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Effective Management

2 Kings 5:1-19 presents a story about Naaman, the general officer of the armies of Syria, who suffered from leprosy. He seeks a cure from the prophet Elisha, fully expecting a dramatic intervention in answer to his prayers. He is quickly disappointed. Instead of asking God to unleash the powers of heaven, Elisha sends Naaman a message, telling him to wash seven times in the River Jordan to heal his flesh and make him clean. Naaman resists the ordinary instructions, desiring the extraordinary. But his attendants urge him to follow the prophet’s directions. Naaman bathes in the Jordan and is healed.

Scrupulous people often live in the grips of high drama. An undisciplined thought can unleash an avalanche of mortal sin. An unexpected emotion can ignite a torrent of fear and anxiety that a feeling displeases God. They may think a forgotten word or an incomplete listing of the details of a sin during the sacrament of reconciliation can deny them forgiveness and make them guilty of the serious sin of sacrilege. This unneeded byplay makes the ordinary seem unappealing and ineffective.

But consider this truth. With few exceptions, scrupulous people will not benefit from a sudden and dramatic intervention by the Spirit of God. Don’t expect such healings. The path to peace and a sense of relief typically is not discovered in the extraordinary but in the ordinary. Well-reasoned healing strategies can be claimed, discovered, and put to effective use in learning to manage the disorder of scrupulosity. The use of these strategies will not be dramatic, but they will be effective.

For a person who suffers with “a tender conscience”—the classical understanding of scrupulosity— the counsel of a consistent confessor/spiritual director is essential. The director, a type of mentor, helps the person with the tender conscience learn the essentials about sin and discover reasonable balances and safeguards to enable spiritual growth. The testimony of the saints and the experiences of countless tens of thousands of men and women witness to the effectiveness of this approach.

For those who suffer something more than classical scrupulosity, an altogether different approach is required. The main difference today between the traditional response and what we now understand as a psychological disorder is our growing knowledge of human behavior. Some people suffer from more than a form of “tenderness.” The condition might best be described as OCD with a religious focus.

Obsessive-Compulsive Disorder (OCD) cannot be cured, but it can be managed effectively in such a way that the person who suffers with the disorder can be freed from its burdens and achieve an ordinary lifestyle. Two basic remedies have proven to be effective.

The first remedy is the diagnosis of the disorder and the prescription of effective drug therapy from your medical doctor. A variety of drugs with varying  dosages have proven to be quite helpful. The drugs supply what is missing or in short supply within the human brain. When faced with an obsessive and/or a compulsive thought, the drug effectively provides the necessary help to resist the destructive ritualistic behavior that follows. In a sense, the thought is both tamed and effectively managed. It does not go away, but a sense of control returns, enabling the person to respond in ways that promote a more integrated and healthy way of living. Relief from the burdens of guilt, anxiety, and fear often results.

A second effective remedy is the use of Exposure Response Prevention (ERP) therapy. ERP therapy is a type of cognitive-behavioral therapy (CBT). This therapy involves the person with OCD facing his or her fears and then refraining from ritualizing. At first, this type of therapy is frightening for a person with OCD with a religious focus (scrupulosity) because it seems to promote “sinning.” However, with the help of an understanding therapist and often with the support of a confessor (at least in the initial stages of treatment), this therapy is very effective and life-giving.

In some cases, both remedies are required in order to achieve the management results that are hoped for. Small steps—one step at a time and with little or no drama—will often produce the intended results and help a person who suffers with this disorder to achieve a sense of peace. Like Naaman in that story from 2 Kings, what may well be needed is a commitment from the sufferer and lower expectations. Who wouldn’t appreciate a miracle, but who also wouldn’t choose to take less-than-dramatic steps that would achieve the same result but with far less fanfare?

A frustration that many of our readers often express when I offer this kind of pastoral advice is that it produces even more anxiety. Some live in a part of the country where the medical and spiritual care they require are not readily available. This can be frustrating and seem like an impossible obstacle.

In part, this problem can be responded to by visiting the Scrupulous Anonymous website sponsored by Liguori Publications. Every edition of this newsletter is there for reference. A second response is to visit my Scrupulous Anonymous page on Facebook. There, I answer questions, post an occasional podcast, and provide links to helpful resources. I have recently added a new link that may prove very beneficial in addressing some management concerns. I encourage you to check it out.

Successful management of OCD and scrupulosity is possible. What once was an option for only a few people with access to all the resources they need is now a reasonable possibility for everyone. I know this new reality is an answer to many prayers that have been offered over the years and is a gift of God’s grace.

Thomas M. Santa, CSsR

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