Caring for the Scrupulous

Pope Francis has spoken almost effortlessly on many different occasions about the priest as a “minister of mercy.” More often than not, he makes this reference when he is speaking about the Sacrament of Reconciliation and the role of the priest. On other occasions, he also references this powerful description of the ministerial priesthood as the primary concern and focus of those who are called to serve in this vocation. By calling a Jubilee Year of Mercy, which concluded last November, Pope Francis prioritized the Church’s role in extending mercy to the world. And while the jubilee year has ended, Pope Francis continues to emphasize priests’ role in being merciful fathers to their flocks.

My experience informs me that my brother priests appreciate the pope’s perspective. I believe that we strive — in and out of the confessional — to pastorally apply the experience of mercy, understanding and reconciliation whenever possible. At the same time, I know that the People of God appreciate this particular emphasis and effort because they experience this reminder of God’s love and concern for his people as both life-giving and grace-filled. Priest and people both desire to powerfully connect and to experience the profound mercy of God as often as possible in their daily lives. They desire both to be strengthened and encouraged by the outpouring of God’s abundant grace.

Despite our ministerial efforts, and despite the pronounced desire for the People of God to experience the mercy of God, there is one group of men and women for whom the experience of knowing and feeling the mercy of God seems so very distant. These are the men and women who suffer from scrupulosity, who truly are unable to believe that they are loved and accepted by God. No word ever seems to calm their aching spirits. The assurances we offer as ministers of God’s grace seem to have no effect. The inability to accept and to believe in the saving mercy of God is not the result of stubbornness or hardness of heart; rather, it is the particular manifestation of a disorder that floods the mind and the heart with “a thousand frightening fantasies” as one author so powerfully identified the disorder and the experience.

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Parishioners wait in line for confession at St. Stanislaus Kostka Parish in Chicago. The confessional is where we as priests oftentimes meet the scrupulous. Catholic New World/ Karen Callaway

Tormented by Sin

It is within the confessional during the celebration of the Sacrament of Reconciliation where we routinely encounter the scrupulous person. More often than not the manifestation of scrupulosity is experienced by both priest and penitent through a disconnected and pain-filled voice that fills the darkness of the confessional — a recitation of perceived sin, punctuated often with an expression of both doubt and endless questioning. I deliberately choose to describe the experience as disconnected because the priest struggles to connect with the penitent and with the pain-filled experience that is being shared in the darkness.

At the same time, the scrupulous penitent is disconnected and disengaged in a very real sense because they are performing a complex ritual, the last expression of a sustained struggle that is marked with anxiety, guilt and a profound sense of loneliness. The often expressionless confession of a litany of sins, most of which are either perceived sins or supposed sins rooted in the fear of sin, is the final step in the ritual. Unfortunately, as soon as the confession is concluded and the ritual completed, a new ritual will be engaged that needs to be played out. There is no finality in the confession, no assurance of mercy, no experience of inner calm and peace let alone any conviction of reconciliation or God’s mercy.

The scrupulous person who is performing the ritual of confession and questioning is trapped and suffering. They have entered the confessional with what they understand is the unrealized expectation that perhaps they will experience, through the recitation of perceived sin and doubt, some form of relief from the torment of the disorder. It is all the more painful because they also understand that this almost mechanical recitation of sin and perceived sin is a useless attempt to calm the anxiety that rages within. The disconnect is expressive of their heartfelt desire not to be in this situation and caught up in the ritual that is being performed. In a very real sense, both priest and penitent are witnesses to the expressive power of an experience in which both would prefer not to engage.

Recognizing the Problem

The experienced pastor and priest will recognize this encounter since it is played out often in the ministry of the Sacrament of Reconciliation. At the same time, the experienced priest will recognize that this is descriptive of one type of scrupulous penitent only. His pastoral sense and experience is correct. What I am describing in this scenario is a person who is suffering from a powerful disorder, understood as scrupulosity but perhaps better understood as a manifestation of obsessive-compulsive disorder (OCD). This is not the traditional understanding of scrupulosity that was routinely handled in the seminary class that is devoted to preparing a priest for the ministry of reconciliation.

The classical understanding of scrupulosity that is outlined in the moral texts is perhaps better understood as a “tender conscience.” This form of scrupulosity is best pastorally remedied through patience, the insistence of maintaining the discipline of a single confessor who can aid the penitent through the navigation of understanding their sin. This pastoral care is rooted in an awareness and understanding that this manifestation of scrupulosity, although painful, is not permanent. Good catechetical training will eventually win out, and the anxiety and the doubt will be significantly reduced, enabling the penitent to enjoy a practiced and helpful discipline of the Sacrament of Reconciliation. This most assuredly is not the experience of scrupulosity that is a manifestation of OCD.

It is essential and very helpful for the application of good pastoral care for the priest both to recognize and to understand that there is a difference between a tender conscience and a person who is suffering with scrupulosity as a particular manifestation of OCD. It is essential that the priest understand that OCD is a behavioral disorder as well as an emotional disorder that has many specific manifestations, one of which can be religious scrupulosity. The pastoral response of the priest is dependent on his personal recognition of what the penitent is expressing and what he actually is hearing in the disconnected voice behind the screen and in the darkness.

If what the priest is hearing is not the expression of a tender conscience but rather a penitent who is suffering from OCD, a focused response that is helpful is possible. The priest does not need to be a professional therapist or, for that matter, even well-schooled in personality disorders. He just needs to be aware of what he is experiencing and then be willing to take the next steps and offer to the penitent pastoral care that is effective and useful.

It is helpful to understand that there essentially is no difference in the psychological and emotional roots of the OCD disorder from one person to the next. The only measurable difference is found in the particular manifestation of the particular doubts and questioning that are experienced. For a person with scrupulosity, it is sin — most often a particular form of sin that is the focus of their questioning and doubt. For still another person with OCD, it might be germs that lead to endless hand washing; it might be a fear of not maintaining basic responsibility in routine household tasks such as locking the door of the house or turning off the oven. The list is endless. It also should be noted that the men and women who suffer OCD often experience a variety of manifestations of the disorder, although one concern does tend to dominate, as is often the case of a person whose central manifestation of OCD is with scrupulosity.

Working Toward a Solution

When the priest encounters a person who is struggling with OCD, his patience will be tried, as will the patience of the penitent. Both priest and penitent will become even more exasperated if the incorrect pastoral remedy is replied. It is in the application of the most helpful pastoral response in which many priests need some improvement in order to focus their pastoral skills.

Central to the understanding of the appropriate pastoral remedy is empathy and not catechetics. It is not possible to explain away OCD even with the most brilliant dissertation. If OCD could be managed with a catechetical application or with accumulated information, the penitent long ago would have reached a point of healing. Through their persistent questioning, which is part of the experience of OCD, they would have arrived at the sought-after answer that would soothe the anxiety and take away the experience of doubt. However, that is not possible with the disorder. More information produces more questioning, and it fuels the manifestation of the disorder.

Signs of Scrupulosity
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In an article at IntegratedCatholicLife.org, Rhonda Ortiz, author of the newsletter Scripture for the Scrupulous, identifies six signs of somebody dealing with scrupulosity. A scrupulous person ...

I understand that the best pastoral practice that can be engaged by the priest is to inform the penitent that you feel and understand their pain and suffering. It often is difficult for the penitent to hear the confessor share this insight, but eventually, perhaps after months and months of confessions, the penitent might respond to the offer of spiritual guidance and support and ask for help and direction. When the penitent asks for help, the priest then can respond with a focused and well-practiced pastoral care that is effective.

The application of good pastoral care in this situation will require additional time and commitment from both the priest and the penitent. However, the time required will be time well spent, because it will produce a helpful pastoral result.

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Keeping penances short and clear is one way priests can help ease the burden for those suffering from scrupulosity. Karen Callaway

Beginning a Conversation

In conversation — and within the context of a focused period of spiritual direction, preferably outside of the confessional and within an agreed upon appointment expressly for the purpose of the needed counseling — the priest should share with the penitent who is suffering with scrupulosity that he is one resource for helping the person learn to manage their scrupulosity. At the same time, it is helpful for the priest also to suggest to the penitent that good psychological care and therapy is very useful in learning how to manage the disorder. This is essential, because many people with scrupulosity mistrust psychologists and, in particular, the application of behavioral modification applications and, occasionally, even prescription therapy that is ultimately very effective. The core message of this conversation is for the penitent to understand that the priest will work with them in seeking good psychological health and well-being. Expect at this point sustained push-back and resistance from the penitent.

There normally will be some sort of resistance to the suggestion of a psychological intervention, even if the person understands that this is the best chance for learning the skills that are necessary for managing the disorder. More often than not the penitent will express their reluctance by claiming that if they engage in psychological care, they will somehow “lose their religion.” In this expression, there often is a deeply held perception that, in some manner, their scrupulosity is understood as their personal “cross,” and by learning to manage the disorder, they somehow are displeasing the Lord. The priest can be very helpful in guiding the discernment of the penitent to choose a healthier way of living and to understand and accept that this choice for health also is a choice to accept God’s will in their life.

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Father Kevin Huber, vocations director for the Diocese of Gary, Ind., proclaims absolution while administering the Sacrament of Reconciliation at St. Casimir Parish in Hammond, Ind., where he is in residence. Karen Callaway

Steps Toward Healing

Entering into a relationship with a scrupulous person and being a resource for them in learning how to accept and to manage their disorder is the only reason for a priest to agree to this commitment of time and energy. If the scrupulous penitent is unwilling to engage in the professional help that is required, and intends only to use the time for spiritual direction as an opportunity not to manage their disorder but rather to engage the disorder through even more questioning of pastoral advice by the priest, is not to agree to enter into the conversation. It becomes counterproductive and not at all helpful for either priest or penitent. This is a painful decision to make, but it is the most loving decision that can be experienced by both the priest and the person who suffers with the OCD disorder.

If the priest and the scrupulous person have managed to arrive at a point where they are in sync with each other and are working together toward the effective management of the disorder, a sacramental option then can be applied. The most effective sacrament for the celebration of the Lord’s healing and reconciliation for a person with OCD-manifested scrupulosity is not the Sacrament of Reconciliation. Rather, the good and sustained pastoral care of a person who suffers with scrupulosity is the regular reception of the anointing of the sick. This sacrament enables a strong spiritual connection between Jesus, who is encountered in the sacrament, and the person who is suffering from an illness, a disorder that is in need of healing. It also removes the occasion of the confession of perceived sin and guilt and the doubt and anxiety that is experienced by the person who suffers from the disorder. In a very real sense, this spiritual practice, under the direction of a skilled spiritual director in the person of the priest, further enables the experience of healing and wholeness, in a sense reconnecting the person with the healthier part of themselves and their experience of the Church in the practice of the sacramental life of the Church. The Sacrament of Reconciliation still may be celebrated but only when both priest and penitent agree that there is actual sin that needs to be confessed, and not the fear of sin or the perceived guilt of sin that is the result of the ravages of the disorder.

If for a variety of reasons this type of pastoral care cannot be applied, there still are some practical ways a priest can help.

The first pastoral skill that can be implemented is for the priest confessor to understand that the confession of a scrupulous person is often highly structured and ritualistic. It may sound to the inexperienced ear to be an invitation for counseling or spiritual direction, but it is not. Frankly, when a scrupulous person is performing the ritual of confession, what they desire only is the completion of the ritual and nothing more. The most loving response of the confessor is to hear the ritualized litany and, without comment, to offer the needed absolution. Second, the priest confessor should understand that the appropriate penance should easily be understood and simple to perform, effectively eliminating any possibility for doubt or confusion. I would suggest something like this: “Pray one Our Father, even if it is distracted and imperfect; all that is required is that you try and pray this prayer, nothing more.” Avoid any penance that cannot be measured easily such as “tell someone that you love them or spend a few minutes in silent prayer.” The scrupulous penitent will be most grateful for your brevity and your clarity.

On one occasion in his apostolic exhortation, Pope Francis reminded his readers that the confessional is not intended to be a “torture chamber” (Evangelii Gaudium, No. 44). If a priest is aware of the ravages of OCD and is willing to apply good pastoral advice and direction, the pain and suffering of the scrupulous penitent will be substantially reduced. Instead of a chamber of torture, the confessional rather will be an experience of the outpouring of God’s grace and mercy.

FATHER THOMAS M. SANTA, CSSR, is director of the evangelization initiative for the Denver province of Redemptorists.

'Understanding Scrupulosity'
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Want to read more on this topic from Father Thomas M. Santa? Liguori Publications earlier this year released a third edition of Father Santa’s book “Understanding Scrupulosity: Questions and Encouragement” ($31.99, or $11.99 for the e-book). For more information, or to order, visit Liguori.org. Here is an excerpt from the introduction:

'Ten Commandments for the Scrupulous'
Since 1964, the Redemptorist order has sponsored Scrupulous Anonymous, a support group for people who suffer from scrupulosity. This article was published as part of the organization’s monthly newsletter. For more information, including online articles and how to subscribe, visit ScrupulousAnonymous.org.