Vasily Glebovich Kaleda postpartum psychosis. Mental illness does not block the road to God
Psychiatrist. Professor of the Department of Practical Theology of the Orthodox St. Tikhon's Humanitarian University. Deputy Director for Development and Innovation, Chief Researcher of the Research Department endogenous psychoses and affective states Science Center mental health. Doctor of Medical Sciences
Psychiatry and religion
PsychiatryVictoria Chitlova:
Hello, dear friends. “Psi-Lecture” program, and our guest - Vasily Glebovich Kaleda, doctor medical sciences, psychiatrist, professor of the department of practical theology at St. Tikhon’s Orthodox Humanitarian University, deputy director for development and innovation at our National Center for Health Care. There is also the chief researcher of the department for the study of endogenous psychoses and affective states. Hello, Vasily Glebovich!
Hello, Victoria!
Victoria Chitlova:
I am very glad that you are with us today. Vasily Glebovich, please tell us how you developed your interest and your activities in this direction?
If we talk about how my interest in activities in the field of psychiatry and religion was formed, it is connected with the personality of one unique psychiatrist of the 20th century, Dmitry Evgenievich Melikhov. This name is very widely known, he was one of the patriarchs domestic psychiatry 20th century, and now his name is very often remembered at ongoing conferences and congresses, everyone remembers him. He was a friend of my grandfather's youth and a friend of our family. I remember him very well, and, probably, under his influence I became a psychiatrist, and under his influence this interest in problems of psychiatry and religion was formed.
Victoria Chitlova:
But you are also a scientist, and your work is related to the study of endogenous psychotic states, including in young men. Are religious themes found within these states?
If we take the last decade, then religious themes are very common among our patients - both adolescence and adulthood. The fact is that mentally ill people, when problems arise, always look for where they can find help and support, and very often they turn to religion, to religious values. On the other hand, when a person experiences such a psychotic state, a delusional state, then within the framework of his delusional experiences, the information that he draws from around him is very often refracted. It could be a film that he recently saw, he suddenly becomes a character in this film, “Avatar,” for example, there was such a film, and quickly a human avatar appeared in our department. The same thing happens when a person falls into some kind of psychosis, very often he has delusional experiences associated with religious experiences. He may feel like a messiah, he may feel like a prophet who is called to do something great, glorious. On the other hand, he may consider himself a very great sinner who does not deserve to live, who must die and may even commit suicide.
Victoria Chitlova:
That is, a non-religious person is unlikely to develop a religious plot if he lived among other cultural categories, so it turns out?
If he lived among different cultural strata of society, probably unlikely. But, nevertheless, it turns out that among our patients, those who suffered psychosis in adolescence with religious content, the percentage of people who were believers before is not so large, about 40%, and 60% are people who Before that, they didn’t say that they were believers, well, they were by no means church people. Somewhere, deep down in their souls, they may have been believers, but by no means church people. And the fact that they suddenly have religious experiences in psychosis is a complete surprise for them or for those around them.
Victoria Chitlova:
We have now very intensively tried to penetrate into pathology, but first I wanted to ask you a few introductory questions. Briefly, from a historical point of view, did psychiatry and religion somehow coexist both in the context of world culture and our Russian history?
Naturally, they coexisted both in the context of world culture and Russian culture. If we take any teaching on psychiatry that was written both in the last century and in the 21st century, then all textbooks highlight a separate, so-called monastic stage of psychiatry, starting from the 11th century until the end of the 18th century, until 1775, when Russia was divided into provinces. This stage is called the monastic stage, because it was at this time that our patients found help, support and consolation in monasteries. And it’s even surprising that the first community that helped the mentally ill was the Kiev Pechersk Lavra. In the Kiev Pechersk Lavra, people lived in caves, including the mentally ill. And here in the patericon of the Kiev-Pechersk Lavra we find one of the very first descriptions of the catatonic form of schizophrenia. And later it was in the monasteries that the description of these mental disorders took place.
First of all, violent patients who attracted attention were distributed. And the patients, who, on the contrary, are very passive, who are spinning, were the ones who were paid attention to first of all.
Victoria Chitlova:
What exactly attracted people, and what was the logic behind placing such people or sending them to monasteries?
It was different, that is, at one time it was that these people themselves were drawn to the monasteries, in some era it was that the state officially sent them there. That is, it is clear that the mission of the monasteries, the mission of the church is to help all those who suffer and are burdened.
Victoria Chitlova:
Acceptance, understanding.
Yes, that’s exactly what people with mental disorders are. That is, this is the mission of the social ministries of the church, the social ministries of monasteries. But later, starting with the Council of the Hundred Heads in 1551, the time of Ivan the Terrible, there was a decree to send people possessed by demons and damaged by their minds to monasteries, so that they would not be a hindrance to society and to admonition.
Victoria Chitlova:
And if we talk in modern context, if we take an unbelieving, non-religious cohort of people, and those who are committed to some religion and actively live in it, where will there be more patients with mental pathology?
This is a very interesting question, and the answer here, it seems to me, is quite clear. The Church always positions itself as a doctor. Therefore, by definition, if you and I come to the clinic, where will there be more patients - in the clinic or in the area around the clinic? It is clear that in the clinic. And the church is such a doctor.
Very often people come with family problems, mental problems, and some other conditions. Of course, there are more people there. How much more - here, apparently, in different parishes it is slightly different, different people give slightly different data, special research was not carried out, but this is more, and this is normal, which means the church is a doctor.
Victoria Chitlova:
Our topic is designated as psychiatry and religion, and I am sure that representatives of different faiths are watching us. I think we can discuss the example of the Orthodox religion to make it clear. But do you have any idea of which religions accumulate more mental pathologies?
I am not ready to say that some religions have more and some have less. In any case, all religions have cultural characteristics, some nationalities belong to one religion, others to another. What the classics of psychiatry, starting with Sikorsky, wrote about all the time, what some modern researchers note, is the accumulation of mentally unbalanced people in non-traditional religions. Even in non-traditional directions, non-traditional trends, some semi-sectarian communities.
There is a concentration of mentally unbalanced people in non-traditional religions, non-traditional movements, and some semi-sectarian communities.
Victoria Chitlova:
That is, they somehow gravitate there more. Or, on the contrary, illnesses arise within organizations.
There are two aspects to this. The first aspect is that it often happens to a person who has some kind of mental disorder, he comes and turns to religion. But our diseases have their own patterns. It often happens that a person comes to the initial stage endogenous disease, he came to church, came to some kind of religious community, after a while he develops psychosis. Why did psychosis occur? Because he ended up there in a religious community? It is clear that psychosis is endogenous, this is a regularity. Based modern ideas, we are talking about the fact that a person may have certain genes that predispose them to the disease. And in order for these genes to manifest themselves, some external factors. Apparently, what Sergei Sergeevich Korsakov also wrote about is that these extreme religious cults often provoke the manifestation of endogenous diseases.
Victoria Chitlova:
This is when a person actively gravitates towards this, which means he is already on these rails, roughly speaking, he has stood on them.
Let's just say that often people who have a tendency, genetic inclinations to mental illness, come to a religious community. If this is a traditional religious community, then it has a psychotherapeutic effect, and there are even very interesting works on this subject. If this is an extreme religious community, then on the contrary, it can contribute to the manifestation of the disease.
Victoria Chitlova:
If a person is healthy and does not experience any subjective problems, should she be committed to some kind of confession in order to protect herself, how do you look at this?
I think this is a personal matter for each person.
Victoria Chitlova:
Does religion have protective properties that will help them protect a person?
The important point is that religion gives a person the meaning of life. And for many people this is very important, that is, many people are faced with the fact that life has no meaning. Many people seek the meaning of life and find it in religion.
Victoria Chitlova:
Some landmarks.
But many people are not looking for any meaning in life; they believe that they live well and are quite happy. This is still a personal choice of each person.
Victoria Chitlova:
Personal choice, absolutely true. Can we outline the range of pathological conditions that clergy encounter? What is found in this environment?
In an appropriate environment, all mental illnesses encountered by psychiatrists can be encountered.
Victoria Chitlova:
Absolutely any, starting with the fact that parents come, they have a child with autism, and they will tell the priest that they have such a problem, that the child has a developmental delay. And it is very important that the priest at some stage says that you still need to consult with specialists. Well, then all the pathology that happens, it can also come into the priest’s field of vision.
Victoria Chitlova:
I think it would be interesting, taking into account your rich practice, to consider what the most common cases are from the point of view of different pathology registries. Exist neurotic conditions, it is known that so-called dissociative or conversion states are not uncommon in religious environments. Can we look at examples of what this is?
It is clear to our viewers that these phenomena occur in a religious environment, but this is a classic example: some exalted person travels to the so-called holy places, before she hears that there are temptations there and all sorts of spiritual problems arise. She goes there and talks about how someone appeared to her there, she saw someone, someone influenced her, someone attacked her, and she heroically fought and fought against it. Here's an example.
Victoria Chitlova:
Can this be called hallucinations, or what is it called from a psychiatry point of view?
From the point of view of psychiatry, we will not call this hallucinations, this is a manifestation hysterical disorder personality. But, nevertheless, clergy in 99% of cases will perceive this as some kind of pathology.
Victoria Chitlova:
This means that the person is impressionable, with an impressionability that is very aroused by the appearance of images. A person heard something somewhere, he begins either to have ideas in his head, or even to sensations. In some cases, there are even serious psychosomatic conversion states, even stigmata. Do you agree with me?
Well, that's about it.
Victoria Chitlova:
Okay, but the clergy perceive such conditions as a deviation from the norm. Our holy scriptures indicate similar situations that actually existed and took place. How should we feel about this?
Here you need to analyze each specific case separately. That is, the traditional approach is that there are individual situations that are described in the lives of saints - those lives that the church accepted as an example of a certain spiritual life. These are exceptional cases. What we encounter in our lives, what priests encounter in their practice, are still cases of a completely different order.
Victoria Chitlova:
Can we say that what is indicated in the scriptures has an uncharacteristic structure for the pathology itself? That is, when we read the scriptures, they lack a number of other symptoms that we would classify. We cannot attribute this to pathological conditions.
Let's just say that we, as psychiatrists, need to have a lot of information in order to make a diagnosis. You still need to communicate with this person, understand what kind of disorder he has, how long it lasted, what preceded it. Accordingly, we, as a rule, do not have this information in the sacred scriptures and lives of saints.
Victoria Chitlova:
We are now in the territory of the so-called borderline psychiatry, a delicate question, let us proceed further. There are so-called obsessive-compulsive disorders. From the point of view of the religious environment, what picture can there be?
A very subtle topic, because very often it is not fully understood. What we call obsessive-compulsive disorders, various obsessions, people do not understand that this is a pathology. People don't understand obsessions when they last certain time, are already beyond the norm.
People do not understand that obsessions, when they last for a certain time, are already beyond the norm.
Victoria Chitlova:
What are obsessions?
Obsession is such a certain obsessive states that are violent in nature, that arise against one’s will this person, it’s quite difficult for him to cope.
Victoria Chitlova:
As a rule, these are thoughts, actions?
Thoughts, actions, something like that.
Victoria Chitlova:
So what are we facing?
In a religious environment, there are often blasphemous thoughts. A person, against his will (this refers to contrasting obsessions), has blasphemous thoughts, an insult to a shrine, an insult to religious images, an insult to religious dogmas, an insult to the Holy Spirit. It is very important here that the priests clearly understand what it is, what it is pathological condition and is in no way a spiritual state. That is, there are cases when a priest misunderstood this condition and did not allow a person to confess or receive communion. Although he was clean mental condition, with treatment it went away very quickly.
Victoria Chitlova:
This also does not apply to delusional states.
In this case, we are talking about obsessive states.
Victoria Chitlova:
That is, the patient understands that the thoughts are wrong, they weigh on him, but constantly haunt him, right?
Victoria Chitlova:
How often are they found in religious environments? depressive states, and can we talk about suicide?
This occurs in religious environments. In general, we are talking about the fact that we have an epidemic, a pandemic of depression, this is a disease of the 21st century. We're talking about the fact that by the age of 20, we will have almost the most common disease, condition. It also occurs quite often in religious environments. Priests probably face depression most often. Here the priest must understand a clear line where the normal experiences of a person, the experience of his inner world, their spiritual quest, where this is the norm, and where it is pathology. This is a very fine line, and, unfortunately, it is not always possible to understand it.
But we can give examples when the priest was the person who first understood this. I can give an example of one young man who went to see a priest all his life, the young man was 17 years old, at some point he began to have thoughts of suicide. The priest referred him to a psychiatrist, they turned to me, I said: everything is fine, let him come with his parents. The priest said that the parents did not know anything. I say: we need to inform them somehow. The parents came, this was the third child in the family, intelligent parents. I asked them: what’s wrong with the child? They said: we don’t know, the priest directed it, the secret of confession. I started asking to find out if there were any symptoms of depression. They answered, in general, they could not find anything. This is a feature of juvenile depression that very often does not manifest itself outwardly. It happens that a young man throws himself out of a window, but in hindsight no one can understand anything.
I talked with this young man, he immediately said that he was having thoughts of suicide, he had already made some specific attempts, despite all this, in his conversation he already had a complete depressive picture, a feeling of hopelessness, loss of the meaning of life, anti-vital thoughts , sadness, sorrow, anguish. And the parents, even in hindsight, still could not retrospectively identify any symptoms. We can say that this is a normal, full-fledged family. The man survived because the priest intervened. And there are quite a few such cases.
Victoria Chitlova:
Our next question is delusional states in a religious environment. What do they look like, Vasily Glebovich?
It is clear that there are delusional states that are very typical. There is a delusion of grandeur, there is a megalomaniac delusion, someone considers themselves Jesus Christ, someone considers themselves Napoleon, someone considers themselves the President Russian Federation. This is all clear and understandable, but the topics are different and not even entirely fundamental.
Victoria Chitlova:
Are we talking about schizophrenia?
About delusional states, psychotic ones. But there are conditions that can be very difficult to understand and very difficult to differentiate, the so-called depressive-delusional states. These are very interesting states. A person comes to church, usually a young man or girl, and is completely immersed in a religious environment. I must say that when this happens suddenly, it should alarm everyone. Yes, religious search is the desire of a normal person. Some people come to church once a year to light a candle, then they come twice a year, then three times a year. And then somehow smoothly, gradually he begins to go often, meets a priest, joins the life of the community, smoothly enters the life of the community and religious life. This is the most normal, harmonious option.
A person comes to church and is completely immersed in a religious environment. I must say that when this happens suddenly, it should alarm everyone.
But there are times when this happens quite abruptly. The man was an unbeliever and suddenly starts going to church. He talks about some of his special manifestations of spiritual life, begins to observe fasts very strictly, that is, as strictly as Orthodox people, church members usually do not observe them so strictly. It’s not even just strictly observing fasts, but somehow excessively. That is, he imposes on himself the fast that people, perhaps, observe in some particularly strict monasteries. And a person lives in the world, a person is 18-20-25 years old. A person begins to pray from morning to evening, he actually begins to pray for many hours, that is, there is a point of view that an Orthodox person does short prayer rules in the morning, short prayer rules in the evening, but if he reveals something else during the day, then this is considered good.
If a person was an unbeliever several months ago and begins to pray from morning to evening, the person goes to church, turns to the priest, the priest says that there should be moderation in everything. There must be a measure of prayer, there must be a measure of rest, there must be a measure of work. But the person doesn’t hear this, starts arguing with the priest, says that the priest doesn’t want to be saved at all, he doesn’t want to help me, goes to another priest, and so on. His parents turn to a person: dear or dear, you can’t eat nothing at all, you can’t go to church so much, from morning to evening. The person doesn't hear. And it very often happens that a person brings himself to a state of exhaustion.
There are cases where a person prayed and fasted like this, and it ended in death. And here we understand when this is a normal quest of a person, a person is looking for a church, looking for spiritual values, and when this is a pathology, it happens that this moment is missed. That is, the criterion is that if a person comes to church, then he must obey the priest. A person may not get along with a priest, all people are different, everyone wants to find a person who is in tune with themselves, a mentor who is in tune with themselves, but when things go further, this is still not normal. When a person, first of all, is not focused on the search for moral values, but on becoming better, kinder, and more kind to the people around him. And when a person deliberately observes religious rituals, this is already some kind of pathology.
Victoria Chitlova:
How can this pathology be called in our language?
In our language, these are depressive-delusional states with delusional ideas, sinfulness, self-blame, self-abasement.
Victoria Chitlova:
What could they mean?
They can be fatal.
Victoria Chitlova:
Suicide or death of asceticism, hunger, in this sense?
I say that there is a specific fatal outcome, death precisely from extreme exhaustion. Such patients often end up in intensive care units. But delusional suicides already happen when a delusional plot appears, when he considers himself a great sinner, and with some kind of messianic context that he must commit suicide in order to save humanity or to save his loved ones. Unfortunately, we have had such patients.
Victoria Chitlova:
I would like to clarify here for our listeners that such conditions are not necessarily an endogenous schizophrenic process. We consider such conditions, including within the framework, for example, of bipolar disorder, or recurrent depressive disorder, that is, endogenous depression that can reach a delusional level. Do you agree with me?
Like that.
Victoria Chitlova:
But if we talk about purely delusional states, without interspersing a depressive mood. What might this look like? Previously there was demonic possession. What does it look like now, Vasily Glebovich?
Possession by demons still occurs in the church environment.
Victoria Chitlova:
Describe an example in detail.
A person describes that a demon entered him, they describe it in different ways: for some it entered through the back of the head, for others it came out through the mouth, for others it entered, excuse me, through the anus, this specific example. And then the person describes how this demon sits inside him. I remember a patient who described how a demon was sitting and knocking on his liver with its hooves or horns, or something like that. In some cases they describe that the demon controls his thoughts, his actions, his movements. There is such a description.
Victoria Chitlova:
At the beginning of our meeting with you, we talked about dissociative and conversion states, where a person’s impressionability could allow short-term similar conditions. What is the difference between psychoses and religious delusional content?
I now remember such patients who went to Famous places, some to Athos, some to the Holy Land, described that at some point they went out, there was such a state. The condition lasted a few seconds, maybe not even minutes, then it passed. Those states that we describe as depressive-delusional or delusional states within the framework of psychotic level, are quite stable, long-lasting, and they interfere with a person. A person in the fight against demons turns out to be incapable of practical work.
Those states that we describe as depressive-delusional states or delusional states within the framework of a psychotic level are quite stable, long-lasting in nature, and they interfere with a person.
Victoria Chitlova:
That is, it is maladapted, and moreover, there are all the criteria for the syndrome that fit into the diagnosis.
Of course yes.
Victoria Chitlova:
Let's move smoothly to the treatment of such conditions. Let’s say a certain sufferer came to church in the described state. What are the real and desired actions of a clergyman? How often does it happen?
The desired actions of the clergyman so that he understands that the condition that this person has is pathological, that it painful condition. Accordingly, he needs to be advised very gently, so as not to offend or offend him, to go to a doctor, to go to a specialist, to see a psychiatrist.
Victoria Chitlova:
Is it possible to help a person with delirium?
Many priests succeed in this. The fact is that often the authority of a priest in the eyes of believers is very high. In particular, believers come out of obedience: the priest said, that’s why I’m doing this.
Victoria Chitlova:
You have been teaching clergy for a long time, and in addition to this very culture of thinking of a clergyman, which involves acceptance, compassion and help, you directly reveal to them the basics of psychiatry, so it turns out?
Victoria Chitlova:
Tell me, how sensitive is this environment of clergy, do certain issues become an ethnic conflict?
I will say this: I teach at the Orthodox St. Tikhon's Humanitarian University, and there are many students there who are going to become priests. This is a fairly young contingent, although, as a rule, evening students, many have higher education, the vast majority, by the way. And we not only reason theoretically, theoretically one can reason a lot and for a long time, and they will not remember anything from it. The most important thing is that we look at and analyze specific patients.
Victoria Chitlova:
Right in the clinic?
Right in the clinic. We take a depressed patient if it is possible to find a sick believer who will have ideas of sinfulness, not at a delusional level, just within the framework of depression. So they see specific depression, they see where a person is simply thinking about his shortcomings, and where there is depression. We examined patients with delusions without possession, and I must say that the clergy are also present, and I never remember anyone saying that no, this is still a purely spiritual phenomenon, it is not mental. That is, in the first classes I feel that there are people who are a little skeptical. Then by the end we always find complete mutual understanding.
Victoria Chitlova:
Do the clergy have an understanding that we are talking about biology in general, these are no longer some spiritual categories that we are talking about? How is this perceived by the priests themselves?
I won’t say that 100% of clergy have such a clear understanding. In the same way, I will not say that 100% of doctors of all specialties have the same understanding that all our mental illnesses are biology.
Victoria Chitlova:
This is biochemistry.
There was a survey recently, a few days ago data showed that doctors were still talking about the evil eye and damage. But in general, there is now such an understanding that there is enough high level, What compulsory subject the training of future clergy should include a subject called pastoral psychiatry. There is a very important document of the Russian Orthodox Church. The document is called "Fundamentals" social concept Russian Orthodox Church". These are not dogmas, of course, but, nevertheless, this is the status of a document, an official document, an official position, which clearly states that the church divides a person’s bodily level, mental level and spiritual level.
Now there is an understanding at a fairly high level that a mandatory subject in the training of future clergy should be a subject called pastoral psychiatry.
Victoria Chitlova:
But Melekhov also said this.
The holy fathers of the church spoke about this, and Dmitry Evgenievich Melekhov only stated their point of view. But by identifying three levels in a person, the church clearly distinguishes between the sphere of competence of a somatologist, the sphere of competence of a psychiatrist and the sphere of competence of a priest. And under no circumstances should we reduce some diseases or some problems to others.
Victoria Chitlova:
Can the clergy discuss details of the patient's thoughts or delusions? Will this not be harmful, is there a position where he should help at this stage?
There is a whole list of conditions when a priest should definitely immediately try to refer a person to a psychiatrist.
Victoria Chitlova:
Do not get involved in the very content of thoughts.
The priest must, on the one hand, understand that this is a serious mental pathology who needs a referral to a psychiatrist, this is the first thing he must understand. Secondly, the priest should not renounce this person under any circumstances. That is, his task is not just to take and redirect - that’s it, I referred him to a psychiatrist, I did my job. His task is to help the person further. Yes, the man went to the hospital, there is no way to leave him, visit him, support him. After he is discharged from the hospital, continue to continue some kind of cooperation, help, and pastoral care with him.
Victoria Chitlova:
Here the clergyman routed the patient to a psychiatric clinic or to an outpatient facility, such as a dispensary. How should a psychiatrist think and behave, what should he know for his part?
For a believer, a priest is a very high authority. He must understand that the person who came to him is a believer; for a believer, his faith is the most sacred. And the doctor to whom such a patient comes must treat his beliefs with very deep respect, on the one hand, and continue to rely on his religious values in his work with this patient. And in many cases it is very important for him to rely on the authority of the priest. And in general, they must cooperate with each other. If there are any issues between them, the priest may consider that the patient is receiving very large doses drugs and so on, that is, the priest should not tell the patient about this that, in my opinion, your doses are too high, let’s halve them, but he should discuss this issue with the doctor. Or if something confuses the priest, you can always turn to another specialist. They must cooperate with each other and develop common tactics.
The priest must support the authority of the psychiatrist, the psychiatrist must rely on the authority of the priest, that the priest has blessed you to do this, the priest has blessed you to be treated with us. Yes, you don’t want to be treated with us, you don’t like the fact that the conditions are not the same or something else, you were blessed by the priest, you must fulfill his blessing.
Victoria Chitlova:
Great, but is there a service in our country or anywhere in the world that combines all this - a priest-psychiatrist?
I know of a priest in Moscow who is the rector of a Moscow church, who comes from a well-known dynasty of psychiatrists. But, nevertheless, in fact, now among his patients there are many people with mental disorders, as far as I know, who are not involved in healing, directly prescribing medications, and so on. But we also have many clinics and hospitals in which priests provide care, who work closely with both medical staff and patients, after all, these are different things - medical work and priestly work, where they work closely, complement each other and decide everything questions together.
Victoria Chitlova:
Our mental health research center on Kashirka has a religious department. There is a study of patients with such conditions. Do doctors themselves also interact directly with clergy?
In some cases they collaborate with priests. That is, it is often the priests who send the sick there, from the monasteries. It is clear that there is contact and these issues are being discussed. But I want to say that in our center there is a temple that was consecrated 25 years ago, a little more, in 1992. And now we will no longer surprise anyone by the fact that the hospital has either a temple or a prayer room. But then it was 1992, that is, it had just collapsed Soviet Union, and in the most leading institution of the Russian Federation, in the scientific center of mental health, a church is opened. At that time, I think it was a state of semi-shock for many. I must say that our church is the first church to be opened in a newly built building. And the Patriarch himself covered it, and leading psychiatrists of the Russian Federation showed that this is very important.
Victoria Chitlova:
Vasily Glebovich, our broadcast is coming to an end. We have highlighted the main milestones that we have planned. The topic is quite broad, you can read additional materials on the Internet, it’s all available. Vasily Glebovich, I have a final question for you - what would you wish for our viewers?
I would like to wish our viewers spiritual harmony so that they can always calmly decide their internal problems, and there was no need to contact psychiatrists. If such a need arose, then they would understand that our illnesses are not shameful in any way. You need to go calmly and seek psychiatric help.
Victoria Chitlova:
Thank you very much. I wanted to appeal to our colleagues who are also watching us, so that they are more aware, feel more broadly, think more broadly and treat their patients more sensitively. Dear friends, we thank you for your understanding with Vasily Glebovich and say goodbye to you. The next broadcast of “Psi-Lecture” will be released in a week. Vasily Glebovich, I thank you, thank you very much.
Thanks a lot for the invitation.
Victoria Chitlova:
All the best.
Goodbye, all the best.
Victoria Chitlova:
Goodbye, happily ever after.
Pastoral psychiatry. With which strange people do priests have to deal with? Many people come whose illness develops on religious grounds. What should priests do? How can relatives recognize the disease?
On June 13, 2015, the guest of the program “Church and the World,” hosted by Metropolitan Hilarion of Volokolamsk on the Russia-24 TV channel, was psychiatrist, Doctor of Medical Sciences, Professor of St. Tikhon’s University Vasily Glebovich Kaleda.
Metropolitan Hilarion: Hello, dear brothers and sisters! You are watching the program “Church and the World”. Today we will talk about pastoral psychiatry. My guest is a psychiatrist, doctor of medical sciences, professor at St. Tikhon’s University Vasily Kaleda. Hello, Vasily Glebovich!
V. Kaleda: Hello, dear lord!
“Pastoral psychiatry” is a relatively new subject in the training course for future clergy of the Russian Orthodox Church. At the university where I teach, this subject has been taught since 2003.
Why did you need to teach this course? First of all, because in the modern world people often have nowhere to turn. And when a person has mental, spiritual problems, he comes to church, comes to the priest. And the task of the priest is, among all those mental problems with which a person came to him, to see mental illness, mental disorder, if any. It is very important here that the priest correctly builds his tactics of communicating with a person who suffers from mental illness. And often the question of a person’s life and death will depend on how the priest behaves.
Metropolitan Hilarion: The field of psychiatry and the field of pastoral counseling are two overlapping fields. Of course, they do not always overlap, but in some cases the joint efforts of a priest and a psychiatrist are necessary. You and I have such experience of working with one patient - this, however, was many years ago, then we met - with whom you worked as a psychiatrist, and I, to the best of my ability, as a shepherd.
I think that it is very important for a clergyman to be able to distinguish phenomena of a spiritual nature from phenomena of a mental nature. Sometimes, unfortunately, clergy are mistaken in this and accept mental illness for demonic possession or for some deviations, or for sinful intentions. And instead of treating a person and sending him to a specialist, they, unfortunately, give prescriptions that lead to sad consequences. That is why it is very important that in all theological schools the subject “Pastoral Psychiatry” is studied, so that in such cases there is close contact between the pastor and the psychiatrist.
V. Kaleda: Yes, sir, that’s exactly it. Indeed, these two areas are very closely related. Often they overlap each other. With all this, at some stages, when we, together with a priest, are caring for a mentally ill person, at some stage the role of the psychiatrist dominates, and at another, it is the priest.
It is clear that the role of the psychiatrist dominates in cases where the mental disorder is very severe. When a person is in a state of psychosis with delusions and hallucinations, considers himself the ruler of the world or, conversely, the Antichrist, or someone else, he will not hear the priest. He doesn’t even always hear the psychiatrist at such moments. The main thing here is the treatment provided by the doctor.
At the next stages of the disease, if we are talking about psychosis, a person often has problems understanding his place in life, the problem of understanding why he turned out to be sick, why he is in a psychiatric hospital. And here, precisely, it is very important for him to hear the word of the priest that illness is not a punishment for something, but a cross that must be borne. And when a person hears this from a priest, then most often he correctly perceives his words. And it often happens that people come to us for treatment precisely with the blessing of a priest.
It also happens that due to illness a person does not realize that he is sick. He believes that these are just some mistakes in his life that he can cope with on his own. And here it is important that the priest tells him: “No, dear, I bless you to go to a psychiatrist and follow all his recommendations. Everything he says, you must do, for obedience.”
Sometimes there are very seriously ill patients. I remember a case with one girl who had a severe form of the disease with pronounced suicidal intentions, with adolescence, literally from the age of 12. She was treated at various clinics, hospitals, she is still being observed by fairly competent doctors, but we clearly understand that our capabilities are limited. And the fact that she walks on earth is the merit of one Moscow priest.
Metropolitan Hilarion: The joint efforts of priests and psychiatrists give the patient a chance to start a new life. And they can really save a person's life. The possibilities of psychiatry are not limitless. We know many cases where psychiatrists make every possible effort, but the disease still progresses. On the other hand, we know cases miraculous healing from a psychiatric illness or cases when it ceases to interfere with a person, and when he, being sick, is not deprived of the opportunity to lead a full life.
It is very important that each person is competent not only in his own field, but also in a related field. I think that psychiatrists who completely ignore the sphere of spiritual, religious life, thereby knock out solid ground from under their own feet, because a solid internal religious foundation helps the doctor in his work. I think you know this from your own experience. But, at the same time, this basis, of course, helps to distinguish in the patient what relates to both spiritual phenomena and the sphere of psychiatry, because often mental illness develops against the background of some sinful habit. For example, mental illness can be a consequence of drug addiction or gambling addiction, or some other sin, even fornication. Mental illness may develop due to uncontrolled lust.
Therefore, the interpenetration of these two areas is, of course, very important, in demand and timely, because if the priest is familiar with the field of pastoral psychiatry, he will make much fewer mistakes.
V. Kaleda: How much a priest understands this area often depends, as I have already said, on the life and fate of a person. Let me give you one example. Not so long ago, about three years ago, there was information about numerous cases of teenage suicides. At that time, a priest approached me and told me that a young man with suicidal thoughts was coming to him for confession. The young man goes to him with early childhood. When the priest turned to the parents of this young man, they could not understand why the priest was referring their son to a psychiatrist.
They came to me in bewilderment, saying that the priest, whom we greatly respect, love, appreciate, sent to you, but we don’t know why. Accordingly, I began to ask my parents leading questions in order to identify some kind of depression based on indirect signs. They couldn’t tell me anything, but not because they were inattentive, but because this depression and thoughts of suicide occurred in the young man outwardly unnoticed. Only the priest knew about this. However, the young man’s situation was so serious that he was ready to jump out of the window several times. He was hospitalized in our clinic and thereby saved.
Another example can be given. There are cases when young men in a state of psychosis want to sharply improve themselves, immediately achieve holiness, become like the great ascetics, try to pray from morning to evening, and fast. This fast turns into a hunger strike, because they first refuse to eat food, and then refuse to drink water. One of our patients, who was a patient with us several times, at some stage began to fast so much that he even stopped taking water. Parents did not pay attention to this. He came to the temple and the priest, seeing his condition, called an ambulance.
Nowadays there is an opinion among psychiatrists that faith is a powerful protective factor, a powerful resource of the individual. At one time, Viktor Frankl said that faith for a person is such an anchor that nothing can compare with. This is true. The scientific psychiatric literature of the last 15-20 years has shown that believers who have a meaning in life understand that all trials are sent to them by God. The stronger a person’s faith, the less pronounced reactive mental disorders. This is shown in modern scientific research.
I remember one doctor who worked in the clinic where I work now. He was a non-believer, but at the same time he admired the catechists who sometimes came to our clinic, admired the confidence that they conveyed to the sick. Indeed, faith gives people confidence in life, which is very important for our mentally ill.
Metropolitan Hilarion: The Gospel describes many cases of healing, including more than once talking about the expulsion of demons from the possessed. Some modern secular New Testament scholars often see the possessed as symptoms of mental illness. Indeed, the symptoms sometimes almost completely coincide, for example, the symptoms of split personality, when two different subjects seem to live in a person, he feels them in himself and switches to one or the other. After all, all this is very similar to the symptoms of demonic possession that are described in the New Testament. And it cannot be ruled out that the demonic possession described there was accompanied by some kind of mental disorders, for these are also two border areas.
On the one hand, we, as Orthodox Christians, know well that the phenomenon of possession is not fictitious, it cannot be reduced to some set of mental disorders. But, on the other hand, we understand that these are also two border areas. When we read about gospel miracles, we see that the Lord Jesus Christ does not just perform a miracle in some automatic magical way, but asks: “Do you believe that I can do this?” Or He says to the father of the demon-possessed youth: “If you believe, then all things are possible to him who believes” (see Mark 9:23). He seems to shift the responsibility for this miracle onto the person himself, in order to mobilize in him that inner potential of faith, the ability to find in himself the necessary response to God’s action.
When we, clergy, work with people - healthy or sick - we always appeal not to some external force that can come and miraculously and magically heal a person, but to the person’s internal resources. We know that in many cases positive, good forces lurk within a person himself, which, if they are multiplied by Divine grace received through confession, through communion, through prayer, through communication with a priest, are capable of working miracles.
V. Kaleda: Indeed, powers can work miracles. We see this often. In our medical practice There are often patients with borderline disorders, and when they gain faith, they also find the meaning of life, managing, with minimal help from psychiatrists, to overcome the disorders that they have.
But in our so-called practice big psychiatry, which deals with psychoses, there are indeed quite a few psychoses that have a religious overtones. Within the framework of this topic, the patient can call himself the messiah, say that he has a special connection with God, or, conversely, call himself the Antichrist, who came into the world and from him comes all the world’s evil. It also often happens that our patients talk about demonic possession, about the influence of demons on them, that demons have taken possession of them, somehow spin around in them, knock on the liver with horns, hooves, or something else.
Psychoses with this theme have certain patterns of development. They usually appear instantly. There is a certain initial stage. Therefore, it is very important that these cases are reviewed by a specialist. It is important that both the priest and the doctor understand that there is different cases. Such cases of delusions need to be treated very carefully and referred to psychiatrists, and it is very important that psychiatrists understand this.
Metropolitan Hilarion: I would like to draw your attention to the case that you spoke about, when a young man, wanting to achieve spiritual improvement, first began to fast very strictly, and then stopped eating and drinking altogether.
I sometimes jokingly tell my parishioners that religion is good in certain doses. An overdose of religion can be just as dangerous as an overdose of anything else. We all know about a certain ascetic practice that exists in our Church: about fast days, about other in various ways abstinence. And we know the limits within which this practice must operate. It should never lead to any kind of fanaticism, extremism, or any excessive feats that harm not only the physical, but also the mental health of a person.
The role of the confessor and shepherd is to help each person find his own measure of spiritual and physical feat, because if a person arbitrarily, of his own free will, succumbing to some external influences, takes on a feat beyond measure, this can lead to tragic consequences. This can lead to what in the language of the Holy Fathers is called prelest - devilish seduction, when a person seems to be ascending from strength to strength along the path leading to the Kingdom of Heaven, but in fact he is simply sliding into the arms of the devil. Of course, this can also lead to serious mental disorders.
That is why wisdom, moderation and, again, competence are so important here, so that clergy know about this complex and rich world in which spiritual and mental phenomena come into contact. So that at the right moment the shepherd can give good advice, and, if necessary, take emergency measures.
Vasily Glebovich Kaleda – psychiatrist, Doctor of Medical Sciences. Among the five brothers and sisters of Vasily Kaleda are two priests and the abbess of the monastery.
When Father Gleb entered open priestly service, one of his spiritual daughters wanted to fast. But she lived with unbelieving parents, and her observance of Lent in relation to food led to very difficult conflicts in the family. Then her dad told her: “Eat absolutely everything your parents give you. They give you meat, eat meat; they give you dairy food, eat it. The main thing is don’t watch TV.” And then his spiritual daughter, at the end of Great Lent, said: “Father Gleb, this was the most serious and difficult Lent in my life!" And the parents’ approach to observing Great Lent was exactly this.
During Lent, the main thing is not food and drink
My memories of the beginning of Great Lent have always been associated with Forgiveness Sunday. In the evening we went to the rite of forgiveness at the Church of Elijah the Ordinary and on the way home we made sure to buy ice cream. Parents said that Lent is a time of some limitation, and the child should feel this. We, like all children, loved ice cream. The symbol of what we gave up during Lent was ice cream. Therefore, we definitely ate it in the evening. We drove home, and in the evening we all prayed together in my dad’s office, in my dad’s home church. The prayer of Ephraim the Syrian was our home rite of forgiveness.
Parents set aside three weeks from Great Lent. First week, Week of the Cross and Holy Week. During these weeks we always fasted more strictly. The period of our childhood was the seventies. We went to a Soviet school. The older ones studied at institutes and universities. Naturally, at school we ate the breakfasts that were given to us. And the students ate what they could then eat in the student canteen. It is clear that they tried to limit themselves as much as possible so that the lunch would be more modest in nature. Didn't take any more gourmet dishes. At the same time, parents always said that Fasting is Fasting, but this does not mean that the child should go hungry. If a person studies and has a heavy workload, then he should eat normally.
At that time, the products were completely different than now. Now every store has a wide variety of different seafood and frozen vegetables. Everything was inaccessible then. AND lean food limited to potatoes pickled cucumber, sauerkraut and various cereals, some mushrooms that we managed to stock up on. I remember that we went to a special store near the Church of St. Nicholas in Khamovniki, which was the only one in Moscow that sold frozen vegetables. Of the seafood that we now have in abundance, back then we only had squid. And not always.
During Great Lent, we also ate food at home. Mom always cooked for us all very selectively. I remember that one of the older brothers, when he entered college, studied with teachers. It was a lot of physical activity, and his mother prepared one specially for him. meat dishes. Another brother, when he was studying at the institute in one of his first years, also experienced considerable physical exercise– the institute was very difficult. Mom also prepared meat dishes and broths for him. I remember this well.
Parents have always tried to ensure that at the very beginning of Lent a certain pace is set that is feasible for our family and each of its members, taking into account their age. It often happens that people begin to actively fast and by the end of Great Lent they are already physically exhausted and, instead of the joy of Christ’s Bright Resurrection, they experience great fatigue and often associated irritability towards each other.
Mom and Dad always noted that during Lent the main thing is not food and drink. The main thing is to find other restrictions. I remember they always told us to limit ourselves in terms of cinema during Lent, although we didn’t go that often, and we didn’t have a TV at home. There could only be very special exceptions.
Now in our families we try to adhere to this approach. I would like the child, at the moment when he becomes more adult, to choose the measure of Fasting that he is able to endure, and that this is exactly the measure that corresponds to the tradition of our Church.
Material prepared Vladimir Khodakov
– “Get yourself together, wimp” is a common expression and a rude form of support for a despondent person. How do you feel about this kind of encouragement?
– I remember one young man with depression. His dad was a shy, active and successful person in life, and he himself was subtle and sensitive. For a long time, as a psychiatrist, I treated him for depression. Of course, I analyzed his behavior from the point of view of suicidal intentions. I say with all responsibility that he had no such thoughts.
Circumstances were such that he soon left for another city to practice, to work for his father, who held a serious position. It so happened that he was delayed in practice for two months and was left without medication.
On top of everything else, his father, seeing that his son was completely different in character, literally tried to educate him every day: “Why are you passive? Why are you sad? Let's find you a wife? Stay calm and carry on. Be a man, don’t be sour.” And then the father returns home one day, and the guy is hanging in the middle of the room. Beforehand, he ran to the store and bought groceries for dinner according to the list that his father left him...
You need to understand that conversations like “get yourself together, you wimp” in severe conditions can end just like this.
– There is clinical depression, and there are a lot of other conditions that we call it: fatigue, blues, melancholy, burnout. Where is the line between true depression and what is often called it?
– The term “depression” has become extremely common, although people do not always realize what really stands behind it. In everyday life this word is used to describe mild condition sadness and longing.
In medical terms, depression is a well-defined condition. It suggests not only a sad mood. In some forms of depression, sad mood is not observed at all.
There is a classic depressive triad. In addition to depressed mood, it includes motor retardation, that is, lack of physical strength do something. Outwardly, the movements of such a person look inhibited and slow. The third component – ideational – involves changes in thinking. The movement of thought is inhibited, in a conversation it is difficult for such a person to find words, concentrate on something, or absorb information.
With depression, there is inadequate low self-esteem, a pessimistic perception of the future, sleep disturbance, decreased appetite, however, there are cases when the patient eats a lot in order to muffle depression.
And although the depressed mood is classic symptom, cases of “ironic”, smiling depression are not uncommon. Such a person treats his experiences with irony, which he hides, but inside he experiences a difficult state, which he describes with the words “cats are scratching at my soul.”
With classic depression, the phenomenon of anhedonia occurs - the loss of the ability to rejoice and react emotionally even to significant events in life. The essence of the disease is the lack of will and the inability to mobilize. The Holy Fathers noted that in these states a person loses taste for everything and loses the ability to feel pleasure.
– A non-specialist cannot always figure out where depression is and where Bad mood and fatigue?
– Outwardly, the state of depression is not always clear. There are depressions that occur without external cause, endogenous. Their cause is inside a person, and not outside. It may be impossible for a non-specialist to separate “depression” from a sad mood. Imagine a serious young man from a decent university who did not complain about anything, did not look sad or inhibited, but suddenly committed a suicidal act. Even retrospectively assessing the last days of his life, one cannot find any psychological trauma: a failed test or unrequited love.
But immediately conversations arise from the series “teenagers today are not the same, they don’t value anything, even own life" I often come across young men who, at the last moment, manage to come to their senses and turn to a psychiatrist. They talk about the state of loss of meaning in life, anti-vital thoughts, although formally and outwardly everything is fine with them.
Photo: Alexander Vaganov, photosight.ru
Severe depression can happen to anyone
– The term “depression” is used widely today, all you hear about depression is what do people usually mean?
– I won’t say so from my surroundings, but it is obvious that in certain circles this term is popular and sometimes it really looks like outward coquetry. However, this does not mean that there is nothing behind the words.
I do not rule out that people often try to cover up their psychological problems. For example, a person does not have a clear goal in life, there is no awareness of why he lives, why he works, why he needs a family. This pause, the desire to find meaning and fill life with it, is really covered up with the expression “I’m depressed.” Some people use “depression” to cover up their reluctance and unwillingness to take life seriously and understand that it is a gift from God.
There is a fact of seasonal mood changes. Many people in autumn and winter weather, when the duration of daylight hours, it’s hard to take it because physiological characteristics. In one of the northern Swedish cities there is a saying that may be completely incomprehensible to us: “Don’t show a Swede a rope in winter.” Not only in Scandinavia and northern Russia long absence The sun is difficult for people to tolerate. But in southern countries Depression is rare; the opposite of depression, manic agitation, occurs more often there.
I came across a man who left for Italy from a northern city, lived there in difficult conditions, but never agreed to return home, where he had a job, an apartment, and friends. To my reasonable question, what are you doing here, you have everything there, he answered: “You have everything, but there’s not enough sun.”
– There is an opinion that losers, weaklings, and internally dissolute people suffer from depression. Successful, purposeful, disciplined people cannot have depression. This is true?
- No, that's not true. And the successful ones, and those who are disciplined in life, and active people Depression happens. I will say more, in such people depression occurs in extreme severe forms. After all, this state is incomprehensible to them. A person who has been active for many years, leading large teams, suddenly experiences melancholy, depression, and finds himself in a state of helplessness. He cannot recognize himself, cannot pull himself together, does not have the physical strength and desire to do what he is used to doing better than others in his life, for example, achieving success.
Among people famous in various fields of culture and science, there are many who suffered from classical depression. This is Jack London, Mark Twain, Van Gogh, Vrubel, Shostakovich, Mozart. I can remember a lot outstanding people, in whose lives there were distinct depressive states that happened to them more than once.
There is such a concept - psychopathy (personality disorder) - a character trait from which a person suffers himself and/or those around him.
One of the types of psychopathy is the constitutional depressive type. This term describes born pessimists. People who go through life and perceive everything in gloomy tones. They perceive Christianity not as the joyful fullness of life in God, but as a depressive religion. The horror is that they often try to instill such a view of Christianity in others. In other words, they are in a state of constant subdepression.
Along with them, there is their complete opposite - very optimistic people, whose life is a continuous bright spot. But both the former and the latter may have severe depression, just as it can happen to “losers” and successful people.
Illness or sin
– Synonyms for depression, especially among believers, are despondency and sadness, which are interpreted as states of sin.
- Sadness is normal condition person. It occurs in a serious traumatic situation. Remember Christ, who was saddened and grieved when he learned that Lazarus had died. Sadness in itself is not a sin.
In general, if you look closely at the works of the holy fathers, it turns out that they describe the classic depressive triad in the finest nuances. In particular, they write about the state of sadness and loss of spirit, about the state of physical and mental heaviness, about the lack of will, and constraint. Athanasius the Great, for example, called despondency a state of aggravation of the body and soul.
But this condition becomes a disease when, stuck in a depressed mood, a person loses hope in God’s mercy and ceases to realize that what is sent to him can have an inner meaning.
– Do devotees of piety suffer from depression, or does this misfortune bypass the prayer books?
– If we take the lives of Russian ascetics of the last century, for example, the lives of Tikhon of Zadonsky, Ignatius Brianchaninov, then upon careful reading we will be convinced that they clearly experienced a state that can be interpreted as clinical depression.
The same severe conditions were with Silouan of Athos. He described them as a feeling of being abandoned by God.
Depression occurs even in very pious people. I had to treat a man who went down in the history of the Russian Orthodox Church as a righteous man.
When we talk about classic depression, we are talking about a purely biological condition that can affect anyone. Another thing is that a person predisposed to a serious spiritual life, who perceives his condition as a cross sent to him, actually achieves transformation or, as believers say, holiness.
–That is, depression can affect a person’s spiritual growth?
– In a state of subdepression, that is, in a mild form, a person really becomes deeper. For example, he understands that many of the things he does every day are, by and large, of secondary importance. He begins to think about the meaning of life, about his relationship with God. At the same time, such a person is more vulnerable, feels injustice and his own sinfulness more subtly.
But if we talk about severe forms of depression, it often feels like being at the bottom of an abyss and a total feeling of being abandoned by God. We cannot talk about any positive influence on spiritual growth here.
In psychiatry there is the concept of “anesthesia of the senses” - this is a complete loss of feeling, including in spiritual and prayerful activities. In this state, a person does not feel either joy or grace even from participating in the sacraments.
– It turns out that non-believers suffer from depression even harder?
- Without a doubt. A person with a Christian worldview perceives life as a kind of school. We go through life, and the Lord sends us trials for our spiritual maturation. I have seen many cases when in this state people came to Church and turned to God.
Even more often I met people who perceived depression as God’s providence, as a condition through which it was important for them to go through. One of my patients said: “Christ endured and we must endure.” For the average person, these words sound wild. But I remember how that patient pronounced them. He said this from the heart, and not for rhetoric, with humility and a clear awareness that this had a deep inner meaning for him of the disease.
The most difficult thing for a depressed person is to come to the realization that life has meaning. We ourselves did not come into this world, and it is not for us to decide when to leave it. For non-believers, this thought is difficult: “Why endure suffering when everything is hopeless ahead?” Understand that a depressed person is a person who has put on dark glasses. The past is a series of mistakes and falls, the present is impenetrable, nothing looms or shines ahead of him.
It is important to understand that depression can be treated
– What are the statistics? How common is clinical depression compared to other conditions we call it?
– I only know general figures. In the world from clinical depression More than 350 million people suffer, in Russia - about eight million. In the northern regions, in percentage terms, the number is more pronounced, in the southern regions - less. But to say what is the percentage of those who consider themselves “depressed” in in a broad sense words and is in a state of sadness, I am not ready.
The problem is that even with classic depression, people are in no hurry to consult a doctor.
In Russian society as a whole, there is no understanding of what depression is, what its scale is, and, most importantly, what its danger is. “Get yourself together, you rag” - that’s our expression.
Let me again give you a textbook example of a young man whose arms and legs are intact, who has a separate apartment and job, but suddenly he lies down on the sofa and cannot do anything. It seems ridiculous to lie there like this: “Come on, get up, go to work.” In addition to the hackneyed phrase “get it together, you rag,” such young people are also told stories about the hard lot of their grandparents who found a way to mobilize even in war.
This is all correct, of course, but more often it leads to self-blame, the decision not to be a burden to the family, and suicidal intentions. A depressed person should not be put under pressure or rudely stimulated. This is how to persuade a person with paraplegia to stand up and walk. Alas, this is not obvious to everyone yet.
The main danger of depression is that it leads to suicide. Therefore, in a number of countries there are medical programs on suicide prevention and identifying depression in loved ones and work colleagues. In Japan, for example, there are popular brochures that explain everything from A to Z: what kind of disease, what are the signs, how it is dangerous for a person, how to behave if you suspect such a condition in another.
– The problem objectively exists, this is understandable. What's the trend?
– According to WHO data, the incidence of depression is increasing. There is an opinion that in the 21st century there will be a pandemic of depression. The rapid growth we are seeing is partly due to better detection. The scientific community is actively involved in the topic of depression. Thanks to enlightenment, even household level Depressive conditions are more often paid attention to. Patients with this problem began to consult doctors much more often.
There are other factors too. For example, the increase in depression is directly related to the increase in life expectancy throughout the world. The fact is that depression is a companion of human aging due to biological reasons, such as brain changes. Depression also accompanies severe somatic diseases: oncological, serious forms coronary disease hearts. In such people, depression is detected in 30-50% of cases.
WHO experts note that one of the reasons for the prevalence of depression is the loss of traditional family and religious values. Previously, a person lived in his own house with his parents and grandparents, that is, a large family. A man lived for decades in the same place and clearly understood that one day he would grow up, become an adult, then grow old and live in a large family where the younger generation would take care of him. Now many live in separate comfortable apartments, and at a certain stage of life they find themselves alone, despite material wealth and the presence of children and grandchildren, who, due to the modern rhythm of life, do not have time to take care of them. Disunity is a phenomenon of our time and definitely a cause of depression.
Finally, there was a loss of traditional religious values. It is human nature to think about the meaning of life. But if in mature age No religious faith, which gives meaning to life to many, it becomes quite difficult for a person. There are even a number of studies conducted by domestic specialists that indicate that in old age, in situations of bereavement, the lack of religious values is an extremely unfavorable prognostic factor.
In other words, depression is not a fashionable disease, it is a serious problem of the present.
Unfortunately, to this day there is one of the myths about psychiatry that, once in the hands of a psychiatrist, a person will inevitably be “zombified” and “turn into a vegetable.” Meanwhile, science has long moved forward. Today we have a large arsenal of drugs and antidepressants with different mechanisms of action and different tolerability, with minimal side effects and high therapeutic productivity, with the ability to use drugs in outpatient practice.
It is important to understand: depression can be treated, and after therapy there is a significant improvement in the condition. Neglecting this is unacceptable and stupid.
The Church has always emphasized the medical ministry. Among the apostles was professional doctor- Apostle Luke. In the book of wisdom of Jesus son of Sirach, the Lord says: “Honor the physician according to the need for him; for the Lord created him, and healing is from the Most High... And give place to the doctor, for the Lord created him too, and let him not depart from you, for he is needed” (Sir.38:1-2, 12). We must always turn to the Doctor with a capital P, but we have no right to demand that the Lord constantly perform a miracle. Yes, Christ said to the paralytic: “Rise and walk.” But this is a special case.
I am convinced that we must go to doctors (with a small letter), so that through medicine and these doctors the Lord will give us his help.
From left to right: Rector of PSTGU Archpriest Vladimir Vorobyov, employee of the Scientific Center for Mental Health Vasily Kaleda and Archpriest Vladimir Novitsky
Loss of interest in life - a sin or a mental disorder? How to communicate with a depressed person? How to help a person who is in a delusional state? In what cases is it necessary to use spiritual approaches - confession, exhortations, gospel examples - and in what cases is the help of a doctor and drug treatment? What to do if a person refuses to be treated, and is it possible to admit him to the Sacraments? These and many other questions were discussed at a pastoral seminar at the Orthodox St. Tikhon's Humanitarian University, which was held on April 12 under the chairmanship of the rector of PSTGU, Archpriest Vladimir Vorobyov.
“A priest quite often has to deal with people suffering from various mental disorders,” stated an employee of the Scientific Center for Mental Health of the Russian Academy of Sciences, professor of the Department of Practical Theology of PSTGU Vasily Kaleda. “According to various sources, at least 15% of the Russian population suffers from mental disorders, and people come to the Church as if they were going to a doctor’s office, they go to the priest with their mental problems.”
The very concept of mental health in medicine is quite conditional, noted Vasily Kaleda. “In many ways, the concept of norm depends on cultural context“Within one culture, a person’s behavior will be considered the norm, in some other culture the same thing will indicate a person’s mental disorder,” he said. “In addition, when communicating with a person, you need to take into account the characteristics of his character and other individual data - upbringing, level of education, age.”
To the leader of the church aid group in emergency situations Archpriest Andrey Bliznyuk(pictured in the center) we often have to provide assistance to people experiencing tragedy and under stress
The spectrum of mental disorders is very wide, Vasily Kaleda also noted. Speaking about the most common disorders, he gave numerous examples from his medical practice. Seminar participants were also given a handout that can be used to diagnose a person with a mental disorder.
Priests often have to deal with mental disorders such as delusions of religious and mystical content and various obsessive states. “Another common disorder is a depressive-delusional state with a sense of one’s own sinfulness,” noted Vasily Kaleda. “A sick person usually does not hear at all what the priest tells him - he is only confident that he is right, and this should alert him.”
“The patristic literature of the first centuries of Christianity provides the most subtle and detailed description of depression, a disease that has a biological basis,” says Vasily Kaleda. - Depression can manifest itself as a reactive state, for example, a reaction to the death of loved ones or other stressful situation" According to him, it is important to distinguish when depression is a manifestation of a person’s spiritual state - despondency, lack of faith or distrust of God, and when it is evidence of illness. Priests often encounter borderline states, and it is the pastor who can be the first to notice mental disorders and recommend that the parishioner see a doctor .
The sooner help is provided to the patient, the sooner treatment begins, the greater the chance of preserving his psyche. “An illness is a destructive process, and one should not treat it as some kind of special mental structure or insanity,” said Archpriest Vladimir Novitsky, psychiatrist by profession. - Mental illness is akin to a fire in a house: if we put out the fire in time, the roof will burn, but the whole building will remain intact. If we wait a little, one floor will burn, if we wait again, the second floor will burn, and so on the whole house. Also human psyche“She is suffering, being destroyed by illness.”
Archpriest Vladimir Novitsky psychiatrist by profession
With severe mental disorders, a person can stand on the brink of life and death, emphasized Vasily Kaleda. “There is a myth that people who talk about suicide will never commit it,” he noted. “In fact, about 80% of suicides, one way or another, gave their loved ones some signals about their proximity to suicide, but those couldn't understand them. The priest should be especially attentive to people who confess that they want to commit suicide, or talk about the meaninglessness of life - such anti-vital sentiments must be taken very seriously.”
Pastoral seminars on social service issues have been held since October 2014 with the aim of developing recommendations for clergy on the issues of spiritual care for people in need of social assistance.
Press service of the Synodal Department for Charity
