DECR Hosted the III International Conference "Church Care for Mentally Ill People"

On November 26-27, 2021, the 3rd international conference on «Church care for mentally ill people. Church and psychiatry: facets of cooperation» took place at the Moscow Patriarchate Department for external church relations.

The conference was organized on the initiative of the Commission for Church Education and Diakonia of the Inter-Council Presence of the Russian Orthodox Church. Its co-organizers were, DECR MP, the metropolia of Voronezh of the Russian Orthodox Church, Section on Clinical Psychiatry, Religiosity and Spirituality of the Russian Society of Psychiatrists, St. Tikhon's Orthodox University for the Humanities and the Metal Health Research Center (MHRC). It was organized with the support of Kirche in Not (Aid to the Church in Need) international foundation.

It was attended by representatives of various Christian confessions from Spain, Italy, the Netherlands and Russia — clergy of the Russian Orthodox Church and the Roman Catholic Church with an experience of providing pastoral care for mentally ill people, as well as professors and students of theological university departments and theological schools, MHRC staff members, theologians and experts.

The conference was presided over by Metropolitan Sergiy of Voronezh and Liski, head of the expert group on the development of the "Pastoral care of the mentally ill" issues of the respective Commission of the Inter-Council Presence. The co-moderator of the conference was Kaleda V.G., Deputy Director of the MHRC and head of the Section on Clinical Psychiatry, Religiosity and Spirituality of the Russian Society of Psychiatrists. The director of the MHRC Klyushnik T.P., head of the Russian department of the Kirche in Not international charitable foundation P.V. Gumenyuk, as well as the Secretary General of the World Psychiatric Association, Vice President of the Russian Society of Psychiatrists P.V. Morozov addressed the participants of the conference with welcoming speeches.

Metropolitan Sergiy of Voronezh and Liski spoke on the "Church care for mental health", in which he noted the widespread prevalence of mental disorders among different age groups of the population, as well as the fact that patients and family members of a sick person in case of loss of mental health primarily turn to clergy. He stressed the importance of cooperation between priests and psychiatrists, emphasizing the need for doctors to study the psychology of religion and the basics of religion: "This is exactly the knowledge that should help psychiatrists understand the role of spirituality and religiosity in the lives of their religious patients… The dialogue between the Church and the psychiatric community has been going on for a long time. However, there are difficulties on the way of such a dialogue that have not been overcome so far. At the same time, in recent years, the number of scientific studies has increased, "demonstrating the benefits for mental health of prayer, religious repentance, participation in church life, cultivation of such Christian virtues as humility and forgiveness. Modern medicine is rediscovering that there is a deep connection between faith and the state of mind". Such conferences are a platform for dialogue and a visible expression of the rapprochement between representatives of the Church and medicine.

Kaleda V.G., Deputy Director of the MHRC, speaking on "Clinical psychiatry, religiosity and spirituality", noted that in many countries the proportion of believers among patients of psychiatric clinics is higher than in society as a whole. But among psychiatrists, the proportion of believers is less than among doctors of other specialties. This is one of the obstacles that prevent bringing Christian truth into the psychiatric community. The speaker noted that in May 2021, the section "Clinical Psychiatry, Religiosity and Spirituality" was established within the Russian Society of Psychiatrists. Its task is to improve the provision of assistance to religious patients with psychiatric diseases. This requires scientific research of the peculiarities of mental disorders with religious content; raising awareness of the psychiatric community about the specifics of mental pathology with religious content and the peculiarities of religious life in mentally ill; organization of psychoeducational work among representatives of religious denominations in order to cooperate in identifying mental pathology and improving the compliance of mentally ill. A number of theological schools of the Russian Orthodox Church and educational courses for clergy have already introduced the discipline "Fundamentals of pastoral psychiatry", a curriculum and manuals have been developed. In the future, it is necessary to spread this initiative in all dioceses of the Church, as well as in all theological schools of various denominations.

Wenceslao Domingo Vial Mena, Professor at the Holy Cross University (Italy, Rome) in the report "Why is it necessary to consider spirituality in mental health?" spoke about the integrity of a person in the unity of his physical, mental and spiritual components. He stressed that the search for the meaning of life is a deep desire of the soul. True spiritual orientation generates healthy attachments, a healthy mind, a sense of joy, and love. A doctor must take into account the spiritual aspects of his patients’ state: "Spiritual phenomena, including transcendence and religiosity, affect life, health and illness. That's why they should be taken into account in psychiatry," said Prof. Vial.

Archpriest Alexiy Baburin, a priest at the hospital church in the MHRC, spoke on "Faith as a requirement of a highly developed mind" and quoted statements of apostles, Church fathers, theologians, philosophers and psychologists about the impact of faith on human health. "Quoting from many statements of prominent scientists, I want to show how important it is to understand the relevance of strong rational faith, active love, prayer to God for those who have devoted themselves to the care for people suffering from various bodily and mental diseases," noted Father Alexiy.

Martin Federico Echavarria Anavitarte (Barcelona, Spain), dean of the School of Psychology, University Abat Oliba CEU spoke on "Mental health according to Thomas Aquinas". He noted that the works of an authoritative Catholic teacher of the Church contain reflections on the causes of mental disorders, a significant part of which is associated with a violation of moral principles. So, some diseases are the result of gluttony, sadism, cruelty and other sins. According to Martin Echavarria, the ideas and arguments of Thomas Aquinas about human mental health remain relevant today. Turning to religious sources of the past can greatly facilitate modern psychiatrists' task of making a correct diagnosis.

Priest José M. Vegas, lecturer at the Catholic Higher Seminary "Mary Queen of the Apostles" (St. Petersburg), licentiate of theology and philosophy of the Pontifical Gregorian University (Rome) in his report on "Fatherhood and its role in mature interpersonal relationships and in the formation of religious consciousness" spoke about the basis of religious experience, about the correct understanding of faith, which presupposes the achievement of human maturity, independence, responsibility and the establishment of mature interpersonal relationships.

Dvoinin A.M., associate professor of the department of psychology of the Faculty of Social Sciences, National Research University “Higher School of Economics” (Moscow) in his report "God as a mental resource of a person" focused on the question of psychological maturity of a person in connection with faith, of religion as an opportunity to find a resource for living and as a strong mental resource of personality.

Shankov F.M., researcher at the Laboratory of Counseling Psychology and Psychotherapy of the Russian Academy of Sciences Psychological Institute, volunteer of the Foundation "Spiritual Heritage of Metropolitan Anthony of Sourozh" (Moscow), in his contribution on "Diversity and unity of spiritual resources of coping with critical situations, based on the screening of the population at the beginning of the COVID-19 pandemic", spoke about the results of a scientific study. Screening showed that spiritual resources help a person to get out of the "vortex of loss" (loss of work, health of loved ones, of feel of control, security). Human relations play an important role: "It seems that it is through a simple human attitude that we can give our patients the greatest, and this will be the greatest gain for them: a sense of connectedness, security, peace, self—efficacy (that God believes in me), hope," the speaker noted.

Vladimirova T.V., senior researcher of the department of youth psychiatry of the MHRC, made a report on "Specifics of the value-semantic sphere of the personality of mentally ill people and religious coping strategies". She drew the attention of the conference participants to the fact that "mental illness does not actually destroy the basis of the value hierarchy in patients with a religious worldview", while in non-believing patients "lack of health entails the loss of basic values and the loss of the meaning of life".

Nemtsev A.V. (Tomsk), head of the department of general professional disciplines of the Tomsk State Pedagogical College, associate professor of the Tomsk Theological Seminary, in his report "Spiritual meanings and values: post-non-classical understanding", presented an introduction into the history of the development of psychology from the perspective of its understanding of religious experiences, as well as his reflections on the use of new scientific approaches in clinical psychology in providing psychological assistance to believers suffering from mental disorders.

Lebedeva A.A., associate professor of the department of psychology, faculty of social sciences and Vitko Y.S., intern of the International laboratory of positive psychology of personality and motivation of the Higher School of Economics made a joint report on "Role and place of religious experience in going through a spiritual crisis". They shared the results of an empirical study, the purpose of which was to systematize from a psychological perspective the states in which people find themselves experiencing a certain crisis in the relationship with the transcendent. The researchers have compiled a typology of four types of crisis. The criteria for their differentiation were signs of presence or absence of religious experience and mythologeme. "The study shows that the divides between psychology, psychiatry and theology can be thin, when we are talking about a person going through a spiritual crisis," the speakers concluded.

Jerzy Wojciech Nawojowski (Spain, Avila), general secretary of International Center of Teresian and Sanjuanist Studies, spoke on "Mysticism and the health of Saint Teresa of Avila". He explained that mysticism, understood as the knowledge of God and divine energies obtained in unity with Him, and rather through "experiencing" His reality than through understanding it, is at the same time a process of deep humanization of a person. Both good health and lack of physical or mental health can be important factors in the process of mystical union with God.

Francisco García Martínez (Spain, Salamanca), professor at the Pontifical University of Salamanca in the report ""His wounds have healed us" [Is 53:5]. The healing force of weakness" spoke about the spiritual experiences of Juan de la Cruz, Dietrich Bonhoeffer, the evangelical "prudent robber" and other people who went through a crisis.

Kirillin V.M., head of the Department of Philology of the Moscow Theological Academy in his contribution focused on the phenomenon of foolishness in spiritual, cultural and historical aspects. He noted that foolishness, as a special kind of austerity, arose in the East around the IV century, and in Russia its heyday fell on the XIV-XVII centuries, and even in Soviet times it was quite widespread. "Fools were usually perceived as denouncers of unrighteous power and heralds of God's will. That is why they were often revered during their lifetime and, of course, after their departure to the Lord." During the Synodal period, the Russian Orthodox Church was cautious about this feat, since foolishness could have different causes, although the external manifestations could be similar. Speaking about the problem of authenticity of the feat of foolishness, the speaker proposed a number of criteria that could help distinguish true foolishness from false.

Drobashenko T.G. , head of the Department for Study of Special Forms of Mental Pathology of the MHRC also spoke about the phenomenon of foolishness and presented a pathographic analysis of the personality of Ioann Yakovlevich Koreisha (1789-1861). She noted that "foolishness for Christ's sake is considered as a form of prophetic service, combined with extreme austerity, constant prayer, gifts of prophecy and healing. The paradox of the feat and its manifestations have always made it difficult to under-stand and evaluate." The speaker analyzed this complex and multifaceted phenomenon using the example of Ioann Yakovlevich Koreisha, who was widely revered during his lifetime and whose help was experienced by many people, who was a patient of a psychiatric hospital for 43 years and performed his ministry from there.

Archpriest Vladimir Shmaliy, lecturer at NRNU MEPhI and Ss Cyril and Methodius Institute of Post-Graduate Studies in his report "Mindfulness practices and Christian life" presented his vision of "mindfulness meditation", which has become widespread recently, and raised the question of whether Christians can use it.

Kopeyko G.I., deputy director for scientific work of the MHRC in the report "Religious fanaticism and religious delirium" presented typical features of religious fanaticism and recommended that clergy learn to distinguish religious worldview from religious delirium, since patients with delusional ideas can harm both themselves and others. As an example, he cited the "Penza sitters" who settled in anticipation of the end of the world in a dungeon dug by them in one of the districts of Penza region, as well as people who fought against the Tax payer ID and burned passports. Their antisocial behavior is akin to the behavior of members of totalitarian sects and terrorist groups obsessed with various super-ideas. They are in conflict with the community, do not listen to the priests and need drug therapy.

Borisova O.A., leading researcher of the group for special forms of mental pathology of the MHRC, spoke about the typology of pathological pseudo-religiosity in patients with mental illnesses.

Archpriest Pavel Velikanov (Moscow), associate professor of Chair of Theology of the Moscow Theological Academy, made a report on "Toxic religiosity and non-clinical psychocorrection in extra-liturgical activities of a parish." He described criteria for distinguishing healthy religiosity from pathological (toxic), and also suggested using the latest psychological and pedagogical technologies and methods in the extra-liturgical activities of the parish to help people with pronounced neurotic religiosity: "The most promising is the use of some socio-pedagogical models of work using art-therapeutic approaches. It is necessary to develop technological protocols describing the sequence of the main stages and technical actions at each stage when using the pedagogical model of systemic art therapy with different categories of parishioners," concluded Father Pavel.

Gedevani E.V., senior researcher of the group for the study of special forms of mental pathology of the MHRC and Smirnova E.V., a graduate student of this group spoke on "Psychopathological specifics of religious delusions of sinfulness in patients with depression". The experiences of a healthy believer and a person suffering from depression with religious delusions of sinfulness are very different; this, first of all, refers to the understanding of repentance and guilt. The speakers noted that the feeling of guilt experienced by a person with religious delusions of sinfulness "does not lead a person to repentance, to getting rid of difficult emotional experiences. Moreover, in this case, the feeling of guilt drives a person away from God. Because behind the exterior facade of a bright religious feeling and a desire for repentance in these cases, there are manifestations of mental illness that require mandatory medical intervention." The peculiarities of counseling work with such patients include correction by an "individual scale of values", suppression of "unreasonable fear of sin" and any incipient delirium formation.

Kurasov E.S. , professor of the Department of Psychiatry at the S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia in his report "Pastoral care in the modern system of approaches to the treatment of mental disorders", presented an overview of the development of psychiatry in the world and in Russia, the evolution of modern (from the 60s of the XX century to the present) targets for treatment of mental disorders. He emphasized that at present, pastoral counseling occupies an important place in the system of treatment and rehabilitation approaches of psychiatry. In its external form, it is similar to psychological counseling (positive dialogue in search of a solution to a problem), but differs from it in its essence. In the Military Medical Academy, counseling work has always been an integral part not only of the medical process, but also of educational work with students.

Voskresensky B.A., associate professor of the Department of Psychiatry and Medical Psychology of the Faculty of Medical Sciences of the N.I. Pirogov RNIMU, lecturer at the St. Philaret Institute, made a report "Pathological mysticism as a clinical, psychotherapeutic and cultural-historical problem". The speaker analyzed the concepts of "mysticism", "pathological mysticism", "false mysticism", "consciousness", "self-consciousness", highlighting "reflexive consciousness" — critical of oneself and at the same time creative, an example of which can be the Christian consciousness. The most important feature of the psyche is self-transcendence (according to S.S. Khoruzhiy), which has three directions: 1) spiritual practices that elevate a person; 2) art that leads to cathartic experiences; and 3) "madness", i.e. a mental disorder that leads to impoverishment, destruction of mental spiritual processes. The speaker focused on some aspects of treatment and psychotherapeutic work with patients who are obsessed with the idea of the influence of mystical forces on them. In conclusion, he noted that "the solution of psychotherapeutic and rehabilitation tasks in relation to the contingent under consideration can be carried out most effectively only with the friendly cooperation of clergy and doctors."

Popovich U.O., senior researcher at the Department of Youth Psychiatry of the MHRC in the report " Specifics of religiosity in endogenous mental disorders in adolescence and youth" told about the results of the study, which was aimed at identifying clinical and psychopathological features, conditions for the formation of religious delirium in adolescence, analysis of the relationship between religiosity at the pre-manifest stage and subsequent manifest psychotic attacks with religious delirium of various contents. She defined the concepts of normal and pathological religiosity, and also cited the generally accepted criteria of normal, healthy religious faith.

Peter Verhagen, professor at the Center for Mental Health in Harderwijk, the Netherlands, presented the concepts of "living religion", "spirituality" and "sacred moments" in his report "Psychotherapy and spiritual Life", which help to "clear" the space for numerous manifestations of faith and spirituality in psychotherapy. He also formulated a number of recommendations on how the patient's religiosity and religious beliefs should be included and taken into account in psychiatric and psychotherapeutic examination and treatment.

Shamrey V.K., head of the Department of Psychiatry of the of the S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia made a report "Pastoral care for persons with suicidal behavior ", in which he described in detail the possibilities, directions and forms of cooperation between the Church, social and medical workers in the prevention of suicidal behavior. "Combining the efforts of clergy and medical professionals in the prevention of suicidal behavior involves taking into account all historical (Christian, clinical) experience, as well as using common methodological (primarily terminological) approaches and modern scientific achievements in this field," the speaker noted.

Rutkovskaya N.S., lecturer of the Department of Psychiatry of the S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia in her report "Specifics of religiosity of psychiatric hospital patients with various forms of suicidal behavior" presented the results of a scientific study aimed at analyzing the peculiarities of religiosity in persons with mental disorders who have committed suicidal acts. The data obtained "confirm the "antisuicidal" significance of the patients' belonging to the traditional (in particular, Orthodox) religion and the degree of their inchurching, and also indicate the negative role in this regard of active occult practices in mentally ill people. In addition, the results obtained suggest that orthodox patients are less likely to commit severe and repeated suicidal attempts, despite the fact that they have depressive symptoms even more often than those, who are "non-Orthodox", and are critical to their condition. However, an increased sense of guilt in orthodox patients requires, in most cases, additional psychotherapeutic correction," the speaker noted.

Merinov A.V., professor of the Department of Psychiatry of Ryazan State Medical University, read the report "Clinical suicidology and the Russian Orthodox Church: points of the most effective interaction". He noted that often a clergyman can be the first to learn about a person's suicidal intentions and should, according to the speaker, "have a clear and tangible response scheme... In this regard, the following ways of optimizing and friendly cooperation with clinical suicidology seem logical: raising awareness of clergy on issues of general and specific psychiatry; developing of minimum diagnostic suicidological requirements and a clear logical scheme of response in case of detection of suicidal aspirations; possibly, creation of an independent crisis service in the Russian Orthodox Church; informing citizens about the available anti-suicidal services."

Priest Ioann Melnik, a master's student at the Sretensky Theological Academy and Vladimirova T.V. , a senior researcher at the Department of Youth Psychiatry of the MHRC, spoke on "Coping strategies in pastoral care for people, who have lost their loved ones (according to the writings of Metropolitan Anthony Blum)".They spoke about the pastoral experience of Metropolitan Anthony of Sourozh, who was a doctor before his ordination, and noted the undoubted parallels between the coping strategies of modern psychiatrists and how Metropolitan Anthony acted, being a spiritually experienced pastor and guided by the Holy Scriptures and his theological knowledge.

Magay A.I., junior researcher of the group of special forms of mental pathology of the MHRC made a report "Integration of mentally ill people into church life: pastoral and medical support". He noted that since 2016, a technology for supporting mentally ill people has been developed, combining a therapeutic component (for help in a medical institution) and a rehabilitation component (for work on the basis of an Orthodox parish). Now this technology is being successfully applied. In 2021 a new project has begun aimed at further developing this technology and de-scribing spiritually oriented approaches that can be used in working with believers with mental disorders. Psychoeducational work with the clergy, as well as cooperation with public organizations, is of great importance for the widespread use of this technology.

In his closing remarks, Metropolitan Sergiy of Voronezh and Liski expressed satisfaction with the fact that in the course of the work of the expert group on "Pastoral care for the mentally ill", the dialogue between psychiatry and the Church has intensified: psychiatrists and clergy representatives involved in this work have learned to listen and hear each other; more and more specialists from different regions of Russia are joining this work; the dialogue with our foreign participants — representatives of the Roman Catholic Church and Protestant denominations — is interesting and mutually beneficial.