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CASE STUDY
"Sister Joyce" •  Scrupulosity

Fr. Stephen J. Rossetti, Ph.D., D.Min. Is President and CEO of SLI.

Sr. "Joyce," in her 50's, has been referred for treatment because of a lifelong history of scrupulosity. She is filled with such excessive and irrational guilt and considerable shame that it is difficult for Sr. Joyce to receive communion at Mass. She thinks of herself as too base to receive the host and when blasphemous thoughts come to mind as she approaches communion, she sees them as proof of her evil nature. She is angry at the Church for the "hellfire and damnation" sermons that she grew up hearing. She believes that these negative sermons have exacerbated her problems. Sr. Joyce is frightened by and keeps a tight lid on feelings of anger and sexual passion. She is chronically tense and is plagued by a generalized anxiety disorder. Occasionally, she suffers from a variety of phobias and has experienced some panic attacks. She is very neat and orderly; she cannot stand a mess and insists on neatness from the children in her classes.

When asked about her image of God, she said, "God is loving and compassionate." However, in the course of spiritual direction, it became clear that her "operative" image of God is just the opposite. Despite her pious life, she feared that God was angry with her because of her sinfulness. While she described God as a loving father, she personally related to God as a punishing judge. During the past 20 years, she had been exposed to the idea that God is kind and forgiving, but the words did not sink in. Growing up, her own father had been angry, strict and demanding. She never measured up to his expectations and she felt constantly threatened with punishment.

Despite her difficulties, Sr. Joyce is a very pious person. She attends Mass daily and receives the Sacraments. She prays the Rosary daily, fasts regularly and is a strong believer. Others view her as a devout religious and an example to all. They are not aware of her inner struggles and the "torture" she experiences with scrupulosity.

Coping With Scrupulosity
There are many people who can sympathize with Sr. Joyce. While their difficulties might not be as severe, they too suffer from anxiety and perhaps depressive traits as a result of scrupulosity, self-hatred, and an internalized negative "parent." The voice of Sr. Joyce's punishing father continues to echo inside her.

Feelings of anger and sexual passion are difficult for anyone to internalize in a completely healthy manner. But for the scrupulous person, these "negative" passions are particularly distressing. It is not surprising that individuals like Sr. Joyce repress them and attempt to lead a rigidly "clean" life of order and control. Unfortunately, as a result of repressing normal human passions, her life had become over-controlled and joyless. Integrating the human passions in a healthy fashion is important for living a happy and balanced life.

Sr. Joyce's tasks are multi-layered. She needs to face her emotions and passions, and learn to express them in a manner appropriate for her religious life. Her sterile and over-controlled life is suffocating her and those with whom she lives and works. She also needs to internalize her intellectual belief in God's mercy and compassion; she needs to learn that she is lovable and made in God's image. Thus, her tasks are both psychological and spiritual.

Treatment
Sr. Joyce is engaged in a long regimen of individual and group therapy, plus spiritual direction. On several occasions, in a confidential setting and with her permission, Sr. Joyce and her therapist and spiritual director meet to discuss her progress. During these joint meetings, her progress is reviewed and future goals are set out.

In therapy, Sr. Joyce is developing a trusting relationship with her therapist. At times, when Sr. Joyce became angry with her therapist, it was initially very difficult for her to acknowledge and express these feelings. At first, she attempted to conceal these feelings or express them in passive-aggressive ways, such as showing up late for sessions. With the encouragement of her therapist, she is expressing these "negative" feelings, although they are often accompanied by feelings of guilt. She is becoming more comfortable with her angry emotions. She is also beginning to have emotions of appreciation and warmth toward her therapist. Although initially difficult to acknowledge, she is now more at ease with warm and caring emotions.

Sr. Joyce attends a Cognitive Behavioral group that helps her challenge some of these "core beliefs:" "I am not good enough;" "My emotions are bad;" "My sexuality is bad;" "I am bad;" "God is angry at me and will punish me." Monitoring and noting when these core beliefs surface is integral to her therapy. She is finding that, over the course of treatment, these core beliefs never completely go away. Likewise, scrupulous thoughts never go away completely. However, she does recognize when these irrational thoughts come into her mind and she is better able to dismiss them quickly. In spiritual direction, she is learning to turn these scrupulous thoughts and feelings over to God. Thus, she does not "fight against" these thoughts so much as to "turn them over to God."

In spiritual direction, it is clear that she needs a personal, healing experience of God's love for her. She accepts the notion of God's love but does not "feel it" or internalize it. Thus, her spiritual director is encouraging her to pray for a personal experience of God's love, in whatever way God would choose to reveal it to her. She is making consistent progress in her spiritual life and is engaging in silent, contemplative prayer that seems to be fruitful.

In the course of therapy and in her prayer, Sr. Joyce has had "corrective experiences."

Currently, she experiences herself as lovable and that her emotions are not evil. She is more relaxed with herself and more relaxed with her students; they find her more flexible and more approachable. Her anxieties are diminished markedly as is her scrupulosity. While she remains somewhat anxious and still has scrupulous thoughts, they bother her less as she quickly gives them to her loving and compassionate God.

Many people are plagued with negative thoughts and irrational feelings of shame. Guilt can be a healthy reminder of our sinfulness and weaknesses, but shame is an inner conviction that we are bad and that God is harsh and unforgiving. Each person needs to remember the good they have done and believe in their hearts that God truly forgives. The healing journey of Sr. Joyce can be instructive for us.

LUKENOTES is a bimonthly publication of Saint Luke Institute.
Permission to use these materials must be requested in writing by contacting
lukenotes@sli.org

SLI EDUCATION DEPARTMENT
Saint Luke Institute
8901 New Hampshire Ave.
Silver Spring, MD 20903
(301) 422-5499 • (301) 422-5519 (fax)

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