If a person’s joints ache, or his heart, or his stomach, the attitude of those around him toward him is always one of compassion. If such a patient’s condition worsens, no one doubts the need for intensive treatment in the hospital. And there is even more sympathy for those who end up in the hospital. In the case of mental disorders, the picture is different. If the problems concern a close relative, the immediate thought is: How can one hand a loved one over to the “nuthouse”? And those around such patients tend to regard them with contempt and wariness rather than compassion. We spoke about this problem with the psychotherapist at the Minsk City Oncology Center, trainer at the “Phenomena” Center for Practical Psychology, and member of the St. Nicholas Brotherhood, Andrey Butko (Minsk).
Philippe Pinel (1745-1826) releasing lunatics from their chains at the Bicetre asylum in Paris in 1793. Artist: Charles Louis Lucien Muller. Photo: kunst-fuer-alle.de
—Andrey Vladimirovich, what do you think about this as a psychiatrist?
—There is such a thing as ignorance. There are people with hypertension or diabetes who consider medicines to be evil. There is no need to take them—period. Pills destroy everything, and without doctors we’d all be happy…
The same can be said with regard to mental disorders. People understand them less and therefore stigmatize them (stigmatization is a prejudiced, negative attitude toward an individual associated with his having certain special traits, characteristics, or illnesses.—E. N.). These illnesses frighten and cause a sense of shame. This again depends on the degree of knowledge in the area of mental health.
—So what is mental illness? And what does psychiatry do? After all, “psyche” in Greek means “soul.” Can the soul really be treated with medicines? St. Simeon the New Theologian has this saying: “The body, being composed of many, moreover unequal parts, which themselves are made up of four elements, when it falls ill, has need of various remedies… But the soul, on the contrary, being immaterial, simple and uncompounded, when it falls ill, one remedy heals it—the Holy Spirit, the grace of the Lord Jesus Christ.”
—There is a certain mismatch in terminology. Because psychiatry, though it bears such a name, does not deal with the soul as an immaterial substance and does not claim to do so. It is a science that deals with quite material phenomena that can be studied, measured, and proven. , Because it is an immaterial phenomenon, science wholly entrusts the soul to the Church and makes no claim upon it.
Andrey Butko If we take the tripartite model of man spoken of in Orthodox theology (spirit, soul, body), then the body is a biological object that can be treated with various medical means.
If we consider the soul in its psychotherapeutic, material understanding (personality, upbringing, character traits, development of this or that feeling, a person’s awareness of his feelings), then this is the realm of the soul that has also been sufficiently studied. Here the method of influence and treatment is psychotherapy.
But a person’s spiritual state, the direction of his life—according to God’s will or against it—this is a purely spiritual matter.
If unbelievers think that bodily illnesses are completely unrelated to a person’s spiritual state, believers are convinced that there is a close connection between soul and body. And disorders in the spirit lead to disorders in the soul, and ultimately in the body.
If we have crossed the threshold of the Church, this does not mean that from now on the Lord Himself takes care of our health, and that grace alone is sufficient for preventing illnesses.
However, if we return to the theme of ignorance, then among believers there are both more and less knowledgeable people. If a person becomes a believer, this does not mean that he becomes smarter and more enlightened. Ignorant people also perceive faith in a distorted way. And the problem here is in knowledge, and not in what religion transmits.
Believers have exactly the same illnesses as unbelievers. And if we have crossed the threshold of the Church, this does not mean that from now on the Lord Himself takes care of our health, and that grace alone is sufficient for preventing illnesses. We still have to brush our teeth, take care of our blood vessels and heart, watch our diet—yes. The body is given to us by the Lord on lease for the time of our earthly life, and each of us is personally responsible for it.
—The human psyche is complex and multifaceted. Can you explain some basic principles by which a psychiatrist determines that he is dealing specifically with an illness?
—Conditionally speaking, all mental disorders can be divided into two large groups. One is illnesses connected with disturbances in metabolism in the brain. For example, schizophrenia is connected with a disturbance in dopamine metabolism, depression with serotonin and norepinephrine, anxiety with glutamic acid. And these are serious illnesses.
However, today many of them are highly treatable. A diagnosis is made for the person, a medicine is selected that normalizes metabolism in specific areas of the brain, and when the person takes this medicine, the illness goes away without a trace. There is no need to labor over some deep self-analysis; it is enough to make the diagnosis, select the therapeutic drug—and the illness disappears.
A completely different category of disorders is connected with stress. These are so-called neuroses. These are functional illnesses in which there are no major, significant disturbances in brain metabolism, or these disturbances are secondary. These illnesses are connected with a person’s character traits. The roots of these disorders lie in childhood, in upbringing. The main method of treating this category of illnesses is psychotherapy, while medicines play a supporting role.
One mother, while raising her child, leads him down the street and says, “Look at the leaves on the trees, what green grass, what flowers.” And the child notices all this.
But another mother who drinks heavily constantly scolds her child. This child was not taught from childhood to notice the beautiful; and when he walks down the street, he does not see the grass, does not see the leaves, the insects, birds—his spiritual state is completely different. These two people will walk down the street, and one will notice the beauty while the other will not, because they had different childhoods and different upbringings.
—And what about sin, human passions? Are only biochemical disturbances in the body and upbringing to blame for there being mentally ill people in our life, like those maniacs?
—I share the view of the Orthodox Church that the world lies in sin, and that man falls ill and dies precisely because of his sinfulness.
Illnesses connected with damage to the brain are unequivocally not a direct consequence of sin.
However, when we speak of sin as missing the mark, as an error that we can commit daily, I would like to emphasize that illnesses connected with damage to the brain are unequivocally not a direct consequence of sin.
When we speak of neuroses, of functional disorders whose basis is an internal conflict, the concept of sin is more applicable here. Mistakes in relation to the commandments and God’s will, made by parents and by the person himself, may be related to these illnesses, but not in every case.
—And what do you say about possession? How do you regard the opinion that equates the concepts of “mentally ill” and “possessed”?
—As a believing man, I am convinced of the existence of angels and demons. I also do not deny that a person can be possessed by demons. I believe that the Holy Orthodox Church can help in this case. But throughout my entire practice I have never seen a possessed person. I think that such a phenomenon nowadays occurs extremely rarely.
Therefore, if Orthodox people observe any signs of mental disorder in a relative, the more correct path is to turn to doctors as soon as possible. Because the time of seeking treatment often affects the outcome.
—Do you mean to say that in psychiatry, as in oncology, the time treatment is begun is the decisive factor?
—This applies to all illnesses. If these are illnesses connected with problems of character, then the younger the person begins working with a psychotherapist, the more opportunities he has to achieve progress.
All the more so if this is an illness connected with brain damage. If treatment is begun at the first symptoms, there will be less brain damage. With the help of medicines it will be possible to slow down the process and suppress it. But if many years have passed and the brain is seriously damaged, then the illness is no longer treatable. Then it is only a disability group, a residential care home, maintenance.
The stage at which people seek help depends on their knowledge and concern for their relative. It is important to be ready to care, to spend effort and money on treatment. No less important is whether the patient is ready to accept this care. After all, there are people stubborn in their ignorance.
I remember a case when a patient was admitted to a psychiatric hospital. None of the doctors doubted that she had schizophrenia. The prescribed treatment gave a good result. But the patient’s mother suddenly took her away without letting her complete the course. The mother said that it was possession, and she was afraid that they might somehow worsen her daughter’s condition in the hospital.
For about three years they took this girl, who was already practically healthy, to exorcisms and to fortune-tellers. The illness progressed, and when the girl’s psyche was already hopelessly destroyed, they returned to the clinic. But the doctors could no longer fully restore all the functions of the nervous system. The girl was officially disabled. I believe that here the mother bears direct guilt, through her ignorance.
—But you must agree that the image of a psychiatric hospital as a punitive institution, a special prison, is widespread. Where with the help of medications they suppress and break a person’s personality… So what is more merciful and compassionate: to hand over a loved one there or not?
—Is handing someone over for an appendectomy an act of mercy? It happens that people die during such operations. But no one asks such a question. As for the psychiatric hospital—this is prejudice. Helping the suffering is merciful.
There are situations when a mentally ill person can be left without help for a long time and nothing terrible will happen to him. But still, I think the most correct thing is to consult a doctor and find out: 1) whether there is a mental disorder or not; 2) what will happen if treated, and what if not treated. And then make a decision.
In general, it is more correct not to single out mental illnesses among other diseases. And not to perceive a psychiatrist as a special kind of doctor. There is no need for a prejudiced attitude. It comes from misunderstanding, fear, or ignorance.
The Church’s questions are questions of good and evil. But questions of mental health are not always questions of good and evil.
The Church’s questions are questions of good and evil. But questions of mental health are not always questions of good and evil. Very often these are much simpler questions, such as: Is it useful to brush your teeth or not?
If our neighbor is bleeding to death. Will we ask him whether he needs the wound bandaged? We will bandage it. And if he resists, we will call the police; they will hold him, and we will bandage the wound. If a person’s life is in danger, we cannot stand aside, even if he himself is trying to perish…
What is more merciful, in a Christian way? If a mental disorder manifests in one of our close ones or acquaintances, then it is more merciful to show reasonableness and not tell the person: This is because of your sins; you yourself are to blame! This only exacerbates his sense of guilt.
It is more correct to show prudence, to calm him; because the person is frightened by his condition—for example, delusions, obsessions, hallucinations. To calm, support, help meet with a doctor, convince him that a visit to the doctor is necessary. It is important to help one’s brother in Christ overcome his own prejudices, fears, anxieties, and not rush headlong to take him to an exorcism!
If you are not indifferent to the health of a loved one, you can make an effort to persuade and convince him to be treated. He may have to take medicines all his life, as hypertensives and diabetics do. But then the person will not become an invalid; he will preserve his body’s strength, which will be quite useful for good deeds.
And, in general, from the very beginning of the mental illness, in the process of its diagnosis and treatment, people with such disorders are in great need of compassion and support! This is precisely where there is a place for Christian virtues such as love and mercy.
