Interior Integration for Catholics Trailer Bonus Episode 87 Season 1

87 Scrupulosity: When OCD Gets Religion

87 Scrupulosity: When OCD Gets Religion87 Scrupulosity: When OCD Gets Religion

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Interior Integration for Catholics Trailer Bonus Episode 87 Season 1

87 Scrupulosity: When OCD Gets Religion

December 6, 2021 Peter T. Malinoski, Ph.D. Full Transcript View the website

Summary: In this episode, we explore the conventional secular and the traditional spiritual ways of understanding scrupulosity, bringing in the experts to define scrupulosity, tells us the signs of being scrupulous, speculate on the causes of the trouble, discuss that standard remedies in the secular and spiritual realms. Then I share with you my views on it, looking at scrupulosity through an Internal Family Systems lens, grounded in a Catholic worldview. We discuss how parts have different God images and the role of shame and anger in the experience of scrupulosity.
Description of Scrupulosity
1. Suddenly my stomach tightens up, there’s a choking in my throat, and my torture begins. The bad thoughts come. . . . I want to drive them out, but they keep coming back. . . . It is terrible to be in a struggle like this! To have a head that goes around and around without my being able to stop it; to be a madman and still quite rational, for all that. . . . I am double. . . . at the very time that I am trying to plan what I want to do, another unwanted thought is in my mind. . . . Distracting me and always hindering me from doing what I want to do.

-- Quoted in Albert Barbaste, “Scrupulosity and the Present Data of Psychiatry,” Theology

Digest, 1.3 (Autumn 1953) 182.

Fr. William Doyle: Around 1900 “My confessions were bad. My confessor does not understand me, he is mistaken in me, not believing that I could be so wicked. I have never had contrition. I am constantly committing sins against faith, against purity. I blaspheme interiorly. I rashly judge, even priests. The oftener I receive Holy Communion, the worse I become,” Around 1900
My story just turned 19 -- terrible bout of scrupulosity.
1. Around sexuality
2. Just started dating the first woman I might consider marrying
3. Physical touching -- romantic contact How far was too far?
  1. Thoughts of sex with her -- plagued me.
4. 1. Do I break up with her? How do I handle this?
5. 1. What was sinful, what was not? Was I on the road to hell? Was I putting her on the road to hell?
6. 1. I thought I was going crazy.
Review: I encourage you to review the last episode, number 86 -- Obsessions, Compulsions, OCD and IFS
1. That episode went deep into obsessions and compulsions and serves as a basis for today's episode.
1. Today's episode, number 87 is entitled Scrupulosity: When OCD Gets Religion and it's released on December 6, 2021, St. Nick's Day.
1. I am Dr. Peter Malinoski, clinical psychologist and passionate Catholic and together, we are taking on the tough topics that matter to you.
2. We bring the best of psychology and human formation and harmonize it with the perennial truths of the Catholic Faith.
3. Interior Integration for Catholics is part of our broader outreach, Souls and Hearts bringing the best of psychology grounded in a Catholic worldview to you and the rest of the world through our website soulsandhearts.com
4. Overview
  1. Start out with definitions of scrupulosity both from spiritual and secular sources, really want to wrap our minds around what scrupulosity is and the different types of scrupulosity. We will discuss the connection between scrupulosity and OCD -- discussion of OCD
5. 1. We will then move to the signs of scrupulosity -- how can you tell when there is scrupulosity?
6. 1. Then we will get into the internal experience of scrupulosity. What is it like to experience intense scruples? Had a taste in the intro, but we will get much more into that.
7. 1. We will discuss what religious and secular experts have to say about the causes of scrupulosity
8. 1. Then what religious and secular experts have to say about the treatment of scrupulosity -- that most recommended therapy approach and the medications typically prescribed.
9. 1. After we've discussed the conventional secular and spiritual approaches to treating scrupulosity, I will how I think about scrupulosity, the root causes of scrupulosity, and how scrupulosity develops and how it can be treated. I will give you an alternative view, grounded in a Catholic understanding of the human person and informed by Internal Family Systems thinking.
Definitions: You know how important definitions are to me. We really want to make sure we understand what we are talking about.
1. Scruple comes from the Latin word scrupulum,
  1. "small, sharp stone" -- like walking with a stone in your shoe.
  2. Ancient Roman weight of 1/24 of an ounce or 1.3 grams.
  3. Something tiny, but that can cause a lot of discomfort.
2. Definitions from Spiritual Sources
  1. Fr. William Doyle, SJ. Scruples and their Treatment 1897: Scrupulosity, in general, is an ill-founded fear of committing sin.
3. 1. Fr. Hugh O'Donnell: Scrupulosity may be defined as a habitual state of mind that, because of an unreasonable fear of sin, inclines a person to judge certain thoughts or actions sinful when they aren't or that they are more gravely wrong than they really are… Scrupulosity involves an emotional condition that interferes with the proper working of the mind and produces a judgement not in accordance with object truth, but with the emotion of fear.
4. 1. Fr. James Jackson, article "On Scrupulosity"
    1. A very good definition
    2. Scrupulosity is an emotional condition, an ultra-sensitivity to sin, which produces excessive anxiety and fear from the thought of eternal damnation…This condition is a religious, moral and psychological state of anxiety, fear and indecision. It is coupled with extreme guilt, depression and fear of punishment from God. However, each person who suffers from it does so uniquely.
5. 1. Fr. Marc Foley: The Context of Holiness: Psychological and Spiritual Reflections on the Life of St. Therese of Lisieux
    1. Excellent, very psychologically informed study of the Little Flower
  2. 1. Not only the best psychological profile of St. Therese of Lisieux, but the best psychobiography of any saint from any author I've read.
  3. 1. A very in-depth look at her mother, St. Zelie as well and the limitations and lack of attunement in the Martin family
  4. 1. Highly recommended reading -- all of chapter 12 is on The Little Flower's scrupulosity.
  5. 1. Scrupulosity is an extremely painful anxiety disorder. It consists of annoying fear that one is offended God or could offend God at any moment and that God will cast her into hell. To protect yourself from eternal damnation, the scrupulous person dissects every thought, motive, and action in order to ascertain if she has send. And since she is deathly afraid that she might have sent, the scrupulous person seeks absolute certitude that she hasn’t send in order to assuage her fears.
7. Definitions from Secular Sources
  1. Timothy Sisemore, Catherine Barton, Mary Keeley From Richmont Graduate University Scrupulosity is a "sin phobia."
8. 1. Jaimie Eckert, Scrupulosity Coach: Scrupulosity is where faith and OCD collide.
9. 1. International OCD Foundation Fact Sheet: What is Scrupulosity? By C. Alec Pollard: A form of Obsessive Compulsive Disorder (OCD) involving religious or moral obsessions. Scrupulous individuals are overly concerned that something they thought or did might be a sin or other violation of religious or moral doctrine.
11. Bridging the Secular and the Spiritual
  1. Joseph W. Ciarrocchi’s The Doubting Disease: Help for Scrupulosity and Religious Compulsions -- published in 1995, and still the most cited text in Catholic circles, even more than a quarter century later.
    1. Dr. Ciarrocchi, a former Catholic priest, trained as a clinical psychologist and served as professor and chairman of pastoral counseling at Loyola University in Maryland prior to his death in 2010.
    2. Scrupulosity refers to seeing sin where there is none.
    3. He viewed scrupulosity as a sub-set of obsessive- compulsive disorder (OCD), basically a kind of “religious OCD.”
    4. He distinguishes
      1. developmental scrupulosity
        self-limited form of scrupulosity
        
        often occurring in adolescents
        
        or shortly after a conversion experience (e.g. St. Ignatius of Loyola)
        
        Temporary, usually disappears.
      2. emotional scrupulosity -- symptoms of OCD
        
        More enduring conditions
      3. Can vary in intensity over time, from being overwhelming to just mildly irritating
      4. Can last for years.
      5. Core experience of scrupulosity: "an intrusive idea, often associated with a sinful impulse, which the person abhors but cannot shake."
      6. "The French label the emotional condition which is sometimes part of scrupulosity "the doubting disease."
Signs of Scrupulosity What do we see.
1. A lot we don't see. Fr. Thomas Santa, past director of Scrupulous Anonymous and Author of the book Understanding Scrupulosity
  1. When people struggle with the scrupulous disorder, most of the suffering, fear, and anxiety they experience happens in isolation. Scrupulosity is mostly an interior struggle, seldom manifesting itself with easily identifiable or observable mannerisms or behaviors. You can’t tell if people are scrupulous by looking at them. While some compulsions of obsessive-compulsive disorder are identifiable, most of the suffering associated with the disorder is personal. Only the sufferer fully knows its debilitating nature.
1. Sources
  1. IOCDF Fact Sheet
2. 1. Jaimie Eckert Scrupulosity Coach
3. 1. The Gateway institute website
4. 1. Doubting Disease 1995 by Joseph Ciarrocchi
6. Obsessions -- excessive concerns about
  1. Fears of Blaspheming, accusing God of being negligent or abusive or evil, cursing God
7. 1. Fears of Sacrilege, abusing our Lord in the Eucharist for example
8. 1. Fears about impulses -- taking one's clothes off in Church, screaming obscenities during Mass
    1. Example of the man concerned about touching his infant daughter's genitals
9. 1. Sexual thoughts about a romantic partner
10. 1. Sexual thoughts or images about a religious figure -- Jesus, Mary, a saint, or possibly a priest or religious.
11. 1. Fears around harming others
    1. I might cause the death of someone if I sneeze or cough during Mass -- I coughed. Maybe I'm sick. Maybe I have COVID. Maybe I'm a spreader.
  2. 1. A pharmacist worries she will fill prescriptions incorrectly and poison customers at her pharmacy.
12. 1. Fears around aggression -- Driver goes over a bump in the Church parking lot in the dark after the parish council meeting. Is concerned he may have run over the pastor.
13. 1. Cooperating in the sins of others
    1. "Man participates in a discussion about a historical figure dead for more than 1000 years, who is alleged to have been a homosexual. He worries that he has committed the sin of detraction." -- Example from Joseph Ciarrocchi.
14. 1. Being a sinful person, dishonest, lacking integrity -- honesty
15. 1. Ruminating about past mistakes, errors, past sins
16. 1. Purity -- looking for moral perfection
17. 1. Not Loving Others enough -- Mother worrying she doesn't love her children enough.
18. 1. Going to hell
19. 1. Death
20. 1. A loss of impulse control
21. 1. Cyclical Doubts
    1. Often about salvation, selling your soul to the devil, in mortal sin
22. 1. Intrusive thoughts and images
    1. 666, Satan, Hell, pornographic images, etc.
24. Compulsions
  1. Behavioral Compulsions
    1. Excessive trips to confession
  2. 1. Repeatedly seeking reassurance from religious leaders and loved ones
  3. 1. Repeated cleansing and purifying rituals
  4. 1. Acts of self-sacrifice
  5. 1. Repetitive religious behaviors
  6. 1. Avoiding situations (for example, religious services) in which they believe a religious or moral error would be especially likely or cause something bad to happen
  7. 1. Avoiding certain objects or locations because of fears they may be sinful
25. 1. Mental Compulsions
    1. Excessive praying (sometimes with an emphasis on the prayer needing to be

perfect) I compulsions about praying. Tithing prayer. 1.6 hours vs. 2.4 hours.

Needing to pray perfectly or at least adequately enough.
Repeatedly imagining sacred images or phrases
Repeating passages from sacred scriptures in one’s head
Making pacts with God to avoid hell or buy time or just to get a little relief in the present moment.
Intense sense of guilt-- feeling guilty all the time -- about things that don't carry moral weight.
Inflated sense of responsibility
Not distinguishing between thoughts and actions.
Example: Joseph Ciarrocchi
1. The Smith family traditionally joins hands around the dinner table to give thanks in prayer before the meal. Susie, age 4, and Billy, age 6 sometimes are fidgety (and always hungry). Mrs. Smith worries that Susie, Billy, and perhaps herself haven’t not “truly prayed” due to the multiple distractions: Susie is scratching her mosquito bite, Billy is leering at the chocolate pudding, and Mrs. Smith remembers she has a school board meeting after dinner. She doubts that their prayers were “heard,” and so request of the family repeat their prayers. Sometimes she makes the whole family repeat them, and sometimes only the children. Once the children needed to repeat them four times, even the Mr. Smith tried to intervene after the second time. Mrs. Smith sought advice from her pastor who urged her not to repeat the prayers, either for herself or the children. When she attempts to follow this advice, however, her entire meal is ruined as she attempts to sort out in her head whether this is acceptable to God. She will continue to worry about it throughout the rest of the evening, including her school board meeting.
Distinguishing Scrupulosity of normal religious practice
1. IOCDF Fact Sheet: Unlike normal religious practice, scrupulous behavior usually exceeds or disregards religious law and may focus excessively on one trivial area of religious practice while other, more important areas may be completely ignored. The behavior of scrupulous individuals is typically inconsistent with that of the rest of the faith community.

Internal Experience of Scrupulosity
1. Plutarch: a first century priest for the Greek god Apollo at the Temple at Delphi. He wrote about the so-called “superstitious” man, who…
  1. And so is the soul of the superstitious man. He turns pale under his crown of flowers, is terrified while he sacrifices, prays with a faltering voice, scatters incense with trembling hands, and all in all proves how mistaken was the saying of Pythagoras that we are at our best when approaching the gods. For that is the time when the superstitious are most miserable and most woebegone....
1. OCD Center of Los Angeles: One of the first documented references to Obsessive Compulsive Disorder (OCD) was in a 1691 sermon by Anglican Bishop John Moore of Norwich in which he discussed men and women who were overwhelmed with unwanted thoughts, and tormented by feelings of guilt and shame over what he described as “religious melancholy.” Priests had started to notice that some churchgoers were attending confession several times a day, and repeatedly confessing to the same sins and shortcomings that they feared would result in divine judgment and eternal damnation. Their penance and absolution would provide only a fleeting glimpse of peace, and then their fears would come roaring back.
2. William Van Ornum, A Thousand frightening fantasies: understanding and human scrupulosity in obsessive-compulsive disorder 1997

24-year-old computer programmer writes, “what worries me is that at any moment and in only a few seconds I can commit serious sin. The only remedy is confession. I worry about what I’ve done until I confess it; then it’s all over. The problem is that I fall or worry again and need to go back.”

Fr. Thomas Santa:
1. Being possessed by a thousand frightening fantasies
2. Constructing a spider web in the mind.
3. People with the disorder often feel as if they are isolated in darkness. They describe this feeling as a “cloud” that perpetually engulfs them. They feel the disorder constantly and uncomfortably, even in the background of day-to-day living. Scrupulosity demands constant attention and can feel like a severe and unrelenting master. At best, most people who suffer with the disorder have learned to live with it. They hope it does not get more pronounced or spill into other areas of life. Relief does not exist, so any promises of relief through activities like rituals are essentially dead ends. For those who are religious, consistent spiritual practices can help and at the same time be debilitating.
From Joseph Ciarrocchi's Book "Doubting Disease
1. Bob is 28-year-old married Jewish man who works for an accounting firm. He is thrilled with the birth of his first child, a bubbly infant girl. Bob is about to be totally involved with her as a parent and share in all aspects of childcare. He was shocked by the following experience: Bob was changing his daughter’s diaper when the thought, idea, or image (he wasn’t quite sure which close parentheses flashed through his mind – “Touch her private parts.” The first time it happened he shuddered, tried to dismiss the idea, and hurriedly completed diapering her. All they tried not to think about it. The next time he changed her diaper, however, the idea came back, but this time in the form of a graphic picture of Bob engaging in the dreaded behavior. This time he felt nausea, became dizzy, and called his wife to finish, saying he thought he was ill and would pass out. The idea began to torment Bob. He found himself not wanting to be alone with his daughter, Les T “give in” to the simples. He refused to bathe her or change her diaper. Sensing something was drastically wrong his wife urged him to seek help. He talked to his rabbi who tried to assure him that he was not a child molester and should dismiss the thoughts.
Psychodynamic perspective
1. Sources
  1. Nancy McWilliams Psychoanalytic Diagnosis --
2. 1. Psychdynamic Diagnostic manual
1. Thinking and Doing predominate over Feeling, sensing, intuiting, listening, playing, daydreaming, enjoying the creative arts and other modes that are less rationally driven or instrumental
1. Hold themselves to very high standards, sometimes impossibly high.
1. Central conflict: Rage and being controlled vs. fear of being condemned or punished.
  1. Cooperation and rebellion
  2. Initiative and sloth
  3. Cleanliness and slovenliness
  4. Order and disorder
  5. Thrift and improvidence
  6. Polarizations inside.
2. Emotion is unformulated, muted suppressed, unavailable, or rationalized and moralized. Except anxiety and sometimes depressed mood
3. Consign most feelings to an undervalued role, associated with childishness, weakness, loss of control, disorganization and dirt
4. Cognition
  1. Condemning oneself for internal thought crimes -- consciously or unconsciously
6. Body states
  1. Hyperarousal -- expressing anxiety through the body
7. 1. Often health problems due to excessive washing
9. Difficulties with
  1. Play
  2. Humor
  3. Spontaneity
10. Pain about isolation.
  1. Shame about being considered weird and unacceptable to others
  2. Capable of loving attachments, but often not able to express their tender selves without anxiety and shame
  3. Relational patterns -- seek relationships in which they can control the partner, sometimes partners who can reassure them
    1. Being intimate in relationships
      1. Emotional connection
    2. 1. Sexuality
Causes of Scrupulosity
1. Spiritual Sources
  1. Fr. James Jackson
    1. The Fathers of the Church considered scrupulosity – or psychasthenia, as the Greek Fathers called it – to be a spiritual problem which leads to a psychological malfunction.
  2. 1. Timothy A. Sisemore. Catherine Barton, Mary Keeley -- The History and Contextual Treatment of Scrupulous OCD
      1. 15th and 16th Century -- connected scruples to moral reasoning, addressed under conscience -- concept of erroneous conscience. -- frees the person to act without resolving the doubt.
1. Secular Sources
  1. IOCDF Fact sheet: The exact cause of scrupulosity is not known. Like other forms of OCD, scrupulosity may be the result of several factors including genetic and environmental influences.
2. 1. OCDUK.com Lots of controversy.
    1. Biological factors
  2. 1. Strep infections affecting the Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infection -- PANDAS
  3. 1. Genetic factors
      1. Runs in families -- 2001 metaanalytic review reported that person with OCD is 4 times more likely to have another family member with OCD than a person who does not have the disorder
  4. 1. Cognitive theory
      1. Everyone experiences intrusive thoughts at times
      2. People with OCD have an inflated sense of responsibility and interpret these thoughts as very significant and important
        
        Caught up in a pattern of Try to resist, block or neutralize them
      3. What is the meaning of the thought to the person?
3. 1. Joseph Ciarrocchi citing David Barlow -- OCD causes
    1. Those temperamentally disposed to having high levels of nervous energy, more pronounced bodily reactions to stress, greater levels of anxiety
  2. 1. OCD is different from other anxiety disorders because those with OCD believe that certain kinds of thoughts are dangerous in themselves
      1. If I think certain thoughts those events will happen.
    2. 1. If I think certain thoughts or spontaneously imagine certain things, or if I have an impulse to do such a thing, then I am the kind of person who would do such things.
        No moral distance between the spontaneous thought or image or impulse and actually doing the act.
        I must be bad. Unclean. Unworthy.
  3. 1. Model for the development of Scrupulosity
      1. Strong belief that certain thoughts are dangerous and unacceptable
    2. 1. Leads to the occurrence of these same intrusive thoughts
    3. 1. This generates significant anxiety
    4. 1. Leading to strong efforts to suppress the thoughts
    5. 1. Which accelerates the frequency of the same kinds of thought
    6. 1. Leading to a need to "turn off" the anxiety by any means
        
        Mental rituals
      2. Physical rituals
      3. These rituals are the compulsions
    7. 1. And then there is a temporary respite, a bit of relief. The compulsive rituals are reinforced because they temporarily decrease anxiety. But then we loopback to the occurrence of the intrusive thoughts again.

Psychodynamic understanding Nancy McWilliams -- Psychoanalytic Diagnosis Obsessive and Compulsive Personality styles:
1. Marc Foley's Approach in The Context of Holiness about St. Therese of Lisieux's scrupulosity
2. Parental figures who set high standards of behavior and expect early conformity to them
  1. E.g. making little kids sit still during Mass
4. Strict and consistent in rewarding good behavior and punishing malfeasance
5. Risk of condemning not only behaviors but the feelings that go with them
  1. Especially anger
7. Issues of control in families of origin.
8. Alternative -- a really lax family in which children are underparented
  1. Child concludes he has to model himself after a parental figure that he invents himself
9. 1. Child might have an aggressive, intense temperament -- projected on to that idealized parental figure.
11. Self esteem comes from meeting the demands of internalized parental figures who hold them to a high standard of behavior and sometimes thought.
12. Value self-control over nearly all other virtues.
  1. Discipline
  2. Order
  3. Loyalty
  4. Integrity
  5. Reliability
  6. Perseverance
Is a particular religion a cause?
1. No:
  1. Timothy Sisemore, Catherine Barton, Mary Keeley: A tendency to blame religion, but no more than counting OCD to be blamed on math class
2. 1. Joseph Ciarrocchi "Religion doesn't cause scrupulosity and more than teach someone French history causes him to believe he is Napoleon. All human beings exist in some cultural context.
3. 1. IOCDF Fact sheet: Scrupulosity is an equal opportunity disorder. It can affect individuals from a variety of different faith traditions. Although more research is needed to truly answer this question, there is currently no evidence to link scrupulosity to a specific religion.
  2. OCD Center of Lost Angeles It is worth noting that Scrupulosity is not partial to any one religion, but rather custom fits its message of doubt to the specific beliefs and practices of the sufferer.
4. Yes:
  1. Joseph Ciarrocchi
    1. …religion may contribute when its content is presented in an overly harsh, punitive manner. Students of such presentations are likely to associate the context of the religious message with fear and anxiety.
      1. Jonathan Edwards, 18th Century Pastor and Theologian in the Congregational Church
        
        The God that holds you over the pit of hell, much as one holds a spider, or some loathsome insect over the fire, abhors you, and is dreadfully provoked: his wrath towards you burns like fire; he looks upon you as worthy of nothing else, but to be cast into the fire; he is of purer eyes than to bear to have you in his sight; you are ten thousand times more abominable in his eyes, than the most hateful venomous serpent is in ours. You have offended him infinitely more than ever a stubborn rebel did his prince; and yet it is nothing but his hand that holds you from falling into the fire every moment. It is to be ascribed to nothing else, that you did not go to hell the last night; that you was suffered to awake again in this world, after you closed your eyes to sleep. And there is no other reason to be given, why you have not dropped into hell since you arose in the morning, but that God’s hand has held you up. There is no other reason to be given why you have not gone to hell, since you have sat here in the house of God, provoking his pure eyes by your sinful wicked manner of attending his solemn worship. Yea, there is nothing else that is to be given as a reason why you do not this very moment drop down into hell.
  3. Heresies from Fr. James Jackson:
    1. Manicheanism: Manichaeism states, on principle, that all matter is evil. If, for example, a child grows up with an extreme attitude to modesty – where the flesh is seen as evil because it is the cause of forbidden impulses – then the slightest catering to the demands or needs of the flesh can result in a torment which rejects the goodness of the body.
  4. 1. Pelagianism: There was once a British monk named Pelagius, who taught that a man can observe God’s laws by human effort alone, that grace was not needed to do so. If the heresy of Pelagianism works its way into the soul it is an easy step to thinking that any lack of perfection is entirely one’s own fault. One thinks, “this business of salvation is my work, so I’d better be perfect when I …” Thus salvation becomes something one must achieve by personal effort instead of by cooperation with grace.
  5. 1. Jansenism: Jansenism is another heresy in which scrupulosity can grow well. It emphasizes that Christ did not die for all, stresses man’s sinfulness, and requires extreme penances on a regular basis. It leads to infrequent communions and flowers into scrupulosity as a matter of course.
      1. Jansenism flourished within Roman Catholicism primarily in the seventeenth and eighteenth centuries, but was condemned as heresy by Pope Innocent X in 1653. Jansenism was also condemned in 1713 by Pope Clement XI in his famous Bull Unigenitus.
    2. 1. Jansenism focuses on how it was impossible for men and women to obey the Lord’s commandments and to be redeemed without God’s special, divine, irresistible grace. Jansenism taught that Christ died only for the elect -- a real sense of predestination
    3. 1. Fr. Marc Foley agrees: Jansenism identified as the "remote cause: of St. Therese of Lisieux's troubles growing up.
        Biographer Conrad de Meester: "Zelie's mother, who taught her daughters an excessive fear of offending God, used to harp on the phrase 'that's a sin' to curb the least imperfections."
        Zelie had an excessive fear of sin and hell. Zelie was terrified that her five-year-old daughter Helene was in purgatory or perhaps even in hell, because she once told a lie.

Spiritual Means of Recovery
1. Joseph Ciarrocchi “Scruples in the History of Pastoral Care” (chapter four of the Doubting Disease) puts scrupulosity in the context of church history before it was viewed through the modern lens of psychiatric diagnosis.
  1. He describes several principles for the treatment of scruples from the pastoral care tradition.
    1. Act contrary to the scruples.
  2. 1. Follow the example of others without lengthy and burdensome moral reasoning.
  3. 1. Rely on the guidance of one spiritual advisor rather than consulting multiple spiritual authorities.
  4. 1. Put oneself in situations that trigger the obsessional thought.
  5. 1. Avoid religious rituals/prayers, which serve as compulsions.
  7. Ciarrocchi writes that these main pastoral principles “contain the seeds of modern behavioral treatments” that include modeling by others, exposure to the upsetting situation, and blocking the compulsive response.
1. Fr. William Doyle 1873-1917 -- more than 100 years ago.
  1. General Remedies from Fr. William Doyle
    1. Prayer -- pray in temptation
  2. 1. Vigilance
  3. 1. Struggle against depression -- sadness increases scrupulosity
  4. 1. Obedience to an experienced confessor -- perfect, trustful and blind obedience
      1. Obedience of action putting into practice the freedom of conscience
    2. 1. Obedience of understanding -- soul remaining in revolt and persisting in its own erroneous ideas. Vanquishing errors of the intellect.
  5. 1. Generosity in Self-Conquest -- acts of self-denial
  7. Particular remedies from Fr. William Doyle 19th century
    1. Doubts must be ignored
  8. 1. Belief in the easiness of forgiveness
  9. 1. Presuming decisions (of the spiritual director)
  10. 1. Lenient view of one's faults -- magnifying glass
  11. 1. Promptness in acting on decisions
  12. 1. Broad-minded interpretation of advice -- broadening the way.
  13. 1. Not piling up questions
1. Ten Commandments for the Scrupulous -- Fr. Thomas Santa, CSsR (2013)
  1. Without exception, you shall not confess sins you have already confessed.
2. 1. You shall confess only sins that are clear and certain.
3. 1. You shall not repeat your penance or any of the words of your penance after confession—for any reason.
4. 1. You shall not worry about breaking your pre-Communion fast unless you put food and drink in your mouth and swallow as a meal
5. 1. You shall not worry about powerful and vivid thoughts, desires, and imaginings involving sex and religion unless you deliberately generate them for the purpose of offending God
6. 1. You shall not worry about powerful and intense feelings, including sexual feelings or emotional outbursts, unless you deliberately generate them to offend God.
7. 1. You shall obey your confessor when he tells you never to repeat a general confession of sins already confessed to him or another confessor.
8. 1. When you doubt your obligation to do or not do something, you will see your doubt as proof that there is no obligation
9. 1. When you are doubtful, you shall assume that the act of commission or omission you’re in doubt about is not sinful, and you shall proceed without dread of sin
10. 1. You shall put your total trust in Jesus Christ, knowing he loves you as only God can and that he will never allow you to lose your soul
    1. Pastoral approach here. Predestination for heaven, Jesus will make us go to heaven. A lot of scrupulous clients are well enough formed to not believe that.
Secular means of recovery
1. IOCDF: Scrupulosity responds to the same treatments as those used with other forms of OCD. Cognitive behavior therapy featuring a procedure called “exposure and response prevention” is the primary psychological treatment for scrupulosity. A certain kind of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs) is the primary drug treatment for OCD. Treatment for scrupulosity may also include consultation from

leaders of the patient’s faith tradition.

Exposure and Response prevention
1. See the last Episode
1. Difficulties with ERP for scrupulosity.
  1. Joseph Ciarrocchi "Doubting Disease": My opinion, based on the clinical and theoretical aspects of scruples, is that scruples are resistant to change because their religious nature places many of them in the domain of overvalued ideas. In other words, the person sees the stakes are so high in religious doubts (i.e. salvation depends and being correct) that the senselessness of the behavior is less evidence. After all, faith itself implies looking beyond sensory experiences in the surface meaning of reality. Scrupulous people usually know that their peers do not act the way they do. But since religious salvation is such an individual experience, can one really take a chance and ignore that’s “inner voice”? Therefore, the religious aspects of scruples create a motivational drive around the symptoms which become overvalued ideas, and hence resistant to change.
2. 1. Jaimie Eckert Scrupulosity Coach: ERP can feel like it has deep moral and spiritual implications. Although it is a method that is helping you develop a normal spirituality, it can feel terribly frightening. For example, the woman who prays compulsively, repeating her prayers dozens of times until she feels they are done “right,” might be asked to pray only once and then stop, no matter how she feels. This can easily feel like a denial of faith. So scrupulous sufferers begin dropping out of treatment when ERP gets more intense.
3. 1. Kevin Foss, Founder of the California OCD and Anxiety Treatment Center in Fullerton, CA:
    1. People suffering with Religious Scrupulosity struggle with the ERP process because they fear that exposure therapy will result in a genuine sin, convey that they are OK with sin and that they do not respect God or God’s will. Furthermore, Scrupulosity sufferers are generally knowledgeable of their faith’s doctrine and Biblical texts, so they are quick to present chapter and verse explaining why they should avoid exposure and give in to compulsive acts. Despite my reminders of clients' logical arguments, they respond with “But you never know” and “But what if God mistakes my intention in the exposure and I’m now really guilty of sin?”
    2. So, to do anything that could potentially put that into question or undermine it was experienced as possibly damaging the practice of faith, challenging one's fundamental belief in God, or leaving one vulnerable to shifting beliefs and a slippery slope into sin.
Psychodynamic approaches for treating OCD but can be applied to scrupulosity. McWilliams
1. Ordinary kindness -- they know they are exasperating for reasons that are unclear to everybody
  1. Priests get frustrated.
2. 1. Parents get frustrated
1. Do not hurry them, advise them, criticize them.
1. Avoid becoming the equivalent of the controlling, demanding parent -- no power struggles
1. But still relate warmly. A lot of acceptance.
1. Avoid intellectualization
1. Help them express anger.
1. Discover their emotions and help them enjoy them.
Joseph Ciarrocchi. Doubting Disease
1. Treatment program is laid out in his book, Doubting disease. It is essentially exposure and response prevention.
  1. Target the scruples you want to change
    1. Identify your obsessional scruples through self-monitoring. Write them down.
  2. 1. Identify you compulsive scruples -- write them down. Avoidance acts to reduce anxiety
  3. 1. Record the circumstances surrounding the scruples
  4. 1. Making ratings of the intensity of the anxiety triggered by each of the obsessions and compulsions.
  5. 1. Record the amount of time spent worrying about the scruples
  6. 1. Lots of forms and charts, all in the book.
  8. Increase your Motivation to Change
    1. Looking at how motivated you are, and where you are in Prochaska and Di Clemente's stages of motivation to change.
  10. Developing a Personal Motivation Plan
    1. Listing the Benefits of eliminating scruples
  11. 1. Listing the Costs of not changing scruples
  13. Preparing for Change
  14. Setting up the plan for repeated exposure to the feared object or condition.
    1. From the very start of the fear response, the body actually starts a counter-response mean to return the body to normal activity levels.
      1. Habituation. Nervous system gets bored with the danger, returns to normal.
    2. 1. Example of jackhammer breaking up the asphalt on your road.
    4. Exposure must be prolonged
    5. Exposure must generate significant anxiety
    6. Exposure must be repeated
  15. The compulsive response must be blocked. Prevented from happening so it breaks the cycle of some relief from the compulsion. Blocking the physical compulsion or the mental compulsion.
  16. More charts and forms
What I think about scrupulosity. IFS-Informed Approach
1. I'm going to start with the bottom line. I think scrupulosity is generated by a desperate attempt to find safety from a terrible, dangerous and uncaring God for shameful, undeserving, despicable sinner
  1. Scrupulosity is a twisted, frantic attempt to find some kind of safety from an angry, heartless God for me, a reprobate, a delinquent, an evildoer.
2. 1. At the core, scrupulosity starts with really appalling, awful God Images -- and the scrupulous person usually isn't aware of the how terrible his or her God images really are, because they are not allowed into conscious awareness.
3. 1. I discuss God images at length in episode 23-29 of this podcast, a seven episode series, all about God images, so check that out.
1. God Images = My emotional and subjective experiences of God, who I feel God to be in the moment. May or may not correspond to who God really is. What I feel about God in my bones. This is my experiential sense how my feelings and how my heart interpret God.
  1. God images are often outside of our conscious awareness
2. 1. Initially God images are shaped by the relationship that I have with my parents.
3. 1. My God images are heavily influenced by psychological factors
4. 1. Different God images can be activated at different times, depending on my emotional states and what psychological mode I am in at a given time.
5. 1. God images are always formed experientially;
    1. God images flow from our relational experiences and
  2. 1. Also how we construe and make sense of those images when we are very young.
6. 1. My God images can be radically different than my God concept.
    1. God Concept = What I profess about God. It is my more intellectual understanding of God, based on what one has been taught, but also based on what I have explored through reading. I decide to believe in my God concept. Reflected in the Creed, expanded in the Catechism, formal teaching.
1. Now I'm really going to apply IFS to Scrupulosity, grounding it in a Catholic understanding of the human person.
  1. Discussed Robert Fox and Alessio Rizzo's Internal Family Systems approach to OCD in the last episode -- number 86 -- Obsessions, Compulsions, OCD and Internal Family Systems.
  2. Brief review: Definition of Parts: Separate, independently operating personalities within us, each with own unique prominent needs, roles in our lives, emotions, body sensations, guiding beliefs and assumptions, typical thoughts, intentions, desires, attitudes, impulses, interpersonal style, and world view. Each part also has an image of God. You can also think of them as separate modes of operating if that is helpful.
  3. Brief review: Self: The core of the person, the center of the person. This is who we sense ourselves to be in our best moments, and when our self is free, and unblended with any of our parts, it governs our whole being as an active, compassionate leader.
1. Here is the critical idea: Each Part has a God Image -- each part has a way of understanding God based on its limited experience and how it understands that experience
  1. We have as many God images as we have parts.
2. 1. How God images form in parts. Parts have distorted God images for three main reasons:
    1. Parts learn via experience and the ways they interpret experience, especially in their spiritual inferences, can be markedly different than what God has revealed about Himself through the Catholic Church -- for example, a part whose role is to be dissociated from the rest of the system so as not to overwhelm the core self and other parts with its burden of interpersonal trauma may see God as distant, disconnected and uncaring, in a Deistic way;
    2. Parts may be very afraid of, angry at, disappointed with or disinterested in God and therefore refuse to connect with Him, preventing them from having needed corrective relational experiences of a loving God
      1. Part's understandings of God can vary wildly. One part may be angry and rejecting of God, another parts may be terrified of God, a third grieving the loss of God, a fourth distant and cold toward God and a fifth part, in the same person, may not believe that God even exists.
    3. 1. As different parts come up and blend with the self, becoming more prominent in the system, they bring their God images into conscious awareness.
        That explains how our conscious perspectives of God can shift. Whichever part of us has taken over, which ever part of us has blended and is driving our bus, that part's God image is dominating in the moment
3. 1. So, in my view, a scrupulous person's parts are in a life and death battle with each other about God. It's more than physical life or death. It's about spiritual life or death, eternal life or death, the stakes couldn't be higher. The scrupulous person's managers believe that if they don't suppress parts with negative God images, the consequence could be to be damned to hell for all eternity.
    1. Manager parts are trying to appease God -- seek his approval, make things all right, strive to meet his demands, to be perfect
      1. Fr. Thomas La Santa: I will make God love me by becoming perfect. In this way God will have to love me. An enormous amount of energy is wasted by the scrupulous person trying to "fix" himself or herself or trying to become perfect.
    2. 1. Fr. Marc Foley: The command "Be ye perfect..." does not enjoin us to strive for a flawless performance in the various tasks of life, but to do them as God wills us. We feel driven to do an A+ job on projects in which we have overinvested our egos. But doing God's will often demands the courage to do a C+ job because God bids us to spend our time and energy on other tasks.
    3. 1. In order to do that, the manager parts have to suppress or exile the parts that have "offensive" God images or who may otherwise seem inappropriate or unacceptable to God.
        Those that are angry at God
        Those that are disappointed in God
        Those who are disgusted with God.
        Those that are indifferent toward God.
        Those that don't believe God exists.
        All those ways of construing God makes sense if you understand the part's experience and how it construes its experience. They are not accurate, they don't correspond to how God really is, but the part doesn't know that.
        Those that generate impulses to get God's attention via acting out in negative ways.
        Manager parts reject any part that experiences God in any negative way.
        Parts seeing other parts as evil, harmful, and terrifying.
        Demons
        Lepers
        Tax collectors
        Prostitutes
        Dangerous sinners -- banishing them.
    4. 1. Manager Parts can speak for God -- they assume they know what God wants. Not in relationship with him, though. Really following a code or a list of rules or expectations. It's not about relationship, really.
4. 1. First two conditions for secure attachment -- 1) felt safety and protection; 2) feeling seen known, heard and understood. Drawing from Daniel P. Brown and David S. Elliott 2016 book Attachment Disturbances in Adults: Treatment for Comprehensive Repair.
    1. Felt safety and protection
      1. In Scrupulosity, there is no felt sense of safety and protection for so many parts, because of their God images and their fears about the God images of other parts being expressed. .
        The first primary condition of secure attachment is not met.
        The most basic relational need is not met -- no felt safety, no felt protection.
        The first primary condition for secure attachment is felt safety and security. It has be felt. And not just by other parts, but by the target part.
        We all have heretical God images.
        Pastor Jonathan Edwards: The wrath of God is like great waters that are dammed for the present; they increase more and more, and rise higher and higher, till an outlet is given; and the longer the stream is stopped, the more rapid and mighty is its course, when once it is let loose. It is true, that judgment against your evil works has not been executed hitherto; the floods of God's vengeance have been withheld; but your guilt in the meantime is constantly increasing, and you are every day treasuring up more wrath; the waters are constantly rising, and waxing more and more mighty; and there is nothing but the mere pleasure of God, that holds the waters back, that are unwilling to be stopped, and press hard to go forward. If God should only withdraw his hand from the flood-gate, it would immediately fly open, and the fiery floods of the fierceness and wrath of God, would rush forth with inconceivable fury, and would come upon you with omnipotent power; and if your strength were ten thousand times greater than it is, yea, ten thousand times greater than the strength of the stoutest, sturdiest devil in hell, it would be nothing to withstand or endure it.
        How are you going to feel safe with a God like that?

Feeling Seen, Known, Heard, Understood
1. because there is no feeling of safety and protection for some parts, they don't want to be seen, heard, known and understood by God. They don't want to be near God, they don't trust him
  1. And that makes sense, given how they see God.
1. Some parts may want to be seen heard known and understood by God, even if they don't feel safe -- they are desperate for attention, any kind of attention from God, even negative attention, so they signal distress by intense impulses toward acting out, especially in ways designed to get God's attention -- blasphemy, for example. Just like a neglected little kid, desperate for some kind of attention from his father may act out.
Scrupulosity is the son of anger and the grandson of shame. Core issues of shame that are suppressed and generate anger. Anger is suppressed and generates fear and scruples.
1. Shame -- the root of so much psychological and emotional distress -- whole 13-epsiode series on shame, from episode 37 to 49.
  1. All goes back to identity. Who am I and Who is God.
2. Scrupulous individuals have a very hard time allowing their anger with God to emerge into conscious awareness and with anger in general. Dangerous emotion
3. But look at the unreasonably demanding and exacting God images their manager parts have -- Their God images are unjust.
4. Who would want to be with a God like that? No part has a really positive God image
  1. Not wanting hell
5. 1. But not really wanting heaven either -- to be face to face with a God like that for all eternity?
6. 1. So God has no opportunity to show the scrupulous person, in relationship, who He really is. Self-perpetuating. I wrote a blog on this on the Souls and Hearts website last week, on Inner Pre-Evangelization: A Focus on Internal Trust.
My Approach
1. Lead from Self --The core of the person, the center of the person. This is who we sense ourselves to be in our best moments, and when our self is free, and unblended with any of our parts, it governs our whole being as an active, compassionate leader.
  1. We want to be recollected, we want the self governing all of our parts
  2. Like the conductor -- leading the musicians in an orchestra
  3. Like the captain -- leading and governing all the sailors on a ship.
  4. When we are recollected, in self, 8 C's
    1. Calm
  5. 1. Curiosity
  6. 1. Compassion
  7. 1. Confidence
  8. 1. Courage
  9. 1. Clarity
  10. 1. Connectedness
  11. 1. Creativity
  12. 1. Kindness
1. Self as the secure internal attachment figure for the parts. Parts coming to trust the self -- Blog on
1. Working collaboratively with the parts -- contracting with them to not overwhelm
  1. Really accepting the parts right now, where they at.
2. 1. Trusting that God is good enough to understand and tolerate our parts' feelings.
1. Scrupulosity as a gift, a signal. Look for the disorder underneath it.
1. Not a question of willpower.
1. Diabolical aspects
  1. Leaving people to their own devices
2. 1. Discouragement, inward focus, despising self,
1. Spiritual Approach
  1. Not about overcoming scrupulosity
2. 1. Blessed are the merciful for mercy shall be theirs
3. 1. Childlike Simplicity and trust lessens our burdens. Parvulos. Little Children. Dust and ashes.
4. 1. Example of a parent -- would you prefer your child to be working on self-perfection
5. 1. Perfectionism draws us to be big, perfect, competent, having it all together.
6. 1. Jacques Phillipe:
    1. The Way of Trust and Love -- particularly helpful for those struggling with scrupulosity.
      1. p. 7 : The heart of Christian life is to receive and welcome God's tenderness and goodness, the revelation of his merciful love and to let oneself be transformed interiorly by that love.
      2. “We would like to be experienced, irreproachable, never making mistakes, never fall, possess unfeeling good judgment and unimpeachable virtues. Which is to say, we would like to have no more need of forgiveness or mercy, no more need of God and his help. 41
      3. If we accept ourselves as we are, we also accept God’s love for us. But if we reject ourselves, if we despise ourselves, we shut ourselves off from the love God has for us, we deny that love. 48-49
      4. We need to practice gentleness toward ourselves so as not to get discouraged and condemn ourselves when faced with their weakness while also nurturing a great desire for holiness. But not a desire for extraordinary perfection. Holiness is different; it is a real desire to love God and our neighbor, and, issuing a kind of halfway love, go to loves extremes. 52
      5. …we shouldn’t fall into a kind of stubborn “therapeutic obstinacy,” with the aim of ridding ourselves absolutely of all imperfections or healing every wound. In doing that, we risk becoming impatient and concentrating our efforts on something God isn’t specifically asking of us or, ultimately, paying more attention to ourselves than to him. 56-57
      6. The more we accept ourselves as we are and are reconciled to our own weakness, the more we can accept other people and love them as they are. 49
      7. What this podcast is all about.
      8. Contrast that with Pastor Jonathan Edwards -- sinners in the hand of an angry God: The bow of God's wrath is bent, and the arrow made ready on the string, and justice bends the arrow at your heart, and strains the bow, and it is nothing but the mere pleasure of God, and that of an angry God, without any promise or obligation at all, that keeps the arrow one moment from being made drunk with your blood.
Remember, you as a listener can call me on my cell any Tuesday or Thursday from 4:30 PM to 5:30 PM. I've set that time aside for you. 317.567.9594. (repeat) or email me at crisis@soulsandhearts.com.
The Resilient Catholics Community at Soulsandhearts.com/rcc. So much information there and videos.
1. I want to invite you to the Resilient Catholics Community
2. The Why of the RCC -- It's all about loving with your whole heart -- all of your being. Getting over all the natural level issues that hold you back from tolerating being loved and from loving God and others.
3. Who
  1. Who is the Resilient Catholics Community for?
    1. It's for you. If you really are into this podcast, if these ways of conceptualizing the human person and integration and human formation and resilience are appealing to you, then the Resilient Catholics community, the RCC may be for you.
  2. 1. I am looking for listeners who want to be with other like-minded Catholics on the journey, on this adventure of human formation with me.
  3. 1. Who deeply desire a personal, intimate relationship with God and with Mary, a real human, close connection
  4. 1. And who recognize they have some natural-level impediments to that deep relating
  5. 1. and who are willing to make sacrifices in time, effort, money, humility and courage to grow in human formation and overcome natural-level impediments to being loved and to loving
  6. 1. What want to shore up their natural foundation for the spiritual life, because grace perfects nature.
  7. 1. Who want to become saints.
  8. 1. Who are willing to be pioneers at the cutting edge in this adventure of human formation. Really at the tip of the spear, the first explorers of this human formation ground for laymen and laywomen.
4. 1. First of all the RCC is My Tribe, my people, bringing together two groups into one
    1. First, faithful, orthodox, serious Catholics who are wounded and suffering and know it
  2. 1. And Second, who are psychologically minded (or at least want to be psychologically minded), who believe in the unconscious and who embrace the unity and multiplicity of the human person
  3. 1. And who want to see through the lens of a core self and parts. Unity and multiplicity make sense.
6. What of the RCC
  1. $99 nonrefundable registration fee gets you the The Initial Measures Kit -- which generates the Individual Results Sheet and the Personalized Human Formation Plan 5 pages of results about your parts -- we've done about 70 of these now, and our members are amazed at the results, how accurately we are in helping them identify their parts and how their parts relate to each other, and the why behind their parts' desires and impulses.
7. 1. Weekly premium Inner Connections podcast, just for RCC community members --Lots of experiential exercises.
8. 1. A complete course for working on your human formation 44 weekly sessions over the course of a year for $99 per month subscription
9. 1. Daily check ins with your companion -- accountability and structure
10. 1. Weekly company meetings with 7 or 8 other members in your small group.
11. 1. Office hours with me
12. 1. Conversation hours with me
13. 1. All this for $99 per month. And we make it financially possible for anyone who is a good fit for the RCC to join through write-offs and scholarships. The fees are not the tail that wags the dog.
14. 1. And there also is opportunities for some parts-based individual coaching as well.
15. 1. Essentially, the What of the RCC is a pilgrimage together.
17. The When of the RCC
  1. We open twice per year to new members in December and June, open until December 31.. We are open now. Soulsandhearts.com/rcc to register.
18. 1. Call me with questions! 317.567.9594. (repeat) or email me at crisis@soulsandhearts.com.
19. 1. So sign up Soulsandhearts.com/rcc.

87 Scrupulosity: When OCD Gets Religion

87 Scrupulosity: When OCD Gets Religion87 Scrupulosity: When OCD Gets Religion

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