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Influence of religious factor on the process of rehabilitation in church family temperance clubs
Until the 18th century an enlightened and masterful healer would consider physical, psychic, social and spiritual aspects of human vital activity in their wholesomeness.
He would follow faithfully the principle of Socrates: “We should not try to cure the body without the soul”. Charmides or on Temperance: tentative, v. III, p. 21. [1].
However, the flourishing of atheist and materialist concepts starts bit by bit to oust from human minds the perception of being made by Creator “in the image and likeness of God” (Genesis 1:26). A human being started to be viewed as a social animal.
Biological approach taken in medicine hampered progress in medical art and science. Albeit some medical scholars tried to oppose this reductionism, their opinion was not taken into account. Meanwhile those who had a consistent view and followed the methodology of medical art and practice tried by centuries kept and developed the principles of holistic medicine.
In Soviet Russia St. Luke (Voino-Yasenetsky), professor of surgery, author of ever-quoted books Spirit, Soul and Body and Purulent Surgery Essays was such a Light. As the Master always emphasized, “There is no “case” for a surgeon, but a living and suffering person” [2]. The medical practice of Archbishop Luke gives us vivid examples of such attitude to patient.
Arch-flamen and doctor, Metropolitan Antony, the head of Diocese of Sourozh of the Russian Orthodox Church in Great Britain and Ireland also testified the triunity of spirit, soul and body in a human being. He wrote on this subject, “But if we turn to the Holy Writ we will see that from the very commencement of the history of humankind two areas were defined with absolute clarity: spirit and flesh. And between them there is a field of human warm-heartedness, human soul, very similar to dusk between darkness and light” [3].
There is no need for me to introduce to you, my esteemed colleagues, the personality of an Italian doctor canonized by Roman Catholic Church, a University professor Giuseppe Moscati whom you very well know.
Padre Antonio Maria Sicari, the hagiographer of the saint doctor, wrote, “Not only did Moscati perceive a patient as a unity of spirit and body, and not only did he look at the disease embracing its wholesome and spiritual aspects, but he took it all as a necessary minimum for going deeper into a “human as one whole”. Treating a person as one psycho-physical whole was to reach his/her spiritual depths, inner suffering of his/her soul, inmost striving for happiness through inspiring with transcendent values” [4].
The necessity of seeing “God’s image” in another person is grounded by a great physiologist, hieromonk and academician of the USSR Academy of Sciences A.A. Ukhtomsky in his doctrine of dominant.
Being religious themselves, many masters of Russian medicine considered the fact of religiosity a therapeutic factor in their medical practice. Enough to give just a few names: N.I. Pirogov, V.P. Filatov, S.S. Yudin, G.A. Pokrovsky.
Along with these names we cannot but mention one of the founders of social psychiatry, Doctor of Medicine D. Ye. Melekhov. Professor Melekhov, son of the priest of Ryazan Diocese, was a pupil and associate of the founders of Soviet psychiatry S.S. Korsakov, P.B. Gannushkin. In his unfinished work Psychiatry and problems of spiritual life he wrote, “Thus, it becomes a general and imperative requirement that a person is viewed as a whole, with the consideration of full range of his/her physical, psychic and spiritual manifestations, as a spiritual personality” [5]. Dmitry Melekhov dispels the ideas of religious faith being a malignant phenomenon and viewed mainly as delusional disorders coming as part of schizophrenia. He asserts that mentally disturbed people can still have normal religious faith.
With mentally ill people he distinguishes religious experiences that are a sign of sickness (“false mysticism”) and religious experiences that are instances of “positive healthy mysticism”.
It should be said that addictology could not develop in a different way. From early 19th century a narrow medico-biological approach to the problem of alcoholism was prevailing. However, such methodology was failing: during one and a half centuries the effectiveness of treatment of alcoholism was remaining extremely low.
Such situation could not be accepted by those doctors who were not just earning their incomes and “brought” patients under abstract concepts of “malady” and “medicines”, as was expressed by philosopher Ivan Ilyin, but took their work as service of love and compassion[6].
One of such caring doctors in the middle of the last century was a young Yugoslavian psychiater Vladimir Hudolin majoring at the Chair of Nervous and Mental Illnesses that was opened in 1921 by an outstanding Russian and Croatian neuropsychiatrist, professor, nobleman M.N. Lapinsky on the basis of Medical Faculty of Zagreb University.
During his internship on the W.H.O scholarship in the clinics of Great Britain and Scotland in 1952/53 doctor Vladimir Hudolin met Joshua Bierer, clinical psychiater and a pioneer in social psychiatry, a “grateful pupil” and successor of Alfred Adler who in 1938/9 set up the first therapeutic social club for patients of psychiatric hospital, as well as Dr. Maxwell Jones in his therapeutic community of Belmont (Henderson Hospital).
During the same period Maxwell Jones starts to develop the idea of transforming psychiatric hospitals into therapeutic communities, and his pupil, an Italian psychiater Franco Basaglia will go even further. In 1968 he would be the first one to state the idea about elimination of psychiatric hospitals, which will happen in Italy 10 years later.
As he came back to Zagreb as a deputy chief of Neuropsychiatric Department at Dr.M. Stojanovic university hospital which became the base of the first specialized chair of alcoholia in Yugoslavia, Vladimir Hudolin, inspired with new ideas, set out in his premises the “open-doors” system introduced in 1865 by a Scottish psychiater John Batty Tuke. He also started to put into practice the methodology of therapeutic communities, strategy of working in small groups and family-based approach.
After the associate professor of medicine Josip Breitenfeld retired in 1959, Vladimir Hudolin became the head of the above-mentioned clinic (presently called the Sisters of Charity Clinical Hospital).
“The new rising star in social psychiatry[7]” was the description given to 45-year-old Vladimir Hudolin by A. Guilherme Ferreira, president of the World Association of Social Psychiatry in 1988-1992. Based on his gathered experience and own speculations he starts to develop socio-ecological theory of alcoholism according to which the problems linked with the use of alcohol and other psychoactive substances should be viewed within the context of deviating behavior, style or mode of life of the sufferer, together with people surrounding him and their environment, taking into consideration how they are influenced by individual psychological and socio-cultural factors.
On April 1, 1964 Vladimir Hudolin, by that time a Doctor of Medical Sciences, opens the first in Croatia Club of Alcoholics in Treatment (C.A.T., Klubovi liječenih alkoholičara. K.L.A. ), which expanded to over 2000 of such clubs in the Balkans by 1979. The results were astonishing: about 60% of the Clubs’ members had sustained lengthy remission[8]. Obviously, this was a revolution in the views on alcoholism and ways to solving the problems it causes.
In Russia the methodic of V. Hudolin became known to the broad circle of readers of The Issues of Narcology in 1990. The articles of B. Gachich, T.B. Neborakova and E.A. Koshkina[9] were published at that time. In 1994 an article by our authoring team[10] came out, where we shared with the colleagues our experience of organizing family temperance clubs (FTC’s) in Moscow and the Moscow area.
The first FTC in Russia was opened on December 5, 1992 with Nikolskaya church in Romashkovo township in the Moscow area, thanks to the help of our Italian friends don Silvio Franck, don Ezio “Nilo” Cadonna, prof. Renzo De Stefani, medical assistant Carlo Tenni, Roberto Cuni. We highly appreciate their input.
We can suppose that it is not without the influence of Vladimir Hudolin, a member of the WHO Expert Group for Mental Health, Alcoholism and Other Addictions that in 1979 the term alcoholism was discarded from the International classification of diseases and replaced with the term alcohol addiction syndrome, and since 1999 alcoholism is considered to be a general term to denote behavior and psychic disorders which result from systematic alcohol intake.
Despite this significant achievement, work on the integration of socio-psychological and medico-biological theories of alcoholism was continued.
In the course of development of holistic approach for healing a patient a biopsychosocial concept was formed first.
The authorship is considered to belong to George Liebman Engel (Doctor of medical sciences, American National Research Health Institute) who in his work A need for new medical model: A challenge for biomedicine[11], published in 1977, pointed out the importance of consideration of biological, psychological and social aspects of the disease while treating a patient.
However, even after adopting new medical practice doctors continued to feel that something was still lacking.
An interdisciplinary, contextual, systemic approach which came to replace the narrow analytic one required that a doctor makes use of spiritual/religious resource of a patient.
It was David B. Larson, doctor of medical sciences, epidemiologist and psychiater, founder and head of American National Research Health Institute, who was with the first ones among medical scholars that publicly brought up the forgotten factor of physical and mental health.
“So what is this factor that so often remains ignored?’, David Larson asks himself, and answers, “It is the power of personal spirituality of a man, or his religiosity” [12]. “The connection between spirituality and health is gaining clinical and medical recognition based on studies published in well-known medical journals” [13], he writes further on.
Dr. Larson initiated quantitative research of health and spirituality in medical literature. His regular reviews of research published in mid-1980ies were instrumental to recognition of potential significance of religiosity and spirituality which used to be neglected, in research institutes, medical educational institutions and healthcare facilities[14].
In 1998 on the basis of Geriatric Division of Duke University Medical Center David B. Larson sets up a Center for Spirituality, Theology and Health aimed at studying the influence of religious faith and identity on psychophysical condition of a person. Large-scale research commence in this field, with materials published in the leading reviewed scientific editions, international conferences are held, numerous monographs come out.
The current head of the above-mentioned center, Doctor of Medical Sciences, psychiater Harold G. Koenig, author of more than 280 scientific articles, 35 substantial books dedicated to this theme, based on positive conclusions made by scientists concerning beneficial effect of religious factor on human health, together with co-authors creates a whole method of religiously integrated cognitive behavioral therapy for treatment of major depression in patients with chronical medical illness[15].
Works come out which state explicitly that religiosity of a person cannot be neglected. In particular, one of the most influential Dutch doctors in recent half-century, professor of psychiatry Herman van Praag states that religiosity is intrinsic to a human being, it is an attribute of human mind, it is enrooted in our very nature, predetermined genetically. A prove to that, as the author notes, is registered activity of brain neurons changing in accordance with the intensiveness and depth of religious feelings. This is also proven by the fact of religious feelings arising with non-believers when certain areas of brain are stimulated with bio-currents. Thus, as the scientist explains, the brain is an intermediate between religious needs and their satisfaction[16].
Academician of the Russian Academy of Medical Sciences P.I. Sidorov in his work Religious resource of mental medicine writes, “By general estimate, from 50 to 90% of patients, as they turned to religion, noticed relief as to the gravity of symptoms: pain, reduction of anxiety and tension, reduction of anosognosia and early address, improving effectiveness of coping strategies and compliance, self-regulation and social adaptation, finding the meaning in life and peace of mind, the feeling of self-esteem and confidence, acceptance and compassion, hope and love.
We can confidently say that religion is the most ancient and the most universal protective-and-compensatory civilization resource instrumental for satisfying most versatile needs of a human being, structuring his/her mentality and identity.
Effectiveness of spiritually integrated treatment was very convincingly shown on different groups of patients and clients with anxious disorders and depression, schizophrenia, disorder of eating behavior, subclinical restlessness and anxiety, dependent disorders, post-traumatic stress disorder of combatants and women subject to sexual violence etc.” [17]
In 2009 Pavel Sidorov founds the Institute of Mental Medicine in Arkhangelsk, which relies in its activities on biopsychosociospiritual concept of ontogenesis enriched with synergetic methodology[18]. The word “synergetics” means “joint action” which emphasizes the coherence of functioning of segments reflected in the behavior of a system as a whole[19].
Let me explain this on the example of different approaches to the problem of alcoholism. From doctor’s perspective it is a disease. Psychologists view it as a kind of addictive behavior. Social workers consider it a part of lifestyle. Spiritual counsellors see a sinful passion in it. So what is it in fact? All taken together, yet not as a sum of parts but something bigger, which cannot so easily be brought into one whole.
“Synergetic approach allows for single methodology for analyzing all forms of addicted behavior – from alcoholism and narcotism to fanaticism and terrorism, corresponding with priority directions of development of contemporary psychiatry” [20], asserts the academician P.I. Sidorov.
Going back to the analysis of our experience of setting up FTC’s in Russia, and considering that they appeared within church and continue to develop mainly at parishes, my colleagues and I came to the conclusion that the approach of Vladimir Hudolin to solving the problems concerned with the use of psychoactive substances perfectly corresponds to Christian ascetic practice of healing every passion, including the addiction to hopped beverages.
Back in the IV century St. John Chrysostom appealed, “But do thou, O man, form associations to restrain the madness of inebriety” [21].
It should be mentioned that family club of temperance does not replace parish church communities because it does not set itself any religious and soteriological goals, but it can well be an effective support in solving life problems of church-goers.
However, if club members are believers, they are brought to recovery and spiritual and moral growth through the combined action on their personalities of council liturgical communication, church sacraments, individual and public prayer, pastoral follow-up, active participation in the life of parish.
In tune with overall trend of medicine development the church family temperance clubs (CFTC’s) working on the principles of self-government, mutual assistance, solidarity and unselfishness, were using their religious resource from the very start.
As to what we do and how, and what results we’d achieved during the period from 1992 to 2008 we already informed you on the pages of Narcology journal[22].
Considering growing number of FTC’s (currently 18 FTC’s work with churches and 2 FTC’s – with state drug addiction institutions) we set up in 2011 an Interregional Social Movement to support family temperance clubs (ISM FTC) and started to deploy our program in cooperation with the Federal state budgetary scientific institution Scientific Center for Mental Health which has in its structure a Division for studying special forms of psychic pathology (chaired by the Candidate of Medical Science O.A. Borisova), founded in 1994 with the aim of studying peculiarities of clinical and psychopathic features of mental disorders in mental patients with religious outlook.
Our program relies on religious outlook, traditional family values in their Christian understanding, includes problem-oriented emotional support and acceptance of people with addictive disorders. The program is based on group psychotherapeutic work aimed at correction of the system of person-to-person interactions considered from the perspective of social-ecological approach of Croatian psychiater Vladimir Hudolin. The idea about formation of abnormal changes of personality and ways of coping with those is based on personality theory by Doctor of Medical Science, professor Yu.V. Valentik. Psychotherapeutic interventions are made on the basis of spiritually-oriented dialogue by Doctor of Psychological Science T.A. Florenskaya.
Weekly two-hour meetings are held with the participation of people with chronical alcoholism in the 2nd stage without co-occurring mental pathology and their relatives (spouses, parents and children of the addicted who gave voluntary consent for participation in group meetings). Such meetings are moderated by a addiction-psychiatrist doctor, assisted by a professional psychologist and a priest. Successful passing of a program is regular participation in group psychotherapeutic meetings throughout a year. Terms of presence in the program are not restricted.
The goal of the study that had longitudinal character and lasted since 2011 was to define duration and quality of remission assessed by methods of clinical trial, by using Short Form-36 Health Status Survey and Symptom Check List-90-Revised (SCL-90-R). The study covered 53 people, including 35 men (66%) and 18 women (34%). Duration of alcoholism addiction was from 2 to 12 years.
Results: remission from one month to six months was registered on 5 people (10%), remission from six months to a year was on 13 people (24.5%), remission lasting over a year was on 35 people (65.5%). Quality of life in remission (SF-36) improved from lower figures (below 130 points) to medium (from 130 to 210 points for 40 people) and high (over 210 points for 8 people). Life satisfaction and realistic attitude to self were formed (SCL-90-R). The level of socialization grew for 40 people (76%), family relations were normalized for 26 people (50%), 10 people got families (19%) that even gave birth to children. 24 people (45%) had their professional skills restored, 12 people (23%) mastered new kinds of activity.
Conclusions: thus, the reviewed approach proved to be highly effective. We suppose that such results were achieved due to:
— multidisciplinary approach;
— parallel participation of addicted patients and their relatives in the program;
— deep re-orientation of personality in values and senses as a result of actualization of a spiritual component of personality;
— remission became a consequence of responsible choice of a patient as a result of restoring interpersonal relations inside the family in the course of group family work;
— harmonization of patient’s personality was influenced by spiritually-directed communication in specially arranged psychotherapeutic environment;
— alteration of patient’s behavior came together with the change of his/her entire life style.
Therefore, we become convinced that the use of religious resource of our patients has positive effect on their rehabilitation and re-socialization.
Given all this, another reference to authoritative opinions of our teachers comes to mind.
On October 15, 1813 during the grand meeting for the renewal of Medical Faculty of the Moscow University its Dean Matvey Yakovlevich Mudrov gave a speech which was life-changing for Russian medicine, A word on piety and moral qualities of Hippocrate’s doctor.
This speech has a reminder to all of us, “I will tell you concisely and clearly: healing is treatment of the sick person as such. This is all the secret of my art, whatever it is! This is all the fruit of my twenty-five-year-old labor by sick people’s beds! … it is the sick person as he is who should be treated, his contents, his organs, his powers” [23].
Mudrov liked to say to young doctors, “Stick to what Hippocrate said. With Hippocrate you will both be the best people and the best doctors” [24].
Let me quote here the father of medicine, “It’s far more important to know what sort of person has a disease than what sort of disease a person has” [25]. – Hippocrates of Cos (c. 460 BC – c. 370 BC)
To conclude my speech I cannot but mention that the conceptual platform of the CFTC’s found its expression in the Concept of the Russian Orthodox Church for the Affirmation of Temperance and Prevention of Alcoholism adopted at the session of Holy Synod of the Moscow Patriarchate on July 25, 2014.
In particular, it says, “The Orthodox church considers alcoholism a hard mental illness associated with deep damage of psychosomatic character, the treatment of which is not possible without understanding by the sick person of spiritual nature of his/her malady, full and sincere repent, turning to the fullness of the grace of Christ” [26] .
March 27-29 2015, city of Opatija, Croatia
| Remission from one month to six months | 5 people (10%) |
| Remission from six months to a year | 13 people (24,5%) |
| Remission lasting over a year | 35 people (65,5%) |
|
Quality of life in remission. Short Form-36 Health Status Survey. |
|
|
improved from lower figures to medium (from 130 to 210 points) |
40 people |
|
improved from lower figures to high (over 210 points) |
8 people |
Simptom Check List-90-Revised.
Life satisfaction and realistic attitude to self were formed.
| The level of socialization grew | 40 people (76%) |
| Family relations were normalized | 26 people (50%) |
|
Got families
|
10 people (19%) |
| Professional Skills Restored | 24 people (45%) |
| Mastered new kinds of activity | 12 people (23%) |
[1] » Σωκράτης εις Χαρμίδην ‘’ (ή » Περί Σωφροσύνης ») § 156 e.
[2] St. Lukas of Crimea (Voyno-Yasenetsky). Autobiography. I have grown fond of suffering. M., Parish of the Church of Descent of the Holy Spirit, 2007. P.178.
[3] Antony (Bloom), metropolitan. Body and matter in spiritual life. / Trans. from English by publ.: Body and matter in spiritual life. Sacrament and image: Essays in the Christian understanding of man. Ed. A.M. Allchin. London: Fellowship of S.Alban and S.Sergius, 1967. URL: http://www.practica.ru/Ma/16.htm; (date of access: Feb. 03 2015).
Antony (Bloom), Metropolitan of Sourozh. Spirituality and Warm-heartedness: Conversation with Orthodox priests. Finland, Kuopio. August 1974 /Transl. from English /Moscow Psychotherapeutic Journal: Special issue Christian Psychology. 1997. #4. Pp. 28-29; URL: http://masarchive.org/Sites/texts/1974-08-00-1-R-E-T-EM01-018.html (date of access: Feb. 03 2015).
[4] Antonio Sicari, Portraits of Saints, vol.2, p.h. Christian Russia, Milan, 1991, pp.149-174. URL: http://christusimperat.org/ru/node/12810 (date of access: March 12 2015).
[5] Melekhov D.Ye. Psychiatry and problems of spiritual life // Psychiatry and actual problems of spiritual life. M., 1997. Pp. 8-61. URL: http://www.psychiatry.ru/lib/1/book/13/chapter/2 (date of access: Feb. 03 2015).
[6] Ivan Ilyin. On calling of a doctor. URL: http://ruskolokol.narod.ru/biblio/iljin/put_k_ochevidnosti/12.html (date of access: March 11 2015).
[7] URL: http://www.waspsocialpsychiatry.com/life-wasp-1964-1992/ (date of access: March 12 2015)
[8] URL: http://www.alcoholnet.net/Manuale%20Club/la_ricaduta.htm (date of access: Feb. 03 2015).
[9] Neborakova T.P., Koshkina Ye.A. // Issues of narcology. — #4. 1990, pp. 56-58.
[10] Baburin A.N., Yermoshin A.F., Zhokhov V.N., Karpova M.N., Nikulin A.V., Turbina L.G. Experience of work of family temperance clubs// Issues of narcology. — #2. 1994, pp.91-94.
[11] Engel G. The need for a new medical model: A challenge for biomedicine // Science. 1977. № 196. P. 129-136.
[12] David B.Larson and Susan S.Larson. The forgotten factor in health. Medical research reveal clinical effect of religion. Article from collection: Herrman R. (executive editor)/ God, Science and Humility. Ten Scientists consider Humility Theology. M.: AST, Astrel, 2007. P.308.
[13] Ib.
[14] Faith, Medicine, and Science: A Festschrift in Honor of Dr. David B. Larson/Jeff Levin, Harold G. Koenig , editors. New York, Haworth Pastoral Press, 2004. P.XVII.
[15] Pearce MJ, Koenig HG, Robins CJ, Nelson B, Shaw SF, Cohen HJ, King MB. Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness. Open Journal of Psychiatry. 2014. Vol.4. No.4. P. 335-352.
[16] Van Praag H. M. Religiosity, a personality trait to be reckoned within psychiatry. World Psychiatry. Feb 2013; 12 (1): p. 33–34.
[17] Sidorov P.I. Religious resource of mental medicine//Human ecology. 2014. #5. P.23.
[18] Sidorov P.I., Novikova I.A. Mental medicine. Moscow, Geotar-Media, 2014. P.19.
[19] Ib.
[20] Sidorov P.I., Novikova I.A. Mental medicine. Moscow, Geotar-Media, 2014. P.523.
[21] From our Holy Father John Chrysostom, Archbishop of Constantinople, Homilies on the Second letter to Timothy. Conversation 1. Full collection of works of St. John Chrysostom in twelve volumes. – St. Petersburg, publication of St. Petersburg Theological Academy, 1905. – Vol.11. – Book 2. – P. 762.
[22]Arch-priest Alexy (Baburin). Follow-up on addicted patients in parish conditions/ Narcology. – 2008. — #10. – pp.88-94.
[23] Sorokina T.S. History of Medicine: Course book for students of higher med.ed.institutions / T.S. Sorokina – 7th edition, reviewed. – M.: Academy, 2008. – P.402
[24]URL: http://www.medpulse.ru/health/yourshealth/medicalachievements/13764.html (date of access: Feb. 03 2015).
[25]URL: http://www.brainyquote.com/quotes/authors/h/hippocrates.html (date of access: Feb. 03 2015).
[26]URL: http://www.patriarchia.ru/db/text/3696047.html (date of access: Feb. 03 2015).