A common experience among people who suffer from scrupulosity, and one I often hear about, is uneven pastoral care. This is not because confessors are deliberately unhelpful—far from it. Rather, many are simply not adequately prepared to minister effectively to scrupulous people. Confessors may believe they understand the disorder, but, too often, they do not. Their seminary formation and the lack of continuing education and formation have not sufficiently prepared them for this specialized ministry.
The confessor’s first pastoral response to the scrupulous person is often shaped by the traditional understanding of scrupulosity as a tender conscience. This understanding commonly forms the basis of a priest’s pastoral training regarding scrupulosity. As a result, the usual remedy is primarily catechetical: the confessor directs the penitent away from assuming mortal sin, explains the necessary conditions for mortal sin—grave matter, deliberate choice, and offense against God—and encourages the penitent to apply the definition of sin more accurately.
A second response, also based on the idea of a tender conscience, is to direct the scrupulous person to seek guidance from only one confessor. For the scrupulous, multiple confessors are not helpful and usually create confusion. Within this model, when it is applied well, the person gradually learns about sin, the purpose of the sacrament of reconciliation, and the healthy practices associated with it. Over time, attentive pastoral care can help form the tender conscience into a healthy one, so that scrupulosity is effectively managed and, in many cases, eventually disappears.
This is the traditional and virtuous pastoral approach to ministering to a person with a tender conscience. But what happens when the person is not suffering from a tender conscience, but from a disorder? What happens when the penitent is suffering from obsessive compulsive disorder (OCD)? In that case, the traditional pastoral response is not only unhelpful, but it can be harmful. It fails to address the real issue. OCD is not a spiritual problem that can be resolved by the usual pastoral remedy; it is a mental disorder. Catechesis, however thorough or well intended, may only make the experience more complicated and confusing.
This is where pastoral care becomes uneven. When the confessor cannot accurately recognize what is happening, he may apply the traditional pastoral response that he believes is necessary and helpful. As a result, both he and the penitent can become frustrated as they are drawn into the ritual patterns of OCD. Some confessors, to their credit, remain patient and compassionate, which is at least comforting, even if it is not ultimately helpful. In fact, the confessor may unintentionally reinforce the OCD by offering reassurance: “No, that is not a sin,” “No, you do not need to go into that much detail,” or, the most common response, “You do not need to keep confessing sins you think you remember. God has already forgiven them.”
Even when OCD appears within the sacrament of reconciliation, it is not fundamentally about sin. The penitent is using the language of sin to express anxiety and suffering. The careful sorting of mortal, grave, and venial categories is less a moral judgment than a reflection of the shame, guilt, and doubt the person is experiencing. Any relief the penitent feels after confession usually fades quickly, because the sacrament of reconciliation is meant to forgive sins, not to heal the emotional suffering caused by a mental disorder.
One unfortunate and relatively recent source of uneven pastoral care for scrupulous penitents is the belief held by some priest confessors that references to OCD or a mental disorder is simply an expression of “modernism.” As a result, they reject any pastoral approach that departs from the traditional understanding of scrupulosity. This is deeply unfortunate, because the suffering encouraged by this view is profoundly troubling.
Another troubling aspect of uneven pastoral care for scrupulous penitents—one that has been reported to me—occurs when a confessor withholds absolution because he believes there is “no firm purpose of amendment.” When I first encountered this response, I was speechless. I could not understand how any priest, faced with a person who is clearly suffering, could respond in this way. If anything, the person’s distress reveals a deep desire for amendment. Scrupulous people despise sin; they are not nurturing it.
Unfortunately, despite the sincere efforts of many, the conditions that lead to uneven pastoral care remain. A person suffering from scrupulosity may still encounter a priest confessor who is not helpful. If this happens to you, my best advice is to choose another confessor and avoid an encounter that does not bring healing or help. I understand that circumstances can make this difficult, but it remains the better choice. You deserve healing, not further suffering.
Uneven pastoral care is not deliberate. In all my years of priestly ministry, I have never encountered a priest who would choose suffering over healing; that is never the intention. Still, there remains a significant gap in the pastoral care needed for scrupulous penitents. This ministry requires skills that go well beyond the basic formation often provided in seminary. Awareness has improved in recent years, but we still have a long way to go to ensure the excellence in pastoral care that scrupulous people need and deserve.