SCRUPOLO. – It is the groundless apprehension that there is sin where there is none. Hence an individual is called scrupulous when he remains durably unable to recognize the moral value of certain actions and to distinguish certain sins, especially sins of thought, despite the teachings of his spiritual director. Because of these conditions, he lives in a state of continuous alarm and excessive uneasiness, since he constantly fears having offended God for unfounded reasons.
Scrupulosity may depend on supernatural or natural causes; in the former case, God permits it to punish pride or to test the devout soul. Scrupulosity then serves to purify the soul, detaching it from spiritual consolations and increasing its effort to avoid every fault. In the latter case, it is a particular aspect of the phobic-obsessional syndrome (v. PSICOSI OSSESSIVA).
I. PATHOLOGICAL SCRUPULOSITY. – Restricting ourselves chiefly to these latter cases, it will first be useful to recall the difference between fixed ideas and compulsive or obsessive ideas. Fixed ideas form part of the subject’s personality, which accepts and cultivates them because they derive from his conscious tendencies and fit within his life program. Compulsive ideas, on the other hand, are regarded by the patient as intruders in his thought, foreign to his personality, parasitic ideas against which he struggles without managing to free himself. They may be purely theoretical and, in that case, do not provoke any considerable defensive reactions on the part of the patient; in other cases they are accompanied by unfounded fears, which are called phobias and cause worries and anxieties, even anguish. The subject vainly attempts to convince himself of the absurdity of these fears, because the ideas that nourish them remain immovable despite his contrary reactions and, if they yield for a time, they soon reappear with their former insistent hammering. Objects of phobia include the fear of having offended God through omissions or acts of various kinds, chiefly through sins of thought, and the fear of having deserved the punishments of hell.
With regard to the pathogenesis of scrupulosity, it must be observed that candidates for obsessive ideas of any kind generally exhibit a clearly recognizable predisposed constitution, which obliges educators to adopt appropriate preventive measures in the physical and psychological spheres, in order to prevent the morbid syndrome from breaking out at a given moment or to make it less severe. Future obsessional patients and future scrupulous persons, in childhood, show a tendency toward tics and a fear of being alone; they are also very sensitive to reprimands. Subsequently, the feeling of doubt becomes increasingly distinct in them, making them indecisive, because in every action they need to ascertain that they are on the right path. For this reason they devote themselves to exaggerated introspection and incessant reasoning, which hinder them in their daily work and contribute to fostering in them that sense of incompleteness which is a salient characteristic of every subject tormented by obsessive ideas. Not all candidates for obsessions and scrupulosity will one day be dominated by compulsive ideas. Some remain free of such ideas throughout their lives; in others they appear early, from childhood, or at puberty, or later, following emotional traumas, infectious diseases, at the time of the climacteric, and so forth.
The fact is that the proper balance of psychic functions is rapidly restored if the disturbing causes were of slight magnitude; but if they were serious, lasted a long time, and acted upon a predisposed constitution, the emotional mechanism may remain sensitized to the detriment of the rational mechanism, and the obsessive or scrupulous syndrome comes into play. Chronic endogenous and exogenous intoxications act unfavorably in this respect above all: of particular importance are a fatiguing way of life, lack of sufficient rest, work in an unhealthy environment, poor nutrition, intestinal and hepatic disorders, and hyperuricemia. There are also emotional traumas, acute and chronic infectious diseases, and dysendocrinopathies, among which those connected with the critical periods of life are important: puberty and the climacteric, both female and male.
The onset of scrupulosity may be slow and progressive; but it is not uncommon for it to appear suddenly and to acquire substance with extraordinary rapidity. Ordinarily, in persons more predisposed to scrupulosity, an exaggerated tendency toward minutiae in 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. If the normal person realizes that he has not acted correctly, he humbles himself, promises to do better, and remains tranquil; but the candidate for scruples is ready to repeat—and in fact repeatedly does repeat—the devotional act until he is certain that he has performed it as he intended. Finally, in his haste to advance in the ascetic life, he adopts maxims that are difficult to apply.
Once scrupulosity has taken hold, the scrupulous person seldom succeeds in freeing himself from it in a short time; for the most part, the syndrome lasts several months, with alternating improvement and deterioration. At first the patient begins to confuse the difficulty of overcoming himself with actual falls, and simple thoughts of sin with consent to those thoughts; subsequently, sin becomes the hated enemy that confronts the scrupulous person at every moment, keeps him in a state of continual alarm, worries and disturbs him, and brings his spiritual progress to a halt. The defensive reactions by which the scrupulous person attempts to resist and free himself from the compulsive ideas that torment him are of three kinds: repeated examinations of conscience, motor reactions, and immediate confession. During examinations of conscience, the patient attempts to recall the circumstances in which he doubts that he sinned, in order to convince himself that he did not consent. Motor reactions occur during the paroxysmal phase of the syndrome and consist of acts of denial accompanied by softly spoken noes, closing of the eyelids, contortions of the trunk, and other postures. Immediate confession is the means preferred by the scrupulous person for regaining tranquility; but the doubt often arises that the confession was not made properly, and new worries then resurface, requiring a second or third confession. In some cases, the object of the worries is not having offended God, but the fear of suddenly dying in sin. Scrupulous persons who, after struggling unsuccessfully against certain temptations, ultimately become their victims find themselves in this state.
Like all obsessions, scrupulosity also follows a cyclical course, and the remission—at least temporary—of the symptoms is constant and occurs even without treatment; nevertheless, suitable 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 are also isolated attacks occurring only once in a lifetime; at times there are two or three episodes, separated by long periods of calm; in some cases there is a chronic scrupulous state, which may cause the patient no excessive distress. The prognosis is good in individuals who have not suffered from obsessions and do not display evident signs of a phobic-obsessive constitution; it is less favorable in cases in which other obsessive manifestations have occurred, especially if these began in childhood.
Like obsessions, scrupulosity generally does not significantly hinder the normal activity and performance of those who suffer from it; many outstanding men who distinguished themselves in the sciences, art, politics, and religion suffered greatly from their obsessions. The rare cases associated with abulia, marked depression of mood, and pronounced moral instability do not belong to the syndrome of scrupulosity under discussion, but to clinical pictures of a different and more serious nature.
The treatment of scrupulosity is related to that of the obsessive syndrome and is both preventive and curative. Preventive treatment should be directed chiefly toward those who display the stigmata of the phobic-obsessive constitution and consists in observing a hygienic way of life, in a sound moral education free from misplaced fears, in safeguarding physical health, and above all in a patient pedagogical approach by which they must be taught how to overcome doubts in practice. The isolating and introspective tendency must also be appropriately countered. Treatment of the attack consists first of all in the ordinary hygienic measures and in removing the causes that triggered the scrupulous syndrome. If hepatic, gastro-intestinal, or any other disorders coexist, it will be advisable to apply the therapy proper to such diseases. Apart from this therapy, tonics for the nervous system and, in particular, regulators of the autonomic nervous system will be administered. In general, electroshock treatment is useless or harmful, whereas insulin precoma may prove useful, but only in severe, persistent cases not affected by ordinary treatment.
Psychotherapy conducted competently and tactfully is of great importance. The scrupulous person must be instructed concerning the true nature of his disorders and must be authoritatively directed in how to behave in the face of the phobias that torment him. He must be taught that the best way to recover is to remain passive in the face of temptations; in any case, the struggle must proceed without excessive zeal, with confidence in victory, and with complete devotion to the will of God. It must also be orderly; that is, one must combat real occasions of sin and not presumed ones, temptations must be addressed according to their hierarchical importance, and one must avoid fighting at the same time
(Alinari photograph)
Collaboration between the physician and the spiritual director is indispensable in certain cases of pathological s.; the physician treats the morbid conditions underlying the syndrome and prescribes the medications appropriate to the case; the confessor intervenes with moral and spiritual means.
II. MORALITY OF THE ACTS OF THE SCRUPULOUS
The morality of the acts of the scrupulous person is to be measured according to the norms conscience (v.). When it becomes habitual, one can no longer speak so much of error as of a state of fear of being mistaken, of sinning. And since it is not possible to divest oneself of such a state in a single day, the scrupulous person may act even against a scrupulous conscience, and does not sin, even if overwhelmed by a keen fear of sin, provided that he exercises moderate diligence in investigation, above all by seeking the advice of others, and does not regard what he does as certainly sinful. Thus he may do what he sees practiced by people who fear God, even if it is contrary to his own viewpoint. On the other hand, however, the scrupulous person is obliged to react against his condition in order to avoid harm to body and soul and at the same time to escape his own selfishness and obstinacy. By failing to apply the remedies methodically prescribed, the scrupulous person becomes directly guilty of the worsening of his condition.direction spirituelle, l'oraïme quotidienne, Tournai 1934; id., Pour consoler et guérir les âmes scrupuleuses et craintives, 3rd ed., ibid. 1938; R. Biot - P. Galimard, Guide médical des vocations sacerdotales et religieuses, Paris 1945; E. Boganelli, Corpo e spirito, Rome 1931, p. 390 ff.