SCRUPLE. - It is the vain apprehension that there is sin where there is no sin. Hence a person is called scrupulous who finds himself durably unable to recognize the moral value of certain actions and to distinguish certain sins, especially of thought, despite the teachings of his spiritual director. Because of these conditions he lives in a state of continuous alarm, of excessive uneasiness, since at every moment he fears he has offended God for unfounded reasons.
Scruple can depend on supernatural causes and on natural causes; in the first case God permits scruple in order to punish pride or to test the devout soul. Scruple then serves to purify the soul, detaching it from spiritual consolations and increasing the effort to avoid every fault. In the second case it is a particular aspect of the phobic-obsessive syndrome (v. OBSESSIVE PSYCHOSIS).
I. PATHOLOGICAL S
Limiting ourselves above all to these latter cases, it will be well to recall first of all the difference between fixed ideas and compulsive or obsessional ideas. Fixed ideas are part of the subject's personality, which accepts and cultivates them, because they derive from his conscious tendencies and fall within his life plan. Compulsive ideas, on the other hand, are regarded by the patient as intruders in his thought, extraneous to his personality, parasitic ideas, against which he struggles without managing to free himself. They may be purely theoretical, and then they do not provoke considerable defensive reactions on the patient's part; in other cases they are accompanied by misplaced fears, which take the name of phobias and are the cause of worries and anxieties, up to anguish. And in vain does the subject try to convince himself of the absurdity of his fears, because the ideas that feed them persist immovably despite his contrary reactions, and if they yield for a time, they soon reappear with the old insistent hammering. The fear of having offended God through omissions or acts of various kinds, principally through sins of thought, and the fear of having deserved the pains of hell are the object of phobia.
As regards the pathogenesis of s., it must be observed that candidates for obsessional ideas of any kind generally present a well-recognizable predisposed terrain, which imposes on educators the obligation to adopt appropriate prophylactic measures in the physical and psychic fields, in order to prevent the morbid syndrome from exploding at a certain moment or to make it less severe. Future obsessives and future scrupulous persons present in childhood a tendency to tics and a fear of being alone; and they are very sensitive to reproaches. Subsequently the feeling of doubt becomes ever more clear-cut in them, and this makes them indecisive, because they need, in every action, to make sure that they are on the right path. For this reason they devote themselves to exaggerated introspection, to incessant reasoning that hinders them in their daily work and helps to feed in them that sense of incompleteness which is the salient characteristic of every subject hammered by obsessional ideas. Not all candidates for obsessions and for s. will one day be dominated by compulsive ideas. Some remain untouched by these ideas throughout their lives; in others they appear precociously, from childhood onward, or at the time of puberty, or belatedly following emotional traumas, infectious diseases, at the time of the climacteric, etc.
The fact is that the proper equilibrium of the psychic functions is rapidly re-established if the disturbing causes were of modest entity; but if these were serious and lasted a long time and acted upon a predisposed terrain, the emotional mechanism may remain sensitized to the detriment of the rational one, and the obsessional or scrupulous syndrome comes into play. Chronic intoxications, both endogenous and exogenous, act unfavorably in this sense: of particular importance are a tiring life, the lack of sufficient rest, work in an unhealthy environment, poor nutrition, intestinal and hepatic affections, hyperuricemia. Then there are emotional traumas, acute and chronic infectious diseases, dysendocrinopathies, among which those linked to the critical periods of life are important: puberty and the climacteric, both female and male.
The onset of s. may be slow and progressive; but it is not rare for s. to appear suddenly and to take shape very rapidly. Usually in persons more predisposed to s. an exaggerated tendency to the minutiae of devotional practices is observed. The normal person pays attention to the performance of the act as a whole, whereas the candidate for scruples concentrates his attention on the parts of which the act is composed. The normal person, if he notices that he has not done well, humbles himself, promises to do better and remains serene; but the candidate for s. is ready to repeat, and in fact repeats several times, the act of piety, until he is sure of having performed it as he intended. Finally, in his haste to progress in the ascetic life, he adopts maxims of difficult application.
Once he has entered into s., the scrupulous person hardly manages to free himself from it in a short time; for the most part the syndrome lasts several months, with alternations of improvement and worsening. At first the patient begins to confuse the difficulty of overcoming himself with real falls, simple thoughts of sin with consent to those very thoughts; subsequently sin becomes the abhorred enemy that stands before the scrupulous person at every moment, keeps him in continuous alarm, worries him, disturbs him, halts him in his spiritual journey. The defensive reactions with which the scrupulous person tries to resist and to free himself from the compulsive ideas that hammer him are of three kinds: repeated examinations of conscience, motor reactions, immediate confession. In the examinations of conscience the patient tries to recall to mind the circumstances in which he doubts he has sinned, in order to convince himself that he has not consented. Motor reactions occur in the paroxysmal phase of the syndrome and consist of acts of denial accompanied by "no" uttered under one's breath, by closing of the eyelids, by contortions of the trunk and in other attitudes. Immediate confession is the means preferred by the scrupulous person to regain tranquility; but often the doubt arises that the confession has not been made well, and then new worries resurface that require a second or a third confession. In some cases, the object of the worries is not that of having offended God, but the fear of being able to die suddenly in sin. It is in this state that those scrupulous persons find themselves who, after having struggled without result against certain temptations, in the end become their victim.
Like all obsessions, s. too has a cyclical course, and the remission, at least temporary, of the symptoms is constant and occurs even without treatment; however, an adequate treatment shortens the course of the syndrome and makes it less severe. The first attack is generally stronger than the subsequent ones, which are better tolerated and more easily concealed. There is no lack of single attacks in a whole lifetime; sometimes there are two or three episodes, interspersed with long periods of calm; in some cases there is a chronic scrupulous state, which may not cause excessive bother to the patient. The prognosis is good in the presence of individuals who have not suffered from obsessions and do not present evident signs of the phobic-obsessive constitution; it is less favorable in cases in which there have been other obsessional manifestations, especially if these began to manifest themselves in childhood.
Like obsessions, so too s. usually does not appreciably hinder the normal activity and the output of those who suffer from them; many very illustrious men who have brought luster to the sciences, art, politics, religion have suffered greatly because of their obsessions. The rare cases that are associated with abulia, notable depression of mood and accentuated moral instability do not belong to the syndrome of s. of which we are speaking, but to pictures of another severity.
The treatment of scruple is connected to that of the obsessive syndrome and is both preventive and curative. Preventive treatment must be directed mainly at those who present the stigmata of the phobic-obsessive constitution and consists in the observance of a hygienic life, in a strong moral education free from misplaced fears, in the protection of physical health, and above all in a patient pedagogical action by which it must be taught how, practically, to overcome doubts. The isolationist and introspective tendency must also be suitably combated. The treatment of the attack consists first of all in the common hygienic measures and in the removal of the causes that have triggered the scrupulous syndrome. If hepatic, gastro-enteric or any other kind of disorders coexist, it will be advisable to carry out the therapy proper to such illnesses. Apart from this therapy, tonics for the nervous system and in particular regulators of the autonomic vegetative system will be administered. In general, electroshock treatment is useless or harmful, whereas insulin pre-coma may prove useful, but only in severe persistent cases not influenced by the common treatments.
Psychotherapy conducted with competence and tact is of great importance. The scrupulous person must be instructed about the true nature of his disorders and must be authoritatively directed on how to behave in the face of the phobias that torment him. He must be taught that the best way to be cured is to remain passive in the face of temptations; in any case the struggle must proceed without excesses of zeal, with confidence in victory, with complete dedication to the will of God. It must also be orderly; that is, the real occasions of sin must be combated and not the presumed ones, temptations must be targeted according to their hierarchical importance, and one must avoid fighting several temptations at the same time and, with certain temptations, departing from the rule of active resistance. It is further necessary to remain serene and not to resort to bodily afflictions, which in these circumstances are often more harmful than useful. Immediate confession, from a psychological point of view, is useful to the patient because it calms him and disposes him to overcome the crises that present themselves; but while it is permissible not to oppose this practice in the moderate scrupulous person, it must be forbidden to severe scrupulous persons, because, while the calming is of brief duration, the minute and repeated examinations of conscience that precede confession are a cause of new worries and new anxieties. To avoid the disturbance of long and detailed examinations of conscience in an atmosphere of spiritual turmoil, a generic accusation is advisable.
Collaboration between physician and spiritual director is indispensable in some cases of pathological scruple; the physician treats the morbid conditions that sustain the syndrome and prescribes the medicaments that benefit the case; the director of conscience intervenes with moral and spiritual means.
II. MORALITY OF THE ACTS OF THE SCRUPULOUS
The morality of the acts of the scrupulous person must be measured according to the norms of an erroneous (v.) and doubtful conscience. When it becomes habitual, one can no longer speak so much of error as of a state of fear of making a mistake, of sinning. And since it is not possible in a single day to strip oneself of such a state, the scrupulous person may act even against his scrupulous conscience, and does not sin, even though he is filled with a vivid fear of sin, provided that he uses a mediocre diligence of inquiry, having recourse above all to the counsel of others, and does not consider what he does to be with certainty sinful. Thus he may do what he sees practiced by God-fearing people, even if it is contrary to his own point of view. On the other hand, however, the scrupulous person is bound to react against his state in order to avoid harm to body and soul and at the same time to escape his own egoism and his own obstinacy. By not applying the remedies methodically prescribed, the scrupulous person makes himself directly guilty of the worsening of his own state.