4.0 Clinical Vignettes
4.1 Clinical Vignette - Laying Down the Structural Foundation
Imagine a 31 year-old unmarried female, currently living with her parents and suffering financial difficulty. She relates her presenting complaint to the clinician as follows: "I am miserable. My living situation is becoming totally unbearable. There is constant turmoil between my parents and I usually end up being put in the middle of it. I have so many troubles of my own that I can't deal with life. I don't handle stress well anyway, and I have plenty of that with school and my "toxic" family. I have no money and no income, and therefore no way of moving out. I'm in school trying to create a career that will fit with my physical capacity. I just can't seem to find a job I'm qualified for that doesn't involve lifting, prolonged standing, or prolonged sitting. I have pinched nerves in my lower back as well as spinal arthritis. I just feel completely overwhelmed because I have no escape from either school stress or turmoil at home. To top it off, I'm having some trouble with my relationship with God."
Where would a clinician begin? First, the clinician would perform psychometric assessment such as the Beck Depression Inventory (BDI), Suicidal Ideation Scale (SIS), Beck Anxiety Inventory (BAI), and Novaco Anger Scale NAS to establish a baseline current and future reference. For this patient, her scores for the BDI are in the clinical depression range and clinical anxiety range of the BAI.
3.0 Psychological-Spiritual Interventions
3.1 Christian-Based Clinical Interventions
The power of the scriptures and the spiritual tradition of the Church conjunctively with cognitive therapy are crucial in the treatment plan for the committed Christian patient or counselee. Since earliest Christian times, the Holy Fathers have written on and studied the passions, [strong emotions] (italics mine). For example in the presentation of the treatment rationale, the patient can be given readings from St. Dorotheus of Gaza: "Disturbance is the movement and stirring of thoughts, which arouse and irritate the heart" (Philokalia, 1984-93)(italics mine).
What the fathers of he church call "movement and stirring of thoughts which arouse the heart" can be easily understood by the clinician to be very related to the automatic thoughts and the triggering of emotions discussed by cognitive-behavioral clinicians. Thus as the Christian patient goes through the "Cognitive treatment" identifying distorted cognitions and restructuring them, they are at the same time performing a "spiritual act." This process would be likely motivational for the Christian patient.
This course has recently been updated and soon to be published in a chapter in an American Psychological Association book. The updated reference for the upcoming book is: Morelli G. (in press). Eastern Orthodox Churches. In Scott Richards, (Ed.), "Handbook of Psychotherapy and Religious Diversity" (2nd edition). Washington, DC: American Psychological Association.
2.0 Bio-Cultural Elements
2.1 Emotion and Neural Processes
Studies from various areas in psychology, suggest cognition, emotion and behavior interact with each other in complex ways (Weitan 1995). There are currently various psychological models to explain this interaction. One model based on Darwinian evolutionary theory is that emotion develops as an adaptive value to a stimulus. The different laboratories of Izard (1984), Tomkins (1991) and Plutchik (1984) come remarkably similar findings on the presence of primary emotions shortly after birth. These researchers agree on six emotions (fear, anger, joy, disgust, interest and surprise) out of about eight or ten primary emotions. Phylogenetically these emotions occur before the brain structures supporting cognition initiate development. That is, subcortical brain areas such as the hypothalamus and the limbic system develop before the cerebral cortex.
1.1 Historical Christian Spiritual Foundations of Counseling.
Christians trace their founding to Jesus Christ, by His sending (decent) of the Holy Spirit at Pentecost on His apostles and disciples. Following St. Paul, we know that the teachings of Jesus were understood by Christians by them being sanctified by this same Holy Spirit. St. Paul did much to spread the teachings of Jesus throughout the Roman world. To one group he wrote: “To this he called you through our gospel, so that you may obtain the glory of our Lord Jesus Christ. So then, brethren, stand firm and hold to the traditions which you were taught by us, either by word of mouth or by letter.” [2 Thessalonians 2: 13-15] These teachings of Jesus passed in tradition to His Church: “I commend you because you remember me in everything and maintain the traditions even as I have delivered them to you.” [1 Corinthians 11:2] St Paul told the Ephesians “you are fellow citizens with the saints and members of the household of God, built upon the foundation of the apostles and prophets, Christ Jesus himself being the cornerstone…” (2: 19, 30) St Luke told his readers: “Take heed to yourselves and to all the flock, in which the Holy Spirit has made you overseers, to care for the church of God which he obtained with the blood of his own Son. [Acts 20:28] Following St. Paul, these traditions, oral first and then written, were passed from the apostles to their successors, the bishops and priests.
Remove falsehood and lies far from me;
Give me neither poverty nor riches--
Feed me with the food allotted to me;
Lest I be full and deny You,
And say, "Who is the LORD?"
Or lest I be poor and steal,
And profane the name of my God. (Proverbs 30:8, 9)
At first glance, considering food in the context of Orthodox spirituality and practice may seem inappropriate. But closer examination indicates, in fact, a rather intimate, meaningful connection between the two. We can see this in the quote from the Book of Proverbs that opens this essay. We should eat "the food allotted to us," and which is necessary for our sustenance. To do otherwise is to make ourselves vulnerable to two spiritual dangers.
Problems with Food as a Spiritual Disorder
The first spiritual danger is that we may become so focused on food as an end in itself that it distracts us from what should be our true end: God. In the most basic and first of the commandments, God told us, "I am the LORD your God . . . You shall have no other gods before Me" (Exodus 20:2, 3). This commandment is echoed by Jesus: "'You shall love the LORD your God with all your heart, with all your soul, and with all your mind.' This is the first and great commandment." (Matthew 22:37, 38).
What is our treasure: God or food? As Our Lord told us, "For where your treasure is, there your heart will be also" (Luke 12:34). As our holy father Elder Paisios of the Holy Mountain tells us, "If you want to take someone away from God, give [them] plenty of material goods . . . [they] will instantly forget Him forever" (Ageloglou, 1998).
But the soul falls ill when its right judgment is impaired and it is overcome by the passions which cause disease (St. Neilos the Ascetic, Philokalia I).
Those of the Fathers of the Church who wrote about the spiritual life were keen observers of human behavior and because of that emphasized the need for “right judgment,” as in St. Neilos’s words, to control and direct human “passions,” or what we now call emotions.
Our understanding of man created by God is that he is composed of body, mind and soul-spirit. While not apprehending the complexity and nuances of brain-behavior relationships, our Church Fathers spoke about the different types of knowledge that was related to each component of mankind. St. Maximus the Confessor (Philokalia II) notes: “Since man is constituted of soul and sentient body, he is limited and defined and he himself imposes limits and makes definitions by virtue of the natural and distinctive reciprocity that exists between himself and these two aspects of creation.” The saint goes on to say: “As a compound of soul and body he is limited essentially by intelligible and sensible realities, while at the same time he himself defines these realities through the capacity to apprehend intellectually and to perceive with his senses.” In achieving our end to become “partakers of the divine nature,” (2 Pt 1:4) it behooves us to use all the gifts, natural and spiritual that God has granted to us.
by Mother Melania (Salem)
At times, people come to our monastery with concerns about close friends and relatives who have been diagnosed with schizophrenia, bipolar disease, or some other such disorder. Often they ask, “Is this really mental illness or is it demonic possession?” So, from the practical need to give a helpful response to such heart-breaking questions, we began studying the Tradition of the Church as it is found in the liturgical books, the writings of the Holy Fathers, and the Lives of the Saints.
Nearly everything we found astonished us:
- The Church does distinguish between mental illness and demonic possession.
- The Fathers generally view both the mentally ill and the possessed with compassion and, at times, even with admiration.
- In the view of the Church, if we aren’t saints, we’re insane.
- It’s better to be possessed by a demon than to be enslaved by our passions.
- The reason that it’s better to be possessed by a demon than to be enslaved by our passions is that enslavement to passions is in fact a worse type of demonic possession.
The Fathers distinguished between mental illness and demonic possession