As part of the Christmas educational readings, a meeting of the section “Care of the Church about depressed patients” was held MP

On January 26, 2019, in the framework of the XVII International Christmas Educational Readings in Moscow, the work of the section “Care of the Church about depressed patients” was held. The meeting was organized jointly by the Synodal Department for Church Charity and Social Service , the Department for External Church Relations of the Moscow Patriarchate and the Commission for Church Enlightenment and Diaconia of the Inter-Council Presence, which has a working group for the pastoral care of the mentally ill. The meeting was led by the chairman of the working group, Metropolitan of Voronezh and Liskinsky, Sergius . The section curators are the secretary of the Commission for Church Enlightenment and Deacon, a DECR employee MB. Nelyubova and a member of the working group on pastoral care for the mentally ill, the head of the direction of assistance to the disabled of the Synodal Department for Charity, V.V. Leontiev. More than 50 people from 14 dioceses took part in the section - clergy and laity of the Russian Orthodox Church, psychiatrists, employees of the Scientific Center for Mental Health (SCR) of the Russian Academy of Sciences, doctors, church social workers. In his introductory report, Metropolitan Sergius of Voronezh noted that one of the section’s tasks was to encourage local clergymen to respond to the problem the meeting was about so that they would not be afraid of mentally ill people and provide help to both the sick and medical specialists, who, for their part, also need support and understanding. Helping people suffering from mental disorders, it is necessary to find balanced approaches and not reduce all manifestations of such disorders exclusively to mental illness or only to devoid of content. Metropolitan Sergius noted that depression is one of the manifestations of "the total sinful damage to human nature, which develops as a result of a complex interaction of social, psychological and biological factors." The most significant reasons for the spread of depression in modern society are the loss of traditional religious values ​​and the crisis of the family. “Depression is a mental illness of a person who is tired of passions. This reveals the spiritual roots of the depressions. Sadness and despondency overwhelm a person when he cannot achieve the desired to which he is bound by passion. Experiencing melancholy and grief always accompany the loss of what he did not have the ability to withhold. The spiritual perfection of a person free from passions is the most radical remedy for depression. ” “Depression, whatever the reason for it, is not only the clinical practice of psychiatrists and psychologists, but also the subject of pastoral care and theological reasoning of the Church. Patients with depressions are especially sensitive to pastoral attention, and therefore the combination of pastoral and psychiatric care, with proper differentiation of the fields of competence of a doctor and a priest, turns out to be very fruitful in the treatment of mental illness, ”said Metropolitan Sergius. In conclusion of his report, Vladyka Sergius stressed: “Depression is one of the most frequent diseases that are encountered by both psychiatrists and clergymen. I hope that today we will be able to fruitfully continue the dialogue of the clergy with the medical community in order to give mentally ill people with depressive disorders the opportunity to get rid of suffering with the help of God's grace. ” Doctor of Medical Sciences, Deputy Director of the NCHP for Development and Innovation, Professor of the Department of Practical Theology at St. Tikhon’s Orthodox University, VG Caleda in his speech on the topic “Depression and the notion of sadness and despondency in patristic literature” noted that 250 million people suffer from depression in the world, and about 9 million in Russia. Scientists call it the number 1 killer, as it often becomes the cause of suicide . The speaker spoke about the types of depression, its forms and causes. Listing the criteria for depression, he noted that a mental disorder can be said when a low mood lasts at least two weeks, and at the same time a person feels it for most of the day. Sleep disturbance, low self-esteem, lack of energy, fatigue, lack of appetite, unreasonable feelings of self-judgment and excessive guilt feelings, unwillingness to live - these are some criteria that indicate the development of depression. He noted that women are more likely to be depressed than men. Due to a number of endocrine changes, more than 20% of women are prone to postpartum depression. The physical component of depression is manifested in the feeling of sadness, sadness, depression; violation of motor activity, when a person becomes inhibited, as well as in mental changes, when a person's thoughts flow slowly and sluggishly. The spiritual manifestations of depression include the feeling of “hardened insensitivity” when a person turns to God with prayer and does not feel any answer; proceeds to the sacraments and does not feel like their participant; unable to read spiritual literature; feels “cold on the heart” and therefore cannot pray. This is all a consequence of depression. Speaking of what the holy fathers wrote about sadness, despondency - manifestations of depression, - Professor Kaleda noted that the holy fathers describe in detail the symptoms and spiritual causes of depression. “And the most surprising thing for us, psychiatrists of the XXI century, for example, is that John Cassian the Roman described that sadness can be causeless. Now we would say that this is endogenous depression, when the cause is at a biological level, when depression occurs without any provocative factor. ” According to the speaker, in many cases it is spiritual causes that lead to depression, and therefore the disease requires not only medicinal, but also spiritual treatment. Candidate of Medical Sciences, Deputy Director for Scientific Work of the NCHP, G.I. Kopeiko, in the report “Age Aspects of Depression” showed that at present depression as a disease is becoming more common in young people, the problem of suicides among young people is particularly relevant. Many cases of suicide attempts have been recorded even in children 10-12 years old. 91% of those attempting suicide attempt suffer from mental illness, and the greatest risk is associated with depression. Statistical peaks with a high suicidal risk occur in adolescence and age after 40 years, about a quarter of older people are prone to depression. Understanding the age characteristics of depression allows you to choose the right approach to both treatment and care for patients. Archpriest Elijah Odyakov, cleric of the Church of the Icon of the Mother of God "Healer" at the NCHP, in his report "Helping the Shepherd in Depression," noted that many clerics believe that depression does not exist as a disease, but "there is only a manifestation of passion, sadness, despondency, laziness weakness; they say that a true believer cannot have depression. ” This is fundamentally wrong, and in the case of depression, a person should certainly turn to doctors. The priest "can and should, if necessary, convince his parishioner to consult a doctor." It often happens that with the word “psychiatrist” a sick person becomes isolated, he can no longer trust the priest and even go to church. Therefore, according to the father of Elijah, the priest in this case should act with particular caution and try to involve the patient's relatives to solve such situations. The speaker listed in detail those complaints, some kind of markers in speech or behavior, which should alert the priest and let him know that his parishioner really needs medical help. A patient can talk about a “feeling of being forgiven,” “lack of a sense of grace,” there may be “complaints of hardened insensitivity,” “emptiness in the soul,” “loss of the meaning of life,” “loss of faith in God.” A person feels indifference to all and to all, is experiencing a "heart yearning." “Sometimes they talk about heavy thoughts. And at inquiries, it turns out that these are thoughts about suicide. There is a feeling of one’s own “special guilt”, “heightened sinfulness”, “worthlessness”, a feeling of immense “shame for one’s past life”, reaching despair. With the threat of suicide, “categorically it is impossible to use or maintain attitude towards the disease, as a punishment for sinful life or hereditary defects ... It is advisable not to make any reproaches to a sick person concerning church life. We must remember that a sick person is very vulnerable and easily sees in any words the idea that he is considered worthless and incapable of anything. The priest should not give the patient banal advice, such as: “You should pull yourself together” or “you could easily cope if you wanted”, etc. Flat consolatory statements should be avoided, “be attentive to any complaints of a sick person and in no case ignore them as a trifle, but listen attentively to everything he says,” said Father Elijah. We must constantly convey to the mind of man that this depression is to blame for the fact that his life seems so painful, empty, painful. It is necessary to support and strengthen the sick in striving for the grace-filled help of God through church sacraments. Candidate of Medical Sciences, Leading Researcher of the NCHP O.A. Borisova made a presentation on "Religious ways of coping with depressive states." The report examined the manifestations of endogenous depression and presented the results of scientific research of the NCHP regarding psychocorrectional work based on the religious values ​​of the patient’s personality. The speaker identified and analyzed in detail four ways of coping with depressive states (the so-called coping strategy): the religious method of “preserving traditional values ​​and meanings”; social support from a religious community or religious relatives; religious rethinking of the situation and self; the so-called unifying religious method, i.e. the acquisition of an emotionally comfortable state, which gives religious faith - comfort, comfort, forgiveness, reconciliation. Spiritually-oriented communication is very important, which leads to the harmonization of the patient's personality and changes in his behavior and lifestyle. Unlike other mental illnesses, depression has a beginning and an end. To help depressed patients, a multidisciplinary approach is needed, which, along with therapy, also requires the pastoral care of a clergyman, support for the religious community, the organization of special conditions for therapeutic communication with simultaneous participation of their relatives' patients in the program, a deep personal value-orientation due to updating the spiritual component, and improving interpersonal relationships in the family in the process of group psychotherapy and their transition to a different quality level Hb. Speech by a master's student at Sretenskaya Theological Seminary A.A. Matienko was devoted to the theme “Pastoral Counseling for Depressed Patients (according to the patristic literature)”. In the writings of the holy fathers there is a description of states of sadness and despondency, which are not depression itself. For example, St. John Chrysostom in Letters to the Olympics writes about the despondency that the saint was able to overcome, and about the need to continue “to watch earnestly for you to acquire a complete world for you ...”. Abba Dorofei, addressing the young man who was tormented by prodigal passion and who was afraid of falling into despair, examines in detail his condition and builds up a “strategy” of spiritual struggle. First of all, he removes from the young man a feeling of guilt for this state: “The culprit of your battle is the devil”; instructs him to avoid situations provoking prodigal thoughts, outlines ways for him to further improve, and also teaches him to pray about this situation, he promises to pray for the young man and shares his own experience of spiritual struggles. The speaker noted that the holy fathers did not talk about death and the Last Judgment with people who were in a difficult psychological state and who had attended suicidal thoughts. They often shared their own experiences in overcoming difficult mental states. “If a shepherd shares his experience, this increases confidence and has a great psychotherapeutic effect,” the speaker noted. Holy Fathers — especially in patericles, letters, and memories of saints — have a description of cases with a specific set of symptoms that are similar to depression. The speaker drew a parallel between the signs and symptoms of depression described by the Holy Fathers from the International Classification of Diseases: “ideological inhibition” - despair, a feeling of being abandoned, thoughts and attempts at suicide; “Disturbing affect” - a desperate soul that rushes everywhere and inspires horror to the counter, etc. Speaking about the care of the holy fathers for the suffering, the speaker called the following types of it: the prayer of the shepherd for the suffering, the calling and teaching of prayer; compassion, emotional support; a call for patience and hope in God; proper attitude to suffering and occupational therapy. According to the speaker, some approaches of the holy fathers are comparable to the methods used by modern psychologists, for example, with active listening, stimulation to reflection, self-disclosure, etc. Candidate of Pedagogical Sciences, Clinical Psychologist, Leading Researcher of the Center for Scientific and Technological Reference, Ye.A. Kazmina made a presentation on “Features of the psychotherapeutic management of patients with depression. Psychometric methods for the analysis of depressive states ". The speaker focused on three main areas for studying depression: cognitive-behavioral, psychodynamic and existential psychotherapy, and presented psychometric techniques for diagnosing the severity level of depressive disorders. She described in detail the psychotherapeutic methods used in the model approaches mentioned. E.A. Kazmina noted that when working with believing patients, an important healing factor is the commonality of religious values, which give meaning to illness and suffering. In the treatment of depressed patients, a “brigadier” approach is important - the cooperation of a psychiatrist, psychotherapist and a priest. Candidate of Philosophy, General Practitioner of the Highest Qualification Category, Medical Officer of the Voronezh Diocese A.A. Shevchenko in his report “Causes of depressive disorders from a theological perspective” noted the problems of dialogue between psychiatry and theology in understanding the experience of experiencing mental disorders. “The experience of science can be described from the point of view of theology, but the language of science cannot adequately describe the religious experience of communion with God,” said the speaker. He spoke about some areas of foreign research in the field of psychiatry, which tried to find in the human genes and the brain not only the cause of depression, but also the source of religious experiences, and describe the religious experience of a person using objective methods. The speaker stressed that he highly appreciates the very fact of the dialogue between the Church and science in the field of helping the mentally ill, but believes that modern psychiatry still lacks theological devotion. Candidate of Medical Sciences, Researcher NTSPZ E.V. Gedevani in the report “Depressive disorders and religiosity” presented a review of the world scientific literature on the effect of religiosity on depressive states. Foreign researchers have accumulated significant data on the protective effects of religion and spirituality on depressive disorders and the level of suicide. There are numerous studies showing improvement in overall mental well-being and health associated with a religious worldview. In studies, scientists divide patients into people with “internal religiosity”, who consider religion as the basis of their existence and following it in their lifetime, and people with “external religiosity” for whom religious beliefs are not so significant and “adjusted” to other life goals. , for example, under social relations or under the task of achieving personal comfort. Studies show that external religiosity is associated with an increased risk of depressive disorder and a higher degree of depressive symptoms. In contrast, internal religiosity tends to negatively relate to depressive symptoms. The protector effect of religiosity is more pronounced in persons who have endured a traumatic situation: often the trauma has led to a deeper spiritual development of a person. According to research by American scientist Harold König, who observed 87 elderly patients with depression for 47 weeks, internal religious motivation leads to early remission. After eliminating a number of depression factors (emotional state, social influence, endogenous factors, etc.), each increase in internal religiosity by 10 points (according to the scale adopted in the study) is comparable to an increase in the rate of onset of remission by 70%. The speaker presented the results of American, Australian, Latin American and European studies indicating the positive impact of religious life motivation on the recovery of depressed patients. Foreign and domestic authors point to the importance of the semantic role of religion in the recovery of the sick: "Participation in the life of religious institutions is associated with a higher religious and social identity and, consequently, with a higher level of subjective psychological well-being." This is evidenced by a 2007 study by Professor Greenfield, which involved 3032 people aged 25-74 years. Studies by another author (Kirov, 1998) testify to the great significance of the semantic role of religion for patients who have suffered mental disorders: “Mental illness, usually accompanied by an affect of fear, feelings of chaos and helplessness, violates the inner order of personality. With the help of faith in God, the balance and integrity of a person split by illness can be restored, which is experienced by the subject as a revival, finding a source of happiness, peace and confidence ... Many patients consciously use prayer in times of great suffering and despair, others see their illness as a test (positive reappraisal ), or rely on their church activities (increasing socialization). " “The most obvious protective factor hindering the realization of suicide is, in the opinion of many researchers, his religious ethical condemnation, because most religious teachings recognize the unconditional value of human life. This idea is meaningful and reflects on the general attitude towards life and the self-esteem of a sick person. An important protective factor is the belief in an afterlife and a loving God. In all religions there are role models for believers, demonstrating how to cope with crisis and stress, thoughts of suicide, and contributing to the development of resources that help to cope with life difficulties. Personal participation of the patient in religious ceremonies is important - this contributes to the reduction of depressogenic effects in stressful life situations. ” At the conclusion of the meeting, Metropolitan Sergius of Voronezh noted that all the issues raised during the reports and discussions will be included in the agenda of future scientific and practical seminars and conferences on the topic "Care of the Church about the mentally ill."