Vasily Glebovich Kaleda: fasting for a child is a time of self-restraint. Kaleda Vasily Glebovich juvenile endogenous paroxysmal psychosis

Pastoral psychiatry. What strange people do priests have to deal with? Many people come whose illness develops on religious grounds. How to be a priest? How can relatives recognize the disease?

On June 13, 2015, Metropolitan Hilarion of Volokolamsk, a psychiatrist, Dr. medical sciences, Professor of St. Tikhon University Vasily Glebovich Kaleda.

Metropolitan Hilarion: Hello dear brothers and sisters! You are watching the program "Church and Peace". Today we will talk about pastoral psychiatry. My guest is a psychiatrist, doctor of medical sciences, professor of St. Tikhon's University Vasily Kaleda. Hello, Vasily Glebovich!
V. Caleda: Hello, dear lord!
"Pastoral Psychiatry" - comparatively new item in the course of training future clergy of the Russian Orthodox Church. The university where I teach has been teaching this subject since 2003.
Why is it necessary to teach this course? First of all, the fact that in modern world people often have nowhere to turn. And when a person has mental, spiritual problems, he comes to church, comes to a priest. And the task of the priest - among all those spiritual problems with which a person came to him, is to see a mental illness, a mental disorder, if any. It is very important here that the priest correctly build his tactics of communication with a person who suffers from a mental illness. And often the question of life and death of a person 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 intersect, but in some cases the joint efforts of the priest and the psychiatrist are necessary. You and I have such an experience of working with one patient - this, however, was many years ago, then you and I 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 between phenomena of a spiritual nature and phenomena of a psychic nature. Sometimes, unfortunately, the clergy are mistaken in this and take mental illness for possession or for some kind of deviation, or for sinful intentions. And instead of treating a person in order to send him to a specialist, they give, unfortunately, such prescriptions that lead to sad consequences. That is why it is very important that the subject "Pastoral Psychiatry" be studied in all theological schools, so that in such cases there is close contact between the pastor and the psychiatrist.
V. Caleda: Yes, sir, that's right. Indeed, these two areas are very closely related. Often they overlap. With all this, at some stages, when we, together with a priest, are leading a mentally ill person, at some stage the role of a psychiatrist dominates, and at some stage it is the priest.
It is clear that the role of the psychiatrist dominates in cases where the mental disorder is very pronounced. 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 even does not always hear a psychiatrist at such moments. The main thing here is the treatment that the doctor provides.
At the next stages of the disease, if we are talking about psychoses, a person often has problems comprehending his place in life, the problem of understanding why he turned out to be sick, why he is in a psychiatric hospital. And here, just, 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 carried. And when a person hears this from a priest, then most often he correctly perceives his words. And it often happens that people turn 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 of his life that he can cope with on his own. And here it is important that the priest told him: “No, dear, I bless you to go to a psychiatrist, to follow all his recommendations. Everything he says, you must do, for obedience.
Sometimes there are very serious patients. I remember a case with one girl who had a severe form of the disease with pronounced suicidal intentions, from adolescence, literally from the age of 12. She was treated in various clinics, hospitals, she is now being observed by fairly competent doctors, but we clearly understand that our capabilities are limited. And the fact that she walks the 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 unlimited. We know many cases when 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 be 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 inner 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 the patient to distinguish between what belongs to both spiritual phenomena and the field of psychiatry, because mental illness often develops against the background of some kind of sinful habit. For example, mental illness can be the result of drug addiction or gambling, or some other sin, up to fornication. Mental illness can develop due to uncontrolled fornication.
Therefore, the interpenetration of these two areas is, of course, very important, in demand and timely, because if a priest is familiar with the field of pastoral psychiatry, he will make much fewer mistakes.
V. Caleda: As I said, the life and fate of a person often depend on how well a priest understands this area. I will give 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 comes to him for confession. The young man goes to him from 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, they say, the priest, whom we respect, love, appreciate, sent to you, and we don’t know why. Accordingly, I began to ask leading questions to my parents in order to indirect evidence identify any depression. They could not tell me anything, but not because they were inattentive, but because this depression and thoughts of suicide flowed in the young man outwardly imperceptibly. Only the priest knew about it. However, the young man was so serious that he was ready to jump out of the window several times. He was hospitalized in our clinic and thus 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 great ascetics, try to pray from morning to evening, to fast. This fast turns into a hunger strike, because they first refuse to eat, and then to drink water. One of our patients, who had been 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.
Now 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. It really is. In the scientific psychiatric literature of the last 15-20 years, it is just shown that believers who have a meaning in life understand that all trials are sent to them by God. The stronger the faith in a person, the less pronounced reactive mental disorders. This has been shown in modern scientific research.
I remember one doctor who worked in the clinic where I work now. He was an unbeliever, but at the same time he admired the catechists who sometimes came to our clinic, he admired the confidence they conveyed to the sick. Indeed, faith gives people confidence in life, which is very important for our mentally ill people.
Metropolitan Hilarion: The gospel records many cases of healing, including there more than once it is said about the expulsion of demons from the possessed. Some modern secular New Testament scholars often see demoniacs as symptoms of mental illness. Indeed, the symptoms sometimes almost completely coincide, for example, the symptoms of a split personality, when two different subjects seem to live in a person, he feels them in himself and switches from one to the other. After all, all this is very similar to the symptoms of possession, which are described in the New Testament. And it cannot be ruled out that the possession described there was accompanied by some kind of mental disorder, for these are also two border areas.
On the one hand, we, as Orthodox Christians, are well aware that the phenomenon of possession is not fictional, 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 the 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 child: “If you believe, then all things are possible to him who believes” (see Mark 9:23). He, as it were, shifts 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 the action of God.
When we, clergymen, work with people, healthy or sick, we always appeal not to some external force that can come and heal a person miraculously and magically, but to the internal resources of a person. We know that in very many cases, positive, good forces are hidden within the 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. Caleda: Indeed, forces can work miracles. We see this often. In our medical practice often there are patients with a borderline circle of disorders, and when they gain faith, they also acquire the meaning of life, managing, with minimal help from psychiatrists, to overcome the disorders that they have.
But in our so-called practice of big psychiatry, which deals with psychoses, there are really quite a few psychoses that have a religious coloring. Within the framework of this topic, the patient can call himself a messiah, say that he has a special connection with God, or vice versa, he calls himself the Antichrist, who came into the world and all the world's evil comes from him. It also often happens that our patients just talk about being possessed by demons, about the influence of demons on them, about the fact that demons have inhabited them, somehow rotate in them, knock on the liver with horns, hooves, or something else.
Psychoses with this theme have certain patterns of development. They occur, as a rule, instantly. There is some initial stage. Therefore, it is very important that these cases are considered by a specialist. It is important that both the priest and the doctor understand that there is different cases. Such cases of delusions of possession need to be taken very seriously and sent 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 mentioned, when a young man, wishing to achieve spiritual perfection, first began to fast very strictly, and then completely stopped eating and drinking.
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 certain ascetic practices that exist in our Church: fast days, other various ways abstinence. And we are aware of the limits within which this practice should operate. It should never lead to some kind of fanaticism, extremism, to some kind of excessive exploits that harm not only the physical, but also the mental health of a person.
The role of a confessor and shepherd is to help each person find their own measure of spiritual and physical achievement, because if a person arbitrarily, voluntarily, 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 delusion - the devilish seduction, when it seems to a person that he ascends from strength to strength along the path leading to the Kingdom of Heaven, but in fact he simply slides into the arms of the devil. Of course, this can also lead to serious mental disorders.
That is why wisdom, moderation are so important here, and, again, competence is so important so that the clergy know about this complex and rich world in which phenomena of the spiritual and psychic order come into contact. So that at the right moment the shepherd could give the right advice, and, if necessary, take emergency measures.

What is modern psychiatry, why to the suffering mental illness are often treated like lepers and what to do if you yourself or someone close to you get sick - these and other questions of the Pravoslavie.ru portal.Ru" answered the doctor of medical sciences, Professor of PTSGU, Deputy Director of the Scientific Center for Mental Health Vasily Glebovich Kaleda.

I would like our conversation to be useful to those who have the intention to seek help, but for some reason hesitate, or those close to them. We all know that in society there are certain "horror stories" associated with psychiatry - let's try to dispel them, if not, then at least speak them out.

People are sure that psychiatric disorders are something extremely rare, and therefore the very fact of having such a disease takes a person out of society. So the first question is, how many people suffer from mental illness?

Mental disorders are quite common. According to available data, about 14% of the population in the Russian Federation suffer from them, while about 5.7% need psychiatric help. Approximately the same figures we will see in the countries of Europe and in the USA. We are talking about the whole spectrum of mental disorders.

First of all, it is necessary to mention depressive conditions, which affect about 350 million people worldwide, and about 9 million in Russia. By 2020, according to WHO experts, depression will come out on top in the world in terms of incidence. Almost 40-45% of severe somatic diseases, including cancer, diseases of cardio-vascular system, post-stroke states, accompanied by depression. Approximately 20% of women in the postpartum period, instead of the joy of motherhood, experience depression. It can be immediately mentioned that severe depression in some cases, in the absence of medical assistance, leads to lethal outcome - to suicide.

Due to the increase in life expectancy and the aging of the population in recent decades, the incidence of various types of dementia of late age, including Alzheimer's disease and its associated disorders, has increased.

The problems of autism in childhood have recently acquired particular relevance (the frequency of occurrence is currently 1 case per 88 children). Very often, when a parent begins to notice that their child is significantly different in their development from their peers, they are ready to go with their problem to anyone, but not to psychiatrists.

Unfortunately, the proportion of people suffering from alcoholism and drug addiction remains high in the Russian Federation.

Currently, due to the change in the general way of life and the stressfulness of our lives, the number of borderline mental disorders has increased. The prevalence of so-called endogenous mental illness associated primarily with genetic predisposition, and not the influence of external factors, which include bipolar affective disorder, recurrent depressive disorder, as well as schizophrenia spectrum diseases, remains approximately the same - about 2%. Schizophrenia occurs in approximately 1% of the population.

It turns out about every hundredth. And what is the percentage of people among such patients who maintain socialization? Why I ask: in the public mind there is a certain stereotype - a person suffering from such a disease, an outcast, to be crazy is kind of shameful.

- Raising the question of the shame of the disease is completely incorrect. It is unacceptable both from a religious and simply from a human point of view. Any illness is a cross sent to a person - and each of these crosses has its own, quite specific meaning. Let's remember the words of St. Ignatius Brianchaninov that we should respect each person as the image of God, regardless of the position he occupies and the state he is in: infant I will honor both the criminal and the pagan as the image of God. What do you care about their infirmities and shortcomings! Watch over yourself so that you do not lack love. This is the Christian attitude towards a person, no matter what illness he suffers from. Let us also remember the attitude of Christ the Savior towards lepers.

We must honor each person as the image of God.

But, unfortunately, sometimes it happens that our patients are perceived precisely as lepers.

In the psychiatric literature, the problem of destigmatization of the mentally ill is discussed very seriously, that is, changing the attitude of society towards the mentally ill and developing such a system for organizing psychiatric care that would make it accessible to all categories of the population, and the need to contact a psychiatrist would be treated as an appeal for help. to any medical specialist. The diagnosis of "schizophrenia" is not a sentence, this disease has various forms of course and outcomes. Modern drugs can qualitatively change the course and outcome of this disease.

According to epidemiological data, approximately 15-20% of cases of schizophrenia have a single-attack course, when, with adequate treatment, recovery essentially occurs.

We, at the Mental Health Research Center, have many examples when people, having fallen ill in adolescence, after 20-25 years have and had a fairly prosperous family and high social status, are married, they have children, they have made a successful career, and someone even in science, having managed to defend dissertations, receive academic titles and recognition. There are also those who have done, as they say now, a successful business. But you need to understand that in each case the forecast is individual.

When we talk about schizophrenia and the so-called schizophrenia spectrum diseases, we must remember that patients with this disease need long-term, and in some cases lifelong, medication. Just like type 1 diabetics need to get insulin injections.

Therefore, no independent attempts to cancel therapy are unacceptable, this leads to an exacerbation of the disease and disability of the patient.

Let's talk about how the onset of the disease occurs. A person, and even more so his relatives, may not understand for a long time what is happening to him. How to understand that you can no longer do without a psychiatrist? I was told how a sick sister was brought to the monastery of one of the local Churches. The first thing they did in the monastery was that they allowed her not to take medicine. The patient's condition worsened. Then the mother abbess got her bearings, they began to specially monitor the intake of medicines, but even the clergy do not always understand what a mental disorder is.

The problem of identifying mental illness is very serious and very difficult. The example you gave is very typical - the monastery decided that they could cope with the disease with their love for this sick girl and care for her. Unfortunately, this often happens - people do not understand that "our" diseases have a very serious biological basis with significant genetically determined disorders. Attentive caring care is, of course, very important, but professional help from doctors is still required.

Unfortunately, many do not realize how serious this disease is. One can recall the tragic death in Pskov in 2013 of Father Pavel Adelheim, who was killed by a mentally ill person, who instead of being hospitalized was sent for a conversation with a priest, or the death of three monks in Optina Pustyna in 1993, also at the hands of a mentally ill person.

Patients with endogenous psychosis often express various ideas of implausible or dubious content (for example, about persecution, about a threat to their lives, about their own greatness, about their guilt), they often say that they hear “voices” inside their heads - commenting, ordering, insulting character. Often they freeze in bizarre positions or experience states of psychomotor agitation. Their behavior towards relatives and friends changes, unreasonable hostility or secrecy may appear, fear for their lives with protective actions in the form of curtaining windows, locking doors, meaningful statements that are incomprehensible to others appear, giving mystery and significance to everyday topics. It is not uncommon for patients to refuse food or carefully check the contents of the food. It happens that there are active actions of a litigious nature (for example, statements to the police, letters to various organizations with complaints about neighbors).

You cannot argue with a person who is in such a state, try to prove something to him, ask clarifying questions. This not only does not work, but can also aggravate existing disorders. If he is relatively calm and tuned in to communication and help, you need to listen carefully to him, try to calm him down and advise him to see a doctor. If the condition is accompanied by strong emotions (fear, anger, anxiety, sadness), it is permissible to recognize the reality of their object and try to calm the patient.

- But we are afraid of psychiatrists. They say - "they will slaughter, it will be like a vegetable", and so on.

Unfortunately, in medicine, drugs that treat serious illness and do not have any side effects at all and cannot be. Hippocrates spoke about this even before our era. Another thing is that when creating modern drugs, the task is to ensure that side effects are minimal and extremely rare. Let's remember cancer patients who lose their hair on the background of appropriate therapy, but they manage to prolong or save their lives. In some connective tissue diseases (for example, systemic lupus erythematosus), hormone therapy, against the background of which pathological fullness appears in people, but life is preserved. In psychiatry, we also encounter serious illnesses, when a person hears voices inside his head like a radio, turned on at full power, which insult him, give various orders, including in some cases to jump out of a window or kill someone. A person experiences fear of persecution, exposure, threats to life. What to do in these cases? Watching a person suffer?

At the first stage of treatment, our task is to save a person from these sufferings, and if at this stage a person becomes drowsy and lethargic, there is nothing to worry about. But our drugs act pathogenetically, that is, they affect the very course of the disease, and drowsiness is in many cases their side effect.

Indeed, there are some false fears about psychiatrists, but I must say that this is not only our unique Russian feature, which is connected with something, it happens all over the world. As a result, the problem of "untreated psychosis" arises - patients already long time express frankly crazy ideas, but nevertheless neither they go to the doctor, nor their relatives.

This problem is especially pronounced in cases where the subject of delusional disorders has a religious connotation. Such patients in a state of psychosis talk about some kind of mission, that they are messiahs sent by God to save the human race, save Russia, save all of humanity from spiritual death, from an economic crisis. Often they are sure that they must suffer - and, unfortunately, there have been cases when patients with religious messianic delirium committed suicide for delusional reasons, sacrificing themselves for the human race.

Among religious psychoses, there are often states with the dominance of delusions of sinfulness. It is clear that the realization of one's sinfulness for a believer is a stage of spiritual life, when he realizes his unworthiness, sins, seriously thinks about them, confesses, takes communion. But when we talk about the delusions of sinfulness, then a person becomes obsessed with the ideas of his sinfulness, while he loses hope in God's mercy, in the possibility of forgiveness of sins.

A person becomes obsessed with the ideas of his sinfulness, while his hope for God's mercy disappears.

We remember that the most important thing that is required from a person who is trying to live a spiritual life is obedience. A person cannot impose penance on himself, cannot fast without a blessing in some special way. This is a strict rule of spiritual life. In any monastery, no one will allow any young worker or novice, with all his zeal, from the very beginning to fulfill the full monastic rule or the rule of the schemnik. He will be sent to various obediences and the volume of prayer work that is useful to him will be clearly told to him. But when we talk about a patient with delusions of sinfulness, he does not hear anyone. He does not hear his confessor - he believes that the priest does not understand the gravity of his sins, does not understand his condition. When the priest strictly tells him that he does not allow reading ten akathists a day, then such a patient concludes that the confessor is a superficial, shallow person, and goes to the next priest. It is clear that the next priest says the same thing, and so on and so forth. Often this is accompanied by the fact that a person begins to actively fast, Great Lent passes, Easter comes, he does not notice that he can rejoice and break the fast, and continues to fast in the same way.

You need to pay attention to this. This zeal is not according to the mind, without obedience, is important symptom mental disorder. Unfortunately, many cases are known when patients with delusions of sinfulness ended up in intensive care units due to a threat to life due to extreme exhaustion. We at the Mental Health Science Center have seen cases where people with depressive delusions of guilt and sinfulness have attempted to commit suicide and kill their loved ones (extended suicide).

Returning to the topic of fear of psychiatry. Of course, we have hospitals - especially in remote provinces - which you really don't want anyone to be in. But on the other hand, life is more expensive - after all, it happens that it is better to send a mentally ill relative to a bad hospital than to lose him altogether?

Problem timely provision medical care - not only psychiatric. This is a public health problem. Unfortunately, we have many examples when a person, having certain symptoms, delays contacting a doctor, and when he finally does, it turns out to be too late. This also applies to oncological diseases that are common today - almost always the patient says that he had certain symptoms a year, one and a half, two years ago, but he did not pay attention to them, dismissed them. We see the same thing in psychiatry.

However, you need to remember and understand: there are conditions that are life-threatening. Vote - hallucinations, as we speak, auditory or verbal - often accompanied by orders. A person hears a voice inside his head that tells him to throw himself out the window - these are specific examples - or do something to another person.

There are also deep depressions with suicidal thoughts, which are experienced very hard. In this state, a person feels so bad that he does not hear what others are saying to him - he cannot perceive their words due to his illness. He is so hard mentally, psychologically, that he does not see any meaning in this life. It happens that he experiences excruciating anxiety, anxiety, and at this stage nothing can stop him from an antisocial act - neither relatives, nor the understanding that there is a mother who will suffer very much if he fulfills his intention, nor his wife , nor children. And therefore, when a person expresses thoughts of suicide, it is imperative to show him to a doctor. Adolescence deserves special attention, when the border between when a person expresses thoughts about suicide and their realization is very thin. Furthermore, severe depression at this age, it may not appear outwardly: it cannot be said that a person is dreary, sad. And yet he can say that life does not make any sense, express the idea that it is better to leave life. Any statements of this kind are the basis for showing a person to a specialist - a psychiatrist or psychotherapist.

Yes, in our society there is a prejudice against psychiatric hospitals. But when it comes to human life, the main thing is to help a person. It is better to put him in a psychiatric hospital than to wear flowers on a famous mound later. But even if there is no threat to life, the sooner we show the patient to a psychiatrist, the sooner he will come out of psychosis. The same applies to the long-term prognosis of the course of the disease: modern research show that the sooner we begin to provide medical care to the patient, the more favorable it is.

I read in your interview about your dad, Archpriest Gleb Kaleda: “He told me how important it is to have believers among psychiatrists.” And we can read about the same thing in the letters of Father John (Krestyankin), when he blessed the afflicted to regularly go to confession and communion and find an Orthodox psychiatrist. And why is it so important?

Yes, Father Gleb really said that it is very important that there are believing psychiatrists. Such psychiatrists whom he knew were Professor Dmitry Evgenievich Melekhov (1899-1979) and Andrei Aleksandrovich Sukhovsky (1941-2012), the latter of whom later became a priest. But Father Gleb never said that one should only turn to believing doctors. Therefore, in our family there was such a tradition: when you had to seek medical help, you first had to pray to the Doctor with a capital letter, and then with humility go to the doctor whom the Lord God would send. There are special forms of prayers not only for the sick, but also for doctors, so that the Lord sends them reason and gives them the opportunity to make the right decision. We need to look for good doctors, professional ones, including when it comes to mental illness.

First you need to pray to the Doctor with capital letter, and then with humility go to the doctor whom the Lord God will send

Even more than that, I will say: when a person is in a psychosis, talking with him about some religious aspects is sometimes not entirely indicated, if not contraindicated. In such states, it is simply not possible to talk with him about some high matters. Yes, at a later stage, when a person comes out of such a state, it would be good to have a believing psychiatrist, but, again, I repeat, this requirement is not mandatory. It is important that there is a confessor who supports a person who understands the need for treatment. We have a lot of educated, professional psychiatrists who respect people's religious beliefs and can provide highly qualified assistance.

And how can one evaluate the state of Russian psychiatry in the context of world psychiatry? Is she good or bad?

At present, the achievements of psychiatry, which are available throughout the world, are publicly available to any doctor in any part of the world. If we talk about psychiatry as a science, then we can say that our domestic psychiatry is at the global level.

The problem we have is the state of many of our psychiatric hospitals, the lack of some drugs for patients who are on dispensary observation and should receive them free of charge, as well as in the provision of social assistance to such patients. At some stage, some of our patients, unfortunately, are unable to work, both in our country and abroad. These patients need not only medical treatment, but also social assistance, care, rehabilitation from the relevant services. And it is precisely with regard to social services that the situation in our country leaves much to be desired.

I must say that now in our country there has been a certain approach to changing the organization of the psychiatric service. We have an insufficiently developed outpatient department - the so-called neuropsychiatric dispensaries and offices of psychiatrists and psychotherapists, which exist at some hospitals and polyclinics. And now a lot of emphasis will be placed on this link, which, of course, is completely justified.

Vasily Glebovich, I want to ask you one last thing. You teach a course in pastoral psychiatry at PSTGU. What is it and why is it needed?

As we have already said, mental illnesses are quite common, and a priest in his pastoral work has to meet people who have mental disabilities. There are more such people in the Church than in the average population, and this is understandable: the Church is a medical clinic, and when a person has some kind of misfortune, he comes there and it is there that he finds consolation.

A course in pastoral psychiatry is indispensable. Such a course is currently available not only at PSTGU, but at the Moscow Theological Academy, Sretensky and Belgorod Theological Seminaries. Metropolitan Anthony (Blum), Professor-Archimandrite Cyprian (Kern) and many other prominent pastors of the Church spoke about the need for this subject in the training programs for pastors.

The goal of this course is for future priests to know the main manifestations of mental illness, to know the pattern of the course, to have an idea of ​​what medicines are prescribed, so as not to follow the lead of their spiritual child and bless him to stop the medicine or reduce the dosage, which, alas, it often happens.

So that the priest knows that, as stated in the Social Concept of the Russian Orthodox Church - and this is an official conciliar document - there is a clear delineation of the scope of his competence and the competence of a psychiatrist. So that he knows the peculiarities of the pastoral counseling of persons suffering from mental illness. And it must be said frankly that maximum success in the management of a mentally ill person can be achieved only in those cases when he is not only observed by a psychiatrist, but is also fed by an experienced confessor.

The murders of the monks in Optina Desert and of the priest Pavel Adelgeim were committed by the sick who heard voices. How can a priest learn to recognize the main signs of mental disorders?

Speech by Professor of the Department of Practical Theology of PSTGU, Deputy Director of the Mental Health Research Center, Doctor of Medical Sciences Vasily Glebovich Kaleda at the XXV Christmas Readings.

On whether the priest can distinguish the disease from the true mystical experience, in some cases, the real life of a person depends.

A recent example: a daughter brought a woman in a state of psychosis for a consultation - delusions of persecution. It turned out that she was taking one serious antipsychotic, we asked her: “And who prescribed this medicine to you?” And she said that in a monastery south of Moscow, where a well-known elder was receiving, this elder prescribed her a neuroleptic. All our doctors were shocked - the priest prescribed a dangerous neuroleptic.

Another example: a twenty-eight-year-old boy came to our center, 1.80 meters tall, weighing 50 kg, his blood pressure was 80/60 — his appearance resembled that of a concentration camp prisoner. For several years he was a worker in a very famous monastery, and at some point he decided to start performing deeds of prayer, was obsessed with the idea of ​​salvation, and imagined himself to be the most important righteous man. But no one in the monastery paid any attention to his condition. As a result, there was a threat to life. To all my words that obedience is important for an Orthodox person, he did not perceive, believing that he knew better how to be saved. So he migrated between our clinic and the intensive care unit.

Are mental and psychiatric disorders more common or rarer in the church environment?

The Church is a medical clinic, so it is natural that many people with mental disorders and psychiatric diagnoses come to the Church and find support and comfort here. So in church environment these people are more common.

The professor of the St. Sergius Orthodox Institute in Paris, Archimandrite Cyprian (Kern), in 1957 published the book "Orthodox Pastoral Ministry", in which for the first time there was a separate chapter "Pastoral Psychiatry". He wrote: “There are states of mind that cannot be defined by the categories of moral theology and that do not enter into the concept of good and evil, virtue and sin. These are all those “depths of the soul” that belong to the field of psychopathology, and not the ascetic.

The pastor should read at least one or two books on pastoral psychiatry,

so as not to condemn indiscriminately in a person, as a sin, that which in itself is only a tragic distortion mental life, a riddle, and not a sin, a mysterious depth of the soul, and not moral depravity.

An outstanding Soviet psychiatrist, the son of a priest from the Ryazan province, Professor Dmitry Melekhov, in his unfinished book Psychiatry and Problems of Spiritual Life (1979), emphasized the particular importance of distinguishing between mentally ill religious experiences as a sign of illness (“false mysticism”) and religious experiences as a manifestation of “ positive healthy mysticism”, which he considered a powerful therapeutic factor in the fight against the disease.

Example: One of my patients, suffering from schizophrenic psychosis and not being a particularly church person, during an exacerbation of his illness, ran twice a day to the temple and began to pester the priests at confession with conversations. At such moments, his mother, who wants her son to start going to church, called the psychiatrist and said that something was wrong with her son again. She understood that his heightened religiosity was a manifestation mental illness.

On Mental Illness and Demon Possession

Dmitry Melekhov believed that the Orthodox faith is the most powerful personal resource in overcoming the manifestations of the disease, negative disorders and personality defects. He said that in some cases of schizophrenia, religious faith makes it possible to preserve the core of the personality.

He also considered it equally unacceptable on the part of a doctor "to immediately interpret any religious experience as a pathology," as on the part of a priest to consider all cases of mental disorder as a manifestation of "devil-possession."

Moreover, "experiences of a painful origin, under certain conditions, can become a source of positive spiritual experience."

Orthodox anthropology says that in a person there is a spiritual sphere, a spiritual sphere and a body. And as Dmitry Melekhov said, "when these three spheres of the human personality - spirit, soul and body, are in agreement, in harmony with each other, which is achieved only under the condition of the predominant influence of the sphere of the spirit, we can talk about health."

In accordance with this, a disease of the spiritual sphere is treated by a priest, a mental illness is treated by a psychiatrist, and a physical illness is treated by a somatologist (therapist, neurologist, etc.). It is clear that all three of these areas are inextricably linked and the disease of the soul affects the state of the spirit and the state of the body.

Melekhov's work was later published in the Clergyman's Handbook (volume 8) and then included in the official document of the Russian Orthodox Church - the Fundamentals of the Social Concept, section "Health of the individual and the people" (XI.5).

It says that there should be a clear distinction between the competences of the spheres of a doctor and a priest. This is a very important postulate, because, unfortunately, many in our Church try to reduce all mental illnesses to demonic possession. There is a powerful anti-psychiatric movement both in the Church and in society.

The Fundamentals of the Social Concept says:

“Singling out the spiritual, mental and bodily levels of its organization in the personal structure, the holy fathers distinguished between illnesses that developed “from nature” and illnesses caused by demonic influence or resulting from passions that enslaved a person. In accordance with this distinction, it seems equally unjustified both to reduce all mental illnesses to manifestations of possession, which entails the unjustified performance of the rite of exorcism, and to attempt to treat any spiritual disorders exclusively by clinical methods.

In the field of psychotherapy, the most fruitful combination of pastoral and medical care for the mentally ill, with a proper delimitation of the areas of competence of the doctor and the priest.

Mental illness does not detract from the dignity of a person. The Church testifies that the mentally ill person is also a bearer of the image of God, remaining our brother in need of compassion and help.

Faced with the patient, the priest must realize that he is facing pathology, this is not his area of ​​​​competence, and he needs to seek help from a psychiatrist.

Main indications for referral to a psychiatrist:

1. Depressive states with anti-vital thoughts, suicidal thoughts and intentions.

Recently, a priest called me and told me that his spiritual daughter had suicidal thoughts. The girl came to me and had no external manifestations of depression. A feature of depression in adolescence is that a person may not express it outwardly. The only thing that alerted me was that the girl went to confession and did not take communion, she had a petrified insensitivity - she did not feel the joy of prayer and therefore refused to take communion.

2. States of severe lethargy with restriction or refusal to take food and water, including under the guise of fasting, expressing ideas of special sinfulness with the imposition of special prayer rules on oneself, with the loss of obedience to the priest in relation to the rules of spiritual life, confidence in one’s own rightness, the loss of a sense of "Easter joy".

One girl went to church, began to fast and pray all day long, went to all services, came to confession with numerous sheets. In the temple, she repeatedly became ill and had to call an ambulance. I began to treat her and prescribed as a medicine to pray less, to return to normal. Then her appetite and ability to work gradually recovered. Everything should be age-appropriate and done under strict spiritual guidance.

3. Depressive states with a pronounced feeling of longing, hopelessness, despair, loss of life prospects, with ideas of self-accusation, humiliation, a decrease in the level of social adaptation.

4. Feeling God-Forsaken, loss of meaning in life and hope for God's mercy, "petrified insensitivity".

In a state of normal sinfulness, a person goes to the sacrament of repentance and then experiences a feeling of Paschal joy. In a state of delirium of sinfulness, the patient is convinced of his super-sinfulness, he does not feel anything, for him Easter is not a reason to stop fasting.

5. Ideas of one's chosenness, messianic or prophetic ministry, accompanied by a surge of strength, energy, reduction of night sleep.

We are all called to be "messiahs" with a small "m", but when a person says that he is clearly aware of himself as the Messiah, the incarnation of the Second Coming, this is a pathology.

6. States of causeless cheerfulness with disorderly increased activity , an uncontrolled influx of thoughts and a reassessment of one's capabilities, with ideas of social or church reorganization.

7. Episodes of unmotivated aggression towards others, risky and antisocial acts, gross impulse disorders that were not previously characteristic of a person (theft, vagrancy, sexual perversions, drug addiction, alcoholism).

8. Expression of unfounded ideas of persecution, influence(hypnosis, radio waves, radiation, etc.), controls, threats to life. (Especially dangerous in the presence of active behavior in accordance with the content of ideas, the search for specific perpetrators of the persecution, statements about the desire to contact them).

Example: A girl from an intelligent family suddenly began to say that her neighbors were watching her, then she began to wrap herself in foil, saying that she was being affected by radio waves. She was taken to the elder, the elder sent for a reprimand. A classic of the genre - a respected priest saw demonic possession in psychiatric pathology.

The disease is chronic, when a person is constantly a carrier of voices. When these voices order something to him, it is very serious. And it doesn't matter who these voices belong to - Cheburashka or Satan - the diagnosis does not change from this. The murder of the priest Pavel Adelgeim and the murders in Optina Desert were committed by patients who heard the voices of demons as a manifestation of mental illness.

10. The feeling of unreality and the adjustment of the environment, the feeling of being in the center of the struggle between the forces of good and evil, the ideas of demonic possession, bright and repetitive states of "enlightenment", "enlightenment", vision.

We all have to wage invisible warfare, but if a person reacts too sharply, believes that the whole world revolves around the struggle he is waging, this is a pathology.

Of course, demonic possession as a phenomenon of spiritual life exists, but quite often demonic possession is a manifestation of delirium in patients. So one patient, who was nineteen years old, said that the whole space around him was stuffed with demons. He came for a consultation because the votes were allowed. We left him, prescribed treatment, and all the symptoms went away.

The phenomenon of demonic possession in many cases is a manifestation of a state with delusional demonic possession. In parish life, it is more common than real demonic possession.

11. States of severe inhibition, "awake sleep" in which a person does not respond to others and their attempts to attract his attention, prolonged freezing in one position, refusal of food and water, dumbness.

A waking dream - simultaneously with reality, the patient sees that he is somewhere in other worlds.

Example: One of our patients, the son of a Moscow priest, knocked out the door in the ward, and after the course of treatment he said that all this time he was either in heaven or in hell, and the broken door was the gates of hell.

12. Pollution obsessions, washing hands, lengthy rechecks, obsessive ritual acts, obsessions of blasphemous content.

13. Increasing decline in performance fatigue, progressive memory loss and intellectual abilities, loss of self-service skills (elderly and senile age).

14. Pathological confidence in their excessive fullness, deliberate restriction in food for the purpose of losing weight, leading to increasing physical exhaustion and the appearance of suicidal tendencies (young age).

In conclusion, I would like to recall the words of St. Ignatius Brianchaninov:

“I will show respect to the blind, and the leper, and the mentally crippled, and the infant, and the criminal, and the pagan, as to the image of God. What do you care about their infirmities and shortcomings! Watch over yourself so that you do not lack love.

Statistics

In 2015, 4,097,925 people applied for mental health care (2.8% of the population).

According to the Scientific Center for Mental Health, in the current socio-economic conditions, 5.7% of the population of the Russian Federation needs psychiatric care.

Ideally, about 14% of the Russian population needs psychiatric care, which is consistent with WHO data.

Total number of persons with mental disorders in Russia:

• Border states — 4,800,000
• Post-traumatic stress disorder - 6,500,000
• Schizophrenic Spectrum Disorders — 3,000,000
• Epilepsy — 100,000
• Dementia late age — 3 000 000
• Oligophrenia - 1,800,000
• Alcoholism — 2,050,000
• Drug addiction — 3,000,000

In total - about 21 million.

An online conference with Doctor of Medical Sciences, Professor Vasily Glebovich Kaleda was held on the Orthodoxy and the World portal. We publish the answers of V.G. Kaledas to questions submitted by readers.

Vasily Glebovich Kaleda. Answers to questions from Pravmir readers

Confessor and psychiatrist

Good afternoon How to avoid dependence on communication with a confessor? In many life situations, you have to ask for advice or help, since there is mail and a telephone for communication. This is good. But sometimes there is no connection, and it can be very difficult to make a decision on your own. Thanks for the replies and your work. Best regards, Natalia

Dear Natalia! In your situation, first of all, you need to talk not about dependence on the spiritual father, but about the features of your character, due to which it is difficult for you to make a decision.

It is very difficult for people with a similar character (anxious and suspicious) to make any decision on their own, as important issues, as well as secondary ones. You left the decision of all such issues to the confessor, since you can almost always contact him. Really serious questions that need to be asked the blessing of a confessor do not arise so often. Each person should have his own active moral position in life.

Please tell us how you yourself would determine which issues should be resolved with a priest, and which with an Orthodox psychiatrist or psychologist? Vasily Glebovich, I believe that our priests often do the work of psychiatrists, playing, so to speak, "in a foreign field." How do you think?

A psychiatrist should be consulted in cases where there are signs or suspicion of a mental illness or mental disorder, and, accordingly, the treatment of these conditions is the competence of a psychiatrist. It is often the priest who is the first to realize that the soul feelings do not fit into the "relative norm" and blesses to turn to a psychiatrist.

There are cases when priests and psychologists, as well as relatives of the patient, not recognizing the morbid nature of the condition, prevent an appeal to a psychiatrist.

It also happens that psychiatrists (with insufficient qualifications) mistake some spiritual experiences for pathology.

For a better understanding by priests of the manifestations of mental illness, in a number of educational institutions The Russian Orthodox Church (PSTGU, Sretensky Theological Seminary, etc.) teaches the course "Pastoral Psychiatry".

General issues

Dear Vasily Glebovich!

Please inform the entire audience of this site that there are no separate Orthodox and non-Orthodox psychologists, just as there are no separate, for example, Orthodox and non-Orthodox surgeons, firefighters and policemen.

No, of course, I understand that an Orthodox believing psychologist, other things being equal, will tell the patient about God and advise him to come to the temple, but still he will not take on the functions of a priest. But this does not mean at all that a non-Orthodox psychologist, in principle, is not able to help a churched person in any way. Unfortunately, in the Orthodox environment, the opinion is very widespread that "Orthodox psychologists are not needed."

I do not share the point of view that "Orthodox psychologists do not need." Psychologists face very different tasks - there are psychologists who work in emergency situations, are engaged in the rehabilitation of patients and people with disabilities. handicapped, help to solve family problems and specific problems of different age periods, determined by prof. suitability, etc. and so on..

Any professional psychologist in working with a person with psychological problems will rely on the resources of his personality. The most important "psychological resource" of an Orthodox person is his faith, his Orthodox worldview (willingness to rely on the will of God, the priority of spiritual values, rejection of suicide as a solution to one's problems, etc.). Therefore, if an Orthodox person has psychological problems, it is better to turn to an Orthodox psychologist (if any), provided that he is highly professional. If not, then you need to contact the psychologist who is available.

Of course, if there is an opportunity to communicate with an experienced confessor who can devote enough time to you, then this is wonderful and most likely will be enough. But in our real life, priests are objectively very busy, and a psychologist at the parish can help find answers to some questions and help formulate the question to the priest better.

1. What is the nature of the occurrence of mental illness? Can a mentally healthy person suddenly become sick?

2. What is the difference between mentally unbalanced person and the mentally ill? Or is it one and the same?

3. Is it possible to “get infected” while being close by, communicating with a sick person for a long time?

4. How to behave with such people? Is it possible to make contact or is it better to avoid communication?

5. Can such people work? Or they need to be protected in every possible way from work, for example, in the parish.

Thank you!

1. There are several groups of mental illnesses: endogenous (schizophrenia, schizoaffective psychosis, affective psychoses), endogenous organic diseases (epilepsy, mental disorders in atrophic processes of the brain, including Alzheimer's, Pick, Parkinson's, etc.), exogenous organic diseases (after traumatic brain injury, with brain tumors, with infectious - organic diseases), exogenous (alcoholism, drug addiction, substance abuse), psychosomatic disorders, psychogenic diseases, borderline mental disorders (neurotic disorders and personality disorders), as well as pathology of mental development (including mental retardation). The nature of these diseases is different. In endogenous diseases, including schizophrenia, hereditary predisposition stands out among the main causes. In some cases, a provoking factor is necessary for its implementation. The underlying concept behind the onset of schizophrenia is the disruption of dopamine production. In addition, in pathological process some other transmitter systems of the brain are involved. Psychogenic diseases, as the name suggests, occur after traumatic situations. Unfortunately, it often happens that a mental illness manifests itself in an “absolutely mentally healthy person” (for all the conventionality of this term), who does not have a hereditary predisposition.

2. These are different concepts. Each disease has its own clear diagnostic criteria.

3. Mental illnesses are “not contagious”, however, being close to a seriously ill person for a long time, some people may experience psychogenic disorders. I admire the courage with which a number of deeply religious relatives of my patients bear their life's cross.

4. The approach to the mentally ill is strictly individual, but we have no right to turn away from them, they need our help and our support. We must remember the words of St. Ignatius Brianchaninov: “Show respect to the blind, and the leper, and the mentally crippled, and the infant, and the criminal, and the pagan, as the image of God. What do you care about his infirmities and shortcomings? Watch over yourself so that you do not lack love.

5. Many of them can work very successfully, including writing and defending dissertations, and holding very high positions. But the working capacity of some of them is reduced or almost lost. Many of them are left to their own devices, no one takes care of them. To obedience in the parish, if there is an opportunity, they should be attracted, for them it is very important. But at the same time, one must be prepared for the fact that they will not arrive at the appointed time, they will be very late without apparent reason, may suddenly abandon obedience and go home, and then appear only after a few days.

How true is the statement that Orthodoxy does not accept yoga and considers yoga as a preparation for communion with demons? Is it true that these activities shake the psyche and cripple the soul?

I will answer your questions in part (I answer questions as Orthodox psychiatrist), and I will express only my personal point of view. It is possible to do physical exercises according to the method of yogis, but it is impossible to cross the line when a change in world perception and worldview is required.

I don't have any scientific data that the number of mentally ill people is higher among yoga practitioners. Among my patients there are patients who managed to practice yoga.

Spirina Vera

Good day, Vasily Glebovich!

I am a beginner psychologist with little experience. Working at the Center additional education children and youth "Bogolep" at the John the Baptist Monastery in the city of Astrakhan.

Please answer the following questions:

1) Is it planned to create a distance course on Orthodox psychotherapy at PSTGU?

3) How did you overcome or are you overcoming difficulties and failures on your way?

Save you Lord!

Dear Vera, good day!

Psychotherapy is a medical specialty, and the creation of a medical faculty at PSTGU is not yet planned. From modern books, I would like to advise you to read: Melekhov D.E. "Psychiatry and issues of spiritual life" (available on the Internet); Metropolitan Hierofei (Vlachos) "Orthodox psychotherapy", Holy Trinity Sergius Lavra, 2004, 368 p.; Jean-Claude Larcher "Healing of Mental Illnesses (Experience of the Christian East of the First Centuries)", M., From Sretensky Monastery, 2007, 223 p.

When I had difficulties and failures in my life, I had a firm conviction (my parents instilled it in me) that this is the Will of God, that there is some meaning in this, which will be understood later.

I wish you God's help in your difficult ministry.

Dear Vasily Glebovich! Is it true that with the introduction of the Unified State Examination, the number of mental illnesses among school graduates has sharply increased? Thank you.

I don't have such data. I think that the peak of various reactive states among school graduates has shifted to the Unified State Examination from the experiences associated with entering the institute.

depression

Good afternoon Lately, I have been experiencing symptoms of irritability, tearfulness, and many others. I turned to a psychotherapist. She diagnosed me deep depression and prescribed tranquilizers. The effect is good though for a reason high cost I can't take them regularly. In addition, she said that drug treatment only relieves the symptoms, but does not completely cure. As a treatment, she suggested that I be like shallow hypnosis sessions and hinted that my problems may be due to the fact that I do not live sex life. I don't know if I can be allowed to interfere with my psyche, no doubt an excellent specialist in his field, but still a person whose recommendations may go against my Christian principles?

I think that the advice given to you by a psychotherapist should be divided into two groups. The first is in relation to drug treatment. Antidepressants need to be taken and in some cases long courses. Depressive states often disappear completely. Indeed, some modern antidepressants are quite expensive, if you are not able to take them, discuss this issue with your doctor, ask him to choose another antidepressant therapy regimen. The second group is psychotherapeutic advice, here you must have your active moral position.

Marina A.

Please tell me, with depression without organic disorders, is drinking antidepressants a life sentence? In fact, such a person is likened to a drug addict? Thank you.

In the psychiatric literature, the concept of "lifelong prescription of antidepressants" is absent (in schizophrenia, in some cases, we can talk about almost "lifelong prescription" of antipsychotics).

In some cases, with the so-called prolonged and chronic depressions, it may be recommended to long-term use antidepressants. But antidepressants do not cause the sensations that drugs cause, so this comparison is not correct.

If you follow your logic, then you can compare with drug addicts a large number of patients with serious chronic diseases, for example, a patient with diabetes who injects himself with insulin for life.

Hello, I am 27 years old, I have been depressed for several years. I went to a psychiatrist only this year - I prescribed azafen, I felt better a little and not for long. After Communion it is also easier, but for 1-2 days. Personal life does not add up, at work - no self-realization (although I studied well, I seem to be able to think). I don't have enough strength to think that everything is fine. I know that I need a doctor's help. Advise which psychiatrist to contact. It is important to me that he be Orthodox. Thank you very much.

Contact me via email [email protected]).

Hello! For as long as I can remember, I have been suffering from depression, which, according to the doctor, is an endogenous disease. I began to go to church, I began to feel better, but now all the medicines have ceased to help: from all antidepressants - it makes me sleepy, and from neuroleptics, and from drugs that remove “voices” - tachycardia and weakness. Those. effects are only side effects. There is such a fear that I can’t even go out into the streets, that the Jesus Prayer does not help. Even the doctor doesn't know what to do.

With endogenous depressions, so-called states of resistance sometimes occur, i.e. when there is no response to the ongoing drug therapy. However, in last years Antidepressants with a different mechanism of action appeared, as well as fundamentally new antipsychotics, which have an officially registered indication for the treatment of prolonged and chronic depression in combination with antidepressant therapy.

I suffer from long depressions, however they sometimes stop. During depression, there is no strength. And most importantly full confidence in the futility of prayer and any movement, and it is impossible to move, the body and soul strive only for peace. I don't know if a doctor can help in this case.

But the most the main problem- this is my son. He does not want to do anything, he is 13 years old, and he asks why I gave birth to him. In the diary, two deuces a day, comments due to behavior, due to being late, due to chronically unfulfilled lessons, bad relations with classmates. We perish, our souls perish together. What to do?! (But I am the spiritual daughter of Father Gleb, there is no way for me to justify myself before God!)

I think that your problem should be divided into two problems (although they are interconnected). The first problem is with your health and the second with your son.

With regard to the first, well-chosen antidepressant and supportive therapy allows minimizing the manifestations of depression and more calmly, more rationally treating the problems with the son. In pubertal (adolescent) age, children often have similar problems, which are gradually leveled out in the future.

Hello, Vasily Glebovich!

A year and a half ago, I lost my husband and daughter in a car accident.

For the third month I have been treated by a psychiatrist for depression, a manifestation of which he considers my panic attacks. He believes that a year of mourning is a lot, then pathology. But I don’t believe that longing for loved ones can be drowned out with pills, and I can’t imagine that it can turn into “ bright sadness“.

Natalia

Dear Natalia! Of course, longing for loved ones cannot be “drowned out with pills”, and a year of “mourning” is not a pathology, the opposite would be pathology.

But now you especially need the support of your loved ones, participation in church sacraments, and …. in drug therapy. Without drug support, it will be even more difficult for you.

Help you Lord.

Vasily Glebovich, good afternoon! Sorry for the long question.

She grew up in a family where there were frequent scandals and very tense relations between her parents. At the institute, I was overworked and fell ill with depression. At the age of 19, I was raped and beaten in a hostel. After that, the depression worsened, sonapax was prescribed, it helped well.

Later she got married, but her relationship with her husband was bad. After 1.5 years, her husband was killed. After that I started strong fears, she could not stay at home alone and sleep, she was afraid of evil spirits. She was in a mental health research center, taking neuroleptics and antidepressants. The condition has improved. I started to become churched.

I am now married again and have a child. But the depression seems to have remained, and besides, I can’t get rid of intimate problems. Sometimes obsessive pictures of rape and sometimes the death of her husband pop up. Sometimes there are flashes of fear - in the dark or when alone. I sleep badly, tired, irritable, anxious. I often turn to my confessor, but he cannot help me with all these problems. What to do? I don’t really want to take pills again, it’s scary to go to a sexologist.

Tell me, please, whom to turn to (maybe an Orthodox psychologist?). I would be grateful for any information.

Regards, Anastasia

You write that you do not sleep well, are tired, irritable, anxious, disturbed by intrusive memories - i.e. have symptoms of depression.

I would not rule out the possibility of taking a small course of modern antidepressant therapy. At a minimum, it is necessary to normalize sleep.

There are Orthodox psychologists, contact me by email. mail ( [email protected])

Hello, Vasily Glebovich! After giving birth, I became very nervous, I'm afraid of everything. Almost immediately, tears well up. Please advise if anything can be done about this.

Good afternoon What you experience is experienced by approximately 15-20% of women in the postpartum period. This condition is temporary and is called postpartum depression. However, so that it does not become protracted, it is necessary to go to an appointment with either a psychotherapist or a psychiatrist.

In these cases, mild antidepressants are prescribed or, if you are breastfeeding, then herbal preparations.

Obsessive Compulsive Disorders

Hello! Tell me, how to deal with obsessive-compulsive disorder (OCD) in the spiritual life? For example, it is very difficult to follow the prayer rules (if I don’t do it by accident, anxiety and palpitations set in). How to deal with suspiciousness and endless repetition of rituals in the ritual side of church life?

On the one hand, you need to ask your confessor to bless you to fulfill the volume of the prayer rule that you can afford. On the other hand, a course of modern antidepressant therapy will allow you to reduce your suspiciousness and anxiety.

I was diagnosed with OCD and prescribed antidepressants, but I think it’s necessary to take pills, especially such ones. Maybe it's better to ask God for healing?

I think the best thing to do is to pray, ask your loved ones to pray for your health and… be sure to take antidepressants.

Neurosis

In the summer there was a situation: I could not sleep all night, because suddenly, when I went to bed, an inexplicable horror surged, so that even speech was not complete for a while - I could not pronounce the words of prayer. And then, sometimes to a greater, sometimes to a lesser extent, a specific fear of death persisted.

After that, sometimes in the evenings there was something similar, but in a much milder form. The other day, too, suddenly rolled such a fear. It became better after I read “Let God Arise” and signed himself and the space around with the sign of the cross.

For more than two weeks, heart problems (feel strong heartbeat, heaviness, it is difficult to lie on the left side, sometimes it is difficult to stand). True, thank God last days got better. But on some site they wrote to me that the problems are not with the heart, but it's just a neurosis.

In addition, there is often a state of ... I don’t know what to call it - despondency, depression ... Sometimes even despair - that I am not correcting myself, I am not fighting sin. Probably, this is already a spiritual area, and not a psychic one, but this state is sometimes very depressing ...

I would be very grateful for your attention and help! Save you Christ!

You correctly wrote on some site that it is a neurosis. More precisely - a depressive state with panic attacks.

This condition is temporary, it is successfully treated, contact either a psychotherapist or a psychiatrist. Help you Lord!

Hello! Tell me what the following manifestations of neurosis may be associated with: I am primarily concerned about unusual and inexplicable sensations in the upper part chest- as if it tightens either the skin or the muscles of the chest, while there is practically no subsiding pain, pulling, bursting, pressing, as if drilling, and precisely in the chest area. The doctor says that these sensations arise on the basis of nervous exhaustion(I have certain endocrine disorders, which only exacerbates the situation).

The doctor (psychiatrist-psychotherapist) treats me mainly with medication, but the drugs help only for a while (sonapax gave a very persistent side effect in the form of pain in the mammary glands, Azafen, if it brought benefits, was only short-term).

Of course, these are not all the symptoms, but from the bodily manifestations, these are the main “problems” that torment me almost every hour. There is also irritability, fussiness, aggression towards other people and other similar emotional manifestations.

The doctor diagnoses - neurasthenia. Let it be. But to my regret, so far the treatment has not brought persistent positive results(quite the contrary), which certainly brings even more mental anguish and reduces the level of productivity at work (it is very hard to work, although I like my job and really don’t want to lose it).

Once again I will outline my questions: what is the cause of unusual “nerve” pains in the chest area? what can be done to eliminate them?

Thank you for your attention!

It is difficult to answer these questions precisely and unambiguously, there are too many different complaints.

As for the specific symptom - unusual pain in the upper chest - their causes can be different: physical sensation anxiety, which is often accompanied by tension in various muscle groups, including the chest; feeling of vital anguish in depression; causeless sensations of mental genesis (the so-called senestopathy).

Azafen and sonapaks do not exhaust all the possible remedies that can help you. Talk to your doctor and discuss the possibility of using more modern drugs.

obsessive states

Hello Vasily Glebovich.

I've been living in hell for 5 years now. Obsessive thoughts with terrible scenes of fornication. Fear that children will be raped. It began with the fact that I was sitting at home with small children, there was a slight depression. I watched a terrible program on TV and was very scared for my children. I don’t sleep: from evening to four in the morning, a struggle with thoughts. Fear that I'm a maniac, etc. I am saved by prayer and the temple, but the relief is weak for two days, and then all over again.

Tell me what's wrong with me? I can not do it anymore. If not for faith, I would have committed suicide long ago. What should I do?

Thank you.

Conditions like yours, with a predominance of obsessive ideas, are successfully treated. See a psychiatrist, don't worry.

Hello, Vasily Glebovich!

My brother has suffered from obsessive-compulsive disorder since childhood.

He has a family and a high-paying job, but every day he starts by calling my father and controls him all day out of fear that something will happen to my father. Once he was greatly frightened by my mother, who herself has a number of phobias. In addition, the brother has a psychopathization of character in the form of emotional restraint.

Family happiness is under threat, there are no children yet. He received no treatment.

My father and I are praying for him, asking him to go to church, confess, take communion. I think that the brother avoids going to church because of the large number of superstitions and fears that accompany novice Christians on the path of churching.

On duty, he spends every two weeks of the month in Moscow. Please advise where to start. Is it possible to overcome this kind of disease with the help of the sacraments? Where to find a good priest in Moscow or Novosibirsk?

Help God! Thank you.

You write that at present the brother avoids going to church, which is apparently due to his illness. In any case, he needs to seek help from a psychiatrist or psychotherapist. Clear progress has now been made in the treatment of these conditions.

Since childhood, I have had two phobias: fear of the dark and of heights.

Faith helps with the first. In a difficult moment, I remember the words of the Apostle Paul, “If God is for us, who can be against us?” and the fear goes away.

The second one is more difficult.

IN early childhood I had a dream in which I fall from the roof of a tall building, land on my feet and remain unharmed. Since then, at a height, I have a wild desire to jump (at the same time, thoughts of suicide do not arise). What can you recommend?

Thank you!

In fact, you are worried about the so-called. contrasting obsessions, i.e. obsessions that are contrary to the desire of a person. At religious people they are often manifested by "blasphemous thoughts", for example, the desire to shout out a cynical phrase in the temple.

As a rule, contrasting obsessions reflect those fears that a person represses and never wants to realize in real life. Perhaps that is why people never implement them. You shouldn't be afraid of them. Cognitive-behavioral therapy can help to cope with them.

Schizophrenia

Hello!

I am a medical student. In the cycle of psychiatry, we were shown many times patients with schizophrenia, whose delusions often had a bright religious coloring in them - for example, the patient himself claims that he is “possessed by demons”, or that he “prays to pagan gods”, they “answer” him, etc.

Treatment - haloperidol, i.e. productive symptoms are removed.

Tell me, are they really “just” mentally ill? Is it possible to distinguish a schizophrenic from a possessed? Is the Kandinsky-Clerambault syndrome just a sign of the paranoid stage of schizophrenia or something else?

Hello dear Katerina Sergeevna!

Congratulations on starting your study of psychiatry! I hope you will agree with me that this is the most interesting and most difficult medical specialty.

The Kandiski-Clerambault syndrome is indeed typical of schizophrenia, for the diagnosis of which it does not matter whose voices the patient hears.

Patients draw the subject of delusional constructions from the reality surrounding them. I had a patient who in one attack heard the "voice of the crocodile Gena", in another - dark forces.

"The syndrome of impossibility" occurs in mental illness (as the subject of a delusional plot), and in special spiritual states.

With endogenous psychoses, which have their own patterns of course, this syndrome is interconnected with other psychopathological disorders.

In spiritual states, this syndrome also has its own characteristics, described in patristic literature and by our contemporaries. At one of the classes in pastoral psychiatry, together with the priests, we analyzed one endogenous patient with this syndrome. Their conclusion is that his statements are a classic manifestation of mental illness (Sch.).

For approaches to the differential diagnosis of these conditions, see my lecture "Psychiatry and Spiritual Life" (https://www.website/psixiatriya-i-duxovnaya-zhizn) and the article "The Church and Psychiatry - History and Modernity", Alpha and Omega Journal ”, 2008, No. 1 (51), pp. 218-232 (Bogoslov.ru http://aliom.orthodoxy.ru/arch/051/vgk.htm).

I wish you to join the ranks of Orthodox psychiatrists.

Hello, Vasily Glebovich!

My brother has schizophrenia. The diagnosis was made 15 years ago. I went to the doctor for 5 years, then stopped.

He does not consider himself sick. He takes the medicines that the doctor last prescribed him. He refuses to go to doctors, he also refuses to take other medicines, he does not consider himself sick, he does not work, he does not communicate with people. Recently, obsessions have begun to appear in him, moreover, more and more new ones appear, and the old ones also remain. Turned into a psycho. dispensary, a doctor came, but could not do anything. What can we relatives do in such a situation?

All that relatives can do in this situation is to persuade the patient to come into contact with doctors.

Over the past 5-7 years, many new drugs have appeared that are much better tolerated. Patients are more willing to accept treatment. Judging by your description, the disease is clearly progressing, so act.

Is it possible for a person with a mental illness (schizophrenia) in a state of remission to do mental work (Jesus Prayer) in accordance with patristic instructions?

Yes, it may be available.

However, it must be remembered that "smart doing" must be carried out under strict spiritual guidance. It is the confessor who must bless the reading of the Jesus Prayer in one volume or another, which is determined both by a person’s spiritual maturity and his spiritual state at the moment.

Remissions in schizophrenia are of different quality: in some cases, one can conditionally speak of "recovery", i.e. about the complete absence of any positive and negative symptoms with a high level of social and labor adaptation, in other cases, residual hallucinatory-delusional experiences with disability persist. But even in the latter case, it is possible (moreover, it can be very important) “smart doing”.

Hello, Vasily Glebovich! My name is Alexandra. I was diagnosed with schizophrenia. Thank God I only had one seizure. I read that one of the consequences of this disease is the degradation of the human volitional sphere. I felt it myself. In addition, my mental abilities have declined. How is it possible for an Orthodox believer to fight this phenomenon, and is it even possible? And one more thing: there is a constant fear of relapse, because its probability is high, how to deal with this fear?

Dear Alexandra!

After the first attack, as a rule, there is a rather long (up to 1.5-2 years) stage of remission formation, during which there is a gradual restoration of the body, including cognitive (i.e., intellectual) functions. So, there is hope that the degradation described by you is a temporary phenomenon. There is a risk of relapse the only way to avoid it - taking preventive therapy.

Hello, Vasily Glebovich. My name is Alexandra.

Let me tell you my medical history.

It all started, in my opinion, from the beginning of my churching. I was quite active in church. Six months later, I began to hear voices. At first it was gentle voices calling me by name and talking to me. Then I began to show signs of charm. I thought it was God talking to me. I had ideas of my own holiness. It also seemed to me that my relatives wanted to kill me. The voices became more and more demanding. At the peak of my illness, I ran barefoot to church, and then the voices ordered me to jump out of the window.

They put me in a mental hospital. When I was taken to the hospital, it seemed to me that I was in the Kingdom of God. When I was in intensive care, I saw “angels”, open skies, raved about religious topics. While I was in the hospital, I had a heavy feeling of the close presence of the devil. I was diagnosed with schizophrenia.

My questions are: to what extent can we say that it was a charm, and to what extent it was a disease? After all, if it was an illness, then how to explain the phenomenon of voices, and in general the religious context of my illness, and if it was charm, then why did I get out of this state exclusively with medical drugs, because I didn’t have any spiritual guidance during the illness and six months after it? It turns out that one of the impetuses for the disease was my churching, can churching be called the cause of the disease?

Dear Alexandra, the condition you endured is described in all textbooks on psychiatry and is called oneiroid. It has a purely painful character and is successfully stopped by neuroleptic therapy. It is very important that the disease, with such hyperacute attacks, is characterized by a favorable course with minimal severity of the so-called negative disorders.

However, you cannot completely relax and you must definitely take preventive treatment. The risk of recurrence is extremely high. Auditory (verbal) hallucinations (more precisely, pseudo-hallucinations) you had, including the so-called imperative (ie commanding) character, which is very dangerous. Thank God, you were detained at the window. In these states, patients, as a rule, consider themselves messiahs, rulers of the world, saviors of mankind, etc. and so on. Very often there are various religious themes. Charm, as a spiritual state, it was not.

You write that you were "actively churching" before that. Your churching was unusually fast precisely because you were already at the initial stage of the disease, at which people very often come to church or convert to sects. In such cases, relatives often say that "a person fell ill because of coming to the Church or turning to a sect." Those. everything is completely confused - what is the cause, what is the effect.

But in any case, everything that happens in a person's life happens according to the will of God. I have patients who, after suffering a similar attack, turned to the Church and truly became churched.

Professor Dmitry Evgenievich Melekhov suffered a similar state (see about him in my speech on the site) after leaving the state of anesthesia, in connection with a complex operation. He experienced the feeling of a solemn service and assessed it in this way: “from the point of view of the clinical and psychophysical level of understanding, it was a oneiroid state at the exit from a violation of consciousness at the crisis end of a serious state of intoxication. And nothing more. From the point of view of the spiritual level of judgment, this was a truly given great encouragement and consolation, which made it possible for the first time to realize this entire period as a time of “visitation” (Compare Luke 19:44: “You did not know the time of your visitation”).”

Other diseases

Hello Vasily Glebovich! Can you please tell me if there is a cure for autism? And how can a person fight this disease?

Autism means immersion in the world of subjective experiences with a weakening or loss of contact with reality and a corresponding change in emotional contact with people around.

Autism is considered as a manifestation of an endogenous disease, and autistic and autistic-like disorders are distinguished in childhood. These states are very different and, accordingly, the prognosis is also very different. At the same time, in some cases, it is possible to achieve very serious success in the rehabilitation of these patients. The main direction in the management of these patients is education and/or rehabilitation of social skills.

Alcoholism

Please tell me how to help a relative? He is 25 years old, has recently begun to abuse alcohol, is aggressive, has strong binges on weekends, does not work, blames everyone for his problems, believes that he is the most righteous of all people, that he has no one to communicate with, because everyone is stupid. Sometimes he says that he is a god or a king, and sometimes that he is a nonentity and a failure.

He is not going to be treated, he does not want to go to the temple either. How to talk to him, whether to give him money and food, whether to take him to the doctor forcibly, is it possible that he has a mental illness?

Based on your description, a mental illness is possible, but your relative has no legal basis for involuntary (compulsory) treatment. We need to persuade him to see a specialist.

Of course, it is necessary to feed, given the painful nature of his condition, but it is better to refrain from giving money.

Taking antipsychotics

Dear Vasily Glebovich! The psychiatrist recommended, along with the continuation of treatment with neuroleptics, to cleanse the body of toxins (for example, according to the method of Nadezhda Semenova). There are occult terms in this method, which is alarming. Are there any non-soulful (or at least neutral) methods of cleansing the body? And I would like to know your opinion about their applicability in psychiatry.

In psychiatry, they use various methods detoxification in the presence of severe side effects of neuroleptic therapy. For this purpose, it is applied infusion therapy(i.e., droppers are placed), therapeutic plasmapheresis is performed, vitamin therapy (multivitamins such as neuromultivit), various antioxidants (drugs such as Mexidol), and drinking plenty of water is recommended.

Dear Vasily Glebovich!

I kindly ask you to help resolve some issues related to the treatment of my adult godson (21 years old) ... He has been under the supervision of psychiatrists for several years, takes various antipsychotics, and several times a year goes to the dispensary to relieve acute conditions, with which he is at home cope hard. And the questions are:

1. To organize a correct spiritual life Orthodox Christian sobriety, "constant wakefulness over oneself" is necessary, however, some antipsychotics (for example, Kopiksol / Clopixol) cause and sedation, that is, the suppression of consciousness, albeit partial. What precautions should be taken by the patient and his relatives in this case?

2. Since August of this year, the godson has been taking Clozapine along with strong antibiotics. There is a noticeable improvement in his condition, but at the same time, cases of infectious diseases… Could this be a consequence of switching to this drug? How can you fight it?

3. Sometimes, the source similar diseases there are not only organic, but also spiritual problems… How can one “get to the bottom” of them? Is it worth it, and if so, how to do it right?

Save me, God! Dimitri

Dear Dimitri! Clopixol is one of the highly effective modern antipsychotics. It has a not very pronounced sedative effect, which in some cases is necessary, in other cases it is considered as a side effect. In such cases, the confessors of the Lavra, Archimandrites Kirill and Naum, gave their blessing to shorten the daily prayer rule.

I don't quite understand why your godson was given additional antibiotics. Clopixol does not cause immune suppression. Your godchild's disease is endogenous, i.e. its occurrence is not connected with his personal spiritual condition. Information necessary for communication with persons with mental disorders can be found on the website of the National Center for Health and Human Development of the Russian Academy of Medical Sciences in the section for non-specialists (http://www.psychiatry.ru)

Personality disorders

Vasily Glebovich, my husband is a former Afghan, and also spent some time in a colony. I would say mentally unhealthy. He periodically has breakdowns into “offended aggressiveness on everyone and everything” (or only on me, when it does). In absentia, 2 psychiatrists said that most likely it was a personality disorder.

He does not want to go to either a psychiatrist or a psychologist. At one time, he agreed to drink magne B6 (advised), but the post office immediately stopped, because. this made him angry (again there was a breakdown and he repeatedly shouted: “then you are sick and you need to be treated in a mental hospital).

Probably the only way to maintain some kind of relationship is to live in his house with a minimum of necessary valuable things (when he breaks down, he either breaks things, or threatens to break, or blackmails with those things without which I cannot go to work, for example) and at the time of breakdowns go to your house ...

I don’t have any questions, I just would like to know what you think about all this, and is there any way to save the family, or there is nothing to save.

The thing is that when he starts another breakdown (even though it has become much less frequent, only once every few months, and he doesn’t seem to break anything anymore, he just resentfully reprimands me how bad I am and can only scatter things and throw something invaluable), I remember those first breakdowns, when he beat, humiliated, broke - and I can’t stand a single minute, I just pray that he would come out somewhere soon and I could close the door. I am immediately pounding, and my body is trembling. He leaves, I close the door, he goes to live in his house and lives there until the end of the breakdown. Then he comes and asks for forgiveness. ... This is usually the picture.

At the moment, everything is finally heading towards a divorce, although I don’t want this, I don’t see any other way out.

The mental disorder described by you at the husband is really similar to disorder of the personality with periodically arising states of a decompensation. You write that "from year to year his breakdowns are getting smaller." You have been living with your husband for several years, all these years you have suffered his breakdowns, and now that they have begun to occur much less frequently ... everything is “going to a divorce”.

The situation remains unclear.

Address to the psychiatrist and ask him to write out drops of neuleptil for your husband. In situations like this, they can be very effective in preventing relapses.

Character and behavior

Hello, Vasily Glebovich!

I am disturbed by recurrent bouts of anger, irritability-hysterics (?!) young man with whom I am dating and currently living together.

During the “attacks”, he starts screaming, waving his arms, tearing off curtains, throwing stools, breaking plates, howling in an inhuman voice. Then this state turns into uncontrollable crying, so that his head begins to shake (perhaps lower jaw, but, in my opinion, the whole head is shaking, as if he were having a chill). Having stopped crying and yelling, he remains angry for a long time, then (usually after sleep) comes to his senses, begins to make amends, to apologize.

When asked why he was angry, he replies, “I don’t know.”

I am especially frightened by the fact that this really happens “out of nowhere”….

Sincerely, Nadia.

Dear Hope!

The condition you describe is correctable. While it is still possible, you should demand in an ultimatum form that your young man would go for a consultation with a psychiatrist (psychotherapist). Naturally, he must go along with you, so you must explain to the doctor what the problem is.

Your support means a lot to him.

Hello! I am 28 years old, I suffer a lot from the fact that I often feel embarrassed and blush, especially in unfamiliar companies. Only when I get used to people do I become more relaxed. It really bothers me at work and in life. I sometimes want to express my opinion, but I know that I will definitely blush. It also frightens those around me, it seems that they didn’t ask anything like that, but already all in “paint”. Sometimes I am offended, right to tears. Can you please tell me how to deal with this?

Fears that are associated with communication are called social phobia. Its treatment is quite real, but it takes time. Ideally, the more and more often you are around people, the more likely it is that this fear will fade away. But, given the fact that it is often painful to start active social communication, doctors usually prescribe at the beginning of treatment drug therapy(tranquilizers, antidepressants). Only a qualified psychiatrist-psychotherapist can choose an adequate treatment regimen.

Hello, dear Vasily Glebovich!

Tell me what's wrong with my husband. He is 29 years old, I am 30. During the day he is at work, advising people. Behaves quite adequately. In the evening he comes home for dinner and leaves.

This is repeated every evening. Arrives late at night or in the morning. He says that in the evenings he is drawn to go somewhere, that he is tired of people, including me, his parents, he wants to be alone. He says he drives alone, sleeps in the car.

We don't have children. We live separately from our parents.

About a year ago, my husband got into a car accident. After 2 months, he changed jobs, left government agencies. Hot-tempered, has recently become suspicious.

Recently, there was an informal relationship with a lady (going to a cafe, he says that things didn’t go any further and that the relationship had ended. Before that, I had a conversation with him. I asked him to be honest with me, end the relationship with the lady. In return, I will stop control of his location, telephone conversations, SMS messages, etc. He agreed.If this is really not a lady, then what is the matter with him?

Save you Lord!

To decide whether it is a mental or psychological problems or a situation of betrayal, this information is not enough. You need (always with your husband) to get an appointment with a family psychologist who can determine further tactics.

Good afternoon Tell me how to help a child who is very acutely experiencing any, even a minor failure, up to the refusal of any activity at all.

The child is 7 years old, went to school. In situations where things don't work out or don't work out, he shuts down and it's very hard to get him to keep going, or try again, or do something else for the time being. he believes that nothing will work anyway, since it didn’t work out right away. Thank you.

Your child needs your special support. It is necessary to find an occupation for him in which he could achieve some success relatively quickly (for example, modeling, drawing, learning a foreign language from a familiar teacher, etc., etc.).

Hello!

I am a student and in the group I am surrounded by people with whom I have to communicate quite closely, but they are not very pleasant to me, or rather their jokes. They offend me, but if the guys see my displeasure or resentment, they say that I am offended by trifles, there is no sense of humor, etc., while such jokes in relation to themselves, both on my part and on the part of each other, are perceived as inappropriate or manifestations of malice. Alone, you can communicate well with everything, but when I am in the company of these certain people, they seem to pull my strings on purpose, and no matter how I try to control myself, in the end I can no longer turn off what was said past my ears and I get a conflict . They rarely act like this with each other because they all have quite explosive personalities, but in our company they think it's the other way around and that I'm the most nervous.

Avoid contact with them the best option, but how to learn this art of self-control ...?

I go to church, take communion several times a year, and pray, but so far my soul is too weak for such attacks.

Thank you in advance!

Dear Nikolay! You have some character traits that make it difficult for you to communicate with classmates. As a rule, these problems with age and with a change in the circle of communication are gradually leveled.

Difficulties in communication, apparently, are also related to the fact that your interests are much deeper and more multifaceted than the interests of your peers. With the problems you describe, if they remain as pronounced, it would make sense to consult a psychologist.

Even with one kind native person(nieces) enmity, hostility and anger arise, how to deal with it? I try to pray for her, but sometimes such hatred flares up in my heart that I have no strength.

You do not write what is the reason for your attitude towards your niece. Maybe the reason is in you, and not in her? And you need to pray for both.

Tell me, please, is it a change of mood, up to a complete loss of critical perception of one’s actions, uncontrollable hysteria, screaming, nervousness, insomnia, feelings of hatred and the manifestation of verbal aggression towards others, lasting from several hours to 2-3 weeks due to natural regular hormonal fluctuations in female body, as well as for any physical trauma, reminiscent of themselves outwardly or with pain, an abnormal manifestation of mood? Should this be given attention from a medical point of view, or are there improvised ways to deal with such outbursts, if in the normal state the senselessness, causelessness and absurdity of such unrest is obvious?

Thank you. Sincerely, Elizabeth.

Dear Elizabeth!

It is quite obvious that the experiences you describe are painful and need medical correction.

You need to strictly observe the regime of work and rest, provide the body with the necessary nutrients, vitamins and minerals. Some dietary restrictions must be observed. For example, in the second phase of the cycle, it is recommended to limit the intake of coffee, tea, animal fats, milk, salt, spices, chocolate, tea, caffeine, alcohol. Benefits from exercise and sports. beneficial effect give a general massage.

Keep a calendar (chart, diary, or any other form of record keeping) of the symptoms that bother you. The calendar should include the following information: symptoms that bother you, the number (or day of the cycle) of each symptom, the severity of each symptom (for example, on a scale of 1 to 5), observation should be carried out for at least 2-3 months

If lifestyle and nutritional changes have not improved your condition, you should seek medical help. In these cases, antidepressants and anxiolytics are prescribed, as well as homeopathic therapy (including the drug mastodion).

Good afternoon If a person is emotional, impressionable and takes “to heart”, he worries. How can you deal with such emotionality and impressionability. Is it possible to read moods or something else in addition to prayers and church sacraments? How do you feel about Sytin's moods?

Sytin's moods are not Christian in spirit, they are based on the exaltation of one's "I". Turn to your confessor and ask him to give you advice on “doing smart” (reading the Jesus Prayer). (On the official website of G.N. Sytin it is said that he is four times Doctor of Science (medical, philosophical, pedagogical, psychological).

Vasily Glebovich, is it possible for an adult to get rid of onychophagia on their own, without contacting a psychotherapist? Is there an experience of getting rid of such dependence in Orthodoxy?

The experience of a special "Orthodox" deliverance from onychophagia is not known to me. These conditions are usually successfully treated. Some time ago, a nun approached me with this problem; against the background of small doses of medications, all the symptoms disappeared.

Sexual deviations, sexual relations, marital problems

Tell me, please, is it possible to find an Orthodox sexologist? We have a problem in our family, but the sexologists whom I contacted on the Internet gave answers that are poorly compatible either with our faith or with a specific situation.

In general, it all comes down to the fact that we do not have intimate life, the husband does not want. And I'm tired of reading, incl. in Christian literature about marriage, about how the physical side of marriage is more important for men than for women, and how a woman should give in and accept it ... in our family it is the other way around.

Unbelieving sexologists are beginning to look for a problem in the fact that we were both virgins before marriage. The husband refuses to seek help. And, of course, they advise me either to come to the reception with him, or, since he does not go, to cheat on him.

I used to look for problems, including in myself. Not because I suffer from a guilt complex, but because I know that everything is more difficult in marriage, and that we cannot but influence each other while living together, in a family. I am sure that somehow it is possible to change the situation for the better, even if I come to the appointment alone, because the changes in me will help my husband too. It is very difficult for me to live the way we live.

You write about some problems in your intimate relationships, which reflect the general level of marital relations. I would advise you to address together to the family psychologist. Unfortunately, I don't know an Orthodox sexologist.

I really loved the man. But he deceived me and left me later. I would be glad to forget him on the same day. But it turned out the opposite. The heart does not forget, I think about him all the time, I have already prayed a lot, and the worst thing is that I don’t perceive other suitors. How can I be?

I think it takes time. WITH similar problem many face. You need to switch to something - go on an interesting tourist or pilgrimage trip (now there is a seasonal price reduction), take on some obedience in the parish, start attending fitness, study foreign language etc. and so on. Over time, a person will appear to whom you will pay attention.

Hello! Is there such a psychological concept as the fear of marriage and how can we deal with it? The young man is 28 years old, loves his girlfriend, has been dating her for 7 years, does not want to lose her, but is terribly afraid of being a husband, father, and suffers from the fact that he cannot cross the inner barrier. His parents have been married all their lives and he has always had material wealth. He himself does not mind turning to a psychologist for help.

Thanks in advance for your reply!

The fear of marriage has not yet been described. There is gynecophobia (fear of women), erotophobia - fear of intimacy, etc.

I think that a young person has the so-called anxious and suspicious character traits, due to which it is difficult for him to make one of the most important decisions in life. He really needs to see a psychologist. However, if he has a confessor, it may be enough for him to bless him for this act.

The bifurcation between actions and beliefs - how long can it continue until it undermines mental strength? What is fraught with the life of a married person who cannot now participate in all the sacraments of the church, although this is the norm in his family, in the conditions of an office romance of “incomplete intimacy”, but permanent?

You need to gain courage and repent, otherwise, over time, you will have to turn to a psychiatrist.

Hello!

Vasily Glebovich, please tell me whether such sexual deviations as homosexuality, lesbianism, etc., are mental illnesses? Does modern psychiatry recognize these deviations as a disease? If so, what sources can be cited?

Thank you! With great respect, Anatoly. Krasnodar city.

Most psychiatrists consider homosexuality a gross pathology, a disease. A homosexual is an individual with a disorder in emotional sphere incapable of forming normal heterosexual relationships.

In the reference book on psychiatry (M., "Medicine", 1985), homosexuality is described in the section "sexual perversions", which is given the following definition - "the pathological orientation of sexual desire and the distortion of the forms of its implementation."

However, under the influence of threats of physical violence and calls for organizing social unrest, the American Psychiatric Association (APA) in 1973 excluded homosexuality from its Diagnostic and Statistical Manual (DSM), that is, from the list of mental disorders. Later, in 1992, the WHO also removed "homosexuality" from the list of diagnoses.

In the current International Classification of Diseases 10th revision (ICD-10), in section F 66 “Psychological and behavioral disorders associated with sexual development and orientation” there is a note: sexual orientation itself is not considered a disorder. "Gender identity disorders" (F 64) include transsexualism, dual role transvestism. Disorders of sexual preference" (F 65) include fetishism, exhibitionism, voyeurism, pedophilia, sadomasochism, etc.

However, not all professionals in the US share the point of view recommended by the APA board. The result of this was the creation in this country of a national association for the study and therapy of homosexuality, abbreviated as NARTH (National Association for Research and Therapy of Homosexuality). This happened back in 1992. This association was founded by Charles Socarides, Benjamin Kaufman and Joseph Nicolosi. C. Socarides became its president, and the psychologist D. Nicolosi, the founder of the Thomas Aquinas Psychological Clinic, became its vice president.

Naturally, most well-known clinical sexologists in Ukraine and Russia also do not consider homosexuality to be the norm. Among them are professors V.V. Krishtal, G.S. Vasilchenko, A.M. Svyadoshch, S.S. Liebig.

Problems in children

Hello! My son is 2.9 years old. I had a severe fright during my pregnancy. preterm birth, but a very long period of exile, although doctors say it is within the “normal range”.

The child is vulnerable and sensitive, perhaps due to the fact that she was shaking over him in infancy, because. up to eight months, constant crying because of the stomach, cured only when they turned to a good doctor. Perhaps, according to the temperament, he is prone to tantrums (there is someone). Main problems:

Often incomprehensible tantrums, it is difficult to switch, distract. It's even hard to figure out why. Panic fear of other people, especially acutely responsive to touch when they greet him or want to pick him up. I was afraid to go myself, although I knew how and went already at 1.4, when I “forgot”. I was afraid of the vacuum cleaner. I think that I am to blame for many of his fears, I was afraid that he would be afraid.

2. Jealousy for the younger brother 9 months, mainly for parental attention and for toys. How to melt his heart?

3. Delay in speech development (says short words about 40-45, does not add up sentences). We were at the neuropathologist. Treatment prescribed: 1 month. cogitum 1 ampoule per day, glycine - 3 times a day, 1 tablet, Nervochel - 3 times a day, 1 tablet.

We have almost completed the course, there are results, every day at least 1 new word, it has become much calmer, tantrums have been greatly reduced.

But recently, after a massage, they decided to do it to my younger brother, too, so that he would develop faster, on the first day he screamed, pulled his arms and legs very much, climbed on me, although the masseuse was well known and he always smiled at her. Then they distracted him, on the second day they distracted him with varying success, but most of the time he screamed. What more benefit or harm from such a massage?

How to respond to prolonged tantrums? How to increase the contact of the baby and reduce aggression towards his brother - can he hit or hug very tightly that the youngest is crying? Whether it is possible to repeat this medical course and through what time? Perhaps we need to undergo some examinations, do we need to contact any doctors? Save you Lord!

In the cases described by you, the massage is cancelled.

When the child is 3 years old, you need to contact a child psychiatrist (up to 3 years, psychiatrists do not look at children).

In connection with the “jealousy” of your son for his younger brother, which happens often, he needs to be given maximum attention from you and from your husband. Sometimes you need to walk with him separately, play separately, make interesting trips separately.

On the American Childhood Stress Scale, the birth of a younger brother is considered moderately stressful. There is a point of view that a child needs to be prepared for the appearance of a brother from the very beginning of pregnancy.

Good afternoon, dear Vasily Glebovich! I have a very attached daughter to me - now she is 4 years old (the only child in the family).

Pregnancy and childbirth were difficult, soon after the birth of the child, a divorce from her husband followed. The child does not go to the garden, the grandmother sits with her. The child is smart, developed - but at the same time emotional, impressionable.

At the age of 3, I had to leave home for the first time for the night - immediately after my departure, she began to cry, scream, complain about her stomach - and so long and hard that my grandmother called an ambulance. Doctors did not find any health problems. Then the child had a fear of going to the toilet for some time. After our joint vacation, everything went away.

A year later, at the age of 4, the child was taken to a developmental circle. From there she returned sad (she said that one of the teachers did not like it). Complaints about her stomach began again, by the night she was already screaming, she could not sleep - they called an ambulance, examined her - everything is in order with her health. After that, for several more days and nights she screamed loudly with complaints about her stomach, then for several more nights she did not sleep due to the fact that she had insomnia, like adults: she woke up at 3 am, could not sleep, cried because this. Then gradually everything came to naught (it lasted about 1.5 weeks in total). The dream resumed.

Doctors say she is in good health. Those. is it psychosomatic? Is it something dangerous? What would you suggest?

Nothing dangerous happens to your child. Similar phenomena in children, in one form or another (for example, frequent urges urination), are not rare.

However, you must understand that in a few years the child needs to go to school, i. to join a new unfamiliar team, and she needs to be prepared for this. After some time, she must be enrolled either in some sports activities (rhythmic gymnastics), or in some circles, or so that she begins to attend Sunday school. At the same time, the main thing should be the personality of the teacher, and not "sports or other successes." You must be sure that he is attentive and kind to children. If you do not prepare the child for school, she may have serious problems adapting to the new team.

Reader responses

Save you Lord!

https://www.site/psixiatriya-i-duxovnaya-zhizn/

It so happened that I read it at a time when I had a certain temptation, part of which was the weakening of faith. So, after reading the article, faith just dropped to a critical level, it was terrible.

Later, when the temptation was over, I wondered why the article had such an effect on me?

After several days of reflection, I came to the conclusion that the article imperceptibly, implicitly, but “shifted the focus” - from spiritual reasoning to spiritual reasoning, from God to man.

Perhaps here Archimandrite Raphael Karelin has harsh wording http://karelin-r.ru/faq/answer/1000/4289/index.html, but he clearly expressed the essence: “In some critical cases, psychiatrists can help with chemical drugs, which have a sedative effect, but THE MAIN MEANS OF HEALING IS LIFE ACCORDING TO THE GOSPEL AND PRAYER "

It is this basis, hope in God (in my opinion) that is not traced in the article, unfortunately ...

I also decided to express some of my impressions / thoughts:

1. The psychiatrist in the article looks like some kind of independent and self-sufficient figure, the article gives the impression that there is a certain area where the priest (and God) are redundant: there is the “chief” doctor - while God is practically not mentioned anywhere, one gets the feeling that God the doctor is “not needed”, He is somehow “forgotten” - the doctor copes well with the help of his knowledge, medicines, etc. It turns out that the sphere of a psychiatrist (even an Orthodox one) somehow “does not include” God ...

2. Quotes: “The sphere of the human spirit, the disease of the human spirit, is the sphere where the spiritual doctor, the priest, heals. The sphere of the human soul is the sphere in which the psychiatrist heals. "When we talk about mental illness, then there are very different states. In one case, priority belongs to a psychiatrist and the patient is not shown communication with a priest, moreover, it can even lead to an aggravation of his condition ... after this acute condition passes, we try, if possible, to invite a priest.” Those. it turns out that for a certain period of time (in this case, an exacerbation of the disease), the patient does not need a priest - only a doctor can help. And the prayers of the priest, of the Church, will they really be “superfluous” in this situation? (not to mention the fact that for an Orthodox person, prayers, hope in God's help should be the main ones). Of course, both medicines and doctors are needed (Trust in God, but don't make a mistake yourself). But the prioritization should not be violated: THE MAIN THING IS PRAYER TO GOD, AND MEDICINES TO HELP. And not vice versa..). And then there is a feeling that the doctor of God is already beginning to replace at some points ...

3. Quote: “In our church environment, the functions of a psychologist, especially a family psychologist, are ideally performed by a priest. And besides him, no one can perform this function better, especially if a person goes to confession and his wife too.” Again, the focus has been shifted: it is not the priest who “performs the functions of a psychologist” (including during confession) – this is the Lord, incl. through the priest saves a person, shows help.

Forgive me for daring to express my thoughts - but I considered it my duty, as a believer, to write all of the above - perhaps you will be interested in such "feedback".

I ask for your prayers!

R.B. Elena

Dear Elena!

I beg your pardon that my article plunged you into a state of despondency. This article is my speech made in the Church of the All-Merciful Savior b. Sorrowing Monastery at a meeting with readers of Pravmir and the editors. Father Alexander Ilyashenko was present at the meeting and we were right next to the altar with him. Apparently in connection with this, in my speech I did not dwell on issues that seemed completely obvious to me in the Orthodox audience. Any work that a Christian begins must be preceded by prayer. When someone gets sick, at the beginning you need to pray to the Physician "of soul and body", and then go to the doctor who was sent by the Lord. It is quite obvious that in an Orthodox environment, if a person ends up in a hospital, everyone tries to pray for him. Recently, in one nunnery (that day, one of the sisters of the monastery was supposed to have an operation) at the liturgy, I heard a prayer for both the sick woman (name) and her surgeon (name), that "The Lord helped him perform surgery."

Now I will try to explain what we (Orthodox psychiatrists) mean when we say that in psychiatric practice “in one case, the priority belongs to the psychiatrist and the patient is not shown communication with the priest, moreover, it can even lead to an aggravation of his condition ... after As soon as this acute condition passes, we try, if possible, to invite a priest.” This position was formulated back in the 19th century by Russian and German psychiatrists. The instructions for employees at the Moscow district hospital for the mentally ill (M., 1907) say that ... "in addition to the immediate duties of church service, the priest conducts a spiritual conversation with the patients of the hospital, on which he will be directed by the medical staff" (i.e. not with all patients of the Orthodox faith).

How can you invite a priest to a patient who is in an acute psychotic state with psychomotor agitation, aggression and declares that he is the Antichrist? Or vice versa, declares that he is Christ? One of my patients (Orthodox), asserted with force that he was both Christ, and Buddha, and the god of the Aztecs. It is clear that this delusional disorders and they are, by definition, not amenable to persuasion, but only to treatment. The patient must be prepared for the meeting with the priest. Obviously, if the patient has Orthodox relatives, then they will pray for him all this time, this is natural. I recall the words of Archimandrite Tavrion (from the desert, near Riga), who said that if a person close to you cannot take communion at this time, then you yourself should take communion more often. Many doctors (including non-believers) can tell from their practice cases when the course of the disease does not fit into its main canons, and explain this only by someone's prayer.

Now regarding the statement of Archimandrite Raphael Karelin. His position formulated in the website you indicated, in the words of His Holiness Patriarch Alexy II, is not just “a private point of view of one very respected priest”, but is in complete contradiction with the official position of the Russian Orthodox Church on this issue, set out in the “Fundamentals of the Social Concept” and adopted at the Bishops' and Local Councils. Also, Father Raphael has specific statements on pedagogy.

For the treatment of psychosis, neuroleptics are used, in which the sedative effect is not the main one, and some modern antipsychotics(eg Abilify) do not have a sedative effect at all. Their mechanism of action is much more subtle.

For many years Archimandrite Kirill (Pavlov), confessor of the Lavra, sent patients to us at the Center. He referred not only psychotic patients, but also patients of the “borderline” level. When we asked him why he sends patients to psychiatrists, he said that they receive spiritual healing from him, and "pills should also be taken."

If a person refuses medical treatment for any serious illness ( acute infarction myocardium, endogenous psychosis, etc. etc.) and demands a miracle from God - then this is a state of either delusion or insanity. Let us remember what Christ said to the devil, who tempted him and demanded a miracle: "...do not tempt the Lord your God." The power of God is perfected in weakness (see 2 Cor. 12:9), including through doctors and medicines.

No need to tempt the Lord and demand a miracle from Him, but you need to pray and go to the doctor ...

St. Theophan the Recluse wrote: “Is it to be treated? Why not get treated? ... disgust from the doctor and medicines - a reproach to God.

And finally, in relation to my statement that “in our church environment, the functions of a psychologist, especially a family psychologist, are ideally performed by a priest. And besides him, no one can perform this function better, especially if a person goes to confession and his wife too.” It is generally accepted that confession includes the actual sacrament of repentance and counseling. The sacrament of repentance is accepted by the Lord, the priest is only a witness. However, a spiritually experienced priest, based on his own spiritual experience and the experience of the Church, can give instruction, spiritual advice on how to overcome this or that sin or family problem, especially if he knows all family members. And most importantly, he will support everyone with his prayer.

Once again, I apologize to you that my article plunged you into a state of despondency.

I ask for your prayers.