Pastoral Psychiatry

Among all the medical specializations one exists, which can be fully linked to priesthood. Its name—psychiatry. Probably it will not be an exaggeration to say, that many priests during the years of their service met up with situations, at the confessional or during other soul-caring, when their spiritual children revealed some emotional or thinking disorder in their behavior. One can find cases of pastoral care for the mentally ill that are in remission. And finally, there is a wide group of borderline (between health and illness) of mental/neurological breaches, the extensiveness of which is sufficiently great.

States of the soul exist, as pointed out by Archimandrite Cyprian (Orthodox Pastoral Service, Paris, 1957) which are difficult to determine by the categories of moral theology and which do not enter into the understanding of good and evil. These states belong not to the ascetic order, but to the psychopathological, and develop from the body, from nature.

In the past, students of the Theological Academy studied pastoral psychiatry. At the present time this subject is not studied for organizational reasons related to its teaching. But this question is being animatedly discussed and, one hopes, will be decided for the better.

Pastoral psychiatry strives to delve into those spheres of spiritual life, which are not qualified as sin, but are "akin" to it, or "nudge" the sick person to sin. For example, anxiety (if this is a symptom) is not a sin, but can lead to severe consequences of the sufferer. As a result of mental illness, the soul of the person becomes, in a way, covered with a "veil of fog," which must dispersed. Such a soul, as correctly noted by one priest, loses its way to the Lord. The will of person is weakened. Pastoral recommendations are premature, because they cannot be accepted by the sick person equally. Healing such illness purely through ascetic means are not justified. The help of a psychiatrist would be appropriate. It is good if there is an Orthodox doctor in the parish. In that case, the priest can use his help. Knowledge of psychiatry would also help the priest. Psychiatry in these situations does not stand in opposition to priesthood, but strives to enrich it with certain knowledge. The role of the priest is to influence the one being nourished towards patience and humility, to pray for him. The role of the doctor, hoping for God's help, is to treat the spiritual disorders with methods of modern medicine.

A psychiatrist-psychotherapist, acting on the will of the person, his reason and emotions, helps overcome the illness or its consequences. He tries to remove the pathological symptoms and syndromes from the central nervous system which, like depression, alarm, asthenia, and others, arose not because of enemy temptation, but because of biology and inheritance. After recovering (when possible) the person returns to his usual state. He can soberly look at the life around him and at himself, go to God's church, pray, work for the benefit of the family and society. In the measure of recovery of the sick, the "weight of the input" of psychiatric help will weaken, but the spiritual, on the other hand, will grow.

Certainly, the aforementioned is just a sketch portraying the intricate region of knowledge of pastoral psychiatry. As an illustration, I will present an example from a book by a famous Russian psychiatrist and a deeply religious person, D.E. Melichov, Psychiatry and the problem of spiritual life. The author, in one of the chapters, describes Dostoevsky's illness and the experience of his spiritual path.

"The illness of F.M. Dostoevsky is very telling for a priest, as an example of inborn inherited epilepsy: the genius writer suffered from epilepsy from age 15. It was a relatively bearable form of mixed epilepsy with rare seizures and equivalents, thanks to which he kept his creative abilities to the end of his life, though he did suffer significant memory loss. This illness was more severe in his student years, then again during the trial, the death sentence, the years of exile and military service.

Making naive attempts to explain or infer the world views and creativity of writers or social activists using an illness is a crude error. F. M. Dostoevsky was a genius author "not thanks to, but in defiance of" the illness. Being an autobiographical author, he in his creativity showed, in part, both the great variety and the contradictory expressions and sufferings of unstable types of human individuals. At the same time, like a believing person, the faith of whom "ran the gauntlet of doubts," he in his array of heroes also reflected attempts to make sense of his illness, and the experience of his battle with illness... Prince Mishkin and Rogozhin in "The Idiot"; the clarity, humility and faith of the Elder Zosima and the revolt of Ivan Karamazov; the clarity and purity of Alesha Karamazov and the deep moral deformity ("infernality") of Fedor Karamazov and Smerdiakov; the uncontrollable power of desires and fits of passion in Dimitry, giving way to deep repentance, the thirst of redemption through the path of suffering, and so on. He perceived himself as a captive of his fate and illness, and battled with it. Duplicity, duality was the fate of not only his heroes, many of whom perished in the battle with their double. He recognized duplicity in himself and to his death summed up his experience of battling with it. But Dostoevsky to the very end kept his creative powers, his critical view of his illness, his character and his deep compassion for people. Duplicity was the tragedy of the ill genius and his heroes. But he kept, as Strachov wrote about him, a "deep spiritual center, determining all the contents of his mind and works," from which energy was emitted, enlivening and transforming all his activity...

From this example, one can succinctly summarize the relation of the religious ill person himself to the expressions of the illness, and delineate the main paths of behavior of the priest/soul caretaker with epileptics. One can underline two main responsibilities of the priest in relation to the sick: 1) urge the ill person to medical physicals and, when necessary—to systematic treatment, and 2) help the ill person in his fight with his illness, critically recognizing and overcoming his anomalies of character and behavior.

The doctor-psychiatrist can treat the ill person in the periods of acute psychoses, help reduce the number of attacks and seizures and, when possible, prevent their reoccurrence. The role of the spiritual father is particularly important for the ill in the periods between attacks, when they realize the tormenting contradictions of the polar states of rise and fall, of sudden insight and great wrath, enlightenment and darkened states, the polar states of the blessed desire for goodwill to the world and people and the dark animosity, suspicion and moralizing teachings... The behavior of the priest is determined by the mutual task of pastors to help a person attain deep repentance, to reinstate the correct spiritual sensation of life in the person's soul, the correct view of their sin and their eternal human calling, which is subjected to such dramatic ordeals in sick persons, when the duplicity is expressed maximally."