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Main forms of neuroses.


In medicine it is typical to single out three main classical forms of neuroses: nervous breakdown, obsessive-compulsive disorder and hysteria. We shall consider them in the order that they are generally discussed in special literature.

Neurosthenia. This is considered to be the most frequent form of neurosis. It was singled out in the 1880s as an individual nosological entity. The American doctors Beard and Van Dusen, independently of each other, first wrote about this neurosis in 1869. Since then the diagnostics of neurosthenia have spread widely. Professor B.D. Karvasarsky offers a curious example: during the First World War, a special program of learning was created in the British army, upon completion of which the doctor received the title "Expert in Neurosthenia."

The given illness, as seen from its very name, is expressed by nervous weakness right down to the deep exhaustion of a person’s living powers. Sleeping hearths of infection become more acute, cholestitis, gastritis, ulcers of the stomach or duodenum make themselves felt. The illness appears to be a catalyst, highlighting the somatic pathology.

The portrait of a neurosthenic is typical — this is a person who is quick-tempered, irritable, quickly wound up, "at the drop of a hat," in whom the nerves are clearly giving out (hypersthenic form of neurasthenia) or, just the opposite, lethargic, whining, feeling tiredness and exhaustion in all of his life powers (hyposthenic form). But it is interesting to note: the high irritability and irascibility of the neurosthenic is not directed toward himself, but towards others! Everybody and everything irritates him, he is often capricious, is easily angered and enraged, but almost never rises to the spiritual height of knowing his own imperfections, mistakes and sins. In this way, neurasthenia is more or less an egotistical neurosis, nurtured by the passion, which the holy fathers called pride or conceit.

Father Alexander Elchaninov wrote: "Nervousness and so on are expressions of sin, and specifically, pride. The main neurasthenic is the devil. Can one imagine a humble, kind, patient person as a neurosthenic?" "Irritability comes from not knowing oneself, from pride, and also from not realizing the depth of our nature’s damage, and from not knowing the meek and humble Jesus." (Righteous St. John of Kronstadt). "No one should justify irritability with some illness" (Elder Ambrose of Optina).

The Archbishop Arseniy (Zhadanovsky) wrote the following concerning the reasons for irritability and loss of spiritual peace: "Sometimes an irritable state comes upon you suddenly, discontent with people around you, an oppressed state of the soul, melancholy, disappointment. The littlest thing — and your mood is ruined. Why? Apparently, your spiritual ground was prepared for this mood previously. Irritability, discontent are called out by envy, hostility towards them…"

Thus, we can infer, that neurasthenia is more or less the consequence of departing from Christ, falling into neo-heathenism. It is an expression of passions. Neurasthenia can be considered in its way the opposite of meekness, humility, patience and a peaceful structure of the spirit.

Priests of the Church paid particular attention to keeping peace of the soul under any life circumstances. "I do not wish you riches, or fame, or success, or even health, but only spiritual peace. This is the most important. If you will have peace — you will be happy" (Ven. Alexis of Zosima). A logical deduction follows: the best medicine for neurasthenia is deep repentance, a Christian way of life, with patient and humble carrying of one’s cross.

Obsessive-compulsive neurosis. Obsessions, that is, existing outside the will and desires of a person, could be specific thoughts, memories, images, doubts, as well as acts. Obsessive fears are also assigned to obsessive neuroses. If a person experiences unaccountable fears of the unknown, it is called a fear syndrome; if he fears something concrete, like darkness, heights, sharp objects, close spaces, similar obsessive states are determined to be phobias, specifying their particular fear by their names. For example, cancerophobia — fear of cancer, claustrophobia — fear of small spaces, hypsophobia — fear of heights, misophobia — fear of being dirty, pantophobia — fear of everything around you.

Sometimes phobias appear only in appropriate circumstances: fear of heights only when rising to heights, fear of mice only upon seeing one (Peter the Great, for instance, panicked at the sight of cockroaches); but sometimes they arise at the very thought of something.

Fear is inherent in fallen man’s nature ("Fear is absence of firm hope," said St. John of Damascus) and deeply biological, because man carries within himself an animal beginning, which instinctively fears threats from without: darkness, attack and so on. In many instances, this acts as a defensive mechanism, protecting us from all threats to our well-being. By fearing, a person becomes more cautious, is able to protect himself, to save himself from approaching threat. Fear is instituted by nature in the memory from previous generations, as psychoanalysts say, in the "collective unconscious" (Carl Young).

But neurotic fears are characteristically not based on any real threat, or it is an illusory or unlikely threat. For example, one person suffers from cardiophobic neurosis, that is, he fears that his heart will stop at any moment. On one hand, theoretically that is possible, because sudden death occurs even among young, apparently healthy people, but the objective possibility of such a sudden heart stoppage in such a person is miniscule, while it has a place as an artificial, imagined, fantasized threat to life, conditional on false thoughts and unfounded fears.

Here is another example: a mother, fervently loving her child, all of a sudden catches herself thinking that she might suffocate him. This thought horrifies her, it does not correspond to her moral views, is not dictated by any real external circumstances — just the opposite, it is absurd, without any real reason. But, like a splinter, it becomes rooted in her consciousness, continues to bring her pain that she is ashamed to acknowledge to anyone.

Obsessive thoughts often begin with the question "What if?" Later it becomes automatic, becomes rooted in the consciousness, and, repeated often, create real difficulties in life. And the more a person battles with them, the stronger they take hold.

The main reason for the development and the very existence of neurotic fears is the overblown sensual imagination, which is usually by-passed by the special literature devoted to this subject. A person, for example, does not simply fear falling from heights, but "ignites" the imaginary situation, imagining his funeral, seeing himself lying in the coffin and so on.

Besides this, in similar states, there is weakness of mental defenses (censorship) due to the natural individualities of the given personality or as the result of a sinful state. It is common knowledge that alcoholics are more susceptible to suggestions. Debauchery substantially weakens spiritual strength. The lack of continual internal effort of self-control, spiritual sobriety and conscious administration of one’s thoughts is manifested (these efforts are described in the literature of the holy fathers).

It must also be admitted that some thoughts are in reality foreign to a given person, therefore demonic. Unfortunately, a person is often unable to determine the true source of his thoughts, and the demonic suggestion easily enters into his soul. Only experienced monks and holy people already purified by prayerful tasks and fasting, are able to reveal the approach of dark spirits. The souls of usual people, enveloped by sinful darkness, often do not sense or see this, because it is hard to see what is dark in the dark.

St. Ignatius (Brianchaninov) explains: "The spirits of hate conduct war against humans so cleverly, that thoughts and ideas suggested by them appear to be the person’s own."

Bishop Varnava (Beliaev) writes: "The mistake of modern persons is, they think that only they suffer "from thoughts," while in actuality they suffer even more from demons… Then, when they try to defeat thought with thought, they see that opposing thoughts — are not simply thoughts, but "obsessive" thoughts, that are impossible to deal with and before which a person is helpless, which have no logical connection and are foreign to him, extraneous and hateful… But if a person does not recognize the Church, grace, holy mysteries and the value of virtues, how can he defend himself? Of course he can’t. And then, since the heart is empty of humility and other virtues, demons come and do whatever they want with the mind and body of the person" (Matt. 12:43-45).

These words of Bishop Varnava are fully confirmed clinically. Obsessive neuroses are harder to treat than any other neurotic type. Often they do not submit to any therapy, exhausting their victims with the most severe sufferings. In stubborn obsessions a person is steadfastly deprived of his ability to work and simply becomes an invalid. "Fear causes great harm, — writes the Elder Macarius of Optina, — the body is weakened by the decline of the spirit and the absence of tranquility, and illness comes without illness." Experience shows that true recovery can come only with the grace of God.

The fear of God (reverence before their Creator) is necessary for every person, but this great gift is often distorted and replaced by animal cowardice. The fear of God has several levels, the first of which is fear of violating God’s laws — sinning, doing something vile, unworthy, and offensive, in the eyes of God. The second level applies to more accomplished pious ascetics and consists of the fear of falling away from God, losing His grace, holy peace, for this departure would mean spiritual death.

"Behold, the fear of the Lord, that is wisdom," — say the Holy Scriptures (Job 28:28). "By living without the fear of God, one cannot accomplish anything noble or amazing," writes the universal teacher of the Church St. John Chrysostom.

On the basis of the literature of the holy fathers, we can conclude that it is precisely the fear of God that is capable of healing a person of his neuroses: when a person gains this spiritual gift, then this noble fear drowns out the other small, day-to-day living fears. Just as a large wave on the ocean absorbs the small ripples, so does the true fear of God consume neurotic fears — phobias.

And finally, the last aspect related to the reason for the rise of fear, which is also not discussed in scientific literature. We see it pointed out in the Holy Scriptures: "There is no fear in love; but perfect love casteth out fear: because fear hath torment" (1 John 4:18). It turns out, that the presence of fear in the soul and heart of a person means the absence or lack of love for God.

Let us now briefly discuss obsessive (compulsive) actions. Their character may be very different. They often take the form of some habitual ritual and are repeated contrary to logic and necessity. For instance, the obsessive washing of hands; rituals while dressing and undressing; senseless moving of furniture; counting money constantly; tapping, rocking; avoidance of specific objects; repetition of specific words and actions upon contact with some seeming evil. A feeling of relief upon performing the obsessive action is characteristic. But this relief is temporary and soon the need to repeat the given ritual arises again.

An important moment for clarifying the nature of obsessive actions is their aforementioned alien nature and their compulsion to performing senseless acts. This is what Bishop Varnava (Beliaev) writes about this: "What is the source of this coercion, if a person with all the strength of his soul rejects and doesn’t want it, considers it an element alien and abnormal? Clearly, from another spiritual essence — evil and unclean. Then one understands the illogic of thought, this tyranny, of which scholars themselves speak, one understands the relief after completing the act… (that is, the devil departs, glad, that he forced a person to do something against his will), one understands the agonizing discontent with oneself, because the person’s conscience tortures the person for listening to the devil."

In particularly difficult cases a person cannot control himself and becomes a sort of "biorobot." Remember, for example, the ritual murder of the three monks in the Optina Monastery, performed by a criminal who later admitted, that some strange power forced him to perform this crime and he could not resist it. Other criminals often mention a similar force that overpowers the will and consciousness. This, by the way, does not lead to their release from legal responsibility. Drug addicts and alcoholics also mention a strange forcible irresistible desire. The power that stands behind all this, I think, is clear.

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