A Psychotherapy for Scruples

by Ernest F. Latko, O.F.M., S.T.D.

In view of the many essays on the nature and treatment of a condition known as scruples, another word would appear to be a mere tedious recapitulation. What can be said of scrupulosity that has not already been many times discussed? What treatment can be suggested other than the ones indicated in manuals of asceticism? This article may justify its appearance in that it presents, apart from a survey of the nature of scruples, an ingenious therapy which was invented by the eminent psychiatrist and neurologist of Lausanne, Dr. Roger Vittoz. He has had wonderful results in treating his clientele, an indication of the efficiency of his method. It springs from the fact that this therapy, better than any other, responds perfectly to the nature of this disease. The records show that in his clinic scruples have sometimes been cured in a matter of days. People of all conditions of life, or different races, of all ages and temperaments, have come to him to be rid of their obsessions; young men and women of the world, Religious and priests, all of them have been cured by his method. With courage regained and their psychic harmony restored, they have returned to take up their places in the world of God.

Only within the last half-century has the nature of scruples been scientifically investigated. Formerly it was regarded as a purely moral state; today it is recognized as a morbid psychic state, a mental illness in the strict sense of the word.

The term scruples derives from the Latin scrupulus, which means a pebble. Figuratively, it refers to something insignificant: to the annoyance and inconvenience caused by a little stone lodged in a shoe, which makes walking at least uncomfortable. Some insignificant little thing is able to plunge a person into paralyzing distress, anxiety, worry, and fear. If the scrupulous person finds a relish in eating, as every normal person will, he becomes very much upset, because he thinks he has committed the sin of gluttony. If he tells a little joke, or plays an innocent trick on someone, he fears he has sinned against Christian charity. If he falls into a slight fault, he becomes very despondent, for he is worried that he has committed a mortal sin, no less. It is this utter lack of proportion between the cause and effect which is one of the aspects of a psychic disease known as scrupulosity.

Scrupulosity is a Psychopathic State

The basic element of this psychoneurotic state is found, not in the above-mentioned lack of proportion, as many spiritual writers believe, but in the psychism of the individual. It therefore hardly enters into its nature, and it is idle, to say the least, even to consider it. This becomes evident when you consider the fact that this condition is produced, not only by important acts, but even by trifling ones as well.

Extremely characteristic of a scrupulous person are his doubt and fear. The first has to do with the intellectual faculties; the second with the life of the affections. In addition, this disease manifests the presence of physical phenomena, too. Here is a person who, while riding in an automobile in which the radio is tuned to jazz music, will remark about the savage music, and shortly after resort to a stupid kind of whistling to make sure he will not hear it, as it might be sinful, or at least a slight imperfection. In view of this, it is easy to see how much more difficult the whole problem becomes. As soon as such divers factors enter into play, it is unwise to classify them according to their appearance and importance.

But a single swallow does not yet make a summer. To make matters even more difficult, doubt and fear do not yet constitute a state of scrupulosity, if they are neither consistent nor incessant. In other words, doubt and fear must penetrate the psychism and tyrannize it with a maddening persistence. It is necessary, therefore, to introduce another factor which also is basic in the true notion of scruples. That factor is obsession.

In order to understand what is meant by this term, consider yourself overwhelmed and enraptured by an aria from a beautiful opera by Verdi, or by a catchy refrain of some of our better American music. What happens? You become "obsessed" by the melody. It haunts you night and day. It finds its way into your ears and remains there whether you like it or not; you hear it constantly. It rests upon your lips notwithstanding your energetic efforts to disembarrass yourself. You cannot for the life of you dismiss it or turn it off, as you can a radio program. It oppresses You: all your reasonings cannot turn it away: you fight a losing battle, so strong is the obsession.

In the theories of such eminent men as Dr. Pierre Janet,¹ renowned psychiatrist, and Antonin Eymieu,² the Jesuit savant, it is this element which occupies the principal role. According to them, scrupulous persons are obsessed, and therefore they must be treated as such.

Various Descriptions of Scrupulosity

Scruples have been variously described. Most writers of treatises on ascetics who treat of this condition, make the mistake of defining this malady which is essentially psychic, not by its constituent element, but by its effects. They regard scruples, not as an obsession of the moral and religious order, but as an anxiety or fear produced by a conscience which is excessively delicate. Some define it as an exaggerated fear of offending God; others regard it as an unreasonable and excessive fear which sees evil where it does not exist, producing withal the most painful anxieties. While they differ in their wording, these definitions are fundamentally the same. However, there is no denying the fact that such a fear by itself is indeed indispensable to our salvation; but great as it ought to be, it must never become excessive. It must be counterbalanced by a humble confidence in the infinite mercy of God. It is this equilibrium maintained between the fear of sin and a humble confidence in the merciful God which is the hallmark of the Saints of God.

Furthermore, the horror of sin found in all Saints without exception, even though at times it is accompanied by a certain anxiety, differs from scruples in its origin and in its intrinsic characteristics. It has its origin, not in a psychism that is defective in its functions, but in a great love of God, and it increases in proportion as that love grows in intensity. It remains at all times under control; it is accepted by the spirit which remains conscious of its internal life, and subjected to the control of the will remarkable for its firmness. On the other hand, the case is entirely different in a scrupulous person. The fear of sin penetrates his psychism, overwhelming it with tyrannizing obsession, so that it becomes part and parcel of his ego.

Three Psychic Elements in Scruples

Therefore, these three psychic elements are essential in scruples. You can have no scruples (in the sense used here) without conscious or unconscious obsession, any more than without a state of doubt and fear. Scruples can be defined as a painful and obsessing doubt which touches upon acts which are to be done, or avoided. Such acts take place either internally or externally.

Scruples have been variously classified. For practical purposes, they can be divided according to the nature of the acts which evoke them, and according to their appearance and duration.

In regard to the first division, that is, the acts which evoke scruples, they can be either profane or religious in the profane sphere examples are innumerable. Here is a dealer in rugs who is tormented with the idea that he has bought goods unwisely, although he knows full well that he bought at bargain prices. There is the vast legion of women (and men, too!) who are forever anxious about their health. There is the example of the jeweler who has locked all doors to his shop before leaving for the night, but who returns several times to reassure himself that the doors are actually bolted.

Two Categories of Religious Scruples

Religious scruples can be subdivided into two categories: those which revolve about purely internal, psychic, phenomena, and those concerned with external acts. Those in the first category are the more excruciating and more difficult to treat, because they penetrate the psychism profoundly. They are very vague, and therefore very apt to be less controlled.

Such scruples consist of thoughts and sentiments. Thoughts revolve principally about the truths of faith, especially about predestination and hell. Obsessed with involuntary doubts, the scrupulous individual has the impression that he is either an unbeliever or a reprobate. In the more general run of cases, however, the individual is assailed by obscene thoughts. Very often his imagination is so vivid as to make him feel deeply that he has consented to such impure thoughts and desires.

Particularly painful, and very curious, are the involuntary sentiments which obsess the soul. Take the example of the good, conscientious mother who is very devoted to her family. She complains that she does not understand why it is that she has the impression that, she hates her family, or that she desires the death of a son or daughter. Sometimes a son or daughter is haunted by an involuntary hatred and hostility against the parent.

Even more curious are blasphemous thoughts, which run through the imagination much like a jingle of a favorite song. Invariably the scrupulous person admits that within his mind he sees, even hears, certain phrases very insulting to God and the Saints. These are particularly disturbing. They will become more dangerous when the person begins to read them, much like the pages of a book or listen to them.

As for the external acts, it is impossible to enumerate them all. Everything within the liturgy or in the various devotions of piety can be the focal point of scruples. For the most part, however, they are concerned especially with Confession and Communion. Many penitents are tormented with the thought that they have confessed their sins in a haphazard manner, or without true repentance. Reassure them again and again that they have repented with sincerity and in all humility, and you talk in vain. Tell them they must not repeat those things, and they return the very next day to take up where they finished previously.

Usual Obsessions of Religious Scrupulosity

In regard to the Eucharist, they are overwhelmed by the obsession that they have not prepared sufficiently for reception, or that they have not made a fervent thanksgiving afterwards. Further, the respect with which certain individuals regard the Eucharist can be transformed into a haunting fear of profaning the Sacrament. These individuals will see hosts everywhere. Abbé G. D'Agnel and Dr. D'Espiney³ write that there are priests, Religious, and laymen who cannot so much as take a step or touch anything without having the impression that they are profaning the Eucharist. They maintain that such conditions are not so rare as one would believe.

In addition, the scrupulous persons suffer anxiety and disquiet on the subject of prayer. One is familiar with such a person who recites his prayers (his mental prayers, that is) with vocal articulation, because he labors under the impression that, if he does not hear them, he has not said them at all. The result is a source of infinite pain in the recitation of daily prayers. This is why one will complain that he has not said them at all, while another will doubt whether he has said them with sufficient attention. A priest will say his Breviary so loudly as to annoy others; or pronounce the words of consecration in Mass over and over again, till he feels satisfied he has done justice to his duty. Others interminably question their attitude in prayer. If they place things which are part of our cult (such as medals, scapulars, rosaries, etc.) in what they think are improper places, or if they so much as touch them with soiled fingers, they are seized with fear that they have shown irreverence to God and to religion.

In the fear of dirt the scrupulous person sees something supernatural or symbolical or mystical. This is analogous to the fear of sin. A typical example of this is one who is anxious about his cleanliness to a fault. He is forever washing his hands whenever he has touched anything worn by someone else, or an article that has been handled by another person. Such a fear of all physical uncleanness is merely an effect of his horror of all moral impurity. It is simply a concrete manner of expressing his obsession against incurring any attempt against his virtue.

Scruples May Be Incessant or Intermittent

With regard to their appearance and duration, scruples can be incessant or intermittent. The latter are manifested at intervals and do not ordinarily last long. Characteristic of this category is the fact that they are a conscious manifestation of a latent and permanent state, whose unconscious continuity the person hardly suspects. Somewhat different is the condition of incessant scruples. Persons so afflicted are daily tortured with an uninterrupted obsession. While they may not have the impression of being obsessed from morning to night, obsessed they most certainly are — sometimes consciously, sometimes unconsciously.

Scrupulosity Distinct from Delicate Conscience

It is very important not to confuse scrupulosity with a delicate conscience. Too often those who are gifted with a delicacy of conscience are identified with the scrupulous. The sons of the world, for instance, will brand as scrupulous such persons as avoid the smallest sins and faults. This is as false as it is uncharitable. A delicacy of conscience is far from being an indication of moral and psychic inferiority. On the contrary, it points unmistakably to a very high morality and superior psychism. It presupposes not only an effective desire of Christian perfection, but also an uncommon mastery of oneself.

Another word of caution. There are individuals who regard as scruples the reproaches of their conscience. If they feel a disquiet on this account, there is a good reason. Usually they confess their mortal sins in a haphazard manner, and continue from day to day with hardly a semblance of true repentance. This, then, is the origin of their worries and anxieties.

Neither is there a condition of morbid scruples in the following instance. There are those who consider as scruples the doubts which they manifest in regard to the culpability of certain acts. These doubts are simply due to their ignorance of divine and human laws. When you enlighten them about their obligations, the apprehensions of evil vanish into thin air. Here is a person who thought that all evil desires which entered his mind are sinful, and consequently he was very much disturbed. He was very relieved when it was pointed to him that only those desires which are entertained willfully are sinful.

Distinction Between Scrupulosity and Insanity

Furthermore, it is necessary to make a distinction between a condition of scruples and insanity. They are not identical. Their difference lies in their nature and effects. Both are states of a derangement which is grave, to a greater or lesser degree. This explains perhaps why they are similar to, and frequently mistaken for, each other. Scruples are a conscious, and insanity an unconscious, obsession. The insane person is not cognizant of his condition at least during times of crisis, while the scrupulous person is cognizant, even when the tyranny of obsessive ideas has overwhelmed him. They differ also in their results. Insanity, precisely because it is unconscious, presents a disease which is more difficult to cure.

Scruples must be combated because they produce such disastrous results in both the natural and supernatural spheres. Spiritual directors, writers, and moralists might differ in their recommendations of measures with which to fight such a condition, but they are all agreed that the disease must be got rid of.

In the natural sphere the scrupulous person suffers intense anguish, making his life one of continuous martyrdom. Whenever he thinks of his sad state, the scrupulous person feels very much discouraged; he falls into a deep melancholy and at times he is brought to the precipice of utter despair. It is not uncommon that he commits suicide. His moral anguish is very often so great as to produce physical illness. His social life, his business, his life in the family circle become very painful both to himself and to others.

Some Shocking Results of Scrupulosity

In the supernatural sphere scruples produce shocking results. This disease is the cancer of the internal life; it destroys the whole work of perfection. To begin with, this obsession is altogether contrary to the spirit of peace so consonant with true Christianity. It maintains the soul in a constant state of agitation and worry.

Further, the scrupulous person acts contrarily to the supernatural life in that he attacks its three principal virtues: faith, hope and charity. For virtuous action we need the strength, courage, and. inspiration from our faith and from hope. Obsessive fear and doubt play havoc with these virtues.

Weakened in soul and body as well, the scrupulous person becomes profoundly discouraged. Soon he loses the very taste and force of prayer. And without prayer, the soul is deprived of the grace of God. In the life of a true Christian, prayer is a vital function, even as respiration is vital for man and beast alike. In time he will not even profit from the reception of the Sacraments of Penance and the Eucharist, the channels by which the grace of God is conveyed to our souls. Yet a little while, and he will divorce himself from these sources of sanctification.

In addition, the scrupulous does not comprehend the eminently social character of Catholicism. Dr. Allers⁴ maintains that, if more details were known about the daily life of these persons, it would soon become apparent that they are excessively egotistical, lacking in Christian charity and love of God; that they are interested only in themselves, for they forever study their conscience without considering their own neglect of duty and imperfections of their own moral life. Entombed entirely within his obsession, the diseased person disinterests himself from his brethren in Christ and ignores them. Morally he becomes an isolated person: he may mingle with his fellow-men physically, because he must whether he likes it or not, but he is not a part of them. From isolation to egoism there is but a step. It is hardly surprising that nothing is able to touch him neither the poor and the hungry and generally miserable whom he used to help and comfort before, nor the Liturgy, the beauty of which used to charm and thrill his heart.

Finally, scruples lead to laxity in morals. A certain ascetical writer of great repute says that, because human nature cannot stand the strain which is so great and unceasing, the scrupulous person will shake off the yoke which bears it down, and pass from extreme rigor to extreme laxity. There is no denying the fact that it is impossible to live without some sort of satisfaction. If one is deprived of the joys of the spirit, one will very soon seek the pleasures of the flesh, to help compensate for his loss.

Growing Prevalence of Mental Ailments

Recently the head of the guidance laboratory of Teachers' College in Columbia University, Professor Esther Lloyd-Jones, made the statement that there are at least 30,000,000 persons in the country who require some form of mental hygiene treatment. It is teachers, she emphasized, who, undoubtedly out of ignorance, contribute to making the figure so large as it is. Perhaps the number would be appreciably increased if statistics on scrupulous individuals could also be ascertained.

If cases of scruples have increased alarmingly in our own day, and some authors assert they have, it is perhaps due in great measure to the moral enervation and cerebral strain of our nervous civilization. Life under constant nervous strain and agitation, life in the grip of fear and worry, and the feeling of economic insecurity predispose one to such a condition. With his usual keen observation, Dr. Allers⁵ remarks that "the growing number of neurotic and ill-adjusted personalities is a corollary to the general insecurity of which modern man has become the victim."

Further, one of the reasons why young men and women fall victims to the obsession of scrupulosity can be found in the fact that they have been deprived in the family circle of a consistently vigorous training and in the confessional of a consistently vigorous and prudent direction. There is, in the confessional, a lack of individualization, as Allers puts it.⁶

End Notes

1. "Les obsessions et la psychasthénie" (2nd ed., Paris, 1908).
2. "Le gouvernement de soi-même." II., 'L'obsession et le scrupule" (27th ed., Paris, 1922).
3. "Le scrupule" (5th ed., P. Téqui, Paris, 1929); Idem, "Direction de conscience et psychothérapie des troubles nerveux" (6th ed., P. Téqui, Paris, 1935).
4. "Confessor and Alienist," in The Ecclesiastical Review, July-December, 1938.
5. "Prevention of Neurosis," in Homiletic and Pastoral Review, August, 1942, p. 1030.
6. Ibid., p. 1027.

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