Alexey Migalnikov 10.20.201726851
We are starting a series of articles about the disease. Their goal is to help the sick person and his loved ones understand the illness and act in it for the benefit of body and soul. Also, these materials can help priests in the spiritual care of sick people, their relatives and doctors.
The articles are based on the works of Russian Orthodox theologians of the second half
of the 20th - early 21st centuries.
Why? On the one hand, their works generalize the patristic thought and experience of previous centuries. On the other hand, the theologians of this period are closest to us living today; they know the current state of medicine and people’s living conditions. These are, first of all, the books of Saints Athanasius (Sakharov) and Luke (Voino-Yasenetsky), Metropolitan Anthony of Sourozh, Archimandrite John (Krestyankin), Abbot Nikon (Vorobyov), Nikolai Evgrafovich Pestov, Hieromonk Job (Gumerov), French theologian Jean-Claude Larche and others. So, today we will talk about the reasons for the existence of diseases.
Once sin and disease were one
In Antiquity, when medicine was just getting on its flimsy legs, and there was no talk of psychiatry, no one drew boundaries between immoral behavior and mental illness.
Any inadequacy was considered a consequence of the influence of supernatural forces on the mind and soul. This state of affairs irritated physicians of the following eras, who for the most part were materialists, not mystics. However, patience ran out only at the end of the 19th century. By the way, at that time psychiatry had already established itself as a separate direction in medicine.
At that time, the nosological approach introduced by the German physician Emil Kraepelin became popular. Now the doctor, before attributing the patient's inadequacy to his bad moral character and demonic possession, had to think seriously and answer several questions: what is wrong with this person? How exactly does it differ from healthy? What are the possible biological and physiological causes of the disease? is there a way to cure it?
This approach not only reinforced a rational view of the patients’ condition, but also helped to more accurately classify mental illnesses and thus improve diagnostics.
Now a psychiatric diagnosis in most countries of the world, including Russia, is made based on the International Classification of Diseases (ICD), and in the USA - on the Diagnostic and Statistical Manual of Mental Disorders (DSM). During the period of their creation and filling, both lists more than once suffered from moralists, who were displeased with some of the phenomena that were exposed in society. For example, in the first two DSMs (from 1952 to 1974), homosexuality was considered a mental disorder. However, even today medical regulatory documents are not ideal: the criteria for some ailments seem too vague. Therefore, some especially boring sinners, comparing their behavior with these descriptions, may suspect that they have an illness.
Did God create diseases?
Let us say right away that God cannot be considered the source of disease, suffering and death. There is evidence of this in the Holy Scriptures: God did not create death and does not rejoice in the destruction of the living, for He created everything for existence, and everything in the world is saving
(Wis. 1:13-14).
Everything that God created is very good
(Gen. 1:31), while diseases are perceived by people as evil and a source of suffering.
Where then did diseases come from in our lives? Maybe they were originally inherent in human nature? No, that's not true. God created the first man, Adam, in His image, and this image of God included the attributes of immortality, strength, and health. The soul and body of the first people were not subject to disease, suffering and death.
Adam and Eve had the opportunity to preserve and improve their original immortal and incorruptible state, but only under the condition of a godly life and communion with the Creator as its source. The latter depended on their own choice, because God created man free.
Where did mortal sins come from?
The Seven Deadly Sins are often confused with the commandments: do not kill, do not steal, do not make yourself an idol, etc. But this is a slightly different story. The commandments can be found in the Bible in list form. According to legend, it was carved on tablets that God personally gave to Moses on Mount Sinai.
Sins are scattered throughout the Bible in the form of separate mentions and hints. They were first cataloged by the monk Evagrius of Pontus in his discourse “on the eight thoughts,” where he described human passions and weaknesses in Greek. His students translated the work into Latin. And later, somewhere between 590 and 604, this list was revised by Gregory the Great, the last pope of the ancient world. This is how the current list of seven deadly sins appeared, which included: pride, greed, lust, envy, gluttony, anger and despondency.
For each of these defects, you can pair a mental disorder described in the latest generation classifiers ICD-10 and DSM-5.
Pride (vanity)
“Two men entered the temple to pray: one was a Pharisee, and the other was a tax collector. The Pharisee, standing, prayed to himself like this: “God! I thank You that I am not like other people, robbers, offenders, adulterers, or like this publican.”... The publican, standing in the distance, did not even dare to raise his eyes to heaven; but, hitting himself on the chest, he said: “God!” be merciful to me, a sinner!’ I tell you that this one went to his house justified more than the other: for everyone who exalts himself will be humiliated.”
(New Testament. Gospel of Luke. Chapter 18. Verses 10–14)
If the DSM-5 had existed at the time these Bible verses were written, the Pharisee might have been diagnosed with narcissistic personality disorder. After all, he clearly exhibits the key signs of this illness: grandiose conceit, confidence in his exclusivity and an arrogant attitude towards others.
This is how the famous American psychiatrist and psychotherapist Aaron Beck describes a true narcissist in the book “Cognitive Psychotherapy of Personality Disorders”:
“David, a 40-year-old lawyer, sought treatment for depression. <…>
The deterioration in well-being was associated with increased discomfort from performing routine work and thoughts that such work did not correspond to his qualifications. In his opinion, he deserved better. <…> David believed that because he was “special,” no one had any right to criticize him, although he had every right to criticize others. <…> He did not see any problem in taking advantage of others if they were “stupid” enough to allow him to do it.”
The similarities between David and the Pharisee are obvious. True, we can only guess whether the latter suffered from his narcissism, but the end of the Gospel quote: “... everyone who exalts himself will be humiliated,” -
clearly hints at the inevitable punishment of God
.
This disease also has other features, which, however, do not always appear and not in all narcissists: the desire to exploit people, a complete lack of empathy and the ability to empathize, the need for an enthusiastic attitude towards oneself from others, envy.
In Russia there is no such thing as narcissism. In ICD-10, it is included in the diagnosis under code F60.8 “Other specific personality disorders.”
Greed (greed)
“And I again saw vanity under the sun; a lonely person, and there is no other; he has neither a son nor a brother; but there is no end to all his labors, and his eye is not satisfied with wealth. “For whom am I toiling and depriving my soul of good? “And this is vanity and an unkind deed!”
(Old Testament. Ecclesiastes. Chapter 4. Verses 7–8)
The obsession with wealth that robs one's time and ability to enjoy life, as expressed in this quote, is a characteristic feature of anancaste personality disorder. In ICD-10 it has code F60.5.
The word "anankaste" comes from a Greek root meaning "compulsion." That is, this disorder can be described as “suffering from self-compulsion to do something.”
People with this diagnosis suffer not only from an obsessive desire to earn all the money in the world. They are also worried about constant doubts about their actions and actions; they tire themselves (and sometimes those around them) with endless double-checks. They are characterized by a passion for order, iron-clad obstinacy in achieving goals, meticulous attention to detail, and work-blocking perfectionism.
In the DSM-5, all of these features would be characteristic of a diagnosis of obsessive-compulsive personality disorder (OCPD). By the way, the symptom related to greed goes by the politically correct and elegant name of “stingy spending style.”
Lust (fornication)
“Let everyone’s marriage be honorable and the bed undefiled; But God judges fornicators and adulterers.”
(New Testament. Epistle to the Hebrews. Chapter 13. Verse 4)
“Do not lie with a man as with a woman: it is an abomination. And do not lie with any cattle, so as to shed semen and become defiled by it.”
(Old Testament. Leviticus. Chapter 18. Verses 22–23)
In the Bible, the sin of fornication is described from qualitatively different sides: as adultery or frequent change of sexual partners, as well as unconventional sexual preferences. Well, from the point of view of modern psychiatry, no sinful addiction is considered a pathology until a person suffers from it, as, for example, in this clinical case:
“An 18-year-old boy was undergoing treatment for secondary syphilis. The patient reported that he suffered from excessive sexual desire. <…> In the last three years, he could not think about anything other than sex. He spent most of his time in brothels, sometimes with available men, and masturbated a lot. A year ago I began to notice skin lesions: first on the penis, later on the face, stomach and other parts of the body. At the same time, he continued to have unprotected sex.”
This dependence in ICD-10 is noted under code F52.7 “Excessive sexual desire.”
The latest generation international classifier also includes a diagnosis regarding extravagant preferences in sexual life - “Disturbances of sexual preference” (F65). This includes fetishism, fetishistic transvestism, sadomasochism, bestiality, etc. However, if you practice amazingly original sex and no one suffers from your “experiments,” there is no reason to panic. It’s worth the effort if you can’t get pleasure in any other way and are seriously worried about it.
Envy
“Do not eat food from an envious person and do not be enticed by his delicious dishes; because as the thoughts are in his soul, so is he; “Eat and drink,” he tells you, but his heart is not with you. The piece you have eaten will be vomited up.”
(Old Testament. Book of Proverbs of Solomon. Chapter 23. Verses 6–8)
The already mentioned narcissism correlates with the sin of envy.
At first glance, it seems paradoxical that a person who is confident in his superiority is inclined to envy someone. However, this dichotomy is the essence of mental illness. The patient’s brain breaks down and wonders: “How can this be? I am superior, and someone else gets the best benefits!”
Narcissists can hide envy of those who are objectively more successful and suffer in silence. But sometimes this feeling results in violence - psychological or physical. Moreover, most often their loved ones suffer from the terror of envious narcissists, because they do not wash their dirty laundry in public for a long time, fearing to tarnish the reputation of the aggressor. This phenomenon was first described and given the name “narcissistic abuse” by Swiss psychoanalyst Alice Miller in her book “The Drama of the Gifted Child.”
There is another diagnosis that is characterized by pathological envy - hysterical personality disorder. It is described in both ICD-10 and DSM-5. People with this illness are very similar to narcissists - especially in their desire to humiliate and command others. But manifestations of hysterical envy, as a rule, are always open, noisy and intrusive; they rarely resort to sophisticated methods.
Gluttony (gluttony)
“And Jacob ate, and Israel became fat, and became stubborn; became fat, plump and fat; and he forsook God who created him, and despised the rock of his salvation.”
(Old Testament. Deuteronomy. Chapter 32. Verse 15)
All gluttony is sinful according to the Bible, but only psychogenic overeating is considered a disease, that is, associated with other mental disorders: depression, stress after the loss of loved ones or major surgery, etc.
A typical case of morbid gluttony was recorded and described by psychiatrists at Yale University:
“Patient N noted that she began to overeat frequently after her seriously ill mother was hospitalized. <…> After the death of the mother, cases of overeating became more frequent. <…>
A typical bout of gluttony N looks like this: first, at dinner with her family, she eats a normal portion of food (150–200 g of meat and a vegetable side dish with bread). While cleaning the table, he eats the leftovers, which is equivalent to another full serving. Then, until the night, he continuously eats different foods, chaotically alternating between salty and sweet snacks.”
In ICD-10, such gluttony is classified as an “Eating Disorder” (F50) and is on a par with the well-known anorexia and bulimia. By the way, they are less common than psychogenic overeating, which affects about 3% of the adult population.
Anger (hatred)
“Everyone who hates his brother is a murderer.”
(New Testament. First Epistle of John. Chapter 3. Verse 15)
The Bible is quite categorical in describing this sin and equates it with the ability to commit murder. However, only extremes can be pathological.
Unhealthy anger has three bold markers: such a person becomes angry over a minor issue, loses control over his actions at the moment of attack and does not care about the consequences. In medicine there is the concept of “psychotic episode”, or “psychosis”, which can manifest itself in uncontrollable rage and be a companion to various diseases.
For example, with bipolar affective disorder (a condition where a person alternates between feeling elated and overexcited and then becoming depressed), so-called “angry mania” occurs. Terrible outbursts of rage also occur in schizophrenia.
But most often, unbridled anger is demonstrated by people suffering from emotionally unstable personality disorder (F60.3 according to ICD-10). Patients with this diagnosis are generally characterized by sudden mood swings, impulsivity and problems with self-control.
Dejection (laziness)
“Do not indulge in sadness in your soul and do not torment yourself with your suspiciousness; the joy of the heart is the life of a person... remove sorrow from you, for sorrow has killed many.”
(Old Testament. Book of Wisdom of Jesus, son of Sirach. Chapter 30. Verses 22–25)
Anyone can unmistakably compare this sin with the most common mental illness of our time - depression. According to recent data from the World Health Organization, more than 300 million people suffer from it.
The Bible quote mentions at least two signs by which illness can be distinguished from an attack of bad mood. Firstly - suspiciousness. Depressed people get stuck on negative thoughts: they devalue their merits, convince themselves of their own worthlessness, the futility of the future, and the negative attitude of others toward themselves. Secondly, the desire to die, which sometimes comes true. A striking example is a clinical case described by the American Psychiatric Association:
“Trish, female, age - 51 years old. Her husband took her to the emergency room after she told him in all seriousness, “I want to kill myself.” Trish lost her zest for life and her ability to enjoy life about four months ago. Over time, the symptoms worsened. During this period, the patient lost 14 pounds due to loss of appetite. Several times a week she woke up at 3 am and could no longer fall back to sleep. Trish felt tired, depressed and had trouble concentrating. She worked in the office of a dog food factory. At some point, the patient began to convince herself that she had made a mistake that could lead to the death of thousands of animals. Trish was afraid of being arrested and wanted to kill herself to avoid going to jail."
In ICD-10, detailed descriptions of the criteria for depression of varying severity are found under codes F32 “Depressive episode” and F33 “Recurrent depressive disorder”, and in DSM-5 it can be found in the section “Major depressive disorder”. Typically, a diagnosis is made if symptoms of the disease persist for more than two weeks.
Trish demonstrated all nine key symptoms described in the American classification: depressed mood, weight loss, lack of joy, insomnia, anxiety, permanent fatigue, strong feelings of guilt, decreased attention and thoughts of suicide - so her case can be called a reference, but not typical . Most often, people complain of fewer symptoms, but this does not mean that they do not need help.
Why doesn't healing come?
On the Cross, Christ, having experienced - absolutely humanly - the apogee of physical and mental pain and despair, exclaimed: My God! My God, why have you forsaken me? (Matt. 27:46). Although He, the Son of God, knew that this was not so.
If suffering and illness are not pleasing to God, why then does He not deliver from them and heal? Does not hear? The question is difficult and insoluble, especially when it comes, for example, to diseases of children. It is impossible to give an unambiguous universal answer to it, but it is also impossible to completely agree with the claim contained in this question - this is both true and not at all true.
Yes, God does not want and does not send us illnesses - but He is not inactive. And His action is always love. It's just not always what we think it should be.
It is incorrect to say that a person sins and is punished by illness - no. Illness is not a punishment, but one of the consequences of the evil operating in the world. This is a choice that a person once made and continues to make to this day, with a disdainful and consumeristic attitude towards life - both his own and that of others, spreading the consequences of this choice throughout the whole world.
Evil is illogical, it is chaos, once generated by leaving God. It does not create, but only destroys. This is a choice of free will, in which God cannot interfere, no matter how strange it may sound. But He never leaves a person, especially if a person begins to move towards each other and does not stop in his grief.
An illness cannot always be healed physically, although the Gospel repeatedly shows us examples of miraculous healings. And, as a rule, these are healings that entail deep spiritual changes in a person.
Christianity claims that there is no will of God for death, illness and evil. But there is - so that a person grows to the best of his spiritual strength, and no matter how strange it sounds to us - he is happy and is able to make others happy.
Personal confessions and stories of people like the artist Vrezh Kirakosyan or the writer Nick Vujicic are probably partly capable of shedding light on this difficult problem and becoming a living testimony for the despairing.
There are things, especially in matters of faith, that are difficult to translate into precise formulations. But there are amazing examples in life, after getting acquainted with which any words are probably not really needed.
