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)

Religious fanaticism and religious delirium

Kopeyko G.I. (Moscow), PhD, deputy director for scientific work, Orekhova P.V., PhD student, Scientific Center of Mental Health.

The problem of religious fanaticism, which is of a multidisciplinary nature, has now acquired particular significance. Guided by various approaches (sociological, politological, philosophical, historical, medical, legal, etc.), experts have different views on this problem and even differently define the term itself [1, 2, 3, 4]. Some believe that the word "fanaticism" comes from the Greek "thanatos" - the god of death in ancient mythology, thus emphasizing that to be a fanatic means to be devoted to something until death [5]. Other authors are convinced that the term "fanaticism" comes from the Latin word "fanatismus", therefore a fanatic is a person frenzied, frantic, ecstatic, driven to an extreme degree of excitement and commitment to certain views [6]. Specialists who study the problem of fanaticism emphasize that there are at least two components to fanaticism: a special personality and a special dominant idea; they define fanaticism as a state associated with a certain personality structure and characterized by conviction, fixation on narrow value systems, this is combined with a high degree of identification of a person with these values, the intensity of fixation on these experiences [7, 8]. Such people are not capable of compromise, dialogue with others, and those who express other views are considered by fanatics as enemies, against whom all means of struggle are used, and no attention is paid to possible consequences.

Let's look at this problem from a clinical point of view. As already mentioned, fanaticism occurs in individuals of a special type with a paranoid temperament, while they have overvalued ideas and are possessed by them. These ideas fill their psyche and have a dominant influence on behavior. P.B. Gannushkin adhered to this point of view, he described religious fanatics as "indifferently cold or demandingly strict, ... human grief does not touch them, and heartless cruelty is their quality" [9]. The main strength of fanatics lies in the invincible will that helps them do what they see fit, which makes them dangerous to society.

Overvalued ideas, first described by the German psychiatrist S. Wernicke [10], or rather overvalued formations, involve the entire sphere of the patient's consciousness, are associated with affective catathymic mechanisms. B.V. Shostakovich [11] wrote: "Overvalued ideas are beliefs closely related to personality traits that arise under the influence of a real situation, are logically developed, acquire excessive importance due to high emotional charge and occupy a dominant place in a person's mind, influencing his actions and behaviour. Overvalued formations are characterized by high emotional richness, stamina, full conviction, and, as a rule, cannot be corrected by opposite ideas.

Specialists differentiate between essential (primary/classic) and induced (infected) fanaticism [7]. Content wise, fanaticism can be political, legal, national-racial, and fanaticism can also be found in such areas as sports, art and health.

The subject of our brief presentation today will be religious fanaticism in its most typical variations. Religious fanaticism arises as a result of the crisis of an individual's religious identity and is an extreme form of religiosity of an individual or group, potentially dangerous for society, which actively invades and negatively affects the worldview of other believers [1]. In these cases we are dealing with an extreme form of religiosity. Fanaticism is a "distorted child of religion" according to Voltaire, since a religious fanatic sees himself as the bearer of the highest truth, considers himself a weapon in the hands of God.

The most important feature of people with fanaticism is the anti-social orientation of their behavior, the systematic violation of social norms, the tendency to self-destruction, up to suicide. Fanaticism is always "gloomy and cruel", fanatics are judges who pass death sentences on those who think differently than they do. As P.B. Gannushkin writes, often under the leadership of fanatics, "savage deeds, monstrous crimes were committed: self-torture, torture, torment, murder"; fanaticism implies "the absurd fury of people blinded by malice" (9). Examples are the religious wars (1618-1648) between Protestants and Catholics, the collective suicides of the Priestless Old Believers at the end of the 17th-19th centuries, the terrorist attacks of September 11, 2001, and other events.

Fanaticism has a destructive power that destroys society, as we have seen in recent decades with the example of companies unleashed around a TIN, a bar code, refusing a passport, waiting for the end of the world. In such cases, religious people with fanatical faith were no longer convinced by the appeals of either the Patriarch or spiritual fathers.

Another fairly large group should also be mentioned - the so-called fanatics of emotions - enthusiastic adherents of religious sects. They serve as mere instruments for the implementation of the goals of the leaders, quickly fall into full obedience and are solely in the grip of one affect, an emotional mood. They are completely uncritical about what is their deified object of worship. In these cases, specific social conditions play an important role, namely, social exclusion, social maladaptation, poor adaptation to reality.

A few words must be said about the difference between true religious belief and religious fanaticism. Let us take an example from the patristic tradition.

The "Ancient Patericon" tells the story of Abba Macarius the Great, "walking to the Mount of Nitria with his disciple, he told this disciple to go on ahead. When the latter had gone on ahead, he met a priest of the pagans, who was in a hurry somewhere, carrying a large piece of wood. The disciple shouted after him saying: 'Oh, devil, where are you off to?' The priest became angry and beat him and left him half dead. Then he hurried on. When he had gone a little further, Abba Macarius met him running and said to him: 'Greetings! Greetings, you hard working man!' Quite astonished, the priest said: 'What good do you see in me, that you greet me?' The old man said to him: 'I greeted you because I saw you working hard and wearing yourself out and hurrying somewhere'. The priest said to him: 'I have been touched by your greeting and I realize that you are a great servant of God. But another wicked monk who met me insulted me and I have given him blows.' Then the priest fell at his feet, hold them and said: 'I will not let you go till you have made me a monk.' They went on together. When they came to the place where the beaten brother was, they put him onto their shoulders and carried him to the church, because he could not walk... The priest converted to Christianity, and then became a monk; through him many pagans became Christians. On this occasion, Abba Macarius said: 'A proud and evil word directs good people to evil, but a humble and good word turns evil people to good' (Patericon by Bishop Ignatius Brianchaninov).

Thus, we see that Christianity calls to hate the sin, but to love the sinner. It is wrong to believe that for salvation you need to perform only a certain set of actions (self-immolation, bodily fasting up to death from exhaustion, many hours of night vigils), in which the performance of bodily feats, religious rites, i.e. the adherence to the letter of the law stands in place of sacrificial love for one's neighbor. For a fanatic, blind adherence to religious rules, to one or another dogma is more valuable than another person; in other words, for such people, "the Sabbath is more important than the man." It is much more difficult to live in Christ, to listen to those neighbors whom the Lord sends, and to meet them with the humble and sacrificial love of Christ. The fanatic sees only perishing people and thanks God that he is not like all other people, he thinks that everyone will perish, and he alone will be saved.

It is important to note that in the case of an endogenous disease, especially at its initial stages, an overvalued formation with religious content creates a wrong picture of a traditional religious worldview. Later, overvalued ideas are transformed into overvalued delirium, which is psychologically understandable and is seemingly based on religious beliefs. The subsequent modification of psychopathological symptoms, which usually occurs 5-8 years after the onset of the disease, is reviled in the replacement of overvalued formations with a disorder of a more severe register - interpretive delirium. Poorly systematized unstable delusional ideas are gradually transformed into a complex paranoid system, delusional ideas of a religious nature are expanding, delusional ideas of relationship and persecution are adding up, capturing an increasing number of imaginary ill-wishers. As a result, a complete reassessment of one's own personality occurs, delusions of grandeur develop, and in some cases hallucinatory manifestations, which very quickly turn into verbal imperative hallucinatory syndrome. At this stage, the entire behavior of patients is determined by religious delusions and often leads to severe and dangerous acts of aggression.

It is important to emphasize that religious delirium, in contrast to overvalued formations, is not determined by the temperament of the individual, and its content may be in sharp contradiction both with the latter and with religious traditions objectively existing in society.

One feature of religious delusions, in particular, of the delirium of the end of the world with religious content, is specific destructive delusional behavior. According to the research data of the Scientific Center of Mental Health, one in ten patients with delusions with religious content showed an explicitly asocial and/or antisocial behavior.

This aspect was described in detail by K. Jaspers [12], who believed that such patients could be extremely dangerous for those around them, especially at the peak of the described mental disorder, due to their readiness for fanatical actions." According to the author, the most frequent acts of violence are: attacks on clergy, misbehavior during Church worships, desecration of churches and blasphemy over icons, often sick people kill their loved ones. Insanity of this kind may also acquire judicial or social significance because such patients often refuse to obey established laws and regulations. Patients with religious delusions can be dangerous for themselves due to refusal of food and self-torture, going in some cases as far as self-crucifixion on the cross.

According to modern researchers [13, 14, 15, 16], an important feature of endogenous psychoses with a religious plot of delusion is a specific form of delusional behavior associated with a high risk of non-suicidal self-destructive actions (penetrating eye injuries, autocastration) and suicidal, as well as, in individual cases, heteroaggressive actions. V.E. Pashkovsky [17] was one of the first to develop a detailed classification of the behavioral characteristics of such patients. Some researchers [18] described the self-destructive behavior of patients with a religious delusion of the end of the world, who misinterpreted the Gospel of Matthew as a call to inflict bodily harm on themselves.

One example of delusions with religious content, involving aggression, may be associating oneself with the Antichrist [15]. The authors give the example of a patient involved in an active religious Protestant life since childhood, who abducted and raped two women. He considered his actions acceptable because, as the Antichrist, he could make them to have sexual intercourse with him and could do it with force, since he was evil.

Torres P. in his study of aggression and violent behavior highlights the concept of "apocalyptic terrorism", citing such destructive religious organizations as Aum Shinrikyo, ISIS, CSA. The ideological basis of all these organizations is the idea that the modern world must be destroyed in order to be saved and cleansed. Incorrectly interpreting the texts of the main religious treatises, the leaders of these extremist groups, together with their numerous followers, staged terrorist acts all over the world [19].

In cases where relatives do not interfere in any way with the delusional behavior of patients and, on the contrary, support their delusional beliefs, one can speak of induced delusion - a delusional disorder that develops in a loved one or in a group of people having a close emotional connection with the delusional patient. In this situation, they fully share the patient's delusional beliefs and, accordingly, are not able to seek the necessary medical help, since they themselves need it, while there is no criticism of both the "inductor" state and their own state.

According to numerous researchers, religious delusions have a worse prognosis compared to delusional disorders that have a different, non-religious plot. The reason is the later terms of admission of patients for treatment due to the lack of criticism of their condition, the significant severity of psychopathological disorders due to the lack of timely and adequate therapy, deeper disorders of social functioning, as well as the need for repeated hospitalizations.

In patients with religious delusions, delusional constructions have a plot of pseudo-religious concepts, which, as a rule, contain a ridiculous and bizarre mixture of ideas from various religious systems. Mental illness contributes to alienation both from people who adhere to traditional values for a given society, and from one's own family. Such patients most often do not maintain contact with the religious community and come into confrontation with their spiritual fathers due to a negative attitude towards traditional religious institutions. Patients with religious delusions show a high degree of non-criticality, rigidity; and patients have features of a personality defect.

References:

1. Kuznetsova M.N. Religious fanaticism: concept, essence and ways of overcoming [Religioznyy fanatizm: ponyatiye, sushchnost' i puti preodoleniya]. Abstract diss. cand. Philosophical Sciences, Omsk - 2003.
2. Toktomatov O.K. Fanatism as a personal and social phenomenon [Fanatizm kak lichnostnyy i sotsial'nyy fenomen]. Abstract diss. cand. Philosophical Sciences, Ulan-Ude - 2018.
3. Sharipova E.M. Sociocultural specifics of religious fanaticism [Sotsiokul'turnaya spetsifika religioznogo fanatizma]. Abstract diss. cand. Sociological Sciences, Tyumen - 2014.
4. Yakhyaev M. Ya. Religious fanaticism as a socio-historical phenomenon [Religioznyy fanatizm kak sotsial'no-istoricheskiy fenomen]. Abstract doc. dis. Philosophical Sciences, Makhachkala - 2006.
5. Zalevsky G.V. Fanaticism as a problem of spiritual health of the individual and society [Fanatizm kak problema dukhovnogo zdorov'ya lichnosti i obshchestva]. Message 1. Psychohistorical characteristics / G.V. Zalevsky // Siberian psychological journal. 2007. No. 26. P. 67.
6. Soviet encyclopedic dictionary. Publishing house "Soviet Encyclopedia", M.: -1980. 1409 p.
7. Korolenko Ts.P., Dmitrieva N.V. Sociodynamic psychiatry - M .: Academic project, Yekaterinburg: "Business book", -2000. 464 p.
8. Akhmedova Kh. B. Fanaticism and the idea of revenge in persons with post-traumatic stress disorders // Social and Clinical Psychiatry, -2003. No. 2. pp. 24-32.
9. Gannushkin P.B. Manifestations of psychopathies: their statics, dynamics and systematic aspects, Nizhny Novgorod: Publishing house of NGMD, 1998. - 128 p.
10. C. Wernicke, Grundri? der Psychiatric. Leipzig 1900. S. 576.
11. Shostakovich B.V. Personality disorders (psychopathy) in forensic psychiatric practice. -M., 2006.-172 p.
12. Jaspers K. General psychopathology. Per. Akopyan L.O. Practice. 1997; 1-1056.
13. Pashkovsky V.E. Psychopathological aspects of religious-archaic delusions. Journal of Mental Health, 2010; 77-84.
14. Reeves R.R., Liberto V. Suicide Associated with the Antichrist Delusion. J Forensic Sci 2006. 51:411-412.
15. Silva, J.A., Leong, G.B., Weinstock, R. Violent behaviors associated with the antichrist delusion. ASTM International, 1997 №42.
16. Kaleda V.G., Popovich U.O., Romanenko N.V., Kopeiko G.I. Religious delusions in juvenile endogenous paroxysmal psychosis. Journal of Neurology and Psychiatry. S.S. Korsakov 2017; 117(12): 13-20.
17. Pashkovsky V.E. On the clinical significance of the religious-archaic delusional complex. Social and clinical psychiatry; 2012; 22(2):43-48.
18. Schwerkoske, J.P., Caplan, J.P., Benfond, D.M. Self-Mutilation and Biblical Delusions: A review. Psychosomatics 2012; 53:327-333.
19. Torres P. Who would destroy the world? Omnical agents and related phenomena. Agression and Violent behavior, 2018 39: 129-138.

Integration of mentally ill people into Church life: pastoral and medical support

Magai A.I. (Moscow), junior researcher of the group of special forms of mental pathology, Solokhina T.A., Doctor of Medical Sciences, head of the Department of organization of psychiatric services, of the Scientific Center of Mental Health

Introduction to the problem

The place of spiritually oriented therapy of endogenous mental patients is determined by the significance of the spiritual model in the diagnostics and treatment of mental disorders. Helping patients with a religious worldview, it is necessary to take into account the axio-semantic features of this category of patients, and the psychological and social context should be expanded to include the spiritual level. Therapeutic interventions should be differentiated at various levels - individual, family, social, and confessional, which contributes to the mobilisation of the religious resource. Researchers register a variety of positive functions of the religious worldview that contribute to the formation of stable remissions in the case of chronic mental pathology (Kopeiko G.I. et al., 2021; Verhagen P., 2020).

Help for people with mental illness

Scientific literature describes special methods of rehabilitation of patients, which include both individual and group forms of work. The most widely used among them are training in social skills, communication, self-esteem, confident behavior, independent living, training in the ability to cope with residual symptoms of psychosis, and family therapy. Adequate and timely application of these approaches ensures successful and effective psychosocial therapy and rehabilitation of mentally ill patients. The practice of such work indicates the need to use elements of rehabilitation soon after the patient exits the acute state, when he has the opportunity to more or less adequately perceive the surrounding reality.

The rehabilitation activities help the patient to feel that his is functioning autonomously and to take responsibility for his condition. Support from family, doctors and a multidisciplinary team of specialists in case of difficulties or exacerbations of the disease helps patients to form their own style of behavior, which can be as close as possible to a full healthy lifestyle. Compliance management strategies are of significant importance in this process, which include improving the safety and tolerability of drugs, psycho-education of patients and their families, adherence to clinical recommendations by the doctor (R. Gray et al., 2002; J. Kane et al, 2006).

Place of community-based care

The analysis of various rehabilitation programs and forms of providing psychiatric care today in various countries shows a wide spread of out-of-hospital approaches. The study of the world's best practices in psychosocial rehabilitation has led a number of experts to the conclusion that the use of group methods of psychosocial and cognitive rehabilitation contributes to the improvement of the system of social adaptation of patients and the further development of psychosocial rehabilitation. Of great importance are socially oriented types of psychiatric care, the formation of which was facilitated by evidence of the negative impact on patients with mental illness of prolonged stay in institutions (social deprivation), awareness of the need to include the various needs of patients and social support in the organization of psychiatric care, the desire of patients to choose and control the provided assistance to them if they live independently in the community. It should be noted that there are cases of abuse on the part of the medical personnel in institutional forms of assistance. Psychosocial therapy and rehabilitation implemented by public organizations as part of mental health activities are effective, as they have the opportunity to use the various resources of social communities at the stage of recovery and resocialization of people with mental disorders.

In the current economic and social conditions of life in Russia, the importance of socially oriented non-profit organizations and the public sector in the system of mental health care is growing. In a significant number of cases, assistance in such organizations is provided by volunteers with special professional education (doctors, psychologists, psychotherapists, social workers), or volunteers who have undergone special training. The training of volunteers, as a rule, is controlled by public organizations, however, the most appropriate is the training of volunteers in specialized psycho-educational programs based on evidence-based technologies at research clinical centers (Kopeiko G.I., Solokhina T.A. et al., 2020).

Comprehensive care for patients with mental disorders

Assistance to patients with endogenous mental illness should include biomedical therapy, psychosocial and sociotherapeutic rehabilitation. It is necessary to use psychoeducational technologies, creating a therapeutic community. The development of European and world research thought in the treatment of mentally ill patients with a religious worldview implies the availability of resources to solve the problem within the patient's personality, and therapeutic efforts should be aimed at changing the way the patient thinks and acts, and, ultimately, changing the whole way of life of a person. We can see this both in the widely used motivational counseling technique (Miller W.R., Rollnick S., 2012) and in the socioecological approach (Hudolin V., 2013), which is used in an outpatient family-oriented program to help people with behavioral disorders ( Zoricic Z., 2019). To develop a healthy family life skill, it is necessary to use systemic family psychotherapy (Nastasic P., 2017).

Influence of the spiritual component on life of a mentally ill person

The last decades have been marked by fundamental research in the field of religious psychiatry (Koenig H.G., 2012; Van Praag H. M., 2013), which noted the need to use a spiritual resource in working with mentally ill people with a religious worldview. Van Praag claims that religiosity is inherent in man, is an attribute of the human mind, rooted in our very being, genetically predetermined. The influence of the religious factor, which has a "protective" function in the case of substance abuse, determines the inverse correlation between the intensity of religious life and the intensity of substance abuse (Chamberlain & Hall, 2000; Koenig et al, 2001; Koenig, 2005). As a rule, behavior patterns generally accepted in a religious community and social support, which is specifically tuned within confession-oriented social networks, are aimed at forming a community that has the function of "motherly support". In some cases, belonging to a religious community contributes to the formation of moral values that are antagonistic to substance abuse.

Believers with severe chronic mental illness are more motivated for spiritual support, since religious beliefs make it possible to find meaning in life and find spiritual comfort (Mohr S., Brandt P. Y., Borras L. et al. 2006). A value-oriented, spiritually-oriented reorientation leads to the weakening of counterfeit attachments and allows one to immerse oneself in a relationship of love to God.

Scientific studies in people who practice traditional religions show a positive impact of spiritual and mystical experiences on indicators of overall mental health; this is evident in a better quality of interpersonal relationships, a lower level of anxiety, a more positive outlook on life in general (Newberg A. et al., 2002). Allport believes that helping a person in a situation of actual problems and existential quests may consist in the transition from an external religious orientation to a mature, comprehensive, internal religiosity (Allport G., 1967).

Principles of spiritually oriented therapy

Modern rehabilitation programs that holistically consider the nature of comorbid disorders can basically use the principles of a therapeutic community, a family systems approach, ideas about coping behavior or coping strategies, as well as spiritually-oriented models of helping patients. The study of religious coping strategies in religious patients made it possible to identify the most effective religious strategies that can be used in the rehabilitation of patients with endogenous mental disorders: 1) religious methods of preserving the basic values of life - the conservation of traditional values and meanings; 2) social support strategy through the religious community; 3) religious transformational coping methods; 4) a religious coping strategy for gaining an emotionally comfortable state that religious faith gives (consolation, comfort, forgiveness, reconciliation) (Verhagen P., 2019, Pargament, K.I. et al, 2014).

Spiritually oriented models, using religious coping based on the inner presence of the living Word and the Holy Spirit, use religious faith and practices to support religious ways of coping, as well as religious teachings to discuss irrational beliefs and to challenge negative knowledge, emphasize the importance of prayer and Christian content in therapy, Christian spiritual justifications for cognitive behavioral therapy procedures are applied (namely, to counter irrational thoughts). The religiously oriented forgiveness strategy is based on the REACH model, where R - remember the offense, E - sympathize with the offender, A - altruistic gift, C - choosing to forgive, H - holding forgiveness. Repentance becomes the result of a axiological transformation of the individual as a result of religious life based on religious faith and teaching (Worthington E. L. et al, 2016).

Rehabilitation programs using spiritually oriented therapy

In Russia, since 1992, a multidisciplinary program of outpatient care for endogenous mental patients with comorbid addictive disorders has been implemented, which includes spiritually-oriented therapy.

The program uses the resources of the state system of assistance to the mentally ill people on the basis of the Scientific Center of Mental Health, the methodology of family sobriety clubs according to the method of Vladimir Khudolin, the experience of pastoral counseling in the parishes of the Russian Orthodox Church (Baburin A.N., 2015). The combined use of biological therapy, psychosociotherapeutic procedures, and spiritually oriented therapy determines the effectiveness of helping comorbid patients with addictive disorders.

In 2020, on the basis of a successful rehabilitation program for mentally ill patients, implemented by the Regional Charitable Public Organization "Family and Mental Health", a set of spiritually oriented activities is being carried out, including group work in small therapeutic groups, group meetings with relatives of patients using spiritually oriented dialogue in accordance with the methodology of T.A. Florenskaya, discussing the issues of the spiritual life of patients from the perspective of the practice of religious life in the Church. Under the guidance of representatives of the professional community, a multidisciplinary model of care has been implemented that allows the use of a rich set of preventive and rehabilitation procedures (Solokhina T.A. et al., 2018).

The structure of the activities used in these programs makes it possible to formulate the basic principles and approaches for integrating mental patients with endogenous mental illness into the life of the church community in cooperation with the professional community.

The fundamental provisions of the comprehensive program include the following:

• in the rehabilitation assistance, an individual approach is important, ensured by the friendly work of a multidisciplinary team of specialists: the cooperation of a psychiatrist and a narcologist with a clinical psychologist, a priest, a social work specialist is necessary;
• the restoration of social status, associated with the return of professional and family well-being, is achieved through the participation of the patient and his family members in the work of the therapeutic community in an outpatient or outpatient setting;
• an integral part of rehabilitation is the voluntary involvement of patients and their family members in a religious Orthodox community, with the church sacraments inherent in life in such a community, participation in worship, conversations with a priest on spiritual issues, and explanation of the basics of Orthodox asceticism;
• in the process of rehabilitation, thanks to the mechanisms of group communication, even in the absence of all members of the patient's family, it is necessary to strive to update the family type of communication and establish social support in the context of the existing social network;
• in addition to outpatient group work, a wide range of social rehabilitation activities are used, such as pilgrimages, sports and creative events, outreach camps and meetings of rehabilitation participants within festivals and forums.

In organizational terms, the main coordinator of assistance to endogenous mentally ill patients based on a spiritually oriented approach in the system of community-oriented care is a socially oriented NGO - the Interregional Public Movement for Support of Family Sobriety Clubs. The advantage of this form of organization of rehabilitation activities is the active participation of volunteers who have undergone special training, the use of the resource of the confessional community, increased motivation for treatment and rehabilitation due to improved social functioning and environmental therapy, and constant interaction of patients with a multidisciplinary team of specialists.

The program includes therapy and rehabilitation modules. The therapy module is implemented in a governmental medical institution (Scientific Center of Mental Health), where diagnostics and selection of drug therapy are carried out, as well as complex medical treatment for the underlying mental illness. Outpatient meetings within the therapeutic community are held once a week for 2 hours. The meeting is moderated by a professional psychiatrist, as well as volunteers who have undergone special training. During participation in the rehabilitation module, patients choose different levels of involvement in the activities of the program. At the initial level, patients take part in rehabilitation groups for one year. At the advanced level of the program, starting from the second year, patients and their relatives are actively involved in various activities within the rehabilitation module.

Importance of a multidisciplinary team

The multidisciplinary principle underlying the work of the program involves the cooperation of a team of specialists at every level of work. In the therapeutic community, professional supervision is provided by a clinical psychologist, a psychiatrist or a volunteer trained in a rehabilitation program, who interacts with the spiritual father of the community, as well as with psychiatrists in a psychiatric institution, to achieve a successful and stable functioning of the community.

The specialist is a leader, or facilitator, who helps build community relationships with the parish and other organizations, including a mental health clinic. The coordinator organizes the internal life of the community, reminds its members of the need to follow the internal rules of the group, interact with the spiritual father and the church parish, seek help from medical specialists if necessary. The collaborative work of a team consisting of a priest, the head of the therapeutic community, a specialist doctor in a psychiatric institution, where the patient goes if necessary, ensures the success of the rehabilitation program implemented by a public organization in the church parish.

Particularly important is the participation of a priest in the activities of the therapeutic community, who, being the regular priest of the parish, also acts as the father-confessor of the community and helps in meeting the urgent spiritual needs of its members. The practical experience of church life, the priest's commitment to the life of the people under the care of the community, as well as the necessary knowledge in the field of psychiatry acquired by the priest in the process of preparing for church service, create the necessary conditions for fruitful and effective assistance to patients in the structure of the community-oriented part of rehabilitation activities.

Psychoeducational programs for volunteers

The continuity of the treatment process and rehabilitation activities is ensured by the special training of volunteers who implement their work within the organization. For these purposes, a psychoeducational program can be used, which was developed on the basis of the Scientific Center of Mental Health and is being implemented at the Volunteer School.

The School of Volunteers provides knowledge on topical issues of psychiatry and narcology, psychotherapy and family psychology, social pedagogy and spiritual asceticism, training sessions and master classes are held. Psychosocial training includes classes to develop social skills (communication), methods of coping with negative emotions and problem-solving behavior. Master classes in art therapy may include film therapy, handcraft, and other types of joint activities. These types of psychosocial interventions should complement psychoeducation, forming a system of knowledge, skills, and abilities of leaders of therapeutic groups, which, during practical work, can help program participants in preventing relapses of the disease, increasing stress resistance, compliance, and social competence.

The basic provisions of the therapeutic group work program are:

• the use of a complex four-part model (biopsychosocial-spiritual), according to which personality changes that occur during the progression of behavioral disorders due to mental illness can be corrected, and the course of diseases can have a favorable prognosis due to the formation of a stable and long-term remission;
• involvement in the rehabilitation process and synergetic work of a multidisciplinary team of specialists, which provides the most complete therapeutic effect and a combination of various types of assistance - drug treatment, psychosocial support, sociotherapeutic interventions and spiritually-oriented assistance;
• the induction of remission is the result of voluntary cooperation of specialists, the patient and his family members on the way to a conscious change in the entire personal structure and, as a result, lifestyle;
• Comprehensive rehabilitation is achieved in the therapeutic community, which operates in the structure of a non-profit organization with direct scientific and methodological support from specialized governmental medical institutions.

The importance of spiritually oriented therapy for the rehabilitation process can be considered from the standpoint of religious coping strategies:

1. Religious faith contributes to the acquisition of meaning and purpose in life; this is especially evident in the experiences of illness, suffering and death. In this case, religious faith helps to strengthen the personality and increases the ability to endure difficult life trials.
2. Religious experience positively influences the sense of control over the situation. A person experiencing life's difficulties and losing the ability to control the situation turns to God, who is able to take care of a person in any case. In the case of chronic illness, the feeling of being cared for is essential and has a beneficial effect on recovery or relief of suffering.
3. People with religious experiences have a feeling of well-being that results from the positive emotions of a believer, such as joy and gratitude. At the same time, a religious worldview helps to cope with negative feelings, such as anger, and also develops the ability to forgive offenses.
4. A religious organization forms in a person feelings of kinship and connection with common values and meanings. Due to the fact that members of a religious organization feel like-minded, relations develop in the community, close relationships are formed among the members of the community. The religious community becomes a source of additional resources for those in need of help.
5. The religious worldview is capable of transforming the value-semantic formations of the individual, due to which the views of a person are reoriented and a different direction in his actions is acquired.

During the implementation of the program, the life style of patients is changing based on a religious worldview, social support is provided among patients and their relatives, training of family members in a new repertoire of social skills, as well as mastering new experience of family interaction due to the mental illness of one of its members. Additional opportunities are being provided in crisis situations.

An important part of the participation in the rehabilitation program is attending group sessions within the therapeutic meetings, as well as being active in achieving therapy goals. In this case, restrictions on participation in the program are contraindications for group work, as well as non-compliance with the conditions of classes and meetings in the group.

References:

1. Kopeiko G. I., Borisova O. A., Kazmina O. Yu. Religious coping strategies in the rehabilitation of the mentally ill people [Religioznyye koping-strategii v reabilitatsii psikhicheski bol'nykh] // Psychiatry. - 2016. - no. 2. - S. 40-49. Kopeiko G. I., Borisova O. A., Kazmina O. Yu. Religious coping strategies in the rehabilitation of the mentally ill // Psychiatry. - 2016. - no. 2. - S. 40-49.
2. Family sobriety clubs as an approach to the rehabilitation of alcohol users and their co-dependent relatives [Semeynyye kluby trezvosti kak podkhod v reabilitatsii lits, zavisimykh ot upotrebleniya alkogolya i ikh sozavisimykh rodstvennikov] / A. N. Baburin, E. A. Sobornnikova, A. I. Magai, E. A. Kazmina // Combined pathology in psychiatry and narcology: problems of diagnostics, therapy, rehabilitation, resocialization: materials of the Third annual scientific and practical conference with international participation, Moscow, November 15-16, 2016 / Peoples' Friendship University of Russia. - Moscow: Peoples' Friendship University of Russia (RUDN), 2016. - P. 91-94.
3. Family sobriety clubs: modern technologies for the psychosocial rehabilitation of people with a religious worldview [Semeynyye kluby trezvosti: sovremennyye tekhnologii psikhosotsial'noy reabilitatsii lyudey s religioznym mirovozzreniyem] / G. I. Kopeiko, A. N. Baburin, E. A. Sobornnikova [and others]; Ed. G.I. Kopeiko, O.A. Borisova, A.N. Baburina, T.A. Solokhina, A.I. Magaya. - MAKS Press: MAKS Press LLC, 2020. - 88 p. - ISBN 978-5-317-06481-5.
4. Solokhina T. A. et al. Innovation and reform potential of the NGO "Family and Mental Health" // Psychiatry. - 2018. - V. 79. - No. 3. - S. 13-22.
5. Verhagen, P. Human flourishing: a promising construct at the interface of religion and psychiatry/ P. Verhagen // Mental health and religious mystical experience: Proceedings of the international conference, Moscow, November 07-08, 2019 / ed. editors: G. I. Kopeiko, O. A. Borisova. - St. Petersburg: LLC "Skifia-print", 2020. - S. 141-150.
6. Allport, Gordon W. Becoming. Basic considerations for a psychology of personality. - New-Haven-London, Yale Univ. press, 1967. - 106 p.
7. Andrew Newberg, M.D., Eugene D'Aquili, M.D., Ph.D. and Vince Rause. Why God Won't Go Away: Brain Sctence and the Biology of Belief. New York, Ballantine Books, 2002. P.129-130.
8. Brezovec E., Jezovita Zoricic J. Z. The role of social integration in the Clubs of Treated Alcoholics in Croatia //Interdisciplinary Description of Complex Systems: INDECS. - 2020. - V. 18. - №. 1. - С. 26-35.
9. Brezovec, E., & Jezovita Zoricic, J. Z. (2020). The role of social integration in the Clubs of Treated Alcoholics in Croatia. Interdisciplinary Description of Complex Systems: INDECS, 18(1), 26-35.
10. Chamberlain & Hall, 2000: pp. 189-197; Koenig et al, 2001: pp. 169-172; Koenig, 2005: pp. 109-112.
11. Gray, R., Wykes, T., & Gournay, K. (2002). From compliance to concordance: a review of the literature on interventions to enhance compliance with antipsychotic medication. Journal of Psychiatric and Mental Health Nursing, 9(3), 277-284.
12. Hudolin V. (ed.). Social psychiatry. - Springer Science & Business Media, 2013.
13. Miller W. R., Rollnick S. Motivational interviewing: Helping people change. - Guilford press, 2012.
14. Mohr S., Brandt P. Y., Borras L. et al. Toward an integration of religiousness and spirituality into the psychosocial dimension of schizophrenia // Am J Psychiatry. 2006; 163:1952-9).
15. Mutton C., Ross H. Where your treasure is, there will your heart be also [microform]: the Gospel, according to Matthew, Ottawa: National Library of Canada, 2001: 172-198
16. Nastasic, P. (2020). Development of the Family System-therapeutic Approach in the Addiction Treatment in Serbia. Interdisciplinary Description of Complex Systems: INDECS, 18(1), 1-14.
17. Van Os, J., Burns, T., Cavallaro, R., Leucht, S., Peuskens, J., Helldin, L., ... & Kane, J. M. (2006). Standardized remission criteria in schizophrenia. Acta Psychiatrica Scandinavica, 113(2), 91-95.
18. Van Praag, H. M. (2013). Religiosity, a personality trait to be reckoned within psychiatry. World Psychiatry, 12(1), 33.
19. Worthington, E. L. (2019). An update of the REACH Forgiveness model: Psychoeducation in groups, do-it-yourself formats, couple enrichment, religious congregations, and as an adjunct to psychotherapy (pp. 277-287). Routledge.

Spiritual meanings and values: post-non-classical understanding

Nemtsev A.V. (Tomsk) Ph.D., head of the Department of General Professional Disciplines of the Tomsk State Pedagogical College, associate professor of the Tomsk Theological Seminary

It is well known that since the advent of scientific psychology in 1879, it has influenced the development of psychiatry. Such luminaries of national and world psychiatry as V.M. Bekhterev, S.S. Korsakov, E. Kraepelin, physiologist I.P. Pavlov, at the beginning of their scientific career, studied at the psychological laboratory of W. Wundt in Leipzig, and then used the gained knowledge in their work [3].

At the end of the 19th century the field of mutual interest was dominated by elementary mental functions - memory, attention, but at the beginning of the 21st century the focus of interest shifted to meanings and values. Meanings and values, according to the apt expression of the greatest Russian psychologist A.N. Leontiev, is the "rocket science" of psychology.

This complex topic should be approached based on ideas about the development of psychology as a science. From the perspective of V.S. Stepin's philosophy of science concept [7], all sciences, both natural and humanitarian, have gone through two stages of their development - the stage of classical science and the stage of non-classical - and are now at the post-non-classical stage. The logic of the transition from one stage to another consists in the increasing inclusion of the subject of knowledge (the researcher) into the picture of reality. The understanding comes that the studied reality does not exist by itself, but depends on the very fact of the study, research methods and even the values of the researcher.

The development of psychology from the classical stage to the post-non-classical was traced by the Russian psychologist Klochko V.E. [2, 4] in his works. His own scientific path began with the study of cognition in the "school" of O.K. Tikhomirov, and ended with the postulation that the spiritual component of the psyche is the main one in the construction of a person's life world. Based on the approach of V.E. Klochko, we will trace how the development of scientific thinking affects the understanding of the psyche in general and the understanding of the religious psyche in particular.

At the classical stage, reflection was the leading category. The mind reflects the objective reality. As in a mirror, everything that is in reality gets into the psyche. Philosopher K. Popper proposed the following image: consciousness (and psyche) is a "tub" into which all the facts of the external world are poured. It looks as if consciousness and psyche are "passive". The classical stage is characterized by linear causality - a cause produces an effect, and no other way.

The classical stage in the development of psychology poses the following questions to the psychology of religion: if the psyche reflects reality, then what kind of reality do religious experiences reflect? If every experience has its causes, what is the cause of the religious experience? And this, strange as it may seem, begs the question: is there a God? Because, if there is a God, then religious experiences reflect the reality of divine being. And if there is no God, then aren't religious experiences painful manifestations of the psyche, along with delusions and hallucinations, the subject of which are also non-existent or distorted objects and connections?

Thus, at the classical stage, religion itself can be called into question: is religion not a disease? S. Freud, A. Beck, A. Ellis believed that religion itself, even in the person of its best representatives, is morbid, is a form of neurosis or a consequence of irrational beliefs [9, 11].

At the non-classical stage, the view of the psyche changes through the rejection of the category of "reflection". L.S. Vygotsky, who is called the "Mozart of psychology", says directly that the main role of the psyche is not to reflect, but "subjectively distort reality in favor of the organism" [1, p.347]. His image [ibid.] - "if an eye could see everything, it would be precisely because of this that it could not see anything" - indicates the selectivity of the psyche and consciousness in favor of man. Even a healthy person can see the limitations of his perception of reality when some facts are revealed to him that he never noticed because he was not ready for this, or his psyche "kept" him from these facts. The projective theory of consciousness, in Popper's terminology, just indicates that the attentional beam or activity beam is directed to highlight a certain part of reality.

Instead of objective reality, the concept of the "lifeworld" appears. Linear causality is replaced by a systemic one (including in psychiatry and narcology): a cause can be an effect, and an effect can be a cause [6]. Diathesis-stress model, biopsychosocial model and biopsychosocial-spiritual model are being developed in science. These models are designed to resolve the question that periodically appears in the practice of psychologists, psychiatrists, narcologists: did the event affect the person, or is the person inclined to perceive only such events?

At this stage, the psychology of religion does not raise the question: Do religious experiences reflect objective reality? Religiosity is perceived as one of the properties of a person. There is another question: is the religiosity of a particular person healthy or pathological? An example is the identification by G. Allport of internal and external religiosity [5]. Studies have shown that internally accepted religiosity is associated with greater adaptability, psychological health, understanding of the other, while external religiosity, which is the result of habit, cultural tradition, is associated with greater aggressiveness, stereotypes and prejudices [10].

We can also mention V. Frankl, who said that the presence of a spiritual (religious) meaning can integrate a person's personality and improve his psyche. While the lack of religious meaning or unrevealed religiosity can be one of the causes of noogenic neurosis, characterized by the lack of meaning in life [8].

At the post-non-classical stage, psychology comes to an understanding that the psyche creates reality: from objective reality, it forms the lifeworld of a person. At this stage, it is almost impossible to do without the concept of "spirit", which is perceived as the pinnacle of the psyche. The spirit generates the reality of human existence by translating the meanings and relationships of a person into the surrounding reality. It is the spirit that ensures the creation of the "world for man", his life world, out of a neutral reality indifferent to a person [4].

There are many life worlds. They are subject to interpretation. This leads the psychology of religion to the question: what is the meaning of religious life for a particular person? This perspective, on the one hand, sets the field for multiple interpretations of religious life, but this allows a specialist who provides assistance to a person with mental disorders to ask the following question: which of the meanings of religious life contributes most to the health of a particular person?

As an illustration of the practical application of the post-non-classical approach, one can cite a clinical case related to the search for the most healthy meaning of religious experiences. A., a woman 39 years old, came to us privately for psychological help. The main complaints were about the threatening "voices of demons" that come from inside and sought to drive her crazy. The voices that tormented her for 9 years were predominantly male, came from inside her head, but sometimes were projected outside. 2 years ago, she disclosed them to a psychiatrist because they became too strong, interfered with work, and communication with loved ones. She was diagnosed with F25 schizoaffective disorder, which led to her dismissal from her job (she worked as a kindergarten teacher), increased tension in family relationships. Her husband forbade her to go to church, because, according to her, the voices intensified after attending the church. Her 16-year-old son was also extremely worried about this situation.

The client interpreted these voices as the voices of demon spirits that came because of a broken promise to God. She asked God for help in the birth of her son, for which she promised to raise him in the faith (not being, by the way, a practicing believer at that time). Having failed to fulfill her promise, she came to the church next time only 7 years later, and at that moment she felt "diabolizing". At the peak of her illness two years ago, the voices threatened to drive her insane, which was to lead her to being completely in their power - the power of demons - in this life, and going to hell in the future. The latter worried the client greatly, since the fear of torment after death was the main reason for attending the church.

We did not have the task of clarifying the nature of the voices, specifying the diagnosis, since psychiatric care was already provided, and the woman continued to receive it in the form of outpatient therapy, which had a certain positive effect - no exacerbations for 2 years. Therefore, we divided the religiosity of this woman into two components: pathological experiences ("voices of demon spirits"), which could not be corrected by psychological methods and which were the "target" of pharmacological therapy, and a personal attitude (values) to pathological religious experiences and religious life in general. In particular, we questioned the woman's belief that the logical connection is correct: "voices" - "madness" - "state without God" - "going to hell". We gave examples of a gentler attitude of the Church towards people with mental disorders: for example, the funeral service for people who have committed suicide at the peak of a mental disorder, the more merciful attitude of saints towards people with impaired mental organization. We have taken the liberty of suggesting that God may also be more merciful to people with mental disorders. That is, we examined how much the belief in the causal relationship "madness" - "hell" corresponds to the position of Christianity, trying to show that this relation is not correct.

The second and main "target" of the value based analysis was the woman's conviction that her pathological religious experiences are the essence of religious life. We asked her how the negative consequences of these experiences (dismissal from work, increased tensions in the family) correlate with the goal of the Christian life? Although reflection on this issue did not lead to an immediate switch to true religious meanings, which are always associated with other people (for example, relatives, colleagues), - this would have been a miracle, but we questioned the significance of pathological experiences that destroy the natural way of life. After the counseling, the woman felt relieved in her condition. In the follow-up - six months after the first meeting - she returned to social life (employment in a new job of desk-work type, appropriate for her mental resources), greater importance of relationships with relatives in the structure of the client's feelings, etc.

The next - promising - stage of counseling may be the acquisition of true religiosity. Religiosity not as removing the fear of hell, but religiosity as a search for meaning in the life that God gave her (in relations with people, in the realization of her own talents).

Summarising, we can note that the complication of scientific thinking (from classical to post-non-classical) leads to a simplification of the questions posed by the psychology of religion - from the question "Is there a God?" to the question "What is the meaning of religious life for a particular person?"

This relieves a specialist providing assistance in the field of mental health from ideological discussions that are not characteristic of his profession, allows him to understand the semantic sphere of a person's life world and, together with him, seek religious meaning that will help restore and strengthen his health.

References:

1. Vygotsky L.S. The Historical Meaning of The Crisis in Psychology [Istoricheskiy smysl psikhologicheskogo krizisa] // Collected works: in 6 volumes / L.S. Vygotsky; ed. A.R. Luria, M.G. Yaroshevsky. - M.: Pedagogy, 1982. - V. 1 .: Questions of the theory and history of psychology. - S. 291-436.
2. Galazhinsky E.V., Klochko V.E. The category of "attitude" in psychology in the light of the paradigm dynamics of science [Kategoriya "otnosheniye" v psikhologii v svete paradigmal'noy dinamiki nauki] // World of Psychology. - 2011. - V.68, No. 4. - P.14-31.
3. Zeigarnik B.V. Pathopsychology / B.V. Zeigarnik. - M.: Publishing House of Moscow. Univ., 1976. - 240 p.
4. Klochko V.E. The problem of consciousness in psychology: a post-non-classical perspective [Problema soznaniya v psikhologii: postneklassicheskiy rakurs] // Vest. Moscow University. Ser. 14. Psychology. - 2013. - No. 4. - P.20-35.
5. Allport G. Personality in psychology [Lichnost' v psikhologii]/ G. Allport. SPb., M.: "Juventa", "KSP +", 1998. - 345 p.
6. Semichov S.B. System approach and socio-biological problem in psychiatry [Sistemnyy podkhod i sotsial'no-biologicheskaya problema v psikhiatrii] // Problems of system approach in psychiatry. Riga, 1977. - S. 39-43.
7. Stepin V.S. Theoretical knowledge: structure, historical evolution [Teoreticheskoye znaniye: struktura, istoricheskaya evolyutsiya] / V.S. Stepin. M.: Progress-Tradition, 2000. - 743 p.
8. Frankl V.E. Fundations of logotherapy. Psychotherapy and religion / V.E. Frankl. - St. Petersburg: Speech, 2000. - 286 p.
9. Freud S. The future of an illusion // Freud Z. Psychoanalysis. Religion. Culture. M.: Renaissance, 1991. - S. 17-64.
10. Hunsberger B. Religion, Meaning, and Prejudice / B. Hunsberger, L.M. Jackson // Journal of Social Issues. - 2005. - Vol. 61. - № 4. - P. 807-826.
11. Lukoff D. DSM-IV religious and spiritual problems [Electronic resource] / D. Lukoff. - URL: http://www.spiritualcompetency.com/dsm4/dsmrsproblem.pdf (accessed 29.10.2021).

Pre-manifest stage in the first psychotic seizures with religious content in adolescence

Popovich U.O. (Moscow), Scientific Center of Mental Health"

Relevance. The early stages of schizophrenia are crucial for further development and outcomes of the disease [1, 2]. This is especially true for the pre-manifest stages of the first psychotic seizures with religious delusions, primarily due to the lack of a clear differentiation between normal and pathological religiosity [3, 4] and, as a result, a relatively longer period of an untreated psychotic state. Patients with religious delusions later come under the supervision of psychiatrists, these patients have more impaired social adaptation, there is a high frequency of rehospitalizations; due to late presentation and severe condition, more drugs are prescribed, the prognosis and outcomes of such conditions are naturally worse [5, 6]. Existing works on pre-manifest stages in paroxysmal psychosis with religious delusions show conflicting results: some researchers argue that religiosity in itself is not a pathoplastic factor in the formation of religious delusions [7, 8, 9], without denying, however, the fact that religiosity often gives specific features to hysterical, depressive states [10]; according to others, religiosity in premorbidity corresponds to a higher frequency of the emergence of a religious delusional plot in the structure of a psychotic attack [11, 12].

In modern literature, the criteria for a normal, healthy religious faith have become generally accepted: 1) focusing on God; 2) reverence and love; 3) respect for one's own personality and for the beliefs of others; 4) focus on good interpersonal relationships; 5) awareness of one's imperfection. Mentally healthy people maintain social adaptation, they do not impose their religious beliefs on those who do not agree with their point of view, they continue to take care of their loved ones, not focusing only on their faith, they are tolerant towards other religions and confessions. At the same time, there are concepts of external and internal religiosity. Manifestations of external religiosity are determined by habit, tradition, social requirements, and in some cases the need to achieve personal gain using religious faith. Internal religiosity is characterized by a desire not demonstrated to other people to build one's own live in accordance with religious commandments, the desire for spiritual and moral perfection.

Pathological religiosity is associated with mental disorders and is characterized by a distortion of traditional religious ideas, the supersedure of the desire for a full spiritual life, exaggerated performance of religious rituals. At the same time, both the religious behavior and the way of life of patients naturally change.

The aim of the research is to identify the conditions for the formation of religious delusions in adolescence, to analyze the characteristics of premorbid in such conditions, to analyze the correlations between religiosity at the pre-manifest stage and the subsequent manifest psychotic attack with religious delusions of various content.

Materials and Methods: The research included 51 adolescent male patients (16-25 years old). All patients were hospitalized with a manifest psychotic attack with delusions of religious content (F20, F25 according to ICD-10) to the Department of Youth Psychiatry in 2015-2020. (Director - Prof. V.G. Kaleda) Scientific Center of Mental Health (Director - Prof. T.P. Klyushnik).

The criteria for inclusion of patients into the research were the formation of religious delusions in the structure of a psychotic attack in adolescence (16-25 years), the onset of the disease in adolescence.

Exclusion criteria: a concomitant mental, neurological or somatic pathology.

The research used clinical psychopathological, psychometric (DUREL, PAS) and statistical methods. During statistical processing, Pearson's ?2 test was used to test statistical hypotheses about the compliance rate between nominal or scoring (ordinal) indicators in the studied groups. The significance of the statistical relationship between the parameters (provided that the distribution of the studied quantitative variable was normal and the variances were equal in the compared general populations) was assessed using the Student's t-test (significance level p<0.05 was considered significant). Calculations were performed using the statistical software package Statistica 8.0 for Windows (StatSoft, USA).

Special attention was given to the patients' religiosity at the pre-manifest stage - upbringing in a religious family, patients' attitude towards it at different age periods, specifics of the emergence of religiosity in the absence of religious formation in childhood, as well as its dynamics in connection with the development of psychopathological processes.

For the psychometric assessment of premorbid, the PAS (premorbid functioning) scale was used [13, 14], which evaluates functioning in terms of social activity, interpersonal relationships, educational and work adaptation in childhood, early and late adolescence, which allows analyzing the level of functioning in premorbid in general . A coefficient below 0.23 corresponds to a conditional social norm. Results in the range from 0.23 to 0.53 are considered borderline. A score above 0.53 is unfavorable, indicating a low level of social functioning.

The religiosity of premorbid patients was assessed using the Duke University Religious Index (DUREL) [15]. This questionnaire includes 5 items and 3 subscales: 1) public religious activity (frequency of attending a church, a religious community); 2) personal religious activity (prayer, reading of the Bible); 3) evaluation of inner religiosity, which is the subject of three questions. Each item is estimated at 5-6 points, the total score is 5-27 and is taken as an assessment of the individual's degree of religiosity.

Research results: in the course of the research, the pre-manifest stages in 51 patients were studied: 11 patients with delusions of sinfulness (type I attacks), 15 with delusions of demonic possession (type II attacks), 20 with antagonistic and messianic delusions (type III), 5 - with oneiroid of religious content (type IV).

Approximately one third of patients (15 prs., 29.4%) were brought up in religious families. They considered themselves believers from childhood, their religiosity was regarded as meeting the criteria of a normal, healthy faith [16, 17], religion shaped their way of life and value system (21-25 points according to DUREL). At the initial stage, in a third of them (33%), religiosity acquired psychopathological features: religious experience increasingly deviated from traditional religious norms, religiosity became ambivalent, fanatical, rigid, and inadequate to current life circumstances [18, 19].

Of the four types of seizures, the greatest number of points on the DUREL scale was scored by patients of group IV, who subsequently suffered a manifest psychotic seizure with a oneiroid of religious content; they also had the highest score on the internal religiosity subscale, however, it should be noted that in 80% of cases their religiosity did not become overvalued at the initial stage and was not pathological: religious delusions arose only at the height of the psychotic state.

The most patients (23 prs., 45.1%), although they called themselves believers, however, did not have religious upbringing, did not follow religious traditions (11-15 points according to DUREL, the "formal religiosity" group), but here, too, patients with IV type of seizures prevailed by the number of points.

13 patients (25.5%) before the onset of the disease described themselves as atheists and had the lowest possible score (score 5 according to DUREL).

Thus, it was found that for the vast majority of patients (70.6%), traditional religiosity with participation in church life was not characteristic before the onset of the disease and started at the initial stage, including in the form of a syndrome of supervaluable formations - metaphysical intoxication; at the same time, the most common was the affective type (43.1%), when a special religious worldview with a pronounced affect developed rather quickly, while the emerged beliefs contradicted the previous ones, and the state itself was "ecstatic" and, in fact, subpsychotic [20]. The patients said that they "understood everything" about their lives and the lives of their relatives, "learned the Truth through God", interpreted religious literature in their own way, tried to involve relatives in the sphere of religious interests, regardless of their attitude to this issue. In terms of incidence, the classic type was in second place (17.6%).

In most patients, the emergence of an overvalued interest in religion was preceded by affective disorders, more often related to the depressive pole.

In 15.7% of cases (8 prs.), the patients had endogenous psychoses in parents as hereditary background, and 3 of them had religion as the theme for past psychotic episodes. In 37.3% of patients, one of the parents had severe pathocharacterological features, impulse disorders in form of alcoholism, depressive episodes of mild and moderate degree, which were overcome without specialized assistance. The greatest hereditary burden for both endogenous psychotic states and pathocharacterological features was observed during seizures with delusions of demonic possession (66.7%).

As for ontogenesis, normal ontogenesis, which implies no mental and physical development lagging behind the age norm, was observed in most cases (20 patients, 41.2%). It was found that in the studied cohort of patients, accelerated ontogenesis was observed in almost a third of patients (27.4%) and most often occurred during seizures with antagonistic and messianic delirium, as well as in oneiroid states with religious content.

In the studied group of patients with all four types of seizures, the most common were pathological and exaggerated types of puberty (58.9%), when adolescents demonstrated addictive behavior, including a non-chemical type of addiction in the form of a hobby for computer and online games, they were characterized by educational maladjustment. Some patients from the groups with delusions of demonic possession and antagonistic delusions were characterized by a demonstrative rejection of the traditional religious way of life of the family, they initiated conflicts on this basis, defiantly refused to attend church, called themselves "militant atheists".

The normal pubertal crisis was characterized by opposition to relatives, the desire for self-assertion, but these manifestations were not pathological, social and educational adaptation was preserved, although academic performance could decrease somewhat, but remained satisfactory (29.4% of cases).

With regard to the premorbid personality structure, schizoid (56.9%) prevailed in our study, psychasthenic (23.5%) were in second place in terms of frequency of occurrence, which is confirmed by the classic studies of E. Krechmer (1930) [21] and P.B.Gannushkin (1907) [22].

As for social and labor adaptation, the most patients received higher (45.1%) or specialized secondary (27.4%) education by the time of manifestation. In a relatively small number of patients (15.7%) at the pre-manifest stage, there was an increase in negative symptoms, they either did not study and did not work, or were engaged in low-skilled work, despite of their special education.

It was found that exogenous provocations play a significant role in the occurrence of manifest seizures. Moreover, psychogenia (35.5%), after which reactive affective disorders arose, apparently contributing to the formation of "religious quests", were more common than the use of psychoactive substances (25.5%) and somatogenia (5.9%).

When assessing premorbid functioning on the PAS scale, it was found that in 51% of the studied group, premorbid functioning was consistently satisfactory, however, in these patients it also tended to decrease as it approached the manifest state.

The condition of patients with a regressive type of functioning (29.4%) worsened more clearly by the beginning of adolescence. In all age periods, they were characterized by low initiative, limited circle of contacts. A small number of patients (19.6%) had consistently unsatisfactory premorbid functioning, which revealed itself in lack of sociability, passivity and formalism in communication with peers. The worst indicators here were demonstrated by patients belonging to type II seizures (delusions of demonic possession).

In juvenile endogenous paroxysmal psychoses with delusions of sinfulness (type I), often even in childhood, patients were characterized by ideas of self-blame with the theme of sinfulness and depressive affective episodes that resolved on their own. So, one of the patients, who suffered the death of several relatives at the age of 7-8, claimed that it was his fault and responsibility, a "punishment" for bad behavior and poor school performance. Another patient, brought up in a religious family, at the age of 5 during Great Lent left only boiled potatoes and bread in the diet, categorically refused other food, could not explain the reasons for such selectivity in food, during the entire period of fasting he looked sad, thoughtful, did not play with other children. The beginning of the initial stage was, on average, at the age of 16-18 years, most often its affective type was encountered. In more than half of the cases, psychogenies acted as exogenous provocations, after which the mood steadily declined, and ideas of guilt before relatives and God developed. Refusal to eat, excessively strict observance of fasts were characteristic. Religious canons were exaggerated, their own, more restrictive, rules were developed ("so as not to fall into the sin of gluttony"), there was a significant (on average 15-20 kg) weight loss. Almost all free time was spent reading religious literature, at the price of studying, while quotes from the Bible, the Gospels were taken literally: so, since "Sunday is the Lord's day," they could sit or lie idle throughout the day. They refused to shave despite the permission of the spiritual father. They skipped work or school if a church holiday fell on a weekday. The bewilderment of the authorities and the dissatisfaction of relatives in this regard were ignored. Closer to the manifestation of an attack, they experienced confusion, indecision (for example, they could not choose a priority exam for preparation during the exam session, which led to a lack of preparation in principle). Patients sought help in the church, lit candles for the highest grade, prayed "to pass the exam." Ideational obsessional disorders of religious content with weird ideas could also arise (for example, thoughts that the rite of Baptism in childhood was performed incorrectly for some reason), which forced them to make numerous pilgrimage trips in search of a clergyman who would perform the rite "correctly" , "as it should be." The psychotic state usually started subacutely.

Most patients with type II seizures (delusions of demonic possession) were raised in non-religious families. Hereditary burden here was severe: the parents of almost 70% of patients had endogenous psychotic episodes or severe pathological characteristics, which created unfavorable social living conditions. In childhood, neurotic episodes in the form of obsessive-phobic disorders often occurred, various fears were characteristic.

Often in late adolescence - early adulthood, patients had attenuated psychotic symptoms: fragmentary auditory true hallucinations, "images", an episodic feeling of "openness of thoughts", a feeling of "impact". There were no more psychotic episodes before the manifest attack.

By early adulthood (16-17 years old), patients gradually developed an interest in sects, fortune-tellers, and yoga with meditation. Overvalued religiosity arose here somewhat later than in other groups: by the age of 19-21, often under the influence of friends or colleagues who "brought them to the Church" and recommended this or that thematic literature. The initial stages were most often neurosis-like or paranoid: there was an increased social withdrawal, panic attacks with fear of death, senestalgia, which during an attack expanded and reached the level of senestopathies and were interpreted as "demonic influence". Suspicion grew and intensified: patients believed that people at school or at work was unfriendly to them, they were "bedeviled", so they prayed for healing from this and asked the priest about it. At the same time, in parallel, they often continued to visit paranormalists, fortune-tellers in order to "remove the curse" and bad sensations, which as they thought, were associated with its effect.Gradually increasing cognitive impairment contributed to a decrease in the patients' professional and educational level. In the Church and at home during prayers blasphemous thoughts of religious content appeared. Such thoughts were also regarded as the result of a "curse", "evil eye".

Often there was a desire to retire to a monastery, and the reasons indicated were either a desire to end conflict relations with relatives, to stop living together with them, or "gratitude" for the fact that God "helped" resolve a difficult life situation. They did not want to be novices, insisted on being tonsured as monks as soon as possible, and refused to thoughtfully study the rules of monastic life before taking the vows. Also, patients actively planned to enter the seminary without a clear understanding of the responsibilities and specifics of education.

The most numerous group consisted of patients who had an acute psychotic attack with antagonistic, messianic delusions (type III attacks). Adolescence was characterized by cyclothymoid-like mood swings from short-term hypomanic (2-3 days) to subdepressive (2-3 weeks). Some patients, starting from adolescence, occasionally showed interest in esoteric practices, mystical teachings, however, the interest was mostly superficial. Patients explained episodic use of PAS by the possibility of "opening a channel of communication with God, the other world." After that, they said that in a state of drug intoxication they received "answers to important questions", joined the "world's wisdom". Gradually (at the age of 17-19) interest in religious and mystical problems grew, an overvalued interest in religion was formed, metaphysical intoxication naturally proceeded along an affective type. Patients "transformed" the room in accordance with their concept of the room in which a believer lives: they painted the walls in monochrome soft colors, replaced almost all literature with religious books, hung a lot of icons, and built self-made altars. Patients of this group, in comparison with others, most often tried to influence their relatives, to "instill" in them "the only correct religiosity". They stubbornly insisted that their loved ones shall follow the rules established by them, pray correctly and together with them, and strictly observe fasts. Any comments, indications of misconceptions on the part of the spiritual father were perceived painfully or negatively, often after that the patients changed the church parish. Despite this state, labor adaptedness did not decrease for a long time. There were also "secret escapes" to monasteries in this group, breaks in successful relationships with partners, relatives, when in the morning the patient, as usual, went to work or study, and then disappeared without a trace and was found a few months later as a novice in one of the monasteries, or relatives accidentally found out that the son had already been tonsured a monk. At the same time, in these cases, the patients neglected the feelings of loved ones, did not think about them, and explained that "God is more important than anything in life."

In type IV seizures at the pre-manifest stage, the most distinct affective disorders of both poles were registered. In childhood, patients were characterized by sensitivity, daydreaming, and a desire for creativity. In this group, patients before the onset of the disease were very religious and were brought up in religious families. As a rule, at the age of 16-17, patients for the first time had slight affective disorders in the form of short-term cyclothymoid-like seasonal mood swings. Gradually, affective disorders became more clear and deep: both hypomanic states with increased sociability, ease of establishing contacts and activity unusual for patients, and depressive states replacing them were registered. Hypomanic phases were generally characterized by increased intellectual and creative productivity, allowing the patient to maintain good social and labor adaptation. However, development of psychotic states here in 60% of cases was associated precisely with manic affect: productive hypomania with hyperactivity, creativity, a desire to expand the scope of activity, slowly, as it approached the onset of a psychotic attack, acquired the features of a manic state with dysphoria, agitation. Pathological religiosity in the vast majority of cases was formed directly in the structure of a psychotic attack, avoiding the stage of overvalued idea disorders. Psychosis, as a rule, manifested itself acutely.

Conclusion. The research found that the majority of patients from the cohort were not traditionally religious people before the onset of the first symptoms of a mental illness, and the religiosity itself, which arose at the initial stage of the schizophrenic process, differed from the traditional one in many respects towards a pathological form. If patients were brought up in religious families, then religiosity only in one of three cases became pathological at the initial stage. In the vast majority of observations, religious themes of the delusional level arose in them at the height of an acute psychotic state and were not involved into the formation of the plot of delusional disorders at the initial stage of the disease. Of greater importance in the formation of psychotic seizures with religious content are hereditary burden, premorbid personality structure, high scores on the PAS scale. In order to confirm the obtained data, it is planned to continue the study of pre-manifest stages in a larger sample of patients.

References

1. Malla A., Shah J., Lal S. Advances and challenges in early intervention in psychosis. World Psychiatry. 2017 Oct; 16(3):274-275. https://doi.org/10.1002/wps.20453.
2. Lewandowski K.E., Cohen T.R., Ongur D. Cognitive and clinical predictors of community functioning across the psychoses. Psych J. 2020 Apr; 9(2):163-173. https://doi.org/10.1002/pchj.356.
3. Vojnovskaya O.A. Methodological problems of differentiation of normal and pathological religiosity [Metodologicheskiye problemy differentsiatsii normal'noy i patologicheskoy religioznosti.]// Tavricheskij zhurnal psihiatrii. 2010; 14: 1(50): 78-83. (In Russ.).
4. Voskresenskij B.A, Radionov D.S. Religiousness and mental disorders - differentiation of norm and pathology [Religioznost' i psikhicheskiye rasstroystva - razgranicheniye normy i patologii]. Nevrologicheskij vestnik. 2018; 50 (4): 67-69. (In Russ.). https://doi.org/10.17816/nb14150.
5. Bhavsar V., Bhugra D. Religious delusions: finding meanings in psychosis. Psychopathology. 2008; 41(3):165-172. https://doi.org/10.1159/000115954.
6. Robles-Garcia R., Lopez-Luna S., Paez F., Escamilla R., Camarena B., Fresan A. History of religious delusions and psychosocial functioning among Mexican patients with paranoid schizophrenia. J Relig Health. 2014 Dec; 53(6):1622-33. https://doi.org/ 10.1007/s10943-013-9727-9.
7. Pfeifer S., Waelty U. Psychopathology and religious commitment--a controlled study. Psychopathology. 1995; 28(2):70-77. https://doi.org/10.1159/000284903.
8. Getz G.E., Fleck D.E., Strakowski S.M. Frequency and severity of religious delusions in Christian patients with psychosis. Psychiatry Res. 2001; 103(1):87-91. https://doi.org/10.1016/s0165-1781(01)00262-1.
9. Rudaleviciene P., Stompe T., Narbekovas A., Raskauskiene N., Bunevicius R. Are religious delusions related to religiosity in schizophrenia? Medicina (Kaunas). 2008; 44(7):529-535. https://doi.org/10.3390/medicina44070068.
10. Meissner W.W. The phenomenology of religious psychopathology. Bull. Menninger Clin. 1991; 55 (3): 281-298.
11. Peters E., Day S., McKenna J., Orbach G. Delusional ideation in religious and psychotic populations. Br J Clin Psychol. 1999; 38(1):83-96. https://doi.org/10.1348/014466599162683.
12. Siddle R., Haddock G., Tarrier N., Faragher E.B. Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2002; 37(3):130-138. doi:10.1007/s001270200005.
13. Cannon-Spoor H.E, Potkin S.G., Wyatt R.J. Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull. 1982; 8(3):470-84. https://doi.org/ 10.1093/schbul/8.3.470.
14. Addington J., van Mastrigt S., Addington D. Patterns of premorbid functioning in first-episode psychosis: initial presentation. Schizophr Res. 2003 Jul 1; 62(1-2):23-30. https://doi.org/ 10.1016/s0920-9964(02)00408-5.
15. Koenig H.G., Bussing A. The Duke University Religion Index (DUREL): A Five-Item Measure for Use in Epidemological Studies.Religions. 2010; 1(1):78-85. https://doi.org/10.3390/rel1010078.
16. Arterburn S., Felton J. Toxic Faith: experiencing healing from painful spiritual abuse. Water Brook Press. 2001: 269 p. ISBN 0877888256.
17. Kopeiko G.I., Samsonov I.S. Religious faith and religious delusions. [Religioznaya vera i religioznyy bred] // Proceedings of the international conference (Moscow, November 7-8, 2019). Mental health and religious experience [Psikhicheskoye zdorov'ye i religioznyy opyt] SPb.: Scythia-print. 2020: 123-132. ISBN 978-5-98620-436-9 (In Russ.).
18. Pargament K.I. The Psychology of Religion and Coping: Theory, Research, Practice. New York, Guilford. 1997: 548 p.
19. Sanderson S., Vandenberg B., Paese P. Authentic religious experience or insanity? J Clin Psychol. 1999 May; 55(5):607-16. https://doi.org/10.1002/(sici)1097-4679 (199905)55:5<607::aid-jclp8>3.0.co;2-8.
20. Dubnickij L.B. Clinical typology of the state of "metaphysical intoxication" in adolescence [Klinicheskaya tipologiya sostoyaniy "metafizicheskoy intoksikatsii" v yunosheskom vozraste] // Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 1977; 3: 432-439 (In Russ.).
21. Krechmer E. Body structure and character [Stroyeniye tela i kharakter]. Moscow-Petrograd, State Publishing House. 1930: 283 p.
22. Gannushkin P.B. Psychasthenic character (to the doctrine of pathological characters) [Psikhastenicheskiy kharakter (k ucheniyu o patologicheskikh kharakterakh)] // Modern psychiatry. 1907, December: 433-441 (In Russ.).