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

Below are papers read at the International conference "Church care for mentally ill people. Church and psychiatry: facets of cooperation", November 26-27, 2021, Moscow (continuation)

"By His wounds you have been healed." The healing force of weakness

Francisco Garcia Martinez (Spain, Salamanca), professor at the Pontifical University of Salamanca

The desert that inhabits us

The pandemic that we are suffering has pushed us to rediscover a dimension of our lives that our technified welfare society thought it could ignore, namely that we are vulnerable creatures, continually harassed, from within and from outside of ourselves, by failure, degradation and death. Uncertainty has become the content of our consciousness to a degree that it has not been for a long time, and all the other events that take place in social and personal life seem to be read from it, at least in the developed West¹. A society that thought it had controlled or could control the fragility of life has collapsed.

However, nihil novum sub sole. Natural or social disasters cyclically affect populations and cultures.

These situations correlate with personal situations that continuously affect people throughout their lives: violence suffered, personal failures, inhuman dependence, old age with its mental and physical deterioration, severe illnesses, mental illnesses or a simple, but often heavy burden of life with limitations that we cannot easily integrate.

Being confronted with these situations in which the created reality seems to be possessed of a logic that is not only mortal, but also malevolent and cynical, the human being has always felt, beyond his believing conscience, an absolute mandate that impels him to order the world in such a way that that it would be a habitable space, a protected space, a humanized space. For the consciousness of the believer, this is a task that humanity has received from God and which is its very essence, as it is said in the narrative of the creation of the world, when God commands man to have dominion in His image over the world that carries chaos in its bowels (Gen. 1:27-28). In other words, in order for the world to continue or to be continuously a space where reality is not determined by chaos, God gives man a higher vocation: to be His image, his representative.

Thus, the believer knows that the world is constantly threatened by the forces of death, which must be subdued and inscribed into the logic of life. And it is here that man's influence on the world is manifested, the work that people must do in the image of God. This work is nothing more than caring for God's creation in all its spheres: in natural, personal and social life. The believer knows that creation, although the Spirit of God works in it, bringing harmony to created matter, is not yet complete and suffers from the forces of death, which must be subordinated or already subordinated to the power of the resurrection of Christ (Phil. 3:10).

A believer must understand that he will not find a perfect life in the world, and that an attempt to build a paradise on earth leads to the absolutization of individual dimensions of life or lives, creating spaces of exclusion. He knows that life consists of matter, which is chaotic in itself, that it must be continuously ordered, and we are unable to do this because we are mortal, limited and weak. Thus, people live in an unstable equilibrium, which they cannot always maintain.

Therefore, the care for the world, commanded to man, will consist not just in building an order that protects lives, something that is obviously necessary, but also in caring for a life affected by suffering, which the human order is unable to eliminate and which in many cases it creates itself.

It would seem that this activity does not always have a concrete impact on the structures of earthly life, but it inscribes into history an "eschatological reserve" that prevents the forgotten people from being forgotten and, consequently, the absolutization of worldly orders. Thus, we see that the care of creation and history is embedded in the Christian vocation as a care that, in the image of God himself, is addressed primarily to the unprotected and suffering, and which constantly opposes the life or society, satisfied in their own order². And here the Church acts as an "expert on humanity"³, because it sees a person in someone whom the world orders want to make invisible.

Speaking about the disease, which can be considered as a "metaphor of the human condition"⁴, we know that it is not easy for the patient to recognize and accept it, nor for those around him who usually tend to hide it from him, making his position in society more marginal, as it is masterfully described in the novel by L.N. Tolstoy's "The Death of Ivan Ilyich". According to how the main character is presented in this novel, only the servant of Ivan Ilyich, who has known the hardships of a subjugated life, is able to comfort and encourage him during his fading away. I would like to emphasize one point: wounds can become a source of humanization when they are accepted and integrated as part of life. They can revive the sources of our authentic existence, realized in the image of God, and the sources of human brotherhood. It is in this anthropological possibility of fragility that the radical action of Christ will be based.

Thus, the life of people affected by crises, including believers, inevitably bears the imprint of these crises, which are a test for them, to which their own being exposes them. Speaking about the COVID-19 pandemic, Pope Francis emphasized that people "will not come out of the crisis the same as before: they will become either better or worse"⁵. Through these trials, we can either move into a true relationship with ourselves, with others, and with God, or we can destroy the very humanity of our lives⁶. Therefore, such trials should be, as far as possible, the time that allows the believer to stop and consciously accept Christ as a model for himself.

Christianity as a dramatic salvation proposal

Christianity is an offer of life that brings a person to the limit of suffering, rather than protecting him from it; it forces the believer to accept and bear his own cross and even the cross of other people in order to find the true solid ground for a perfect life. It is in this situation that a paradoxical saving companion is offered to a person, who himself has also experienced suffering, but who is full of life and can share it.

In Kierkegaard's polemic with the Danish Church of his time, this may have been a Gordian knot of tension. The philosopher condemned the bishop's desire to get believers out of anguish with a consolation that did not mention extreme poverty and, consequently, devalued the way of salvation offered by Christianity. Only in sorrow, the philosopher believed, do we know who we are. Only in sorrow do we find the way to salvation. It is impossible to get the experience of salvation and consolation without touching the abyss of despair.

Some religious leaders illustrate this paradox:

• Let us think of Saint Juan de la Cruz thrown into a cell, in fact a prison, by the brothers of his order, and almost abandoned to death, if not to physical death, then to the death of his vocation and, thus, his personality. It is in this anguished situation, in the midst of extreme physical weakness, dirt and contempt that he is given the highest experience of God, which he reflected in a Spiritual Song and his other poems composed there⁷.
• In the same way Dietrich Bonhoeffer, locked up in a prison at a time when the power of evil seemed stronger than that of God, writes the profound prayer In me there is darkness...⁸, which describes his own experience of anguish, in which God reveals Himself as a Savior without modifying the external situation.
• And, finally, the experience of suffering of a person who has realized the abyss of his sin, from which he can no longer free himself, and yet knows that sin has been overcome by grace. This is a gospel story telling about a robber crucified next to Jesus (Luke 23:40-43). And the person who turned this into a principle of spiritual life was Saint Silouan of Athos, who said: "Keep thy mind in hell and do not despair."⁹

These experiences, which occur in a simple and hidden way in many Christians, unite the Christian faith, since salvation always comes as an overcoming of the possibilities of the world, offering what it longs for, but cannot give itself. This is the core of what happened in the paschal mystery of Christ who gives himself to participate as an event of salvation. That is why it is in connection with this event that the ultimate foundation of eternal life is received, which frees the human being from his fear of limitation and death.

The weakness of Christ as a salvific event

The affirmation of the descent of Christ into hell and, even more, the resurrection as ascent from hell¹⁰, confirms the salvific radical nature of the ministry of Jesus in this context. "For you know the grace of our Lord Jesus Christ, that though He was rich, yet for your sake He became poor, so that you through His poverty might become rich." (2 Cor 8:9), says Saint Paul, turning the event into a statement of faith.

Certainly, throughout his ministry, Jesus has worked to create an order of life where the excluded would be uprooted from the social chaos that swallowed them up, disidentifying them and annulling their presence in the world. Now, this ministry develops, assuming the fragile and harassed life of the creature.

With His birth (with His incarnation) He becomes our brother in flesh and blood not only in the space of human activity, but also in the space of inaction (Phil. 2:6-8). He becomes one of us with an existential poverty typical of the human, as described in the story of the beginning of His ministry - in the narrative of temptations. He is threatened by the forces of destruction, he is harassed by the historical forces of hatred, trying to deprive him of his dignity (Matt. 4:1-11; Luke 4:1-13). And in this situation, when "cries and tears" come out of His chest (Heb.5:7), he will nevertheless pull himself together and accompany the creation, " subjected to frustration" (Rom. 8:20).

The appropriation of this situation gives Him the possibility of becoming the ultimate and radical intercessor of men. This intercession will no longer be a foreign word to suffering, but the same human suffering that cries out for its redemption within God. Inserted in the very life of God, the wounded body of Christ begs to be definitively transformed within the life of God (1 Cor 15:28). Pascal pointed to it when he affirmed that "Jesus will be in agony until the end of the world"¹¹. Thus, the intercession of Christ becomes a hope for salvation for man.

In addition, the basic and solidary experience of His infirmity makes Him a mystagogue, pointing the way to God from within His opposite - darkness. In the Epistle to the Hebrews, Jesus is presented as a model of saving faith, and the path of His suffering becomes a source of encouragement and hope for the believer (Heb. 12:1-3). This idea is taken to the limit by the Apostle Paul when he speaks about dying with Christ in order to be resurrected with Him (Rom. 6:8; 2 Tim. 2:11-13).

Thus, for the believer, the historical infirmity of Jesus and the constant memory of Him are a refuge, meaning and future, and we see this in the prayers that poor and humiliated people offer before the cross.

Thus, the infirmity of Christ marks the direction of the Church's activity. This activity should not be limited only to taking care of the world - that is, to organizing and transforming it. But it is also called to enter into its own poverty and suffering and from there illuminate the way for a compassionate, welcoming and encouraging accompaniment of humanity, which will help people to accept not only the riches of life, but also human existential infirmity as a space in which being is realized.

Epilogue. "You are the light of the world"

On this path, which passes through existential infirmity and suffering, and which turns into caring for others in the image of God, the experience of Julian of Norwich, which some recalled during forced isolation during the pandemic¹², is very important. The space of her mystical experience is a disease that puts her in the hands of death and from which she begins to recover at the moment when the priest hands her a crucifix. It is when she stops fighting death that she understands the tenderness of the crucified Christ's love for her. And at this moment she begins to come back to life to announce to everyone: "All shall be well, and all shall be well and all manner of thing shall be well." A message that does not amount to a naive and unrealistic statement that everything will be resolved, but which should be read as a paraphrase of the exclamation of the Apostle Paul from the Epistle to the Romans: "For I am persuaded, that neither death, nor life, nor angels, nor principalities, nor powers, nor things present, nor things to come, nor height, nor depth, nor any other creature, shall be able to separate us from the love of God, which is in Christ Jesus our Lord." (Rom. 8:38-39); or like the affirmation of Jesus, from the Gospel of John: "These things I have spoken unto you, that in me ye might have peace. In the world ye shall have tribulation: but be of good cheer; I have overcome the world." (John 16:33).

His imprisoned life, after experiencing pain and agony firsthand, becomes a source of evangelical hope in an environment plagued by wars and plagues, with the poverty and pain that they always bring with them.

The Church and the believer must allow themselves to be led into this space of radical infirmity and acquire there that humility which, paradoxically, endows them with equally radical strength and turns them into the light of the world. This is the Easter mystery, which one way or another must be realized in every believer and in the Church itself. Speaking here in Moscow, I can't help but recall that Fyodor Mikhailovich Dostoevsky also walked the same path, who with his wounded life witnessed in his literature the victory of light over darkness¹³.

¹Ch. Andre, "La incertidumbre invita a la sabidur?a" y Y.-A. Thalmann, "Mantener la calma en tiempos de incertidumbre", Mente y cerebro 108 (2021) 1-19.20-25.

²Here are the Beatitudes, in which the Evangelist Luke contrasts the Kingdom preached by Jesus and a world of satisfied people that hides the suffering: "But woe to you who are rich, for you have already received your comfort. Woe to you who are well fed now, for you will go hungry. Woe to you who laugh now, for you will mourn and weep." (6, 24-25). And from here also comes the category of "preferential option for the poor", received in the universal Church from the III General Conference of the Latin American Episcopate in Puebla in 1979.

³Paul VI, Address to the United Nations organization in 1965 (https://www.vatican.va/content/paul-vi/es/speeches/1965/documents/hf_p-vi_spe_19651004_united-nations.html. As of 19.10.2021).

⁴D. Innerariti, "Antropolog?a del hombre enfermo. La enfermedad como metafora de la condicion humana", en: E. Anrubia (ed.), La fragilidad de los hombres. La enfermedad, la filosof?a y la muerte, Madrid 2008, 91-102.

⁵Video message of the Holy Father Francis on the occasion of the 75th UN General Assembly 25.09.2020 (https://www.vatican.va/content/francesco/en/messages/pont-messages/2020/documents/papa-francesco_20200925_videomessaggio-onu.html)

⁶"The psychologists and the theologians, the poets and the mystics, assure us that impasse can be the condition for creative growth and transformation if the experience of impasse is fully appropriated within one's heart and flesh with consciousness and consent; if the limitations of one's humanity and human condition are squarely faced and the sorrow of finitude allowed to invade the human spirit with real, existential powerlessness; if the ego does not demand understanding in the name of control and predictability but is willing to admit the mystery of its own being and surrender itself to this mystery; if the path into the unknown, into the uncontrolled and unpredictable margins of life, is freely taken when the path of deadly clarity fades" (C. Fitzgerald, "Impasse and Dark Night", en: T. H. Edwards, Living with Apocalypse. Spiritual Resources for Social Compassion, San Francisco 1984, 93-116 (96). https://www.baltimorecarmel.org/wp-content/writings/CF_Impasse_and_Dark_Night.pdf (15-9-2021).

⁷Cf. F. Ruiz (dir.), Dios habla en la noche. Vida palabra ambiente de san Juan de la Cruz, Madrid 1990, 157-188: "Noche oscura. Transfiguracion en Toledo".

⁸"O God, early in the morning I cry to you. Help me to pray And to concentrate my thoughts on you; I can't do this alone. In me there's darkness, But with you there's light; I'm lonely, but you don't leave me; I'm feeble in heart, but with you there's help; I'm restless, but with you there's peace. In me there's bitterness, but with you there's patience; I don't understand your ways, But you know the way for me." (Resistance and submission. Letters and notes from captivity, Salamanca 2008, 105). Shortly before he died he wrote: "Our joy is hidden in suffering, and our life in death" (Quoted by E. Bethge, Dietrich Bonhoeffer. Te?logo-cristiano-hombre actual, Bilbao 1970, 1245).

⁹"Without this experience of descent into hell, it is impossible to truly know what the love of Christ, His Golgotha and His resurrection are" (Archimandrite Sophronius, Writings of St. Silouan of Athos, Madrid, 1996, 192). Jean Lafrance explains this phrase as follows: "It is a matter of realizing that hell is not only an objective reality, but that each of us is in hell to the extent that he is separated from God, from others and from himself. Hell is the division that I experience in myself, not doing the good that I want, doing the evil that I do not want" (The Power of Prayer, Madrid, 2000, 73).

¹⁰Cf. A. Gesche,"L'agonie de la Resurrection ou la Descente aux Enfers", Revue theologique de Louvain 25 (1994) 5-29.

¹¹Pensees, "Le mystere de Jesus", 553.

¹²See, for example, Michael Fox's book, Julian of Norwich: Wisdom in a Time of Pandemic-And Beyond, Bloomington 2020.

¹³"OnApril 14, 1867… Dostoevsky takes his wife to the museum to show her the Sistine Madonna by Raphael. He believes that this painting perfectly illustrates the idea that suffering creates beauty; he achieves the same in his novels, in which the characters acquire moral splendor through misfortune, cleansed of everything ugly, vulgar, dirty, pitiful" (V. Tanase, Dostoievski, Barcelona 2021, 146. Highlighted by us. - F.M).

Toxic religiosity and non-clinical psychocorrection in extra-liturgical activities of a parish

Archpriest Pavel Velikanov, Chair of Theology of the Moscow Theological Academy

One of the difficult issues that almost any parish priest is facing is the problem of mental health of parishioners, namely believers with mental health problems of varying severity. Although this problem seems to be universal, it has its own specifics in the church environment.

The first and basic difficulty we face is the problem of defining the norm. Though in psychiatry the divide between the norm and pathology is relatively definable - albeit with some difficulties, - in psychology this line is greatly expanded depending on the scholarly tradition and the system of criteria. In religion, the problem of the norm becomes practically nonsolvable. Christianity affirms Jesus Christ Himself as the only norm of man; accordingly, all the other people automatically find themselves in the area of abnormality, pathology. But even within this "abnormal" community, we will see by no means a linear gradation from "closer to Christ" or "farther from Christ", but many intersecting, often conflicting with each other planes, facets, shades, each of which will claim that its understanding of how much it corresponds to the Spirit of God or not, is true.

How can we talk about the phenomenon of "toxic religiosity" in such a situation? After all, what a secular researcher can call "toxic", from the position of a church person is the norm for a believer, and perhaps even a desired ideal!

For example, Stephen Arterburn and Jack Felton - who introduced the concept of "toxic faith" into the scientific vocabulary - point to the following religious attitudes, which, in their view, are clearly toxic¹:

1. "God's love and favor depend on my behavior.
2. When tragedy strikes, true believers should have a real peace about it.
3. If I have real faith, God will heal me or someone I am praying for.
4. All ministers are men and women of God who can be trusted.
5. Material blessings are a sign of spiritual strength.
6. The more money I give to God, the more money He will give to me.
7. I can work my way to heaven.
8. Problems in my life result from some particular sin.
9. I must not stop meeting others' needs.
10. I must always submit to authority.
11. God uses only spiritual giants.
12. Having true faith means waiting for God to help me and doing nothing until He does.
13. If it's not in the Bible, it isn't relevant.
14. God will find me a perfect mate.
15. Everything that happens to me is good.
16. A strong faith will protect me from problems and pain.
17. God hates sinners, is angry with me, and wants to punish me.
18. Christ was merely a great teacher.
19. God is too big to care about me.
20. More than anything else, God wants me to be happy.
21. I can become God."

If this list is read to almost any Orthodox parish (and not only orthodox!), without special comments, believers will easily agree with most of the statements. Is the Christian religion really inherently toxic in itself? And what is toxic for a researcher is a desirable norm for the church environment itself?

We should note that Samuel J. Pfeifer in his article "Faith-induced Neurosis: Myth or Reality?" criticizes Arterburn's and Felton's approach, saying that they create labels that can easily be misunderstood as (mono-) causal models of psychopathology in a religious patient². According to Pfeifer, neurosis can be not only "ecclesiogenic", but also "ecclesiomorphic"³. But in any case, according to Hark (1984), "neurosis disturbs religious life, whereas positive religiosity contributes towards healing."

Toxic (neurotic) religiosity can be defined as a concept in psychology and psychiatry that reveals the causal relationship between religious faith (or religious formation) and the development of neurotic disorders. This concept describes heterogeneous phenomena and factors in a person's religious life that have a negative impact on his psychological state and mental health⁴. St. Porfirios Kavsokalivitis says that the essence of Christianity is love, inspiration, hunger for the Divine, and striving for it is a natural desire of our soul. But for many people, religion is a struggle, disturbance and stress. Therefore, many "religious" people are considered unhappy people because it is obvious what a deplorable state they are in. And it is really so. If you do not understand religion in its depth, if you do not live it, then religion (piety) turns into a disease, and even into a terrible disease. So terrible that a person loses control over his actions, becomes weak-willed and powerless, suffers from anxiety and stress, he is guided by an evil spirit. He bows, cries, beseeches, as if humbling himself, but all this humility is a satanic act. Some of these people perceive religion as a form of torment. In the church they bow, cross themselves, say: "We are sinful, unworthy," but as soon as they go out into the street, they begin to say blasphemy if someone annoys them even a little. It becomes obvious that there is a demon in them."⁵

According to Marina Filonik, any neurotic is characterized by "neurotic unconsciousness", which manifests itself as an absolute certainty that his ideas are true; but when "such a person finds himself in an authoritative system of norms and rules with a strict distinction between "what is good and what is bad", often his already existing "neuroses" are fixed, which leads to even greater personal unfreedom."⁶ "Righteous piety combined with hatred of all others can be a typical example of this kind of substitution," the researcher believes⁷.

Toxic religiosity has several factors.

1. Psychopathological (neurotic). It can be caused either by specifics or deviations in the work of the psyche, or by psychological traumatization. The corresponding dysfunction leaves its bright specific mark on the particular type of toxic religiosity.
2. Existential. The lack of clarity in relations with God, the world, people around you and yourself. The fear of being unworthy of a relationship when the things will be sorted out.
3. Spiritual (ontological). Lack of deep faith in the goodness of God and His willingness to gather the "prodigal son" in His fatherly arms. Inner alienation from the grace of the Spirit that illuminates the soul.

In each specific situation, the significance of each of these factors may be different, but in any case they are all present to a certain extent.

What factors of parish life can provoke neuroticism?

1. Rigidity of social roles, "blind obedience". A spiritual child cannot question whether the father confessor's blessings are really correct and appropriate, since this will be perceived by both sides as a sin of disobedience. Only in a situation of acute crisis is it possible to go beyond this form of behavior.
2. Mutual alienation while maintaining external friendliness. In a more or less large parish, especially with a high turnover of parishioners, it is impossible to build deep and safe interpersonal trusting relationships.
3. Fear to declare one's own "spiritual failure".
4. Justification of violence and overstrain.
5. Cultivating hatred for any manifestation of corporality.
6. False understanding of "self-distrust".
7. Blindness to the didactic word due to its "obliteration".
8. Identification of the penitential attitude with the psychopathological position of a "victim", repressive practice of confession of sins.
9. A spiritually justified ban on the expression of feelings, "internal censorship" of feelings.
10. Non-recognition of personal boundaries, habituation to life with a bare soul.

Thus, once in the church, a person with an unstable or disturbed psyche can easily find himself trapped: the specifics of the church environment will not allow him to form a request for healing, while a faint hope would loom somewhere in the distance that only the Church will help him. It seems that it is possible to provide assistance, while not always help by spiritual and ascetic means can be provided precisely because a person is not ready to accept it due to a neurotic or mental disorder.

What if we look at the phenomenon of neurotic religiosity through the prism of the Gospel description of Christ? Here is the result in the form of a comparative table (table 1).

Table 1. Criteria for distinguishing between healthy and pathological (toxic) religiosity

The problem with toxic religiosity in a parish is further complicated by the fact that a priest who does not have a specialized psychological education cannot serve as a psychologist; despite the fact that to some extent every clergyman is confronted with psychological problems and is forced to deal with them in one way or another.

However, is it really not possible to do anything at a parish to help people with obvious neurotic religiosity - if they do not want to seek psychotherapeutic help in principle? At the parish, it is possible to create conditions during extra-liturgical activities that will help, if not resolve the neurotic conflict, then at least significantly weaken it.

Is there a way out of this impasse? I propose to consider a new approach to solving this issue through the application of the recent psychological and pedagogical technologies and methods within the parish's extra-liturgical activities.

Why does extra-liturgical activity have a high therapeutic potential in relation to neurotic religiosity?

1. A person suffering from a neurotic disorder is prone to social isolation rather than to active interaction with other members of the parish. The divine service itself does not presuppose (within the prevailing tradition) joint "doing": the choir sings, the priest serves, the believer prays in his place and does not interfere anywhere. Extra-liturgical activity helps to overcome this "tightness".
2. Neuroticism occurs along the line of "you have to" - "it's impossible!" Setting short-term and achievable goals, for example, completing any activity with some small but tangible result, helps a person to believe in his ability to achieve the goals.
3. .Manual labor is of particular importance in order to "bring the neurotic back to himself" from the hassle of the "ideal Self". Muscle memory, skills, participation of the body in activities with a correctly chosen balance between skills and the tasks (requirements) (see M. Chiksentmihayi)⁸ restores the neurotic's lost or weakened contact with himself. "Alienation from oneself" is the first most important unconscious means of reducing destructive neurotic tension⁹, and therefore restoring connection with oneself is the most important element of therapy.
4. Extra-liturgical activity in small groups (for example, the practice of Gospel reading), in which there is no hierarchical subordination, but equality and respect for the otherness of the other prevails, helps a person suffering from a neurotic disorder to feel the joy of being accepted by other members of the community. The atmosphere of trust gradually reduces the fear of showing others "your real nasty face", the neurotic mental spasm opens.
5. The neurotic need to "be able to cope with everything yourself"¹⁰ in the process of building working relationships with a "common cause" is gradually "unsealed": the neurotic gets used to turning to others for help and advice and gradually no longer sees this as evidence of his own deep inferiority.
6. For a neurotic, a systematic and structured study of a particular subject or skill also has a psychotherapeutic effect. From the report on the results of educational classes for prisoners in 1913, we learn that "School classes and homework, complementing the detainee's free time in the prison, gave healthy food to his mind and created a cheerful and balanced mood to patiently endure heavy captivity. The peaceful relations with each other are especially evident among the students-prisoners".¹¹

According to St. Theophan the Recluse, properly organized leisure is an important element of education, since any idleness disposes to sin. St. Theophan believed that the basis of leisure should be a certain handwork, which would help to develop creativity, and at the same time give rest. In the "Paper on Theological Schools" he writes: "If this way of studying would allow them to have enough home time, then oblige them to do handwork, depending on who is capable of what - drawing, carpentry, turning, tailoring, etc."¹²

The most promising is the use of some socio-pedagogical models of work with art-therapeutic approaches. It is necessary to develop technological protocols describing the sequence of the main stages and technical actions at each stage when using the pedagogical model of systemic art therapy with different categories of parishioners.

Art therapy in the modern sense is the use of almost all types of art with therapeutic, correctional and developmental purposes¹³. This includes bibliotherapy (treatment using the influence of literature), singing therapy, drama therapy (means of theater and role-playing), visual art therapy, imagotherapy (therapeutic effects of theater and images), music therapy.

According to the chairman of the Russian Art Therapy Association, Doctor of Medical Sciences A.I.Kopytin, the main tasks of art therapy are the following:

1. Correction of disturbed personality relationships.
2. Formation (restoration) of a healthy self-image.
3. Improving adaptive behaviors based on creative interaction with the environment.
4. Support for the creative identity of clients.
5. Finding existential, spiritual guidelines and reasons for existence¹⁴.

Practicing art therapists note that it is "artistic activity that often makes it possible to escape the "censorship of consciousness", therefore it presents a unique opportunity for the study of unconscious processes, the expression and actualization of latent ideas and states, those social roles and behaviors that stay in a "repressed" form, or are poorly manifested in everyday life."¹⁵

Of particular importance for the church environment is the fact that through creative activity, the right to be emotional is rehabilitated as such: "The factor of artistic expression," writes A.I. Kopytin, "is associated with the expression of the client's feelings, needs and thoughts through his work with various visual materials and creation of artistic images. Artistic expression is not a one-time act, but a process unfolded over time, which includes several main stages".¹⁶

What is interesting about art therapy, including eco- and environmental therapy, from the perspective of theological reflection? First of all, this is a rethinking of the therapeutic potential available in the church spiritual tradition, which is only slightly revealed in modern practice. Art therapists actually create their own "rituals," Ronen Berger says bluntly about this, that some specialists see art therapy as a form of modern ritual. The lack of a common symbolic, spiritual mode of communication in modern society makes it difficult to use traditional rituals and requires the use of secular, non-religious rituals to resolve existential issues in the process of psychotherapy¹⁷. A logical question would be: what prevents the actualization of traditional rituals in the context of therapy?

The second aspect is a new reading of the actual therapeutic effect of church life. The Church is the "healer of human souls and bodies". But if in psychotherapy and psychiatry there are, albeit conditional, but still quite clear criteria for health and illness, so for the church consciousness, especially in the field of mental health they are too vague. This is a whole area for theological research - the possibility of determining the measurable parameters of the mental health of an Orthodox Christian.

And finally, the third aspect is the theological understanding of the therapeutic side of synergy, the co-creation of man and God in a religious act. If, according to Fr Pavel Florensky, there is only one criterion of ecclesiality - i.e. beauty, then why not consider the spiritual significance and therapeutic effect of the involvement of the parishioner in creative activity according to his talents and needs?

All of the above are just rough accents on the first sketch on the topic of what can be done for our parishioners to improve the quality of their church life.

¹Arterburn S., Felton J. Faith that hurts. Faith that heals. Thomas Nelson Publishers. Nashvile.1992. p. 98.

²Pfeifer S. Faith-induced Neurosis: Myth or Reality? Journal of Psychology and Theology Copyright 1994 by Rosemead School of Psychology 1994, Vol. 22, No. 2, 87-96

³Pfeifer S. Faith-induced Neurosis: Myth or Reality? Journal of Psychology and Theology Copyright 1994 by Rosemead School of Psychology 1994, Vol. 22, No. 2, 87-96

⁴Velikanov P., Archpriest, Neurotic Religiosity: Genesis, phenomenology and prospects of Interaction within the Orthodox Tradition [Невротическая религиозность: генезис, феноменология и перспективы взаимодействия в рамках православной традиции]. // Questions of theology. 2020. № 2 (4)

⁵St. Porfirios Kavsokalivitis Vita and Words[ Житие и слова]. Maloyaroslavets, 2014. p. 165.

⁶Filonik M. S. Psychological analysis of the phenomena of distortions of religious experience [Психологический анализ феноменов искажений религиозного опыта]// Consultative psychology and psychotherapy. 2015. Vol. 23. No. 5 (89). p. 109.

⁷Ebid.

⁸Chiksentmihayi M. Flow: The Psychology of Optimal Experience. М., 2017, p. 124.

⁹See: Horney, K.. Neurosis and human growth. The struggle toward self-realizution. St. Petersburg: East European Institute of Psychoanalysis, 1997. p. 181.

¹⁰See: Horney, K.. Neurosis and human growth, p.350.

¹¹Cit. ex: Ivochkin D.A. The activity of the Russian Orthodox Church to strengthen the moral foundations of prisoners in prisons in the Smolensk region in the second half of the XIX - early XX century [Деятельность Русской Православной Церкви по укреплению нравственных устоев заключенных в тюрьмах на Смоленщине во второй половине XIX - начале ХХ века ] // Historical Sciences, 2017, 1. p. 282.

¹²St. Theophan (Govorov), Paper on Theological Schools [Записка о духовых школах] //. Archive of the Russian Panteleimon Monastery on Mount Athos (hereinafter - ARPmA). op. 24 (St. Theophan (Govorov)). D. 39. Ed. hr. 4009. L. 8.

¹³Volodina K.A. The use of art therapy in the activity of a practical psychologist in an organization [Применение арт-терапии в деятельности практического психолога в организации] // Organizational psychology, 2017. V. 7. p. 88.

¹⁴Kopytin A.I. Art-therapeutic environment from the point of view of clinical, social and ecological approaches [Арт-терапевтическая среда с точки зрения клинического, социального и экологического подходов] //Ecological and environmental approaches in art therapy M., 2019, p. 20.

¹⁵Volodina K.A. The use of art therapy in the activity of a practical psychologist in an organization [Применение арт-терапии в деятельности практического психолога в организации ] // Organizational psychology, 2017. V. 7. p. 88.

¹⁶Kopytin A.I. Theory and practice of art therapy[Теория и практика арт-терапии] - St. Petersburg: Peter, 2002. p.42

¹⁷Berger, R. Theory and practice of nature therapy [Теория и практика природной терапии] // Ecological and environmental approaches in art therapy M., 2019, p. 65.

Psychopathological specifics of religious delusions of sinfulness in patients with depression

Gedevani Ekaterina Vladimirovna (Moscow), Ph.D., senior researcher of the group for the study of special forms of mental pathology of the FSBI "Scientific Center for Mental Health"

For clergy, in their pastoral care for spiritual children, it is extremely important to be able to distinguish true repentance from a depressive state when a person's soul is under the painful burden of ideas of guilt, sinfulness, despair. In order to distinguish the experiences of a believer from the experiences of a person suffering from depression with religious delusions of sinfulness, it is necessary to understand the essence of true repentance.

The Holy Scripture, the 2nd Epistle of St Apostle Paul to the Corinthians 7:10, says: "Godly sorrow brings repentance that leads to salvation and leaves no regret, but worldly sorrow brings death." Holy fathers interpret these words in the following way: "He that sorroweth for sins, he alone attains some advantage from his sorrow, for he maketh his sins wane and disappear. For since the medicine has been prepared for this thing, in this case only is it potent, and displays its profitableness; and in the other cases is even injurious". Those who mourn with worldly sorrow, "after they have sorrowed vehemently condemn themselves, bringing forth this greatest token of having done it unto harm… "For no one will condemn himself if he have sorrowed for sin, if he have mourned and afflicted himself" (St. John Chrysostom, Homily XV on second Corinthians). "Just as, if someone's tongue has suffered damage, honey might seem tart to them and they need to be cured in order to taste the sweetness, the same is true of the fear of God: in souls where it is engendered, on hearing the message of the Gospels, it causes sorrow, since these souls are still surrounded by the wounds of their sins; but as soon as they cast these off, through repentance, they feel the joy of the good news, according to the words of the Savior: "Your grief will turn to joy.""(St. Gregory Palamas, Homily XXIX on the healing of the paralytic in Capernaum).

St. John Climacus spoke about the meaning of true repentance: "Repentance is the renewal of baptism. Repentance is a contract with God for a second life. Repentance is the daughter of hope and the renunciation of despair. Repentance is reconciliation with the Lord by the practice of good deeds contrary to the sins" (The Ladder of Divine Ascent, Step 5. On painstaking and true repentance which constitute the life of the holy convicts; and about the prison).

The Old Testament also find warns against harmful of worldly sorrow: " Do not give in to sadness, or torment yourself deliberately. Gladness of heart is the very life of a person, and cheerfulness prolongs his days. Distract yourself and renew your courage, drive resentment far away from you; For grief has killed many, and nothing is to be gained from resentment. Envy and anger shorten one's days, and anxiety brings on premature old age." (Sirach, 30:21-24).

The specifics of the worldview of depressive patients with religious delusions of sinfulness lies in a strong sense of guilt, which completely absorbs a person, taking him away from God. This feeling cannot lead to true repentance, to deliverance from difficult emotional experiences, since in this case, manifestations of mental illness are hidden behind the outer facade of pronounced religiosity, and they require obligatory medical intervention. The danger of such conditions is that a person can harm his own health and well-being, and in the most severe cases, attempt suicide (Pashkovsky V. E., 2009; Huguelet, P., et al., 2007; Weber, Samuel R.A; Pargament, Kenneth I.B, 2014).

The phenomenon of religious delusions of sinfulness has attracted the attention of both clergy and healers for several centuries (Griesinger W., 1871; Schneider K., 1955; Leonhard K., 1957; G. St?ber, E. Franzek, H. Beckmann, 1993). The demonological interpretation of this phenomenon, which was established in the Middle Ages, retains a certain meaning even today, since the depressive delusions of sinfulness are often combined with the delusions of possession, which was called "demonomania" or "demonomaniac melancholy" or "demonomelancholia". Meanwhile, hallucinations also appear in such descriptions; in addition, there are indications of a special relationship between religious melancholy and the "sexual system".

In the literature of past centuries, one of the most common names for depression with religious delusions of sinfulness is Melancholia religiosa (Griesinger W., 1871). In this disease, along with the clinically obvious symptoms of melancholia, the feelings of guilt, "remorse" and thoughts of sinfulness caused by the disease are at the forefront. Mention is made of the constant self-accusations of patients who have never considered themselves worthy of Divine Grace. E. V. Feuchtersieben (1845) uses the definition of "religious obsession", which is "associated with repentance for actually or supposedly committed sins."

Among the first researchers of the clinical picture, defined as "religious melancholy", there were often theologians and counselors, which was determined by the religious content of these states. However, they tried to separate "religious melancholy", which was understood as clearly somatogenic, from real piety.

One of the first researchers to describe in detail the state of religious delirium of sinfulness in depression was Ideler K.W. (1947), he also called this state "gentle melancholy". The theory of the origin of this condition was based on his general, etiological theory revolving around religious "passions". He especially singled out extreme feelings of guilt and pangs of conscience precisely in the context of experiencing the loss of grace and faith. However, he also added that the "motive" of religious melancholy often does not arise at all from hypertrophied piety, but can be present "in any serious mental illness"; besides, he notes that, therefore, of all types of melancholy, religious melancholy is the most common.

In the course of the further development of clinical psychiatry, descriptions of "Melancholia religiosa" appear, which is characterized not only by an explicitly low mood and delusional ideas of sinfulness, but also by a painful feeling of God-forsakenness. R. Kraft-Ebing (1874) writes about such states. He attributes them to "traditionally religious" patients. He talks about their experience of "repressed feelings of reverence and relief associated with prayer", which makes prayer "ineffective" and drives the patient to despair, as he feels as if "he is forsaken by God and has lost salvation".

In the course of the study of depressions with religious delusions of sinfulness, it was noted that delusional ideas of sinfulness more often appear in melancholic depressions, characterized by a dreary mood with ideas of guilt and a depressive interpretation of previous and present events (Kopeyko G.I., Gedevani E.V., Borisova O .A., Shankov F.M., Smirnova B.V., Kaleda V.G., 2021).

In such cases, an explicitly low mood was expressed in a dreary affect, ideas of low value, a sense of guilt directed at the patient himself. The peculiarity of depressive ideas was predetermined by the "individual scale of values" (Janzarik W., 1957), associated with the assessment by patients of all their misdeeds in the religious plane, which was determined by the dominance of the religious worldview in the value-semantic sphere of patients. So, for example, patients accused themselves of "carnal indulgence", of "lack of love for one's neighbor", "of negligence." There was a fairly clear formation of the instance in relation to which the feeling of guilt was directed: guilt before God, and not a family, judicial, professional group of reference persons. All the patient's attention was focused on misdeeds in the religious sphere. There were also fantasies about the coming punishment: about going to hell, and so on. Along with this, real offenses, such as neglected duties or insufficient care for one's family, developed strongly when the sense of one's own guilt began to extend into the past, with an exaggeration of "actual, long-committed offenses." There were also fantastic delusions about imaginary wrongdoing. Such experiences contributed to the rapid formation of judgments about their own sinfulness. The patients were overcome by ideas of sinfulness, up to the most serious and unforgivable sin, "sin against the Holy Spirit" (The "sin against the Holy Spirit," namely, the "slander" of the Holy Spirit, is specifically mentioned in the New Testament as the only sin in general that will not be forgiven forever and ever).

In an acute depressive state, patients often said that confession did not bring relief, did not relieve the sin they had committed, stated that repentance was not accessible or they did not feel the fullness of repentance that did not restore spiritual harmony and a sense of forgiveness.

Of particular note is the painful feeling of God-forsakenness, which is acute in depressive states and was felt by patients as a loss of a sense of God's mercy: God is "cruel, implacable, merciless" (Rosmarin D.H., Bigda-Peyton J.S., Ongur D., Pargament K.I., Bjorgvinsson T., 2013 ). Changes were also noted in the ideational sphere, which in these observations was characterized by a distorted prayer: an inability to "pray fervently" or read prayer rules, or a feeling of "prayer futility", "religious emptiness". In especially severe depressions, there were feelings of rejection and damnation, despair and hopelessness, thoughts of sinfulness and unforgiveness (Miller, F. and Chabrier, L.A., 1987). The described experiences were interpreted clearly as a "demonic attack", which often led to the search for help in a purely religious environment, for example, in exorcism rites. There were also individual cases when delusional ideas related to achieving in suicide a "new erasure of the boundaries of being", "the last possibility of the manifestation of life", "the last hope for union with God", which determined the extreme suicidal danger of these states.

In patients with depressive delusional ideas of sinfulness and God-forsakenness (n=43), suicidal thoughts and intentions were observed in 67% of cases, and suicidal attempts were observed in 20% (n=13). In connection with this fact, I would like to note some features of counseling work with such patients. What is needed is to help the patient make some adjustments to his "individual scale of values", which was mentioned earlier, in suppressing the "unreasonable fear of sinning" and any incipient delirium formation, which may be evidenced, for example, by statements like: "I am afraid of being damned" and etc.

It should also be understood that sick people, in particular, depressive ones, can also have "correct" religious experiences (fully corresponding to the foundations of the Orthodox tradition), which can be a support in spiritual care. Any suspicion of an acute mental condition with religious content should be a reason for the temporary suspension of spiritual counseling work in order to avoid aggravation of delusional disorders. It is very important for the spiritual counselor to identify the psychological differences between the depressive message of "the impossibility of believing any longer" and "conscious unbelief".

In conclusion, we shall emphasize the importance of the fact that, due to the specific content of depressions with religious delusions of sinfulness, directly related to religious experiences, they are often not recognized as a mental disorder requiring medical assistance. This is due to the difficulty of distinguishing between a normal religious worldview and pathological pseudo-religiosity. This often leads to aggravation of the condition and late referral to psychiatrists, and in extreme cases can lead to negative consequences, in particular, to suicidal attempts.

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