4. On Certain Pathological Bodily States

91. Preliminary Note. From the intimate conjunction which exists between body and soul, it is easily understood that there also exists a most efficacious mutual influence between these two conjoined parts. The soul influences the body and the body influences the soul. A body well chastised serves the soul excellently, while on the contrary a rebellious body or one given to vices weighs down the soul. There is added the fact that, from original sin, lamentable disturbances have crept into the bodily powers, which indeed are still accustomed to be increased by atavism, that is, by a particular hereditary and native disposition transmitted by parents. All these things are established by daily experience and are denied by no one. But one must not proceed so far with several modern unbelievers that man's liberty and the imputability of actions are utterly denied, as if man had to act necessarily according to his native propensities and hereditary dispositions of the brain. For if this were so, then even the worst criminals would almost always have excuses for their crimes. For they could rightly say that they committed crimes not freely, but from a necessary hereditary disposition. They would not have to be punished, but pitied. These things indeed are false, and therefore in our times not only the liberty of man, but also the very great influence of the soul upon the body, notwithstanding native bodily propensity, is admitted even by some rationalist psychiatric physicians. For this reason those physicians are accustomed to employ so-called "suggestion," that is, moral persuasion in mental diseases; and, although rationalists, they acknowledge the beneficial influence of the priest-confessor in diseases of this kind. But on the other side it is of the greatest interest to the confessor to have some knowledge of these diseased states of the mind, and that for two reasons: 1. because of the utility of the penitent; for if the confessor judges rightly concerning the state of the penitent, he can assist him more efficaciously; 2. because of the utility of the confessor himself; for not rarely confessors ignorant of diseased states of this kind err dangerously, thinking with excessive credulity that all those things are objectively true which penitents narrate, for example, concerning miraculous visions had, diabolical invasions, etc. Hence arise the derisions of the malicious, disturbances of the faithful, detractions against the confessor himself, etc. - Since these things are so, we indicate certain brief rules concerning this matter, referring for a fuller doctrine to works which treat this matter expressly and which are accustomed to be called "pastoral medicine," "pastoral psychiatry," and by other similar names.¹¹⁵

¹¹⁵ Cf. Surbled, La morale dans ses rapports avec la médecine et l'hygiène, ed. 10, Paris 1905. A. Römer, Psychiatrie und Seelsorge (Berlin 1899). This author is indeed of the Protestant religion, but treats this matter excellently. S. Weber, Zwangsgedanken und Zwangszustände in pastoral-psychiatrischer Beurteilung (Paderborn 1903). Jos. Antonelli, Medicina pastoralis, ed. 3 (Rome 1906). Ig. Familler, Pastoral-Psychiatrie (Freiburg 1898). Raymond O.P., Le guide des nerveux et des scrupuleux (Paris 1911). Bergmann, Die Seelenleiden der Nervösen (Freiburg i. Br. 1923). Gemelli O.M., Skrupulosität und Psychasthenie (Regensburg 1915). Pierre Janet, La médecine psychologique (Paris 1923). Eymieu, Le gouvernement de soi même (Paris 1910).

92. Rule 1. In extraordinary and portentous facts supernatural or diabolical powers are never to be supposed, unless they have first been proved with moral certitude. If even the least doubt remains after investigation has been made, the effects produced must be ascribed to natural powers.

Otherwise the greatest illusions and grave inconveniences would certainly arise. Hence the phenomena of somnambulism, telepathy, etc., are not ordinarily to be proclaimed as diabolical effects, since it is not certainly established that they cannot be produced either by natural powers or by the most cunning craftiness of men. Nevertheless from this it is not lawful to conclude that any Christian whatever can licitly be present at societies or circles in which such phenomena are shown. For not rarely grave dangers against religion and good morals arise from this.¹¹⁶

¹¹⁶ Cf. below, on superstition (II, n. 520 sqq.), where this matter will be treated more broadly and where decisions of the Holy See against spiritism and magnetism will also be brought forward.

93. Rule 2. The voluntary and the free can be taken away not only in perfect insanity, but also in hypnotism and in certain pathological states of the mind. But if there is doubt whether an act committed in states of this kind is voluntary and free or not: in evil works (in odiosis) it is to be held as involuntary or at least as not a grave sin; but in favorable matters what has been done is considered to have been rightly done.

All admit that the voluntary is taken away in perfect insanity; experience establishes that the voluntary is also taken away in hypnotism (at least sometimes); for a hypnotized person sometimes does those things which outside the state of hypnotism he certainly would never do. In other pathological states of the mind experience likewise establishes that the voluntary is sometimes taken away, as is plain, for example, during epilepsy, during melancholia, which sometimes causes the so-called abulia or incapacity of willing efficaciously, during hallucination, and in some phenomena of hysteria. But in doubt concerning the liberty of an objectively evil act, it is not imputed morally as a grave sin, because no one is considered evil unless he is proved so. Moreover, in these cases grave voluntary malice cannot be proved. Hence the confessor must be a very mild judge in circumstances of this kind. But if there is question of a good act doubtfully voluntary and free, nothing prevents it from being presumed to have been done freely and voluntarily until the contrary is proved.

94. Rule 3. The voluntary, if it is not totally taken away, nevertheless is certainly greatly diminished in diverse and many diseased conditions of the nerves, among which above all are to be enumerated the so-called obsessions, fixed ideas (Zwangsvorstellungen), and hysteria.

95. Fixed ideas¹¹⁷ or obsessions greatly torment many men otherwise of sound mind, and they are concerned with almost infinite matters, so that up to this day they have not yet been able to be reduced by expert physicians to determined categories. For example, one man has a fixed idea that he must wash his hands almost a hundred times in a day; another in all things, even most holy things, always sees obscene things; a third labors under the fixed idea that he is utterly unable to pass through a vast place (agoraphobia, Platzangst), and so on. Experience shows that fixed ideas vanish completely for a time and appear again after an interval more or less long. What the causes of fixed ideas are is not yet certainly known. It seems likely that they are caused sometimes from hereditary disposition, sometimes from certain transmutations of the brain, sometimes from neurasthenia, and very often from vehement fear suffered; wherefore they also are accustomed to be called phobias. Fixed ideas greatly diminish the voluntary, so that scarcely, and indeed scarcely at all, can there be mortal sin in them. At most there is venial sin, and sometimes there is no sin.

Against fixed ideas there is no more efficacious means than (besides wise care of bodily health) strict obedience toward a prudent, strong, and especially patient confessor or director. For from such obedience and from the personal influence of the confessor, fixed ideas, if they do not entirely cease, at least leave life more tolerable, which otherwise can scarcely be borne. In time past fixed ideas were sometimes removed by physicians with the aid of hypnotism; but today's practice now less frequently employs hypnotism because of the inconveniences sometimes following from it, but rather has recourse to so-called psychotherapy or moral persuasions, which hardly anyone can perform better than a well-instructed confessor. Above all, however, the confessor should then strive to conciliate to himself the perfect trust of the one who labors under fixed ideas. Let him say to him that there is no great danger of sinning in these phantasms and obsessions; let him induce him to light labor which distracts the mind to other thoughts; but let him never say sharply: You are mad! your ideas are absurdities and follies, or other similar harsh words. But let him strongly, and at the same time bravely and sweetly, admonish him to patience; let him command him not to do anything unusual, for example, unusual exercises of piety, nor to go to other persons for asking counsel, nor especially to read books treating of temptations, disturbances of the nerves, fixed ideas, etc. For experience establishes that by the reading of such books fixed ideas are not only not cured, but rather are confirmed or transformed into other worse ones. - The confessor should also be very cautious concerning the so-called psychoanalysis invented by Freud and developed by others, since from psychoanalytic attempts there not rarely arise very baneful effects.

¹¹⁷ Cf. Familler, Pastoral-Psychiatrie 21; A. Ziehen, Psychiatrie (Berlin 1894) 120 sqq. Terminology in this matter is by no means uniform among diverse authors. As much as suffices for our purpose, under fixed ideas we comprehend all the things which by others are called: phobias, obsessions, psychasthenia, lucid dementia, etc. For in all these states this is common, that a man, however much he knows that this idea or impulsion is not sufficiently founded, nevertheless is unable to expel it.

96. Hysteria, if you look at the name (ὑστέρα), is a woman's infirmity, but today this name is used to signify a special disease of the nerves, which is found both in women and in men. Nevertheless it must be admitted that hysteria is found more often in females than in men;¹¹⁸ perhaps for this reason, because the nervous system in men is firmer than in women. First of all it must be observed that this disease is by no means always something shameful, nor does it always arise from lust. For experience establishes that most pious men and women sometimes labor under hysterical disease. Nevertheless it has also been discovered that those who labor under hysteria suffer temptations against chastity more easily and more vehemently. For when their nervous system is disturbed, and notably the genital nerves, then their will is weakened. What the cause of hysteria is, or what it itself is, still lies hidden from us. It seems to be at least principally a morbid autosuggestion which is also called pythiatismus (Babinski). Perhaps it is not an organic disease, but a functional one, as physicians say; that is, hysteria does not cause organic lesions, but more or less impedes physiological or psychological functions. The symptoms of hysteria are almost infinite and always variable, so that someone has rightly said that "in hysteria nothing is constant except its inconstancy." Yet this is established among all, that right judgment, the moral sense, and the voluntary are greatly diminished by hysteria. Let the confessor act with the greatest prudence and caution with persons laboring under hysteria, because otherwise both he himself and they will easily suffer great harms.¹¹⁹ Since it is not so easy to discern whether the disease of hysteria is truly present, it is worth the labor to bring forward here certain characteristic signs of this state, which are called the stigmata of hysteria:¹²⁰

1. Egoism altogether exaggerated and morbid. The hysterical person is accustomed to refer everything to himself or herself. Therefore such a person continually complains that other people do not sufficiently consider him or offend him with many kinds of things, which in reality are futile. From this the person also tries to make others pity him. He feels great satisfaction if other people acknowledge or admire his pains, anxieties, labors. But if others seem to neglect him, then with all his powers, even by exaggerations and lies, he thrusts himself and his state upon them. He does not care for his neighbor except because of egoism. Hence he also often offends his neighbor, not indeed by grave deeds, but as if by needle-pricks, so that those dwelling with him or often conversing with him must tolerate many inconveniences. In one word: the hysterical person, whatever he does, whatever he suffers, refers everything to his own honor or utility or satisfaction. He does not shrink even from tolerating great pains, provided that he is acknowledged by others as another Job.

2. Abnormal inconstancy¹²¹ in affections, and those very vehement, is the second characteristic sign of hysteria. The hysterical person now exults with jubilation of mind, afterward because of futile reasons is saddened unto death;¹²² today with great trust he approaches the confessor or physician and observes their commands most faithfully, tomorrow he complains about the confessor and physician as about men without heart and intelligence.

3. Defect of truth and veracity (pseudologia phantastica or mythomania) is the third, and indeed the saddest and most dangerous, quality of hysteria. This defect manifests itself both in actions and in words. The hysterical person deceives himself, deceives others, although he does not always do this knowingly or from malice. Hence in such a person there are sometimes found actions which, considered at first sight, appear miraculous, for example, heavenly visions, diabolical apparitions, fasting prolonged for several weeks (while secretly the person eats), indeed even bloody stigmata in the hands, feet, and side. Not rarely also the hysterical person narrates foul lies concerning the things and deeds of others, indeed very badly blackens the honor of the confessor and causes him many inconveniences.

4. Sins against temperance not customary are also sometimes a sign of hysteria. We have already said above that hysterical disease does not always arise from excesses of lust, as some falsely think; nevertheless experience establishes that hysteria easily leads to inordinate carnal delectations, and indeed with almost equal intensity to inordinate delectations of foods and drink as to venereal delectations. Hence hysterical persons often commit excesses in Venus and Bacchus. These phenomena are spontaneously understood if it is observed that the moral judgment of the hysterical person is clouded because of the person's exaggerated sensitive appetite. This disease can be aggravated to such a point that a person otherwise modest casts aside every shame and openly tempts, indeed even compels, other persons to immodesty. Since, moreover, the person affected by this disease has suffered a defect in the truth of judgment and in the veracity of speech, not rarely he falsely accuses others of lust committed with him. For this reason let a priest outside confession not speak alone with a woman alone, so that calumny cannot afterward be made against him. Alas! not one innocent priest, because of his imprudence, has in this way been falsely accused and condemned.

¹¹⁸ Cf. A. Aub, Die Hysterie des Mannes, Munich 1911.

¹¹⁹ Cf. Capellmann-Bergmann, Pastoralmedizin 10, 122: "In general, the greatest caution and reserve are to be recommended to the cleric in dealing with hysterical persons." Familler, l. c. 67 sqq.; Ziehen, l. c. 243 sqq.

¹²⁰ We omit merely bodily stigmata, as, for example, defect of the conjunctival, pharyngeal reflex, etc.

¹²¹ Great lability of representations and moods.

¹²² "Jubilant to the heavens, saddened unto death," the so-called laughing-weeping. Cf. Surbled, l. c. t. IV, cap. 4.

97. Morality of acts committed in hysteria. Acts committed by a hysterical person cannot be said to be utterly involuntary, except rather rarely, namely, when the absence of cognition and volition is established; nevertheless they must be considered imperfectly voluntary and consequently judged more mildly in the confessional. Therefore it often happens that an act committed by a hysterical person is not a mortal sin, which, if it had been committed by a healthy person, would without any doubt be grave fault. And this must especially be attended to in impure thoughts and desires, indeed sometimes even in external shameful acts.

98. Cure of hysterical disease. Some remedies must be sought from medical art, others from moral theology. It is indeed established among all that hysteria not rarely takes its origin from disease of the nerves and other bodily indispositions. Therefore first, with the aid of an expert physician, the bodily disease, if any exists, must be removed. Yet an organic bodily disease cannot always be found among hysterical persons. Then the confessor or priest should first of all strive to procure for himself the complete confidence and obedience of the hysterical person; and this indeed is a matter by no means easy. But when these have been obtained, with all prudence, all patience, and all firmness, let him endeavor that the abnormal egoism of the hysterical person be wiped away; let him suggest honest distractions and delectations; let him not permit excessive exercises of piety and mortification; but let him prescribe above all works of mercy and charity toward one's neighbor. By this manner of living and acting, hysteria will gradually cease or at least will become more tolerable.