Mental illness does not block the road to God. Sexual deviations, sexual relations, problems in marriage

According to the World Health Organization, by 2020 depression will become the most common disease in the world. Many call it an epidemic of the 21st century, although Hippocrates also described a condition called “melancholy.” What is depression, why does it occur and how to deal with it? Answers these and other questions psychiatrist, Doctor of Medical Sciences Vasily Glebovich Kaleda, Deputy Chief Physician of the Scientific Center for Mental Health Russian Academy medical sciences, professor at PSTGU.

Vasily Glebovich, what are the signs of depression and how to recognize it?

Depression (from the Latin deprimo, meaning “oppression”, “suppression”) is painful condition, which is characterized by three main symptoms, the so-called depressive triad. Firstly, this is a sad, melancholy, melancholy mood (the so-called thymic component of depression), secondly, motor or motor retardation, and finally, ideational retardation, that is, a slowdown in the pace of thinking and speech.

When we talk about depression, the first thing we think about is a bad mood. But this is not enough! The most important sign illness - a person loses strength. Outwardly, his movements are smooth, slow, inhibited, and mental activity is also disrupted. Patients often complain of a loss of meaning in life, a feeling of some kind of dullness, internal slowdown, it becomes difficult for them to formulate thoughts, and they feel as if their head is completely empty.

Characterized by a decrease in self-esteem, the emergence of the conviction that a person is a complete failure in life, that no one needs him, that he is a burden to his loved ones. In this case, patients experience sleep disturbances, difficulty falling asleep, often have early awakenings or the inability to get up in the morning, decreased appetite, and weakened libido.

The clinical manifestations of depression are very diverse, so there are quite a lot of its varieties, which in appearance can be very different from each other. But one of the main characteristics of depression is its severity: it is relatively mild - subdepression, moderate depression and severe depression.

If at mild degree illness, a person remains able to work and this mood does not greatly affect his daily life and sphere of communication, then moderate depression already leads to loss of strength and affects the ability to communicate. At severe depression a person practically loses both ability to work and social activity. With this form of depression, a person often experiences suicidal thoughts - both in a passive form and in the form of suicidal intentions and even suicidal readiness. Patients suffering from this form of depression often attempt suicide.

According to a WHO study, about 90% of all suicides on the planet are committed by patients with various mental disorders, of which about 60% suffered from depression.

With severe depression, a person endures unbearable mental suffering; in fact, the soul itself suffers, the perception of the real world narrows, it is difficult - or even impossible - for a person to communicate with his relatives and loved ones, in this state he may not hear the words of the priest addressed to him, he often loses life values, which he had before. As a rule, they already lose their ability to work, because the suffering is very severe.

If we talk about people of faith, they commit suicide attempts much less often, because they have a life-affirming worldview and a sense of responsibility before God for their lives. But it happens that even believers are not able to endure this suffering and commit irreparable things.

From sadness to depression

How to understand when a person is already starting to feel depressed, and when he is “just sad”? Especially if we are talking about close people, whose condition is extremely difficult to objectively assess?

When we talk about depression, we mean a specific disease that has a number of formalized criteria, and one of the most important is its duration. We can talk about depression when this condition lasts for at least two weeks.

Each person is characterized by states of sadness, sadness, despondency - these are normal manifestations human emotions. If some unpleasant, traumatic event occurs, then normally an emotional reaction to it appears. But if a person has a misfortune, but he does not get upset, this is precisely a pathology.

However, if a person has a reaction to a traumatic event, then normally it should be adequate to the level of the event that occurred. Often in our practice we are faced with the fact that a person has experienced a psychotraumatic situation, but his reaction to this situation is inadequate. For example, being fired from a job is unpleasant, but reacting to it with suicide is not normal. In such cases, we talk about psychogenically provoked depression, and this condition requires medical, medication and psychotherapeutic support.

In any case, when a person experiences this long-term condition with a sad, sad, depressed mood, loss of strength, problems in comprehension, loss of meaning in life, lack of prospects in it - these are the symptoms when you need to see a doctor.

Depression “for no reason”

It is important to understand that in addition to reactive depression, which occurs as a reaction to some kind of traumatic situation, there are also so-called endogenous depressions, the causes of which are purely biological, associated with certain metabolic disorders. I had to treat people who are no longer alive and who can be called ascetics of the 20th century. And they also had depression!

Some of them had endogenous depressions that arose without any visible, understandable reason. This depression was characterized by some kind of sad, sad, depressed mood, loss of strength. And this condition went very well with drug therapy.

That is, believers are also not immune from depression?

Unfortunately no. They are not immune from both endogenous depression and psychogenically provoked depression. It must be borne in mind that each person has his own special level of stress resistance, depending on his character, personality traits and, of course, worldview. One of the greatest psychiatrists of the 20th century, Viktor Frankl, said: “Religion gives a person a spiritual anchor of salvation with a sense of self-confidence that he cannot find anywhere else.”

"Christian" depression

When we talk about people of faith, in addition to the above symptoms associated with mood and lethargy, there is a feeling of being abandoned by God. Such people will say that it is difficult for them to concentrate on prayer, that they have lost their sense of grace, that they feel on the verge of spiritual death, that they have a cold heart, a petrified insensibility. They can even talk about their own special sinfulness and loss of faith. And that feeling of repentance, the degree of their repentance for their sinfulness will not correspond to real spiritual life, that is, to the real misdeeds that such people have.

Repentance, the sacraments of Confession and Communion are those things that strengthen a person, instill new strength, new hopes. A person who is depressed comes to the priest, repents of his sins, takes communion, but he does not experience this joy of starting a new life, the joy of meeting the Lord. And among believers, this is one of the main criteria for the presence of a depressive disorder.

They are not lazy

Another important complaint of a person suffering from depression is that he does not want to do anything. This is the so-called apathy, loss of desire to do anything, loss of the meaning to do anything. At the same time, people often complain about a lack of strength, about rapid fatigue - both during physical and mental work. And often those around them perceive this as if the person has become lazy. They tell him: “Pull yourself together, force yourself to do something.”

When such symptoms appear in adolescence, the relatives and stern fathers around them sometimes try to influence them physically and force them to do something, not realizing that the child, the youth is simply in a painful state.

One thing worth emphasizing here is important point: When we talk about depression, we say that it is a painful condition that arose at a certain point and caused certain changes in a person's behavior. We all have character traits, and they usually accompany us throughout our lives.

It is clear that with age a person changes, some character traits change. But here’s the situation: before, everything was fine with the person, he was cheerful and sociable, he was engaged in active work, was studying successfully, and suddenly something happened to him, something happened, and now he looks somehow sad, melancholy and dreary, and there seems to be no reason for sadness - here there is reason to suspect depression.

Not so long ago, the peak of depression was between the ages of 30 and 40, but today depression has become dramatically younger, and it often affects people under 25 years of age.

Among the types of depression, the so-called depression with “youthful asthenic failure” is distinguished, when the manifestations of a decline in intellectual and mental strength come to the fore, when a person loses the ability to think.

This is especially noticeable among students, especially when a person is successfully studying at the institute, has completed one course, a second, a third, and then there comes a moment when he looks at a book and cannot understand anything. He reads the material, but cannot comprehend it. He tries to re-read it again, but again he can’t understand anything. Then at some stage he gives up all his textbooks and starts going for walks.

Relatives cannot figure out what is happening. They are trying to influence him in some way, but this condition is painful. At the same time there are interesting cases, for example, “depression without depression,” when the mood is normal, but the person is motorally inhibited, he cannot do anything, he has neither physical strength nor desire to do anything, his intellectual abilities have somehow disappeared.

Is depression from fasting a reality?

If one of the signs of depression is the loss of physical ability to work and think, then how safe is it for people with mental work to fast? Can a man, working in a responsible position? leadership position, feel good eating porridge or carrots? Or, for example, a woman accountant who has a reporting period during Lent, but no one has canceled her household duties? To what extent can such situations cause stress and lead a weakened body after winter to depression?

Firstly, the time of fasting is not a time of hunger strike. As it were, lean food contains sufficient quantity substances necessary for the body. An example can be given a large number of people who strictly observed fasting and at the same time fulfilled the serious responsibilities assigned to them.

I remember Metropolitan John (Wendland) of Yaroslavl and Rostov, who, of course, led an entire diocese, metropolis, and who had a unique dish during Lent - semolina on potato broth. Not everyone who tried this lean food was ready to eat it.

My dad, Father Gleb, always, as far as I remember, strictly fasted, and combined fasting with serious scientific and administrative work, and at one time he had to travel one and a half to two hours one way to his place of work. There was quite a serious physical load, but he coped with it.

Now, in general, fasting has become much easier than 30 years ago. Now you can go to any supermarket, and there will be a huge selection of dishes marked “Lenten product”. Recently, seafood has appeared that we did not know before, and a large number of frozen and fresh vegetables have appeared. Previously, in childhood, relatively speaking, during Lent we knew only sauerkraut, pickles, and potatoes. That is, there was no current variety of products.

I repeat: fasting is not a time of hunger strike and not a time when a person simply follows a certain diet. If fasting is perceived only as adherence to a certain diet, then this is not fasting, but just fasting diet, which, however, can also be quite useful.

Fasting has other goals - spiritual ones. And probably, here each person, together with his confessor, must determine the measure of fasting that he can really endure. People may be spiritually fragile or, for one reason or another, begin to fast very strictly, and by the end of the fast they have exhausted all their physical and mental strength, and instead of the joy of Christ’s Resurrection, they become tired and irritable. Probably in such cases it is better to discuss this with your confessor and, perhaps, receive a blessing for some weakening of the fast.

If we talk about us, about people who work, then in any case, lean food differs from regular food in that it is more “labor-intensive”. In particular, regarding cooking, it needs to be cooked longer and in larger quantities. Not every person at work has a buffet that offers lean food or at least close to lean food. In this case, a person must somehow understand what kind of fasting he can endure and what his personal fasting will consist of.

My dad once gave an example - his spiritual daughter came to him (it was the beginning of the nineties or the end of the eighties). She lived with unbelieving parents, and it was very difficult for her to fast at home; it caused constant conflicts with her parents and tension in the family situation.

It is clear that because of these conflicts, people did not approach the bright holiday of Easter in a festive mood at all. And dad told her, as an obedience, to eat absolutely everything that her parents prepare at home. Just don't watch TV. As a result, after Easter, she said that it was the hardest fast of her life.

Probably, those people who, due to some circumstances, find it difficult to fully observe fasting in relation to food - and all of us - need to set some individual goals during fasting. Everyone knows their weaknesses and can impose some feasible restrictions on themselves. This will be a real fast, which has primarily spiritual goals, and not just abstinence from food, a diet.

You and I must always remember that Orthodoxy is the joyful fullness of life in Christ. Man by nature consists of three parts: from spirit, soul and body, and we must strive to ensure that our lives are fulfilling and harmonious, but at the same time the spirit must dominate. Only when a person’s spiritual life dominates is he truly mentally healthy.

Interviewed by Lika Sideleva (

– I would like our conversation to be useful to those who intend to seek help, but for some reason hesitate, or to the loved ones of such people. We all know that in society there are certain “horror stories” associated with psychiatry - let’s try to, if not dispel them, then at least talk 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 beyond the pale of society. So the first question is: how many people suffer from mental illness?

– Mental disorders are quite common. According to available data in Russian Federation they affect about 14% of the population, while about 5.7% require psychiatric care. We will see approximately the same numbers in European countries and the USA. It's about about the whole spectrum of mental disorders.

First of all, we need 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 take first place in the world in terms of incidence. Almost 40-45% of severe somatic diseases, including cancer, diseases of the cardiovascular system, post-stroke conditions, are accompanied by depression. Approximately 20% of women in the postpartum period experience depression instead of the joy of motherhood. We can immediately mention that severe depression in some cases, in the absence of medical assistance, leads to death - suicide.

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

The problems of autism have recently become particularly relevant in childhood(current incidence is 1 case in 88 children). Very often, when parents begin 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 Russian Federation remains high specific gravity persons suffering from alcoholism and drug addiction.

Currently, due to changes in the general lifestyle and the stressful nature of our lives, the number of borderline mental disorders has increased. The prevalence of so-called endogenous mental illnesses, associated primarily with genetic predisposition rather than 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 affects approximately 1% of the population.

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

– Raising the question of the shamefulness 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, completely definite meaning. Let us remember the words that we must show respect to every person as the image of God, regardless of the position he occupies and the state in which he is: “And the blind, and the leper, and the mentally damaged, and the infant, and the criminal I will show respect to the criminal and the pagan as an image of God. What do you care about their weaknesses and shortcomings! Watch yourself so that you do not lack love.” This is it Christian attitude to a person, no matter what disease he suffers. Let us also remember the attitude of Christ the Savior towards lepers.

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

In the psychiatric literature, the problem of destigmatization of the mentally ill is very seriously discussed, that is, changing society’s attitude towards the mentally ill and developing 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 a request for help to any medical specialist. The diagnosis of “schizophrenia” is not a death sentence; this disease has various forms of progression and possible outcomes. Modern medications can qualitatively change the course and outcome of this disease.

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

Here, at the Scientific Center for Mental Health, there are many examples where people, having fallen ill in adolescence, 20-25 years later have and have had a fairly prosperous family and high social status, married, they have children, they have made a successful career, and some even in science, managing to defend dissertations, receive academic titles and recognition. There are also those who have made, as they say now, a successful business. But you need to understand that in each case the prognosis 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, treatment medicines. Just like the sick diabetes mellitus The first type requires insulin injections.

Therefore, no independent attempts to cancel therapy are acceptable; 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 especially his loved ones, may not understand for a long time what is happening to him. How do you understand that you can’t 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 at the monastery was to allow her not to take medication. The patient's condition worsened. Then Mother Abbess got her bearings, they began to specifically monitor the intake of medications, but even 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 are very serious. biological basis with significant genetically determined disorders. Attentive and caring care is, of course, very important, but still required professional help doctors.

Unfortunately, many people do not realize how serious this disease is. One can recall the tragic death in Pskov in 2013, 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 Pustina 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 life, about their own greatness, about their guilt); they often say that they hear “voices” inside their heads - commenting, ordering, insulting. They often freeze in bizarre poses or experience states of psychomotor agitation. Their behavior towards relatives and friends changes, unreasonable hostility or secrecy may appear, fear for their lives with taking protective actions in the form of curtaining windows, locking doors, meaningful statements appear that are incomprehensible to others, adding mystery and significance to everyday topics. Often patients refuse to eat or carefully check the contents of 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 anything to him, or ask clarifying questions. Not only does this not work, but it can also worsen existing disorders. If he is relatively calm and in the mood for communication and help, you need to listen to him carefully, try to calm him down and advise him to see a doctor. If the condition is accompanied strong emotions(fear, anger, anxiety, sadness), it is acceptable to acknowledge the reality of their object and try to calm the patient.

– But we are afraid of psychiatrists. They say “they’ll kill it, it’ll be like a vegetable,” and so on.

– Unfortunately, in medicine there are no drugs that treat serious diseases and have no side effects at all and cannot be. Hippocrates spoke about this even before our era. Another thing is that when creating modern medicines, the goal is to ensure that side effects are minimal and extremely rare. Let's remember cancer patients who experience hair loss due to appropriate therapy, but manage to prolong or save their lives. For some connective tissue diseases (for example, systemic lupus erythematosus) hormone therapy, against the background of which people become pathologically overweight, but life is preserved. In psychiatry, we are also faced with serious illnesses when a person hears voices inside his head, like a radio turned on at full blast, which insult him and give various orders, including in some cases to jump out of a window or kill someone. A person experiences fear of persecution, influence, threat to life. What to do in these cases? Watch a person suffer?

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

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

This problem is especially pronounced in cases where the theme 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 humanity from spiritual death, from the economic crisis. Often they are sure that they must suffer - and, unfortunately, there have been cases when patients with religious messianic delusions committed suicide for delusional reasons, sacrificing themselves for the human race.

Among religious psychoses, states with dominance of delusions of sinfulness are often encountered. It is clear that awareness of one’s sinfulness for a believer is a stage of spiritual life when he realizes his unworthiness and sins, thinks seriously about them, confesses, and receives communion. But when we talk about delusions of sinfulness, a person becomes obsessed with the ideas of his sinfulness, while his hope for God’s mercy and the possibility of forgiveness of sins disappears.

You and I remember that the most important thing that is required of a person who is trying to live a spiritual life is obedience. A person cannot impose penance on himself, cannot fast in any special way without a blessing. This is a strict rule of spiritual life. In any monastery, no one will allow any young worker or novice, with all his zeal, to fulfill the full monastic rule or the rule of a schemanik from the very beginning. They will send him to various obediences and clearly tell him the amount of prayer work that is useful 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 severity of his sins, does not understand his condition. When the priest sternly tells him that he does not allow ten akathists to be read 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 on. This is often accompanied by the fact that a person begins to actively fast, Lent passes, Easter comes, he does not notice that he can rejoice and break his 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, there are many cases where patients with delusions of sinfulness due to extreme exhaustion ended up in intensive care units due to a threat to their lives. At the Scientific Center for Mental Health, we observed cases where patients with depressive delusions of guilt and sinfulness attempted to commit suicide and murder of their loved ones (extended suicide).

– Returning to the topic of fear of psychiatry. Of course, we have hospitals - especially in remote provinces - that you really wouldn’t want anyone to end up 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 care. This is a general medical problem. Unfortunately, we have many examples when a person, having certain symptoms, delays seeing a doctor, and when he finally does, it is too late. This also applies to the popular ones today. oncological diseases– the patient almost always says that he started having certain symptoms a year, a year and a half, two years ago, but he didn’t pay attention to them and brushed them off. We see the same thing with psychiatry.

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

There are also deep depressions with suicidal thoughts, which are very difficult to experience. In this state, a person is so bad that he does not hear what others say to him - he cannot perceive their words due to his illness. It’s so difficult for him mentally and psychologically that he doesn’t see any meaning in this life. It happens that he experiences excruciating anxiety, worry, and at this stage nothing may hold him back from an antisocial act - neither his loved ones, 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 line between when a person expresses thoughts about suicide and their implementation is very thin. Furthermore, severe depression at this age it may not appear outwardly: it cannot be said that the person is melancholy or sad. And yet he can say that life has no meaning, express the idea that it is better to leave life. Any statements of this kind are grounds for showing the person to a specialist - a psychiatrist or psychotherapist.

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

– I read in your interview about your dad, Archpriest Gleb Kaled: “He told me how important it is that there are believers among psychiatrists.” And we can read about the same thing in his letters, when he blessed the suffering to regularly confess and receive communion and find Orthodox psychiatrist. Why is this so important?

– Yes, Father Gleb really said that it is very important that there are believing psychiatrists. The psychiatrists he knew were Professor Dmitry Evgenievich Melekhov(1899-1979) and Andrey Alexandrovich Sukhovsky(1941-2012), the latter of whom then became a priest. But Father Gleb never said that you should only turn to believing doctors. Therefore, in our family there was such a tradition: when we had to seek medical help, we first had to pray to the Doctor with a capital D, and then humbly 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 would send them reason and give them the opportunity to make the right decision. Need to find good doctors, professional, including when it comes to mental illness.

First you need to pray to the Doctor with a capital P, 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 psychosis, talking with him about some religious aspects is sometimes not entirely indicated, if not contraindicated. In such states, there is simply no way to talk to him about some lofty matters. Yes, at a further 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 to have a confessor who supports a person who understands the need for treatment. We have a lot of competent, professional psychiatrists who respect a person’s religious beliefs and can provide highly qualified assistance.

– How can one generally evaluate the state of domestic psychiatry in the context of world psychiatry? Is she good or bad?

– Currently, the achievements of psychiatry, which are available all over the world, are publicly available to any doctor in any part of the world. If we talk about psychiatry as a science, we can say that our domestic psychiatry is at the world level.

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

It must be said that now in our country there has been a certain approach to changing the organization of psychiatric services. We have an underdeveloped outpatient department - the so-called neuropsychiatric dispensaries and offices of psychiatrists and psychotherapists, which exist in some hospitals and clinics. And now great emphasis will be placed on this link, which, of course, is completely justified.

– As we have already said, mental illnesses occur quite often, and a priest in his pastoral work has to meet people who have mental disorders. There are more such people in the Church than in the average population, and this is understandable: the Church is a doctor, 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 absolutely necessary. Such a course is currently available not only at PSTGU, but at the Moscow Theological Academy, Sretensky and Belgorod Theological Seminaries. The need for this subject in pastoral training programs was once discussed by Professor Archimandrite Cyprian (Kern) and many other outstanding pastors of the Church.

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

So that the priest knows that, as stated in - and this is an official conciliar document - there is a clear distinction between the scope of his competence and the competence of a psychiatrist. So that he knows the features of pastoral counseling for people 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 also cared for by an experienced confessor.

Psychiatrist. Professor of the Department of Practical Theology of the Orthodox St. Tikhon's Humanitarian University. Deputy development director and innovation activity, chief researcher of the department for the study of endogenous psychoses and affective states of the Scientific Center for Mental Health. Doctor of Medical Sciences

Psychiatry and religion

Psychiatry

Victoria Chitlova:

Hello, dear friends. The “Psi-Lecture” program, and our guest is Vasily Glebovich Kaleda, Doctor of Medical Sciences, psychiatrist, professor of the Department of Practical Theology at St. Tikhon’s Orthodox Humanitarian University, Deputy Director for Development and Innovation at our National Center for Humanities. There is also the chief researcher of the department for the study of endogenous psychoses and affective states. Hello, Vasily Glebovich!

Hello, Victoria!

Victoria Chitlova:

I am very glad that you are with us today. Vasily Glebovich, please tell us how you developed your interest and your activities in this direction?

If we talk about how my interest in activities in the field of psychiatry and religion was formed, it is connected with the personality of one unique psychiatrist of the 20th century, Dmitry Evgenievich Melikhov. This name is very widely known, he was one of the patriarchs of Russian psychiatry of the 20th century, and now his name is very often remembered at ongoing conferences and congresses, everyone remembers him. He was a friend of my grandfather's youth and a friend of our family. I remember him very well, and, probably, under his influence I became a psychiatrist, and under his influence this interest in problems of psychiatry and religion was formed.

Victoria Chitlova:

But you are also a scientist, and your work is related to the study of endogenous psychotic states, including in young men. Are religious themes found within these states?

If we take the last decade, then religious themes are very common among our patients - both adolescence and adulthood. The fact is that mentally ill people, when problems arise, always look for where they can find help and support, and very often they turn to religion, to religious values. On the other hand, when a person experiences such a psychotic state, a delusional state, then within the framework of his delusional experiences, the information that he draws from around him is very often refracted. It could be a film that he recently saw, he suddenly becomes a character in this film, “Avatar,” for example, there was such a film, and quickly a human avatar appeared in our department. The same thing happens when a person falls into some kind of psychosis, very often he has delusional experiences associated with religious experiences. He may feel like a messiah, he may feel like a prophet who is called to do something great, glorious. On the other hand, he may consider himself a very great sinner who does not deserve to live, who must die and may even commit suicide.

Victoria Chitlova:

That is, a non-religious person is unlikely to develop a religious plot if he lived among other cultural categories, so it turns out?

If he lived among different cultural strata of society, probably unlikely. But, nevertheless, it turns out that among our patients, those who suffered psychosis in adolescence with religious content, the percentage of people who were believers before is not so large, about 40%, and 60% are people who Before that, they didn’t say that they were believers, well, they were by no means church people. Somewhere, deep down in their souls, they may have been believers, but by no means church people. And the fact that they suddenly have religious experiences in psychosis is a complete surprise for them or for those around them.

Victoria Chitlova:

We have now very intensively tried to penetrate into pathology, but first I wanted to ask you a few introductory questions. Briefly, from a historical point of view, did psychiatry and religion somehow coexist both in the context of world culture and our Russian history?

Naturally, they coexisted both in the context of world culture and Russian culture. If we take any teaching on psychiatry that was written both in the last century and in the 21st century, then all textbooks highlight a separate, so-called monastic stage of psychiatry, starting from the 11th century until the end of the 18th century, until 1775, when Russia was divided into provinces. This stage is called the monastic stage, because it was at this time that our patients found help, support and consolation in monasteries. And it’s even surprising that the first community that helped the mentally ill was the Kiev Pechersk Lavra. In the Kiev Pechersk Lavra, people lived in caves, including the mentally ill. And here in the patericon of the Kiev-Pechersk Lavra we find one of the very first descriptions of the catatonic form of schizophrenia. And later it was in the monasteries that the description of these mental disorders took place.

First of all, violent patients who attracted attention were distributed. And the patients, who, on the contrary, are very passive, who are spinning, were the ones who were paid attention to first of all.

Victoria Chitlova:

What exactly attracted people, and what was the logic behind placing such people or sending them to monasteries?

It was different, that is, at one time it was that these people themselves were drawn to the monasteries, in some era it was that the state officially sent them there. That is, it is clear that the mission of the monasteries, the mission of the church is to help all those who suffer and are burdened.

Victoria Chitlova:

Acceptance, understanding.

Yes, that’s exactly what people with mental disorders are. That is, this is the mission of the social ministries of the church, the social ministries of monasteries. But later, starting with the Council of the Hundred Heads in 1551, the time of Ivan the Terrible, there was a decree to send people possessed by demons and damaged by their minds to monasteries, so that they would not be a hindrance to society and to admonition.

Victoria Chitlova:

And if we talk in modern context, if we take an unbelieving, non-religious cohort of people, and those who are committed to some religion and actively live in it, where will there be more patients with mental pathology?

This is a very interesting question, and the answer here, it seems to me, is quite clear. The Church always positions itself as a doctor. Therefore, by definition, if you and I come to the clinic, where will there be more patients - in the clinic or in the area around the clinic? It is clear that in the clinic. And the church is such a doctor.

Very often people come with family problems, mental problems, and some other conditions. Of course, there are more people there. How much more - here, apparently, in different parishes it is slightly different, different people give slightly different data, special research was not carried out, but this is more, and this is normal, which means the church is a doctor.

Victoria Chitlova:

Our topic is designated as psychiatry and religion, and I am sure that representatives of different faiths are watching us. I think we can discuss the example of the Orthodox religion to make it clear. But do you have any idea of ​​which religions accumulate more mental pathologies?

I am not ready to say that some religions have more and some have less. In any case, all religions have cultural characteristics, some nationalities belong to one religion, others to another. What the classics of psychiatry, starting with Sikorsky, wrote about all the time, what some modern researchers note, is the accumulation of mentally unbalanced people in non-traditional religions. Even in non-traditional directions, non-traditional trends, some semi-sectarian communities.

There is a concentration of mentally unbalanced people in non-traditional religions, non-traditional movements, and some semi-sectarian communities.

Victoria Chitlova:

That is, they somehow gravitate there more. Or, on the contrary, illnesses arise within organizations.

There are two aspects to this. The first aspect is that it often happens to a person who has some kind of mental disorder, he comes and turns to religion. But our diseases have their own patterns. It often happens that a person comes to the initial stage endogenous disease, he came to church, came to some kind of religious community, after a while he develops psychosis. Why did psychosis occur? Because he ended up there in a religious community? It is clear that psychosis is endogenous, this is a regularity. Based on modern concepts, we say that a person may have certain genes that predispose them to the disease. And in order for these genes to manifest themselves, some external factors are needed. Apparently, what Sergei Sergeevich Korsakov also wrote about is that these extreme religious cults often provoke the manifestation of endogenous diseases.

Victoria Chitlova:

This is when a person actively gravitates towards this, which means he is already on these rails, roughly speaking, he has stood on them.

Let's just say that often people who have a tendency, genetic inclinations to mental illness, come to a religious community. If this is a traditional religious community, then it has a psychotherapeutic effect, and there are even very interesting works on this subject. If this is an extreme religious community, then on the contrary, it can contribute to the manifestation of the disease.

Victoria Chitlova:

If a person is healthy and does not experience any subjective problems, should she be committed to some kind of confession in order to protect herself, how do you look at this?

I think this is a personal matter for each person.

Victoria Chitlova:

Does religion have protective properties that will help them protect a person?

The important point is that religion gives a person the meaning of life. And for many people this is very important, that is, many people are faced with the fact that life has no meaning. Many people seek the meaning of life and find it in religion.

Victoria Chitlova:

Some landmarks.

But many people are not looking for any meaning in life; they believe that they live well and are quite happy. This is still a personal choice of each person.

Victoria Chitlova:

Personal choice, absolutely true. Can we outline the range of pathological conditions that clergy encounter? What is found in this environment?

In an appropriate environment, all mental illnesses encountered by psychiatrists can be encountered.

Victoria Chitlova:

Absolutely any, starting with the fact that parents come, they have a child with autism, and they will tell the priest that they have such a problem, that the child has a developmental delay. And it is very important that the priest at some stage says that you still need to consult with specialists. Well, then all the pathology that happens, it can also come into the priest’s field of vision.

Victoria Chitlova:

I think it would be interesting, taking into account your rich practice, to consider what the most common cases are from the point of view of different pathology registries. Exist neurotic conditions, it is known that so-called dissociative or conversion states are not uncommon in religious environments. Can we look at examples of what this is?

It is clear to our viewers that these phenomena occur in a religious environment, but this is a classic example: some exalted person travels to the so-called holy places, before she hears that there are temptations there and all sorts of spiritual problems arise. She goes there and talks about how someone appeared to her there, she saw someone, someone influenced her, someone attacked her, and she heroically fought and fought against it. Here's an example.

Victoria Chitlova:

Can this be called hallucinations, or what is it called from a psychiatry point of view?

From the point of view of psychiatry, we will not call this hallucinations, this is a manifestation hysterical disorder personality. But, nevertheless, clergy in 99% of cases will perceive this as some kind of pathology.

Victoria Chitlova:

This means that the person is impressionable, with an impressionability that is very aroused by the appearance of images. A person heard something somewhere, he begins either to have ideas in his head, or even to sensations. In some cases, there are even serious psychosomatic conversion states, even stigmata. Do you agree with me?

Well, that's about it.

Victoria Chitlova:

Okay, but the clergy perceive such conditions as a deviation from the norm. Our holy scriptures indicate similar situations that actually existed and took place. How should we feel about this?

Here you need to analyze each specific case separately. That is, the traditional approach is that there are individual situations that are described in the lives of saints - those lives that the church accepted as an example of a certain spiritual life. These are exceptional cases. What we encounter in our lives, what priests encounter in their practice, are still cases of a completely different order.

Victoria Chitlova:

Can we say that what is indicated in the scriptures has an uncharacteristic structure for the pathology itself? That is, when we read the scriptures, they lack a number of other symptoms that we would classify. We cannot attribute this to pathological conditions.

Let's just say that we, as psychiatrists, need to have a lot of information in order to make a diagnosis. You still need to communicate with this person, understand what kind of disorder he has, how long it lasted, what preceded it. Accordingly, we, as a rule, do not have this information in the sacred scriptures and lives of saints.

Victoria Chitlova:

We are now in the territory of the so-called borderline psychiatry, a subtle question, let us proceed further. There are so-called obsessive-compulsive disorders. From the point of view of the religious environment, what picture can there be?

A very subtle topic, because very often it is not fully understood. What we call obsessive-compulsive disorders, various obsessions, people do not understand that this is a pathology. People do not understand that obsessions, when they last for a certain time, are already beyond the norm.

People do not understand that obsessions, when they last for a certain time, are already beyond the norm.

Victoria Chitlova:

What are obsessions?

Obsession is such certain obsessive states that are of a violent nature, that arise against the will this person, it’s quite difficult for him to cope.

Victoria Chitlova:

As a rule, these are thoughts, actions?

Thoughts, actions, something like that.

Victoria Chitlova:

So what are we facing?

In a religious environment, there are often blasphemous thoughts. A person, against his will (this refers to contrasting obsessions), has blasphemous thoughts, an insult to a shrine, an insult to religious images, an insult to religious dogmas, an insult to the Holy Spirit. It is very important here that priests clearly understand what it is, that it is a pathological condition and is in no way a spiritual condition. That is, there are cases when a priest misunderstood this condition and did not allow a person to confess or receive communion. Although he had a purely mental condition, it went away very quickly with treatment.

Victoria Chitlova:

This also does not apply to delusional states.

In this case, we are talking about obsessive states.

Victoria Chitlova:

That is, the patient understands that the thoughts are wrong, they weigh on him, but constantly haunt him, right?

Victoria Chitlova:

How often are they found in religious environments? depressive states, and can we talk about suicide?

This occurs in religious environments. In general, we are talking about the fact that we have an epidemic, a pandemic of depression, this is a disease of the 21st century. We're talking about the fact that by the age of 20, we will have almost the most common disease, condition. It also occurs quite often in religious environments. Priests probably face depression most often. Here the priest must understand a clear line where the normal experiences of a person, the experience of his inner world, their spiritual quest, where this is the norm, and where it is pathology. This is a very fine line, and, unfortunately, it is not always possible to understand it.

But we can give examples when the priest was the person who first understood this. I can give an example of one young man who went to see a priest all his life, the young man was 17 years old, at some point he began to have thoughts of suicide. The priest referred him to a psychiatrist, they turned to me, I said: everything is fine, let him come with his parents. The priest said that the parents did not know anything. I say: we need to inform them somehow. The parents came, this was the third child in the family, intelligent parents. I asked them: what’s wrong with the child? They said: we don’t know, the priest directed it, the secret of confession. I started asking to find out if there were any symptoms of depression. They answered, in general, they could not find anything. This is a feature of juvenile depression that very often does not manifest itself outwardly. It happens that a young man throws himself out of a window, but in hindsight no one can understand anything.

I talked with this young man, he immediately said that he was having thoughts of suicide, he had already made some specific attempts, despite all this, in his conversation he already had a complete depressive picture, a feeling of hopelessness, loss of the meaning of life, anti-vital thoughts , sadness, sorrow, anguish. And the parents, even in hindsight, still could not retrospectively identify any symptoms. We can say that this is a normal, full-fledged family. The man survived because the priest intervened. And there are quite a few such cases.

Victoria Chitlova:

Our next question is delusional states in a religious environment. What do they look like, Vasily Glebovich?

It is clear that there are delusional states that are very typical. There is delusion of grandeur, there is megalomaniacal delirium, some consider themselves Jesus Christ, some consider themselves Napoleon, some consider themselves the President of the Russian Federation. This is all clear and understandable, but the topics are different and not even entirely fundamental.

Victoria Chitlova:

Are we talking about schizophrenia?

About delusional states, psychotic ones. But there are conditions that can be very difficult to understand and very difficult to differentiate, the so-called depressive-delusional states. These are very interesting states. A person comes to church, usually a young man or girl, and is completely immersed in a religious environment. I must say that when this happens suddenly, it should alarm everyone. Yes, religious quest is an aspiration normal person. Some people come to church once a year to light a candle, then they come twice a year, then three times a year. And then somehow smoothly, gradually he begins to go often, meets a priest, joins the life of the community, smoothly enters the life of the community and religious life. This is the most normal, harmonious option.

A person comes to church and is completely immersed in a religious environment. I must say that when this happens suddenly, it should alarm everyone.

But there are times when this happens quite abruptly. The man was an unbeliever and suddenly starts going to church. He talks about some of his special manifestations of spiritual life, begins to observe fasts very strictly, that is, as strictly as Orthodox people, church members usually do not observe them so strictly. It’s not even just strictly observing fasts, but somehow excessively. That is, he imposes on himself the fast that people, perhaps, observe in some particularly strict monasteries. And a person lives in the world, a person is 18-20-25 years old. A person begins to pray from morning to evening, he actually begins to pray for many hours, that is, there is a point of view that Orthodox man In the morning he does short prayer rules, in the evening he does short prayer rules, but if he reveals something else during the day, then it is considered good.

If a person was an unbeliever several months ago and begins to pray from morning to evening, the person goes to church, turns to the priest, the priest says that there should be moderation in everything. There must be a measure of prayer, there must be a measure of rest, there must be a measure of work. But the person doesn’t hear this, starts arguing with the priest, says that the priest doesn’t want to be saved at all, he doesn’t want to help me, goes to another priest, and so on. His parents turn to a person: dear or dear, you can’t eat nothing at all, you can’t go to church so much, from morning to evening. The person doesn't hear. And it very often happens that a person brings himself to a state of exhaustion.

There are cases where a person prayed and fasted like this, and it ended in death. And here we understand when these are normal searches of a person, a person is looking for a church, looking for spiritual values, and when this is a pathology, it happens that this moment is missed. That is, the criterion is that if a person comes to church, then he must obey the priest. A person may not get along with a priest, all people are different, everyone wants to find a person who is in tune with themselves, a mentor who is in tune with themselves, but when things go further, this is still not normal. When a person, first of all, is not focused on the search for moral values, but on becoming better, kinder, and more kind to the people around him. And when a person deliberately observes religious rituals, this is already some kind of pathology.

Victoria Chitlova:

How can this pathology be called in our language?

In our language, these are depressive-delusional states with delusional ideas, sinfulness, self-blame, self-abasement.

Victoria Chitlova:

What could they mean?

They can be fatal.

Victoria Chitlova:

Suicide or death of asceticism, hunger, in this sense?

I say that there is a specific fatal outcome, death precisely from extreme exhaustion. Such patients often end up in intensive care units. But delusional suicides already happen when a delusional plot appears, when he considers himself a great sinner, and with some kind of messianic context that he must commit suicide in order to save humanity or to save his loved ones. Unfortunately, we have had such patients.

Victoria Chitlova:

I would like to clarify here for our listeners that such conditions are not necessarily an endogenous schizophrenic process. We consider such conditions, including within the framework, for example, of bipolar disorder, or recurrent depressive disorder, that is, endogenous depression that can reach a delusional level. Do you agree with me?

Like that.

Victoria Chitlova:

But if we talk about purely delusional states, without interspersing a depressive mood. What might this look like? Previously there was demonic possession. What does it look like now, Vasily Glebovich?

Possession by demons still occurs in the church environment.

Victoria Chitlova:

Describe an example in detail.

A person describes that a demon has entered him, they describe it in different ways: for some it entered through the back of the head, for others it came out through the mouth, for others it entered, excuse me, through the anus, this is a specific example. And then the person describes how this demon sits inside him. I remember a patient who described how a demon was sitting and knocking on his liver with its hooves or horns, or something like that. In some cases they describe that the demon controls his thoughts, his actions, his movements. There is such a description.

Victoria Chitlova:

At the beginning of our meeting with you, we talked about dissociative and conversion states, where a person’s impressionability could allow for short-term such states. What is the difference between psychoses and religious delusional content?

I now remember such patients who went to famous places, some to Athos, some to the Holy Land, they described that at some point they came out, there was such a state. The condition lasted a few seconds, maybe not even minutes, then it passed. Those states that we describe as depressive-delusional or delusional states within the framework of psychotic level, are quite stable in nature, long-term character, and they interfere with a person. A person in the fight against demons turns out to be incapable of practical work.

Those states that we describe as depressive-delusional states or delusional states within the framework of a psychotic level are quite stable, long-lasting in nature, and they interfere with a person.

Victoria Chitlova:

That is, it is maladapted, and moreover, there are all the criteria for the syndrome that fit into the diagnosis.

Of course yes.

Victoria Chitlova:

Let's move smoothly to the treatment of such conditions. Let’s say a certain sufferer came to church in the described state. What are the real and desired actions of a clergyman? How often does it happen?

The desired actions of the clergyman are for him to understand that the condition that this person has is pathological, that it is a painful condition. Accordingly, he needs to be advised very gently, so as not to offend or offend him, to go to a doctor, to go to a specialist, to see a psychiatrist.

Victoria Chitlova:

Is it possible to help a person with delirium?

Many priests succeed in this. The fact is that often the authority of a priest in the eyes of believers is very high. In particular, believers come out of obedience: the priest said, that’s why I’m doing this.

Victoria Chitlova:

You have been teaching clergy for a long time, and in addition to this very culture of thinking of a clergyman, which involves acceptance, compassion and help, you directly reveal to them the basics of psychiatry, so it turns out?

Victoria Chitlova:

Tell me, how sensitive is this environment of clergy, do certain issues become an ethnic conflict?

I will say this: I teach at the Orthodox St. Tikhon's humanitarian university, there are a lot of students there who are going to be priests. This is a fairly young contingent, although, as a rule, they are evening students, many have higher education, the vast majority, by the way. And we not only reason theoretically, theoretically one can reason a lot and for a long time, and they will not remember anything from it. The most important thing is that we look at and analyze specific patients.

Victoria Chitlova:

Right in the clinic?

Right in the clinic. We take a depressed patient if it is possible to find a sick believer who will have ideas of sinfulness, not at a delusional level, just within the framework of depression. So they see specific depression, they see where a person is simply thinking about his shortcomings, and where there is depression. We examined patients with delusions without possession, and I must say that the clergy are also present, and I never remember anyone saying that no, this is still a purely spiritual phenomenon, it is not mental. That is, in the first classes I feel that there are people who are a little skeptical. Then by the end we always find complete mutual understanding.

Victoria Chitlova:

Do the clergy have an understanding that we are talking about biology in general, these are no longer some spiritual categories that we are talking about? How is this perceived by the priests themselves?

I won’t say that 100% of clergy have such a clear understanding. In the same way, I will not say that 100% of doctors of all specialties have the same understanding that all our mental illness- this is biology.

Victoria Chitlova:

This is biochemistry.

There was a survey recently, a few days ago data showed that doctors were still talking about the evil eye and damage. But in general there is now such an understanding at a fairly high level that compulsory subject the training of future clergy should include a subject called pastoral psychiatry. There is a very important document of the Russian Orthodox Church. The document is called "Fundamentals" social concept Russian Orthodox Church". This is not dogma, of course, but, nevertheless, this is the status of the document, official document, the official position, which clearly states that the church divides a person’s bodily level, mental level and spiritual level.

Now there is an understanding at a fairly high level that a mandatory subject in the training of future clergy should be a subject called pastoral psychiatry.

Victoria Chitlova:

But Melekhov also said this.

The holy fathers of the church spoke about this, and Dmitry Evgenievich Melekhov only stated their point of view. But by identifying three levels in a person, the church clearly distinguishes between the sphere of competence of a somatologist, the sphere of competence of a psychiatrist and the sphere of competence of a priest. And under no circumstances should we reduce some diseases or some problems to others.

Victoria Chitlova:

Can the clergy discuss details of the patient's thoughts or delusions? Will this not be harmful, is there a position where he should help at this stage?

There is a whole list of conditions when a priest should definitely immediately try to refer a person to a psychiatrist.

Victoria Chitlova:

Do not get involved in the very content of thoughts.

The priest must, on the one hand, understand that this is a serious mental pathology that needs a referral to a psychiatrist; this is the first thing he must understand. Secondly, the priest should not renounce this person under any circumstances. That is, his task is not just to take and redirect - that’s it, I referred him to a psychiatrist, I did my job. His task is to help the person further. Yes, the man went to the hospital, there is no way to leave him, visit him, support him. After he is discharged from the hospital, continue to continue some kind of cooperation, help, and pastoral care with him.

Victoria Chitlova:

Here the clergyman routed the patient to a psychiatric clinic or to an outpatient facility, such as a dispensary. How should a psychiatrist think and behave, what should he know for his part?

For a believer, a priest is a very high authority. He must understand that the person who came to him is a believer; for a believer, his faith is the most sacred. And the doctor to whom such a patient comes must treat his beliefs with very deep respect, on the one hand, and continue to rely on his religious values ​​in his work with this patient. And in many cases it is very important for him to rely on the authority of the priest. And in general, they must cooperate with each other. If there are any issues between them, the priest may consider that the patient is receiving very large doses drugs and so on, that is, the priest should not tell the patient about this that, in my opinion, your doses are too high, let’s halve them, but he should discuss this issue with the doctor. Or if something confuses the priest, you can always turn to another specialist. They must cooperate with each other and develop common tactics.

The priest must support the authority of the psychiatrist, the psychiatrist must rely on the authority of the priest, that the priest has blessed you to do this, the priest has blessed you to be treated with us. Yes, you don’t want to be treated with us, you don’t like the fact that the conditions are not the same or something else, you were blessed by the priest, you must fulfill his blessing.

Victoria Chitlova:

Great, but is there a service in our country or anywhere in the world that combines all this - a priest-psychiatrist?

I know of a priest in Moscow who is the rector of a Moscow church, who comes from a well-known dynasty of psychiatrists. But, nevertheless, in fact, now among his patients there are many people with mental disorders, as far as I know, who are not involved in healing, directly prescribing medications, and so on. But we also have many clinics and hospitals in which priests provide care, who work closely with both medical staff and patients, after all, these are different things - medical work and priestly work, where they work closely, complement each other and decide everything questions together.

Victoria Chitlova:

Our mental health research center on Kashirka has a religious department. There is a study of patients with such conditions. Do doctors themselves also interact directly with clergy?

In some cases they collaborate with priests. That is, it is often the priests who send the sick there, from the monasteries. It is clear that there is contact and these issues are being discussed. But I want to say that in our center there is a temple that was consecrated 25 years ago, a little more, in 1992. And now we will no longer surprise anyone by the fact that the hospital has either a temple or a prayer room. But then it was 1992, that is, it had just collapsed Soviet Union, and in the most leading institution of the Russian Federation, in the scientific center of mental health, a church is opened. At that time, I think it was a state of semi-shock for many. I must say that our church is the first church to be opened in a newly built building. And the Patriarch himself covered it, and leading psychiatrists of the Russian Federation showed that this is very important.

Victoria Chitlova:

Vasily Glebovich, our broadcast is coming to an end. We have highlighted the main milestones that we have planned. The topic is quite broad, you can read additional materials on the Internet, it’s all available. Vasily Glebovich, I have a final question for you - what would you wish for our viewers?

I would wish our viewers spiritual harmony so that they can always calmly decide their internal problems, and there was no need to contact psychiatrists. If such a need arose, then they would understand that our illnesses are not shameful in any way. You need to go calmly and seek psychiatric help.

Victoria Chitlova:

Thank you very much. I wanted to appeal to our colleagues who are also watching us, so that they are more aware, feel more broadly, think more broadly and treat their patients more sensitively. Dear friends, we thank you for your understanding with Vasily Glebovich and say goodbye to you. The next broadcast of “Psi-Lecture” will be released in a week. Vasily Glebovich, I thank you, thank you very much.

Thanks a lot for the invitation.

Victoria Chitlova:

All the best.

Goodbye, all the best.

Victoria Chitlova:

Goodbye, happily ever after.

One of the consequences of the Fall of man is his morbidity (passion), his vulnerability to countless physical dangers and illnesses; vulnerability not only of the body, but also of the psyche. Mental illness is the hardest cross! But a mentally ill person is no less dear to our Creator and Father, and perhaps - due to suffering - even more than any of us. We talk about these people, about their opportunities in the Church, about mental and spiritual health with Vasily Glebovich Kaleda, a psychiatrist, Doctor of Medical Sciences, professor of the Department of Practical Theology at St. Tikhon’s Orthodox Humanitarian University.

You grew up deeply religious Orthodox family, Your grandfather is glorified among the host of Russian holy martyrs and confessors, your father and brothers are priests, your sister is an abbess, your mother also took monastic vows in her old age. Why did you choose medicine and then psychiatry? What determined your choice?

Indeed, I grew up in a family with deep Orthodox church traditions. By the way, my grandfather, holy martyr Vladimir Ambartsumov, who was executed at the Butovo training ground, was born in Saratov; our family has a special spiritual connection with your city, and I am pleased to answer questions from the magazine of the Saratov Metropolis.

However, before becoming a priest, my father devoted many years to geology; my mother dreamed of becoming a doctor, but became a biologist; two of my priest brothers are geologists by first education, and my sisters have a medical education. There were doctors in the family before. Perhaps there is some connection with the name: four Vasilys were in the Kaled family, and all four were doctors. You can say that by choosing medicine, I continued a family tradition.

And the choice of psychiatry is influenced by the father’s personality. Dad had great respect for medicine and singled out psychiatry among all medical disciplines. He believed that the competence of a psychiatrist somewhere borders on the competence of a priest. And he told me how important it is that among psychiatrists there are believers, so that a person, if he or his neighbor needs the help of a psychiatrist, has the opportunity to turn to an Orthodox doctor.

A friend of my grandfather, Hieromartyr Vladimir Ambartsumov, was Dmitry Evgenievich Melekhov, one of the patriarchs of Russian psychiatry. Soon after his death (he died in 1979), his work “Psychiatry and Problems of Spiritual Life” was published in samizdat; my father wrote the preface to this publication. Later this book was published quite legally. Dmitry Evgenievich visited our house, and each of his visits became an event for me, then a teenager. While studying at medical school, I finally realized that psychiatry was my calling. And in the future I never regretted my choice.

What is mental health? Is it possible to say with confidence: this person, even with some problems, is still mentally healthy, but this one is sick?

The problem of norms in psychiatry is very important and not at all simple. On the one hand, each person is individual, unique and inimitable. Everyone has the right to their own worldview. We are so different. But on the other hand, we are all very similar. Life confronts us all with essentially the same problems. Mental health is a set of attitudes and qualities, functional abilities that allow an individual to adapt to the environment. This is a person’s ability to cope with the circumstances of his life while maintaining optimal emotional background and appropriateness of behavior. A mentally healthy person can and should cope with all the difficulties that exist in his life. Of course, the difficulties are very different. There are times that a person seems unable to stand them. But let's remember our new martyrs and confessors, who went through everything: the methods of investigation of that time, prisons, hunger camps - and remained mentally healthy people, mentally healthy. Let us also remember the greatest psychiatrist and psychotherapist of the twentieth century, Viktor Frankl, the founder of logotherapy, that is, a branch of psychotherapy based on the search for the meaning of life. Frankl founded this movement while in Nazi concentration camps. This is the ability healthy person cope with all the trials, in other words, temptations that God sends him.

It follows, in essence, from your answer that faith is either the most important condition, or, let’s say, an inexhaustible source of mental health. Any of us believers, thank God, people, personal experience he is convinced of this. We would perceive our difficulties, sorrows, troubles, losses completely differently if we were not believers. Newfound faith takes our ability to overcome suffering to a completely different level, impossible for a non-believer.

We cannot but agree with this! A person’s ability to overcome difficulties depends on his worldview and worldview. Let's return to Viktor Frankl: he said that faith has a powerful protective ability, and in this sense no other worldview can compare with it. A man of faith more stable than a person who has no faith. Precisely because he perceives these difficulties as sent by the Savior. In any of his misfortunes, he seeks and finds meaning. In Rus', it has long been customary to say about trouble: “The Lord has visited.” Because trouble makes a person think about his spiritual life.

If we still talk not about the norm, but about the disease, then it is important to understand: a severe, genetically determined mental illness can develop in any person - regardless of his worldview. Another thing is borderline mental disorders that arise in people with certain character traits and, again, with a certain worldview. It is in these cases that the patient’s worldview is of great importance. If he was brought up in a religious environment, if with his mother’s milk he imbibed the conviction that life has a higher meaning and suffering also has meaning, this is the cross that the Savior sends to a person - then he perceives everything that happens to him from this very point of view . If a person does not have such a view of life, he perceives every test, every difficulty as a failure in life. And here I can confidently say: borderline-type disorders and neurotic diseases are much less common in people who lead a full spiritual life than in non-believers.

You teach pastoral psychiatry. What is the essence of this subject? Why is it necessary when training future shepherds?

Pastoral psychiatry is a branch of pastoral theology associated with the characteristics of counseling for persons suffering from mental disorders. This requires coordination of efforts, collaboration between the pastor and the psychiatrist. In this case, the priest is required to understand the boundaries of mental health, which we just talked about, and the ability to recognize psychopathology in time and make an adequate decision. Mental disorders, both severe and border level, are common: according to medical statistics, 15% of the population suffer from one or another disease of this kind, the only question is the degree of severity. And people suffering from mental illnesses tend to turn to the Church, to priests. That is why in the church and parish environment there are relatively more people with these problems than the average population. This is fine! This just means that the Church is a healer, both mental and spiritual. Any priest has to communicate with people who have certain disorders - I repeat, the degree of severity may vary. It often happens that it is the priest, and not the doctor, who becomes the first person to whom a person turns with a problem of a psychiatric nature. The pastor must be able to behave with these people, help them and, most importantly, clearly see those cases when a person needs to be sent to a psychiatrist. Somehow I came across an American statistic: 40% of people who turn to psychiatrists do so on the advice of clergy of various faiths.

It should be added that the origins of the course on pastoral psychiatry, which is now taught in many religious educational institutions, was Archimandrite Cyprian (Kern), professor of pastoral theology at the St. Sergius Institute in Paris: in his book on pastoral theology, he devoted a separate chapter to this very subject. He wrote about those human problems, which cannot be described by the criteria of moral theology, which have nothing to do with the concept of sin. These problems are manifestations of psychopathology. But the author of the first special manual on pastoral psychiatry was precisely the professor of psychiatry Dmitry Evgenievich Melekhov, whom we talked about, the son of a repressed priest. Today it is already absolutely clear that the standard (if we are not afraid of this word) of pastoral education should also include a course in psychiatry.

Of course, this is a theological question rather than a medical one, but still - in your opinion: is there a connection between mental illness and sin? Why do the main types of delirium seem to be grimaces of the main sinful passions? Delirium of grandeur, for example, and, as it were, its shadow, the reverse side - delirium of persecution - what is this if not a grimace of pride? And isn’t depression a grimace of despondency? Why is that?

Delusions of grandeur, like any other delusions, have only a distant relation to the sin of pride. Delirium is a manifestation of severe mental illness. The connection with sin is no longer traceable here. But in other cases, it is possible to trace the connection between sin and the occurrence of a mental disorder - a disorder, I emphasize, and not an endogenous, genetically determined disease. For example, the sin of sadness, the sin of despondency. A person indulges in sadness, having suffered damage, having suffered some kind of loss, becomes despondent from his difficulties. Psychologically this is quite understandable. But what is especially important here is the worldview of this person and his hierarchy of values. A believer, having in life highest values, will try to put everything correctly in its place and will gradually overcome his difficulties, but a person who is not a believer is more likely to experience a state of despair, a complete loss of the meaning of life. The condition will already meet the criteria for depression - the person will need a psychiatrist. The spiritual state was thus reflected in the mental state. Such a psychiatrist’s patient has something to turn to and a priest too, something to say in confession. And he must receive help - from both sides, both from the shepherd and from the doctor. At the same time, it is very important that love lives in the priest, that he is merciful to this person and is able to really support him. It should be noted that, according to WHO, by 2020 depression will become the second most common illness worldwide; and WHO experts see the main reasons for this precisely in the loss of traditional family and religious values.

How possible is spiritual, church life for people suffering from severe mental illnesses, for example, various forms of schizophrenia?

It is not a person’s fault that he came into this world with a serious, genetically determined disease. And if we are truly believing Christians, we cannot allow the thought that these people are limited in their spiritual life, that the Kingdom of God is closed to them. The cross of mental illness is a very difficult one, perhaps the heaviest cross, but a believer, bearing this cross, can preserve a full spiritual life for himself. He is not limited in anything, this position is fundamental - in nothing, including the possibility of achieving holiness.

It should be added: schizophrenia - it can be very different, and a patient with schizophrenia can be in different states. He may suffer an acute psychotic attack with delusions and hallucinations, but then in some cases there is a very high quality remission. The person is adequate, works successfully, can occupy a responsible position, and successfully arrange his family life. And his spiritual life is in no way hampered or distorted by illness: it corresponds to his personal spiritual experience.

It happens that a patient in a state of psychosis experiences some special spiritual state, a feeling of special closeness to God. Then this feeling in all its depth is lost - if only because it is difficult to deal with ordinary life, - but the person remembers it and after the attack comes to faith. And in the future he lives a completely normal (which is important), full-fledged church life. God brings us to Himself in different ways, and someone, paradoxically, like this - through mental illness.

But there are, of course, other cases - when psychosis has a religious connotation, but all these quasi-religious experiences are only a product of the disease. Such a patient perceives spiritual concepts distorted. In such cases we talk about “toxic” faith. The trouble is that these patients are often very active. They preach their completely distorted concepts about God, about spiritual life, about the Church and the sacraments, they try to convey their false experience to other people. This is something to keep in mind.

Mental illness is often thought of in connection with demonic possession (or what it is called). The sight of the so-called reprimands makes us assume that simply sick people are gathered in the temple. What would you say about this? How to distinguish mental illness from obsession? Who should be treated with drugs, and who needs spiritual help?

First of all, I would like to remind you that the blessed His Holiness Patriarch Alexy II was a resolute opponent of the widespread and uncontrolled practice of “reporting” that spread just in those years. He said that the ritual of expelling evil spirits should be performed only in extremely rare, exceptional cases. Personally, I have never been present at mass reprimands, but my colleagues - people, mind you, believers - observed this. And they said with confidence that the majority of those “reported” are, as they say, our contingent: those suffering from mental disorders. Mental illness of one type or another has a certain structure, is characterized by many parameters, and professional doctor always sees that a person is sick, and sees why he is sick. As for the state of demonic possession, spiritual damage, it manifests itself primarily in the reaction to the shrine. This is checked by the “blind method,” as doctors say: the person does not know that he has now been led to a reliquary or to a bowl of holy water. If he nevertheless reacts, then it makes sense to talk about demonic possession. And about the help of a priest, of course - not just any priest, but one who has the bishop’s blessing to read certain prayers over those tormented by unclean spirits. Otherwise, it is a purely psychiatric problem and has no relation to the spiritual state. This is a common case; we have many patients who have some kind of religious theme in the structure of their delusions, including this one: “There is a demon inside me.” Many of these patients are believers, Orthodox people. If there is a church at the clinic where they are located, they attend services, confess, receive communion, and they actually do not have any demonic possession.

Unfortunately, we are faced with cases where priests, who do not have sufficient experience and have not taken a course in pastoral psychiatry in seminaries, send completely “classic” patients for so-called lectures. Quite recently they brought me a girl, a student, who suddenly began to wrap herself in foil and put a saucepan on her head to protect herself from some “rays from outer space.” Indeed, a classic of psychiatry (the so-called student case)! But instead of immediately taking their daughter to the doctor, the parents took her to some “elder”, stood in line to see him for six hours, and then he sent them to a lecture, which, of course, did not help. Now this patient’s condition is satisfactory, the disease was controlled with the help of medications.

You have already said here that a patient whose delusions have a religious overtones can be very active. But there will be people who will believe him! Does it happen that an ordinary sick person is mistaken for a saint?

Of course it happens. In the same way, it happens that a person talks about his demon possession or about some extraordinary visions, about his special closeness to God and special gifts - but all this is actually just a disease. That is why we, psychiatrists who teach pastoral psychiatry, tell future priests: there is reason to be wary if your parishioner assures you that he has already achieved some high spiritual states, that he is visited by the Mother of God, saints, etc. The spiritual path is long and difficult , is thorny, and only a few survive it and become great ascetics, who are visited by Angels, saints and the Mother of God Herself. There are no instant highs here, and if a person is sure that this is exactly what happened to him, in the vast majority of cases this is a manifestation of pathology. And this once again shows us the importance of cooperation between a psychiatrist and a pastor, with a clear delineation of their areas of competence.

Drawings of psychiatric patients
Journal "Orthodoxy and Modernity" No. 26 (42)

– “Get yourself together, wimp” is a common expression and a rude form of support for a despondent person. How do you feel about this kind of encouragement?

– I remember one young man with depression. His dad was shy, active and in life successful man, and he himself is subtle and sensitive. For a long time, as a psychiatrist, I treated him for depression. Of course, I analyzed his behavior from the point of view of suicidal intentions. I say with all responsibility that he had no such thoughts.

Circumstances were such that he soon left for another city to practice, to work for his father, who held a serious position. It so happened that he was delayed in practice for two months and was left without medication.

On top of everything else, his father, seeing that his son was completely different in character, literally tried to educate him every day: “Why are you passive? Why are you sad? Let's find you a wife? Stay calm and carry on. Be a man, don’t be sour.” And then the father returns home one day, and the guy is hanging in the middle of the room. Beforehand, he ran to the store and bought groceries for dinner according to the list that his father left him...

You need to understand that conversations like “get yourself together, you wimp” in severe conditions can end just like this.

– There is clinical depression, and there are a lot of other conditions that we call it: fatigue, blues, melancholy, burnout. Where is the line between true depression and what is often called it?

– The term “depression” has become extremely common, although people do not always realize what really stands behind it. In everyday life this word is used to describe mild condition sadness and longing.

In medical terms, depression is a well-defined condition. It suggests not only a sad mood. In some forms of depression, sad mood is not observed at all.

There is a classic depressive triad. In addition to depressed mood, it includes motor retardation, that is, the lack of physical strength to do anything. Outwardly, the movements of such a person look inhibited and slow. The third component – ​​ideational – involves changes in thinking. The movement of thought is inhibited, in a conversation it is difficult for such a person to find words, concentrate on something, or absorb information.

With depression, there is inadequate low self-esteem, a pessimistic perception of the future, sleep disturbance, decreased appetite, however, there are cases when the patient eats a lot in order to muffle depression.

And although the depressed mood is classic symptom, cases of “ironic”, smiling depression are not uncommon. Such a person treats his experiences with irony, which he hides, but inside he experiences a difficult state, which he describes with the words “cats are scratching at my soul.”

With classic depression, the phenomenon of anhedonia occurs - the loss of the ability to rejoice and react emotionally even to significant events in life. The essence of the disease is the lack of will and the inability to mobilize. The Holy Fathers noted that in these states a person loses taste for everything and loses the ability to feel pleasure.

– A non-specialist cannot always figure out where depression is, and where is bad mood and fatigue?

– Outwardly, the state of depression is not always clear. There are depressions that occur without external cause, endogenous. Their cause is inside a person, and not outside. It may be impossible for a non-specialist to separate “depression” from a sad mood. Imagine a serious young man from a decent university who did not complain about anything, did not look sad or inhibited, but suddenly committed a suicidal act. Even retrospectively assessing the last days of his life, one cannot find any psychological trauma: a failed test or unrequited love.

But immediately conversations arise from the series “teenagers today are not the same, they don’t value anything, even own life" I often come across young men who, at the last moment, manage to come to their senses and turn to a psychiatrist. They talk about the state of loss of meaning in life, anti-vital thoughts, although formally and outwardly everything is fine with them.

Photo: Alexander Vaganov, photosight.ru

Severe depression can happen to anyone

– The term “depression” is used widely today, all you hear about depression is what do people usually mean?

– I won’t say so from my surroundings, but it is obvious that in certain circles this term is popular and sometimes it really looks like outward coquetry. However, this does not mean that there is nothing behind the words.

It is possible that people often try to cover up their psychological problems with the word “depression.” For example, a person does not have a clear goal in life, there is no awareness of why he lives, why he works, why he needs a family. This pause, the desire to find meaning and fill life with it, is really covered up with the expression “I’m depressed.” Some people use “depression” to cover up their reluctance and unwillingness to take life seriously and understand that it is a gift from God.

There is a fact seasonal change moods. Many people in autumn and winter weather, when the duration of daylight hours, it is difficult to perceive this due to physiological characteristics. In one of the northern Swedish cities there is a saying that may be completely incomprehensible to us: “Don’t show a Swede a rope in winter.” Not only in Scandinavia and northern Russia long absence The sun is difficult for people to tolerate. But in southern countries, depression is rare; there, the opposite of depression - manic agitation - occurs more often.

I came across a man who left for Italy from a northern city, lived there in difficult conditions, but never agreed to return home, where he had a job, an apartment, and friends. To my reasonable question, what are you doing here, you have everything there, he answered: “You have everything, but there’s not enough sun.”

– There is an opinion that losers, weaklings, and internally dissolute people suffer from depression. Successful, purposeful, disciplined people cannot have depression. This is true?

- No, that's not true. Both successful people, those who are disciplined in life, and active people experience depression. I will say more, in such people depression occurs in extremely severe forms. After all, this state is incomprehensible to them. A person who has been active for many years, leading large teams, suddenly experiences melancholy, depression, and finds himself in a state of helplessness. He cannot recognize himself, cannot pull himself together, does not have the physical strength and desire to do what he is used to doing better than others in his life, for example, achieving success.

Among people famous in various fields of culture and science, there are many who suffered from classical depression. This is Jack London, Mark Twain, Van Gogh, Vrubel, Shostakovich, Mozart. One can recall many outstanding people in whose lives there were distinct depressive states that happened to them more than once.

There is such a concept - psychopathy (personality disorder) - a character trait from which a person suffers himself and/or those around him.

One of the types of psychopathy is the constitutional depressive type. This term describes born pessimists. People who go through life and perceive everything in gloomy tones. They perceive Christianity not as the joyful fullness of life in God, but as a depressive religion. The horror is that they often try to instill such a view of Christianity in others. In other words, they are in a state of constant subdepression.

Along with them, there is their complete opposite - very optimistic people, whose life is a continuous bright spot. But both the former and the latter may have severe depression, just as it can happen to “losers” and successful people.

Illness or sin

– Synonyms for depression, especially among believers, are despondency and sadness, which are interpreted as states of sin.

– Sadness is a normal human state. It occurs in a serious traumatic situation. Remember Christ, who was saddened and grieved when he learned that Lazarus had died. Sadness in itself is not a sin.

In general, if you look closely at the works of the holy fathers, it turns out that they describe the classic depressive triad in the finest nuances. In particular, they write about the state of sadness and loss of spirit, about the state of physical and mental heaviness, about the lack of will, and constraint. Athanasius the Great, for example, called despondency a state of aggravation of the body and soul.

But this condition becomes a disease when, stuck in a depressed mood, a person loses hope in God’s mercy and ceases to realize that what is sent to him can have an inner meaning.

– Do devotees of piety suffer from depression, or does this misfortune bypass the prayer books?

– If we take the lives of Russian ascetics of the last century, for example, the lives of Tikhon of Zadonsky, Ignatius Brianchaninov, then upon careful reading we will be convinced that they clearly experienced a state that can be interpreted as clinical depression.

The same severe conditions were with Silouan of Athos. He described them as a feeling of being abandoned by God.

Depression occurs even in very pious people. I had to treat a man who went down in the history of the Russian Orthodox Church as a righteous man.

When we talk about classic depression, we are talking about a purely biological condition that can affect anyone. Another thing is that a person predisposed to a serious spiritual life, who perceives his condition as a cross sent to him, actually achieves transformation or, as believers say, holiness.

–That is, depression can affect a person’s spiritual growth?

– In a state of subdepression, that is, in a mild form, a person really becomes deeper. For example, he understands that many of the things he does every day are, by and large, of secondary importance. He begins to think about the meaning of life, about his relationship with God. At the same time, such a person is more vulnerable, feels injustice and his own sinfulness more subtly.

But if we talk about severe forms of depression, it often feels like being at the bottom of an abyss and a total feeling of being abandoned by God. About nothing positive impact We cannot talk about spiritual growth here.

In psychiatry there is the concept of “anesthesia of the senses” - this is a complete loss of feeling, including in spiritual and prayerful activities. In this state, a person does not feel either joy or grace even from participating in the sacraments.

– It turns out that non-believers suffer from depression even harder?

- Without a doubt. A person with a Christian worldview perceives life as a kind of school. We go through life, and the Lord sends us trials for our spiritual maturation. I have seen many cases when in this state people came to Church and turned to God.

Even more often I met people who perceived depression as God’s providence, as a condition through which it was important for them to go through. One of my patients said: “Christ endured and we must endure.” For the average person, these words sound wild. But I remember how that patient pronounced them. He said this from the heart, and not for rhetoric, with humility and a clear awareness that this had a deep inner meaning for him of the disease.

The most difficult thing for a depressed person is to come to the realization that life has meaning. We ourselves did not come into this world, and it is not for us to decide when to leave it. For non-believers, this thought is difficult: “Why endure suffering when everything is hopeless ahead?” Understand that a depressed person is a person who has put on dark glasses. The past is a series of mistakes and falls, the present is impenetrable, nothing looms or shines ahead of him.

It is important to understand that depression can be treated

– What are the statistics? How common is clinical depression compared to other conditions we call it?

– I only know general figures. In the world from clinical depression More than 350 million people suffer, in Russia - about eight million. In the northern regions, in percentage terms, the number is more pronounced, in the southern regions - less. But to say what is the percentage of those who consider themselves “depressed” in in a broad sense words and is in a state of sadness, I am not ready.

The problem is that even with classic depression, people are in no hurry to consult a doctor.

In Russian society as a whole, there is no understanding of what depression is, what its scale is, and, most importantly, what its danger is. “Get yourself together, you rag” - that’s our expression.

Let me again give you a textbook example of a young man whose arms and legs are intact, who has a separate apartment and job, but suddenly he lies down on the sofa and cannot do anything. It seems ridiculous to lie there like this: “Come on, get up, go to work.” In addition to the hackneyed phrase “get it together, you rag,” such young people are also told stories about the hard lot of their grandparents who found a way to mobilize even in war.

This is all correct, of course, but more often it leads to self-blame, the decision not to be a burden to the family, and suicidal intentions. A depressed person should not be put under pressure or rudely stimulated. This is how to persuade a person with paralysis lower limbs get up and walk. Alas, this is not obvious to everyone yet.

The main danger of depression is that it leads to suicide. Therefore, in a number of countries there are medical programs on suicide prevention and identifying depression in loved ones and work colleagues. In Japan, for example, there are popular brochures that explain everything from A to Z: what kind of disease, what are the signs, how it is dangerous for a person, how to behave if you suspect such a condition in another.

– The problem objectively exists, this is understandable. What's the trend?

– According to WHO data, the incidence of depression is increasing. There is an opinion that in the 21st century there will be a pandemic of depression. The rapid growth we are seeing is partly due to better detection. The scientific community is actively involved in the topic of depression. Thanks to education, even at the everyday level, depressive conditions are more often paid attention to. Patients with this problem began to consult doctors much more often.

There are other factors too. For example, the increase in depression is directly related to the increase in life expectancy throughout the world. The fact is that depression is a companion of human aging due to biological reasons, such as brain restructuring. Depression also accompanies severe somatic diseases: cancer, serious forms coronary disease hearts. In such people, depression is detected in 30-50% of cases.

WHO experts note that one of the reasons for the prevalence of depression is the loss of traditional family and religious values. Formerly a man lived in his own house with his parents and grandparents, that is, a large family. A man lived for decades in the same place and clearly understood that one day he would grow up, become an adult, then grow old and live in a large family where the younger generation would take care of him. Now many live in separate comfortable apartments, and at a certain stage of life they find themselves alone, despite material wealth and the presence of children and grandchildren, who, due to the modern rhythm of life, do not have time to take care of them. Disunity is a phenomenon of our time and definitely a cause of depression.

Finally, there was a loss of traditional religious values. It is human nature to think about the meaning of life. But if in adulthood there is no religious faith, which gives meaning to life to many, it becomes quite difficult for a person. There are even a number of studies conducted by domestic specialists that indicate that in old age, in situations of bereavement, the lack of religious values ​​is an extremely unfavorable prognostic factor.

In other words, depression is not a fashionable disease, it is a serious problem of the present.

Unfortunately, to this day there is one of the myths about psychiatry that, once in the hands of a psychiatrist, a person will inevitably be “zombified” and “turn into a vegetable.” Meanwhile, science has long moved forward. Today we have a large arsenal of drugs and antidepressants with different mechanisms of action and different tolerability, with minimal side effects and high therapeutic productivity, with the ability to use drugs in outpatient practice.

It is important to understand: depression can be treated, and after therapy there is a significant improvement in the condition. Neglecting this is unacceptable and stupid.

The Church has always emphasized the medical ministry. Among the apostles there was a professional doctor - the Apostle Luke. In the book of wisdom of Jesus son of Sirach, the Lord says: “Honor the physician according to the need for him; for the Lord created him, and healing is from the Most High... And give place to the doctor, for the Lord created him too, and let him not depart from you, for he is needed” (Sir.38:1-2, 12). We must always turn to the Doctor with a capital P, but we have no right to demand that the Lord constantly perform a miracle. Yes, Christ said to the paralytic: “Rise and walk.” But this is a special case.

I am convinced that we must go to doctors (with a small letter), so that through medicine and these doctors the Lord will give us his help.