Tuesday, February 17, 2009

Orthodox Psychotherapy

The notion of “Orthodox psychotherapy” has gained considerable currency in the English-speaking Orthodox world over the course of the past fifteen years. The term itself was coined by Metropolitan Hierotheos (Vlachos) of Hafpaktos, and was introduced in his works The Illness and Cure of the Soul in the Orthodox Tradition (English translation, 1993) and Orthodox Psychotherapy: The Science of the Fathers (English translation, 1994). (In fact, the former work is intended as a supplement to the latter.) The inspiration for these works came largely from the thought of Protopresbyter John Romanides who, though not employing the term “Orthodox psychotherapy,” did frequently speak of the Church as a spiritual hospital functioning to cure spiritual illness. The most recent contribution to the genre and, in my opinion, the most helpful, is Archbishop Chrysostomos of Etna’s A Guide to Orthodox Psychotherapy: The Science, Theology, and Spiritual Practice Behind It and Its Clinical Applications (2007). The few comments that I offer here are not directed specifically to any single one of these works, but will be of a more general nature.

I find that the very term “Orthodox psychotherapy” creates a great deal of confusion and misunderstanding. While Metropolitan Hierotheos has every right to use the term “psychotherapy” in the literal sense of “cure of the soul,” it is a stubborn fact that the rest of the world does not. “Psychotherapy” has inescapable clinical associations; it implies a clinical means of treating mental disorders. Metropolitan Hierotheos does not, if I understand him correctly, have a clinical environment in mind when employing the term. So far as I can gather, he uses the term “Orthodox psychotherapy” simply to mean the entirety of the Orthodox spiritual life. Therapy, for him, is not a technique or method; rather, it encompasses the entire experience of the spiritual life.


This results in something of an equivocation. What really is “Orthodox psychotherapy”? Is it in any way comparable to “secular” psychotherapy? Does it have clinical applications? Can it be used to cure psychological disorders? I’m afraid that Metropolitan Hierotheos largely sidesteps these questions. These questions are, however, addressed by Archbishop Chrysostomos in his above-mentioned book. Following chapters on the relationship between science and religion, on theological notions of body, soul, and spirit, and on Hesychasm and the cleansing of the mind, the Archbishop concludes with a chapter on the clinical applications of "Orthodox psychotherapy." This intention of this final chapter “is not so much one of guiding the reader from the theory of Orthodox psychotherapy to its application, as it is to offer some comments and general caveats about that application.” While not denying points of convergence between Orthodox psychotherapy and science, the author argues that the two have different aims, consequences, and assumptions:
Not only is the aim of Orthodox psychotherapy different from that of secular psychotherapy, but also the techniques of treatment that the two may employ in common adventitiously are meant to have very different consequences and are predicated on much different assumptions about the constituent components of the psychosomatic structure of man.
He offers two main caveats concerning the dangers of applying hesychastic methodology in clinical settings. The first is the lack of a strictly scientific method in the evaluation of such treatment and the generally anecdotal nature of its claims; the second is that Hesychastic methods are not “always appropriate to the clinic.” On a broader level, Archbishop Chrysostomos is troubled by a “trend in some circles within the Orthodox Church to equate certain psychological illnesses with disorders of a spiritual kind,” for instance equating spiritual despondency with clinical depression.


If we accept Archbishop Chrysostomos’ arguments, we can conclude that “Orthodox psychotherapy” and secular psychotherapy, while certainly having points in common, are radically different in both method and aim. Attempts to apply Hesychastic “technique” in a clinical setting are objectionable both from a scientific perspective and from an Orthodox perspective.

Where, then, does that leave us? The first point is to bear firmly in mind that “Orthodox psychotherapy” is simply not a form of psychotherapy in the way that term is universally understood. The second is to acknowledge that, given that the two are entirely different practices, both have a place: one does not usurp the other. A psychologically ill person should have recourse both to clinical psychotherapy and to the spiritual treatment found in the life of the Church.

C. S. Lewis, in his chapter on “Morality and Psychoanalysis” in Mere Christianity, puts the matter quite well:
[P]sychoanalysis itself, apart from all the philosophical additions that Freud and others have made to it, is not in the lease contradictory to Christianity. Its technique overlaps with Christian morality at some points and it would not be a bad thing if every person knew something about it: but it does not run the same course all the way, for the two techniques are doing rather different things.

When a man makes a moral choice two things are involved. One is the act of choosing. The other is the various feelings, impulses and so on which his psychological outfit presents him with, and which are the raw material of his choice. Now this raw material may be of two kinds. Either it may be what we would call normal: it may consist of the sort of feelings that are common to all men. Or else it may consist of quite unnatural feelings due to things that have gone wrong in his subconscious. Thus fear of things that are really dangerous would be an example of the first kind: an irrational fear of cats or spiders would be an example of the second kind. The desire of a man for a woman would be of the first kind: the perverted desire of a man for a man would be of the second. Now what psychoanalysis undertakes to do is to remove the abnormal feelings, that is, to five the man better raw material for his acts of choice; morality is concerned with the acts of choice themselves.
None of what I have written is intended to imply that I disagree with the actual content of Metropolitan Hierotheos’ books. My objection is primarily to the confusion that the term “Orthodox psychotherapy” can cause. Simply put, what he calls “Orthodox psychotherapy” can too easily be taken as an equivalent of, or substitute for, clinical psychotherapy. People needing psychological help should not think that “Orthodox psychotherapy” offers them a clinical method of treatment; nor should clinical psychotherapists think that they can borrow points of practice from “Orthodox psychotherapy.”

Two final points: It is often remarked that we live in an age of therapy. I am reluctant to see Orthodoxy become yet another therapy. I am also troubled by the tendency of some Orthodox to use the models of “Orthodox psychotherapy” or of “the Church as spiritual hospital” as definitive ascetic or ecclesiological realities. They are models, images, and should not be reified.

24 comments:

aaronandbrighid said...

Excellent post, Father. If I remember correctly, your last point is something emphasised by Fr Nicholas Loudovikos, a former student of Fr Romanides whose work has not yet been published in English.

Felix Culpa said...

Very interesting. Is there anywhere you can point me to follow up on that? Unfortunately, I don't read modern Greek.

Adam Fallenoffenbar said...

--I am also troubled by the tendency of some Orthodox to use the models of “Orthodox psychotherapy” or of “the Church as spiritual hospital” as definitive ascetic or ecclesiological realities. They are models, images, and should not be reified.--

I agree, but it is to be expected if Met. Hierotheos' works form a fundamental part of their understanding of Orthodoxy. It is my general impression (and complaint) that he understands the "hospital" metaphor precisely as an eccl. reality, or at least as the metaphor to which all metaphors must bow - especially that dreadful Latin legal one. I have come to see this attitude as a reactionary distortion.

Felix Culpa said...

Adam, I quite agree with you. I remember listening (on tape) to the proceedings of a conference dedicated to the idea of the Church as spiritual hospital at which Metropolitan Hierotheos and Fr George Mettalinos (both of whom I respect tremendously), among others, were present. At one point one of the speakers said,quite emphatically, that the Church as spiritual hospital was THE ONE and ONLY way in which properly to understand the Church. Thus began my suspicions about the overuse of this model.

Sbdn. Lucas said...

Father,

Might an examination of the limitations & merits of the therapeutic/hospital imagery comprise a future post?

aaronandbrighid said...

Father> I've sent you an e-mail regarding the query about Fr Loudovikos. Regarding the conference that you mentioned, there's an article in Divine Ascent where Met. Hierotheos says 'the teaching that the Church is a spiritual Hospital and that true theology is related to the therapy of the soul is not an isolated part of the teaching about the Church, but rather the way and requirement for the experiencing of church life and the acquisition of the Orthodox church spirit' (DA #3/4, p. 62-3). Was this at all like what you heard, or was it more strongly worded?

Felix Culpa said...

Lucas: Yes, it might indeed!

Aaron: That sounds about right. The conference was held at the Glorious Ascension Monastery in Georgia somewhere around 1998 or so.

Adam Fallenoffenbar said...

"Adam, I quite agree with you. I remember listening (on tape) to the proceedings of a conference dedicated to the idea of the Church as spiritual hospital at which Metropolitan Hierotheos and Fr George Mettalinos (both of whom I respect tremendously), among others, were present."

One of the others was I, as a catechumen.

I think that Aaron's post illustrates what you're trying to avoid, namely that the attitude you're concerned with can't be blamed on over-zealous disciples. It is part-and-parcel of Met. H's teaching.

Andrea Elizabeth said...

Father,

As a fan of the Metropolitan and of Father Romanides, the thing I appreciate about their approach is that it changes the definition of who is ill and who is well. From the last paragraph of Ch. 1 of Orthodox Psychotherapy,

"So in the Church we are divided into the sick, those undergoing therapeutic treatment, and those - saints - who have already been healed. "The Fathers do not categorise people as moral and immoral or good and bad on the basis of moral laws. This division is superficial. At depth humanity is differentiated into the sick in soul, those being healed and those healed. All who are not in a state of illumination are sick in soul...It is not only good will, good resolve, moral practice and devotion to the Orthodox Tradition which make an Orthodox, but also purification, illumination and deification. These stages of healing are the purpose of the mystical life of the Church, as the liturgical texts bear witness" (5)."

I believe he is saying that unless one is united to Christ through purification, illumination and deification, then he or she is unwell. This would put wellness in the context of Christ's Church.

To define wellness otherwise, as having an absence of irrational fear for example, can set one up to be deluded about their actual state of needing healing or correction. All of us have a distorted sense of reality to the extent we rationalize or are unaware of our sin. Clinical psychotherapy can provide insight into the attributes of dysfunction, but I don't really look to it as a cure, though God is merciful and works in mysterious ways and can help people anywhere, but I think the bar for what help actually needed is set too low. Coping is the goal instead of theosis. I agree that teaching hesychasm in a clinical setting is inappropriate, it's context is within the life of the Church including the Sacraments, prayers, readings, feasts, fasts, services, the calendar and the influence of the body militant and triumphant.

I tend to think that irrational fears and losing touch with reality is heavily influenced by the spirit world. Devils in people cause abuse (sin in relationship) to happen and being abused can to a whole range of dysfunctional thoughts and reactions, unless one has grown in grace. I prefer the cures in the Church which aims at the source, than bandaids that help you talk yourself out of certain thought patterns. Recognizing that one has unhealthy thought patterns is a big step, and I think this enables one to confess in prayer or to a trusted person that one wants a better way and to ask for mercy. I believe the Lord will answer this prayer, and that difficult obedience and repentance must follow.

He may answer it through a clinical therapist, but that is not where my hope is. But maybe that's the most trusted or capable person that can be found - which would be a sad situation, imo.

Btw, A Beautiful Mind is one of my favorite movies. He didn't find healing in the Church, but certain parallels can be made. May God reveal to me my vain, time-wasting, imaginations.

Felix Culpa said...

Which in turn goes back to Fr John Romanides. I hope to start commenting on the new book of his lectures on patrisitc theology soon. I'll return to a number of points I made in this post.

Felix Culpa said...

Andrea Elizabeth: I certainly don't disagree with much of what you write. As I stated in the post, my intention is not so much to criticize the content of Metropolitan Hierotheos' thought, so much as to suggest that his use of the term "psychotherapy" can cause confusion.

As Archbishop Chrysostomos writes in the words I cited by him, Orthodox psychotherapy and clinical psychotherapy have different aims, consequences, and assumptions. I think therefore that it's a bad idea to put the two into competition with one another; it's a matter of apples and oranges. Therefore I'd myself be reluctant to speak in terms of preferring one over the other.

Anonymous said...

All of your points are generally well-received, Father, and there is much food for thought here. I hope and pray that in the years to come a fruitful discourse can develop within the Church on the approximate convergences/ divergences of the respective disciplines, as it is my feeling that clinical psychotherapy has much to teach us in our increasingly complex and individualistic social context, and so will continue to possess a relative significance in the pursuit of psychological soundness for humanity both within and without the Church. I agree strongly with the sentiment that any specifically 'hesychastic' therapeutic approach would have little relevance outside of the Church, and could even pose certain dangers. But I do find myself conflicted about the pertinence of modern psychotherapy for the mentally ill Christian, who is pursuing with reasonable faithfulness the prescribed spiritual discipline of the Church. Perhaps, for many reasons, it is different in our time and place but I wonder how one might address the body of evidence in the work of Jean-Claude Larchet, which suggests that during the spiritual zenith (probably) of the Byzantine Empire, monasteries seem to have served the function at times of the modern psychological clinic, apparently with some degree of success? (I refer primarily to 'Mental Disorders & Spiritual Healing'- I don't have the work on hand now, so I'm operating on recollection.) Are we so much more complex now, or has spiritual life deteriorated to such a degree that this approach can no longer be considered as viable for many? I'm sorry that I can only contribute more questions- but I do think this one may have some relevance: Where does monasticism fit into the equation today, if at all, in the healing of the mentally ill today?

Felix Culpa said...

Anonymous: I'll respond at greater length to your comment later today. For the moment I'll simply mention that the connection between mental illness and monasticism today is that most monks nowadays are mentally ill!

Anonymous said...

Father- I greatly appreciate your intention to engage my question more fully. It has been my experience, as well, that in a sense without any pejorative connotation, your comment about monastics rings true. However- apart from certain truly pathological instances- I see how this can be thoroughly beneficial for many who we would term 'mentally ill': that in certain instances, this cross will even allow them to reach a great degree of humility, or possible sanctity. While I have strong reservations about monks with certain weaknesses being any position of spiritual or administrative authority within the monastery, I wonder if might agree with my suggestion that a mentally ill monk may find relative psychological stability and spiritual growth in the rank and file, that perhaps he would not in the world, and with the intervention of the medical/clinical approach?- Symeon.

Felix Culpa said...

I'll address two points raised by Anonymous, the first concerning whether monasteries today should serve as de facto mental hospitals (as if they don't already!), the second concerning whether monasticism might not be an appropriate vocation for some mentally ill (as if it already isn't!). My response will be purely practical, perhaps a bit hard-nosed, and based on my own experience. I've adopted a somewhat jocular tone here not because I don't appreciate the value of these questions, but because addressing these questions brings to mind so many tragi-comic episodes I've witnessed over the years.

Many monasteries today have become dumping grounds for families trying to find a place to deposit a rebellious son, a drunken uncle, or a troubled or homeless fellow who shows up at their parish. The results are more often than not disastrous. The presence of such deeply troubled people can seriously disrupt the life of a monastery. Most monasteries simply don't have the resources or training to deal with people with serious mental illness or chemical dependence. Its a lose-lose situation: the monastics' lives are disrupted, and the troubled people do not get the help that they urgently need. Monasteries are not good half-way houses.

Now, it might certainly be a good thing if monasteries or larger parishes were to create rehabilitation programs that would help people in recovery. But most monasteries today, as I noted,simply don't have the resources or training to host such programs.

I'm also reluctant to endorse the idea that monasticism might make a good vocation for the mentally ill. This might sound horribly elitist and patronizing -- as well as in stark contradiction to reality -- but monasticism is for the strong, not the weak. People with serious mental disorders do not often make good monks, and the presence of mentally ill monks does not help raise the spiritual level of a given monastery. Something of a parallel could perhaps be made with the question of monastic vocations for the homosexually-inclined. There is a terrible irony at work here. One hears people suggest that the homosexually-inclined should become monastics -- and then one hears the same people complain that monasteries are full of homosexuals!

All this might sound rather cynical, for which I ask your forgiveness. But I think it should be born in mind that monasteries are not, first and foremost, charitable institutions. Not every family can or should take in people with serious problems, nor should every monastic family.

Now, to back up a bit and address some points raised by Andrea Elizabeth. Every single one of us stands in need of the spiritual therapy that only the Church can offer. All of us are spiritually unwell. But there are also people who need, in addition to the Church's therapy, additional psychological therapy. And I would certainly agree that psychological therapy alone is not enough; again, we all need the Church's methods of healing. So there should be no question of competition here. Nor should the Church's method of healing and the clinical method of healing be confused or conflated, although there certainly are considerable points of convergence.

Andrea Elizabeth said...

Father, I see what you mean. One of Metropolitan Jonah's goals is for there to be Orthodox hospitals and more social service oriented facilities. Secular training would be helpful if not necessary for those who would want to undertake such a vocation.

I don't know what other name could be given for 'psychotherapy' in the Orthodox sense. "Spiritual healing" seems a bit too categorized as it de-emphasizes the soul, heart and mind, and "soul" or psyche seems to encompass them all more. Orthodox practice is holistic in nature, even incorporating the body.

Anonymous said...

Father-

I really appreciate your insights. While some of what you said could be perceived as cynical, I respect that these are your opinions grounded in your personal experience. I suppose we all bring something to the table, and would never pretend that my thoughts surrounding the issue are purely disinterested, either.
My thoughts suggest that there are more nuances here than we can begin to address without digressions far beyond the limits of this blog. But I will submit a few more questions for our mutual consideration, by no means demanding of a reply.
From attentiveness to spiritual biography/ hagiography it is apparent that there are monastic saints of the Church who might well be candidates for a retrospective diagnosis of some type of mental illness. I will grant that these folks were mostly still functioning within a culture with 'pre-modern' suppositions about such things- to give a particular instance, what we might term depression now could have then been understood as a 'melancholy' temperament... this is to say nothing of the whole issue of 'homosexuality'!- and in some cases maybe, the spiritual level of the culture at large was certainly an advantage in strengthening people generally against the full-fledged development of certain tendencies. So my retrospective projections may have little worth; but I think it is nonetheless fair to assume that there are among the saints- monastic and non- those who by modern standards of evaluation, would be judged 'mentally ill'. I guess I would concur with your statement that monasticism is ideally for the strong, and not the weak, and that in order for monasticism to offer healing, the rank and file should optimally be at a certain level of spiritual and mental soundness. Granting you this point:- in most cases, the mentally ill should be discouraged from pursuing the angelic way of life,- is there still healing to be found for them in contact with spiritually healthy monasteries, perhaps over and above reliance on the secular mental health apparatuses? Forgive me for further digression, but there we are. I would happily correspond privately if this is more desirable.- Symeon

V and E said...

Wow.

I've intuited some of your comments re. monastics, but I've never dared utter these thoughts aloud.

I've heard my priest speak glowingly of how large monasteries in the Old Country (Romania or Ukraine) took care of the mentally handicapped. I take it this was a unique vocation and anomalous?

- V.

Felix Culpa said...

It is certainly true, as V. notes, that many monasteries do already often serve as de facto facilities for the mentally handicapped. I don’t think that this is, in fact, unique and anomalous to the “old world,” however. I also don’t doubt that in many cases monasteries can and do provide havens of healing for psychologically troubled people.

It would be wonderful if more monasteries today could function as therapeutic centers for the recovery of those suffering from mental illness or chemical dependency. However, this would need to be done with careful, systematic cooperation between clergy and mental health professionals. The objections that I raised in a comment above were more practical than theoretical. I welcome Metropolitan Jonah’s call for Orthodox hospitals and service-oriented facilities, noted by Andrea Elizabeth in her comment.

Healing for psychological illnesses can certainly be found through contact with spiritually healthy monasteries – or, for that matter, with devout and serious monastics, clergy, and laity, wherever they might be found. But this does not in any way cancel the need for seeking help from professionals.

Symeon (Anonymous) raises the interesting question of whether some saints could be given a “retrospective diagnosis of some type of mental illness.” Cases certainly spring to mind. If St Tikhon of Zadonsk were alive today he’d almost certainly be diagnosed with clinical depression. That said, I’m very uncomfortable with such attempts at retrospective diagnosis. A secular example might shed some light on this. Think of the mass of books attempting to psychoanalyse Abraham Lincoln. Interesting as such books are, I find that they more often than not try to fit Lincoln’s personality into psychological categories that would have been incomprehensible to Lincoln himself; there’s something deeply anachronistic about the whole project.

In response to Andrea Elizabeth’s comment, I can only point out that the Church has gotten by for twenty centuries without resorting to the term “psychotherapy,” and I see no particular reason for it to start to do so now, particularly when, as I argued in my post, it can result in confusion and misunderstanding.

I’ll offer a concrete example to illustrate my last point. Archbishop Chrysostomos, in the book I mention in my post, cites a letter that appeared in the periodical “Ekklesiastike Parembase” (No 93, November, 2003, p. 9), a published in Metropolitan Hierotheos’ diocese. The writer of this letter reports the case of a woman who “told me that she was cured of schizophrenia with the help of an Orthodox priest who used the methods of Orthodox Psychotherapy.”

Now, what exactly is meant here by “the methods of Orthodox Psychotherapy”? Does this refer simply to active participation in the mysteriological and spiritual life of the Church? Or does this refer to some sort of “clinical” practice, something more like conventional psychotherapy? Or perhaps some combination of the two? Again: what IS “Orthodox psychotherapy”? What is actually being talked about here? What is this “method”?

Moreover, this nebulous “method” is being put forward for a cure for schizophrenia. This I find really very dangerous. Anyone suffering from schizophrenia needs to get serious medical treatment along with spiritual treatment through the Church’s sacramental and ascetic life.

Metropolitan Hierotheos, at the beginning of his book “Orthodox Psychotherapy,” makes it clear that he’s using the term “psychotherapy” in a manner entirely distinct from the way it’s used by secular psychologists. Fine and good. But now this same “Orthodox psychotherapy,” which supposedly is something entirely different from clinical psychotherapy, is now being advertised as a cure for schizophrenia. This is a potentially fatal confusion. This sort of equivocation is largely why I’m so suspect of the term.

margi said...
This comment has been removed by the author.
Anonymous said...

Dear Father, you mentioned the "anecdotal nature of its (Orthodox Psychotherapy) claims". Yet,, as I understand it this is precisely one of the problems of psychoanalysis. Much of what passes for psychotherapy, or for the "competing" psychotherapies offered outside of the church are anecdotal. Some of these are opposed to one another and so many different approaches are employed and with such varying degrees of success that one can hardly embue psychotherapy with the sort of authority that you and others do. I agree that many of them are helpful, therapeutic and some are more sicientific than others. But I am personally offended for the sake of the church that we have entrusted the ill to such a bunch of theories. The fathers had a robust understanding of the human person that seems to me to at least rival and perhaps surpass any psychoanalytic theory out there. I think that there are therapeutic principles that can be used to help broken people, that these principles are both spiritual and psychologically effective, and that priests and spiritual fathers and mothers need to be trained in the use of them.

Alex Johnson said...

Here is another opinion in the matter:

http://www.oodegr.com/english/psyxotherap/kosm_psyx1.htm

Fr. Constantine Strategopoulos was for many years head of the office for external Mission of the Church of Greece and was a spiritual child of Elder Porphyrios.

Also a comment from University Professor Mr. Jean Claude Larcher, who has a doctorate in human sciences and has studied psychopathology, philosophy and the Fathers of the East. He also has a clinical experience of psychiatric clinics:

http://www.oodegr.com/english/psyxotherap/kosm_psyxotherap1.htm

Anonymous said...

@buy

Well, it seems my friend that someone has taken you up on your little "challenge" and actually done a clinical analysis of Orthodox Therapeutic techniques : http://www.oodegr.com/english/biblia/zoran_vujisic/perieh.htm

Anonymous said...

Blogger Felix Culpa said...

"Moreover, this nebulous “method” is being put forward for a cure for schizophrenia. This I find really very dangerous. Anyone suffering from schizophrenia needs to get serious medical treatment"

Now what you're putting forward is complete nonsense, whether is looked from the point of view on orthodox church or from scientific ground. There is accumulating evidence that drugs that are used to treat condition called schizophrenia are acttually damaging the central nervous system in the long run.