Borderline States—Between Body and Soul

Dmitry Avdeev (†2022) on depression, neuroses, and other nervous disorders

 

 

I don’t wish you wealth, fame, success, or even good health, but only peace in your soul. That’s the most important thing. If you have peace, you will be happy.

- St. Alexiy of St. Zosima Hermitage

 

We increasingly talk and hear about chronic fatigue, neuroses, depression, and other diseases that arise “due to nerves.” And doctors, based on numerous studies, state that a huge number of physical illnesses develop precisely as a result of prolonged nervous strain. Moreover, about half of the diseases currently studied by psychiatry are borderline conditions (those that arise due to nerves).

A discussion with the well‑known Moscow psychiatrist, Candidate of Medical Sciences D. A. Avdeev, about these disorders, ways to overcome them, and the Christian approach to them was recorded some years ago for a spiritual educational program on Belarusian television, however only fragments of it were aired.

In 2022, Dmitry Alexandrovich passed away prematurely from cancer. He was a professional who believed in God and sought to foster a Christian attitude towards mental illnesses, which led him to develop a model of Orthodox psychotherapy. This article contains a more complete version of his video interview.

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May it be unto you according to your faith…

Modern man’s life is full of stress and emotional overload. And it’s no wonder—the abundance of events and information, like a powerful tsunami, overwhelms our thoughts and feelings every day. There’s practically no time to stop and catch our breath. We’re always in a hurry…

It’s also getting colder, and it’s raining. Autumn is a time when emotional crises and chronic illnesses become more pronounced, and overall well‑being and mood deteriorate.

But is it only the pace of our lives and climatic conditions that are to blame for the fact that the number of diseases arising “due to nerves” is rapidly increasing, and borderline conditions are increasingly developing into mental illnesses? Here is what is written on this matter in the “Foundations of the Social Concept of the Russian Orthodox Church”:

The Church views mental illnesses as one of the manifestations of the general sinful corruption of human nature.

From the history of medicine, it is known that from the moment of the baptism of Rus’, medicine in Rus’ was under the direct patronage of the Orthodox Church. Holy Prince Vladimir declared in his Charter that doctors are church people, subordinate to the bishop. And monasteries provided care not only for the poor but also for the sick, which also included those “deprived of reason.” The process of separating psychiatry from the Church began only at the end of the 18th century, when psychiatrists decided to become more “objective” and rely solely on data from clinical and laboratory observations.

After October 1917, [1] a person was reduced to pure physiology—mere flesh, without any hint of the existence of a soul. Psychiatry began to view a person’s personality from the same perspective. However, the term “psyche” means “soul” in Greek.

Currently, spirituality is once again being discussed in psychiatry. Clinics are opening house churches, providing spiritual care for patients, and holding scientific and theological conferences with the participation of clergy and psychiatrists.

“By nature” or from sin?

—As a psychiatrist and a believer, how would you assess the causes of neurosis, depression, and other nervous disorders? Is it stress, the hectic pace of our lives, or something else?

—One might ask oneself: was life really simpler in the time of Ivan the Terrible? Or in any other era, for example, in the Napoleonic era? Of course not. But it would be disingenuous if I said that we are not affected by speed, by the pace of life. There are even such concepts as “exhaustion depression,” “informational neuroses,” but these are just the backdrop, the environment. Archpriest Dimitry Smirnov made the remarkable comparison of modern man’s spiritual state to a jug that’s been shattered. Unfortunately, it’s been reduced to a pile of shards.

Psychiatry, psychotherapy, and psychology do not talk about sin. But the main thing to pay attention to is a person’s spiritual state, which cannot be good without spiritual peace, without a clear conscience, without the person striving to overcome pride, vanity, and other sinful passions.

—So, are borderline states sinful states? Or are mental disorders a type of illness? How should we treat them, and how should they be cured?

—I’ve been studying borderline states for about twenty years now, and I see that these are diseases, but they are often sinful diseases. When sin occurs in the depths of the human spirit, it disorganizes the will and emotions. And I’ve long noticed in my practice that neuroses and many forms of depression (in particular, neurotic depression) have spiritual roots. And from those roots, certain physical manifestations arise. After all, a person is a combination of the spiritual, the mental, and the physical. This is how it all descends in a hierarchy, step by step: spirit, soul, and body.

I can give you one telling example. Once, a patient came to me complaining of a neurotic disorder. During the conversation, he said: “Doctor, if you only knew how much I’m tormented by envy! It’s eating me up from the inside! After all, I envy everyone—those who have a better apartment, a more successful job, higher earnings. And it weighs so heavily on me! I’m just burning up inside.”

So, should we give such a patient a sedative tablet three times a day? And put a checkmark, as if the problem were solved? That would be completely wrong. Nothing will happen without understanding that he is in the grip of sinful passions, without repentance, without work on himself.

It is necessary to identify the three main causes in the development of mental illnesses. Mental illnesses may be a consequence of some organic disorders in the body, i.e., they are diseases “of nature,” which are either hereditary in nature or associated with individual biological factors. These include schizophrenia, manic‑depressive psychosis, epileptic psychosis, and senile psychosis.

The term “from nature” was introduced by John Climacus. We read in his works that he observed that in some monastics, certain states of spiritual turmoil did not pass after prayer, the sign of the cross, or after the performance of church sacraments. We have a remarkable example in the life of Venerable Theodosius of the Kiev Caves, who spent three years caring for a monk who suffered from what would now be called catatonia.

A few examples. A typical symptom of schizophrenia is delusion (delusion is a false conclusion). It is impossible to try to rationally convince a person suffering from delusions. Depressive psychosis. It is associated with changes in the brain tissue’s neurotransmitters. The mother says to such a patient: “Well, pull yourself together.” And she starts to feel offended, angry, and guilty—but what the patient needs is medical help. There is a change in the emotional state in the case of epilepsy, when the patient exhibits aggressive behavior, requires medical assistance and active treatment of the disease.

The second group—a vast group of mental disorders—are illnesses resulting from passions that have enslaved the soul.

The third group consists of illnesses caused by demonic assault, brought about by demonic influence.

Here, it’s important not to get things mixed up. I’ve come across situations more than once where, say, a patient is experiencing the onset of schizophrenia, the debut of a psychotic process; and their relatives are church‑going believers. And so they decide that they shouldn’t go to a doctor but should instead go for an exorcism. Of course, prayer is needed, as is church commemoration and the blessing of a spiritual advisor. But this is a mistake, and there’s a danger lurking here. It’s important to understand that mental disorders are, after all, a separate group of diseases.

And at the same time, these illnesses may be a cross laid upon us by the Lord. Sometimes I witness very remarkable examples: a person seems to have a severe mental illness—but how they grow spiritually against that backdrop! I remember one of my patients. He is a moderately disabled person due to a mental illness, and as a doctor I tried to console and reassure him. But he looked at me and said: “Doctor, don’t. The situation I’m in is the most salvific for me.” And, of course, the Christian path is not closed to such a person, and the Kingdom of Heaven is not closed to them. No, this is our brother in Christ who needs help, prayer, compassion, and support.

Depression doesn’t always mean despondency.

—Dmitry Alexandrovich, let's take a closer look at depression. What are its characteristics, and how does it arise?

—In some cases, depression is a painful disorder. And this is due to the fact that in the brain structures, neurotransmitters such as serotonin, dopamine, and norepinephrine are reduced to almost zero, and the person experiences a pessimistic, depressed mood. They are inactive. Relatives and acquaintances try to somehow stimulate them: They tell them to get a job, to pray more. But they can’t do it because they are sick. At the first stage, medical assistance is needed—psychiatric and psychotherapeutic—and as recovery progresses, psychological and spiritual support will become more prominent.

And then there are depressions (and there are significantly more of them, in fact the vast majority) as a consequence of the passions of despondency and sorrow that have enslaved the soul. This point is very significant. It is necessary to distinguish—and this applies to the clergy as well—between sin and illness.

In general, depression has become one of the leading health issues; there are about 500 million people worldwide suffering from depressive disorders. The use of psychotropic medications and antidepressants has gotten out of control for medical professionals and cannot be accounted for in any way. Moreover, depression is becoming younger; today we are talking about childhood depression.

—Sometimes, depressive states or a nervous breakdown can lead a person to think about suicide. What would you advise someone who might be on the verge of suicide?

—This is very serious… But I would advise you to cross yourself with faith and say: “Lord, Jesus Christ, Son of God, have mercy on me, a sinner!” Then go to church and, without holding anything back, sincerely tell the priest all your worries and concerns during confession. If you need first aid, that’s exactly where to find it.

Speaking about the problem of suicide in general, it is known that only ten percent of those who commit suicide are mentally ill people. Ninety percent are mentally healthy but spiritually deeply damaged people. And do you know how many of them there are? Thirty-nine to forty per every 100,000 people! That is tens of thousands — a city of suicides every year! We are talking about successful suicides. But there are also attempted suicides, and they are much more numerous.

There are many mental illnesses toward which we need to form a Christian, Orthodox attitude.

Neurosis = conflict

—What are the characteristics of neuroses?

—Neurosis has many spiritual roots. Probably, to put it very briefly, neurosis is a clash between what is desired and reality. And the more powerful the clash, the stronger the manifestation of neurosis. It is always an internal conflict. Sometimes I give an example like this: I clench two fists, press them together, and ask the patient which hand should I break—the right one or the left one? Both are equally painful! There is no way out of this dead‑end situation.

In these cases, humility, inner peace and kindness are needed. Can one imagine such a state of affliction in St. Seraphim of Sarov, who greeted everyone with the words: “My joy, Christ is risen!”? An Orthodox Christian may be ill, may be poor, or homeless—it is all the will of God. But with the right spiritual disposition, in the soul of an Orthodox Christian “roses bloom and nightingales sing.” This is an indisputable truth. Remember the Savior’s words: “My peace I give to you!”

One can suffer from neurosis for a long time until a person understands the true causes of neurotic disorders, until he realizes that it is his perception, value system, attitudes, and some incorrect behavioral stereotypes that are to blame for the illness. A daughter hasn’t spoken to her mother for ten years because of some principles, and she experiences terrible inner tension, has a headache, and her conscience is troubled… But what’s the solution? To go up to her mother, hug her, kiss her, and ask for forgiveness—and everything will fall into place. And people stubbornly refuse to relent, ending up with illnesses or heart attacks. After all, today it is known that eighty percent of all diseases arise from stress.

I remember how one woman wrote to me in a letter: “Here I am, sick, and I don’t understand at all what clash of the desired and the real you’re talking about in the case of neuroses.” I replied: “My dear (I think her name was Liudmila), God has allowed you to be sick right now, and you’re so burdened by it that you want to be healthy at any cost… Humility! Humility is the main remedy.” Walking the Christian path to Christ—that is the main remedy for neuroses.

“You can’t make a silk purse from a sow’s ear.”

—And what if a person is lost? Maybe they didn’t have faith, or they’ve just started coming to church. They’ve backed themselves into a corner—and they’re in a deep, years‑long depression or suffering from a neurosis. Can they pull themselves out on their own? Or do they still need outside help?

—This is, in fact, what my colleagues and I have been doing for many years. Of course, the Lord guides all of us. And He will not abandon this person, provided that person prays, sincerely believes, and turns to the sacraments of the Church. Look, the “Foundations of the Social Concept of the Russian Orthodox Church” beautifully states that an Orthodox psychotherapist or psychologist is the co‑worker of a clergyman. A meeting with him often precedes a meeting with a priest. And often people come to me who are not yet ready to go to confession, but they already have spiritual questions. They come to me with these questions during their appointments, and we try to resolve them. Of course, this makes life easier for such a person, because an Orthodox psychologist or someone who has been attending church for a long time and has read the Holy Fathers can give good, beneficial advice.

—Some psychotherapists claim that if a child develops mental disorders or complexes as a result of improper upbringing, they are practically incurable as the child grows older. What’s your comment as a doctor and a person of faith?

—Perhaps I should start by answering your question from a different angle. The thief who spent his whole life stealing and killing, when he found himself on the cross to the right of the Savior in the last three hours of his life, repented, changed his ways, and was the first to enter paradise. Therefore, in my opinion, claims that drug addiction, alcoholism, certain neurotic disorders, and childhood experiences are incurable do not correspond to reality. In my view, such psychotherapists have mercenary motives and want to keep the patient tied to them.

Take, for example, psychoanalysis. When I talked to French psychoanalysts and asked them: “Well, how effective is it?”—I saw bewilderment and a smile in their eyes; what effectiveness? The client attends psychoanalysis sessions for three, five, or seven years. And a psychoanalytic procedure costs quite a lot of money, lasts about an hour, and takes place twice or three times a week. It turns into a lifestyle.

Of course, there’s the issue of the starting point—“You can’t make a silk purse from a sow’s ear,” as they sometimes say. If a child has pious parents and is familiar with the sacraments of the Church, then in general such a child has more opportunities—that is, he has certain initial advantages in life. And yet, as long as a person is alive, as long as a person is breathing, the Lord gives him a chance to change, for transformation and revival.

Orthodoxy is not something you can just pick up on the fly.

—The fear of God versus fear as a phobia: What is the difference?

—The fear of God brings peace and tranquility to the heart. Fear as a phobia is demonic fear. Who is the most neurotic? The devil. And the fear instilled by him gives rise to precisely this state in the heart.

In my books, I compare and contrast repentant lamentation over sins and neurotic self‑criticism. Repentant lamentation over sins gives rise to peace, tranquility, and joy in the heart. But neurotic self‑criticism is like grinding water in a mortar, like running in circles, sorrow for sorrow and nothing else. It doesn’t bring anything constructive.

—But how can a person figure out which fear is which?

—For that, you need to study the holy fathers. And Orthodoxy isn’t something you can just pick up on the fly, it’s not something you can learn in five minutes. You need to study it, try to live in a Christian way, and go to church. And gradually, little by little, your way of thinking will develop in the right direction.

“Be attentive to yourself, so that hot‑temperedness, irritability, and resentment do not gain the upper hand over you—for otherwise you will lead a troubled and disorderly life. But cultivate generosity, meekness, lack of malice, and everything that is fitting for Christians, so that you may lead a peaceful and serene life” —St. Ephraim the Syrian.

 

Elena Nasledysheva spoke with Dr. Dmitry Avdeev, M.D., Ph.D.

Translation by Myron Platte.

 

1. That is, the October Revolution in Russia.

 

Source: https://orthochristian.com/180676.html