A section of the Christmas Readings dedicated to the Church’s pastoral care for people with mental illness was held at the DECR

DECR Communication service, 31.01.2026.

On January 24, 2026, a section of the 34th International Christmas Educational Readings took place at the Department for External Church Relations of the Moscow Patriarchate on the topic: “The Church’s Care for People with Mental Illness. Mental Disorders and the Personality of the Patient: Challenges of Our Time.”

The section was jointly organized by the Department for External Church Relations, the Commission on Church Enlightenment and Diakonia of the Inter-Council Presence –within which an expert working group on pastoral care for people with mental illness operates – as well as by the Mental Health Research Center. Section meetings on this issue have been held annually since 2018.

The meeting was chaired by Metropolitan Sergiy (Fomin), head of the expert working group. The section was curated by M.B. Nelyubova, secretary of the Commission on Church Enlightenment and Diakonia and an employee of the Department for External Church Relations.

About 40 people took part in the section’s work – clergy and laity fr om 10 dioceses of the Russian Orthodox Church, representatives of the Roman Catholic Church and Protestant communities, academic psychiatrists, staff of the Mental Health Research Center (MHRC), the Pirogov Russian National Research Medical University, the Serbsky National Medical Research Center for Psychiatry and Narcology, state and public organizations, physicians, church social workers, and students of theological and secular educational institutions.

In his introductory report, “Saving the Image of God: A Pastoral View on Contemporary Teachings about the Soul,” Metropolitan Sergiy noted that Orthodox Tradition defines mental health as a state of the person striving for union with Christ, capable of communion with God, love, good deeds, repentance, and hope. Mental disorders are the suffering of fallen nature, distorting the relationship with God and with other people. Of particular danger is demon-likeness – a voluntary assimilation of one’s will to fallen spirits, leading to sinful corruption and spiritual death. Modern society, by cultivating absolute “freedom” and self-assertion, generates loneliness, anguish, and aggression, becoming a source of mental ailments. The widespread teaching on “self-actualization,” which proclaims the realization of one’s potential as the highest goal of life, turns the human “self” into the measure of all things and reduces God to merely a “psychological projection,” opening a direct path “to spiritual blindness and grievous passions, the root of which is demonic pride.” The popular idea of “effective functioning” in society as a criterion of mental and physical health fails to take into account that society itself may be spiritually ill and also leads away fr om the true path. These false teachings do not heal but aggravate illness, depriving suffering of meaning and reinforcing egoism. The hierarch warned against the temptation to misinterpret trichotomy (spirit, soul, body), replacing “the integrity of the human person with yet another scheme and presenting a person as consisting of three ‘parts’ – separate and almost materially tangible.” “Fr om the Holy Gospel we know that our Lord Jesus Christ Himself healed not an abstract ‘soul’ or ‘spirit,’ but whole people: the blind, the lame, the demon-possessed. He restored their wholeness. In the same way, the clergy help a person freely build a right relationship with God, struggle with passions, and care for the integral personality seeking salvation, rather than for some isolated ‘spiritual component’ of a person.”

He named three main directions for the joint response of medical professionals and clergy to contemporary challenges in the sphere of mental health:

– counteracting the suffering of human nature, that is, opposing the very manifestations of mental illness, wh ere “medicine and psychotherapy are essentially God-given means for healing damaged nature.”
– counteracting the influences of the world: personal ascetic effort, “hygiene of the soul”—informational restraint, rootedness in church life, prayer, the gift of discernment, and learning love.
– counteracting demonic possession: recognizing the reality of the influence of dark forces on the weakened soul. This requires conciliarity, trust in the Church on the part of physicians, and cooperation between the spiritual father, psychiatrist, and psychologist.

The common task along this path is to equip pastors and physicians with the patristic understanding of the human person, so that each may become a warrior of Christ, capable of discerning evil and offering true help that leads to communion with God.

The text of Metropolitan Sergiy’s address is provided below.

V.G. Kaleda, Doctor of Medical Sciences, Deputy Director for Scientific and Organizational Activities and Head of the Department of Adolescent Psychiatry at the Mental Health Research Center, Professor, and Chairman of the Section on Clinical Psychiatry of Religiosity and Spirituality of the Russian Society of Psychiatrists, delivered a report entitled “Personality Disorders and the Challenges of Modernity.” Speaking about mental health as a person’s ability to cope with life’s stresses and to realize their potential, he noted that many contemporary researchers recognize that religious values are of immense importance for a person’s inner harmony and mental health. The loss of value orientations and moral degradation are among the causes of the emergence of mental disorders, the appearance of new forms of addictions, and the high level of stress factors in the life of a modern person. Among the main challenges of our time, he identified the growth in anxiety-depressive disorders, the epidemic of post-traumatic stress disorders, declining birth rates, increasing life expectancy, and changes in life patterns. The aging of the population is accompanied by an increase in dementia. Worldwide, about 350 million people of all age groups (around 5% of the population) suffer fr om depression. In Russia, the number of people with this condition is approaching 9 million. The speaker also touched on the characteristics of different generations and their responses to the challenges of their time, including problems of alcoholism, aggression, and others. He noted the rise of internet addiction, which is becoming a serious social problem, and also addressed the topic of artificial intelligence as a new challenge that affects people’s cognitive abilities while at the same time opening up new opportunities.

V.G. Kaleda also focused separately on the issue of mutual understanding and interaction between clergy and psychiatrists, and on the need to study psychiatry in theological educational institutions and religious culture in medical ones. He noted: “It is not surprising that among people who come to church, there are more individuals with mental disorders than in the general population. After all, the Church is a place of healing. If we were to say that only healthy people should be in a hospital, then what kind of hospital would that be?.. At present, many general church documents clearly state that a priest should know psychiatry; a course in pastoral psychiatry is taught in theological educational institutions, and a manual for clergy, ‘Fundamentals of Pastoral Psychiatry,’ has been published.”

Igumen Iona (Zaymovsky), Candidate of Theology, Associate Professor of the Sretensky Theological Academy, and Head of the Center for Christian Addictology, delivered a report entitled “Is Addiction a Fatal Disease? A View of a Christian Addictologist.” He noted that alongside alcoholism and drug addiction, which are obviously life-threatening diseases, there also exist behavioral addictions (gambling, sex addiction, etc.). Using a biopsychosocial approach grounded in Christian spirituality, he broadly interprets death fr om any type of addiction not only as physical but also as spiritual, manifested in damage to the social and psychological spheres. The key concept examined in the report is lack of control (an irresistible craving, obsession), which is a marker of destructive addictive behavior and which arises fr om the loss of control over use. “Lack of control cannot be explained exclusively by social, psychological, or psychiatric causes. It seems to be rooted in the very mystery of the human person and represents a phenomenon of a spiritual order.” According to the speaker, lack of control is in fact being controlled by certain spiritual forces behind addiction that push a person toward biological, social, psychological, and spiritual death. “The main message of Christian addictology is: God heals fr om addiction. God frees from lack of control those who turn to Him… But the power of addiction is great. That is why an addicted person must show perseverance, persistence, steadfastness, faithfulness, and faith. That is why rehabilitation programs and self-help groups are important,” the speaker concluded.

U.O. Popovich, Candidate of Medical Sciences and Senior Researcher of the Department of Adolescent Psychiatry at the Mental Health Research Center, spoke about mental disorders among modern youth. She noted that adolescence is characterized by the formation of worldview, increased interest in existential questions, and a tendency toward risky behavior. During this period, there is an increase in anxiety and depressive disorders: about 30% of young people experience anxiety, and 20% experience depression. External risk factors include social pressure, academic workload, cyberbullying, and the consequences of the COVID-19 pandemic; internal risk factors include hormonal changes, genetic predisposition, and the immaturity of stress-coping mechanisms. Among young people, the most common are anxiety disorders, eating disorders, addictions, and non-suicidal self-injury. An important issue is youth suicide. Suicidal behavior among young people is caused by internal conflicts, social stress, and mental disorders (depression, bipolar disorder, PTSD, borderline personality disorder, schizophrenia). In 80–90% of suicide cases, there are mental disorders. Signs of suicide risk include talking about death, isolation, changes in behavior and mood. Prevention and treatment require a comprehensive approach: psychotherapy, medication, family support, raising awareness, and improving access to care. It is important to develop emotional literacy, create a supportive environment, and expand psychological services for young people. Early diagnosis and timely assistance significantly increase the chances of successful treatment and rehabilitation.

Priest Ioann Melnik, Master of Theology, rector of the church in honor of the Hieromartyr Seraphim Chichagov in the city of Lobnya, and Chairman of the Diocesan Department for Culture of the Sergiev Posad Diocese, delivered a report on the topic “Pastoral Assistance of a Priest in Coping with Grief (the Experience of Metropolitan Anthony of Sourozh).” He noted that in a state of grief arising from the loss of a loved one, people often seek support in the Church and turn to a priest. Using the example of the pastoral experience of Metropolitan Anthony of Sourozh, Father Ioann proposed a strategy for combining certain psychotherapeutic approaches with pastoral work to help a grieving person: to bring them out of the state of grief and to achieve psychological and spiritual stabilization. He set out in detail recommendations for providing pastoral assistance to a grieving person, which combine a biblical and patristic perspective with certain recommendations from modern psychotherapy. He emphasized that spiritual assistance is effectively received by a person when it is timely and responds to their needs. A pastor, by borrowing certain knowledge from psychotherapy, can more effectively help the grieving person, taking into account the characteristics of their personality. In the pastoral experience of Metropolitan Anthony in comforting the grieving, there are elements similar to psychotherapeutic ones. He does not systematize his experience but gives a theological evaluation of the mechanisms used in the process of consolation. The experience of the hierarch shows that pastoral means have functions similar to psychotherapeutic coping strategies, are effective, and can be integrated into the methodological system of priestly assistance to the grieving. His pastoral approach and openness to scientific knowledge make possible discussion and cooperation between pastor and psychotherapist.

Father Ioann noted that a priest should not assume the role and competence of a psychiatrist or psychotherapist, especially when it comes to the pathological course of grief – in such cases, a person should be immediately referred to a competent specialist. “Psychotherapeutic work with grief relies on systematic knowledge, which is supplemented by various practices aimed at bringing the patient out of a pathological state and resolving the main conflicts. In turn, religious experience has its own means designed to alleviate the experience of death and to cope with grief. By assimilating scientific experience, a priest has the opportunity to carry out deeper, more systematic, and timely work with the grief of a person who has turned to him for help.”

The presentation of Priest Georgy Dumbi, a cleric of the Patriarchal Metochion – the Church of the Holy Blessed Grand Prince Alexander Nevsky at MGIMO – on the topic “Religious Trauma Syndrome: Relevance and Prevention” was devoted to examining the psychological state that arises as a result of destructive religious practices: prolonged staying under conditions of rigid religious rules, intimidation and restriction of freedom of choice on the basis of faith, humiliation and devaluation of the individual. Religious trauma syndrome arises not because of faith itself, but because of how faith is transmitted and applied in a destructive form. This syndrome has much in common with other types of trauma, such as betrayal trauma or complex post-traumatic stress disorder. Its main manifestations include: anxiety and fears, loss of identity, depression and apathy, loss of interest in life, lowered self-esteem, and others. Religious trauma syndrome can significantly aggravate or even underlie other mental disorders, such as post-traumatic stress disorder, obsessive-compulsive disorder, and eating disorders. Scientific research confirms that religious trauma syndrome is not a matter of isolated cases, but a significant psychological problem which, in some countries, affects a considerable percentage of the population.

E.V. Gedevani, Candidate of Medical Sciences and Senior Researcher of the Department of Transcultural Psychiatry at the Mental Health Research Center, devoted her presentation to the topic “Existential Crises and Youth.” The states that almost every person encounters throughout life – existential crises – can vary in intensity: from “normal” to conditions with severe psychopathological disorders. In the first case, they pass on their own or require short-term psychological correction, leading a person to the discovery of new meanings in life. In severe cases, when critical episodes are accompanied by the development of mental pathology, medical involvement and psychotherapy are required. Such crises are most severe at a young age. Researchers propose using several types of psychotherapy to overcome this phenomenon: existential, meaning-centered, and understanding-oriented. Religiosity and spirituality have a significant protective effect against existential distress, depression, and suicidal behavior. Unfortunately, in recent years, young people have been moving away from traditional religiosity.

Hieromonk Amphilochius (Pushkarev), a postgraduate student of the Moscow Theological Academy, presented a report on the topic “Pastoral Counseling of Patients with Depression.” He noted that according to the World Health Organization, more than 280 million people worldwide suffer from depression; between 1990 and 2021 their number increased by 56%, and suicide, often associated with depression, remains the second leading cause of death among young people aged 15–29. Each year there is an increase in the number of suicide attempts among children and adolescents: thus, in the age group from 15 to 29, suicide is one of the leading causes of death. Russia leads in adolescent and child suicides. According to data from the Investigative Committee of the Russian Federation, in 2021 the number of child suicides increased by 37.4% compared to 2020 and amounted to 753 cases versus 548 cases respectively.

There is a significant gap between the actual prevalence of depression and the number of people receiving professional psychiatric care: 32% of the population worldwide report symptoms of mental disorders, 20% officially suffer, 5.5% have established diagnoses, and only less than 2.5% are under the supervision of psychiatrists. Despite the development of pharmacology and psychotherapy, the healthcare system is not coping with the scale of the problem.

An important omission is the ignoring of the spiritual dimension of depression, which is present in most cases. The speaker considers it important to expand the traditional biopsychosocial model to a biopsychosociospiritual one, including the spiritual component in order to increase the effectiveness of treatment. Spiritual well-being plays a significant role in the prevention and treatment of depression. It provides a 40% reduction in the risk of developing depression and acts as a powerful protective factor. Integrated spiritual treatment shows 30–35% better results compared to standard therapy. Existential factors, such as the meaning of life and purpose, demonstrate a stable inverse correlation with depression.

The Russian Orthodox Church considers mental illnesses as a manifestation of the sinful distortion of human nature and emphasizes the importance of pastoral care, which should be combined with medical assistance. The report lists signs of depression in which priests should recommend seeking help from psychiatrists, as well as common misconceptions among believers that hinder treatment.

The role of the priest in the process of treating depression is multifaceted. It includes support in obtaining professional help, assistance in understanding the illness, work with relatives, and interaction with medical specialists. Pastoral care is viewed as a unique resource for diagnosis, increasing adherence to treatment, and providing spiritual support to patients, contributing to their recovery and the preservation of a sense of love and dignity. In conclusion, the need for shared responsibility of the clergy and medicine in matters of mental health is emphasized.

N.V. Lazko, Candidate of Medical Sciences and an employee of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology of the Ministry of Health of Russia, delivered a report entitled “Features of Mental Disorders in Accordance with the ‘Syndrome–Personality–Situation’ Concept under Conditions of Active Fraudulent Activities against the Background of the Ongoing Special Military Operation.” Her presentation was devoted to the problem of the influence of fraudulent activities on the mental state of persons with chronic mental disorders. She noted that mentally healthy individuals who have been subjected to fraudulent actions develop adjustment disorders. In elderly people with mild disorders, more severe conditions develop as a reaction to the actions of fraudsters – organic personality disorders and non-psychotic mixed disorders of organic nature. People who initially had severe mental disorders are more vulnerable; their reaction to fraudulent actions may be ambiguous, their mental illness may worsen, and they may commit socially dangerous acts, as a result of which compulsory medical measures may be applied to them. Believers may experience a prolonged and severe spiritual crisis. Natalia Viktorovna noted that in the current tense social situation, joint actions of a psychiatrist, psychologist, and priest are necessary, as well as the involvement of social service workers, law enforcement officers, and volunteers, in order to overcome the consequences of fraudulent activities affecting people with mental disorders.

A.I. Magay, Junior Researcher of the Department of Transcultural Psychiatry at the Mental Health Research Center, spoke about a spiritually oriented approach in counseling families with mental disorders. The speaker noted the characteristics of the psycho-emotional life of such families, including stigmatization and intra-family stereotypes, and described a method of group counseling based on a spiritually oriented approach following Florenskaya’s dialogical model, which includes the stages of listening, formulating the request, providing spiritual support, and feedback. This method implies group counseling for families with mental disorders, which includes a structured conversation based on general principles of counseling with elements of spiritually oriented dialogue. The goal of this counseling is to provide psychological support to members of the aforementioned families, drawing on the theory of religious coping strategies. He noted the particular importance of a multidisciplinary team (physician, psychologist, priest) and of religious coping strategies. The report presents research results confirming the effectiveness of spiritually oriented methods in rehabilitation, as well as adapted questionnaires for assessing spirituality and religiosity in patients. The outcome of this work is an improvement in the social functioning of families, a reduction in relapses, and increased awareness among relatives about methods of support.