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The Pastoral Psychiatry.

That what nowadays they call “the pastoral psychiatry” already acquired the right of the citizenship in the western science since the certain time, while in the orthodox East this is the almost unknown sphere of the pastoral activity. It must not be understood as the certain additional part of the Book of Needs or Nomocanon, since it does not belong to the field of the pastoral asceticism, but is the certain parallel sphere of the pastoral spiritual care, which nevertheless should not be left by a priest without attention. Several preliminary observations seem to us necessary concerning this question.

The spiritual care and confession in particular are the spheres inaccessible for the outside observation. Resolution of the spiritual life questions, connected with confession, passes “in foro interno.” A confessor is present at confession only as a witness. The confessionary secret is absolute.

But there is another thing. There is a region that is more intimate and more thoroughly hidden by the penitent, than the sin. There is something in the human soul, what is not sinful and, that most of the penitent do not suspect of, is hidden from the look of the conscience and, even more, not subordinated to the conscience itself. There are certain hiding-places of the soul, which a sinner himself does not examine and perhaps does not suspect that they exist. There are such states of the soul, which require entirely different estimation, than the ascetic and moral-theological one. These states, which cannot be determined by the categories of the moral theology and which do not enter into the concept of the good and evil, the virtue and sin. These are all the depths of the soul, which belong to the psychopathological, but not ascetic sphere.

An educator, judge, pastor and doctor look differently at the emotionally unbalanced person. Is it possible to consider that the certain acts of such persons are only the sins, which should be subjected to penance? Is any anomaly of the emotional life — a breach of the moral law and standards of the code of asceticism? Is any anomaly more a disease, than an evil matter? Do they put a question, where the boundary between the ethics and psychopathology passes?

It is possible to define with the known risk of schematization “the pastoral psychiatry,” as an attempt of coordination of the work of a psychologist (or psychiatrist) and of a pastor in the most intimate spheres of his activity. One should not think that a pastor can enlist a psychiatrist to that what was opened to him at the confessionary table. Rather it should be allowed, that a pastor himself must be somewhat familiar with the psychoanalytical observations, must read one or two books on the pastoral psychiatry, plunge more deeply in what the moral psychology is, in order not to condemn as a sin that what is only a tragic bend of the emotional life, the riddle, and not the sin, the mysterious depth of the soul, and not moral depravity.

Here arise some questions of the fundamental character, on solution of which will depend one or another attitude to the object.

1. Is it permissible from the point of view of the Orthodoxy, to speak about the pastoral psychiatry? Is it possible to combine this discipline with the basic principles of our hereditary of the patristic and church legend ethics and asceticism? The similar approach to the question cannot but cause surprise. But, by the way, one could repeatedly hear such questions. Precisely the connection between the pastoral psychiatry, and ethics and asceticism can cause surprise. The essence of the matter lies in the fact that psychiatry does not lay claim to those spheres, which belong to asceticism. Asceticism is occupied with the fight against sins and passions, while the pastoral psychiatry attempts to penetrate in those spheres of emotional life, which in no way can be qualified as the sin and evil. Asceticism gives wise advice, obtained from the fathers and teachers of the Church, for the recovery from sins and vices: pride, despondency, avarice, vanity, gluttony, lechery and the like. Psychiatry searches for the deep reasons of those spiritual states of the man, which root in the secret hiding-places of the soul, in the sub-consciousness, in the hereditary or acquired contradictions of a human being. Psychiatry focuses its attention on the fact that in the essence does not interest asceticism: obtrusive ideas, phobias, neurasthenia, hysteria and so on.

From the point of view of the Orthodoxy and the church legend, there is no reason for seeing any obstacles for the usage of any psychiatric or psychoanalytical data in the activity of a pastor. Psychiatry principally must not contradict the pastoral service, not interfere with it or diminish the value of the spiritual care. In the work of a pastor can be used all means of aid to the souls on the way to salvation. The pastoral psychiatry is not equal to asceticism in the terms of its value, their spheres are adjacent, but they do not exclude one another, because psychiatry does not interfere with the region of the pure theology. Its search is in those spheres, where asceticism does not have a direct application. Psychiatry in the hands of a pastor is the booster agent for detecting not the sin, but the pathologic phenomena, connected with mental, i.e., with emotional, but not spiritual diseases.

2. It is possible to look at the discussed question in another way. If it is permissible and completely reasonable to speak about the psychiatric booster agents for the actions of a pastor, i.e., about the pastoral psychiatry, then it is permissible to raise the question about the fundamental admittance of psychiatry, as it is, or to place stress on the pastoral psychiatry. This means: is it possible generally, from a theological, pastoral, spiritual, ecclesiastical point of view to allow psychiatry to those spheres, where, it would seem, one should speak only of the spiritual, but not medical. In other words, with what right a medical discipline will be permitted to be not only in the modus operandi of a pastor, but also generally into the sphere of the spiritual life.

If we agree with the fact that the pastoral psychiatry must not interfere with the field of asceticism, then should not one exclude any right of the interference of a medical science with the existence of a various complex emotional phenomena? In other words, must not a pastor consider that these phenomena, from the point of view of the Church, do not at all exist? Is not any complex emotional phenomenon a simply sinful state? Should not one generally attribute all that what happens in the soul of a human to the field of asceticism? Should one, from the point of view of the Orthodoxy and the church legend, exclude any moral psychology, and pass it over to the region of the moral theology? Are not all the mentioned neurasthenia, phobias, maniacal states, etc. only the sins?

The mind attempts to simplify everything and to exclude all the problems. The answer in that case suggests itself: all this is only a sin, the holy fathers knew of no psychoanalyses, but they could heal the depths of the soul and sin itself, fought with the evil, and not with the riddles of the soul. With such posing of the question the very word “psychiatry,” and moreover “the pastoral psychiatry” is the encroachment upon the bequeathed by fathers-ascetics orthodox understanding of the sin and fight with it. In that case the question is turned only to the simplified ethical estimation of everything that the man harbors.

In fact, is it not easier to look at all this as at the consequence of the first-born sin, as at the sign of our general sinfulness and tendency towards the sin? In its essence everything happening to the man is the consequence of his limitedness and mortality. Mortality and diseases are the consequence of Adam's downfall, since in the first-born sin the man lost his previous heavenly state. Emotional anomaly (neurasthenia, hysterias and so forth) go back to the one common reason --- to the first-born sin. But can the matter be limited only with mental illnesses; are there any other diseases and general inclination of the man towards them the consequence of the same Adam's sin? In the heavenly state the man would hardly experience these different illnesses. But all these pathological cases are the facts and not the play of imagination and over-anxiousness alone. Is it possible in that case, from the point of view of asceticism and the church legend, to cure these illnesses? Does the orthodox asceticism admit the medicine and can it come from the evil one?

The answer is out of doubts: it will hardly come to someone’s mind to forbid, from the point of view of the Orthodoxy, to use doctor’s advice. Assuming that the first-born sin caused mortality, and consequently sickliness, then should one plunge into the problems of allowing the treatment of the man and saving him from the premature death?

If generally all diseases must be subjected to healing, then the special diseases, the emotional ailments must not be the exception from this rule. Otherwise the Orthodoxy must oppose to any psychiatry, but not only to the pastoral one and hospitals for the mental patients should be shut.

The question is in that: is any disease evil? There is no doubt, that it is the consequence of the first-born sin, but is any disease itself the evil, which is only subjected to penance? Is it necessary to treat neurasthenia only by some ascetic means? Do mental illnesses stand at the same level, as the sins of pride and avarice?

St. John Chrysostom writes as follows: “There exists the evil: lechery, adultery, extortion and other vices, worth of the most great censure and punishment. But there exist, or better they are called the evil: hunger, tortures, death, sickness, etc. This is not the evil, but is only called like that. If this was evil, then it would not be the reason for the good.” Hence it is clear that before a pastor in the soul of the repentant reveal themselves: theft, judging of the neighbor, pride, carnal passions; but during confession, or in the pastoral practice, out of confession, there can appear: obtrusive ideas, maniacal states, neurasthenia, etc. We repeat, that the cases of pure psychopathology, just as one or another ailment or the sin of judging the neighbor, — everything together are the consequences of the first-born sin. But it is not possible to bring all these consequences under the unique concept of sin. Only the third of the given examples are sins.

A pastor, called not to judge, but to save the world, to change it with the rays of the Favor light, to contribute to the creation of “the new creature” in Christ, must know how to perceive all these phenomena thoughtfully, sensibly and compassionately and give his advice to the each one. In the case of the physical infirmity a pastor can help with his prayer and encouragement; in the case of sin he must instruct, expose, reproach and perhaps punish; in the psychological case he himself, first of all, should understand, with what he deals, wisely treat and help such person.

Starting the difficult matter of the spiritual care, a pastor must not draw the psychiatrist to his work, but in a certain measure be prepared himself, concerning the requirements of psychology and pastoral psychiatry. This will not at all injure his Orthodoxy and spirituality. Psychology was always included into the program of the spiritual educational institutions, and this can be somewhat extended so that candidates into the priesthood could become acquainted with the new manuals on moral psychology, pastoral psychiatry, psychoanalysis, adapting them to the conditions of the orthodox pastoral service.

It was indicated above (part 1, chapter 2), that a priest while estimating the man must in particular remember of his freedom, personality and moral merit. Now one should dwell upon the question about the internal difficulties of human nature, with which a pastor meets. There is the danger of simplification and optimistic approach to the personality of the man. A priest does not dare to build the deceptive estimations of the human nature, when everything is not that satisfactory in the soul of the man. Wise philosopher said that the soul of the man has no harmony. Berdyaev was right, when he spoke much about the conflicts and contradictions in the man.

The modernity complicates life and in many respects distorts the personality of the man. The type of the successful person or the thinking of nothing simpleton disappears from the face of the earth. Parents, an educator and a pastor himself need to think thoroughly in each case, where one or another internal bend, those irregularities in the development and the habits, by which much in the life of each person is determined, come from.

Earlier it was indicated that the inclination to freedom and love is characteristic of the man. But it was said as well, that the man does not so easily reject anything, as he rejects freedom. Moreover, freedom itself is given to us without our will and free agreement, what leads to the very difficult positions. It was said, that the human personality is unique and that it is the most valuable thing the man possesses and that distinguishes him from the members of the herd or beehive. But indeed one should in no way forget that in each personality there are many things that are not born there; that each “I” is composed from many qualities not belonging to it.

If to think that over in a better way, then it will become clear, how easily the man gives away his freedom and becomes the slave of conditionalities of the medium, party, passions, habits. A pastor, as an educator, is entrusted to develop and bring up the freedom of the man in a good direction. At the same time he should examine what belongs to the man himself, and what comes from the medium and genus.

In each personality according to the psychological terminology act: phenotype, biological type and genotype. Phenotype is what the man is by himself, what he has personal, his gifts, and his content, that what makes his personality. These are, so to say, his hypostatic features. Of this consists the understanding of the personality that it is unique, that it is not a copy, but something, what was not and will not be in the history any more. But, after looking more attentively at any person we shall see, that besides his personal qualities, each one carries in him that what they traditionally call biological type. The medium, friends, upbringing, personal experiences can somehow be reflected in the personal gifts of the man and in one or another case can make a useful person and a good worker from a mediocrity, the same way as to mangle, vulgarize and spoil a gifted from his birth person. The authority of heredity, the voice of blood and ancestors are very strong in the man. The same Berdyaev, so ardently preaching his “personalism,” had to acknowledge in his autobiography that in his “I” there was much from “not-me,” but from the family and genus. This all is genotype. In this respect is interesting the attempt of such analyses of the ancestral beginning, made by Emil Zola in his “Rugon-Macars.”

Therefore the man seems to be an intricate knot, a certain complex tissue, woven from many and frequently contradictory data, which do not make it possible to make the simplified generalizations. One might speak about the psychological or moral types only with many reservations. The usual division into the phlegmatic and sanguine persons is oversimplified. Now they speak more frequently about the cyclic recurrence and about schisms (discontinuity), the terms, which originate from the Greek language. The first word “cycle” indicates “circle” in Greek - (it can be compared with a quietly flowing river), in which the lifts and lowering of the moods can be subordinated to some pace; in it the happiness and suffering do not alternate so sharply. In the second one, the emotional moods are subjected to the sharp “schisms,” breaches. In the nature of such people rule undercurrents, waterfalls, not subordinated to the rhythm; there can be frequent and unexpected changes from the silence to the storm.

But however it may be, all this does not make it possible to relate the people into one or another group without taking into account the different circumstances: the temperament qualities, all conditions of pheno-bio-genotype. The man always remains subjected to the different kind of the unexpected contingencies, which require considering him not as an absolutely complete type, but subjected to different chances. Therefore a pastor must always be ready to see the possibility of different contradictions in the man. The man is a riddle, hieroglyph, which requires attentive observation and cannot be so is easily deciphered.

In fact, how many contradictions are placed in each soul! Jealousy and love, happiness and desperation, inspiration and apathy, tendency towards creative perpetuation of oneself and the ghost of death, erasing everything and placing limit to all, the thirst of freedom and charm of the servitude. Is it so easy to understand what caused one or another mood, or act? It suffices to recall the appearance of Tsar John the Terrible, the cruel despot and hangman, on the one hand, and the devout, waiting for humility. In the newspapers they wrote that Parisian hangman Deybner was a very kind person, he took care of students and gave money for their education. In each person is placed that, what Klug calls “the genius” and “the demon.” By “the genius” one should not understand that what we usually define like genial, but that what pulls the man upwards, to the light, to God, while “the demon” one should understand in the sense of the spirit, leading to the low, evil, banal, dark. In each person there is some mixture of the opposite beginnings, some “light and shade.” This can be the fading daylight, the messenger of the night; or, on the contrary, this is the morning star, which predicts the coming of the new day. All these are not yet final qualities of a virtue or sin, but the signs of something hidden, be it the hope for the positive creation, or the alarming sign of the coming obscurity.

Since a pastor is called to give a hand and to contribute to the “sublimation” of the low beginnings in the man into something high, then he is obligated to follow attentively the development of the emotional qualities of the guided. He can help in time, encourage and save, but can also miss the threatening signs of the nascent disease, which is not a sin yet, but can become one very easily because of his inattention. The things that a pastor does not know how to use, always use the others, “which come from the other side.”

How often we hear about the moods! What great power they have over the man. Moods are not always sinful, but can become alike. A vigilant priest must use them. Among these moods anxiety occupies a very important place. This is the strange emotional state, which is underestimated by many. For many psychiatrists and psychoanalysts it is often the form of psychasthenia, which depends on the education, medium, health, overall nervousness. But this is the simplified understanding. This is one question, if “the mood” is good or bad, if it is the work of the sinful habits. But these moods by themselves can be not sinful. In particular, the very anxiety is not a sin, which it is necessary to punish pastorally. But is it possible to miss this emotional state, to which Kirkergor drew so much attention? He wrote the remarkable book, “Begriff der Angst” (“Le concept de l'angoiss”). For him anxiety is not the fact of psychotherapy, but the consequence of the first-born sin.

To determine anxiety as a sin is a too surface approach. It actually is the consequence of the first-born sin, as any unhealthy phenomenon. But to miss this phenomenon means to miss the necessary moment for averting the worse and truly sinful phenomena. People, who live with moods, what is so characteristic among some intellectuals, in the medium the Chekhovian characters, who lived by some “elusiveness,” are very frequently sick with this sensation of anxiety, which differs from fear. Fear is always the dread of something determined (war, death, epidemic, misfortunes, etc.), while anxiety is terrible, for it does not know its object. This is the unaccountable state of uneasiness, which a pastor must think over, give his advice in the correct moment and dispel that danger, which can lead to the ruinous consequences. The empty “mood” is “unsettledness” of the incorrectly living soul, what cannot be denied, but it is not possible to think of the moods only as of a whim or something definitely sinful. Andre Gide in his “If the Seed Does Not Die” narrates about the boy of 11 years (the book is autobiographic), who without understanding, what death is, with the news about it fell into some unaccountable state of anxiety, “une angoisse indéffinissable,” inexplicable sadness as a burst open weir, which does not restrain some inland sea.

This sadness or anxiety must be noted in time, one should not let it be developed, must balance it with something healthy. This is not a psychic illness alone, neither a simple sin. This is not at all the state of despondency, known to fathers-ascetics, but some predisposition to the emotional sensitivity, which can turn both into the evil, and into the good. It is possible that this is some special sign of giftedness of the man, which one should know how to use.

One of the perhaps most terrible elements in the man is the element of the moods, with which it is sometimes so difficult to manage and to direct them into the appropriate river bed. Could it be that the best motives of the man are born from the “moods” or anxiety? Might it be the sign of certain poetic, romantic inclination? Was it not for the moods that the better works of art and poetry were created: the lyric poetry of Lermontov and Tyutchev, the pathetic symphony of Tchaikovsky, his Trio and the 2d concert of Rachmaninoff? What anxiety did these sounds give birth to and was all so satisfactory in the soul of the man, when he wrote the immortal words and sounds? But did not these moods and anxieties lead the others to desperation, despondency and even suicide?

“What man knoweth the things of a man, save the spirit of man which is in him?” (1 Cor. 2:11). Who will guess the complex riddle, which is the man himself? And if very few of the artists and musicians remained in the strip of light, and the others left it for the sake of their secret gloom, - then did not this frequently prick the conscience of an inattentive and careless pastor?

It is high time we passed from these general psychoanalytical observations to the real evidences of that what the pastoral psychiatry worked out lately. First of all it is important to find out the distinguishing features of mental illnesses and the degree of unbalanced state, in order to outline the possibilities for the pastoral interference. Here it is necessary to meet with the wide variety of opinions of the separate scientists, different approaches to the phenomena of mental illnesses, which all together considerably complicates the matter. But nevertheless, without plunging into the divergences and details in the secondary questions, one can reduce the fruits of the pastoral psychoanalysis and psychiatry to some common main postulates.

First of all, all emotional illnesses can be divided into two main groups, of endogenous and exogenous diseases. The endogenous are the inherited mental illnesses, i.e., such, in which the genotype predominates over the phenotype. However, such emotional illnesses, which are acquired as the consequences of any infection or a nervous break-down, are called exogenous, thus the phenotype and biological type predominate over the genotype. Here occurs the so called “Erlebnis-struktur.” In his valuable book the rector of the psychiatric institute in Holland de Bless comes to the conclusion that in the 14 types of the psychoses a pastor can help only in the innate cases.

Besides this division of the emotional anomalies by their origin, the manuals on the pastoral psychiatry divide mental illnesses into psychoses and psychoneuroses. In the first, the disease of the mind and consciousness exists to a larger or smaller degree, while in the second ones the mind is touched to the lesser degree, and the center of the unhealthy state lies rather in the sphere of the nervous activity. In psychoses they distinguish either: 1) the total stoppage of the cerebral activity (feebleminded, idiots, “fools”) or 2) psychoses as the consequences of some illness (typhus, meningitis), or 3) psychoses from poisoning: a) from without (from alcohol, morphine, cocaine) and b) from within (from the improper action of the kidneys or thyroid gland); here some psychiatrists place 4) melancholy and anxiety (Bless), what perhaps requires greater caution in their treatment. As psychoneuroses specialists count the different types of: 1) psychasthenia, in the form of obtrusive ideas and fear of the space and solitude; 2) neurasthenia in its most usual form, where the activity of the man (a disease not of the will, but of the might) is affected. Finally the very special position occupy hysteria, one of the most dangerous forms of mental illness, from the religious point of view, since it is very strongly manifested precisely in the religious sphere and is closely connected with it.

In the indicated work of Bless just as in the very important book of Robert de Sinéty, S. J, “Psychopatplogie et direction” (Paris, 1934. pp. 20, 255), it is possible to find valuable indications for the practical guidance of a priest.

Since in these books, written by the prominent Catholic scientists, much rests on the Papal encyclicals, on the legalizations of the Roman canonical code, on the theological assertions of Thomas the Aquinas, not all can have the identical value for an orthodox priest, not all the conclusions are applicable for us. But that, what proceeds from the purely scientific medical observations, and the general practical hints, is appropriate for us. It is very useful for an orthodox priest to get acquainted with these works in order to select for oneself, thinking maturely, what can prove to be similar to the spirit of the orthodox pastoral guidance and conditions of our life.

It is possible to accept this practical observation for the general guidance: facing with possession of the different kinds of fears, with “scrupulousness” and psychasthenias, it is useful that a pastor would try to strengthen the will of the patient, to defeat his fears and anxiety, to weaken the overanxiousness of conscience and to distract the attention of a patient from that what presses onto his imagination. In such cases the influence of a pastor can be very useful. A priest, after revealing such state of the soul, could, both at confession, and in the particular conversation, influence the patient and help him to come out of those deadlocks, which he creates himself.

The view of the specialists on the so-called maniacal states is much more pessimistic. Some of the psychiatrists (Bless) consider directly that any interference is useless, since it is not possible to re-convince such sick consciousness. Any attempt of the influence will lead to nothing but the more clearly expressed manifestation of mania. One should rather gain the complete confidence of the victim of this illness, change the themes of conversations and distract his attention from the pursuing fear of poisoning, solitude, space, etc. There is no need to speak about any responsibility of such sick person. His will is paralyzed, the mind is fuddled, and he is in the captivity of his fears. With the incorrect treatment frequently there can appear complications, just as in the presence of the incorrect upbringing in the childhood. In such cases a pastor needs to search for help in the prayer, in the sympathy and possibly in soothing of the sick.

Generally in the complex cases, which can confuse the conscience, a pastor must always remember that sympathy and kind attitude are better than the superfluous strictness, for he meets with the sick will or sick mind. A priest faces not with the abstract types of diseases, but with those requiring sympathy and treatment sick people.

Hysteria occupies a very special position in the number of emotional distortions. If all the mentioned above cases of different fears are encountered in the pastoral practice comparatively rarely, then the cases of hysteria present the completely opposite phenomenon. Hysterical men and women are more in number than we think. One scientist said that everyone is a little hysterical. But it is important for a priest that the disease of hysteria more easily finds the contact points with the religious manifestations. In the Russian church way of life this phenomenon is called “mironosnichestvo — the Myrrh carrying.” This is the increased exaltation of the religious feeling, which searches for the object of adoration and admiration in a priest. Any gifted pastor, preacher, serving beautifully, undergoes the danger to be the object of such admiration. Russian way of life suffers from this enough, but one should not think that this is only our typical feature. Among the people, who live the intensive spiritual life, hysteria finds its victims very frequently. Maurice Dide (“Hysteria and the human evolution”) finds that hysteria is encountered much more rarely in the active orders, than in those, which lead secluded life (Ursulinka, Carmelites, etc.). The increased mysticism easily contributes to the manifestation of hysterical inclinations. Bless indicates that “a hysteriac is the cross for a pastor and the object of temptation the believers” (p. 103). Difficulties for a pastor and educator hide in the fact that this illness can easily be concealed under the innocent forms. Bless even does not consider hysteria to be an independent disease; or there exist manifestations of hysteria, which take root somewhere much deeper. Nevertheless science is not totally helpless in this sphere: it knows the distinguishing features of such hysterical manifestations, easily determines the hysterical type and therefore already worked out a number of the booster agents for their ease.

The opinion that the hysterical manifestations are caused only by the sexual sphere of the man is forgotten long ago. Although the very name of the disease gives, it would seem, the reason for such estimation, and although in the antiquity they considered that it is characteristic only of women, nowadays the scientists think otherwise. The reality itself shows that hysteria is widespread among men. True, women are more subjected to it, than men. The sphere of the sex, of course, plays not the ultimate role in this case, but everything is explained not only with it.

Hysteria differs from the other emotional illnesses even by the fact, that its signs are clearly manifested and accessible even for the surface observation. These signs are revealed in the emotional and physical spheres. The mental signs can be brought to the following:

1. Light changeability of moods and sudden moves from one extreme to the other.

2. The tendency to live in the unreal and connected with this desire to seem someone greater, than the reality allows. Maurice Dide especially insists on the fact that hysteriacs love to play a role. This scientist says: “For a hysteriac the entire life results in performing a comedy, but their heart even does not participate in this at all.” Theatricality and imitation are very characteristic of a hysteriac. Bless indicates that a hysteriac can represent himself as “an imagining patient,” as an over-anxious person; sometimes he plays the role of an eternally misunderstood person, who does not find response in the medium, which underestimates him; sometimes this can be of entirely reverse character, since a hysteriac counts himself a pariah, forgotten, unnecessary. This skill to play a role, to transform himself hiding behind one, then — behind another mask, is explained by his possession of the easy receptivity, special feature to fall under the influence and even by light susceptibility to hypnosis. Therefore it is never known, how much time one or another mood will endure in such a patient. In the religious life, says Bless, hysteriacs can easily pass from bigotry to indifference.

3. One additional distinguishing feature in the moods of hysteriacs is connected with the certain “infantilism” (childishness). A hysteriac constantly wants to be in the center of attention, to attract interest and even sympathy to him. The same theatricality pushes a hysteriac to the role of an unhappy patient, but he can also pass over to threats; if this does not help, then tears come for help. Hysteriacs are generally easily subjected to tearfulness.

4. Such detail in playing of a role can be of interest: a hysteriac loves to threaten with suicide. He willingly speaks, that life bored him, that he decided to end his life by suicide, but somehow, amazingly the help comes to him in time and saves him from the loop or poison. Suicides are extremely little among hysteriacs, according to the evidence of Dide.

5. Predisposition to lies, frequently, artistic lies, is also the lot of hysteriacs, which is explained by the same desire of playing a role, and to the life in unreal. “Myth-mania,” pose, falsity — these are distinguishing features of hysterical nature, in the opinion of many psychiatrists.

6. “The mental anarchy” — is also one of the special features of this category of mental patients.

Not only these emotional and mental signs give a hysteriac out. There are the purely physical ones, which are indicated by the psychiatry.
1. Long ago certain sufferings, about which complain hysterical persons, were already noted: A) the sensation of a nail in the head “clavus hystericus,” b) the sensation of some ball in the throat “globus hystericus” This last phenomenon is sometimes not only self-sensation of a hysteriac, but also it is accessible to the hearing of other people. Hysteriacs speak in a special voice, which does not make clear sounds, but is as if cracked, excited, jingling, as if due to the presence of some pea in the vocal system. However, some scientists are ready to accept that these signs of a ball or hysterical aphonia are not the lot of hysteriacs alone. Fear, anxiety, breaks down can also cause a similar phenomenon, but nevertheless this is encountered with hysteriacs more frequently.
2. Blunt of a feeling of touch and sometimes even insensitivity to some painful feelings together with the increased sensitivity to touch to the other parts of the body, are typical for hysteriacs and testify about the force of auto-suggestion.
3. The easily caused laughter or tearfulness.
4. Hysterical fits can sometimes end with the attacks of epilepsy, or ones close to it.
5. In the Catholic world occur the cases of stigmatization, which can frequently appear due to hysteria. Their pastoral books do not like to mention this.
6. The absence of sleep and appetite also frequently accompanies hysterical phenomenon.
The reasons and source of this illness are determined differently, they are numerous and diverse. In the opinion of some, hysteria to a considerable degree is hereditary, at least, predisposition to it. Others consider that the incorrect upbringing especially in the years of maturing can influence the development of hysteria (Bless, Maurice Dide). Many scientists agree with the fact that the external reasons can be the agents of this illness: the war with its dangers and horrors (Bless, Dr. Kurt Bloom); disappointment with the unsuccessful career, worries, connected with false denunciations and charges in the law court, death of close ones and even the fear of exams, earthquakes, the fear of sexual temptations and many other things (Bless).

The possibility of aid in the case of hysteriacs is differently estimated by the scientists. In the mild cases, especially in the period of maturing, doctors do not look at the sick hopelessly. Under the observation of a doctor and in the course of time hysteria can be cured. In the more complex cases the disease can be cured with difficulty. Concerning the more difficult cases of hysteria Bless says his opinion: “the present victims of this illness befit neither for marital life nor for monastic one. These unhappy people make unhappy the members of their family, converting their life into real hell.” He gives the remark of one clever confessor: “If ordination into the monks is a difficult matter, then marriage is still more difficult, since in the marriage there is no preliminary period of being a novice.”

What can a pastor make? Not everything, but in any case much. He must learn about the number of measures for the persons, subjected to hysteria: 1) to speak less about his illness and not to turn attention to the opinion of the sick, 2) since much depends on the good will of the patient himself, then a pastor, as a doctor, must arouse in the sick desire to be cured and confidence, 3) to avoid any religious excesses, special “exploits,” 4) firmness and constancy in the spiritual guidance of such people, who, seeing, that their contrivances do not help with this confessor, easily change their spiritual leaders, 5) change in the situation (domestic or school one) in the case, if it is harmful for the sick and prevents a pastor or doctor from carrying out of what they find necessary, 6) the fight with whims and tearfulness of children, 7) the specially vigilant attitude to the patient, who is in the period of maturing.

Because of the impossibility to mention all the interesting cases and useful advice, we send you away to the reading of the Pastoral psychiatry and consider it timely to raise the question: Which is the practical value of the pastoral psychiatry? Can a pastor obtain benefit for himself and his activity from the acquaintance with this subject?

If in the previous times the medicine and psychiatry occupied in the eyes of many people the position hostile to religion, then the situation considerably changed in our time. A doctor must not compulsory be a materialist, the present science does not at all contradict the faith and church consciousness, the presence of many profoundly believing scientists, working in the field of the natural sciences, medicine and psychiatry. Psychoanalysis, not at all compulsory of Freud’s type with laying stress on the sexuality, — all this together makes it possible to speak about the objects of the present chapter completely differently, than it was done one hundred years ago. Many believing scientists, especially in the West and in the Catholicism, willingly remain the obedient sons of the Church. On the other hand, the Catholic hierarchy itself wonderfully understood the need and benefit of collaboration of the science and Church. There are many guiding books on the pastoral psychiatry, written not only by the spiritual persons, but also by the believing doctors.

A. Remers, the author of the book “Psychiatry and the Spiritual Care” (Berlin, 1899), writes: “Between the contemporary psychiatry and the Christianity is possible at least the mutual understanding.” (p. 12)

In the beginning of the present chapter was expressed the warning, not to mix up the plans of the spiritual care and medical science. The absolute mystery of confession does not allow a pastor to draw a doctor of the mental illnesses to the confessionary lectern, just as a feeling of tact in a pastor will not allow him to send the repentant into the hospital for mental patients. A pastor is not called to make the diagnosis of the mental illnesses, since this is not his business; but the knowledge, concerning this sphere, will cause no harm, since this will allow him to understand the emotional problems of the guided more easily and in the degree of their well-being. Acquaintance with the scientific data and methods will make a pastor more careful in his moral estimations. A pastor, after learning much, will not make the false steps and give incorrect advice in the doubtful and alarming cases.

It is not possible to make any generalizations in the brief course of lectures; even life itself does not tolerate generalizations and schematic conclusions. In each individual case it is necessary to act with “caution,” very carefully and to get filled by the spirit of compassion and pity, attention and internal tact.

It can be especially important to advise a pastor not to yield to optimism and self-confidence in his difficult and responsible work of the soul guidance. Fulfilling the pastoral duty, he must entrust everything to the mercy of God, Who is not only the impartial Judge, but also the loving Father.