particular, it was noted that 72% of recent studies have proven a positive correlation between religiosity and mental health, and among the factors of the positive influence of religion on mental health mentioned "a sense of belonging to something greater, awareness of the meaning of life, the ability to overcome difficulties, hope and optimism, the formation of self-awareness and self-esteem (in relationship with God), the development of the abilities of patience, forgiveness and gratitude, belonging to the community."

The report addressed the issue of the impact of religious coping on stress associated mental disorders, as well as two types of religious coping: preserving and transforming. Preserving coping is the desire to preserve or protect significant spiritual values in the face of threat, challenge or loss. This is the strongest tendency in overcoming difficulties. Transformative coping is a religious transformation or transformation of one's "spiritual sense ". "Confession-oriented rehabilitation should form an approach that takes into account the peculiarities of the value-semantic structures of Orthodox patients. The activities addressing these values can be a driving motivation for the inclusion of patients into rehabilitation." The basis and specific feature of religious coping is faith itself, faith as a support for an individual. Faith, which according to St. Macarius of Optina "consists not only in believing that God exists, but also in belief in His all-wise Providence, guiding His creation and arranging everything for the benefit."

Fyodor M. Shankov, a staff member of the Metal Health Research Center, spoke on "Types of spiritual coping with critical situations during the COVID-19 pandemic". He presented results of an empirical and conceptual study of the process of spiritual coping, initiated together with his teacher late Prof. Fyodor E. Vasilyuk, a representative of the school of understanding psychotherapy.

He noted that most of the credible researches in this area are related to the study of coping in stressful situations during catastrophes, but they do not take into account the religious factor, since most of the psychotherapist researchers are non-believers (70%), and don't understand spiritual experience of religious patients. Professionals who deal with religious patients often experience burnout-"empathic distress." At the same time, according to research, 83% of patients would like the doctor to be aware of their spiritual views and to start himself a conversation about it. Speaking about the dimensions of spiritual coping, Vasilyuk F.E. introduced the concepts of Eucharistic - filled with gratitude for trials; metanoia - tendencies to change; catholicity - the openness of a person to the church community, for example, during joint prayer. He contrasted the utilitarian spiritual coping, which is used instrumentally to cure a mental disorder, to the actual value-based spiritual coping, in which the disease is perceived as a condition for the establishment of spiritual values.

More than 1000 respondents participated in a study that determined what exactly is the source of spiritual coping for people:

• connection with God and experiencing closeness to Him, turning to Him in prayer;
• spiritual perspective in everyday life - daily thanksgiving to God for what a person has, perception of one's situation as a spiritual test;
• turning to God as a source of harmony, reconciliation;
• spiritual practice - communication with the spiritual father, participation in Church sacraments, prayer;
• spiritual self-transcendence - for example, the belief that life will continue in a different form after death.

The study showed that when a person turns to God personally, perceives His presence in his life, all other resources increase in him.

The "outline map" developed by specialists for the search for spiritual resources allows to select the most effective coping tools for the patient, depending on his inclination, for example, to emotional perception or intellectual spirituality based on knowledge.

In conclusion, Fyodor M. Shankov noted: "Our sampling showed that spiritual resources are extremely important for most clients; they ask for this support. By building on our research and suggesting concrete practices, we can also build a dialogue and mission among scientists who have been historically influenced by materialistic views."

Priest Ioann Melnik, a student at the Sretensky Theological Academy, in his report "Pastoral care for people, who have lost their loved ones," spoke about the results of a research aimed at determining the form and effectiveness of pastoral assistance to a person in a state of grief, as well as the role of religion and faith in God in the process of coping with situations of loss of a loved one and grief. The study showed that the majority of respondents (72%) - Orthodox Christians - in a situation of grief due to the loss of a loved one, turned to a priest for advice; three-quarters of them believed that the advice of the priest helped them cope with grief. When comforting a grieving person, the priest helps him to recognize the loss; feel and process pain; learn to cope independently in those areas of life where the influence of the deceased was most important; build new emotionally rich connections and relationships. "The methodology of pastoral assistance will consist of four important stages: the definition and evangelical explanation of death, work with feelings, adaptation to life without the deceased, and establishing a place in your life for the memory of the departed." Father Ioann told in detail how a pastor should build a conversation with a grieving person, teach how to pray correctly, warn against superstitions and conjectures, explain the true understanding of such things as the afterlife, the state of a person after death, prayer and dreams. "Despite the fact that the Orthodox Church has rich experience in pastoral counseling, including both ancient and modern theologians and pastors, it is advisable to use in pastoral care modern knowledge about the process of grief reaction in the loss of a loved one and methods of coping developed by modern specialists. This will help to take into account the individual characteristics of people who are often insufficiently churched or have a secular worldview. In addition, modern approaches make it possible to detail the provision of pastoral assistance at different stages of the grief reaction, taking into account specific forms of expression of grief," the speaker concluded.

Pishchikova Lyubov E., MD, Head of the Department of Gerontopsychiatry, Letnikova Zinaida V., Ph.D. (Medicine), Senior Researcher at the Department of Gerontopsychiatry of the V. Serbsky National Medical Research Centre for Psychiatry and Narcology spoke about "Religious Strategies for Coping with Pathological Grief Reactions in Late Age". They dwelled on the studies of various aspects of spiritual psychiatry, which have been carried out at their institute since Soviet times by such prominent scientists as D.E. Melekhov, Yu.I. Polishchuk, F.V. Kondratiev, Z.I. Kekelidze.

"In older religious patients, severe emotional and cognitive impairments develop less frequently. Affective disorders quickly undergo reduction, and dementias proceed with less progression, patients retain social adaptation for a longer time and continue to take part in church sacraments and divine services.

Lazko Natalya V., Ph.D. (Medicine), V. Serbsky National Medical Research Centre for Psychiatry and Narcology in the report "Actual problems of helping mentally ill people during socially significant stressful events" said that under the influence of stressful situations, for example, the COVID 19 pandemic, mentally unstable people demonstrate reactive behavior in the form of disorganization, family aggression, and underestimation of the consequences of steps taken. From a medical point of view, of course, correction of therapy is necessary. But it is also important to include such patients in helping other people - those who are worse off. For some patients, their personal participation in church life changes: the exhausting expectation of future disasters often leads to distancing from the Eucharistic communion: "It is all over, and even God will not help." Such patients need to be brought back into church life. The role of clergy is exceptionally important, they can explain what is happening to such patients, involve them in community service, and help overcome spiritual doubts.

DECR communication service