Psychotherapy.

Psychotheraphy occupies a unique position in medicine. Two individuals meet in the mutual process of doctor and patient working together. A soul is healed by a soul. Those ailing with a psychotherapeutic profile are a completely special contingent. Their sufferings are often related to moral conflicts, family difficulties, trouble after difficult illnesses, spiritual searchings. As a rule, the person looking into the eyes of the doctor feels a deficit of love, understanding of others, support from his close friends. He turned to the specialist when the sufferings filled his whole soul, his whole organism, and there is no more strength to bear it. Sometimes his sufferings turn into severe somatic symptoms, different pains, numbness, other disorders.

Most often I have to treat and consult people either unbelieving, or with weak, unformed faith. For this reason, the psychotherapist has a great responsibility, both as a doctor and as a person. His task is to help the patient constricted by illnesses and conflicts, confusion and losses. For the doctor dedicated to psychotherapy, it is important to have personal spiritual values, which will determine his work with patients. Without a personal (I add: Orthodox) spiritual platform he will not be able to distinguish situational (psychosocial) and biological reasons for illnesses from existential, world outlook ones.

The domination of materialism and, correspondingly, the lack of spiritual demands of doctors in this very complex and very specialized, in the medicinal sense of the word, profession has not gone unnoticed. Most unfortunately, Orthodox spirituality is not a criteria for a psychotherapist’s activity in our society. But how right it would be to be guided by Christian values in such a complex task as soul-caring. In reality, each psychotherapist works in the measure of his view of life, of his principles. On the other hand, there is another difficult problem — even if there is faith in Christ in the doctor’s soul, it does not always find a response in the heart of the patient.

The doctor does not choose his patients. In his visits, he may see a rabid atheist or a representative of another philosophical-religious bent. In the latter cases, the medical credo "do no harm" should be applied fully. My experience shows that the focus of healing non-believers and non-Orthodox should be on common sense, spiritual support, medications. That is, it should be more psychophysiologically oriented. But we should also reverently treat the soul of such a person, because it also is the image of the Creator. If a person comes for a visit, the soul of whom wants to find God, but tosses about in ignorance, then the Orthodox psychotherapist must help him spiritually as well. He does not replace a priest. He only precedes him. The doctor is sometimes a "barrier," protecting the patient from even greater temptations (alcohol, vice, suicide).

Often patients ask me about the meaning of personal life, after seeing icons and the Gospel in my office. Then to those, whose heart is open to faith, I tell about Christianity, about the Christian understanding of life’s meaning, the meaning of suffering. I am sure that psychotherapy, which follows the principle "be patient, everything will pass" is not permissible in most cases. I will relate just a few examples.

About a year and a half ago, a wealthy 52-year-old entrepreneur came to me in the state of obvious anxiety. He told me that he does not want to live any longer, because he no longer sees any reason to live. In the last eight years he was married three times to women half his age, earned much money, and this is the sorry result…

Another example. A middle-aged woman lost her only son. Grief, tears, hopelessness and despair did not leave her from the moment of the automobile catastrophe, which occurred two years before… Another example. A young person who has suffered two heart attacks by the time he was 38… There is a theme that is practically forbidden in layman medicine and psychology. That is the theme of death. Doctors prefer to remain silent about death. Science is helpless here. Severely ill patients are consistently comforted: "Everything will be fine," "Everything will be normal." And the person dies in this lie. He dies unprepared, without repentance, without a spiritual will and testament.

I have often seen the death of unbelieving persons. I remember one person well. Horror and panic were on his face, he was full of the greatest anxiety. There are no words that can describe the chilling fear of the soul in which he found himself. Even the thought of death arouses despair in the atheist. For the Orthodox person, the memory of their hour of death — is an important factor in improving their life. From childhood on, the Christian asks the Lord for a death without sin, peaceful, blameless, and a good answer at the dread judgment seat of Christ. When one reads about the death of the righteous and saints, the soul become filled with deep emotion and joy, not with grief…

Curative psychotherapeutic influence should, in my opinion, have a hierarchy of goals: from the immediate (to calm, instill hope, remove symptoms of illness) to the most important — the internal growth and development, the conversion to enduring values. In the opposite case, psychopractice can become a dangerous manipulator of people’s souls or bring only a "cosmetic" effect.

I am deeply convinced that psychotherapy, when possible, should become a "bridge" to faith in God. I truly rejoice when I see my former patients in church. If later on they come to see me, it is only as guests, because in their souls they found the Almighty Healer — our Lord Jesus Christ.

I will share another example with you. For three years, I worked in the rehabilitation unit of the cardiology clinic. I had to mentally rehabilitate those recovering from a heart attack. The patients, who were mainly men of working age, could find no peace. Their mood was depressed, there were often tears in their eyes. Others — were bewildered, were at a loss and did not believe this was happening to them. Of course, at 45-50 years old, one has lots of plans, projects. And all of a sudden, a severe illness strikes — heart attack. The words alone causes people to shudder, goose bumps come out.

As a doctor psychotherapist and psychiatrist, I was supposed to diagnose mental anomalies and treat them, using medications and psychological influences, according to instructions. Different researchers have determined, that even 6-12 months after the heart attack, 90% of the patients are still depressed. The reason for the stubbornness of depression, as observations showed, were united with the loss of the reason for living, the destruction of hopes.

In becoming familiar in detail with literature about the mental rehabilitation of heart attack victims, I noticed one tendency, which could be called a departure from reality, smoothing over the sharp corners or distraction. Of course, it is important to calm down, but then what? I asked myself these questions very often.

In the Center of Mental Health of the Russian AMN in May 1993 there was a conference called "Mental disorders and cardiovascular pathology." I was a participant. The theme of mental rehabilitation of heart attack victims was discussed in the context of the question "quality of life." There were many presentations and lectures on psychological rehabilitation.

The main philosophical thought of those speaking followed the following outline: live worthily — ail worthily — die worthily. In addition, worthily was understood more as consisting of societal way of life, but certainly not moral. There was not a single word about spirituality, God, faith. The scholars, it seemed to me, tried to hide behind their scientific terminology, to avoid answering to the main question: "What should be set against illness?" This is precisely the question in which secular medicine and psychology find themselves at a dead end. The way out is not simple, it can be found in turning to Christ, in humility.

Metropolitan Benjamin (Fedchenkov) wrote: "Undoubtedly there exists a connection between unbelief and so called education (in atheistic countries, editor’s comment). But the matter is not in education, in our opinion, but in something else. In what, precisely? In non-humility! Or, more simply, pride! At least, my opinion is such. Education sets people apart from the masses, gives them an advantage, opinion of self grows… and with this comes pride. "Faith is humility," says St. Barsanuphius the Great. But this is not the most important; an educated person begins to believe in himself: in his mind, in his knowledge, not in God, not in God’s grace." There is nothing more I need to add.

My mother, Galina Petrovna Avdeeva, has been the chairman of the clinic where I saw patients for 14 years. She, as a religious person, tries to create a warm Christian climate in the hospital in all ways possible. Under her direction, we worked out a program to help the ill in the ambulatory wing. One of the main ideas of the program was that a heart attack (or some other severe pathology) — is an event, from which it is necessary to extract something valuable for the future, turn the sufferings into something meaningful and overcome the illness on the mental and spiritual levels. With God’s help, we attempted a holistic approach to a person in the unity of all the spheres of his existence: biological, social-psychological and spiritual. The slogan of our program has become "Doctor and patient in search of meaning."

My spiritual director, Father Boris Zakirov, who is quite familiar with the questions of psychology and philosophy, often came to our clinic. He met with the doctors, familiarized himself with our plans, made many recommendations and blessed the program "for the glory of God and for helping others." To willing patients, we began to read the teachings of the holy fathers, particularly those, which touched on the humble acceptance of illnesses for Christ’s sake. In my office, we listened to fragments of Orthodox singing, met with priests. After I returned from the Holy Land, we were given the blessing to rub ourselves with the votive oil from the Lord’s Tomb, from the Tomb of the Most Holy Mother of God. To our great joy, the cardiology clinic was 100 meters from the Church of the Entrance of the Mother of God into the Temple. Some of the ill, when possible, attended services, prepared themselves for confession and Holy Communion. And before being released home, they became truly Orthodox. Glory to God, pouring mercy and generosity on us!

With particular attention, we, together with the ill and recovering, read the teachings of S. Theophan the Recluse. How clearly, how precisely Bishop Theophan, the beloved of God, speaks of illnesses, of their meaning for our life. I will gladly quote the Saint: "Everything is from God: illnesses, and health, and everything, which is from God, is given us for our salvation. Thus, should you accept your illness and thank God for caring about your salvation. How that which God gives serves in salvation, we do not need to seek, because we may never find out. Sometimes, God sends one thing as punishment, as a penance; sometimes as a wake-up call, to bring a person to one’s senses; sometimes, to save one from a danger that would have threatened the person if he were well; sometimes, so that the person would show patience and thus earn a greater reward; sometimes, to purify the person of all passions, and for other reasons… You, when you remember your sins, say: "Glory to Thee, O Lord, that You have given me penance for improvement!" When you remember, that you have not always in the past remembered God, say: "Glory to Thee, O Lord, that You are giving me a reason to remember You more often!" (Publication 1, letter 42, page 41).