Scruples

Scruples are as distressing and dangerous to the poor penitent who suffers from them as they are troublesome and difficult to deal with from the point of view of the confessor. Theologians have studied the subject for centuries, and we have the results of their labors in our handbooks of moral theology. There we find the notion of the scrupulous conscience accurately defined, its causes traced, and various remedies prescribed. Among the causes of scruples those of the natural order predominate. Thus, to select one of our modern theologians, although Lehmkuhl teaches that scruples may be due to the action of the devil, and that we must also take into account the permission of Almighty God, yet he pays most attention to the natural causes of scruples. These, he says, may be either bodily or spiritual. In detail he enumerates a melancholy and timid disposition, a diseased state of the brain and of the nervous system, weakness caused by overwork, study, or austerities, weakness of judgment, pride and self-conceit, suggestion by reading scrupulous authors or from coming under the influence of a too scrupulous confessor. It is obvious that these natural causes may, and probably will, manifest themselves in other matters besides scruples of conscience about sin and confession. We are not, then, surprised to find that this is so. A pathological state of mind, of which the scrupulous conscience is only one manifestation, has long been recognized by the medical profession. However, it has been specially studied by the medical profession only within the last fifty or sixty years, and by foreign more than by British doctors. It may be of interest, and not without profit, to see something of what the doctors of medicine have done in this field, a field common to them and to the moral theologian.

It will be best to begin by transcribing a few typical cases. These will convince us that medicine has essentially the same phenomena to deal with as moral theology has. What the moral theologian calls scrupulosity, the medical practitioner calls the doubting mania, in French folie du doute, and délire du toucher, in German Grübelsucht.

My batch of cases is taken from Hypnotism, by J. Milne Bramwell, M.B., C.M., London, 1906.

In the first case, which I select out of many, the moral element is very conspicuous. A confessor would not be astonished if he got such a case in the confessional. He would class it among those in which the sufferer fears sin in all his actions.

‘‘Mr. ——, aged 28, first consulted me in April, 1894. His father was very nervous and passionate, and had suffered from brain fever and chorea. At the age of 14, the patient had many religious doubts and fears, and believed he had committed the unpardonable sin. At 16, while working in a cocoa manufactory, he began to fear that the red lead, which was used in fastening certain hot pipes, might get into the tins containing cocoa, and so poison people. This was the commencement of a folie du doute and délire du toucher, which had never since left him. Instead of going on with his work he was irresistibly impelled to clean and reclean the tins. The following is taken from the letter of a friend to whom he confided his troubles:—‘On October 1st, 1891, Mr. —— told me that he had attempted to commit suicide, as his life was so miserable (he had taken poison). He had read of a case of poisoning through eating chocolate, and connected himself with it, though it was five years since he had helped to manufacture any. He now believed he might have been careless with the molds, and thus have produced a poisoned chocolate, which years afterwards had caused the child’s death!’ The grotesque absurdity of the story, as he related it to me, would have made me laugh, had I not felt how terribly real it was to him. His vivid imagination had pictured every incident of the tragedy: the child buying the chocolate, running home full of happiness, then becoming ill and gradually sickening in awful agony till released by death. The keenness of mind with which he sought to prove the reasonableness of his belief that he had poisoned the child was extraordinary. He wrote:— ‘Yesterday I was unscrewing some gas burners in a provision shop and got some white lead on my hands, and I have been thinking that it may have got amongst the food.’ I found that brooding over this fancy had brought him to the verge of despair, and for weeks his life was a perpetual agony. He worries himself about his work of fixing advertisement-plates to walls, and can never persuade himself that they are securely fastened. He fancies the nails are bad, or the mortar loose, and makes himself ill over it. I have pointed out to him that if a plate fell it would almost invariably slide down the wall. This has not prevented him from painting a most elaborate mental picture of the decapitation of an unfortunate youngster, who happened to be playing marbles with his head against the wall. To enumerate all his troubles would take a small volume. ... When I first saw the patient the folie

du doute and délire du toucher were constant, and most varied in their manifestations. If he accidentally touched persons in the street, he began to fear that he might have injured them, and exaggerated the touch into a more or less violent push. If the person touched were a woman, he feared that she might have been pregnant, and that he might have injured the child. If he saw a piece of orange-peel on the pavement, he kicked it into the road, but soon afterwards began to think that this was a more dangerous place, as any one slipping on it might strike his head against the curb-stone; and so he was irresistibly impelled to return and put it in its former position. At one time he used to bind himself to perform certain acts by vowing he would give God his money if he did not do them. Then, sometimes, he was uncertain whether he had vowed or not; owing to this he gave sums to religious objects which were quite disproportionate to his income. Apart from his peculiar fancies, I found the patient perfectly rational and intelligent; and though his délire du toucher hindered him greatly in his work, he generally managed to execute it, but on some occasions he was compelled to abandon the attempt.’’¹

¹ Op. cit., p. 241.

The next case has also a moral tinge in it.

“Mr. ——, aged 32, April, 1895. Ten years previously this patient began to have peculiar doubts and fears. He felt that if he did anything opposed to popular superstition something dreadful would happen to the Almighty. He was capable of recognizing the absurdity of this when it was pointed out to him; but directly afterwards his morbid ideas returned and governed his actions. Every fresh superstition he heard of was added to his list; and so many unlucky days and places were created by his doing, or failing to do, things against, or in conformity with, these superstitions, that his actions were seriously interfered with. Thus, months often passed before he could find a propitious day for buying an article of clothing, and a still longer time would elapse before he found a suitable occasion to put it on. Sometimes there was nowhere for him to go, and nothing he could do. He was utterly wretched, but had succeeded in concealing his trouble from every one.’’²

² Op. cit., p. 244.

There is no ethical quality in the next two cases.

“Mr. ——, aged 25, first consulted me March, 1890. Formerly strong and athletic, distinguished football player, bicyclist, etc. Two years previously, after the death of his mother from cancer of the breast, he began to fear that he might contract the same disease. This idea grew stronger and stronger; he became neurasthenic, and suffered from insomnia, depression, dyspepsia, etc. Finally the dread of cancer passed into the firm conviction that his left breast was infected by it. He now remained nearly always in one room, and would not go into another without muffling himself up and putting on an overcoat. For some months he complained of difficulty in moving the left arm, and carried it in a sling. I found nothing to justify his fears, but the muscles of the arm were distinctly wasted from disuse.’’ 4

“A man aged 40, of healthy constitution, has since childhood attached prophetic signification to puerile facts and events. To wear a certain necktie promises him happiness or unhappiness. If he does not touch a certain boundary-stone he thinks evil will happen to him. If he does not re-read a certain line, or make a certain letter thicker when writing, something horrible will befall him. At first, his strange ideas were insignificant, or he was able to resist them ; but as he grew older they filled his life and rendered it intolerable. For twenty years he made a pilgrimage every Sunday to the railway station in order to kick a certain post three times with each foot. If he did not do this his father would die. In order to rid himself of these obsessions he made vows and associated threats with them. He said, for example: ‘If I yield to one of my caprices in the course of an hour I shall have apoplexy before twenty-four hours have passed.’ At first this succeeded, but soon the effect of the vows diminished, and he was compelled to make them stronger. The unhappy man now stands sometimes for a quarter of an hour muttering the most fearful imprecations, in order to get the strength to go an errand. If he omits them he is forced to obey the most absurd impulses. He must stop before a certain house, retrace his steps, touch boundaries, stop passers-by, or touch their clothes: in a word, he is obliged to act like a@ maniac. His intellect is perfectly normal, and he attends to his business as if nothing were the matter.”⁴

⁴ Op. cit., p. 250.

3 Op. cit., p. 239.

These senseless fears and anxieties are often connected with the sufferer’s professional duties.

‘*A young priest, not timid in the performance of his other religious duties, suffered agony on entering the pulpit. Another suffered in the same way when he received a confession. A medical student suffered extreme agony at the sight of a few drops of blood. A chemist made up a prescription which caused the death of a customer. He was able to prove that it was dispensed exactly as ordered by the doctor; but, as his existence became a veritable torture from constant fear of making a mistake, he sold his business. A notary had morbid fears only when he had to give a professional opinion. A hairdresser noticed that his hand trembled one day, and then constantly dreaded that this would reappear when he shaved his best customers. The same anxiety did not exist when he had to shave a poor or unknown customer. Dr. Frémineau reports the case of an actor who abandoned his profession on account of extreme stage-fright. This condition only appeared after a successful career. Dr. Bérillon reports several similar cases. Reigler has noticed a morbid fear amongst railway mechanics, to which he has given the name of sidérodromophobie ; this is characterized by an extraordinary aversion to their habitual occupation, and the sight of a train or the whistle of an engine is sufficient to revive their anxiety. Grasset mentions that a distinguished Parisian surgeon commences to be anxious the moment a patient leaves his consulting-room with a prescription. He anxiously asks himself whether he could have written centigrammes instead of milligrammes; and only recovers his mental calm when his servant, sent to seek the patient, brings back the prescription, and he can see that it is all right. Another doctor, he says, is rendered perfectly miserable by the fear of microbes. Brochin reports the case of a doctor who fears no contagious malady except diphtheria, and who shows proof of veritable heroism every time he sees a diphtheritic patient. A case has recently been reported from abroad, where a medical man, dreading that his fees might be the means of contagion, invented elaborate methods of sterilizing them; and I know of a similar case in this country.’’ 6

These cases could be multiplied indefinitely, but they are fairly typical and will serve our present purpose. In all of them the common element of vain fears and consequent anxieties is conspicuous. This same element is that which constitutes the essence of a scruple, and the only difference between them and ordinary cases of scruples lies in the object of the empty dread and anxiety. The scrupulous person has an unreasoning dread of committing sin, and is morbidly anxious about it. While in some of the cases cited a similar object may be discerned, in others the object of dread and anxiety has nothing to do with ethics and morality. We are then justified in regarding the object of these vain dreads as accidental and immaterial; the essence of scruples, folie du doute, or the doubting mania is the same, and it lies in the vain dread of something and consequent anxiety and trouble about it.

5 Op. cit., p. 251.

Medical writers agree in classifying these and allied pathological states of mind under the head of fixed ideas or obsessions. They note that there is a gradual progress from the state of perfect sanity, the mens sana in corpore sano, to that of insanity and madness. The sane mind estimates things at their true value. If an object is to be feared and avoided, it prescribes the necessary means to be taken for that purpose and entrusts the will with the task of putting them in execution. It does not fear an evil more than is reasonable, and it has control over its fears, so that it can dismiss them if they are groundless, or, at least, prevent them from paralyzing all activity. Such a state of perfect health is rare. We are nearly all a little bit mad and a prey to our impressions and imaginations. Something makes a vivid impression on us, a musical air, a joke, an apt phrase, or an unkind look or word, and it takes possession of the mind. By constant repetition the effect becomes intensified, exaggerated, and persistent ; we cannot get rid of the idea; it refuses to budge even at our peremptory word of command.

No very great harm has been done so far, but every idea has a tendency to get itself translated into act. If it is deeply ingrained in the imagination, vivid, and persistent, it exerts a strong attractive or repulsive force on the will. If the will is weak, either from natural causes or from habit, if it has been accustomed to yield and to allow the idea to have free course, we have the first pronounced stage of mental disease, the fixed idea properly so called.

Fixed ideas of this kind manifest themselves in very various ways. The following types are familiar to students of the subject: — Arithmomaniacs are impelled by an unreasoning impulse to count all sorts of objects and to draw up statistics. Onomatomaniacs feel a morbid desire to know the names of everybody they meet. Metaphysical maniacs are tormented by a craving to get to the bottom of insoluble problems. I knew a case of an ecclesiastical student who furtively attended the Mass said for the people on Sundays in order that he might be able to draw up statistics about the attendance. He put down in his book how many men, women, boys, and girls attended Mass every Sunday and holy-day of the year. A college boy whom I knew kept a record of all the cricket scores of the season, and in his spare time he drew up imaginary matches and assigned imaginary scores to the players. A typical case is quoted by Ribot:

“*A young law student, the son of neuropathic parents, was completely absorbed with the idea of knowing the origin, the why, and the how of the forced circulation of bank-notes. . . . This thought kept his attention continually strained, prevented him from doing anything else, placed a bar between the external world and himself, and whatever efforts he might make to rid himself of it, he was utterly unable to accomplish that purpose. Finally concluding that notwithstanding his long reflections and deep researches to the end of solving this vexed problem, he was incapable of any other mental work, he fell into such a state of despondency and apathy that he desired to discontinue his course of studies. . . . His sleep insufficient and broken; frequently he lay awake whole nights, ever absorbed by his dominant idea. In this case a very singular phenomenon must be noted; namely, that in consequence of the continuous tension of his mind upon the problem of bank-notes and their forced circulation, he at last retained permanently before his eyes the image and picture of the bank-notes themselves, in all their varieties of form, size, and color. The idea with its incessant repetitions and intensity, came to assume a force of projection that made it equivalent to reality. Yet he himself had ever the full consciousness that the images floating before his eyes were merely a freak of his imagination.’’⁶

⁶ The Psychology of Attention, Eng. transl., p. 87.

This last characteristic is important. One who is laboring under a fixed idea is conscious of his weakness, and is often ashamed of it, but for all that he yields to it, and finds it more or less difficult to avoid doing so.

In this first class of fixed ideas the intellect alone is concerned. In the second class an emotional element also makes its appearance. The besetting idea is accompanied by fear, dread, and anxiety, and to this class scruples belong. Here also the objects which excite the unreasoning dread are very numerous and varied. In agoraphobia the sufferer cannot cross an open space without being overcome by a feeling of dizziness; in claustrophobia, on the contrary, the object of dread is a confined space; some people dare not look down from a lofty height for fear of throwing themselves down. Some are morbidly afraid of infection from disease and are constantly washing their hands to escape it; others are never satisfied that they have locked the safe, or their place of business, or the door of their house when they left, and they are impelled to return again and again to make sure, and yet they are never satisfied. However, they have not as yet lost all self-control in the matter, they sometimes succeed in resisting the impulse which they well know is foolish and groundless. In this respect they differ from the third class where the will has become powerless to resist the impulse. To this third class belong kleptomaniacs, erotomaniacs, dipsomaniacs, homicidal and suicidal maniacs, and many other instances. With the loss of self-control this third class has passed beyond the range of help at the hands of the confessor; we are no further concerned with it beyond marking it as the limit toward which the other classes tend. We are here interested in the causes which produce the second class and in the remedies to be applied for their cure.

There is a general consensus of opinion among the medical faculty that all these troubles are due to one and the same physical cause — degeneracy. Ribot says : —

‘‘The authors that have investigated the determining causes of fixed ideas, all reach the same conclusion; they find it, namely, to be a symptom of degeneration. One might even maintain that not everybody who may wish it can have fixed ideas. A primordial condition—the neuropathic constitution—is requisite. The latter may be inherited, or it may be acquired. Persons of the one class are of the offspring of parents to whom they are indebted for the sad legacy of degenerate organisms. These are by far the most numerous. The others have been exhausted by circumstances and mode of life: physical or intellectual fatigue, emotions, strong passions, sexual or other excesses, anemia, debilitating diseases, etc.”⁷

⁷ The Psychology of Attention, Eng. transl., p. 89.

As we have seen, theologians, too, are prepared to assign to degeneracy, physical or nervous debility, a large share in the production of scruples. However, they mention other causes as well, and in this they would seem to have the support of Dr. Bramwell, who writes : —

‘‘Imperative ideas are usually regarded as being typical of degeneracy, and especially of hereditary degeneracy. Some of my cases seem to confirm this: they were weak mentally and physically, and had unsatisfactory hereditary antecedents. . . . On the other hand, the transition from the normal state to imperative ideas, is almost insensible— the repetition of an insignificant saying being, according to Ribot, the slightest form, and preoccupation, such as anxiety about an examination, a degree higher. Most children, too, have suffered at one time or another from imperative ideas. This appears to arise from an exaggerated sense of the importance of what they say and do, and also from an exaggerated fear regarding the notice taken of them by others. [Is not this allied to the pride and self-conceit mentioned as causes of scruples by theologians?] Some of my patients were physically far above the average, and many of them possessed mental endowments of high quality, and their morbid ideas did not prevent them doing valuable work. Most of them, it is true, were of an emotional nervous type, but is the sensitive, mobile brain necessarily degenerate? May not the accidents to which it is liable be the result of its higher and more complex development? The thoroughbred is more emotional and nervous than the cart-horse, but is this necessarily an evidence of its hereditary degeneracy ?’’ *

In the light of the foregoing study of the nature and causes of scruples, the rules given by theologians for their cure will, if I mistake not, acquire a new value. First and foremost we see the necessity of a prudent, kind, but firm, confessor. He will not get angry or impatient with his scrupulous penitent, the case will rather excite his interest and sympathy. As soon as he has convinced himself that his penitent is really scrupulous, he will try to discover the cause of his malady. Very often the cause will be degeneracy in the medical sense, and the confessor, while prescribing other remedies, will take care to recommend him to see a doctor or he will himself suggest a holiday or feeding up. If the cause is some form of pride he will know how to administer a paternal snubbing when occasion arises. As the scruples are nothing but empty fears, he will briefly point this out to his afflicted penitent, and as the scrupulous state has been formed by indulging those vain fears, the confessor will take care as far as possible to stop the process of fostering them. He will not allow anything to be said about them, they must not be confessed, nor even thought about, if that is possible. With this object in view he will prescribe constant occupation in interesting work of one sort or another. Such indirect remedies are often most effective, but they should be supplemented by direct action against the scrupulous dread, much in the same way as a horse is taught to face objects at which it is inclined to shy. If the scruples have their origin in indiscreet fervor, the penitent should be taught that God asks for a reasonable service, and that spiritual progress, if it is to be solid and lasting, is almost always slow and gradual. An humble consciousness of one’s own weakness and consequent trust in God are great safeguards against the danger of scruples.

8 Hypnotism, p. 255.