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Scruples, Neuroses, and the Confessional

by Eamon F. O'Doherty

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  • Description:
    In writing this article Eamon F. O’Doherty helps us to understand the psychology of scruples and to distinguish the four types of guilt: theological, rational, healthy emotional, and neurotic.
  • Larger Work:
    The American Ecclesiastical Review
  • Pages: 398-405
  • Publisher & Date:
    The Catholic University of America Press, June 1964

In the course of his ministry the priest not infrequently meets parishioners and penitents who, in the popular meaning of the term, are called scrupulous. There are, however, many different conditions--different from each other and I suggest different from "scruples" proper--subsumed under the single term "scrupulous." Theologians have long asserted the close connection between the condition called "scruples" and certain forms of mental illness. But it would be a mistake to assume that all scruples are forms of mental illness, or that all scrupulous people are neurotic. The psychologist is familiar with the fallacy called "psychomechanistic parallelism": the fallacy of assuming that where two observable behaviour patterns are similar, the psychological processes underlying them must be the same.

It is important to recognize in the first instance that scruples in the strict sense are a spiritual trial, a purification, which usually works through a great deal of interior suffering, an agony of doubt and uncertainty about sin or guilt, and a meticulous care for and observance of the law. According to Lehmkuhl, "est timor peccati, ubi non est peccatum, ex inanis rationis apprehensione." 1 It is too often forgotten by contemporary writers, that scruples in the strict sense are a morbus spiritualis, which is not the same as a mental illness. Scruples, Lehmkuhl observes, "aliquando a Deo permittuntur ad spiritualem utilitatem."2 In the past it is probably true that all the similar behaviour patterns which are popularly called scruples were thought of as forms of morbus spiritualis.3 But we are in danger of going to the other extreme now and thinking of them all as neuroses or forms of mental illness. Scruples in the strict sense can be thought of as a difficult and painful stage in the process of maturation in the spiritual life. They may serve as a mortification, as a means of deepening one's realization of the spiritual world, and as a means of acquiring docility, humility, and self-knowledge. They may also perhaps serve something of the purpose of the dark night of the soul in as much as they may lead to a deepening of faith and trust in God. Unhappily however many of the manifestations of scruples are paralleled in the neuroses, so that it is often very difficult to decide whether one is dealing with a scrupulous person or with a mentally ill person, and also to decide whether to apply the rules and injunctions of the moral theologians or not. For what might very well be right and efficacious in the case of "real" scruples, might be very undesirable indeed in the parallel case of neurotics. Thus, the exacting of obedience to the will and decisions of the confessor is a sound rule where the condition is a morbus spiritualis but may only aggravate the condition (e.g., of a hysteric or of a compulsive-obsessional neurotic) whose presenting symptoms may closely resemble scruples proper. (It is probably not necessary to point out that scruples must be distinguished from both tender conscience and false conscience.)

In order to help us to understand the psychology of scruples it is important to make certain distinctions about the notion of guilt. There are really four types of guilt. First there is theological guilt. This is the condition of a person who has sciens volens violated the law of God. Secondly there is rational guilt. This is the condition of a person who has sciens volens violated the natural law, even though he does not explicitly advert to the element of transgression of the commandments or the law of God. Thirdly there is the condition of normal or healthy emotional guilt. This is the state of emotions, which is experienced when a reasonably balanced person, who is neither hardened to sin, nor pathologically cold, commits a serious sin or transgression of the moral order. It is perfectly healthy or normal for a youth, for example, to feel something of this if he commits a sin of impurity, or for an adult to feel this if he commits a serious violation of positive law. This is the state of feeling, which most people feel at some time or other in connection with confession. It is not itself "real" guilt, but is a natural concomitant of real guilt, and serves as an "indicator" that something is wrong in the moral order. Finally there is neurotic guilt. This is a complex state of the emotions, involving dread, anxiety, fear of punishment, desire for punishment, a sense of horror, depression, self-loathing, etc. It is neurotic if it is out of all proportion to the apparent cause, or if it exists without apparent cause, and is usually protracted through time and of such magnitude that it interferes with one's normal adaptation, or produces physiological consequences (e.g., insomnia, loss of weight, morbid suicidal ideas, sweating, anorexia, gastric symptoms, etc.).

Emotional guilt, both "normal" and "neurotic," antedates sin proper. It is related to the infantile experiences of training, violation of the rules a mother imposes on her child, infantile aggression, destructive impulses which emerge at a very early age, and to many other factors besides. The child, and a fortiori the infant, can learn to conform to rules. But his behaviour is not yet "moral" or "immoral" behaviour. Yet it is subject to sanctions. Certain kinds of behaviour are acceptable; others are unacceptable. Reward follows on some of them, punishment on others. The child rapidly acquires a set of built-in controls, operating at a premoral level (i.e., at a level below that of conceptual thinking and judgment) which give rise to the "feeling" of guilt. In the case of some children, these feelings can be very intense indeed, and in the case of others, they may be very painful. The child's only defense against these painful feelings lies either in rigid conformity, so that they will not occur, or in repression, so that they may be extruded from consciousness. It is probably here that we find the origin of scruples. For the former process (rigid conformity) is a way of avoiding any experience of guilt-feelings, and this may perhaps be the source of scruples in the strict sense, while the latter may lead to a neurotic process: the repressed guilt feelings may remain repressed for a very long time, to emerge again in adolescence, or in adulthood, or even in senescence. Thus it is probably true to say that both real and apparent scruples have their origin in infantile experience. The former mode is describable as genuine scruples because through the operation of this process one may in fact avoid serious sin. But the latter mode (repression giving rise to neurotic processes) is the source of the illnesses, which so closely resemble scruples.

The illness, which most closely resembles scruples is the illness called a compulsive-obsessional neurosis. This is a condition in which the individual suffers from the presence of ideas or images in his mind which he cannot root out, and which lead to agonies of self-examination, repetitive performance of routine actions, preoccupation with intention, or with the saying of a particular set of words (e.g., the words of consecration, or the breviary), or with trivialities which cripple his freedom of action (e.g., a person who is in dire need of somewhere to live at a reasonable rent, but cannot take on any of the available places, because they have gas fires, or because they have to be approached by a lift, or because of some other irrational factor. This must however be distinguished from the notion of phobia). In this illness the form remains the same for different cases, but the content of the obsessional ideas or compulsive actions is determined by the personal life history of the sufferer. Thus the content will be different for a bank clerk, a professional cricketer, a believing Christian in the world, a nun, a priest. One should look first to the form, rather than the content. There is no future whatsoever in spending long hours arguing with such a person, e.g., a nun, or a priest, about the performance of duty, the saying of prayers, etc., or in theological disputes about the mercy and justice of God. If the sufferer had been a cricketer, would there be any point of arguing interminably with him about the scores of a particular match, or the reasons why he had missed a particular catch? The form is the same, only the content is different.

Equally impressive is the condition known as involutional melancholia. This is an illness specific to the declining years, the late sixties or early seventies being particularly vulnerable. It is characterized by the very intense and painful suffering in the mind. While the sufferer seeks consolation in lengthy discussions with a priest he is still overwhelmed by feelings of guilt, failure, impending punishment, etc. He constantly seeks repeated forgiveness, reassurance that he is not going to hell. It can look like a real theological problem, even a special grace, since the sufferer will hark back to sins and peccadilloes of infancy or adolescence. But the observer will notice also marked loss of weight, great melancholy beyond consolation, insomnia, loss of normal adaptation, etc. This is a curable condition and the sooner a psychiatrist is called the better. (This holds also for the condition of compulsive-obsessional neurosis, though here the amount of help the psychiatrist can give is very much less.)

Depressions and anxiety states are another psychiatric set of illnesses, wherein behaviour analogous to that of scruples may appear. There are two kinds of depression (and we do not here refer to the perfectly normal experience of feeling sad or depressed in an appropriate degree, and when the situation provides an adequate cause for the sadness). The first pathological depression is called a reactive depression: a condition in which there is a cause, e.g., loss of a parent, or loss of one's good name or way of life, but in which the intensity of the emotion and its duration through time are out of proportion to the apparent cause. In these cases also the criterion must be the degree to which one's normal adaptation is interfered with (e.g., a mother who in this situation refuses to care for her children, a parish priest who simply sits at home and mopes endlessly, etc.). The other form is endogenous depression. In this condition one feels intolerable sadness, misery, self-depreciation, etc., without any discernible cause in the environment or indeed within oneself. The depression wells up from within. It can be paralysing, and will certainly make it impossible for the sufferer to carry on his normal way of life. It cannot be too strongly stressed that this is a real and definable illness and is amenable to ready treatment. There is no point whatsoever in telling the sufferer to pull himself together. One might as well tell a sufferer from tuberculosis to heal up his pulmonary lesions. The real danger in this condition is suicide. Suicidal ideas appear only too frequently in this state, and it is the opinion of the present writer that most successful suicides are due to endogenous depressions. (Hysterics also attempt suicide, but as a symbolic gesture, and they rarely pull it off.) Anxiety states characterize the middle years (they are precipitated perhaps by the awareness of declining powers, the sense of failure, the unavoidable awareness of impending death).

Sufferers from both the depressions and the anxiety states may have recourse to liquor as a way of coping with their condition. The depressed individual gets a temporary relief; the anxiety is temporarily allayed. But there is no cure along these lines, and gradually the sheer amount of alcohol must be steadily increased. But the important thing from the point of view of this paper is that both these conditions may precipitate states, which closely resemble scruples proper. Thus the depression may be accompanied by vivid and acute sense of inadequacy. In a priest this may appear in the guise of a conversion to spiritual things. But the unhealthy character of the apparent "conversion" will appear in many ways: there will be no real deepening of the spiritual life, no increase of faith, or of zeal. Rather the person becomes preoccupied with self, seeking only relief from his condition. The anxieties may be accompanied by a deepening awareness of the last things, but emotional fear with physiological consequences will predominate over the timor Domini which is the reverential fear of the saints. It cannot be too much stressed, however, that the consequences for the individual's physical health and the degree to which he cannot sustain his normal adaptation (to job, community, way of life, obligations, interpersonal relations, etc.) must be the premier criterion in deciding whether one is dealing with scruples or with a natural illness ("ex fructibus eorum cognoscetis eos").

Some forms of hysteria may also resemble scruples. Hysteria is a polymorphous disease. But in all the many forms in which it appears, there would seem to be one thing in common: a repression of or fear of the consciousness of, the whole sexual apparatus. That is not the whole story of course because it is too summarized, but at least this is true: the etiology of hysteria always seems to point to something wrong in the pyschosexual development of the individual suffering from it. The hysteric may produce wounds resembling stigmata, or see "visions," or appear as a very holy person. But equally she may become preoccupied with guilt. This will not usually be consciously sexual guilt, because of the repression mechanisms underlying the illness, but may appear in the context of small misdemeanors, or things, which are not sinful in any way (thus a girl may be full of guilt feelings about her menstruation periods). It is particularly important not to treat such people as scrupulous. They may actually be deriving a vicarious sexual satisfaction from their apparent anxiety and guilt feeling about something harmless or neutral. It is of course a fortiori dangerous to probe for the "real" cause of the guilt feelings, since this will be the same as the root cause of the hysteria itself. The result may only be the release of intense libido, which gets rapidly out of control.

There is a common form of near-"scruples" which appears in adolescence. This is the condition of a youth not otherwise emotionally disturbed who gets very upset about the real state of his conscience. He is clearly very much in earnest, but very frightened, worried, anxious, preoccupied with notions of sin, but particularly with the problem of responsibility, consent, etc. He may try out some rationalizations ("I do not know whether I was awake or not," "I think I did it but. . .", "I was not sure if it was wrong," etc.). Such a boy (or girl) may be in need of great help. This is not yet scruples and one should be very loth indeed ever to allow a young person in the teens to get the idea that he is scrupulous in the strict sense. The case I have just described is the case of someone who perhaps has been committing serious sin for some time (e.g., masturbation), and has succeeded for a long time in keeping the guilt-feelings associated with this act from consciousness, through repression. But as he moves on through the teens the possibility of keeping his real guilt at bay diminishes. This will be particularly true of the more intelligent, the more insightful, of this age group. Unconsciously the youth knows that if he once allows the guilt-feelings through, he will have to acknowledge his real guilt, and conversely, if he accepts his real guilt, he will have to cope with the most intense guilt-feelings. He will therefore try to hold his real guilt at bay, to stave it off. We do not really help such a one by telling him that he is really in Baptismal innocence, and is just being scrupulous. He knows very well that he isn't. Our task here as in so many analogous situations is to try to help him to accept his real guilt, not to declare him innocent.

All the conditions I have described have several factors in common, and some are also common to "real" scruples. They all seek not perfection, but self-satisfaction. They all seek not forgiveness but a declaration of innocence. They are all states in which the rational conscience is under severe pressure from the pre-rational conscience of the child, operating through guilt-feeling, rather than through guilt-judgment.

But "real" scruples are not a natural illness. They are a spiritual trial. They may appear in a personality, which is weak, or even childish. But the genuinely scrupulous person is really seeking help to advance in the spiritual life. He will retain insight and control, simply because the psyche is healthy though perhaps immature, while the pseudo-scruples we have been considering are manifestations of a disturbed psyche. And precisely because he retains insight and control, one may quite rightly apply the rules of the great moralists: one may exact obedience to the will and judgment of the director. The director may play the part of an "objective conscience" in place of the penitent's own conscience, because the latter is under such severe pressure as to be temporarily incapable of decision-making. Indeed the test in practice, which the wise confessor can apply is this: if he finds after a reasonably short time (I would suggest three or perhaps four try-outs) that the sufferer is really incapable of obeying, or of benefiting from the advice given, he might legitimately conclude that the condition is a natural illness, and not scruples. The scrupulous person, going through the spiritual illness or trial of scruples, remains docile, grows rapidly in humility, is prepared to suffer (while the analogous natural conditions seek only relief), does not seek self-justification, and does not manifest morbid somatic symptoms. Pseudo-scruples have rightly been described as a way of defending against real guilt, while real scruples are a way of coming to grips with real guilt, however slight.

Notes

* Professor of Logic and Psychology and Head of the Department of Psychology at the National University of Ireland, Dublin. Visiting Professor 1964-1965 at The Catholic University of America. M.A. (The National University of Ireland), Ph.D. (Cambridge, England), Fellow of the British Psychological Society.

1 Augustin Lehmkuhl, Theologia Moralis (Friburgi Brisgoviae: Herder, 1898), I, 53.

2 Ibid., 59.

3 Ibid.

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