SCRUPLE. — Scruple is the vain apprehension that there is sin where there is none. Hence a scrupulous person is one who is permanently unable to recognize the moral value of certain actions and to distinguish certain sins, especially those of thought, despite the teachings of the spiritual director. Because of this condition, he lives in a state of continuous alarm, of excessive unease, fearing at every moment that he has offended God for unfounded reasons.
Scruple may depend on supernatural causes or on natural causes; in the first case, God permits scruple to punish pride or to test the devoted soul. Scruple then serves to purify the soul, detaching it from spiritual consolations, increasing the effort to avoid every fault. In the second case, it is a particular aspect of the phobic-obsessive syndrome (v. PSYCHOSIS, OBSESSIVE).
I. PATHOLOGICAL SCRUPLE
Limiting ourselves especially to these latter cases, it will be well to recall first the difference between fixed ideas and compulsive or obsessive ideas. Fixed ideas are part of the subject’s personality; he accepts and cultivates them because they derive from his conscious tendencies and fit into his life plan. Compulsive ideas, on the other hand, are regarded by the patient as intrusive into his thought, alien to his personality, parasitic ideas against which he struggles without being able to free himself. They may be purely theoretical and then provoke no significant defensive reactions on the patient’s part; in other cases they are accompanied by unreasonable fears, which take the name of phobias and are a source of worry and anxiety, even to the point of anguish. In vain does the subject try to convince himself of the absurdity of his fears, for the ideas that feed them remain unshaken in the face of contrary reactions, and if they yield for a time, they soon return with the same insistent pounding. The object of phobia is the fear of having offended God by omissions or acts of various kinds, chiefly by sins of thought, and the fear of having merited the pains of hell.As regards the pathogenesis of scruple, it must be observed that candidates for obsessive ideas of any kind generally present a recognizable predisposed ground, which imposes on educators the obligation to adopt suitable prophylactic measures in the physical and psychic spheres, to prevent the morbid syndrome from breaking out at a certain point or to make it less severe. Future obsessives and future scrupulous persons show in childhood a tendency to fears and a fear of being alone; they are very sensitive to reproaches. Later, the feeling of doubt becomes ever clearer in them and makes them indecisive, because they need, in every action, to assure themselves that they are on the right path. For this reason they devote themselves to exaggerated introspection, to incessant reasoning that hinders their daily work and contributes to nourish in them that sense of incompleteness which is the salient characteristic of every subject plagued by obsessive ideas. Not all candidates for obsessions and scruple will one day be dominated by compulsive ideas. Some remain all their lives free from these ideas; in others they appear early, even in childhood, or at the time of puberty, or late, following emotional traumas, infectious diseases, or the climacteric, etc.
The fact remains that the proper balance of psychic functions is quickly restored if the disturbing causes were of modest importance; but if these were serious and long-lasting and acted upon a predisposed ground, the emotional mechanism may remain sensitized to the detriment of the rational one, and the obsessive syndrome or scruple comes into play. Unfavorable in this sense are above all chronic endogenous and exogenous intoxications: of particular importance are exhausting lives, lack of sufficient rest, work in unhealthy surroundings, poor nourishment, intestinal and hepatic affections, hyperuricemia. Then there are emotional traumas, acute and chronic infectious diseases, disorders of various kinds, among which those connected with critical periods of life are important: puberty and the climacteric, both in women and in men.
The onset of scruple may be slow and progressive; but it is not rare for scruple to appear suddenly and to take on consistency with extreme rapidity. Usually in persons most predisposed to scruple there is an exaggerated tendency to the minutiae of pious practices. 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 realizes that he has not done well, humbles himself, promises to do better, and remains serene; but the candidate for scruples is ready to repeat and does in fact repeat the act of piety several times until he is sure that he has performed it as he intended. Finally, in his haste to advance in the ascetic life, he adopts maxims of difficult application.
Once in the grip of scruple, the scrupulous person rarely succeeds in freeing himself quickly; for the most part the syndrome lasts for 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 the thoughts themselves; later sin becomes the hated enemy that is presented to the scrupulous person at every moment, keeping him in continuous alarm, worrying him, disturbing him, and arresting him in his spiritual progress. The defensive reactions with which the scrupulous person tries to resist and free himself from the compulsive ideas that plague him are of three kinds: repeated examinations of conscience, motor reactions, and immediate confession. In the examinations of conscience the patient tries to recall to mind the circumstances in which he doubts he has sinned, to convince himself that he has not consented. Motor reactions occur in the paroxysmal phase of the syndrome and consist in acts of denial accompanied by muttered “no’s,” closing of the eyelids, contortions of the trunk, and other attitudes. Immediate confession is the means preferred by the scrupulous person to regain tranquility; but often the doubt arises that the confession was not well made, and then new worries surface that call for a second or third confession. In some cases the object of the worries is not the fear of having offended God but the fear of dying suddenly in sin. In this state are found those scruples that, after having struggled without result against certain temptations, finally become their victims.
Like all obsessions, scruple has a cyclic course, and the remission, at least temporary, of the symptoms is constant and occurs even without treatment; yet 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 are not lacking cases of a single attack in a lifetime; sometimes there are two or three episodes, separated by long periods of calm; in some cases there is a chronic scrupulous state, which may not cause the patient excessive trouble. The prognosis is good in the presence of individuals who have not suffered from obsessions and do not show evident signs of the phobic-obsessive constitution; it is less favorable in cases in which there have been other obsessive manifestations, especially if these began to appear in childhood.
Like obsessions, so too the scrupulous conscience usually does not significantly hinder the normal activity and productivity of those who suffer from it; many illustrious men who have distinguished themselves in the sciences, art, politics, and religion have greatly suffered from their scruples. The rare cases that are associated with abulia, notable depression of mood, and marked moral instability do not belong to the syndrome of the scrupulous conscience under discussion here but rather to conditions of greater severity.
The treatment of the scrupulous conscience is linked to that of the obsessive syndrome and is both preventive and curative. Preventive care should primarily be directed toward those who exhibit the traits of a phobic-obsessive constitution and consists in observing a hygienic way of life, in strong moral education free from groundless fears, in safeguarding physical health, and above all in patient pedagogical action through which one must be taught how to practically overcome doubts. The tendency toward isolation and introspection must also be appropriately countered. The treatment of an acute episode consists first of all in common hygienic measures and in removing the causes that have triggered the scrupulous syndrome. If hepatic, gastro-enteric, or any other disturbances coexist, it will be advisable to implement the therapy specific to such ailments. Alongside this therapy, tonics for the nervous system will be administered, particularly regulators of the autonomic vegetative system. In general, electroshock therapy is useless or harmful, whereas insulin pre-coma may prove useful, but only in severe, persistent cases that do not respond to common treatments.
Of great importance is psychotherapy conducted with competence and tact. The scrupulous person must be instructed about the true nature of his disturbances and must be authoritatively guided on 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 dedication to the will of God. He must also be given order; that is, real occasions of sin must be combated, not presumed ones, temptations must be addressed according to their hierarchical importance, and one must avoid fighting several at the same time.